hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|MO,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Ste. Genevieve County Memorial Hospital,11/25/2024,2.0.0,Ste. Genevieve County Memorial Hospital,"800 Ste Genevieve Dr, Ste. Genevieve, MO 63670",282NC0060X,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|AETNA|COMMERCIAL|negotiated_dollar,standard_charge|AETNA|COMMERCIAL|negotiated_percentage,standard_charge|AETNA|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA|COMMERCIAL,standard_charge|AETNA|COMMERCIAL|methodology,additional_payer_notes|AETNA|COMMERCIAL,standard_charge|AETNA_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|AETNA_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|AETNA_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|AETNA_MEDICARE|MEDICARE,standard_charge|AETNA_MEDICARE|MEDICARE|methodology,additional_payer_notes|AETNA_MEDICARE|MEDICARE,standard_charge|ALLWELL|MEDICARE|negotiated_dollar,standard_charge|ALLWELL|MEDICARE|negotiated_percentage,standard_charge|ALLWELL|MEDICARE|negotiated_algorithm,estimated_amount|ALLWELL|MEDICARE,standard_charge|ALLWELL|MEDICARE|methodology,additional_payer_notes|ALLWELL|MEDICARE,standard_charge|AMBETTER|MEDICARE|negotiated_dollar,standard_charge|AMBETTER|MEDICARE|negotiated_percentage,standard_charge|AMBETTER|MEDICARE|negotiated_algorithm,estimated_amount|AMBETTER|MEDICARE,standard_charge|AMBETTER|MEDICARE|methodology,additional_payer_notes|AMBETTER|MEDICARE,standard_charge|BCBS_BLUE_ACCESS|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_BLUE_ACCESS|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_BLUE_ACCESS|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_BLUE_ACCESS|COMMERCIAL,standard_charge|BCBS_BLUE_ACCESS|COMMERCIAL|methodology,additional_payer_notes|BCBS_BLUE_ACCESS|COMMERCIAL,standard_charge|BCBS_BLUE_ACCESS_CHOICE|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_BLUE_ACCESS_CHOICE|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_BLUE_ACCESS_CHOICE|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_BLUE_ACCESS_CHOICE|COMMERCIAL,standard_charge|BCBS_BLUE_ACCESS_CHOICE|COMMERCIAL|methodology,additional_payer_notes|BCBS_BLUE_ACCESS_CHOICE|COMMERCIAL,standard_charge|BCBS_BLUE_PREFERRED|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_BLUE_PREFERRED|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_BLUE_PREFERRED|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_BLUE_PREFERRED|COMMERCIAL,standard_charge|BCBS_BLUE_PREFERRED|COMMERCIAL|methodology,additional_payer_notes|BCBS_BLUE_PREFERRED|COMMERCIAL,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_MEDICARE|MEDICARE,standard_charge|BCBS_MEDICARE|MEDICARE|methodology,additional_payer_notes|BCBS_MEDICARE|MEDICARE,standard_charge|BCBS_PATHWAY|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_PATHWAY|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_PATHWAY|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_PATHWAY|COMMERCIAL,standard_charge|BCBS_PATHWAY|COMMERCIAL|methodology,additional_payer_notes|BCBS_PATHWAY|COMMERCIAL,standard_charge|BCBS_PATHWAY_X|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_PATHWAY_X|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_PATHWAY_X|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_PATHWAY_X|COMMERCIAL,standard_charge|BCBS_PATHWAY_X|COMMERCIAL|methodology,additional_payer_notes|BCBS_PATHWAY_X|COMMERCIAL,standard_charge|BCBS_TRADITIONAL|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_TRADITIONAL|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_TRADITIONAL|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS_TRADITIONAL|COMMERCIAL,standard_charge|BCBS_TRADITIONAL|COMMERCIAL|methodology,additional_payer_notes|BCBS_TRADITIONAL|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|methodology,additional_payer_notes|CIGNA|COMMERCIAL,standard_charge|HEALTHLINK_COMPMANAGEMENT|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHLINK_COMPMANAGEMENT|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHLINK_COMPMANAGEMENT|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHLINK_COMPMANAGEMENT|COMMERCIAL,standard_charge|HEALTHLINK_COMPMANAGEMENT|COMMERCIAL|methodology,additional_payer_notes|HEALTHLINK_COMPMANAGEMENT|COMMERCIAL,standard_charge|HEALTHLINK_HMO|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHLINK_HMO|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHLINK_HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHLINK_HMO|COMMERCIAL,standard_charge|HEALTHLINK_HMO|COMMERCIAL|methodology,additional_payer_notes|HEALTHLINK_HMO|COMMERCIAL,standard_charge|HEALTHLINK_PPO|COMMERCIAL|negotiated_dollar,standard_charge|HEALTHLINK_PPO|COMMERCIAL|negotiated_percentage,standard_charge|HEALTHLINK_PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTHLINK_PPO|COMMERCIAL,standard_charge|HEALTHLINK_PPO|COMMERCIAL|methodology,additional_payer_notes|HEALTHLINK_PPO|COMMERCIAL,standard_charge|HEALTHY_BLUE|MEDICAID|negotiated_dollar,standard_charge|HEALTHY_BLUE|MEDICAID|negotiated_percentage,standard_charge|HEALTHY_BLUE|MEDICAID|negotiated_algorithm,estimated_amount|HEALTHY_BLUE|MEDICAID,standard_charge|HEALTHY_BLUE|MEDICAID|methodology,additional_payer_notes|HEALTHY_BLUE|MEDICAID,standard_charge|HOMESTATE|MEDICAID|negotiated_dollar,standard_charge|HOMESTATE|MEDICAID|negotiated_percentage,standard_charge|HOMESTATE|MEDICAID|negotiated_algorithm,estimated_amount|HOMESTATE|MEDICAID,standard_charge|HOMESTATE|MEDICAID|methodology,additional_payer_notes|HOMESTATE|MEDICAID,standard_charge|MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MEDICAID|MEDICAID,standard_charge|MEDICAID|MEDICAID|methodology,additional_payer_notes|MEDICAID|MEDICAID,standard_charge|MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICARE|MEDICARE,standard_charge|MERITAIN|COMMERCIAL|negotiated_dollar,standard_charge|MERITAIN|COMMERCIAL|negotiated_percentage,standard_charge|MERITAIN|COMMERCIAL|negotiated_algorithm,estimated_amount|MERITAIN|COMMERCIAL,standard_charge|MERITAIN|COMMERCIAL|methodology,additional_payer_notes|MERITAIN|COMMERCIAL,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_dollar,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_percentage,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_algorithm,estimated_amount|MULTIPLAN|COMMERCIAL,standard_charge|MULTIPLAN|COMMERCIAL|methodology,additional_payer_notes|MULTIPLAN|COMMERCIAL,standard_charge|PPHP|MEDICARE|negotiated_dollar,standard_charge|PPHP|MEDICARE|negotiated_percentage,standard_charge|PPHP|MEDICARE|negotiated_algorithm,estimated_amount|PPHP|MEDICARE,standard_charge|PPHP|MEDICARE|methodology,additional_payer_notes|PPHP|MEDICARE,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|UHC_COMMUNITY_PLAN|MEDICAID|negotiated_dollar,standard_charge|UHC_COMMUNITY_PLAN|MEDICAID|negotiated_percentage,standard_charge|UHC_COMMUNITY_PLAN|MEDICAID|negotiated_algorithm,estimated_amount|UHC_COMMUNITY_PLAN|MEDICAID,standard_charge|UHC_COMMUNITY_PLAN|MEDICAID|methodology,additional_payer_notes|UHC_COMMUNITY_PLAN|MEDICAID,standard_charge|UHC_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|UHC_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|UHC_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|UHC_MEDICARE|MEDICARE,standard_charge|UHC_MEDICARE|MEDICARE|methodology,additional_payer_notes|UHC_MEDICARE|MEDICARE,standard_charge|UMR|COMMERCIAL|negotiated_dollar,standard_charge|UMR|COMMERCIAL|negotiated_percentage,standard_charge|UMR|COMMERCIAL|negotiated_algorithm,estimated_amount|UMR|COMMERCIAL,standard_charge|UMR|COMMERCIAL|methodology,additional_payer_notes|UMR|COMMERCIAL,standard_charge|VA|MEDICARE|negotiated_dollar,standard_charge|VA|MEDICARE|negotiated_percentage,standard_charge|VA|MEDICARE|negotiated_algorithm,estimated_amount|VA|MEDICARE,standard_charge|VA|MEDICARE|methodology,additional_payer_notes|VA|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
"EMPLOYEE CHEST X-RAY, 1 VIEW",C990400001,CDM,320,RC,71045,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,235,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,15.48,271,
"EMPLOYEE CHEST X-RAY, 1 VIEW",C990400001,CDM,320,RC,71045,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,235,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,15.48,271,
OC-VENIPUNCTURE,C990850014,CDM,300,RC,36415,HCPCS,Outpatient,,,17.5,8.75,,13.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.95,74,,,Percent of Total Billed Charges,74% of total billed charges,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,14.7,84,,,Percent of Total Billed Charges,84% of total billed charges,14.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,15,500,,,fee schedule,500% of healthlink,15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.48,77,,,Percent of total Billed charges,77% of total billed charges,14.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.38,64,
CHEST 1 VIEW,C990850018,CDM,324,RC,71045,HCPCS,Outpatient,,,117,58.5,,90.09,77,,,Percent of Total Billed Charges,77% of total billed charges,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.58,74,,,Percent of Total Billed Charges,74% of total billed charges,80.73,69,,,Percent of Total Billed Charges,69% of total billed charges,80.73,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.73,69,,,Percent of Total Billed Charges,69% of total billed charges,80.73,69,,,Percent of Total Billed Charges,69% of total billed charges,98.28,84,,,Percent of Total Billed Charges,84% of total billed charges,95.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.13,89,,,Percent of total Billed Charges,89% of total Billed charges,104.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.09,77,,,Percent of total Billed charges,77% of total billed charges,99.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,271,
CHEST 2 VIEWS,C990850019,CDM,324,RC,71046,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.16,74,,,Percent of Total Billed Charges,74% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,112.56,84,,,Percent of Total Billed Charges,84% of total billed charges,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.26,89,,,Percent of total Billed Charges,89% of total Billed charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,271,
L SPINE 2-3 VIEW,C990850020,CDM,320,RC,72100,HCPCS,Outpatient,,,245,122.5,,188.65,77,,,Percent of Total Billed Charges,77% of total billed charges,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.3,74,,,Percent of Total Billed Charges,74% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,205.8,84,,,Percent of Total Billed Charges,84% of total billed charges,200.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.68,400,,,fee schedule,400% of healthlink fee schedule,125.33,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,133.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.65,77,,,Percent of total Billed charges,77% of total billed charges,208.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.41,271,
OCC MED HEART SCORE,C990850021,CDM,350,RC,75571,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,634.87,350,,,fee schedule,350% of bcbs fee schedule,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,889,
OC-CMP,C990850022,CDM,301,RC,80053,HCPCS,Outpatient,,,30.5,15.25,,23.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.57,74,,,Percent of Total Billed Charges,74% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,25.62,84,,,Percent of Total Billed Charges,84% of total billed charges,25.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.2,500,,,fee schedule,500% of healthlink,77.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.49,77,,,Percent of total Billed charges,77% of total billed charges,25.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,77.2,
OC-LIPID PROFILE,C990850023,CDM,301,RC,80061,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.85,500,,,fee schedule,500% of healthlink,97.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,97.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,97.85,
DRUG SCREENING COLLECTION,C990850024,CDM,300,RC,80305,HCPCS,Outpatient,,,22.05,11.03,,16.98,77,,,Percent of Total Billed Charges,77% of total billed charges,5.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.32,74,,,Percent of Total Billed Charges,74% of total billed charges,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,18.52,84,,,Percent of Total Billed Charges,84% of total billed charges,18.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.62,89,,,Percent of total Billed Charges,89% of total Billed charges,19.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,120,,,Fee Schedule,120% of MO Medicaid Rate,12.1,120,,,Fee Schedule,120% of MO Medicaid Rate,12.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,77,,,Percent of total Billed charges,77% of total billed charges,18.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.51,64,
10 PANEL DRUG SCREEN,C990850025,CDM,300,RC,80305,HCPCS,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,120,,,Fee Schedule,120% of MO Medicaid Rate,12.1,120,,,Fee Schedule,120% of MO Medicaid Rate,12.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.1,120,,,Fee Schedule,120% of MO Medicaid Rate,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,64,
5 PANEL QUICK DRUG SCREEN/COL,C990850026,CDM,300,RC,80306,HCPCS,Outpatient,,,44.1,22.05,,33.96,77,,,Percent of Total Billed Charges,77% of total billed charges,11.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.63,74,,,Percent of Total Billed Charges,74% of total billed charges,30.43,69,,,Percent of Total Billed Charges,69% of total billed charges,30.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.43,69,,,Percent of Total Billed Charges,69% of total billed charges,30.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37.04,84,,,Percent of Total Billed Charges,84% of total billed charges,36.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.25,89,,,Percent of total Billed Charges,89% of total Billed charges,39.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,11.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.96,77,,,Percent of total Billed charges,77% of total billed charges,37.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,11.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.03,64,
5PANEL DRUG SCREEN,C990850027,CDM,300,RC,80307,HCPCS,Outpatient,,,23.8,11.9,,18.33,77,,,Percent of Total Billed Charges,77% of total billed charges,6.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.61,74,,,Percent of Total Billed Charges,74% of total billed charges,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,19.99,84,,,Percent of Total Billed Charges,84% of total billed charges,19.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.18,89,,,Percent of total Billed Charges,89% of total Billed charges,21.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,77,,,Percent of total Billed charges,77% of total billed charges,20.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,64,
TRAMADOL DRUG SCREEN,C990850030,CDM,300,RC,80373,HCPCS,Outpatient,,,102.11,51.06,,78.62,77,,,Percent of Total Billed Charges,77% of total billed charges,26.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.56,74,,,Percent of Total Billed Charges,74% of total billed charges,70.46,69,,,Percent of Total Billed Charges,69% of total billed charges,70.46,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.46,69,,,Percent of Total Billed Charges,69% of total billed charges,70.46,69,,,Percent of Total Billed Charges,69% of total billed charges,85.77,84,,,Percent of Total Billed Charges,84% of total billed charges,83.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.88,89,,,Percent of total Billed Charges,89% of total Billed charges,90.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,25.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.62,77,,,Percent of total Billed charges,77% of total billed charges,86.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,25.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,90.88,
OC-UA W/MICRO,C990850031,CDM,307,RC,81001,HCPCS,Outpatient,,,20,10,,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.8,74,,,Percent of Total Billed Charges,74% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16.8,84,,,Percent of Total Billed Charges,84% of total billed charges,16.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.15,500,,,fee schedule,500% of healthlink,23.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.04,64,
BREATH ALCOHOL,C990850034,CDM,300,RC,82075,HCPCS,Outpatient,,,56.7,28.35,,43.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.96,74,,,Percent of Total Billed Charges,74% of total billed charges,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.63,84,,,Percent of Total Billed Charges,84% of total billed charges,46.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.66,77,,,Percent of total Billed charges,77% of total billed charges,48.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,88,
BREATH ALCOHOL,C990850035,CDM,300,RC,82075,HCPCS,Outpatient,,,56.7,28.35,,43.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.96,74,,,Percent of Total Billed Charges,74% of total billed charges,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.63,84,,,Percent of Total Billed Charges,84% of total billed charges,46.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.66,77,,,Percent of total Billed charges,77% of total billed charges,48.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,88,
OCCULT BLOOD STOOL,C990850036,CDM,301,RC,82270,HCPCS,Outpatient,,,10,5,,7.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.4,74,,,Percent of Total Billed Charges,74% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8.4,84,,,Percent of Total Billed Charges,84% of total billed charges,8.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.7,77,,,Percent of total Billed charges,77% of total billed charges,8.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.5,64,
CHOLESTEROL,C990850037,CDM,301,RC,82465,HCPCS,Outpatient,,,9,4.5,,6.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.66,74,,,Percent of Total Billed Charges,74% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7.56,84,,,Percent of Total Billed Charges,84% of total billed charges,7.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.8,500,,,fee schedule,500% of healthlink,31.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.93,77,,,Percent of total Billed charges,77% of total billed charges,7.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.25,64,
CHROMIUM,C990850038,CDM,301,RC,82495,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.05,500,,,fee schedule,500% of healthlink,148.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,148.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.46,120,,,Fee Schedule,120% of MO Medicaid Rate,19.46,120,,,Fee Schedule,120% of MO Medicaid Rate,19.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.46,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,148.05,
GLUCOSE,C990850039,CDM,301,RC,82947,HCPCS,Outpatient,,,9,4.5,,6.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.66,74,,,Percent of Total Billed Charges,74% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7.56,84,,,Percent of Total Billed Charges,84% of total billed charges,7.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.93,77,,,Percent of total Billed charges,77% of total billed charges,7.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.25,64,
TSH,C990850041,CDM,301,RC,84443,HCPCS,Outpatient,,,17.5,8.75,,13.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.95,74,,,Percent of Total Billed Charges,74% of total billed charges,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,69,,,Percent of Total Billed Charges,69% of total billed charges,14.7,84,,,Percent of Total Billed Charges,84% of total billed charges,14.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.65,500,,,fee schedule,500% of healthlink,122.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.48,77,,,Percent of total Billed charges,77% of total billed charges,14.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.38,122.65,
OC-CBC,C990850042,CDM,300,RC,85025,HCPCS,Outpatient,,,23,11.5,,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.02,74,,,Percent of Total Billed Charges,74% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,19.32,84,,,Percent of Total Billed Charges,84% of total billed charges,18.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.75,500,,,fee schedule,500% of healthlink,56.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,56.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,64,
QUANIFERON GOLD,C990850043,CDM,302,RC,86480,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.45,500,,,fee schedule,500% of healthlink,452.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,452.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,59.5,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.5,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,452.45,
HEPATITIS B SURFACE AB QNT,C990850044,CDM,302,RC,86706,HCPCS,Outpatient,,,16.5,8.25,,12.71,77,,,Percent of Total Billed Charges,77% of total billed charges,4.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.21,74,,,Percent of Total Billed Charges,74% of total billed charges,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,13.86,84,,,Percent of Total Billed Charges,84% of total billed charges,13.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.4,500,,,fee schedule,500% of healthlink,78.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,78.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,77,,,Percent of total Billed charges,77% of total billed charges,14.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.13,78.4,
MUMPS IGG,C990850045,CDM,302,RC,86735,HCPCS,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.3,500,,,fee schedule,500% of healthlink,95.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,95.3,
RUBELLA IMMUNE STATUS,C990850046,CDM,302,RC,86762,HCPCS,Outpatient,,,11.5,5.75,,8.86,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.51,74,,,Percent of Total Billed Charges,74% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.86,77,,,Percent of total Billed charges,77% of total billed charges,9.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.88,105.1,
MEASLES IGG,C990850047,CDM,302,RC,86765,HCPCS,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,94.05,
VZV IGG,C990850048,CDM,302,RC,86787,HCPCS,Outpatient,,,11,5.5,,8.47,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.14,74,,,Percent of Total Billed Charges,74% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,9.24,84,,,Percent of Total Billed Charges,84% of total billed charges,9.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.47,77,,,Percent of total Billed charges,77% of total billed charges,9.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,94.05,
HEP A VACCINE,C990850049,CDM,771,RC,90632,HCPCS,Outpatient,,,64.05,32.03,,49.32,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.4,74,,,Percent of Total Billed Charges,74% of total billed charges,44.19,69,,,Percent of Total Billed Charges,69% of total billed charges,44.19,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.19,69,,,Percent of Total Billed Charges,69% of total billed charges,44.19,69,,,Percent of Total Billed Charges,69% of total billed charges,53.8,84,,,Percent of Total Billed Charges,84% of total billed charges,52.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,57,89,,,Percent of total Billed Charges,89% of total Billed charges,57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.32,77,,,Percent of total Billed charges,77% of total billed charges,54.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,26.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,
OCC MED EKG,C990850058,CDM,730,RC,93000,HCPCS,Outpatient,,,84.5,42.25,,65.07,77,,,Percent of Total Billed Charges,77% of total billed charges,21.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160,100,,,Case rate,pays based on per visit rate,155,100,,,case rate,pays based on per visit,155,100,,,case rate,pays based on per visit,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155,100,,,case rate,pays based on per visit,155,100,,,case rate,pays based on per day rate,164,100,,,case rate,pays based on per day rate,69.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.21,89,,,Percent of total Billed Charges,89% of total Billed charges,75.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.07,77,,,Percent of total Billed charges,77% of total billed charges,71.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,34.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,296,
DRUG SCREENING COLLECTION,C990850063,CDM,300,RC,99000,HCPCS,Outpatient,,,22.05,11.03,,16.98,77,,,Percent of Total Billed Charges,77% of total billed charges,5.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.32,74,,,Percent of Total Billed Charges,74% of total billed charges,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,69,,,Percent of Total Billed Charges,69% of total billed charges,18.52,84,,,Percent of Total Billed Charges,84% of total billed charges,18.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.62,89,,,Percent of total Billed Charges,89% of total Billed charges,19.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,77,,,Percent of total Billed charges,77% of total billed charges,18.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,5.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.51,64,
10 PANEL QUICK DRUG SCREEN,C990850084,CDM,300,RC,,,Outpatient,,,27.3,13.65,,21.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.2,74,,,Percent of Total Billed Charges,74% of total billed charges,18.84,69,,,Percent of Total Billed Charges,69% of total billed charges,18.84,69,,,Percent of Total Billed Charges,69% of total billed charges,6.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.84,69,,,Percent of Total Billed Charges,69% of total billed charges,18.84,69,,,Percent of Total Billed Charges,69% of total billed charges,22.93,84,,,Percent of Total Billed Charges,84% of total billed charges,22.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.3,89,,,Percent of total Billed Charges,89% of total Billed charges,24.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.02,77,,,Percent of total Billed charges,77% of total billed charges,23.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.83,64,
10 PANEL WITH ETOH,C990850085,CDM,300,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,64,
5 PANEL DRUG SCREEN,C990850087,CDM,300,RC,,,Outpatient,,,23.8,11.9,,18.33,77,,,Percent of Total Billed Charges,77% of total billed charges,6.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.61,74,,,Percent of Total Billed Charges,74% of total billed charges,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,16.42,69,,,Percent of Total Billed Charges,69% of total billed charges,19.99,84,,,Percent of Total Billed Charges,84% of total billed charges,19.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.18,89,,,Percent of total Billed Charges,89% of total Billed charges,21.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,77,,,Percent of total Billed charges,77% of total billed charges,20.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,5.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,64,
BATH SALT DRUG SCREEN,C990850091,CDM,300,RC,,,Outpatient,,,105,52.5,,80.85,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.7,74,,,Percent of Total Billed Charges,74% of total billed charges,72.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.2,84,,,Percent of Total Billed Charges,84% of total billed charges,86.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.45,89,,,Percent of total Billed Charges,89% of total Billed charges,93.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,77,,,Percent of total Billed charges,77% of total billed charges,89.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.45,
K2 DRUG SCREEN,C990850129,CDM,300,RC,,,Outpatient,,,115.5,57.75,,88.94,77,,,Percent of Total Billed Charges,77% of total billed charges,29.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.47,74,,,Percent of Total Billed Charges,74% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,97.02,84,,,Percent of Total Billed Charges,84% of total billed charges,94.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.8,89,,,Percent of total Billed Charges,89% of total Billed charges,102.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.94,77,,,Percent of total Billed charges,77% of total billed charges,98.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,47.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.88,102.8,
MRO CHARGE,C990850135,CDM,300,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,64,
MRO NON-NEG DRUG SCREEN REVIEW,C990850136,CDM,300,RC,,,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,48.1,74,,,Percent of Total Billed Charges,74% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,84,,,Percent of Total Billed Charges,84% of total billed charges,53.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,64,
HGB & HCT,C990850167,CDM,300,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,64,
OC-PSA,C990850198,CDM,300,RC,G0103,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,18.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,134.25,
"COVID SARS CoV2 RNA, RL",C990850227,CDM,300,RC,U0003,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,90,120,,,Fee Schedule,120% of MO Medicaid Rate,90,120,,,Fee Schedule,120% of MO Medicaid Rate,90,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,90,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,90,
10 Panel Quick Drug Screen/Col,C990850228,CDM,300,RC,80306,HCPCS,Outpatient,,,43.35,21.68,,33.38,77,,,Percent of Total Billed Charges,77% of total billed charges,11.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.08,74,,,Percent of Total Billed Charges,74% of total billed charges,29.91,69,,,Percent of Total Billed Charges,69% of total billed charges,29.91,69,,,Percent of Total Billed Charges,69% of total billed charges,10.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.91,69,,,Percent of Total Billed Charges,69% of total billed charges,29.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.41,84,,,Percent of Total Billed Charges,84% of total billed charges,35.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.58,89,,,Percent of total Billed Charges,89% of total Billed charges,38.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.38,77,,,Percent of total Billed charges,77% of total billed charges,36.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,10.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,10.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.84,64,
10 Panel Instant Test,C990850231,CDM,300,RC,,,Outpatient,,,28,14,,21.56,77,,,Percent of Total Billed Charges,77% of total billed charges,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.72,74,,,Percent of Total Billed Charges,74% of total billed charges,19.32,69,,,Percent of Total Billed Charges,69% of total billed charges,19.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.32,69,,,Percent of Total Billed Charges,69% of total billed charges,19.32,69,,,Percent of Total Billed Charges,69% of total billed charges,23.52,84,,,Percent of Total Billed Charges,84% of total billed charges,22.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.92,89,,,Percent of total Billed Charges,89% of total Billed charges,24.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.56,77,,,Percent of total Billed charges,77% of total billed charges,23.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7,64,
EH-CMP,C990860001,CDM,301,RC,80053,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.2,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.56,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.2,500,,,fee schedule,500% of healthlink,77.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.56,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.56,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,10.13,77.2,
EH-LIPID PROFILE,C990860002,CDM,301,RC,80061,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.74,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.39,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.85,500,,,fee schedule,500% of healthlink,97.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,97.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.39,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,13.39,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,12.85,97.85,
EH-HEPATIC FUNCTION PANEL,C990860003,CDM,301,RC,80076,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.21,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.17,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.65,500,,,fee schedule,500% of healthlink,59.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.17,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,8.17,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,7.84,64,
EH-URINALYSIS,C990860004,CDM,307,RC,81001,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.96,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.17,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.15,500,,,fee schedule,500% of healthlink,23.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,3.17,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.17,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,3.04,64,
EH-CREATININE SERUM,C990860005,CDM,301,RC,82565,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.4,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.12,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.4,500,,,fee schedule,500% of healthlink,37.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.91,120,,,Fee Schedule,120% of MO Medicaid Rate,4.91,120,,,Fee Schedule,120% of MO Medicaid Rate,4.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.12,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,4.91,120,,,Fee Schedule,120% of MO Medicaid Rate,5.12,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,4.91,64,
EH-GLUCOSE,C990860006,CDM,301,RC,82947,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.91,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.93,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,3.93,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,3.77,64,
EH-BUN (UREA NITROGEN),C990860008,CDM,301,RC,84520,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.94,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.95,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.8,500,,,fee schedule,500% of healthlink,28.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.79,120,,,Fee Schedule,120% of MO Medicaid Rate,3.79,120,,,Fee Schedule,120% of MO Medicaid Rate,3.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,3.95,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,3.79,120,,,Fee Schedule,120% of MO Medicaid Rate,3.95,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,3.79,64,
EH-CBC,C990860009,CDM,300,RC,85025,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.71,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.77,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.75,500,,,fee schedule,500% of healthlink,56.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,56.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.77,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.77,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,7.45,64,
EH-HEPATITIS B CORE AB,C990860010,CDM,302,RC,86704,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.06,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.05,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.05,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,11.57,88,
EH-HEPATITIS B SURFACE AB,C990860011,CDM,302,RC,86706,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.43,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.74,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.4,500,,,fee schedule,500% of healthlink,78.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,78.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.74,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.74,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,10.31,78.4,
"EH-RUBELLA, IgG",C990860012,CDM,302,RC,86762,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.99,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.39,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.39,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,13.81,105.1,
EH COVID19 ANTIGEN-Rapid SGCMH,C990860013,CDM,300,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,64,
"EH-VZV AB, IgG",C990860014,CDM,302,RC,86787,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.1,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.88,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.88,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,12.36,94.05,
EH-CULT AFB,C990860015,CDM,306,RC,87116,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.5,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.8,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.2,500,,,fee schedule,500% of healthlink,61.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.8,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.8,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,10.37,64,
EH -acid fast smear,C990860016,CDM,306,RC,87206,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.74,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.39,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.39,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.39,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,5.17,64,
EH-HEPATITIS B SURFACE AG,C990860017,CDM,302,RC,87340,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.91,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.33,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.05,500,,,fee schedule,500% of healthlink,74.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.33,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,10.33,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,9.91,74.05,
EH-MRSA PCR,C990860018,CDM,306,RC,87798,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.86,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.09,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.09,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,33.68,256.25,
"COVD, FLU, RSV",C990860027,CDM,300,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,64,
EH-SARS COV2/FLU AB SGCMH,C990860029,CDM,300,RC,0240U,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.29,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.63,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,142.63,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,142.63,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,178.29,
EH-PSA SCREEN,C990860030,CDM,300,RC,G0103,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.14,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.31,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,18.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.31,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,19.31,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,18.53,134.25,
COVID SARS CoV2 RNA,C990860033,CDM,300,RC,U0003,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,90,120,,,Fee Schedule,120% of MO Medicaid Rate,90,120,,,Fee Schedule,120% of MO Medicaid Rate,90,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,90,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,90,
"COVID SARS CoV2 RNA, RL",C990860034,CDM,300,RC,U0003,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,90,120,,,Fee Schedule,120% of MO Medicaid Rate,90,120,,,Fee Schedule,120% of MO Medicaid Rate,90,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,90,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,90,
EH Rapid Flu,C990860035,CDM,300,RC,87804,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.69,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.55,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,15.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.55,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,16.55,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,15.89,87.6,
EH Rapid Strep,C990860036,CDM,300,RC,87880,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.66,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.53,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.86,120,,,Fee Schedule,120% of MO Medicaid Rate,15.86,120,,,Fee Schedule,120% of MO Medicaid Rate,15.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.53,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,15.86,120,,,Fee Schedule,120% of MO Medicaid Rate,16.53,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,15.86,87.6,
EH Measles IGM,C990860037,CDM,300,RC,86765,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.1,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.88,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.88,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,12.36,94.05,
EH Mumps IGM,C990860038,CDM,300,RC,86735,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.31,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.05,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.3,500,,,fee schedule,500% of healthlink,95.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.05,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,13.05,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,12.53,95.3,
EH-Measles IGG,C990860039,CDM,300,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,64,
PFIZER VACCINE,D990010001,CDM,636,RC,91300,HCPCS,Outpatient,,,3.5,1.75,,2.7,77,,,Percent of Total Billed Charges,77% of total billed charges,0.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,45,,,Percent of Total Billed Charges,45% of total billed charges,3.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.7,77,,,Percent of total Billed charges,77% of total billed charges,2.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.88,3.12,
MODERNA VACCINE,D990010002,CDM,636,RC,91301,HCPCS,Outpatient,,,3.5,1.75,,2.7,77,,,Percent of Total Billed Charges,77% of total billed charges,0.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,45,,,Percent of Total Billed Charges,45% of total billed charges,3.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.7,77,,,Percent of total Billed charges,77% of total billed charges,2.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.88,3.12,
.45 NS+20 MEQ KCL 1000ML,D990220001,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.9 NS+20 MEQ KCL 1000ML,D990220002,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"9% NS, 500ML, NON-PLASTIC",D990220003,CDM,258,RC,,,Outpatient,,,108,54,,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.92,74,,,Percent of Total Billed Charges,74% of total billed charges,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,90.72,84,,,Percent of Total Billed Charges,84% of total billed charges,88.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.12,89,,,Percent of total Billed Charges,89% of total Billed charges,96.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,96.12,
D5 1/2 NS 500 ML,D990220004,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.45 NS 1000ML,D990220005,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.9 NS 1000ML,D990220006,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.9% NS 100ml Bag,D990220007,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.9% NS 250 ML,D990220008,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.9% NS 500ML,D990220009,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
.9% NS 50ML,D990220010,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D10W 500 ML,D990220011,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5 1/2 NS 1000ML,D990220012,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5 LR 1000ML,D990220013,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5.2 NS 1000ML,D990220014,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5.33 NS 500ML,D990220015,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5.45NS+10MEQ KCL 1000ML,D990220016,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5.45NS+20MEQ KCL 1000ML,D990220017,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5.45NS+40MEQ KCL 1000ML,D990220018,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5NS 1000,D990220019,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5W 1000ML,D990220020,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
D5W 250ML,D990220021,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
LR 1000ML,D990220022,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
DERMABOND,D990220023,CDM,636,RC,G0168,HCPCS,Outpatient,,,113,56.5,,87.01,77,,,Percent of Total Billed Charges,77% of total billed charges,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,50.85,45,,,Percent of Total Billed Charges,45% of total billed charges,100.57,89,,,Percent of total Billed Charges,89% of total Billed charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.01,77,,,Percent of total Billed charges,77% of total billed charges,96.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,100.57,
KYLEENA SYSTEM,D990220024,CDM,636,RC,J7296,HCPCS,Outpatient,,,2214,1107,,1704.78,77,,,Percent of Total Billed Charges,77% of total billed charges,564.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,564.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,996.3,45,,,Percent of Total Billed Charges,45% of total billed charges,1970.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1970.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1970.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.78,77,,,Percent of total Billed charges,77% of total billed charges,1881.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,636.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,903.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.5,1970.46,
KYLEENA SYSTEM,D990220024,CDM,636,RC,J7296,HCPCS,Outpatient,,,2214,1107,,1704.78,77,,,Percent of Total Billed Charges,77% of total billed charges,564.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,564.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,996.3,45,,,Percent of Total Billed Charges,45% of total billed charges,1970.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1970.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1970.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.78,77,,,Percent of total Billed charges,77% of total billed charges,1881.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,636.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,903.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.5,1970.46,
MARENA SYSTEM,D990220025,CDM,636,RC,J7298,HCPCS,Outpatient,,,2214,1107,,1704.78,77,,,Percent of Total Billed Charges,77% of total billed charges,564.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,564.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1527.66,69,,,Percent of Total Billed Charges,69% of total billed charges,996.3,45,,,Percent of Total Billed Charges,45% of total billed charges,1970.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1970.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1970.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,903.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.78,77,,,Percent of total Billed charges,77% of total billed charges,1881.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,636.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,903.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,553.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.5,1970.46,
PNEUMONIA RX,D990220026,CDM,636,RC,90732,HCPCS,Outpatient,,,113,56.5,,87.01,77,,,Percent of Total Billed Charges,77% of total billed charges,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,50.85,45,,,Percent of Total Billed Charges,45% of total billed charges,100.57,89,,,Percent of total Billed Charges,89% of total Billed charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.01,77,,,Percent of total Billed charges,77% of total billed charges,96.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,100.57,
D5W 500 ML,D990221211,CDM,636,RC,J7060,HCPCS,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,45,,,Percent of Total Billed Charges,45% of total billed charges,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Kii Low Prof Optic Trocar 5x55,D990221271,CDM,272,RC,,,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
LR 500ML,D990221272,CDM,258,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
RHo IMMUNE GLOBULIN DOSE,D990380001,CDM,636,RC,J2790,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,183.83,45,,,Percent of Total Billed Charges,45% of total billed charges,363.57,89,,,Percent of total Billed Charges,89% of total Billed charges,363.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,166.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.13,363.57,
CYSTO CONRAY 500ML,D990400001,CDM,255,RC,,,Outpatient,,,164,82,,126.28,77,,,Percent of Total Billed Charges,77% of total billed charges,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.36,74,,,Percent of Total Billed Charges,74% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,137.76,84,,,Percent of Total Billed Charges,84% of total billed charges,134.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.96,89,,,Percent of total Billed Charges,89% of total Billed charges,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.28,77,,,Percent of total Billed charges,77% of total billed charges,139.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41,145.96,
GASTROVIEW 240ML,D990400002,CDM,250,RC,,,Outpatient,,,93.5,46.75,,72,77,,,Percent of Total Billed Charges,77% of total billed charges,23.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.19,74,,,Percent of Total Billed Charges,74% of total billed charges,64.52,69,,,Percent of Total Billed Charges,69% of total billed charges,64.52,69,,,Percent of Total Billed Charges,69% of total billed charges,23.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,69,,,Percent of Total Billed Charges,69% of total billed charges,64.52,69,,,Percent of Total Billed Charges,69% of total billed charges,78.54,84,,,Percent of Total Billed Charges,84% of total billed charges,76.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.22,89,,,Percent of total Billed Charges,89% of total Billed charges,83.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72,77,,,Percent of total Billed charges,77% of total billed charges,79.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.38,83.22,
NON IONIC 20 ML,D990400003,CDM,255,RC,,,Outpatient,,,62.5,31.25,,48.13,77,,,Percent of Total Billed Charges,77% of total billed charges,15.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.25,74,,,Percent of Total Billed Charges,74% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,84,,,Percent of Total Billed Charges,84% of total billed charges,51.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.63,89,,,Percent of total Billed Charges,89% of total Billed charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.13,77,,,Percent of total Billed charges,77% of total billed charges,53.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.63,55.63,
MRI CONTRAST MEDIA,D990430001,CDM,255,RC,,,Outpatient,,,443.5,221.75,,341.5,77,,,Percent of Total Billed Charges,77% of total billed charges,113.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.19,74,,,Percent of Total Billed Charges,74% of total billed charges,306.02,69,,,Percent of Total Billed Charges,69% of total billed charges,306.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.02,69,,,Percent of Total Billed Charges,69% of total billed charges,306.02,69,,,Percent of Total Billed Charges,69% of total billed charges,372.54,84,,,Percent of Total Billed Charges,84% of total billed charges,363.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,394.72,89,,,Percent of total Billed Charges,89% of total Billed charges,394.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,394.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.5,77,,,Percent of total Billed charges,77% of total billed charges,376.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,394.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.88,394.72,
TC D-FLUCO-HEPTONATE,D990480001,CDM,255,RC,,,Outpatient,,,62,31,,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.88,74,,,Percent of Total Billed Charges,74% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.08,84,,,Percent of Total Billed Charges,84% of total billed charges,50.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.18,89,,,Percent of total Billed Charges,89% of total Billed charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,55.18,
TC SESTAMIBI,D990480002,CDM,343,RC,A9500,HCPCS,Outpatient,,,570,285,,438.9,77,,,Percent of Total Billed Charges,77% of total billed charges,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,421.8,74,,,Percent of Total Billed Charges,74% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,478.8,84,,,Percent of Total Billed Charges,84% of total billed charges,467.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,507.3,89,,,Percent of total Billed Charges,89% of total Billed charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.9,77,,,Percent of total Billed charges,77% of total billed charges,484.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,285,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.5,507.3,
TC TETROFOSMIN,D990480003,CDM,343,RC,A9502,HCPCS,Outpatient,,,288,144,,221.76,77,,,Percent of Total Billed Charges,77% of total billed charges,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,213.12,74,,,Percent of Total Billed Charges,74% of total billed charges,198.72,69,,,Percent of Total Billed Charges,69% of total billed charges,198.72,69,,,Percent of Total Billed Charges,69% of total billed charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.72,69,,,Percent of Total Billed Charges,69% of total billed charges,198.72,69,,,Percent of Total Billed Charges,69% of total billed charges,241.92,84,,,Percent of Total Billed Charges,84% of total billed charges,236.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.32,89,,,Percent of total Billed Charges,89% of total Billed charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.76,77,,,Percent of total Billed charges,77% of total billed charges,244.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,144,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72,256.32,
TC MEDRONATE,D990480004,CDM,343,RC,A9503,HCPCS,Outpatient,,,258,129,,198.66,77,,,Percent of Total Billed Charges,77% of total billed charges,65.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.92,74,,,Percent of Total Billed Charges,74% of total billed charges,178.02,69,,,Percent of Total Billed Charges,69% of total billed charges,178.02,69,,,Percent of Total Billed Charges,69% of total billed charges,64.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.02,69,,,Percent of Total Billed Charges,69% of total billed charges,178.02,69,,,Percent of Total Billed Charges,69% of total billed charges,216.72,84,,,Percent of Total Billed Charges,84% of total billed charges,211.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.62,89,,,Percent of total Billed Charges,89% of total Billed charges,229.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.66,77,,,Percent of total Billed charges,77% of total billed charges,219.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.5,229.62,
THALLIUM,D990480005,CDM,343,RC,A9505,HCPCS,Outpatient,,,223.5,111.75,,172.1,77,,,Percent of Total Billed Charges,77% of total billed charges,56.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.39,74,,,Percent of Total Billed Charges,74% of total billed charges,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,187.74,84,,,Percent of Total Billed Charges,84% of total billed charges,183.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.92,89,,,Percent of total Billed Charges,89% of total Billed charges,198.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.1,77,,,Percent of total Billed charges,77% of total billed charges,189.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.88,198.92,
TC DISOFENIN/VIAL,D990480006,CDM,343,RC,A9510,HCPCS,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.62,74,,,Percent of Total Billed Charges,74% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,84,,,Percent of Total Billed Charges,84% of total billed charges,51.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.07,89,,,Percent of total Billed Charges,89% of total Billed charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,56.07,
TC PERTECHNETATE,D990480007,CDM,343,RC,A9512,HCPCS,Outpatient,,,150,75,,115.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111,74,,,Percent of Total Billed Charges,74% of total billed charges,103.5,69,,,Percent of Total Billed Charges,69% of total billed charges,103.5,69,,,Percent of Total Billed Charges,69% of total billed charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.5,69,,,Percent of Total Billed Charges,69% of total billed charges,103.5,69,,,Percent of Total Billed Charges,69% of total billed charges,126,84,,,Percent of Total Billed Charges,84% of total billed charges,123,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.5,89,,,Percent of total Billed Charges,89% of total Billed charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,77,,,Percent of total Billed charges,77% of total billed charges,127.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.5,133.5,
TC LABELED WBC,D990480008,CDM,343,RC,A9521,HCPCS,Outpatient,,,4031.5,2015.75,,3104.26,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1259.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2983.31,74,,,Percent of Total Billed Charges,74% of total billed charges,2781.74,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1007.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2781.74,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3386.46,84,,,Percent of Total Billed Charges,84% of total billed charges,3305.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3588.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3588.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3588.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1644.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1644.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1644.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1007.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3104.26,77,,,Percent of total Billed charges,77% of total billed charges,3426.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1159.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2015.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1644.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1007.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1007.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1007.88,3588.04,
TC MEBROFENI,D990480009,CDM,343,RC,A9537,HCPCS,Outpatient,,,193.5,96.75,,149,77,,,Percent of Total Billed Charges,77% of total billed charges,49.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,143.19,74,,,Percent of Total Billed Charges,74% of total billed charges,133.52,69,,,Percent of Total Billed Charges,69% of total billed charges,133.52,69,,,Percent of Total Billed Charges,69% of total billed charges,48.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.52,69,,,Percent of Total Billed Charges,69% of total billed charges,133.52,69,,,Percent of Total Billed Charges,69% of total billed charges,162.54,84,,,Percent of Total Billed Charges,84% of total billed charges,158.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,172.22,89,,,Percent of total Billed Charges,89% of total Billed charges,172.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149,77,,,Percent of total Billed charges,77% of total billed charges,164.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.38,172.22,
TECH TC 99 M MEBROFENIN,D990480010,CDM,343,RC,A9537,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.08,89,,,Percent of total Billed Charges,89% of total Billed charges,153.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43,153.08,
TC ALBUMIN,D990480011,CDM,343,RC,A9540,HCPCS,Outpatient,,,768,384,,591.36,77,,,Percent of Total Billed Charges,77% of total billed charges,195.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,240,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,568.32,74,,,Percent of Total Billed Charges,74% of total billed charges,529.92,69,,,Percent of Total Billed Charges,69% of total billed charges,529.92,69,,,Percent of Total Billed Charges,69% of total billed charges,192,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,529.92,69,,,Percent of Total Billed Charges,69% of total billed charges,529.92,69,,,Percent of Total Billed Charges,69% of total billed charges,645.12,84,,,Percent of Total Billed Charges,84% of total billed charges,629.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,683.52,89,,,Percent of total Billed Charges,89% of total Billed charges,683.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,683.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,313.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,313.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,591.36,77,,,Percent of total Billed charges,77% of total billed charges,652.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,220.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,384,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,313.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,683.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,683.52,
TC SUFFER COLLOID/DOSE,D990480012,CDM,343,RC,A9541,HCPCS,Outpatient,,,582.5,291.25,,448.53,77,,,Percent of Total Billed Charges,77% of total billed charges,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,431.05,74,,,Percent of Total Billed Charges,74% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,489.3,84,,,Percent of Total Billed Charges,84% of total billed charges,477.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,518.43,89,,,Percent of total Billed Charges,89% of total Billed charges,518.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.53,77,,,Percent of total Billed charges,77% of total billed charges,495.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,291.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.63,518.43,
TC LABELED RBC,D990480013,CDM,343,RC,A9560,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.36,89,,,Percent of total Billed Charges,89% of total Billed charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,110.36,
TC MERTIATIDE MAG-3,D990480014,CDM,343,RC,A9562,HCPCS,Outpatient,,,1789,894.5,,1377.53,77,,,Percent of Total Billed Charges,77% of total billed charges,456.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,456.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,559.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1323.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1234.41,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.41,69,,,Percent of Total Billed Charges,69% of total billed charges,447.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.41,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.41,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1466.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1592.21,89,,,Percent of total Billed Charges,89% of total Billed charges,1592.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1592.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,447.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1377.53,77,,,Percent of total Billed charges,77% of total billed charges,1520.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,514.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,894.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,729.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,447.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1592.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,447.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.25,1592.21,
TC PENTETATE,D990480015,CDM,343,RC,A9562,HCPCS,Outpatient,,,844.5,422.25,,650.27,77,,,Percent of Total Billed Charges,77% of total billed charges,215.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,624.93,74,,,Percent of Total Billed Charges,74% of total billed charges,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,709.38,84,,,Percent of Total Billed Charges,84% of total billed charges,692.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,751.61,89,,,Percent of total Billed Charges,89% of total Billed charges,751.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,751.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,650.27,77,,,Percent of total Billed charges,77% of total billed charges,717.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,422.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,751.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.13,751.61,
TC PENTETATE,D990480015,CDM,343,RC,A9567,HCPCS,Outpatient,,,844.5,422.25,,650.27,77,,,Percent of Total Billed Charges,77% of total billed charges,215.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,624.93,74,,,Percent of Total Billed Charges,74% of total billed charges,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,582.71,69,,,Percent of Total Billed Charges,69% of total billed charges,709.38,84,,,Percent of Total Billed Charges,84% of total billed charges,692.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,751.61,89,,,Percent of total Billed Charges,89% of total Billed charges,751.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,751.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,650.27,77,,,Percent of total Billed charges,77% of total billed charges,717.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,422.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,344.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,751.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.13,751.61,
TECH TC 99M EX LABEL AUTO WBC,D990480016,CDM,343,RC,A9569,HCPCS,Outpatient,,,1712,856,,1318.24,77,,,Percent of Total Billed Charges,77% of total billed charges,436.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,535,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1266.88,74,,,Percent of Total Billed Charges,74% of total billed charges,1181.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1181.28,69,,,Percent of Total Billed Charges,69% of total billed charges,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1181.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1181.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1438.08,84,,,Percent of Total Billed Charges,84% of total billed charges,1403.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1523.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1523.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1523.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.24,77,,,Percent of total Billed charges,77% of total billed charges,1455.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,492.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,856,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1523.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428,1523.68,
CCK-CHPLECTSTODININ,D990480017,CDM,636,RC,J2805,HCPCS,Outpatient,,,368,184,,283.36,77,,,Percent of Total Billed Charges,77% of total billed charges,93.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,253.92,69,,,Percent of Total Billed Charges,69% of total billed charges,253.92,69,,,Percent of Total Billed Charges,69% of total billed charges,253.92,69,,,Percent of Total Billed Charges,69% of total billed charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.92,69,,,Percent of Total Billed Charges,69% of total billed charges,253.92,69,,,Percent of Total Billed Charges,69% of total billed charges,253.92,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,45,,,Percent of Total Billed Charges,45% of total billed charges,327.52,89,,,Percent of total Billed Charges,89% of total Billed charges,327.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,327.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.36,77,,,Percent of total Billed charges,77% of total billed charges,312.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92,327.52,
FLU HIGH DOSE,D990550004,CDM,636,RC,90662,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,33.75,45,,,Percent of Total Billed Charges,45% of total billed charges,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.75,
PREV PNEUMOCOCCAL-13 VACC0.5ml,D990550005,CDM,636,RC,90670,HCPCS,Outpatient,,,360.5,180.25,,277.59,77,,,Percent of Total Billed Charges,77% of total billed charges,91.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,248.75,69,,,Percent of Total Billed Charges,69% of total billed charges,248.75,69,,,Percent of Total Billed Charges,69% of total billed charges,248.75,69,,,Percent of Total Billed Charges,69% of total billed charges,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.75,69,,,Percent of Total Billed Charges,69% of total billed charges,248.75,69,,,Percent of Total Billed Charges,69% of total billed charges,248.75,69,,,Percent of Total Billed Charges,69% of total billed charges,162.23,45,,,Percent of Total Billed Charges,45% of total billed charges,320.85,89,,,Percent of total Billed Charges,89% of total Billed charges,320.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,320.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.59,77,,,Percent of total Billed charges,77% of total billed charges,306.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,147.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.13,320.85,
PREVNAR PNEUMOCOCCAL-20,D990550006,CDM,636,RC,90677,HCPCS,Outpatient,,,346.5,173.25,,266.81,77,,,Percent of Total Billed Charges,77% of total billed charges,88.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.09,69,,,Percent of Total Billed Charges,69% of total billed charges,239.09,69,,,Percent of Total Billed Charges,69% of total billed charges,239.09,69,,,Percent of Total Billed Charges,69% of total billed charges,86.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.09,69,,,Percent of Total Billed Charges,69% of total billed charges,239.09,69,,,Percent of Total Billed Charges,69% of total billed charges,239.09,69,,,Percent of Total Billed Charges,69% of total billed charges,155.93,45,,,Percent of Total Billed Charges,45% of total billed charges,308.39,89,,,Percent of total Billed Charges,89% of total Billed charges,308.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.81,77,,,Percent of total Billed charges,77% of total billed charges,294.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.63,308.39,
FLU RX,D990550007,CDM,636,RC,90656,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,18,45,,,Percent of Total Billed Charges,45% of total billed charges,35.6,89,,,Percent of total Billed Charges,89% of total Billed charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,35.6,
COVID-19 (Mod) Booster 0.25 ML,D990550152,CDM,250,RC,,,Outpatient,,,1,0.5,,0.77,77,,,Percent of Total Billed Charges,77% of total billed charges,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,0.74,74,,,Percent of Total Billed Charges,74% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.84,84,,,Percent of Total Billed Charges,84% of total billed charges,0.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,0.89,89,,,Percent of total Billed Charges,89% of total Billed charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.77,77,,,Percent of total Billed charges,77% of total billed charges,0.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,0.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.25,0.89,
Ethyl Chloride Spray 104ml,D990550216,CDM,636,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4569.24,100,,,Case rate,Pays based on per visit rate,4569.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4569.24,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4569.24,4569.24,
Ipilimumab 50mg/10ml VL,D990550297,CDM,636,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4569.24,100,,,Case rate,Pays based on per visit rate,4569.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4569.24,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4569.24,4569.24,
LIDOCAINE-MPF 2% 10ML AMPULE,D990550350,CDM,636,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4569.24,100,,,Case rate,Pays based on per visit rate,4569.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4569.24,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4569.24,4569.24,
"Tecentriq 1,200mg Vial (Study",D990550550,CDM,636,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4569.24,100,,,Case rate,Pays based on per visit rate,4569.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4569.24,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4569.24,4569.24,
ZOFRAN 4MG INJECTION,D990550603,CDM,250,RC,,,Outpatient,,,144,72,,110.88,77,,,Percent of Total Billed Charges,77% of total billed charges,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.56,74,,,Percent of Total Billed Charges,74% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,120.96,84,,,Percent of Total Billed Charges,84% of total billed charges,118.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.16,89,,,Percent of total Billed Charges,89% of total Billed charges,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.88,77,,,Percent of total Billed charges,77% of total billed charges,122.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36,128.16,
ACCUCHECK,D990550606,CDM,250,RC,,,Outpatient,,,16.5,8.25,,12.71,77,,,Percent of Total Billed Charges,77% of total billed charges,4.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.21,74,,,Percent of Total Billed Charges,74% of total billed charges,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.39,69,,,Percent of Total Billed Charges,69% of total billed charges,13.86,84,,,Percent of Total Billed Charges,84% of total billed charges,13.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.69,89,,,Percent of total Billed Charges,89% of total Billed charges,14.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,77,,,Percent of total Billed charges,77% of total billed charges,14.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.13,14.69,
ACETAMINOPHEN 120MG SUPP,D990550608,CDM,259,RC,,,Outpatient,,,9,4.5,,6.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.66,74,,,Percent of Total Billed Charges,74% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7.56,84,,,Percent of Total Billed Charges,84% of total billed charges,7.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.93,77,,,Percent of total Billed charges,77% of total billed charges,7.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.25,8.01,
ACETAMINOPHEN 650MG SUPP,D990550610,CDM,259,RC,,,Outpatient,,,10,5,,7.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.4,74,,,Percent of Total Billed Charges,74% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8.4,84,,,Percent of Total Billed Charges,84% of total billed charges,8.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.7,77,,,Percent of total Billed charges,77% of total billed charges,8.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.5,8.9,
DIBUCAINE OINT 1% 30 GM,D990550720,CDM,259,RC,,,Outpatient,,,25.5,12.75,,19.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.87,74,,,Percent of Total Billed Charges,74% of total billed charges,17.6,69,,,Percent of Total Billed Charges,69% of total billed charges,17.6,69,,,Percent of Total Billed Charges,69% of total billed charges,6.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,69,,,Percent of Total Billed Charges,69% of total billed charges,17.6,69,,,Percent of Total Billed Charges,69% of total billed charges,21.42,84,,,Percent of Total Billed Charges,84% of total billed charges,20.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.7,89,,,Percent of total Billed Charges,89% of total Billed charges,22.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,77,,,Percent of total Billed charges,77% of total billed charges,21.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,22.7,
GELFOAM SPONGE SZ100X6,D990550764,CDM,250,RC,,,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.9,74,,,Percent of Total Billed Charges,74% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,155.4,84,,,Percent of Total Billed Charges,84% of total billed charges,151.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.65,89,,,Percent of total Billed Charges,89% of total Billed charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,164.65,
Ketorolac 60mg/2ml Vial,D990550801,CDM,636,RC,J1885,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,27.45,45,,,Percent of Total Billed Charges,45% of total billed charges,54.29,89,,,Percent of total Billed Charges,89% of total Billed charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,54.29,
LIDOCAINE 0.5% PF 50 ML VIAL,D990550813,CDM,250,RC,,,Outpatient,,,87,43.5,,66.99,77,,,Percent of Total Billed Charges,77% of total billed charges,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.38,74,,,Percent of Total Billed Charges,74% of total billed charges,60.03,69,,,Percent of Total Billed Charges,69% of total billed charges,60.03,69,,,Percent of Total Billed Charges,69% of total billed charges,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.03,69,,,Percent of Total Billed Charges,69% of total billed charges,60.03,69,,,Percent of Total Billed Charges,69% of total billed charges,73.08,84,,,Percent of Total Billed Charges,84% of total billed charges,71.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.43,89,,,Percent of total Billed Charges,89% of total Billed charges,77.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.99,77,,,Percent of total Billed charges,77% of total billed charges,73.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.75,77.43,
Oxymetazoline Nasal Spr 15ml,D990550905,CDM,637,RC,,,Outpatient,,,22.5,11.25,,17.33,77,,,Percent of Total Billed Charges,77% of total billed charges,5.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.65,74,,,Percent of Total Billed Charges,74% of total billed charges,15.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.53,69,,,Percent of Total Billed Charges,69% of total billed charges,18.9,84,,,Percent of Total Billed Charges,84% of total billed charges,18.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.03,89,,,Percent of total Billed Charges,89% of total Billed charges,20.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.33,77,,,Percent of total Billed charges,77% of total billed charges,19.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.63,20.03,
Triple Antibiotic Oint 0.9gmPK,D990551008,CDM,259,RC,,,Outpatient,,,7.5,3.75,,5.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.55,74,,,Percent of Total Billed Charges,74% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,84,,,Percent of Total Billed Charges,84% of total billed charges,6.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.68,89,,,Percent of total Billed Charges,89% of total Billed charges,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,77,,,Percent of total Billed charges,77% of total billed charges,6.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.68,
Crofab 1 Gram Vial,D990551066,CDM,636,RC,J0840,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4569.24,100,,,Case rate,Pays based on per visit rate,4569.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4569.24,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4569.24,4569.24,
MethylPREDNIS Ace I100mg/5ml V,D990551086,CDM,636,RC,J1010,HCPCS,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,45,,,Percent of Total Billed Charges,45% of total billed charges,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
SOD.FERRIC GLUC 62.5mg/5ml VL,D990551178,CDM,636,RC,J2916,HCPCS,Outpatient,,,243,121.5,,187.11,77,,,Percent of Total Billed Charges,77% of total billed charges,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,109.35,45,,,Percent of Total Billed Charges,45% of total billed charges,216.27,89,,,Percent of total Billed Charges,89% of total Billed charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.11,77,,,Percent of total Billed charges,77% of total billed charges,206.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.75,216.27,
Casirivimab/Imdevimab 600mg/10,D990551351,CDM,636,RC,Q0244,HCPCS,Outpatient,,,1,0.5,,0.77,77,,,Percent of Total Billed Charges,77% of total billed charges,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.45,45,,,Percent of Total Billed Charges,45% of total billed charges,0.89,89,,,Percent of total Billed Charges,89% of total Billed charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.77,77,,,Percent of total Billed charges,77% of total billed charges,0.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.25,0.89,
BAMLANIVIMAB/ETESEVIMAB,D990551352,CDM,636,RC,Q0245,HCPCS,Outpatient,,,1,0.5,,0.77,77,,,Percent of Total Billed Charges,77% of total billed charges,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.69,69,,,Percent of Total Billed Charges,69% of total billed charges,0.45,45,,,Percent of Total Billed Charges,45% of total billed charges,0.89,89,,,Percent of total Billed Charges,89% of total Billed charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.77,77,,,Percent of total Billed charges,77% of total billed charges,0.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.25,0.89,
TET.IMMUNE GLOBULIN 250 UNITS,D990551364,CDM,250,RC,86769,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.66,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.13,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,36.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.13,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,42.13,100,,,Fee Schedule,100% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,36.4,52.66,
Egg Free Flu Vaccine,D990551366,CDM,636,RC,90673,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,33.75,45,,,Percent of Total Billed Charges,45% of total billed charges,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.75,
Riv3 Vaccine No Preserv IM,D990551367,CDM,636,RC,90673,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.65,45,,,Percent of Total Billed Charges,45% of total billed charges,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,68.53,
Iiv4 Vacc No Prsv 0.5 Ml IM,D990551368,CDM,636,RC,90686,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.65,45,,,Percent of Total Billed Charges,45% of total billed charges,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,68.53,
FluMist vaccine,D990551439,CDM,636,RC,90660,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,33.75,45,,,Percent of Total Billed Charges,45% of total billed charges,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.75,
LIDOCAINE 2% 5ml UNIT DOSE,D990760001,CDM,272,RC,,,Outpatient,,,23,11.5,,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.02,74,,,Percent of Total Billed Charges,74% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,19.32,84,,,Percent of Total Billed Charges,84% of total billed charges,18.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.47,89,,,Percent of total Billed Charges,89% of total Billed charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,20.47,
ALEXIS LARGE C-SEC G6313,I990220001,CDM,278,RC,,,Outpatient,,,141,70.5,,108.57,77,,,Percent of Total Billed Charges,77% of total billed charges,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,98.7,70,,,Percent of Total Billed Charges,70% total billed charges,97.29,69,,,Percent of total Billed Charges,69% of total Billed charges,97.29,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,97.29,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.57,77,,,Percent of total Billed charges,77% of total billed charges,119.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.25,119.85,
ALEXIS XLG S-SEC G6414,I990220002,CDM,278,RC,,,Outpatient,,,177,88.5,,136.29,77,,,Percent of Total Billed Charges,77% of total billed charges,45.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,123.9,70,,,Percent of Total Billed Charges,70% total billed charges,122.13,69,,,Percent of total Billed Charges,69% of total Billed charges,122.13,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,122.13,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.29,77,,,Percent of total Billed charges,77% of total billed charges,150.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.25,150.45,
ALLODERM,I990220003,CDM,278,RC,,,Outpatient,,,11244,5622,,8657.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2867.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2867.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3513.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7758.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7758.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7758.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2811,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7758.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7758.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7758.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7870.8,70,,,Percent of Total Billed Charges,70% total billed charges,7758.36,69,,,Percent of total Billed Charges,69% of total Billed charges,7758.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7758.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4587.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4587.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4587.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2811,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8657.88,77,,,Percent of total Billed charges,77% of total billed charges,9557.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3232.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5622,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4587.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2811,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5622,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2811,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2811,9557.4,
AOS HUMERAL NAIL COMPONENTS,I990220004,CDM,278,RC,,,Outpatient,,,9475,4737.5,,7295.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2416.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2416.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2960.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6537.75,69,,,Percent of Total Billed Charges,69% of total billed charges,6537.75,69,,,Percent of Total Billed Charges,69% of total billed charges,6537.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6537.75,69,,,Percent of Total Billed Charges,69% of total billed charges,6537.75,69,,,Percent of Total Billed Charges,69% of total billed charges,6537.75,69,,,Percent of Total Billed Charges,69% of total billed charges,6632.5,70,,,Percent of Total Billed Charges,70% total billed charges,6537.75,69,,,Percent of total Billed Charges,69% of total Billed charges,6537.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6537.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3865.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3865.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3865.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7295.75,77,,,Percent of total Billed charges,77% of total billed charges,8053.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2724.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4737.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3865.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4737.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2368.75,8053.75,
AOS ORIF CLAVICLE COMPONENTS,I990220005,CDM,278,RC,,,Outpatient,,,9106,4553,,7011.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2322.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2322.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2845.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6283.14,69,,,Percent of Total Billed Charges,69% of total billed charges,6283.14,69,,,Percent of Total Billed Charges,69% of total billed charges,6283.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6283.14,69,,,Percent of Total Billed Charges,69% of total billed charges,6283.14,69,,,Percent of Total Billed Charges,69% of total billed charges,6283.14,69,,,Percent of Total Billed Charges,69% of total billed charges,6374.2,70,,,Percent of Total Billed Charges,70% total billed charges,6283.14,69,,,Percent of total Billed Charges,69% of total Billed charges,6283.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6283.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3715.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3715.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3715.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7011.62,77,,,Percent of total Billed charges,77% of total billed charges,7740.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2617.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4553,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3715.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4553,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2276.5,7740.1,
AR-3638 FiberTak,I990220006,CDM,278,RC,,,Outpatient,,,3306,1653,,2545.62,77,,,Percent of Total Billed Charges,77% of total billed charges,843.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1033.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2281.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2281.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2281.14,69,,,Percent of Total Billed Charges,69% of total billed charges,826.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2281.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2281.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2281.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2314.2,70,,,Percent of Total Billed Charges,70% total billed charges,2281.14,69,,,Percent of total Billed Charges,69% of total Billed charges,2281.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2281.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1348.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1348.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1348.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2545.62,77,,,Percent of total Billed charges,77% of total billed charges,2810.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,950.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1653,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1348.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,826.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1653,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,826.5,2810.1,
"AR-4570 FIBRSTITCH IMPLT, CURV",I990220007,CDM,278,RC,,,Outpatient,,,2142,1071,,1649.34,77,,,Percent of Total Billed Charges,77% of total billed charges,546.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,546.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,669.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1499.4,70,,,Percent of Total Billed Charges,70% total billed charges,1477.98,69,,,Percent of total Billed Charges,69% of total Billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1477.98,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,873.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,873.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,873.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1649.34,77,,,Percent of total Billed charges,77% of total billed charges,1820.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,615.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,873.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.5,1820.7,
AR-7234 Fiberloop #2,I990220008,CDM,278,RC,,,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,151.55,70,,,Percent of Total Billed Charges,70% total billed charges,149.39,69,,,Percent of total Billed Charges,69% of total Billed charges,149.39,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,149.39,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,184.03,
AR-DBL LOAD 4.7MM SWVLK,I990220009,CDM,278,RC,,,Outpatient,,,1839,919.5,,1416.03,77,,,Percent of Total Billed Charges,77% of total billed charges,468.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,468.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1287.3,70,,,Percent of Total Billed Charges,70% total billed charges,1268.91,69,,,Percent of total Billed Charges,69% of total Billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1268.91,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,750.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,750.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,750.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.03,77,,,Percent of total Billed charges,77% of total billed charges,1563.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,528.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,750.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,459.75,1563.15,
"AR-FIBR RC DBLLD TAPE BL/W,BLK",I990220010,CDM,278,RC,,,Outpatient,,,1601.5,800.75,,1233.16,77,,,Percent of Total Billed Charges,77% of total billed charges,408.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1105.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.04,69,,,Percent of Total Billed Charges,69% of total billed charges,400.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1121.05,70,,,Percent of Total Billed Charges,70% total billed charges,1105.04,69,,,Percent of total Billed Charges,69% of total Billed charges,1105.04,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1105.04,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,653.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.16,77,,,Percent of total Billed charges,77% of total billed charges,1361.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,653.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,400.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.38,1361.28,
"AR-LNT IMPNT SYS,3.9 SWIV",I990220011,CDM,278,RC,,,Outpatient,,,4945.5,2472.75,,3808.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1261.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1261.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1545.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3412.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1236.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3461.85,70,,,Percent of Total Billed Charges,70% total billed charges,3412.4,69,,,Percent of total Billed Charges,69% of total Billed charges,3412.4,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3412.4,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2017.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2017.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2017.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1236.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3808.04,77,,,Percent of total Billed charges,77% of total billed charges,4203.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1421.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2472.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2017.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1236.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2472.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1236.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1236.38,4203.68,
"AR-SUTURETAPE FBRLNK,1.3MM WH/",I990220012,CDM,278,RC,,,Outpatient,,,368.5,184.25,,283.75,77,,,Percent of Total Billed Charges,77% of total billed charges,93.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.27,69,,,Percent of Total Billed Charges,69% of total billed charges,254.27,69,,,Percent of Total Billed Charges,69% of total billed charges,254.27,69,,,Percent of Total Billed Charges,69% of total billed charges,92.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.27,69,,,Percent of Total Billed Charges,69% of total billed charges,254.27,69,,,Percent of Total Billed Charges,69% of total billed charges,254.27,69,,,Percent of Total Billed Charges,69% of total billed charges,257.95,70,,,Percent of Total Billed Charges,70% total billed charges,254.27,69,,,Percent of total Billed Charges,69% of total Billed charges,254.27,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,254.27,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,150.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.75,77,,,Percent of total Billed charges,77% of total billed charges,313.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.13,313.23,
ARTHOCARE SPEED LOCK,I990220013,CDM,278,RC,,,Outpatient,,,1155.5,577.75,,889.74,77,,,Percent of Total Billed Charges,77% of total billed charges,294.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,294.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,797.3,69,,,Percent of Total Billed Charges,69% of total billed charges,797.3,69,,,Percent of Total Billed Charges,69% of total billed charges,797.3,69,,,Percent of Total Billed Charges,69% of total billed charges,288.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,797.3,69,,,Percent of Total Billed Charges,69% of total billed charges,797.3,69,,,Percent of Total Billed Charges,69% of total billed charges,797.3,69,,,Percent of Total Billed Charges,69% of total billed charges,808.85,70,,,Percent of Total Billed Charges,70% total billed charges,797.3,69,,,Percent of total Billed Charges,69% of total Billed charges,797.3,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,797.3,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,471.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,889.74,77,,,Percent of total Billed charges,77% of total billed charges,982.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,332.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,471.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,288.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.88,982.18,
ARTHREX ACL RPR COMP,I990220014,CDM,278,RC,,,Outpatient,,,3768,1884,,2901.36,77,,,Percent of Total Billed Charges,77% of total billed charges,960.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1177.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2599.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.92,69,,,Percent of Total Billed Charges,69% of total billed charges,942,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2599.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2637.6,70,,,Percent of Total Billed Charges,70% total billed charges,2599.92,69,,,Percent of total Billed Charges,69% of total Billed charges,2599.92,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2599.92,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1537.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1537.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1537.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,942,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2901.36,77,,,Percent of total Billed charges,77% of total billed charges,3202.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1083.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1884,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1537.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,942,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1884,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,942,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,942,3202.8,
ARTHREX ACL TIGHTROPE W/FIBERT,I990220015,CDM,278,RC,,,Outpatient,,,1450,725,,1116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,369.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.5,69,,,Percent of Total Billed Charges,69% of total billed charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1015,70,,,Percent of Total Billed Charges,70% total billed charges,1000.5,69,,,Percent of total Billed Charges,69% of total Billed charges,1000.5,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1000.5,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.5,77,,,Percent of total Billed charges,77% of total billed charges,1232.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,416.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,591.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.5,1232.5,
ARTHREX BC KNTLESS SWIVL 4.7mm,I990220016,CDM,278,RC,,,Outpatient,,,2293.5,1146.75,,1766,77,,,Percent of Total Billed Charges,77% of total billed charges,584.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,716.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1582.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1582.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1582.52,69,,,Percent of Total Billed Charges,69% of total billed charges,573.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1582.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1582.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1582.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1605.45,70,,,Percent of Total Billed Charges,70% total billed charges,1582.52,69,,,Percent of total Billed Charges,69% of total Billed charges,1582.52,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1582.52,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,935.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,935.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,935.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766,77,,,Percent of total Billed charges,77% of total billed charges,1949.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,935.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,573.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.38,1949.48,
ARTHREX Biceps Tendon Implant,I990220017,CDM,278,RC,,,Outpatient,,,1785,892.5,,1374.45,77,,,Percent of Total Billed Charges,77% of total billed charges,455.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,455.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,557.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1231.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1231.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1231.65,69,,,Percent of Total Billed Charges,69% of total billed charges,446.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1231.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1231.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1231.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1249.5,70,,,Percent of Total Billed Charges,70% total billed charges,1231.65,69,,,Percent of total Billed Charges,69% of total Billed charges,1231.65,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1231.65,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,728.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,728.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,728.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,446.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.45,77,,,Percent of total Billed charges,77% of total billed charges,1517.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,513.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,728.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,446.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,446.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.25,1517.25,
"ARTHREX FBRSTITCH IMPLNT, CURV",I990220018,CDM,278,RC,,,Outpatient,,,2142,1071,,1649.34,77,,,Percent of Total Billed Charges,77% of total billed charges,546.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,546.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,669.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1499.4,70,,,Percent of Total Billed Charges,70% total billed charges,1477.98,69,,,Percent of total Billed Charges,69% of total Billed charges,1477.98,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1477.98,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,873.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,873.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,873.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1649.34,77,,,Percent of total Billed charges,77% of total billed charges,1820.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,615.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,873.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,535.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.5,1820.7,
"Arthrex Fibula Nail, 3.0x180mm",I990220019,CDM,278,RC,,,Outpatient,,,12958,6479,,9977.66,77,,,Percent of Total Billed Charges,77% of total billed charges,3304.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3304.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4049.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8941.02,69,,,Percent of Total Billed Charges,69% of total billed charges,8941.02,69,,,Percent of Total Billed Charges,69% of total billed charges,8941.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8941.02,69,,,Percent of Total Billed Charges,69% of total billed charges,8941.02,69,,,Percent of Total Billed Charges,69% of total billed charges,8941.02,69,,,Percent of Total Billed Charges,69% of total billed charges,9070.6,70,,,Percent of Total Billed Charges,70% total billed charges,8941.02,69,,,Percent of total Billed Charges,69% of total Billed charges,8941.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8941.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5286.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5286.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5286.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9977.66,77,,,Percent of total Billed charges,77% of total billed charges,11014.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3725.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6479,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5286.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6479,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3239.5,11014.3,
Arthrex Fibulock Implant,I990220020,CDM,278,RC,,,Outpatient,,,4326.5,2163.25,,3331.41,77,,,Percent of Total Billed Charges,77% of total billed charges,1103.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1103.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1352.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2985.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2985.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2985.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1081.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2985.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2985.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2985.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3028.55,70,,,Percent of Total Billed Charges,70% total billed charges,2985.29,69,,,Percent of total Billed Charges,69% of total Billed charges,2985.29,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2985.29,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1765.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1765.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1765.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3331.41,77,,,Percent of total Billed charges,77% of total billed charges,3677.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1243.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2163.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1765.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1081.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2163.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1081.63,3677.53,
"ARTHREX IMPNT DEL SYS, DISTAL",I990220021,CDM,278,RC,,,Outpatient,,,2803,1401.5,,2158.31,77,,,Percent of Total Billed Charges,77% of total billed charges,714.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,714.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,875.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1934.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1934.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1934.07,69,,,Percent of Total Billed Charges,69% of total billed charges,700.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1934.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1934.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1934.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.1,70,,,Percent of Total Billed Charges,70% total billed charges,1934.07,69,,,Percent of total Billed Charges,69% of total Billed charges,1934.07,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1934.07,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,700.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2158.31,77,,,Percent of total Billed charges,77% of total billed charges,2382.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,805.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1143.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,700.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,700.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,700.75,2382.55,
ARTHREX INT BRACE COMP,I990220022,CDM,278,RC,,,Outpatient,,,4451,2225.5,,3427.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1135.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1135.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1390.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3071.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3071.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3071.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3071.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3071.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3071.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3115.7,70,,,Percent of Total Billed Charges,70% total billed charges,3071.19,69,,,Percent of total Billed Charges,69% of total Billed charges,3071.19,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3071.19,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1816.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1816.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1816.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3427.27,77,,,Percent of total Billed charges,77% of total billed charges,3783.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1279.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2225.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1816.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2225.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1112.75,3783.35,
ARTHREX KNOTLESS IMPLNT SYSTEM,I990220023,CDM,278,RC,,,Outpatient,,,15354,7677,,11822.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3915.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3915.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4798.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10594.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10594.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10594.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10594.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10594.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10594.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10747.8,70,,,Percent of Total Billed Charges,70% total billed charges,10594.26,69,,,Percent of total Billed Charges,69% of total Billed charges,10594.26,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,10594.26,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6264.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6264.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6264.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3838.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11822.58,77,,,Percent of total Billed charges,77% of total billed charges,13050.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4414.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7677,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6264.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3838.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7677,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3838.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.5,13050.9,
Arthrex Knotless T-rope w/drv,I990220024,CDM,278,RC,,,Outpatient,,,9241.5,4620.75,,7115.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2356.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2356.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2887.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6376.64,69,,,Percent of Total Billed Charges,69% of total billed charges,6376.64,69,,,Percent of Total Billed Charges,69% of total billed charges,6376.64,69,,,Percent of Total Billed Charges,69% of total billed charges,2310.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6376.64,69,,,Percent of Total Billed Charges,69% of total billed charges,6376.64,69,,,Percent of Total Billed Charges,69% of total billed charges,6376.64,69,,,Percent of Total Billed Charges,69% of total billed charges,6469.05,70,,,Percent of Total Billed Charges,70% total billed charges,6376.64,69,,,Percent of total Billed Charges,69% of total Billed charges,6376.64,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6376.64,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3770.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3770.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3770.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2310.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7115.96,77,,,Percent of total Billed charges,77% of total billed charges,7855.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2656.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4620.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3770.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2310.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4620.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2310.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2310.38,7855.28,
ARTHREX MINI TIGHTROPE COMP,I990220025,CDM,278,RC,,,Outpatient,,,2610.5,1305.25,,2010.09,77,,,Percent of Total Billed Charges,77% of total billed charges,665.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,815.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1801.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1801.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1801.25,69,,,Percent of Total Billed Charges,69% of total billed charges,652.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1801.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1801.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1801.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1827.35,70,,,Percent of Total Billed Charges,70% total billed charges,1801.25,69,,,Percent of total Billed Charges,69% of total Billed charges,1801.25,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1801.25,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1065.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1065.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1065.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,652.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2010.09,77,,,Percent of total Billed charges,77% of total billed charges,2218.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,750.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1065.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,652.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,652.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,652.63,2218.93,
ARTHREX QUICKSET KIT,I990220026,CDM,278,RC,,,Outpatient,,,22164,11082,,17066.28,77,,,Percent of Total Billed Charges,77% of total billed charges,5651.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5651.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6926.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15293.16,69,,,Percent of Total Billed Charges,69% of total billed charges,15293.16,69,,,Percent of Total Billed Charges,69% of total billed charges,15293.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5541,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15293.16,69,,,Percent of Total Billed Charges,69% of total billed charges,15293.16,69,,,Percent of Total Billed Charges,69% of total billed charges,15293.16,69,,,Percent of Total Billed Charges,69% of total billed charges,15514.8,70,,,Percent of Total Billed Charges,70% total billed charges,15293.16,69,,,Percent of total Billed Charges,69% of total Billed charges,15293.16,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,15293.16,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9042.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9042.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9042.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5541,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17066.28,77,,,Percent of total Billed charges,77% of total billed charges,18839.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6372.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11082,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9042.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5541,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11082,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5541,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5541,18839.4,
ARTHREX SPEEDBERG IMPLANT KIT,I990220027,CDM,278,RC,,,Outpatient,,,5011,2505.5,,3858.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1277.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1277.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1565.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3457.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3457.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3457.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3457.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3457.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3457.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3507.7,70,,,Percent of Total Billed Charges,70% total billed charges,3457.59,69,,,Percent of total Billed Charges,69% of total Billed charges,3457.59,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3457.59,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2044.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2044.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2044.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3858.47,77,,,Percent of total Billed charges,77% of total billed charges,4259.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1440.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2505.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2044.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2505.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1252.75,4259.35,
ARTHREX SPEEDBRG IMPLANT,I990220028,CDM,278,RC,,,Outpatient,,,5184,2592,,3991.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1321.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1321.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1620,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3576.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3576.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3576.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1296,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3576.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3576.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3576.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3628.8,70,,,Percent of Total Billed Charges,70% total billed charges,3576.96,69,,,Percent of total Billed Charges,69% of total Billed charges,3576.96,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3576.96,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2115.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2115.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2115.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1296,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3991.68,77,,,Percent of total Billed charges,77% of total billed charges,4406.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1490.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2592,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2115.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1296,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2592,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1296,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1296,4406.4,
ARTHREX SUTR ANCHBIO-COMP-S-TA,I990220029,CDM,278,RC,,,Outpatient,,,3258,1629,,2508.66,77,,,Percent of Total Billed Charges,77% of total billed charges,830.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,830.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1018.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2248.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2248.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2248.02,69,,,Percent of Total Billed Charges,69% of total billed charges,814.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2248.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2248.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2248.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2280.6,70,,,Percent of Total Billed Charges,70% total billed charges,2248.02,69,,,Percent of total Billed Charges,69% of total Billed charges,2248.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2248.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,814.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2508.66,77,,,Percent of total Billed charges,77% of total billed charges,2769.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,936.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1629,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1329.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,814.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1629,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,814.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,814.5,2769.3,
ARTHREX TKL SPDBRG IMP SYS,I990220030,CDM,278,RC,,,Outpatient,,,13291.5,6645.75,,10234.46,77,,,Percent of Total Billed Charges,77% of total billed charges,3389.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3389.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4153.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9171.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9171.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9171.14,69,,,Percent of Total Billed Charges,69% of total billed charges,3322.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9171.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9171.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9171.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9304.05,70,,,Percent of Total Billed Charges,70% total billed charges,9171.14,69,,,Percent of total Billed Charges,69% of total Billed charges,9171.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9171.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5422.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5422.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5422.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3322.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10234.46,77,,,Percent of total Billed charges,77% of total billed charges,11297.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3821.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6645.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5422.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3322.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6645.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3322.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3322.88,11297.78,
ARTHREX UNILAT KNEE,I990220031,CDM,278,RC,,,Outpatient,,,7745,3872.5,,5963.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1974.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1974.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2420.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5344.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5344.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5344.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1936.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5344.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5344.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5344.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5421.5,70,,,Percent of Total Billed Charges,70% total billed charges,5344.05,69,,,Percent of total Billed Charges,69% of total Billed charges,5344.05,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5344.05,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3159.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3159.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3159.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1936.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5963.65,77,,,Percent of total Billed charges,77% of total billed charges,6583.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2226.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3872.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3159.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1936.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3872.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1936.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1936.25,6583.25,
"ARTHREX, Tenodesis Impl System",I990220032,CDM,278,RC,,,Outpatient,,,1174,587,,903.98,77,,,Percent of Total Billed Charges,77% of total billed charges,299.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,810.06,69,,,Percent of Total Billed Charges,69% of total billed charges,810.06,69,,,Percent of Total Billed Charges,69% of total billed charges,810.06,69,,,Percent of Total Billed Charges,69% of total billed charges,293.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,810.06,69,,,Percent of Total Billed Charges,69% of total billed charges,810.06,69,,,Percent of Total Billed Charges,69% of total billed charges,810.06,69,,,Percent of Total Billed Charges,69% of total billed charges,821.8,70,,,Percent of Total Billed Charges,70% total billed charges,810.06,69,,,Percent of total Billed Charges,69% of total Billed charges,810.06,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,810.06,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,478.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,903.98,77,,,Percent of total Billed charges,77% of total billed charges,997.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,337.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,478.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,293.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.5,997.9,
"ARTHREX,Suture CRKSCRW 3.5x10m",I990220033,CDM,278,RC,,,Outpatient,,,496.5,248.25,,382.31,77,,,Percent of Total Billed Charges,77% of total billed charges,126.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.59,69,,,Percent of Total Billed Charges,69% of total billed charges,342.59,69,,,Percent of Total Billed Charges,69% of total billed charges,342.59,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.59,69,,,Percent of Total Billed Charges,69% of total billed charges,342.59,69,,,Percent of Total Billed Charges,69% of total billed charges,342.59,69,,,Percent of Total Billed Charges,69% of total billed charges,347.55,70,,,Percent of Total Billed Charges,70% total billed charges,342.59,69,,,Percent of total Billed Charges,69% of total Billed charges,342.59,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,342.59,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,202.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,382.31,77,,,Percent of total Billed charges,77% of total billed charges,422.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,142.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,202.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,422.03,
ARTICULAR COMP 15MM 2.5X3.5,I990220034,CDM,278,RC,,,Outpatient,,,5462.5,2731.25,,4206.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1392.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1392.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1707.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3769.13,69,,,Percent of Total Billed Charges,69% of total billed charges,3769.13,69,,,Percent of Total Billed Charges,69% of total billed charges,3769.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3769.13,69,,,Percent of Total Billed Charges,69% of total billed charges,3769.13,69,,,Percent of Total Billed Charges,69% of total billed charges,3769.13,69,,,Percent of Total Billed Charges,69% of total billed charges,3823.75,70,,,Percent of Total Billed Charges,70% total billed charges,3769.13,69,,,Percent of total Billed Charges,69% of total Billed charges,3769.13,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3769.13,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2228.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2228.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2228.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4206.13,77,,,Percent of total Billed charges,77% of total billed charges,4643.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1570.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2731.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2228.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2731.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1365.63,4643.13,
BIOMET DERMASPAN GRAFT,I990220035,CDM,278,RC,,,Outpatient,,,5663.5,2831.75,,4360.9,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1769.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3907.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3907.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3907.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1415.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3907.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3907.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3907.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3964.45,70,,,Percent of Total Billed Charges,70% total billed charges,3907.82,69,,,Percent of total Billed Charges,69% of total Billed charges,3907.82,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3907.82,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2310.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2310.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2310.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1415.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4360.9,77,,,Percent of total Billed charges,77% of total billed charges,4813.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1628.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2831.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2310.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1415.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2831.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1415.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1415.88,4813.98,
BIOMET E-POLY LINER,I990220036,CDM,278,RC,,,Outpatient,,,3942,1971,,3035.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1231.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2719.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2719.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2719.98,69,,,Percent of Total Billed Charges,69% of total billed charges,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2719.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2719.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2719.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2759.4,70,,,Percent of Total Billed Charges,70% total billed charges,2719.98,69,,,Percent of total Billed Charges,69% of total Billed charges,2719.98,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2719.98,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3035.34,77,,,Percent of total Billed charges,77% of total billed charges,3350.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1971,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.5,3350.7,
BIOMET FEM NAIL,I990220037,CDM,278,RC,,,Outpatient,,,5765,2882.5,,4439.05,77,,,Percent of Total Billed Charges,77% of total billed charges,1470.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1470.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1801.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4035.5,70,,,Percent of Total Billed Charges,70% total billed charges,3977.85,69,,,Percent of total Billed Charges,69% of total Billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3977.85,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4439.05,77,,,Percent of total Billed charges,77% of total billed charges,4900.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1657.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2882.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2882.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1441.25,4900.25,
BIOMET FEMORAL HEAD,I990220038,CDM,278,RC,,,Outpatient,,,2683.5,1341.75,,2066.3,77,,,Percent of Total Billed Charges,77% of total billed charges,684.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,684.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,838.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1851.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1851.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1851.62,69,,,Percent of Total Billed Charges,69% of total billed charges,670.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1851.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1851.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1851.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.45,70,,,Percent of Total Billed Charges,70% total billed charges,1851.62,69,,,Percent of total Billed Charges,69% of total Billed charges,1851.62,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1851.62,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1094.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1094.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1094.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,670.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2066.3,77,,,Percent of total Billed charges,77% of total billed charges,2280.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,771.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1094.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,670.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,670.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,670.88,2280.98,
BIOMET SLEEVE,I990220039,CDM,278,RC,,,Outpatient,,,800,400,,616,77,,,Percent of Total Billed Charges,77% of total billed charges,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,552,69,,,Percent of Total Billed Charges,69% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,552,69,,,Percent of Total Billed Charges,69% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,560,70,,,Percent of Total Billed Charges,70% total billed charges,552,69,,,Percent of total Billed Charges,69% of total Billed charges,552,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,552,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616,77,,,Percent of total Billed charges,77% of total billed charges,680,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,326.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,680,
BME SPEED IMPLANT,I990220040,CDM,278,RC,,,Outpatient,,,2603,1301.5,,2004.31,77,,,Percent of Total Billed Charges,77% of total billed charges,663.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,813.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1796.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1796.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1796.07,69,,,Percent of Total Billed Charges,69% of total billed charges,650.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1796.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1796.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1822.1,70,,,Percent of Total Billed Charges,70% total billed charges,1796.07,69,,,Percent of total Billed Charges,69% of total Billed charges,1796.07,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1796.07,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1062.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1062.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1062.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,650.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.31,77,,,Percent of total Billed charges,77% of total billed charges,2212.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,748.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1062.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,650.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,650.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,650.75,2212.55,
BONE GRAFT CR CANCELLOUS 5CC,I990220041,CDM,278,RC,,,Outpatient,,,5071.5,2535.75,,3905.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1293.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3499.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3499.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3499.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3499.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3499.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3499.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3550.05,70,,,Percent of Total Billed Charges,70% total billed charges,3499.34,69,,,Percent of total Billed Charges,69% of total Billed charges,3499.34,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3499.34,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2069.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2069.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2069.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3905.06,77,,,Percent of total Billed charges,77% of total billed charges,4310.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1458.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2069.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2535.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1267.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.88,4310.78,
CALCANEUS MESH PLATE,I990220042,CDM,278,RC,,,Outpatient,,,2143.5,1071.75,,1650.5,77,,,Percent of Total Billed Charges,77% of total billed charges,546.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,546.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,669.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1479.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1479.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1479.02,69,,,Percent of Total Billed Charges,69% of total billed charges,535.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1479.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1479.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1479.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1500.45,70,,,Percent of Total Billed Charges,70% total billed charges,1479.02,69,,,Percent of total Billed Charges,69% of total Billed charges,1479.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1479.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,874.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,874.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,874.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,535.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1650.5,77,,,Percent of total Billed charges,77% of total billed charges,1821.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,616.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,874.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,535.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,535.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.88,1821.98,
CONICAL SUBLATOR IMPLANT,I990220043,CDM,278,RC,,,Outpatient,,,3138.5,1569.25,,2416.65,77,,,Percent of Total Billed Charges,77% of total billed charges,800.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,800.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,980.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.95,70,,,Percent of Total Billed Charges,70% total billed charges,2165.57,69,,,Percent of total Billed Charges,69% of total Billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2165.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2416.65,77,,,Percent of total Billed charges,77% of total billed charges,2667.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,902.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1569.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1569.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,784.63,2667.73,
CROSSFIX MENISCAL STRAIGHT,I990220044,CDM,278,RC,,,Outpatient,,,799,399.5,,615.23,77,,,Percent of Total Billed Charges,77% of total billed charges,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,559.3,70,,,Percent of Total Billed Charges,70% total billed charges,551.31,69,,,Percent of total Billed Charges,69% of total Billed charges,551.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,551.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,615.23,77,,,Percent of total Billed charges,77% of total billed charges,679.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,325.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.75,679.15,
CROSSFIX MINISCAL UP CURVE,I990220045,CDM,278,RC,,,Outpatient,,,799,399.5,,615.23,77,,,Percent of Total Billed Charges,77% of total billed charges,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,559.3,70,,,Percent of Total Billed Charges,70% total billed charges,551.31,69,,,Percent of total Billed Charges,69% of total Billed charges,551.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,551.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,615.23,77,,,Percent of total Billed charges,77% of total billed charges,679.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,325.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.75,679.15,
CSI IMPLANT,I990220046,CDM,278,RC,,,Outpatient,,,3138.5,1569.25,,2416.65,77,,,Percent of Total Billed Charges,77% of total billed charges,800.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,800.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,980.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.95,70,,,Percent of Total Billed Charges,70% total billed charges,2165.57,69,,,Percent of total Billed Charges,69% of total Billed charges,2165.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2165.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2416.65,77,,,Percent of total Billed charges,77% of total billed charges,2667.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,902.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1569.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1280.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1569.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,784.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,784.63,2667.73,
DENVER NASAL SPLINT,I990220047,CDM,278,RC,,,Outpatient,,,92.5,46.25,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,64.75,70,,,Percent of Total Billed Charges,70% total billed charges,63.83,69,,,Percent of total Billed Charges,69% of total Billed charges,63.83,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,63.83,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,78.63,
DISTAL FEMUR FX COMPONENT,I990220048,CDM,278,RC,,,Outpatient,,,8069,4034.5,,6213.13,77,,,Percent of Total Billed Charges,77% of total billed charges,2057.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2057.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2521.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5567.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5567.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5567.61,69,,,Percent of Total Billed Charges,69% of total billed charges,2017.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5567.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5567.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5567.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5648.3,70,,,Percent of Total Billed Charges,70% total billed charges,5567.61,69,,,Percent of total Billed Charges,69% of total Billed charges,5567.61,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5567.61,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3292.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3292.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3292.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2017.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6213.13,77,,,Percent of total Billed charges,77% of total billed charges,6858.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2319.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4034.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3292.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2017.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4034.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2017.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2017.25,6858.65,
DJO Hook Plate,I990220049,CDM,278,RC,,,Outpatient,,,9518.5,4759.25,,7329.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2427.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2427.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6567.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6567.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6567.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2379.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6567.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6567.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6567.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6662.95,70,,,Percent of Total Billed Charges,70% total billed charges,6567.77,69,,,Percent of total Billed Charges,69% of total Billed charges,6567.77,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6567.77,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3883.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3883.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3883.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2379.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7329.25,77,,,Percent of total Billed charges,77% of total billed charges,8090.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2736.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4759.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3883.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2379.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4759.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2379.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2379.63,8090.73,
DJO Olive Wire,I990220050,CDM,278,RC,,,Outpatient,,,462,231,,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,323.4,70,,,Percent of Total Billed Charges,70% total billed charges,318.78,69,,,Percent of total Billed Charges,69% of total Billed charges,318.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,318.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,392.7,
DRILL SLEEVE TRUKOR,I990220051,CDM,278,RC,,,Outpatient,,,644.5,322.25,,496.27,77,,,Percent of Total Billed Charges,77% of total billed charges,164.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,444.71,69,,,Percent of Total Billed Charges,69% of total billed charges,444.71,69,,,Percent of Total Billed Charges,69% of total billed charges,444.71,69,,,Percent of Total Billed Charges,69% of total billed charges,161.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.71,69,,,Percent of Total Billed Charges,69% of total billed charges,444.71,69,,,Percent of Total Billed Charges,69% of total billed charges,444.71,69,,,Percent of Total Billed Charges,69% of total billed charges,451.15,70,,,Percent of Total Billed Charges,70% total billed charges,444.71,69,,,Percent of total Billed Charges,69% of total Billed charges,444.71,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,444.71,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,262.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.27,77,,,Percent of total Billed charges,77% of total billed charges,547.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.13,547.83,
DW Tornier Reversed Insert,I990220052,CDM,278,RC,,,Outpatient,,,3760.5,1880.25,,2895.59,77,,,Percent of Total Billed Charges,77% of total billed charges,958.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1175.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2632.35,70,,,Percent of Total Billed Charges,70% total billed charges,2594.75,69,,,Percent of total Billed Charges,69% of total Billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2594.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2895.59,77,,,Percent of total Billed charges,77% of total billed charges,3196.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1081.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1880.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1880.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,940.13,3196.43,
DW Tornier Reversed Lateral,I990220053,CDM,278,RC,,,Outpatient,,,10189,5094.5,,7845.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2598.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2598.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3184.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7030.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7030.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7030.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2547.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7030.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7030.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7030.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7132.3,70,,,Percent of Total Billed Charges,70% total billed charges,7030.41,69,,,Percent of total Billed Charges,69% of total Billed charges,7030.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7030.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4157.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4157.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4157.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2547.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7845.53,77,,,Percent of total Billed charges,77% of total billed charges,8660.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2929.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5094.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4157.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2547.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5094.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2547.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2547.25,8660.65,
DW Tornier Reversed Standard,I990220054,CDM,278,RC,,,Outpatient,,,5421,2710.5,,4174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,1382.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1694.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3740.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3740.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3740.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3740.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3740.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3740.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3794.7,70,,,Percent of Total Billed Charges,70% total billed charges,3740.49,69,,,Percent of total Billed Charges,69% of total Billed charges,3740.49,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3740.49,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2211.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2211.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2211.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4174.17,77,,,Percent of total Billed charges,77% of total billed charges,4607.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1558.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2710.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2211.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2710.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1355.25,4607.85,
DW Tornier Reversed Stem,I990220055,CDM,278,RC,,,Outpatient,,,13075,6537.5,,10067.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3334.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3334.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4085.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9021.75,69,,,Percent of Total Billed Charges,69% of total billed charges,9021.75,69,,,Percent of Total Billed Charges,69% of total billed charges,9021.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9021.75,69,,,Percent of Total Billed Charges,69% of total billed charges,9021.75,69,,,Percent of Total Billed Charges,69% of total billed charges,9021.75,69,,,Percent of Total Billed Charges,69% of total billed charges,9152.5,70,,,Percent of Total Billed Charges,70% total billed charges,9021.75,69,,,Percent of total Billed Charges,69% of total Billed charges,9021.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9021.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5334.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5334.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5334.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10067.75,77,,,Percent of total Billed charges,77% of total billed charges,11113.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3759.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6537.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5334.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6537.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.75,11113.75,
DW Tornier Reversed Tray,I990220056,CDM,278,RC,,,Outpatient,,,5867,2933.5,,4517.59,77,,,Percent of Total Billed Charges,77% of total billed charges,1496.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1496.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1833.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4048.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4048.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4048.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1466.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4048.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4048.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4048.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4106.9,70,,,Percent of Total Billed Charges,70% total billed charges,4048.23,69,,,Percent of total Billed Charges,69% of total Billed charges,4048.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4048.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2393.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2393.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2393.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1466.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4517.59,77,,,Percent of total Billed charges,77% of total billed charges,4986.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1686.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2933.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2393.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1466.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2933.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1466.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1466.75,4986.95,
Ear Vent Tube 1.35 X 3,I990220057,CDM,278,RC,,,Outpatient,,,47.5,23.75,,36.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,33.25,70,,,Percent of Total Billed Charges,70% total billed charges,32.78,69,,,Percent of total Billed Charges,69% of total Billed charges,32.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,32.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.58,77,,,Percent of total Billed charges,77% of total billed charges,40.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,40.38,
EASYCLIP STAPLE,I990220058,CDM,278,RC,,,Outpatient,,,2364.5,1182.25,,1820.67,77,,,Percent of Total Billed Charges,77% of total billed charges,602.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,602.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,738.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1631.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1631.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1631.51,69,,,Percent of Total Billed Charges,69% of total billed charges,591.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1631.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1631.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1631.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.15,70,,,Percent of Total Billed Charges,70% total billed charges,1631.51,69,,,Percent of total Billed Charges,69% of total Billed charges,1631.51,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1631.51,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,964.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,964.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,964.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.67,77,,,Percent of total Billed charges,77% of total billed charges,2009.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,679.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,964.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,591.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,591.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,591.13,2009.83,
EVANS WEDGE 8 MM,I990220059,CDM,278,RC,,,Outpatient,,,2653.5,1326.75,,2043.2,77,,,Percent of Total Billed Charges,77% of total billed charges,676.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,829.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1830.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1830.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1830.92,69,,,Percent of Total Billed Charges,69% of total billed charges,663.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1830.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1830.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1830.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1857.45,70,,,Percent of Total Billed Charges,70% total billed charges,1830.92,69,,,Percent of total Billed Charges,69% of total Billed charges,1830.92,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1830.92,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1082.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1082.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1082.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,663.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.2,77,,,Percent of total Billed charges,77% of total billed charges,2255.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1082.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,663.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,663.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.38,2255.48,
FALLOPIAN RINGS,I990220060,CDM,278,RC,,,Outpatient,,,172.5,86.25,,132.83,77,,,Percent of Total Billed Charges,77% of total billed charges,43.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.03,69,,,Percent of Total Billed Charges,69% of total billed charges,119.03,69,,,Percent of Total Billed Charges,69% of total billed charges,119.03,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.03,69,,,Percent of Total Billed Charges,69% of total billed charges,119.03,69,,,Percent of Total Billed Charges,69% of total billed charges,119.03,69,,,Percent of Total Billed Charges,69% of total billed charges,120.75,70,,,Percent of Total Billed Charges,70% total billed charges,119.03,69,,,Percent of total Billed Charges,69% of total Billed charges,119.03,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,119.03,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,70.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.83,77,,,Percent of total Billed charges,77% of total billed charges,146.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.13,146.63,
FLEX HINGE TOE IMPLANT,I990220061,CDM,278,RC,,,Outpatient,,,9270,4635,,7137.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2363.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2363.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2896.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6396.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6396.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6396.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6396.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6396.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6396.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6489,70,,,Percent of Total Billed Charges,70% total billed charges,6396.3,69,,,Percent of total Billed Charges,69% of total Billed charges,6396.3,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6396.3,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3782.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3782.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3782.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7137.9,77,,,Percent of total Billed charges,77% of total billed charges,7879.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2665.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4635,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3782.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4635,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2317.5,7879.5,
"FLEXIBLE PEDIATRIC NAIL,BIOMET",I990220062,CDM,278,RC,,,Outpatient,,,1265.5,632.75,,974.44,77,,,Percent of Total Billed Charges,77% of total billed charges,322.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,873.2,69,,,Percent of Total Billed Charges,69% of total billed charges,873.2,69,,,Percent of Total Billed Charges,69% of total billed charges,873.2,69,,,Percent of Total Billed Charges,69% of total billed charges,316.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,873.2,69,,,Percent of Total Billed Charges,69% of total billed charges,873.2,69,,,Percent of Total Billed Charges,69% of total billed charges,873.2,69,,,Percent of Total Billed Charges,69% of total billed charges,885.85,70,,,Percent of Total Billed Charges,70% total billed charges,873.2,69,,,Percent of total Billed Charges,69% of total Billed charges,873.2,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,873.2,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,516.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,974.44,77,,,Percent of total Billed charges,77% of total billed charges,1075.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,363.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,516.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,316.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.38,1075.68,
GRAFT SEMI T W/GRAC,I990220063,CDM,278,RC,,,Outpatient,,,5985.5,2992.75,,4608.84,77,,,Percent of Total Billed Charges,77% of total billed charges,1526.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1526.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1870.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4130,69,,,Percent of Total Billed Charges,69% of total billed charges,4130,69,,,Percent of Total Billed Charges,69% of total billed charges,4130,69,,,Percent of Total Billed Charges,69% of total billed charges,1496.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4130,69,,,Percent of Total Billed Charges,69% of total billed charges,4130,69,,,Percent of Total Billed Charges,69% of total billed charges,4130,69,,,Percent of Total Billed Charges,69% of total billed charges,4189.85,70,,,Percent of Total Billed Charges,70% total billed charges,4130,69,,,Percent of total Billed Charges,69% of total Billed charges,4130,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4130,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2442.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2442.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2442.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1496.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4608.84,77,,,Percent of total Billed charges,77% of total billed charges,5087.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1720.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2992.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2442.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1496.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2992.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1496.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1496.38,5087.68,
HERNIA PATCH 2.5 INCH,I990220064,CDM,278,RC,,,Outpatient,,,889,444.5,,684.53,77,,,Percent of Total Billed Charges,77% of total billed charges,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,622.3,70,,,Percent of Total Billed Charges,70% total billed charges,613.41,69,,,Percent of total Billed Charges,69% of total Billed charges,613.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,613.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,362.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,684.53,77,,,Percent of total Billed charges,77% of total billed charges,755.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,362.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.25,755.65,
HERNIA PATCH 3.2 INCH,I990220065,CDM,278,RC,,,Outpatient,,,1139.5,569.75,,877.42,77,,,Percent of Total Billed Charges,77% of total billed charges,290.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,786.26,69,,,Percent of Total Billed Charges,69% of total billed charges,786.26,69,,,Percent of Total Billed Charges,69% of total billed charges,786.26,69,,,Percent of Total Billed Charges,69% of total billed charges,284.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.26,69,,,Percent of Total Billed Charges,69% of total billed charges,786.26,69,,,Percent of Total Billed Charges,69% of total billed charges,786.26,69,,,Percent of Total Billed Charges,69% of total billed charges,797.65,70,,,Percent of Total Billed Charges,70% total billed charges,786.26,69,,,Percent of total Billed Charges,69% of total Billed charges,786.26,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,786.26,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,464.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.42,77,,,Percent of total Billed charges,77% of total billed charges,968.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,464.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,284.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.88,968.58,
HIP ARTHOPLASTY COMP-BIOMET,I990220066,CDM,278,RC,,,Outpatient,,,11488,5744,,8845.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2929.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2929.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3590,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7926.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7926.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7926.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2872,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7926.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7926.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8041.6,70,,,Percent of Total Billed Charges,70% total billed charges,7926.72,69,,,Percent of total Billed Charges,69% of total Billed charges,7926.72,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7926.72,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4687.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4687.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4687.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2872,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8845.76,77,,,Percent of total Billed charges,77% of total billed charges,9764.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3302.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5744,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4687.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2872,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5744,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2872,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2872,9764.8,
HIP NAILING COMPONENT,I990220067,CDM,278,RC,,,Outpatient,,,9143.5,4571.75,,7040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,2331.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2331.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2857.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6309.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6309.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6309.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2285.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6309.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6309.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6309.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6400.45,70,,,Percent of Total Billed Charges,70% total billed charges,6309.02,69,,,Percent of total Billed Charges,69% of total Billed charges,6309.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6309.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3730.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3730.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3730.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2285.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7040.5,77,,,Percent of total Billed charges,77% of total billed charges,7771.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2628.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4571.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3730.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2285.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4571.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2285.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2285.88,7771.98,
HIP REVISION COMP,I990220068,CDM,278,RC,,,Outpatient,,,15827,7913.5,,12186.79,77,,,Percent of Total Billed Charges,77% of total billed charges,4035.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4035.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4945.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10920.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10920.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10920.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3956.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10920.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10920.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10920.63,69,,,Percent of Total Billed Charges,69% of total billed charges,11078.9,70,,,Percent of Total Billed Charges,70% total billed charges,10920.63,69,,,Percent of total Billed Charges,69% of total Billed charges,10920.63,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,10920.63,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6457.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6457.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6457.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3956.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12186.79,77,,,Percent of total Billed charges,77% of total billed charges,13452.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4550.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7913.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6457.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3956.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7913.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3956.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3956.75,13452.95,
IMPLANT APERFIX FEM 10X29 MM,I990220069,CDM,278,RC,,,Outpatient,,,2446,1223,,1883.42,77,,,Percent of Total Billed Charges,77% of total billed charges,623.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,623.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,764.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1687.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1687.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1687.74,69,,,Percent of Total Billed Charges,69% of total billed charges,611.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1687.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1687.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1687.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1712.2,70,,,Percent of Total Billed Charges,70% total billed charges,1687.74,69,,,Percent of total Billed Charges,69% of total Billed charges,1687.74,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1687.74,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,997.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,997.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,997.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,611.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1883.42,77,,,Percent of total Billed charges,77% of total billed charges,2079.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,703.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,997.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,611.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,611.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.5,2079.1,
IMPLANT APERFIX TIB 10X30 MM,I990220070,CDM,278,RC,,,Outpatient,,,1187,593.5,,913.99,77,,,Percent of Total Billed Charges,77% of total billed charges,302.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,819.03,69,,,Percent of Total Billed Charges,69% of total billed charges,819.03,69,,,Percent of Total Billed Charges,69% of total billed charges,819.03,69,,,Percent of Total Billed Charges,69% of total billed charges,296.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,819.03,69,,,Percent of Total Billed Charges,69% of total billed charges,819.03,69,,,Percent of Total Billed Charges,69% of total billed charges,819.03,69,,,Percent of Total Billed Charges,69% of total billed charges,830.9,70,,,Percent of Total Billed Charges,70% total billed charges,819.03,69,,,Percent of total Billed Charges,69% of total Billed charges,819.03,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,819.03,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,484.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.99,77,,,Percent of total Billed charges,77% of total billed charges,1008.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,484.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,296.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.75,1008.95,
IMPLANT SYNDESMOSIS REPAIR,I990220071,CDM,278,RC,,,Outpatient,,,1822.5,911.25,,1403.33,77,,,Percent of Total Billed Charges,77% of total billed charges,464.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,464.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,569.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1257.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1257.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1257.53,69,,,Percent of Total Billed Charges,69% of total billed charges,455.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1257.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1257.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1257.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1275.75,70,,,Percent of Total Billed Charges,70% total billed charges,1257.53,69,,,Percent of total Billed Charges,69% of total Billed charges,1257.53,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1257.53,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,743.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,743.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,743.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,455.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1403.33,77,,,Percent of total Billed charges,77% of total billed charges,1549.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,523.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,743.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,455.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,455.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.63,1549.13,
INTERNALBRACE LIGAMENT,I990220072,CDM,278,RC,,,Outpatient,,,3007,1503.5,,2315.39,77,,,Percent of Total Billed Charges,77% of total billed charges,766.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,766.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,939.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2074.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2074.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2074.83,69,,,Percent of Total Billed Charges,69% of total billed charges,751.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2074.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2074.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2074.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2104.9,70,,,Percent of Total Billed Charges,70% total billed charges,2074.83,69,,,Percent of total Billed Charges,69% of total Billed charges,2074.83,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2074.83,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1226.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1226.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1226.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,751.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2315.39,77,,,Percent of total Billed charges,77% of total billed charges,2555.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,864.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1503.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1226.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,751.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1503.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,751.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,751.75,2555.95,
KNOTLESS TIGHTROPE REPAIR TRAY,I990220073,CDM,278,RC,,,Outpatient,,,2549,1274.5,,1962.73,77,,,Percent of Total Billed Charges,77% of total billed charges,650,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,796.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1758.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1758.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1758.81,69,,,Percent of Total Billed Charges,69% of total billed charges,637.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1758.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1758.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1758.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1784.3,70,,,Percent of Total Billed Charges,70% total billed charges,1758.81,69,,,Percent of total Billed Charges,69% of total Billed charges,1758.81,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1758.81,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1039.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1039.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1039.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,637.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.73,77,,,Percent of total Billed charges,77% of total billed charges,2166.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,732.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1039.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,637.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,637.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.25,2166.65,
LIGATING LOOP SURGITE POLYSORB,I990220074,CDM,278,RC,,,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,78.4,70,,,Percent of Total Billed Charges,70% total billed charges,77.28,69,,,Percent of total Billed Charges,69% of total Billed charges,77.28,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,77.28,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,95.2,
MALYUGIN RING - CATARACT,I990220075,CDM,278,RC,,,Outpatient,,,623,311.5,,479.71,77,,,Percent of Total Billed Charges,77% of total billed charges,158.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,429.87,69,,,Percent of Total Billed Charges,69% of total billed charges,429.87,69,,,Percent of Total Billed Charges,69% of total billed charges,429.87,69,,,Percent of Total Billed Charges,69% of total billed charges,155.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,429.87,69,,,Percent of Total Billed Charges,69% of total billed charges,429.87,69,,,Percent of Total Billed Charges,69% of total billed charges,429.87,69,,,Percent of Total Billed Charges,69% of total billed charges,436.1,70,,,Percent of Total Billed Charges,70% total billed charges,429.87,69,,,Percent of total Billed Charges,69% of total Billed charges,429.87,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,429.87,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,254.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,254.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,254.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,479.71,77,,,Percent of total Billed charges,77% of total billed charges,529.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.75,529.55,
MIC PEG SAFE FEED KIT,I990220076,CDM,278,RC,,,Outpatient,,,344,172,,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,240.8,70,,,Percent of Total Billed Charges,70% total billed charges,237.36,69,,,Percent of total Billed Charges,69% of total Billed charges,237.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,237.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,140.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86,292.4,
MICROPORT HIP LINER,I990220077,CDM,278,RC,,,Outpatient,,,2767,1383.5,,2130.59,77,,,Percent of Total Billed Charges,77% of total billed charges,705.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1909.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1909.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1909.23,69,,,Percent of Total Billed Charges,69% of total billed charges,691.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1909.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1909.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1909.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1936.9,70,,,Percent of Total Billed Charges,70% total billed charges,1909.23,69,,,Percent of total Billed Charges,69% of total Billed charges,1909.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1909.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1128.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.59,77,,,Percent of total Billed charges,77% of total billed charges,2351.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1128.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,691.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.75,2351.95,
MICROPORT HIP SHELL,I990220078,CDM,278,RC,,,Outpatient,,,3873,1936.5,,2982.21,77,,,Percent of Total Billed Charges,77% of total billed charges,987.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,987.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1210.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2672.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2672.37,69,,,Percent of Total Billed Charges,69% of total billed charges,968.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2672.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2672.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2672.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.1,70,,,Percent of Total Billed Charges,70% total billed charges,2672.37,69,,,Percent of total Billed Charges,69% of total Billed charges,2672.37,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2672.37,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1580.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1580.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1580.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,968.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2982.21,77,,,Percent of total Billed charges,77% of total billed charges,3292.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1113.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1936.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1580.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,968.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1936.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,968.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,968.25,3292.05,
OBTRYX II HALO,I990220079,CDM,278,RC,,,Outpatient,,,2927,1463.5,,2253.79,77,,,Percent of Total Billed Charges,77% of total billed charges,746.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,746.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,914.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2019.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2019.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2019.63,69,,,Percent of Total Billed Charges,69% of total billed charges,731.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2019.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2019.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2019.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2048.9,70,,,Percent of Total Billed Charges,70% total billed charges,2019.63,69,,,Percent of total Billed Charges,69% of total Billed charges,2019.63,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2019.63,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1194.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1194.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1194.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2253.79,77,,,Percent of total Billed charges,77% of total billed charges,2487.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,841.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1194.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,731.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,731.75,2487.95,
ORIF CLAVICLE (Sonoma),I990220080,CDM,278,RC,,,Outpatient,,,8867,4433.5,,6827.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2261.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2261.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2770.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6118.23,69,,,Percent of Total Billed Charges,69% of total billed charges,6118.23,69,,,Percent of Total Billed Charges,69% of total billed charges,6118.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6118.23,69,,,Percent of Total Billed Charges,69% of total billed charges,6118.23,69,,,Percent of Total Billed Charges,69% of total billed charges,6118.23,69,,,Percent of Total Billed Charges,69% of total billed charges,6206.9,70,,,Percent of Total Billed Charges,70% total billed charges,6118.23,69,,,Percent of total Billed Charges,69% of total Billed charges,6118.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6118.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3617.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3617.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3617.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6827.59,77,,,Percent of total Billed charges,77% of total billed charges,7536.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2549.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4433.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3617.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4433.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2216.75,7536.95,
OSTEOCHONDRAL ALLOGRAFT,I990220081,CDM,278,RC,,,Outpatient,,,21699,10849.5,,16708.23,77,,,Percent of Total Billed Charges,77% of total billed charges,5533.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5533.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6780.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14972.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14972.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14972.31,69,,,Percent of Total Billed Charges,69% of total billed charges,5424.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14972.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14972.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14972.31,69,,,Percent of Total Billed Charges,69% of total billed charges,15189.3,70,,,Percent of Total Billed Charges,70% total billed charges,14972.31,69,,,Percent of total Billed Charges,69% of total Billed charges,14972.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,14972.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8853.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8853.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8853.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5424.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16708.23,77,,,Percent of total Billed charges,77% of total billed charges,18444.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6238.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10849.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8853.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5424.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10849.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5424.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5424.75,18444.15,
OSTEOSET RESORBABLE MINI BEAD,I990220082,CDM,278,RC,,,Outpatient,,,1854.5,927.25,,1427.97,77,,,Percent of Total Billed Charges,77% of total billed charges,472.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,472.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,579.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1279.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1279.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1279.61,69,,,Percent of Total Billed Charges,69% of total billed charges,463.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1279.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1279.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1279.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1298.15,70,,,Percent of Total Billed Charges,70% total billed charges,1279.61,69,,,Percent of total Billed Charges,69% of total Billed charges,1279.61,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1279.61,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,756.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1427.97,77,,,Percent of total Billed charges,77% of total billed charges,1576.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,533.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,756.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,463.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,463.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.63,1576.33,
PANTALOR FUSION COMPONENT,I990220083,CDM,278,RC,,,Outpatient,,,14293,7146.5,,11005.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3644.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3644.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4466.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9862.17,69,,,Percent of Total Billed Charges,69% of total billed charges,9862.17,69,,,Percent of Total Billed Charges,69% of total billed charges,9862.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3573.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9862.17,69,,,Percent of Total Billed Charges,69% of total billed charges,9862.17,69,,,Percent of Total Billed Charges,69% of total billed charges,9862.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10005.1,70,,,Percent of Total Billed Charges,70% total billed charges,9862.17,69,,,Percent of total Billed Charges,69% of total Billed charges,9862.17,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9862.17,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5831.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5831.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5831.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3573.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11005.61,77,,,Percent of total Billed charges,77% of total billed charges,12149.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4109.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7146.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5831.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3573.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7146.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3573.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3573.25,12149.05,
PATELLA FEMORAL ARTHRO COMP,I990220084,CDM,278,RC,,,Outpatient,,,12932.5,6466.25,,9958.03,77,,,Percent of Total Billed Charges,77% of total billed charges,3297.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3297.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4041.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8923.43,69,,,Percent of Total Billed Charges,69% of total billed charges,8923.43,69,,,Percent of Total Billed Charges,69% of total billed charges,8923.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3233.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8923.43,69,,,Percent of Total Billed Charges,69% of total billed charges,8923.43,69,,,Percent of Total Billed Charges,69% of total billed charges,8923.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9052.75,70,,,Percent of Total Billed Charges,70% total billed charges,8923.43,69,,,Percent of total Billed Charges,69% of total Billed charges,8923.43,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8923.43,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5276.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5276.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5276.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3233.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9958.03,77,,,Percent of total Billed charges,77% of total billed charges,10992.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3718.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6466.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5276.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3233.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6466.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3233.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3233.13,10992.63,
PORT DOUBLE LUMEN BARD,I990220085,CDM,278,RC,,,Outpatient,,,1741.5,870.75,,1340.96,77,,,Percent of Total Billed Charges,77% of total billed charges,444.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,444.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,544.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1201.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1201.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1201.64,69,,,Percent of Total Billed Charges,69% of total billed charges,435.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1201.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1201.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1201.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1219.05,70,,,Percent of Total Billed Charges,70% total billed charges,1201.64,69,,,Percent of total Billed Charges,69% of total Billed charges,1201.64,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1201.64,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,710.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,710.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,710.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1340.96,77,,,Percent of total Billed charges,77% of total billed charges,1480.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,500.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,710.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,435.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,435.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.38,1480.28,
PROPEL ENT 70011,I990220086,CDM,278,RC,,,Outpatient,,,2162,1081,,1664.74,77,,,Percent of Total Billed Charges,77% of total billed charges,551.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,551.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,675.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1491.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.78,69,,,Percent of Total Billed Charges,69% of total billed charges,540.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1491.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.4,70,,,Percent of Total Billed Charges,70% total billed charges,1491.78,69,,,Percent of total Billed Charges,69% of total Billed charges,1491.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1491.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,882.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,882.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,882.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,540.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1664.74,77,,,Percent of total Billed charges,77% of total billed charges,1837.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,621.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,882.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,540.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,540.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.5,1837.7,
PROPEL MINI ENT 60011,I990220087,CDM,278,RC,,,Outpatient,,,2104,1052,,1620.08,77,,,Percent of Total Billed Charges,77% of total billed charges,536.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,536.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,657.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1451.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1451.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1451.76,69,,,Percent of Total Billed Charges,69% of total billed charges,526,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1451.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1451.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1472.8,70,,,Percent of Total Billed Charges,70% total billed charges,1451.76,69,,,Percent of total Billed Charges,69% of total Billed charges,1451.76,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1451.76,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,858.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,858.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,858.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,526,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.08,77,,,Percent of total Billed charges,77% of total billed charges,1788.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,604.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,858.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,526,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,526,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,526,1788.4,
PROXIMAL TENODESIS IMPLANT SYS,I990220088,CDM,278,RC,,,Outpatient,,,1780.5,890.25,,1370.99,77,,,Percent of Total Billed Charges,77% of total billed charges,454.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,454.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,556.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1228.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1228.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1228.55,69,,,Percent of Total Billed Charges,69% of total billed charges,445.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1228.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1228.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1228.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1246.35,70,,,Percent of Total Billed Charges,70% total billed charges,1228.55,69,,,Percent of total Billed Charges,69% of total Billed charges,1228.55,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1228.55,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,726.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,726.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,726.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,445.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1370.99,77,,,Percent of total Billed charges,77% of total billed charges,1513.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,511.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,726.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,445.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,445.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.13,1513.43,
REAMER FULL,I990220089,CDM,278,RC,,,Outpatient,,,1144,572,,880.88,77,,,Percent of Total Billed Charges,77% of total billed charges,291.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,789.36,69,,,Percent of Total Billed Charges,69% of total billed charges,789.36,69,,,Percent of Total Billed Charges,69% of total billed charges,789.36,69,,,Percent of Total Billed Charges,69% of total billed charges,286,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.36,69,,,Percent of Total Billed Charges,69% of total billed charges,789.36,69,,,Percent of Total Billed Charges,69% of total billed charges,789.36,69,,,Percent of Total Billed Charges,69% of total billed charges,800.8,70,,,Percent of Total Billed Charges,70% total billed charges,789.36,69,,,Percent of total Billed Charges,69% of total Billed charges,789.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,789.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,466.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,466.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,466.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,286,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.88,77,,,Percent of total Billed charges,77% of total billed charges,972.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,328.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,466.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,286,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,286,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286,972.4,
RELOAD CRV TIP 2.0 TRISTATE,I990220090,CDM,278,RC,,,Outpatient,,,941.5,470.75,,724.96,77,,,Percent of Total Billed Charges,77% of total billed charges,240.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,240.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,294.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,649.64,69,,,Percent of Total Billed Charges,69% of total billed charges,649.64,69,,,Percent of Total Billed Charges,69% of total billed charges,649.64,69,,,Percent of Total Billed Charges,69% of total billed charges,235.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.64,69,,,Percent of Total Billed Charges,69% of total billed charges,649.64,69,,,Percent of Total Billed Charges,69% of total billed charges,649.64,69,,,Percent of Total Billed Charges,69% of total billed charges,659.05,70,,,Percent of Total Billed Charges,70% total billed charges,649.64,69,,,Percent of total Billed Charges,69% of total Billed charges,649.64,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,649.64,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,384.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.96,77,,,Percent of total Billed charges,77% of total billed charges,800.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,384.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,235.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.38,800.28,
RESECTOR 3.5 FULL RADIUS,I990220091,CDM,278,RC,,,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,98,70,,,Percent of Total Billed Charges,70% total billed charges,96.6,69,,,Percent of total Billed Charges,69% of total Billed charges,96.6,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,96.6,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,119,
SEA SPINE BONE GRAFT,I990220092,CDM,278,RC,,,Outpatient,,,336,168,,258.72,77,,,Percent of Total Billed Charges,77% of total billed charges,85.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.84,69,,,Percent of Total Billed Charges,69% of total billed charges,231.84,69,,,Percent of Total Billed Charges,69% of total billed charges,231.84,69,,,Percent of Total Billed Charges,69% of total billed charges,84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.84,69,,,Percent of Total Billed Charges,69% of total billed charges,231.84,69,,,Percent of Total Billed Charges,69% of total billed charges,231.84,69,,,Percent of Total Billed Charges,69% of total billed charges,235.2,70,,,Percent of Total Billed Charges,70% total billed charges,231.84,69,,,Percent of total Billed Charges,69% of total Billed charges,231.84,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,231.84,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,137.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.72,77,,,Percent of total Billed charges,77% of total billed charges,285.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84,285.6,
SEPTAL BUTON TAMI 5CM,I990220093,CDM,278,RC,,,Outpatient,,,710,355,,546.7,77,,,Percent of Total Billed Charges,77% of total billed charges,181.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,489.9,69,,,Percent of Total Billed Charges,69% of total billed charges,489.9,69,,,Percent of Total Billed Charges,69% of total billed charges,489.9,69,,,Percent of Total Billed Charges,69% of total billed charges,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.9,69,,,Percent of Total Billed Charges,69% of total billed charges,489.9,69,,,Percent of Total Billed Charges,69% of total billed charges,489.9,69,,,Percent of Total Billed Charges,69% of total billed charges,497,70,,,Percent of Total Billed Charges,70% total billed charges,489.9,69,,,Percent of total Billed Charges,69% of total Billed charges,489.9,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,489.9,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,289.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,546.7,77,,,Percent of total Billed charges,77% of total billed charges,603.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.5,603.5,
SKELETAL CMC,I990220094,CDM,278,RC,,,Outpatient,,,15900,7950,,12243,77,,,Percent of Total Billed Charges,77% of total billed charges,4054.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4054.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4968.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10971,69,,,Percent of Total Billed Charges,69% of total billed charges,10971,69,,,Percent of Total Billed Charges,69% of total billed charges,10971,69,,,Percent of Total Billed Charges,69% of total billed charges,3975,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10971,69,,,Percent of Total Billed Charges,69% of total billed charges,10971,69,,,Percent of Total Billed Charges,69% of total billed charges,10971,69,,,Percent of Total Billed Charges,69% of total billed charges,11130,70,,,Percent of Total Billed Charges,70% total billed charges,10971,69,,,Percent of total Billed Charges,69% of total Billed charges,10971,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,10971,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6487.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6487.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6487.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3975,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12243,77,,,Percent of total Billed charges,77% of total billed charges,13515,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4571.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7950,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6487.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3975,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7950,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3975,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975,13515,
SMART TOE IMPLANT,I990220095,CDM,278,RC,,,Outpatient,,,1676,838,,1290.52,77,,,Percent of Total Billed Charges,77% of total billed charges,427.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,523.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1156.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1156.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1156.44,69,,,Percent of Total Billed Charges,69% of total billed charges,419,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1156.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1156.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1156.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1173.2,70,,,Percent of Total Billed Charges,70% total billed charges,1156.44,69,,,Percent of total Billed Charges,69% of total Billed charges,1156.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1156.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,683.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,683.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,683.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.52,77,,,Percent of total Billed charges,77% of total billed charges,1424.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,481.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,683.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,419,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419,1424.6,
SMARTNAIL (DR SLOAN),I990220096,CDM,278,RC,,,Outpatient,,,395.5,197.75,,304.54,77,,,Percent of Total Billed Charges,77% of total billed charges,100.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,276.85,70,,,Percent of Total Billed Charges,70% total billed charges,272.9,69,,,Percent of total Billed Charges,69% of total Billed charges,272.9,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,272.9,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,161.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.54,77,,,Percent of total Billed charges,77% of total billed charges,336.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.88,336.18,
SPECTRUM SMOOTH RND 325,I990220097,CDM,278,RC,,,Outpatient,,,2019.5,1009.75,,1555.02,77,,,Percent of Total Billed Charges,77% of total billed charges,514.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,514.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,631.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1393.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1393.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1393.46,69,,,Percent of Total Billed Charges,69% of total billed charges,504.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1393.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1393.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1393.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1413.65,70,,,Percent of Total Billed Charges,70% total billed charges,1393.46,69,,,Percent of total Billed Charges,69% of total Billed charges,1393.46,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1393.46,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,823.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,823.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,823.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1555.02,77,,,Percent of total Billed charges,77% of total billed charges,1716.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,580.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,823.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,504.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,504.88,1716.58,
STIMUBLAST PUTTY,I990220098,CDM,278,RC,,,Outpatient,,,562,281,,432.74,77,,,Percent of Total Billed Charges,77% of total billed charges,143.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,387.78,69,,,Percent of Total Billed Charges,69% of total billed charges,387.78,69,,,Percent of Total Billed Charges,69% of total billed charges,387.78,69,,,Percent of Total Billed Charges,69% of total billed charges,140.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.78,69,,,Percent of Total Billed Charges,69% of total billed charges,387.78,69,,,Percent of Total Billed Charges,69% of total billed charges,387.78,69,,,Percent of Total Billed Charges,69% of total billed charges,393.4,70,,,Percent of Total Billed Charges,70% total billed charges,387.78,69,,,Percent of total Billed Charges,69% of total Billed charges,387.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,387.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,229.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,432.74,77,,,Percent of total Billed charges,77% of total billed charges,477.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,229.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,140.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.5,477.7,
STRYKER ANKLE ARTHRODESIS COMP,I990220099,CDM,278,RC,,,Outpatient,,,19172.5,9586.25,,14762.83,77,,,Percent of Total Billed Charges,77% of total billed charges,4888.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4888.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5991.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13229.03,69,,,Percent of Total Billed Charges,69% of total billed charges,13229.03,69,,,Percent of Total Billed Charges,69% of total billed charges,13229.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4793.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13229.03,69,,,Percent of Total Billed Charges,69% of total billed charges,13229.03,69,,,Percent of Total Billed Charges,69% of total billed charges,13229.03,69,,,Percent of Total Billed Charges,69% of total billed charges,13420.75,70,,,Percent of Total Billed Charges,70% total billed charges,13229.03,69,,,Percent of total Billed Charges,69% of total Billed charges,13229.03,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,13229.03,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14762.83,77,,,Percent of total Billed charges,77% of total billed charges,16296.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5512.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9586.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4793.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9586.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4793.13,16296.63,
STRYKER ANKLE FUSION,I990220100,CDM,278,RC,,,Outpatient,,,13558,6779,,10439.66,77,,,Percent of Total Billed Charges,77% of total billed charges,3457.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3457.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4236.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9355.02,69,,,Percent of Total Billed Charges,69% of total billed charges,9355.02,69,,,Percent of Total Billed Charges,69% of total billed charges,9355.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9355.02,69,,,Percent of Total Billed Charges,69% of total billed charges,9355.02,69,,,Percent of Total Billed Charges,69% of total billed charges,9355.02,69,,,Percent of Total Billed Charges,69% of total billed charges,9490.6,70,,,Percent of Total Billed Charges,70% total billed charges,9355.02,69,,,Percent of total Billed Charges,69% of total Billed charges,9355.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9355.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5531.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5531.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5531.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3389.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10439.66,77,,,Percent of total Billed charges,77% of total billed charges,11524.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3897.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6779,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5531.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3389.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6779,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3389.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3389.5,11524.3,
STRYKER HYDORSET,I990220101,CDM,278,RC,,,Outpatient,,,3767.5,1883.75,,2900.98,77,,,Percent of Total Billed Charges,77% of total billed charges,960.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1177.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2599.58,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.58,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.58,69,,,Percent of Total Billed Charges,69% of total billed charges,941.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2599.58,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.58,69,,,Percent of Total Billed Charges,69% of total billed charges,2599.58,69,,,Percent of Total Billed Charges,69% of total billed charges,2637.25,70,,,Percent of Total Billed Charges,70% total billed charges,2599.58,69,,,Percent of total Billed Charges,69% of total Billed charges,2599.58,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2599.58,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1537.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1537.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1537.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2900.98,77,,,Percent of total Billed charges,77% of total billed charges,3202.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1083.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1883.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1537.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1883.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,941.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.88,3202.38,
STRYKER KNOTLESS SHOULDER ANCH,I990220102,CDM,278,RC,,,Outpatient,,,986.5,493.25,,759.61,77,,,Percent of Total Billed Charges,77% of total billed charges,251.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,308.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.69,69,,,Percent of Total Billed Charges,69% of total billed charges,680.69,69,,,Percent of Total Billed Charges,69% of total billed charges,680.69,69,,,Percent of Total Billed Charges,69% of total billed charges,246.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.69,69,,,Percent of Total Billed Charges,69% of total billed charges,680.69,69,,,Percent of Total Billed Charges,69% of total billed charges,680.69,69,,,Percent of Total Billed Charges,69% of total billed charges,690.55,70,,,Percent of Total Billed Charges,70% total billed charges,680.69,69,,,Percent of total Billed Charges,69% of total Billed charges,680.69,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,680.69,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,402.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,402.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,402.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.61,77,,,Percent of total Billed charges,77% of total billed charges,838.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,283.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,402.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,246.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.63,838.53,
STRYKER ORIF ANKLE COMPONENTS,I990220103,CDM,278,RC,,,Outpatient,,,10361,5180.5,,7977.97,77,,,Percent of Total Billed Charges,77% of total billed charges,2642.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2642.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3237.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7149.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7149.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7149.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2590.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7149.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7149.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7149.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.7,70,,,Percent of Total Billed Charges,70% total billed charges,7149.09,69,,,Percent of total Billed Charges,69% of total Billed charges,7149.09,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7149.09,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4227.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4227.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4227.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2590.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7977.97,77,,,Percent of total Billed charges,77% of total billed charges,8806.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2978.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5180.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4227.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2590.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5180.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2590.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2590.25,8806.85,
STRYKER PEEK ZIP,I990220104,CDM,278,RC,,,Outpatient,,,719,359.5,,553.63,77,,,Percent of Total Billed Charges,77% of total billed charges,183.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,496.11,69,,,Percent of Total Billed Charges,69% of total billed charges,496.11,69,,,Percent of Total Billed Charges,69% of total billed charges,496.11,69,,,Percent of Total Billed Charges,69% of total billed charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.11,69,,,Percent of Total Billed Charges,69% of total billed charges,496.11,69,,,Percent of Total Billed Charges,69% of total billed charges,496.11,69,,,Percent of Total Billed Charges,69% of total billed charges,503.3,70,,,Percent of Total Billed Charges,70% total billed charges,496.11,69,,,Percent of total Billed Charges,69% of total Billed charges,496.11,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,496.11,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.63,77,,,Percent of total Billed charges,77% of total billed charges,611.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.75,611.15,
Stryker ReelX STT Knotless Anc,I990220105,CDM,278,RC,,,Outpatient,,,1028,514,,791.56,77,,,Percent of Total Billed Charges,77% of total billed charges,262.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,321.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,709.32,69,,,Percent of Total Billed Charges,69% of total billed charges,709.32,69,,,Percent of Total Billed Charges,69% of total billed charges,709.32,69,,,Percent of Total Billed Charges,69% of total billed charges,257,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.32,69,,,Percent of Total Billed Charges,69% of total billed charges,709.32,69,,,Percent of Total Billed Charges,69% of total billed charges,709.32,69,,,Percent of Total Billed Charges,69% of total billed charges,719.6,70,,,Percent of Total Billed Charges,70% total billed charges,709.32,69,,,Percent of total Billed Charges,69% of total Billed charges,709.32,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,709.32,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,419.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,791.56,77,,,Percent of total Billed charges,77% of total billed charges,873.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,295.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,419.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,257,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,257,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257,873.8,
STRYKER SLYM Y PLATE,I990220106,CDM,278,RC,,,Outpatient,,,3091.5,1545.75,,2380.46,77,,,Percent of Total Billed Charges,77% of total billed charges,788.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,788.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,966.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2133.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2133.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2133.14,69,,,Percent of Total Billed Charges,69% of total billed charges,772.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2133.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2133.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2133.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2164.05,70,,,Percent of Total Billed Charges,70% total billed charges,2133.14,69,,,Percent of total Billed Charges,69% of total Billed charges,2133.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2133.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1261.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1261.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1261.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,772.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2380.46,77,,,Percent of total Billed charges,77% of total billed charges,2627.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,888.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1545.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1261.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,772.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1545.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,772.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.88,2627.78,
STRYKER TISSUEMEND 5X6cm,I990220107,CDM,278,RC,,,Outpatient,,,4980,2490,,3834.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1269.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1269.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1556.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3436.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3436.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3436.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3436.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3436.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3436.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3486,70,,,Percent of Total Billed Charges,70% total billed charges,3436.2,69,,,Percent of total Billed Charges,69% of total Billed charges,3436.2,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3436.2,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2031.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2031.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2031.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3834.6,77,,,Percent of total Billed charges,77% of total billed charges,4233,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1431.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2490,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2031.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2490,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245,4233,
SURGIMESH EASY PLUG,I990220108,CDM,278,RC,,,Outpatient,,,667,333.5,,513.59,77,,,Percent of Total Billed Charges,77% of total billed charges,170.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,466.9,70,,,Percent of Total Billed Charges,70% total billed charges,460.23,69,,,Percent of total Billed Charges,69% of total Billed charges,460.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,460.23,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,272.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.59,77,,,Percent of total Billed charges,77% of total billed charges,566.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,191.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,272.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.75,566.95,
SUTR ANCH CRKSCRW FT 3.5X10MM,I990220109,CDM,278,RC,,,Outpatient,,,753,376.5,,579.81,77,,,Percent of Total Billed Charges,77% of total billed charges,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,527.1,70,,,Percent of Total Billed Charges,70% total billed charges,519.57,69,,,Percent of total Billed Charges,69% of total Billed charges,519.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,519.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,307.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.81,77,,,Percent of total Billed charges,77% of total billed charges,640.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.25,640.05,
SUTURE CARTRIDGE PP SMART,I990220110,CDM,278,RC,,,Outpatient,,,384,192,,295.68,77,,,Percent of Total Billed Charges,77% of total billed charges,97.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.96,69,,,Percent of Total Billed Charges,69% of total billed charges,264.96,69,,,Percent of Total Billed Charges,69% of total billed charges,264.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.96,69,,,Percent of Total Billed Charges,69% of total billed charges,264.96,69,,,Percent of Total Billed Charges,69% of total billed charges,264.96,69,,,Percent of Total Billed Charges,69% of total billed charges,268.8,70,,,Percent of Total Billed Charges,70% total billed charges,264.96,69,,,Percent of total Billed Charges,69% of total Billed charges,264.96,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,264.96,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,156.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.68,77,,,Percent of total Billed charges,77% of total billed charges,326.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,326.4,
SUTURE LASSO ARTHREX,I990220111,CDM,278,RC,,,Outpatient,,,1012.5,506.25,,779.63,77,,,Percent of Total Billed Charges,77% of total billed charges,258.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,316.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,698.63,69,,,Percent of Total Billed Charges,69% of total billed charges,698.63,69,,,Percent of Total Billed Charges,69% of total billed charges,698.63,69,,,Percent of Total Billed Charges,69% of total billed charges,253.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,698.63,69,,,Percent of Total Billed Charges,69% of total billed charges,698.63,69,,,Percent of Total Billed Charges,69% of total billed charges,698.63,69,,,Percent of Total Billed Charges,69% of total billed charges,708.75,70,,,Percent of Total Billed Charges,70% total billed charges,698.63,69,,,Percent of total Billed Charges,69% of total Billed charges,698.63,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,698.63,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,413.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,413.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,413.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,779.63,77,,,Percent of total Billed charges,77% of total billed charges,860.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,291.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,413.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,253.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.13,860.63,
Synthes Cann. TFN Nail,I990220112,CDM,278,RC,,,Outpatient,,,16561.5,8280.75,,12752.36,77,,,Percent of Total Billed Charges,77% of total billed charges,4223.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4223.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5175.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11427.44,69,,,Percent of Total Billed Charges,69% of total billed charges,11427.44,69,,,Percent of Total Billed Charges,69% of total billed charges,11427.44,69,,,Percent of Total Billed Charges,69% of total billed charges,4140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11427.44,69,,,Percent of Total Billed Charges,69% of total billed charges,11427.44,69,,,Percent of Total Billed Charges,69% of total billed charges,11427.44,69,,,Percent of Total Billed Charges,69% of total billed charges,11593.05,70,,,Percent of Total Billed Charges,70% total billed charges,11427.44,69,,,Percent of total Billed Charges,69% of total Billed charges,11427.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,11427.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6757.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6757.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6757.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12752.36,77,,,Percent of total Billed charges,77% of total billed charges,14077.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4761.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8280.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6757.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8280.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4140.38,14077.28,
Synthes Reaming Rod 351.707S,I990220113,CDM,278,RC,,,Outpatient,,,865.5,432.75,,666.44,77,,,Percent of Total Billed Charges,77% of total billed charges,220.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,597.2,69,,,Percent of Total Billed Charges,69% of total billed charges,597.2,69,,,Percent of Total Billed Charges,69% of total billed charges,597.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.2,69,,,Percent of Total Billed Charges,69% of total billed charges,597.2,69,,,Percent of Total Billed Charges,69% of total billed charges,597.2,69,,,Percent of Total Billed Charges,69% of total billed charges,605.85,70,,,Percent of Total Billed Charges,70% total billed charges,597.2,69,,,Percent of total Billed Charges,69% of total Billed charges,597.2,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,597.2,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,353.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,666.44,77,,,Percent of total Billed charges,77% of total billed charges,735.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,248.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,353.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,216.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,216.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.38,735.68,
TIBIAL BEARING COMPONENT,I990220114,CDM,278,RC,,,Outpatient,,,6540,3270,,5035.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1667.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1667.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2043.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4512.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4512.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4512.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1635,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4512.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4512.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4578,70,,,Percent of Total Billed Charges,70% total billed charges,4512.6,69,,,Percent of total Billed Charges,69% of total Billed charges,4512.6,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4512.6,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2668.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2668.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2668.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1635,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5035.8,77,,,Percent of total Billed charges,77% of total billed charges,5559,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1880.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3270,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2668.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1635,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3270,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1635,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1635,5559,
TIBIAL KNEE INSERT,I990220115,CDM,278,RC,,,Outpatient,,,1806,903,,1390.62,77,,,Percent of Total Billed Charges,77% of total billed charges,460.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,460.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,564.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1246.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1246.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1246.14,69,,,Percent of Total Billed Charges,69% of total billed charges,451.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1246.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1246.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1246.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1264.2,70,,,Percent of Total Billed Charges,70% total billed charges,1246.14,69,,,Percent of total Billed Charges,69% of total Billed charges,1246.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1246.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,736.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,736.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,736.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,451.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1390.62,77,,,Percent of total Billed charges,77% of total billed charges,1535.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,519.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,736.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,451.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,451.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,451.5,1535.1,
TIBIAL LOCKING BAR,I990220116,CDM,278,RC,,,Outpatient,,,485,242.5,,373.45,77,,,Percent of Total Billed Charges,77% of total billed charges,123.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,339.5,70,,,Percent of Total Billed Charges,70% total billed charges,334.65,69,,,Percent of total Billed Charges,69% of total Billed charges,334.65,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,334.65,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,197.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.45,77,,,Percent of total Billed charges,77% of total billed charges,412.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,197.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.25,412.25,
TIBIAL NAIL,I990220117,CDM,278,RC,,,Outpatient,,,5765,2882.5,,4439.05,77,,,Percent of Total Billed Charges,77% of total billed charges,1470.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1470.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1801.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4035.5,70,,,Percent of Total Billed Charges,70% total billed charges,3977.85,69,,,Percent of total Billed Charges,69% of total Billed charges,3977.85,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3977.85,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4439.05,77,,,Percent of total Billed charges,77% of total billed charges,4900.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1657.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2882.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2352.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2882.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1441.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1441.25,4900.25,
TIBIALIS TENDON POST GRAFT,I990220118,CDM,278,RC,,,Outpatient,,,4495.5,2247.75,,3461.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1404.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3101.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3101.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3101.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3101.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3101.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3101.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3146.85,70,,,Percent of Total Billed Charges,70% total billed charges,3101.9,69,,,Percent of total Billed Charges,69% of total Billed charges,3101.9,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3101.9,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1834.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1834.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1834.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3461.54,77,,,Percent of total Billed charges,77% of total billed charges,3821.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1292.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2247.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1834.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2247.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1123.88,3821.18,
TISSUE MEND ALLOGRAFT,I990220119,CDM,278,RC,,,Outpatient,,,2161.5,1080.75,,1664.36,77,,,Percent of Total Billed Charges,77% of total billed charges,551.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,551.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,675.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1491.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.44,69,,,Percent of Total Billed Charges,69% of total billed charges,540.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1491.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1491.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.05,70,,,Percent of Total Billed Charges,70% total billed charges,1491.44,69,,,Percent of total Billed Charges,69% of total Billed charges,1491.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1491.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,881.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,881.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,881.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,540.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1664.36,77,,,Percent of total Billed charges,77% of total billed charges,1837.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,621.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,881.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,540.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,540.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.38,1837.28,
TRICORTICAL BONE WEDGE,I990220121,CDM,278,RC,,,Outpatient,,,2536.5,1268.25,,1953.11,77,,,Percent of Total Billed Charges,77% of total billed charges,646.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,646.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1750.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1750.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1750.19,69,,,Percent of Total Billed Charges,69% of total billed charges,634.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1750.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1750.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1750.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1775.55,70,,,Percent of Total Billed Charges,70% total billed charges,1750.19,69,,,Percent of total Billed Charges,69% of total Billed charges,1750.19,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1750.19,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1034.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1034.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1034.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1953.11,77,,,Percent of total Billed charges,77% of total billed charges,2156.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,729.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1034.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,634.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,634.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.13,2156.03,
TRILLIANT 2 STEP IMPLANT,I990220122,CDM,278,RC,,,Outpatient,,,1710.5,855.25,,1317.09,77,,,Percent of Total Billed Charges,77% of total billed charges,436.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,534.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1180.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1180.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1180.25,69,,,Percent of Total Billed Charges,69% of total billed charges,427.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1180.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1180.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1180.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1197.35,70,,,Percent of Total Billed Charges,70% total billed charges,1180.25,69,,,Percent of total Billed Charges,69% of total Billed charges,1180.25,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1180.25,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,697.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1317.09,77,,,Percent of total Billed charges,77% of total billed charges,1453.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,491.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,697.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,427.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,427.63,1453.93,
TRILLIANT BUNION HEMI IMPLANT,I990220123,CDM,278,RC,,,Outpatient,,,10383.5,5191.75,,7995.3,77,,,Percent of Total Billed Charges,77% of total billed charges,2647.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2647.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7164.62,69,,,Percent of Total Billed Charges,69% of total billed charges,7164.62,69,,,Percent of Total Billed Charges,69% of total billed charges,7164.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7164.62,69,,,Percent of Total Billed Charges,69% of total billed charges,7164.62,69,,,Percent of Total Billed Charges,69% of total billed charges,7164.62,69,,,Percent of Total Billed Charges,69% of total billed charges,7268.45,70,,,Percent of Total Billed Charges,70% total billed charges,7164.62,69,,,Percent of total Billed Charges,69% of total Billed charges,7164.62,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7164.62,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4236.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4236.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4236.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7995.3,77,,,Percent of total Billed charges,77% of total billed charges,8825.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2985.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5191.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4236.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5191.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.88,8825.98,
TRILLIANT HEMI AWL,I990220124,CDM,278,RC,,,Outpatient,,,462,231,,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,323.4,70,,,Percent of Total Billed Charges,70% total billed charges,318.78,69,,,Percent of total Billed Charges,69% of total Billed charges,318.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,318.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,392.7,
TRILLIANT HEMI BROACH,I990220125,CDM,278,RC,,,Outpatient,,,1236,618,,951.72,77,,,Percent of Total Billed Charges,77% of total billed charges,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,865.2,70,,,Percent of Total Billed Charges,70% total billed charges,852.84,69,,,Percent of total Billed Charges,69% of total Billed charges,852.84,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,852.84,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.72,77,,,Percent of total Billed charges,77% of total billed charges,1050.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309,1050.6,
TRILLIANT HEMI IMPLANT SMALL,I990220126,CDM,278,RC,,,Outpatient,,,5408,2704,,4164.16,77,,,Percent of Total Billed Charges,77% of total billed charges,1379.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1690,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3785.6,70,,,Percent of Total Billed Charges,70% total billed charges,3731.52,69,,,Percent of total Billed Charges,69% of total Billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3731.52,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4164.16,77,,,Percent of total Billed charges,77% of total billed charges,4596.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1554.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2704,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2704,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1352,4596.8,
ULTRAFIX RX SUTURE,I990220127,CDM,278,RC,,,Outpatient,,,548,274,,421.96,77,,,Percent of Total Billed Charges,77% of total billed charges,139.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.12,69,,,Percent of Total Billed Charges,69% of total billed charges,378.12,69,,,Percent of Total Billed Charges,69% of total billed charges,378.12,69,,,Percent of Total Billed Charges,69% of total billed charges,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.12,69,,,Percent of Total Billed Charges,69% of total billed charges,378.12,69,,,Percent of Total Billed Charges,69% of total billed charges,378.12,69,,,Percent of Total Billed Charges,69% of total billed charges,383.6,70,,,Percent of Total Billed Charges,70% total billed charges,378.12,69,,,Percent of total Billed Charges,69% of total Billed charges,378.12,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,378.12,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,223.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.96,77,,,Percent of total Billed charges,77% of total billed charges,465.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137,465.8,
VITOSS BONE GRAFT,I990220128,CDM,278,RC,,,Outpatient,,,5706.5,2853.25,,4394.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1455.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1455.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1783.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3937.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3937.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3937.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1426.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3937.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3937.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3937.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3994.55,70,,,Percent of Total Billed Charges,70% total billed charges,3937.49,69,,,Percent of total Billed Charges,69% of total Billed charges,3937.49,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3937.49,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2328.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2328.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2328.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1426.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4394.01,77,,,Percent of total Billed charges,77% of total billed charges,4850.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1640.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2853.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2328.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1426.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2853.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1426.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1426.63,4850.53,
WRIGHT MED GRAFT JACKET,I990220129,CDM,278,RC,,,Outpatient,,,5892,2946,,4536.84,77,,,Percent of Total Billed Charges,77% of total billed charges,1502.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1502.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1841.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4065.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4065.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4065.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1473,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4065.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4065.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4065.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4124.4,70,,,Percent of Total Billed Charges,70% total billed charges,4065.48,69,,,Percent of total Billed Charges,69% of total Billed charges,4065.48,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4065.48,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2403.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2403.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2403.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4536.84,77,,,Percent of total Billed charges,77% of total billed charges,5008.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1693.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2946,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2403.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1473,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2946,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1473,5008.2,
WRIGHT MED GRAFT JACKET 5X10,I990220130,CDM,278,RC,,,Outpatient,,,7395,3697.5,,5694.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1885.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1885.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2310.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5102.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5102.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5102.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1848.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5102.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5102.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5102.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5176.5,70,,,Percent of Total Billed Charges,70% total billed charges,5102.55,69,,,Percent of total Billed Charges,69% of total Billed charges,5102.55,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5102.55,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3017.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3017.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3017.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1848.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5694.15,77,,,Percent of total Billed charges,77% of total billed charges,6285.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2126.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3697.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3017.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1848.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1848.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1848.75,6285.75,
Z/B LP CORTICAL SCREW,I990220131,CDM,278,RC,,,Outpatient,,,394.5,197.25,,303.77,77,,,Percent of Total Billed Charges,77% of total billed charges,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,276.15,70,,,Percent of Total Billed Charges,70% total billed charges,272.21,69,,,Percent of total Billed Charges,69% of total Billed charges,272.21,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,272.21,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,160.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.77,77,,,Percent of total Billed charges,77% of total billed charges,335.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.63,335.33,
Zimmer 28mm COCR Mod HD +6mm,I990220132,CDM,278,RC,,,Outpatient,,,2596,1298,,1998.92,77,,,Percent of Total Billed Charges,77% of total billed charges,661.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,661.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,811.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1817.2,70,,,Percent of Total Billed Charges,70% total billed charges,1791.24,69,,,Percent of total Billed Charges,69% of total Billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1791.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1059.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1998.92,77,,,Percent of total Billed charges,77% of total billed charges,2206.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,746.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1059.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649,2206.6,
ZIMMER 28mm DIACOCR MOD 3mm NK,I990220133,CDM,278,RC,,,Outpatient,,,2596,1298,,1998.92,77,,,Percent of Total Billed Charges,77% of total billed charges,661.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,661.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,811.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1817.2,70,,,Percent of Total Billed Charges,70% total billed charges,1791.24,69,,,Percent of total Billed Charges,69% of total Billed charges,1791.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1791.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1059.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1998.92,77,,,Percent of total Billed charges,77% of total billed charges,2206.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,746.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1059.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649,2206.6,
Zimmer Bone Scrw 6.5x25 selftp,I990220134,CDM,278,RC,,,Outpatient,,,411.5,205.75,,316.86,77,,,Percent of Total Billed Charges,77% of total billed charges,104.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,283.94,69,,,Percent of Total Billed Charges,69% of total billed charges,283.94,69,,,Percent of Total Billed Charges,69% of total billed charges,283.94,69,,,Percent of Total Billed Charges,69% of total billed charges,102.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.94,69,,,Percent of Total Billed Charges,69% of total billed charges,283.94,69,,,Percent of Total Billed Charges,69% of total billed charges,283.94,69,,,Percent of Total Billed Charges,69% of total billed charges,288.05,70,,,Percent of Total Billed Charges,70% total billed charges,283.94,69,,,Percent of total Billed Charges,69% of total Billed charges,283.94,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,283.94,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,167.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.86,77,,,Percent of total Billed charges,77% of total billed charges,349.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.88,349.78,
Zimmer COMP PRIM STEM 1mmMINI,I990220135,CDM,278,RC,,,Outpatient,,,13844.5,6922.25,,10660.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3530.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3530.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4326.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9552.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9552.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9552.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3461.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9552.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9552.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9552.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9691.15,70,,,Percent of Total Billed Charges,70% total billed charges,9552.71,69,,,Percent of total Billed Charges,69% of total Billed charges,9552.71,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9552.71,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5648.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5648.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5648.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3461.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10660.27,77,,,Percent of total Billed charges,77% of total billed charges,11767.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3980.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6922.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5648.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3461.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6922.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3461.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3461.13,11767.83,
Zimmer COMP RVRS 25mm BSPLT HA,I990220136,CDM,278,RC,,,Outpatient,,,6490,3245,,4997.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1654.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1654.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2028.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4543,70,,,Percent of Total Billed Charges,70% total billed charges,4478.1,69,,,Percent of total Billed Charges,69% of total Billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4478.1,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4997.3,77,,,Percent of total Billed charges,77% of total billed charges,5516.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1865.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3245,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3245,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1622.5,5516.5,
Zimmer COMP RVRS SHLDR GL 36mm,I990220137,CDM,278,RC,,,Outpatient,,,5408,2704,,4164.16,77,,,Percent of Total Billed Charges,77% of total billed charges,1379.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1690,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3785.6,70,,,Percent of Total Billed Charges,70% total billed charges,3731.52,69,,,Percent of total Billed Charges,69% of total Billed charges,3731.52,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3731.52,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4164.16,77,,,Percent of total Billed charges,77% of total billed charges,4596.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1554.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2704,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2206.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2704,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1352,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1352,4596.8,
Zimmer COMP RVS CNTRL 6.5x25mm,I990220138,CDM,278,RC,,,Outpatient,,,324.5,162.25,,249.87,77,,,Percent of Total Billed Charges,77% of total billed charges,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,227.15,70,,,Percent of Total Billed Charges,70% total billed charges,223.91,69,,,Percent of total Billed Charges,69% of total Billed charges,223.91,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,223.91,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.87,77,,,Percent of total Billed charges,77% of total billed charges,275.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,132.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.13,275.83,
ZIMMER ECHO PF 12MM STD FEMORA,I990220139,CDM,278,RC,,,Outpatient,,,5971,2985.5,,4597.67,77,,,Percent of Total Billed Charges,77% of total billed charges,1522.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1522.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1865.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4119.99,69,,,Percent of Total Billed Charges,69% of total billed charges,4119.99,69,,,Percent of Total Billed Charges,69% of total billed charges,4119.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.99,69,,,Percent of Total Billed Charges,69% of total billed charges,4119.99,69,,,Percent of Total Billed Charges,69% of total billed charges,4119.99,69,,,Percent of Total Billed Charges,69% of total billed charges,4179.7,70,,,Percent of Total Billed Charges,70% total billed charges,4119.99,69,,,Percent of total Billed Charges,69% of total Billed charges,4119.99,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4119.99,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2436.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2436.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2436.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1492.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.67,77,,,Percent of total Billed charges,77% of total billed charges,5075.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1716.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2985.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2436.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1492.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2985.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1492.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1492.75,5075.35,
Zimmer G7 Dual Mobi Liner 42mm,I990220140,CDM,278,RC,,,Outpatient,,,8048,4024,,6196.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2052.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2052.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2515,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5553.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5553.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5553.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2012,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5553.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5553.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5553.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5633.6,70,,,Percent of Total Billed Charges,70% total billed charges,5553.12,69,,,Percent of total Billed Charges,69% of total Billed charges,5553.12,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5553.12,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3283.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3283.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3283.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2012,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6196.96,77,,,Percent of total Billed charges,77% of total billed charges,6840.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2313.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4024,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3283.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2012,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4024,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2012,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012,6840.8,
Zimmer HMRL BEARING 36mm STD,I990220141,CDM,278,RC,,,Outpatient,,,3677.5,1838.75,,2831.68,77,,,Percent of Total Billed Charges,77% of total billed charges,937.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,937.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1149.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2537.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2537.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2537.48,69,,,Percent of Total Billed Charges,69% of total billed charges,919.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2537.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2537.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2537.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2574.25,70,,,Percent of Total Billed Charges,70% total billed charges,2537.48,69,,,Percent of total Billed Charges,69% of total Billed charges,2537.48,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2537.48,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1500.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1500.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1500.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2831.68,77,,,Percent of total Billed charges,77% of total billed charges,3125.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1057.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1838.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1500.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,919.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1838.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,919.38,3125.88,
Zimmer HMRL TRAY+6 STD,I990220142,CDM,278,RC,,,Outpatient,,,6490,3245,,4997.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1654.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1654.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2028.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4543,70,,,Percent of Total Billed Charges,70% total billed charges,4478.1,69,,,Percent of total Billed Charges,69% of total Billed charges,4478.1,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4478.1,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4997.3,77,,,Percent of total Billed charges,77% of total billed charges,5516.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1865.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3245,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2647.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3245,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1622.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1622.5,5516.5,
Zimmer Hole Shell 52mm,I990220143,CDM,278,RC,,,Outpatient,,,19036.5,9518.25,,14658.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4854.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4854.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5948.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13135.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13135.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13135.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13135.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13135.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13135.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13325.55,70,,,Percent of Total Billed Charges,70% total billed charges,13135.19,69,,,Percent of total Billed Charges,69% of total Billed charges,13135.19,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,13135.19,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7766.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7766.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7766.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14658.11,77,,,Percent of total Billed charges,77% of total billed charges,16181.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5472.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9518.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7766.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4759.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9518.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4759.13,16181.03,
ZIMMER RINGLOC BIPOLAR 28X52mm,I990220144,CDM,278,RC,,,Outpatient,,,5711.5,2855.75,,4397.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1456.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1456.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1784.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3940.94,69,,,Percent of Total Billed Charges,69% of total billed charges,3940.94,69,,,Percent of Total Billed Charges,69% of total billed charges,3940.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1427.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3940.94,69,,,Percent of Total Billed Charges,69% of total billed charges,3940.94,69,,,Percent of Total Billed Charges,69% of total billed charges,3940.94,69,,,Percent of Total Billed Charges,69% of total billed charges,3998.05,70,,,Percent of Total Billed Charges,70% total billed charges,3940.94,69,,,Percent of total Billed Charges,69% of total Billed charges,3940.94,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3940.94,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2330.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2330.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2330.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1427.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4397.86,77,,,Percent of total Billed charges,77% of total billed charges,4854.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1642.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2855.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2330.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1427.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2855.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1427.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1427.88,4854.78,
Zimmer Vivacit DM Bear 28x42mm,I990220145,CDM,278,RC,,,Outpatient,,,11681.5,5840.75,,8994.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2978.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3650.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8060.24,69,,,Percent of Total Billed Charges,69% of total billed charges,8060.24,69,,,Percent of Total Billed Charges,69% of total billed charges,8060.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2920.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8060.24,69,,,Percent of Total Billed Charges,69% of total billed charges,8060.24,69,,,Percent of Total Billed Charges,69% of total billed charges,8060.24,69,,,Percent of Total Billed Charges,69% of total billed charges,8177.05,70,,,Percent of Total Billed Charges,70% total billed charges,8060.24,69,,,Percent of total Billed Charges,69% of total Billed charges,8060.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8060.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4766.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4766.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4766.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2920.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8994.76,77,,,Percent of total Billed charges,77% of total billed charges,9929.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3358.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5840.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4766.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2920.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5840.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2920.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2920.38,9929.28,
BONE CEMENT,I990220147,CDM,278,RC,,,Outpatient,,,734.5,367.25,,565.57,77,,,Percent of Total Billed Charges,77% of total billed charges,187.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,506.81,69,,,Percent of Total Billed Charges,69% of total billed charges,506.81,69,,,Percent of Total Billed Charges,69% of total billed charges,506.81,69,,,Percent of Total Billed Charges,69% of total billed charges,183.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.81,69,,,Percent of Total Billed Charges,69% of total billed charges,506.81,69,,,Percent of Total Billed Charges,69% of total billed charges,506.81,69,,,Percent of Total Billed Charges,69% of total billed charges,514.15,70,,,Percent of Total Billed Charges,70% total billed charges,506.81,69,,,Percent of total Billed Charges,69% of total Billed charges,506.81,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,506.81,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,299.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.57,77,,,Percent of total Billed charges,77% of total billed charges,624.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,183.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.63,624.33,
HIP ARTHOPLASTY COMPONENT,I990220148,CDM,278,RC,,,Outpatient,,,7482.5,3741.25,,5761.53,77,,,Percent of Total Billed Charges,77% of total billed charges,1908.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1908.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2338.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5162.93,69,,,Percent of Total Billed Charges,69% of total billed charges,5162.93,69,,,Percent of Total Billed Charges,69% of total billed charges,5162.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5162.93,69,,,Percent of Total Billed Charges,69% of total billed charges,5162.93,69,,,Percent of Total Billed Charges,69% of total billed charges,5162.93,69,,,Percent of Total Billed Charges,69% of total billed charges,5237.75,70,,,Percent of Total Billed Charges,70% total billed charges,5162.93,69,,,Percent of total Billed Charges,69% of total Billed charges,5162.93,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5162.93,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3052.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3052.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3052.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1870.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5761.53,77,,,Percent of total Billed charges,77% of total billed charges,6360.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2151.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3741.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3052.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1870.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3741.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1870.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.63,6360.13,
Implant-Fracture/Fixation Comp,I990220149,CDM,278,RC,C1713,HCPCS,Outpatient,,,1201.5,600.75,,925.16,77,,,Percent of Total Billed Charges,77% of total billed charges,306.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,375.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,829.04,69,,,Percent of Total Billed Charges,69% of total billed charges,829.04,69,,,Percent of Total Billed Charges,69% of total billed charges,829.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.04,69,,,Percent of Total Billed Charges,69% of total billed charges,829.04,69,,,Percent of Total Billed Charges,69% of total billed charges,829.04,69,,,Percent of Total Billed Charges,69% of total billed charges,841.05,70,,,Percent of Total Billed Charges,70% total billed charges,829.04,69,,,Percent of total Billed Charges,69% of total Billed charges,829.04,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,829.04,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,490.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,490.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,490.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,925.16,77,,,Percent of total Billed charges,77% of total billed charges,1021.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,345.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,490.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,300.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.38,1021.28,
ARTHREX CMC RECON SYS IMPLANT,I990220150,CDM,278,RC,C1713,HCPCS,Outpatient,,,5014.5,2507.25,,3861.17,77,,,Percent of Total Billed Charges,77% of total billed charges,1278.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1278.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1567.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3460.01,69,,,Percent of Total Billed Charges,69% of total billed charges,3460.01,69,,,Percent of Total Billed Charges,69% of total billed charges,3460.01,69,,,Percent of Total Billed Charges,69% of total billed charges,1253.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3460.01,69,,,Percent of Total Billed Charges,69% of total billed charges,3460.01,69,,,Percent of Total Billed Charges,69% of total billed charges,3460.01,69,,,Percent of Total Billed Charges,69% of total billed charges,3510.15,70,,,Percent of Total Billed Charges,70% total billed charges,3460.01,69,,,Percent of total Billed Charges,69% of total Billed charges,3460.01,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3460.01,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2045.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2045.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2045.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1253.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3861.17,77,,,Percent of total Billed charges,77% of total billed charges,4262.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1441.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2507.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2045.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1253.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2507.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1253.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1253.63,4262.33,
BIOCOMPOSITE PUSHLOCK 2.9X15.5,I990220151,CDM,278,RC,C1713,HCPCS,Outpatient,,,1358,679,,1045.66,77,,,Percent of Total Billed Charges,77% of total billed charges,346.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,937.02,69,,,Percent of Total Billed Charges,69% of total billed charges,937.02,69,,,Percent of Total Billed Charges,69% of total billed charges,937.02,69,,,Percent of Total Billed Charges,69% of total billed charges,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,937.02,69,,,Percent of Total Billed Charges,69% of total billed charges,937.02,69,,,Percent of Total Billed Charges,69% of total billed charges,937.02,69,,,Percent of Total Billed Charges,69% of total billed charges,950.6,70,,,Percent of Total Billed Charges,70% total billed charges,937.02,69,,,Percent of total Billed Charges,69% of total Billed charges,937.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,937.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,554.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1045.66,77,,,Percent of total Billed charges,77% of total billed charges,1154.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,390.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,554.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.5,1154.3,
BIOMET DISTAL RADIUS FX COMP,I990220152,CDM,278,RC,C1713,HCPCS,Outpatient,,,15499,7749.5,,11934.23,77,,,Percent of Total Billed Charges,77% of total billed charges,3952.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3952.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10694.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10694.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10694.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3874.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10694.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10694.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10694.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10849.3,70,,,Percent of Total Billed Charges,70% total billed charges,10694.31,69,,,Percent of total Billed Charges,69% of total Billed charges,10694.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,10694.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6323.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6323.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6323.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3874.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11934.23,77,,,Percent of total Billed charges,77% of total billed charges,13174.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4455.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7749.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6323.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3874.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7749.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3874.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3874.75,13174.15,
"SCREW BN/BN,TIS/BN",I990220153,CDM,278,RC,C1713,HCPCS,Outpatient,,,1612,806,,1241.24,77,,,Percent of Total Billed Charges,77% of total billed charges,411.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,411.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,503.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1112.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1112.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1112.28,69,,,Percent of Total Billed Charges,69% of total billed charges,403,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1112.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1112.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1112.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1128.4,70,,,Percent of Total Billed Charges,70% total billed charges,1112.28,69,,,Percent of total Billed Charges,69% of total Billed charges,1112.28,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1112.28,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,657.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,657.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,657.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1241.24,77,,,Percent of total Billed charges,77% of total billed charges,1370.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,463.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,657.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,403,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403,1370.2,
ALLOGRAFT/LIFENET BONE DOWELS,I990220192,CDM,278,RC,C1734,HCPCS,Outpatient,,,9929.5,4964.75,,7645.72,77,,,Percent of Total Billed Charges,77% of total billed charges,2532.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2532.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3102.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6851.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6851.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6851.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2482.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6851.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6851.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6851.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6950.65,70,,,Percent of Total Billed Charges,70% total billed charges,6851.36,69,,,Percent of total Billed Charges,69% of total Billed charges,6851.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,6851.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4051.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4051.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4051.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2482.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7645.72,77,,,Percent of total Billed charges,77% of total billed charges,8440.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2854.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4964.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4051.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2482.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2482.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2482.38,8440.08,
"Imp-Connective Tissue, Human",I990220193,CDM,278,RC,C1762,HCPCS,Outpatient,,,21546,10773,,16590.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5494.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5494.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6733.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14866.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14866.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14866.74,69,,,Percent of Total Billed Charges,69% of total billed charges,5386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14866.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14866.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14866.74,69,,,Percent of Total Billed Charges,69% of total billed charges,15082.2,70,,,Percent of Total Billed Charges,70% total billed charges,14866.74,69,,,Percent of total Billed Charges,69% of total Billed charges,14866.74,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,14866.74,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8790.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8790.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8790.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16590.42,77,,,Percent of total Billed charges,77% of total billed charges,18314.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6194.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10773,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8790.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10773,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5386.5,18314.1,
Imp-Connective Tissue Nonhuman,I990220194,CDM,278,RC,C1763,HCPCS,Outpatient,,,12482.5,6241.25,,9611.53,77,,,Percent of Total Billed Charges,77% of total billed charges,3183.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3183.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3900.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8612.93,69,,,Percent of Total Billed Charges,69% of total billed charges,8612.93,69,,,Percent of Total Billed Charges,69% of total billed charges,8612.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3120.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8612.93,69,,,Percent of Total Billed Charges,69% of total billed charges,8612.93,69,,,Percent of Total Billed Charges,69% of total billed charges,8612.93,69,,,Percent of Total Billed Charges,69% of total billed charges,8737.75,70,,,Percent of Total Billed Charges,70% total billed charges,8612.93,69,,,Percent of total Billed Charges,69% of total Billed charges,8612.93,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8612.93,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5092.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5092.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5092.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3120.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9611.53,77,,,Percent of total Billed charges,77% of total billed charges,10610.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3588.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6241.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5092.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3120.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6241.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3120.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3120.63,10610.13,
LOCKING PLATE,I990220195,CDM,278,RC,C1765,HCPCS,Outpatient,,,2196,1098,,1690.92,77,,,Percent of Total Billed Charges,77% of total billed charges,559.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,559.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1515.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1515.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1515.24,69,,,Percent of Total Billed Charges,69% of total billed charges,549,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1515.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1515.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1515.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1537.2,70,,,Percent of Total Billed Charges,70% total billed charges,1515.24,69,,,Percent of total Billed Charges,69% of total Billed charges,1515.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1515.24,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,895.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,895.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,895.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,549,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1690.92,77,,,Percent of total Billed charges,77% of total billed charges,1866.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,631.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,895.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,549,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,549,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549,1866.6,
GUIDEWIRE,I990220196,CDM,278,RC,C1769,HCPCS,Outpatient,,,232.5,116.25,,179.03,77,,,Percent of Total Billed Charges,77% of total billed charges,59.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.43,69,,,Percent of Total Billed Charges,69% of total billed charges,160.43,69,,,Percent of Total Billed Charges,69% of total billed charges,160.43,69,,,Percent of Total Billed Charges,69% of total billed charges,58.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.43,69,,,Percent of Total Billed Charges,69% of total billed charges,160.43,69,,,Percent of Total Billed Charges,69% of total billed charges,160.43,69,,,Percent of Total Billed Charges,69% of total billed charges,162.75,70,,,Percent of Total Billed Charges,70% total billed charges,160.43,69,,,Percent of total Billed Charges,69% of total Billed charges,160.43,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,160.43,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,94.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.03,77,,,Percent of total Billed charges,77% of total billed charges,197.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.13,197.63,
Imp-Urinary Device w/ Sling,I990220201,CDM,278,RC,C1771,HCPCS,Outpatient,,,3077.5,1538.75,,2369.68,77,,,Percent of Total Billed Charges,77% of total billed charges,784.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,784.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,961.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2123.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2123.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2123.48,69,,,Percent of Total Billed Charges,69% of total billed charges,769.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2123.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2123.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2123.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2154.25,70,,,Percent of Total Billed Charges,70% total billed charges,2123.48,69,,,Percent of total Billed Charges,69% of total Billed charges,2123.48,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2123.48,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1255.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,769.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2369.68,77,,,Percent of total Billed charges,77% of total billed charges,2615.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,884.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1538.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1255.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,769.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1538.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,769.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,769.38,2615.88,
BIOMET-TOTAL SHOULDER,I990220202,CDM,278,RC,C1776,HCPCS,Outpatient,,,19538.5,9769.25,,15044.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4982.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4982.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6105.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13481.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13481.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13481.57,69,,,Percent of Total Billed Charges,69% of total billed charges,4884.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13481.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13481.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13481.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13676.95,70,,,Percent of Total Billed Charges,70% total billed charges,13481.57,69,,,Percent of total Billed Charges,69% of total Billed charges,13481.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,13481.57,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7971.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7971.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7971.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4884.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15044.65,77,,,Percent of total Billed charges,77% of total billed charges,16607.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5617.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9769.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7971.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4884.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9769.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4884.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4884.63,16607.73,
Implant-Joint Device,I990220203,CDM,278,RC,C1776,HCPCS,Outpatient,,,21514.5,10757.25,,16566.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5486.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5486.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6723.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14845.01,69,,,Percent of Total Billed Charges,69% of total billed charges,14845.01,69,,,Percent of Total Billed Charges,69% of total billed charges,14845.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5378.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14845.01,69,,,Percent of Total Billed Charges,69% of total billed charges,14845.01,69,,,Percent of Total Billed Charges,69% of total billed charges,14845.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15060.15,70,,,Percent of Total Billed Charges,70% total billed charges,14845.01,69,,,Percent of total Billed Charges,69% of total Billed charges,14845.01,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,14845.01,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8777.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8777.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8777.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5378.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16566.17,77,,,Percent of total Billed charges,77% of total billed charges,18287.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6185.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10757.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8777.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5378.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10757.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5378.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5378.63,18287.33,
TOTAL ANKLE COMPONENTS,I990220204,CDM,278,RC,C1776,HCPCS,Outpatient,,,42960.5,21480.25,,33079.59,77,,,Percent of Total Billed Charges,77% of total billed charges,10954.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10954.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13425.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29642.75,69,,,Percent of Total Billed Charges,69% of total billed charges,29642.75,69,,,Percent of Total Billed Charges,69% of total billed charges,29642.75,69,,,Percent of Total Billed Charges,69% of total billed charges,10740.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29642.75,69,,,Percent of Total Billed Charges,69% of total billed charges,29642.75,69,,,Percent of Total Billed Charges,69% of total billed charges,29642.75,69,,,Percent of Total Billed Charges,69% of total billed charges,30072.35,70,,,Percent of Total Billed Charges,70% total billed charges,29642.75,69,,,Percent of total Billed Charges,69% of total Billed charges,29642.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,29642.75,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,17527.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17527.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17527.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10740.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33079.59,77,,,Percent of total Billed charges,77% of total billed charges,36516.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12351.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21480.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17527.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10740.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21480.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10740.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10740.13,36516.43,
TOTAL HIP COMPONENT,I990220205,CDM,278,RC,C1776,HCPCS,Outpatient,,,42345,21172.5,,32605.65,77,,,Percent of Total Billed Charges,77% of total billed charges,10797.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10797.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13232.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29218.05,69,,,Percent of Total Billed Charges,69% of total billed charges,29218.05,69,,,Percent of Total Billed Charges,69% of total billed charges,29218.05,69,,,Percent of Total Billed Charges,69% of total billed charges,10586.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29218.05,69,,,Percent of Total Billed Charges,69% of total billed charges,29218.05,69,,,Percent of Total Billed Charges,69% of total billed charges,29218.05,69,,,Percent of Total Billed Charges,69% of total billed charges,29641.5,70,,,Percent of Total Billed Charges,70% total billed charges,29218.05,69,,,Percent of total Billed Charges,69% of total Billed charges,29218.05,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,29218.05,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,17276.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17276.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17276.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10586.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32605.65,77,,,Percent of total Billed charges,77% of total billed charges,35993.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12174.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21172.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17276.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10586.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21172.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10586.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10586.25,35993.25,
TOTAL KNEE 2 COMPONENT,I990220206,CDM,278,RC,C1776,HCPCS,Outpatient,,,13692.5,6846.25,,10543.23,77,,,Percent of Total Billed Charges,77% of total billed charges,3491.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3491.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4278.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9447.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9447.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9447.83,69,,,Percent of Total Billed Charges,69% of total billed charges,3423.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9447.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9447.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9447.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9584.75,70,,,Percent of Total Billed Charges,70% total billed charges,9447.83,69,,,Percent of total Billed Charges,69% of total Billed charges,9447.83,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9447.83,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5586.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5586.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5586.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10543.23,77,,,Percent of total Billed charges,77% of total billed charges,11638.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3936.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6846.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5586.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3423.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6846.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3423.13,11638.63,
Implant-Joint Component,I990220207,CDM,278,RC,C1776,HCPCS,Outpatient,,,20800,10400,,16016,77,,,Percent of Total Billed Charges,77% of total billed charges,5304,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5304,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6500,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14352,69,,,Percent of Total Billed Charges,69% of total billed charges,14352,69,,,Percent of Total Billed Charges,69% of total billed charges,14352,69,,,Percent of Total Billed Charges,69% of total billed charges,5200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14352,69,,,Percent of Total Billed Charges,69% of total billed charges,14352,69,,,Percent of Total Billed Charges,69% of total billed charges,14352,69,,,Percent of Total Billed Charges,69% of total billed charges,14560,70,,,Percent of Total Billed Charges,70% total billed charges,14352,69,,,Percent of total Billed Charges,69% of total Billed charges,14352,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,14352,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8486.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8486.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8486.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16016,77,,,Percent of total Billed charges,77% of total billed charges,17680,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5980,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10400,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8486.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10400,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5200,17680,
TOTAL KNEE COMPONENT,I990220208,CDM,278,RC,C1776,HCPCS,Outpatient,,,21632,10816,,16656.64,77,,,Percent of Total Billed Charges,77% of total billed charges,5516.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5516.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6760,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14926.08,69,,,Percent of Total Billed Charges,69% of total billed charges,14926.08,69,,,Percent of Total Billed Charges,69% of total billed charges,14926.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5408,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14926.08,69,,,Percent of Total Billed Charges,69% of total billed charges,14926.08,69,,,Percent of Total Billed Charges,69% of total billed charges,14926.08,69,,,Percent of Total Billed Charges,69% of total billed charges,15142.4,70,,,Percent of Total Billed Charges,70% total billed charges,14926.08,69,,,Percent of total Billed Charges,69% of total Billed charges,14926.08,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,14926.08,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8825.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8825.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8825.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5408,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16656.64,77,,,Percent of total Billed charges,77% of total billed charges,18387.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6219.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10816,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8825.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5408,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10816,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5408,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5408,18387.2,
Implant-Mesh,I990220209,CDM,278,RC,C1781,HCPCS,Outpatient,,,394.5,197.25,,303.77,77,,,Percent of Total Billed Charges,77% of total billed charges,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,276.15,70,,,Percent of Total Billed Charges,70% total billed charges,272.21,69,,,Percent of total Billed Charges,69% of total Billed charges,272.21,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,272.21,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,160.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.77,77,,,Percent of total Billed charges,77% of total billed charges,335.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.63,335.33,
INFUSE-A-PORT,I990220213,CDM,278,RC,C1788,HCPCS,Outpatient,,,1821.5,910.75,,1402.56,77,,,Percent of Total Billed Charges,77% of total billed charges,464.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,464.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,569.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1256.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1256.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1256.84,69,,,Percent of Total Billed Charges,69% of total billed charges,455.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1256.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1256.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1275.05,70,,,Percent of Total Billed Charges,70% total billed charges,1256.84,69,,,Percent of total Billed Charges,69% of total Billed charges,1256.84,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1256.84,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,743.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,743.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,743.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,455.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.56,77,,,Percent of total Billed charges,77% of total billed charges,1548.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,523.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,743.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,455.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,455.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.38,1548.28,
Implant-Fracture/Fixation Comp,I990220214,CDM,278,RC,C1713,HCPCS,Outpatient,,,1016,508,,782.32,77,,,Percent of Total Billed Charges,77% of total billed charges,259.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,317.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,701.04,69,,,Percent of Total Billed Charges,69% of total billed charges,701.04,69,,,Percent of Total Billed Charges,69% of total billed charges,701.04,69,,,Percent of Total Billed Charges,69% of total billed charges,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,701.04,69,,,Percent of Total Billed Charges,69% of total billed charges,701.04,69,,,Percent of Total Billed Charges,69% of total billed charges,701.04,69,,,Percent of Total Billed Charges,69% of total billed charges,711.2,70,,,Percent of Total Billed Charges,70% total billed charges,701.04,69,,,Percent of total Billed Charges,69% of total Billed charges,701.04,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,701.04,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,414.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,782.32,77,,,Percent of total Billed charges,77% of total billed charges,863.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,292.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,414.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254,863.6,
DRILL BIT,I990220215,CDM,278,RC,C1889,HCPCS,Outpatient,,,1444,722,,1111.88,77,,,Percent of Total Billed Charges,77% of total billed charges,368.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,368.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,451.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,996.36,69,,,Percent of Total Billed Charges,69% of total billed charges,996.36,69,,,Percent of Total Billed Charges,69% of total billed charges,996.36,69,,,Percent of Total Billed Charges,69% of total billed charges,361,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,996.36,69,,,Percent of Total Billed Charges,69% of total billed charges,996.36,69,,,Percent of Total Billed Charges,69% of total billed charges,996.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1010.8,70,,,Percent of Total Billed Charges,70% total billed charges,996.36,69,,,Percent of total Billed Charges,69% of total Billed charges,996.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,996.36,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,589.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,589.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,589.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1111.88,77,,,Percent of total Billed charges,77% of total billed charges,1227.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,415.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,589.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,361,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,361,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361,1227.4,
WASHER-IMPLANTABLE,I990220216,CDM,278,RC,C1889,HCPCS,Outpatient,,,217.5,108.75,,167.48,77,,,Percent of Total Billed Charges,77% of total billed charges,55.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.25,70,,,Percent of Total Billed Charges,70% total billed charges,150.08,69,,,Percent of total Billed Charges,69% of total Billed charges,150.08,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,150.08,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,88.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.48,77,,,Percent of total Billed charges,77% of total billed charges,184.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.38,184.88,
Impant-Stent Temp w/o delivery,I990220242,CDM,278,RC,C2617,HCPCS,Outpatient,,,591,295.5,,455.07,77,,,Percent of Total Billed Charges,77% of total billed charges,150.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,407.79,69,,,Percent of Total Billed Charges,69% of total billed charges,407.79,69,,,Percent of Total Billed Charges,69% of total billed charges,407.79,69,,,Percent of Total Billed Charges,69% of total billed charges,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.79,69,,,Percent of Total Billed Charges,69% of total billed charges,407.79,69,,,Percent of Total Billed Charges,69% of total billed charges,407.79,69,,,Percent of Total Billed Charges,69% of total billed charges,413.7,70,,,Percent of Total Billed Charges,70% total billed charges,407.79,69,,,Percent of total Billed Charges,69% of total Billed charges,407.79,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,407.79,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,241.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,77,,,Percent of total Billed charges,77% of total billed charges,502.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.75,502.35,
INTRAOCULAR LENS,I990220243,CDM,276,RC,V2630,HCPCS,Outpatient,,,1734,867,,1335.18,77,,,Percent of Total Billed Charges,77% of total billed charges,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1196.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1196.46,69,,,Percent of Total Billed Charges,69% of total billed charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1196.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1196.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1196.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1213.8,70,,,Percent of Total Billed Charges,70% total billed charges,1196.46,69,,,Percent of total Billed Charges,69% of total Billed charges,1196.46,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1196.46,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.18,77,,,Percent of total Billed charges,77% of total billed charges,1473.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.5,1473.9,
HYDRAFOAM 2X2,I990760001,CDM,278,RC,,,Outpatient,,,8.5,4.25,,6.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.95,70,,,Percent of Total Billed Charges,70% total billed charges,5.87,69,,,Percent of total Billed Charges,69% of total Billed charges,5.87,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5.87,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.55,77,,,Percent of total Billed charges,77% of total billed charges,7.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.13,7.23,
HYDRAFOAM 4X4.25,I990760002,CDM,278,RC,,,Outpatient,,,14,7,,10.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,70,,,Percent of Total Billed Charges,70% total billed charges,9.66,69,,,Percent of total Billed Charges,69% of total Billed charges,9.66,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,9.66,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.78,77,,,Percent of total Billed charges,77% of total billed charges,11.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.5,11.9,
Flu Vaccine Administration,P990010001,CDM,771,RC,G0008,HCPCS,Outpatient,,,68,34,,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.32,74,,,Percent of Total Billed Charges,74% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.12,84,,,Percent of Total Billed Charges,84% of total billed charges,55.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.52,89,,,Percent of total Billed Charges,89% of total Billed charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,27.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,
Flu Vaccine Administration,P990010001,CDM,771,RC,90471,HCPCS,Outpatient,,,68,34,,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.32,74,,,Percent of Total Billed Charges,74% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.12,84,,,Percent of Total Billed Charges,84% of total billed charges,55.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.52,89,,,Percent of total Billed Charges,89% of total Billed charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,27.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,
Pneumonia Vac Administration,P990010003,CDM,771,RC,90471,HCPCS,Outpatient,,,68,34,,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.32,74,,,Percent of Total Billed Charges,74% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.12,84,,,Percent of Total Billed Charges,84% of total billed charges,55.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.52,89,,,Percent of total Billed Charges,89% of total Billed charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,27.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,
Pneumonia Vac Administration,P990010003,CDM,771,RC,G0009,HCPCS,Outpatient,,,68,34,,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.32,74,,,Percent of Total Billed Charges,74% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,46.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.12,84,,,Percent of Total Billed Charges,84% of total billed charges,55.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.52,89,,,Percent of total Billed Charges,89% of total Billed charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,27.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,
EPIDURAL ANESTHESIA,P990230001,CDM,964,RC,1967,HCPCS,Outpatient,,,2514.5,1257.25,,,,,,other,not seperately reimbusable,101.05,100,,,fee schedule,pays based on 100% cms opps rate,104.42,100,,,fee schedule,pays based on 100%  cms opps rate,127.98,100,,,fee schedule,pays based on 100% cms opps rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101.05,100,,,fee schedule,pays based on 100% cms opps rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1558.99,62,,,Percent of total Billed Charges,62% of total billed charges,1558.99,62,,,Percent of Total Billed Charges,62% of Healthlink HMO Fee Schedule,1558.99,62,,,Percent of Total Billed Charges,62% of Total Billed Charges,2263.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,2263.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2263.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.05,100,,,fee schedule,pays based on 100% cms opps rate,,,,,Other,Not Seperately Reimbusable,156.65,100,,,Fee Schedule,100% of Multiplan Fee Schedule,116.2,100,,,Fee Schedule,100% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,2263.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.05,100,,,Fee Schedule,100% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,101.05,100,,,Fee schedule,100% of CMS OPPS Rate,101.05,2263.05,
CONTINUOUS SPINAL CATHETER,P990230003,CDM,964,RC,1996,HCPCS,Outpatient,,,2514.5,1257.25,,,,,,other,not seperately reimbusable,60.63,100,,,fee schedule,pays based on 100% cms opps rate,63.2,100,,,fee schedule,pays based on 100%  cms opps rate,77.46,100,,,fee schedule,pays based on 100% cms opps rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.63,100,,,fee schedule,pays based on 100% cms opps rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1558.99,62,,,Percent of total Billed Charges,62% of total billed charges,1558.99,62,,,Percent of Total Billed Charges,62% of Healthlink HMO Fee Schedule,1558.99,62,,,Percent of Total Billed Charges,62% of Total Billed Charges,2263.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,2263.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2263.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.63,100,,,fee schedule,pays based on 100% cms opps rate,,,,,Other,Not Seperately Reimbusable,93.99,100,,,Fee Schedule,100% of Multiplan Fee Schedule,69.72,100,,,Fee Schedule,100% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,2263.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.63,100,,,Fee Schedule,100% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,60.63,100,,,Fee schedule,100% of CMS OPPS Rate,60.63,2263.05,
CENTRAL LINE ANES>5 YRS OF AGE,P990230004,CDM,964,RC,36556,HCPCS,Outpatient,,,539.5,269.75,,200.31,175,,,fee schedule,175% of aetna fee schedule,91.61,115,,,fee schedule,115% of cms physician fee schedule,93.44,117.3,,,fee schedule,117.3% of cms physician fee schedule,114.51,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.61,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.08,100,,,fee schedule,100% of cigna fee schedule,132.59,100,,,fee schedule,100% of healthlink fee schedule,128.31,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,132.59,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,485.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,485.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.61,115,,,fee schedule,115% of cms fee schedule,200.31,175,,,Fee Schedule,175% of CMS Fee Schedule,141.99,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,105.35,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,112.56,100,,,Fee Schedule,100% of UHC Fee Schedule,485.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.61,115,,,Fee Schedule,115% of CMS OPPS Rate,102.45,100,,,Fee Schedule,100% of UMR Fee Schedule,91.61,115,,,Fee Schedule,115% of CMS OPPS Rate,91.61,485.55,
Removal CVC w/o Port/Pump,P990230006,CDM,964,RC,36589,HCPCS,Outpatient,,,647,323.5,,224.7,175,,,fee schedule,175% of aetna fee schedule,145.15,115,,,fee schedule,115% of cms physician fee schedule,148.06,117.3,,,fee schedule,117.3% of cms physician fee schedule,181.44,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.15,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,158.14,100,,,fee schedule,100% of cigna fee schedule,209.51,100,,,fee schedule,100% of healthlink fee schedule,202.76,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,209.51,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,582.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,582.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,582.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.15,115,,,fee schedule,115% of cms fee schedule,224.7,175,,,Fee Schedule,175% of CMS Fee Schedule,224.99,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,166.93,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,180.89,100,,,Fee Schedule,100% of UHC Fee Schedule,582.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.15,115,,,Fee Schedule,115% of CMS OPPS Rate,164.64,100,,,Fee Schedule,100% of UMR Fee Schedule,145.15,115,,,Fee Schedule,115% of CMS OPPS Rate,145.15,582.3,
LUMBAR PUNCTURE,P990230007,CDM,964,RC,62270,HCPCS,Outpatient,,,878,439,,122.59,175,,,fee schedule,175% of aetna fee schedule,69.43,115,,,fee schedule,115% of cms physician fee schedule,70.81,117.3,,,fee schedule,117.3% of cms physician fee schedule,86.78,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.43,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72.5,100,,,fee schedule,100% of cigna fee schedule,97.9,100,,,fee schedule,100% of healthlink fee schedule,94.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,97.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,790.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,790.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,790.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.43,115,,,fee schedule,115% of cms fee schedule,122.59,175,,,Fee Schedule,175% of CMS Fee Schedule,107.61,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,79.84,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,107.61,100,,,Fee Schedule,100% of UHC Fee Schedule,790.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.43,115,,,Fee Schedule,115% of CMS OPPS Rate,100.2,100,,,Fee Schedule,100% of UMR Fee Schedule,69.43,115,,,Fee Schedule,115% of CMS OPPS Rate,69.43,790.2,
EPIDURAL BLOOD PATCH,P990230008,CDM,964,RC,62273,HCPCS,Outpatient,,,1069.5,534.75,,175.49,175,,,fee schedule,175% of aetna fee schedule,122.61,115,,,fee schedule,115% of cms physician fee schedule,125.07,117.3,,,fee schedule,117.3% of cms physician fee schedule,153.27,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,122.61,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,131.38,100,,,fee schedule,100% of cigna fee schedule,177.42,100,,,fee schedule,100% of healthlink fee schedule,171.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,177.42,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,962.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,962.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,962.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.61,115,,,fee schedule,115% of cms fee schedule,175.49,175,,,Fee Schedule,175% of CMS Fee Schedule,190.05,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,141,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,157.26,100,,,Fee Schedule,100% of UHC Fee Schedule,962.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.61,115,,,Fee Schedule,115% of CMS OPPS Rate,146.43,100,,,Fee Schedule,100% of UMR Fee Schedule,122.61,115,,,Fee Schedule,115% of CMS OPPS Rate,122.61,962.55,
EPIDURAL PLACEMENT/POSTOP PAIN,P990230009,CDM,964,RC,62326,HCPCS,Outpatient,,,942,471,,186.03,135,,,fee schedule,135% of aetna fee schedule,92.97,115,,,fee schedule,115% of cms physician fee schedule,94.83,117.3,,,fee schedule,117.3% of cms physician fee schedule,116.21,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.97,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.27,100,,,fee schedule,100% of cigna fee schedule,138.11,100,,,fee schedule,100% of healthlink fee schedule,133.74,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,138.11,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.97,115,,,fee schedule,115% of cms fee schedule,186.03,135,,,Fee Schedule,135% of CMS Fee Schedule ,144.1,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,106.91,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,123.69,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.97,115,,,Fee Schedule,115% of CMS OPPS Rate,115.17,100,,,Fee Schedule,100% of UMR Fee Schedule,92.97,115,,,Fee Schedule,115% of CMS OPPS Rate,92.97,847.8,
"BLOCK, INTERSCALENE W/IMAGING",P990230010,CDM,964,RC,64415,HCPCS,Outpatient,,,874.5,437.25,,115.13,175,,,fee schedule,175% of aetna fee schedule,75.97,115,,,fee schedule,115% of cms physician fee schedule,77.49,117.3,,,fee schedule,117.3% of cms physician fee schedule,94.96,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.97,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.62,100,,,fee schedule,100% of cigna fee schedule,100.77,100,,,fee schedule,100% of healthlink fee schedule,97.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,100.77,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,787.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.97,115,,,fee schedule,115% of cms fee schedule,115.13,175,,,Fee Schedule,175% of CMS Fee Schedule,117.75,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,87.36,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,90.75,100,,,Fee Schedule,100% of UHC Fee Schedule,787.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.97,115,,,Fee Schedule,115% of CMS OPPS Rate,84.5,100,,,Fee Schedule,100% of UMR Fee Schedule,75.97,115,,,Fee Schedule,115% of CMS OPPS Rate,74.62,787.05,
"BLOCK, AXILLARY W/IMAGING",P990230011,CDM,964,RC,64417,HCPCS,Outpatient,,,942,471,,113.87,175,,,fee schedule,175% of aetna fee schedule,69.68,115,,,fee schedule,115% of cms physician fee schedule,71.07,117.3,,,fee schedule,117.3% of cms physician fee schedule,87.1,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.68,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.24,100,,,fee schedule,100% of cigna fee schedule,96.21,100,,,fee schedule,100% of healthlink fee schedule,93.16,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,96.21,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.68,115,,,fee schedule,115% of cms fee schedule,113.87,175,,,Fee Schedule,175% of CMS Fee Schedule,108,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,80.13,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,97.67,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.68,115,,,Fee Schedule,115% of CMS OPPS Rate,90.94,100,,,Fee Schedule,100% of UMR Fee Schedule,69.68,115,,,Fee Schedule,115% of CMS OPPS Rate,69.68,847.8,
"BLOCK, INTERCOSTAL NERVE, MULT",P990230012,CDM,964,RC,64421,HCPCS,Outpatient,,,942,471,,141.96,175,,,fee schedule,175% of aetna fee schedule,27.08,115,,,fee schedule,115% of cms physician fee schedule,27.62,117.3,,,fee schedule,117.3% of cms physician fee schedule,33.85,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.08,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.55,100,,,fee schedule,100% of cigna fee schedule,39.9,100,,,fee schedule,100% of healthlink fee schedule,38.63,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,39.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.08,115,,,fee schedule,115% of cms fee schedule,141.96,175,,,Fee Schedule,175% of CMS Fee Schedule,41.98,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,31.14,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,127.17,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.08,115,,,Fee Schedule,115% of CMS OPPS Rate,118.41,100,,,Fee Schedule,100% of UMR Fee Schedule,27.08,115,,,Fee Schedule,115% of CMS OPPS Rate,27.08,847.8,
"BLOCK, ILIOINGUIANAL",P990230013,CDM,964,RC,64425,HCPCS,Outpatient,,,942,471,,147.65,175,,,fee schedule,175% of aetna fee schedule,58.74,115,,,fee schedule,115% of cms physician fee schedule,59.92,117.3,,,fee schedule,117.3% of cms physician fee schedule,73.43,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.74,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.18,100,,,fee schedule,100% of cigna fee schedule,86.68,100,,,fee schedule,100% of healthlink fee schedule,83.94,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,86.68,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.74,115,,,fee schedule,115% of cms fee schedule,147.65,175,,,Fee Schedule,175% of CMS Fee Schedule,91.05,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,67.55,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,131.18,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.74,115,,,Fee Schedule,115% of CMS OPPS Rate,122.14,100,,,Fee Schedule,100% of UMR Fee Schedule,58.74,115,,,Fee Schedule,115% of CMS OPPS Rate,58.74,847.8,
"BLOCK, POPLITEAL NERVE W/IMAGI",P990230014,CDM,964,RC,64445,HCPCS,Outpatient,,,1222,611,,126.12,175,,,fee schedule,175% of aetna fee schedule,77.99,115,,,fee schedule,115% of cms physician fee schedule,79.55,117.3,,,fee schedule,117.3% of cms physician fee schedule,97.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.99,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.33,100,,,fee schedule,100% of cigna fee schedule,84.17,100,,,fee schedule,100% of healthlink fee schedule,81.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.17,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1099.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1099.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1099.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.99,115,,,fee schedule,115% of cms fee schedule,126.12,175,,,Fee Schedule,175% of CMS Fee Schedule,120.89,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,89.69,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,101.16,100,,,Fee Schedule,100% of UHC Fee Schedule,1099.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.99,115,,,Fee Schedule,115% of CMS OPPS Rate,94.19,100,,,Fee Schedule,100% of UMR Fee Schedule,77.99,115,,,Fee Schedule,115% of CMS OPPS Rate,62.33,1099.8,
"BLOCK, SCIATIC NERVE W/IMAGING",P990230015,CDM,964,RC,64445,HCPCS,Outpatient,,,1222,611,,126.12,175,,,fee schedule,175% of aetna fee schedule,77.99,115,,,fee schedule,115% of cms physician fee schedule,79.55,117.3,,,fee schedule,117.3% of cms physician fee schedule,97.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.99,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.33,100,,,fee schedule,100% of cigna fee schedule,84.17,100,,,fee schedule,100% of healthlink fee schedule,81.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.17,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1099.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1099.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1099.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.99,115,,,fee schedule,115% of cms fee schedule,126.12,175,,,Fee Schedule,175% of CMS Fee Schedule,120.89,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,89.69,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,101.16,100,,,Fee Schedule,100% of UHC Fee Schedule,1099.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.99,115,,,Fee Schedule,115% of CMS OPPS Rate,94.19,100,,,Fee Schedule,100% of UMR Fee Schedule,77.99,115,,,Fee Schedule,115% of CMS OPPS Rate,62.33,1099.8,
"I PAC BLOCK, W/IMAGING",P990230016,CDM,964,RC,64445,HCPCS,Outpatient,,,1222,611,,126.12,175,,,fee schedule,175% of aetna fee schedule,77.99,115,,,fee schedule,115% of cms physician fee schedule,79.55,117.3,,,fee schedule,117.3% of cms physician fee schedule,97.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.99,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.33,100,,,fee schedule,100% of cigna fee schedule,84.17,100,,,fee schedule,100% of healthlink fee schedule,81.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.17,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1099.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1099.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1099.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.99,115,,,fee schedule,115% of cms fee schedule,126.12,175,,,Fee Schedule,175% of CMS Fee Schedule,120.89,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,89.69,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,101.16,100,,,Fee Schedule,100% of UHC Fee Schedule,1099.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.99,115,,,Fee Schedule,115% of CMS OPPS Rate,94.19,100,,,Fee Schedule,100% of UMR Fee Schedule,77.99,115,,,Fee Schedule,115% of CMS OPPS Rate,62.33,1099.8,
"BLOCK, ADDUCTOR CANAL",P990230017,CDM,964,RC,64447,HCPCS,Outpatient,,,942,471,,109.66,175,,,fee schedule,175% of aetna fee schedule,68.83,115,,,fee schedule,115% of cms physician fee schedule,70.2,117.3,,,fee schedule,117.3% of cms physician fee schedule,86.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.83,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.21,100,,,fee schedule,100% of cigna fee schedule,84.01,100,,,fee schedule,100% of healthlink fee schedule,81.35,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.83,115,,,fee schedule,115% of cms fee schedule,109.66,175,,,Fee Schedule,175% of CMS Fee Schedule,106.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,79.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,92.66,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,86.28,100,,,Fee Schedule,100% of UMR Fee Schedule,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,62.21,847.8,
"BLOCK, FEMORAL NERVE W/IMAGING",P990230018,CDM,964,RC,64447,HCPCS,Outpatient,,,1290,645,,109.66,175,,,fee schedule,175% of aetna fee schedule,68.83,115,,,fee schedule,115% of cms physician fee schedule,70.2,117.3,,,fee schedule,117.3% of cms physician fee schedule,86.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.83,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.21,100,,,fee schedule,100% of cigna fee schedule,84.01,100,,,fee schedule,100% of healthlink fee schedule,81.35,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1161,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.83,115,,,fee schedule,115% of cms fee schedule,109.66,175,,,Fee Schedule,175% of CMS Fee Schedule,106.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,79.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,92.66,100,,,Fee Schedule,100% of UHC Fee Schedule,1161,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,86.28,100,,,Fee Schedule,100% of UMR Fee Schedule,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,62.21,1161,
"BLOCK, SAPHENOUS NERVE W/IMAGI",P990230019,CDM,964,RC,64447,HCPCS,Outpatient,,,1290.5,645.25,,109.66,175,,,fee schedule,175% of aetna fee schedule,68.83,115,,,fee schedule,115% of cms physician fee schedule,70.2,117.3,,,fee schedule,117.3% of cms physician fee schedule,86.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.83,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.21,100,,,fee schedule,100% of cigna fee schedule,84.01,100,,,fee schedule,100% of healthlink fee schedule,81.35,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1161.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1161.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1161.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.83,115,,,fee schedule,115% of cms fee schedule,109.66,175,,,Fee Schedule,175% of CMS Fee Schedule,106.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,79.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,92.66,100,,,Fee Schedule,100% of UHC Fee Schedule,1161.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,86.28,100,,,Fee Schedule,100% of UMR Fee Schedule,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,62.21,1161.45,
PENG Block,P990230020,CDM,964,RC,64450,HCPCS,Outpatient,,,430,215,,113.72,175,,,fee schedule,175% of aetna fee schedule,45.23,115,,,fee schedule,115% of cms physician fee schedule,46.13,117.3,,,fee schedule,117.3% of cms physician fee schedule,56.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.23,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.24,100,,,fee schedule,100% of cigna fee schedule,66.5,100,,,fee schedule,100% of healthlink fee schedule,64.4,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,66.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,387,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,387,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,115,,,fee schedule,115% of cms fee schedule,113.72,175,,,Fee Schedule,175% of CMS Fee Schedule,70.11,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,52.01,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,61.53,100,,,Fee Schedule,100% of UHC Fee Schedule,387,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,115,,,Fee Schedule,115% of CMS OPPS Rate,57.29,100,,,Fee Schedule,100% of UMR Fee Schedule,45.23,115,,,Fee Schedule,115% of CMS OPPS Rate,45.23,387,
"BLOCK, PERIPHERAL NERVE/BRANCH",P990230021,CDM,964,RC,64450,HCPCS,Outpatient,,,874.5,437.25,,113.72,175,,,fee schedule,175% of aetna fee schedule,45.23,115,,,fee schedule,115% of cms physician fee schedule,46.13,117.3,,,fee schedule,117.3% of cms physician fee schedule,56.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.23,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.24,100,,,fee schedule,100% of cigna fee schedule,66.5,100,,,fee schedule,100% of healthlink fee schedule,64.4,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,66.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,787.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,115,,,fee schedule,115% of cms fee schedule,113.72,175,,,Fee Schedule,175% of CMS Fee Schedule,70.11,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,52.01,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,61.53,100,,,Fee Schedule,100% of UHC Fee Schedule,787.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,115,,,Fee Schedule,115% of CMS OPPS Rate,57.29,100,,,Fee Schedule,100% of UMR Fee Schedule,45.23,115,,,Fee Schedule,115% of CMS OPPS Rate,45.23,787.05,
"BLOCK, SAPHENOUS",P990230022,CDM,964,RC,64447,HCPCS,Outpatient,,,874.5,437.25,,109.66,175,,,fee schedule,175% of aetna fee schedule,68.83,115,,,fee schedule,115% of cms physician fee schedule,70.2,117.3,,,fee schedule,117.3% of cms physician fee schedule,86.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.83,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.21,100,,,fee schedule,100% of cigna fee schedule,84.01,100,,,fee schedule,100% of healthlink fee schedule,81.35,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,787.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.83,115,,,fee schedule,115% of cms fee schedule,109.66,175,,,Fee Schedule,175% of CMS Fee Schedule,106.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,79.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,92.66,100,,,Fee Schedule,100% of UHC Fee Schedule,787.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,86.28,100,,,Fee Schedule,100% of UMR Fee Schedule,68.83,115,,,Fee Schedule,115% of CMS OPPS Rate,62.21,787.05,
"BLOCK, TAP UNILAT",P990230023,CDM,964,RC,64486,HCPCS,Outpatient,,,874.5,437.25,,,,,,other,not seperately reimbusable,60.58,115,,,fee schedule,115% of cms physician fee schedule,61.79,117.3,,,fee schedule,117.3% of cms physician fee schedule,75.73,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.58,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.54,100,,,fee schedule,100% of cigna fee schedule,89.85,100,,,fee schedule,100% of healthlink fee schedule,87.01,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,89.85,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,787.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.58,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,93.9,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,69.67,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,78.11,100,,,Fee Schedule,100% of UHC Fee Schedule,787.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.58,115,,,Fee Schedule,115% of CMS OPPS Rate,72.73,100,,,Fee Schedule,100% of UMR Fee Schedule,60.58,115,,,Fee Schedule,115% of CMS OPPS Rate,60.58,787.05,
"BLOCK,TAP BILAT(Transvers ABD)",P990230024,CDM,964,RC,64488,HCPCS,Outpatient,,,942,471,,97.67,135,,,fee schedule,135% of aetna fee schedule,75.54,115,,,fee schedule,115% of cms physician fee schedule,77.05,117.3,,,fee schedule,117.3% of cms physician fee schedule,94.43,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.54,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.3,100,,,fee schedule,100% of cigna fee schedule,111.14,100,,,fee schedule,100% of healthlink fee schedule,107.62,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,111.14,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.54,115,,,fee schedule,115% of cms fee schedule,97.67,135,,,Fee Schedule,135% of CMS Fee Schedule ,117.09,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,86.88,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,98.04,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.54,115,,,Fee Schedule,115% of CMS OPPS Rate,91.28,100,,,Fee Schedule,100% of UMR Fee Schedule,75.54,115,,,Fee Schedule,115% of CMS OPPS Rate,75.54,847.8,
"BLOCK, SUPERFICIAL CERV PLEXUS",P990230025,CDM,964,RC,64999,HCPCS,Outpatient,,,874.5,437.25,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,542.19,62,,,Percent of total Billed Charges,62% of total billed charges,542.19,62,,,Fee Schedule,62% of Healthlink HMO Fee Schedule,542.19,62,,,Fee Schedule,62% of Healthlink PPO Fee Schedule,787.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,787.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,542.19,787.05,
CARDIOPULMONARY RESUSCITATION,P990230026,CDM,964,RC,92950,HCPCS,Outpatient,,,1504.5,752.25,,443.24,135,,,fee schedule,135% of aetna fee schedule,199.97,115,,,fee schedule,115% of cms physician fee schedule,203.97,117.3,,,fee schedule,117.3% of cms physician fee schedule,249.97,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.97,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218.99,100,,,fee schedule,100% of cigna fee schedule,273.27,100,,,fee schedule,100% of healthlink fee schedule,254.55,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,273.27,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1354.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1354.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1354.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.97,115,,,fee schedule,115% of cms fee schedule,443.24,135,,,Fee Schedule,135% of CMS Fee Schedule ,309.96,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,229.97,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,253.48,100,,,Fee Schedule,100% of UHC Fee Schedule,1354.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.97,115,,,Fee Schedule,115% of CMS OPPS Rate,225.83,100,,,Fee Schedule,100% of UMR Fee Schedule,199.97,115,,,Fee Schedule,115% of CMS OPPS Rate,199.97,1354.05,
Anesthesia Consult 20-29 min,P990230027,CDM,510,RC,99242,HCPCS,Outpatient,,,180,90,,138.6,77,,,Percent of Total Billed Charges,77% of total billed charges,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.6,77,,,Percent of total Billed charges,77% of total billed charges,153,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45,160.2,
Anesthesia Consult 20-29 min,P990230027,CDM,510,RC,G0463,HCPCS,Outpatient,,,180,90,,138.6,77,,,Percent of Total Billed Charges,77% of total billed charges,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.6,77,,,Percent of total Billed charges,77% of total billed charges,153,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45,160.2,
Anesthesia Consult 30-39 min,P990230028,CDM,510,RC,99213,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
Anesthesia Consult 30-39 min,P990230028,CDM,510,RC,99243,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
Anesthesia Consult 40-54 min,P990230029,CDM,510,RC,99214,HCPCS,Outpatient,,,478,239,,368.06,77,,,Percent of Total Billed Charges,77% of total billed charges,121.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,195.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.06,77,,,Percent of total Billed charges,77% of total billed charges,406.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.5,425.42,
Anesthesia Consult 40-54 min,P990230029,CDM,510,RC,99244,HCPCS,Outpatient,,,478,239,,368.06,77,,,Percent of Total Billed Charges,77% of total billed charges,121.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,195.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.06,77,,,Percent of total Billed charges,77% of total billed charges,406.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.5,425.42,
Anesthesia Consult 55+ min,P990230030,CDM,510,RC,99245,HCPCS,Outpatient,,,597.5,298.75,,460.08,77,,,Percent of Total Billed Charges,77% of total billed charges,152.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.08,77,,,Percent of total Billed charges,77% of total billed charges,507.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,298.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,531.78,
Anesthesia Consult 55+ min,P990230030,CDM,510,RC,99215,HCPCS,Outpatient,,,597.5,298.75,,460.08,77,,,Percent of Total Billed Charges,77% of total billed charges,152.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.08,77,,,Percent of total Billed charges,77% of total billed charges,507.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,298.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,531.78,
NEONATAL RESUSCITATION,P990230031,CDM,964,RC,99465,HCPCS,Outpatient,,,1504.5,752.25,,187.65,175,,,fee schedule,175% of aetna fee schedule,154.4,115,,,fee schedule,115% of cms physician fee schedule,157.49,117.3,,,fee schedule,117.3% of cms physician fee schedule,193,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.4,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,167.57,100,,,fee schedule,100% of cigna fee schedule,160.41,100,,,fee schedule,100% of healthlink fee schedule,146.08,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,160.41,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1354.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1354.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1354.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.4,115,,,fee schedule,115% of cms fee schedule,187.65,135,,,Fee Schedule,135% of CMS Fee Schedule ,239.32,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,177.56,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,127.03,100,,,Fee Schedule,100% of UHC Fee Schedule,1354.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.4,115,,,Fee Schedule,115% of CMS OPPS Rate,120.83,100,,,Fee Schedule,100% of UMR Fee Schedule,154.4,115,,,Fee Schedule,115% of CMS OPPS Rate,120.83,1354.05,
ANESTHESIA UNIT,P990230032,CDM,964,RC,,,Outpatient,,,192.5,96.25,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.35,62,,,Percent of total Billed Charges,62% of total billed charges,119.35,62,,,Percent of Total Billed Charges,62% of Healthlink HMO Fee Schedule,119.35,62,,,Percent of Total Billed Charges,62% of Total Billed Charges,173.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,173.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,173.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,119.35,173.25,
DELIVERY ANESTHESIA,P990230033,CDM,964,RC,,,Outpatient,,,855.5,427.75,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,530.41,62,,,Percent of total Billed Charges,62% of total billed charges,530.41,62,,,Percent of Total Billed Charges,62% of Healthlink HMO Fee Schedule,530.41,62,,,Percent of Total Billed Charges,62% of Total Billed Charges,769.95,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,769.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,769.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,769.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,530.41,769.95,
Standby each 30 min,P990230108,CDM,370,RC,99360,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.5,74,,,Percent of Total Billed Charges,74% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,63,84,,,Percent of Total Billed Charges,84% of total billed charges,61.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.75,
"PICC Line Placement, 5 yr+",P990230113,CDM,964,RC,36569,HCPCS,Outpatient,,,360,180,,164.64,175,,,fee schedule,175% of aetna fee schedule,102.37,115,,,fee schedule,115% of cms physician fee schedule,104.42,117.3,,,fee schedule,117.3% of cms physician fee schedule,127.97,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.37,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,110.66,100,,,fee schedule,100% of cigna fee schedule,146.61,100,,,fee schedule,100% of healthlink fee schedule,141.89,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,146.61,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,324,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,324,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.37,115,,,fee schedule,115% of cms fee schedule,164.64,175,,,Fee Schedule,175% of CMS Fee Schedule,158.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,117.73,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,124.66,100,,,Fee Schedule,100% of UHC Fee Schedule,324,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.37,115,,,Fee Schedule,115% of CMS OPPS Rate,113.46,100,,,Fee Schedule,100% of UMR Fee Schedule,102.37,115,,,Fee Schedule,115% of CMS OPPS Rate,102.37,324,
"Inj, Dx OR Therap Sub Lmbr/SAC",P990230114,CDM,964,RC,62322,HCPCS,Outpatient,,,942,471,,109.13,135,,,fee schedule,135% of aetna fee schedule,86.14,115,,,fee schedule,115% of cms physician fee schedule,87.86,117.3,,,fee schedule,117.3% of cms physician fee schedule,107.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.14,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.63,100,,,fee schedule,100% of cigna fee schedule,131.84,100,,,fee schedule,100% of healthlink fee schedule,127.66,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,131.84,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,847.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,115,,,fee schedule,115% of cms fee schedule,109.13,135,,,Fee Schedule,135% of CMS Fee Schedule ,133.51,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,99.06,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,118.52,100,,,Fee Schedule,100% of UHC Fee Schedule,847.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,115,,,Fee Schedule,115% of CMS OPPS Rate,110.35,100,,,Fee Schedule,100% of UMR Fee Schedule,86.14,115,,,Fee Schedule,115% of CMS OPPS Rate,86.14,847.8,
I & D SIMPLE SQ/CYST/ABCESS,P990310001,CDM,981,RC,10060,HCPCS,Outpatient,,,355,177.5,,138.09,175,,,fee schedule,175% of aetna fee schedule,112.39,115,,,fee schedule,115% of cms physician fee schedule,114.64,117.3,,,fee schedule,117.3% of cms physician fee schedule,140.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.39,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.51,100,,,fee schedule,100% of cigna fee schedule,104.84,100,,,fee schedule,100% of healthlink fee schedule,100.08,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,104.84,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,319.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,319.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.39,115,,,fee schedule,115% of cms fee schedule,138.09,175,,,Fee Schedule,175% of CMS Fee Schedule,174.2,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,129.25,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,124.2,100,,,Fee Schedule,100% of UHC Fee Schedule,319.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.39,115,,,Fee Schedule,115% of CMS OPPS Rate,110.69,100,,,Fee Schedule,100% of UMR Fee Schedule,112.39,115,,,Fee Schedule,115% of CMS OPPS Rate,100.08,319.5,
I & D COMPLEX SQ/CYST/ABC,P990310002,CDM,981,RC,10061,HCPCS,Outpatient,,,544,272,,246.82,175,,,fee schedule,175% of aetna fee schedule,196.13,115,,,fee schedule,115% of cms physician fee schedule,200.06,117.3,,,fee schedule,117.3% of cms physician fee schedule,245.17,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196.13,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.04,100,,,fee schedule,100% of cigna fee schedule,191.84,100,,,fee schedule,100% of healthlink fee schedule,183.12,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,191.84,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,489.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,196.13,115,,,fee schedule,115% of cms fee schedule,246.82,175,,,Fee Schedule,175% of CMS Fee Schedule,304.01,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,225.55,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,228.71,100,,,Fee Schedule,100% of UHC Fee Schedule,489.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,196.13,115,,,Fee Schedule,115% of CMS OPPS Rate,203.83,100,,,Fee Schedule,100% of UMR Fee Schedule,196.13,115,,,Fee Schedule,115% of CMS OPPS Rate,183.12,489.6,
"I & D PILONIDAL CYST, SIM",P990310003,CDM,981,RC,10080,HCPCS,Outpatient,,,384,192,,240.72,135,,,fee schedule,135% of aetna fee schedule,111.21,115,,,fee schedule,115% of cms physician fee schedule,113.43,117.3,,,fee schedule,117.3% of cms physician fee schedule,139.01,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.21,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.54,100,,,fee schedule,100% of cigna fee schedule,107.69,100,,,fee schedule,100% of healthlink fee schedule,102.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,107.69,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,345.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,345.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,115,,,fee schedule,115% of cms fee schedule,240.72,135,,,Fee Schedule,135% of CMS Fee Schedule ,172.37,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,127.89,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,129.55,100,,,Fee Schedule,100% of UHC Fee Schedule,345.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,115,,,Fee Schedule,115% of CMS OPPS Rate,115.45,100,,,Fee Schedule,100% of UMR Fee Schedule,111.21,115,,,Fee Schedule,115% of CMS OPPS Rate,102.8,345.6,
"SQ, SIMPLE",P990310004,CDM,981,RC,10120,HCPCS,Outpatient,,,298.5,149.25,,133.89,175,,,fee schedule,175% of aetna fee schedule,111.44,115,,,fee schedule,115% of cms physician fee schedule,113.66,117.3,,,fee schedule,117.3% of cms physician fee schedule,139.29,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.44,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.05,100,,,fee schedule,100% of cigna fee schedule,107.23,100,,,fee schedule,100% of healthlink fee schedule,102.35,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,107.23,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,268.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,268.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.44,115,,,fee schedule,115% of cms fee schedule,133.89,175,,,Fee Schedule,175% of CMS Fee Schedule,172.72,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,128.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,130.73,100,,,Fee Schedule,100% of UHC Fee Schedule,268.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.44,115,,,Fee Schedule,115% of CMS OPPS Rate,116.5,100,,,Fee Schedule,100% of UMR Fee Schedule,111.44,115,,,Fee Schedule,115% of CMS OPPS Rate,102.35,268.65,
"SQ, COMPLICATED",P990310005,CDM,981,RC,10121,HCPCS,Outpatient,,,642,321,,277.31,175,,,fee schedule,175% of aetna fee schedule,196.58,115,,,fee schedule,115% of cms physician fee schedule,200.51,117.3,,,fee schedule,117.3% of cms physician fee schedule,245.73,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196.58,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.34,100,,,fee schedule,100% of cigna fee schedule,197.76,100,,,fee schedule,100% of healthlink fee schedule,188.77,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,197.76,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,577.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,577.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,196.58,115,,,fee schedule,115% of cms fee schedule,277.31,175,,,Fee Schedule,175% of CMS Fee Schedule,304.7,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,226.07,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,236.59,100,,,Fee Schedule,100% of UHC Fee Schedule,577.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,196.58,115,,,Fee Schedule,115% of CMS OPPS Rate,210.85,100,,,Fee Schedule,100% of UMR Fee Schedule,196.58,115,,,Fee Schedule,115% of CMS OPPS Rate,188.77,577.8,
"I & D HEMATOMA, SIMPLE",P990310006,CDM,981,RC,10140,HCPCS,Outpatient,,,356.5,178.25,,175.6,175,,,fee schedule,175% of aetna fee schedule,125.98,115,,,fee schedule,115% of cms physician fee schedule,128.5,117.3,,,fee schedule,117.3% of cms physician fee schedule,157.48,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.98,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.43,100,,,fee schedule,100% of cigna fee schedule,125.44,100,,,fee schedule,100% of healthlink fee schedule,119.74,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,125.44,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,320.85,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,320.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.98,115,,,fee schedule,115% of cms fee schedule,175.6,175,,,Fee Schedule,175% of CMS Fee Schedule,195.27,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,144.88,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,150.65,100,,,Fee Schedule,100% of UHC Fee Schedule,320.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.98,115,,,Fee Schedule,115% of CMS OPPS Rate,134.26,100,,,Fee Schedule,100% of UMR Fee Schedule,125.98,115,,,Fee Schedule,115% of CMS OPPS Rate,119.74,320.85,
"PUNCTURE, ASPIRATE",P990310007,CDM,981,RC,10160,HCPCS,Outpatient,,,284,142,,141.24,175,,,fee schedule,175% of aetna fee schedule,102.45,115,,,fee schedule,115% of cms physician fee schedule,104.5,117.3,,,fee schedule,117.3% of cms physician fee schedule,128.07,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.45,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.95,100,,,fee schedule,100% of cigna fee schedule,99.61,100,,,fee schedule,100% of healthlink fee schedule,95.08,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,99.61,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,255.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,255.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.45,115,,,fee schedule,115% of cms fee schedule,141.24,175,,,Fee Schedule,175% of CMS Fee Schedule,158.8,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,117.82,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,120.45,100,,,Fee Schedule,100% of UHC Fee Schedule,255.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.45,115,,,Fee Schedule,115% of CMS OPPS Rate,107.35,100,,,Fee Schedule,100% of UMR Fee Schedule,102.45,115,,,Fee Schedule,115% of CMS OPPS Rate,95.08,255.6,
DEBRIDE INF SKIN <10% BSA,P990310008,CDM,981,RC,11000,HCPCS,Outpatient,,,341,170.5,,51.08,175,,,fee schedule,175% of aetna fee schedule,30.26,115,,,fee schedule,115% of cms physician fee schedule,30.86,117.3,,,fee schedule,117.3% of cms physician fee schedule,37.82,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.26,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.43,100,,,fee schedule,100% of cigna fee schedule,31.43,100,,,fee schedule,100% of healthlink fee schedule,30,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,31.43,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,306.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,306.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.26,115,,,fee schedule,115% of cms fee schedule,51.08,175,,,Fee Schedule,175% of CMS Fee Schedule,46.9,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,34.79,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,36.75,100,,,Fee Schedule,100% of UHC Fee Schedule,306.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.26,115,,,Fee Schedule,115% of CMS OPPS Rate,32.75,100,,,Fee Schedule,100% of UMR Fee Schedule,30.26,115,,,Fee Schedule,115% of CMS OPPS Rate,30,306.9,
DEBRIDE MUSCLE/FASCIA 1ST 20CM,P990310009,CDM,981,RC,11043,HCPCS,Outpatient,,,2342,1171,,345.7,175,,,fee schedule,175% of aetna fee schedule,165.59,115,,,fee schedule,115% of cms physician fee schedule,168.9,117.3,,,fee schedule,117.3% of cms physician fee schedule,206.99,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.59,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,179,100,,,fee schedule,100% of cigna fee schedule,168.29,100,,,fee schedule,100% of healthlink fee schedule,160.64,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,168.29,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,2107.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,2107.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.59,115,,,fee schedule,115% of cms fee schedule,345.7,175,,,Fee Schedule,175% of CMS Fee Schedule,256.66,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,190.43,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,198.89,100,,,Fee Schedule,100% of UHC Fee Schedule,2107.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.59,115,,,Fee Schedule,115% of CMS OPPS Rate,177.25,100,,,Fee Schedule,100% of UMR Fee Schedule,165.59,115,,,Fee Schedule,115% of CMS OPPS Rate,160.64,2107.8,
TRIM N/DYSTROPHIC NAILS ANY #,P990310010,CDM,981,RC,11719,HCPCS,Outpatient,,,134.5,67.25,,14.05,175,,,fee schedule,175% of aetna fee schedule,8.15,115,,,fee schedule,115% of cms physician fee schedule,8.32,117.3,,,fee schedule,117.3% of cms physician fee schedule,10.19,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.15,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.01,100,,,fee schedule,100% of cigna fee schedule,8.47,100,,,fee schedule,100% of healthlink fee schedule,8.09,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,8.47,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,121.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,121.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.15,115,,,fee schedule,115% of cms fee schedule,14.05,175,,,Fee Schedule,175% of CMS Fee Schedule,12.64,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,9.38,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,9.86,100,,,Fee Schedule,100% of UHC Fee Schedule,121.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.15,115,,,Fee Schedule,115% of CMS OPPS Rate,8.79,100,,,Fee Schedule,100% of UMR Fee Schedule,8.15,115,,,Fee Schedule,115% of CMS OPPS Rate,8.09,121.05,
"AVULSION NAIL PLATE, PART",P990310011,CDM,981,RC,11730,HCPCS,Outpatient,,,382,191,,93.26,175,,,fee schedule,175% of aetna fee schedule,58.35,115,,,fee schedule,115% of cms physician fee schedule,59.52,117.3,,,fee schedule,117.3% of cms physician fee schedule,72.94,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.35,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.35,100,,,fee schedule,100% of cigna fee schedule,59.57,100,,,fee schedule,100% of healthlink fee schedule,56.86,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,59.57,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,343.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,343.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.35,115,,,fee schedule,115% of cms fee schedule,93.26,175,,,Fee Schedule,175% of CMS Fee Schedule,90.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,67.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,70.54,100,,,Fee Schedule,100% of UHC Fee Schedule,343.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.35,115,,,Fee Schedule,115% of CMS OPPS Rate,62.86,100,,,Fee Schedule,100% of UMR Fee Schedule,58.35,115,,,Fee Schedule,115% of CMS OPPS Rate,56.86,343.8,
EVAC SUBUNGUAL HEMATOMA,P990310012,CDM,981,RC,11740,HCPCS,Outpatient,,,320,160,,47.62,175,,,fee schedule,175% of aetna fee schedule,33.84,115,,,fee schedule,115% of cms physician fee schedule,34.52,117.3,,,fee schedule,117.3% of cms physician fee schedule,42.31,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.84,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.87,100,,,fee schedule,100% of cigna fee schedule,32.78,100,,,fee schedule,100% of healthlink fee schedule,31.29,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,32.78,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,288,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.84,115,,,fee schedule,115% of cms fee schedule,47.62,175,,,Fee Schedule,175% of CMS Fee Schedule,52.46,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,38.92,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,40.55,100,,,Fee Schedule,100% of UHC Fee Schedule,288,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.84,115,,,Fee Schedule,115% of CMS OPPS Rate,36.14,100,,,Fee Schedule,100% of UMR Fee Schedule,33.84,115,,,Fee Schedule,115% of CMS OPPS Rate,31.29,288,
NAIL EXCISION PART/COMPLE,P990310013,CDM,981,RC,11750,HCPCS,Outpatient,,,320,160,,260.66,175,,,fee schedule,175% of aetna fee schedule,109.15,115,,,fee schedule,115% of cms physician fee schedule,111.33,117.3,,,fee schedule,117.3% of cms physician fee schedule,136.43,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,109.15,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.11,100,,,fee schedule,100% of cigna fee schedule,108.23,100,,,fee schedule,100% of healthlink fee schedule,103.31,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,108.23,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,288,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.15,115,,,fee schedule,115% of cms fee schedule,260.66,175,,,Fee Schedule,175% of CMS Fee Schedule,169.18,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,125.52,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,129.58,100,,,Fee Schedule,100% of UHC Fee Schedule,288,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.15,115,,,Fee Schedule,115% of CMS OPPS Rate,115.48,100,,,Fee Schedule,100% of UMR Fee Schedule,109.15,115,,,Fee Schedule,115% of CMS OPPS Rate,103.31,288,
REPAIR OF NAIL BED,P990310014,CDM,981,RC,11760,HCPCS,Outpatient,,,405,202.5,,188.3,175,,,fee schedule,175% of aetna fee schedule,117.06,115,,,fee schedule,115% of cms physician fee schedule,119.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,146.32,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.06,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.37,100,,,fee schedule,100% of cigna fee schedule,121.63,100,,,fee schedule,100% of healthlink fee schedule,116.1,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,121.63,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,364.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,364.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.06,115,,,fee schedule,115% of cms fee schedule,188.3,175,,,Fee Schedule,175% of CMS Fee Schedule,181.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,134.62,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,145.04,100,,,Fee Schedule,100% of UHC Fee Schedule,364.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.06,115,,,Fee Schedule,115% of CMS OPPS Rate,129.26,100,,,Fee Schedule,100% of UMR Fee Schedule,117.06,115,,,Fee Schedule,115% of CMS OPPS Rate,116.1,364.5,
SIMPLE REPAIR:0-2.5 cm,P990310015,CDM,981,RC,12001,HCPCS,Outpatient,,,593.5,296.75,,155.82,175,,,fee schedule,175% of aetna fee schedule,48.79,115,,,fee schedule,115% of cms physician fee schedule,49.77,117.3,,,fee schedule,117.3% of cms physician fee schedule,60.99,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.79,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.45,100,,,fee schedule,100% of cigna fee schedule,49.31,100,,,fee schedule,100% of healthlink fee schedule,47.07,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,49.31,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,534.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,534.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,534.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.79,115,,,fee schedule,115% of cms fee schedule,155.82,175,,,Fee Schedule,175% of CMS Fee Schedule,75.63,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,56.11,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,56.89,100,,,Fee Schedule,100% of UHC Fee Schedule,534.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.79,115,,,Fee Schedule,115% of CMS OPPS Rate,50.7,100,,,Fee Schedule,100% of UMR Fee Schedule,48.79,115,,,Fee Schedule,115% of CMS OPPS Rate,47.07,534.15,
SIMPLE REPAIR:2.6-7.5cm,P990310016,CDM,981,RC,12002,HCPCS,Outpatient,,,712,356,,172.36,175,,,fee schedule,175% of aetna fee schedule,64.32,115,,,fee schedule,115% of cms physician fee schedule,65.61,117.3,,,fee schedule,117.3% of cms physician fee schedule,80.4,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.32,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.98,100,,,fee schedule,100% of cigna fee schedule,65.79,100,,,fee schedule,100% of healthlink fee schedule,62.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,65.79,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,640.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,640.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.32,115,,,fee schedule,115% of cms fee schedule,172.36,175,,,Fee Schedule,175% of CMS Fee Schedule,99.7,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,73.97,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,74.89,100,,,Fee Schedule,100% of UHC Fee Schedule,640.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.32,115,,,Fee Schedule,115% of CMS OPPS Rate,66.74,100,,,Fee Schedule,100% of UMR Fee Schedule,64.32,115,,,Fee Schedule,115% of CMS OPPS Rate,62.8,640.8,
SIMPLE REPAIR:7.6-12.5cm,P990310017,CDM,981,RC,12004,HCPCS,Outpatient,,,1028,514,,203.53,175,,,fee schedule,175% of aetna fee schedule,80.5,115,,,fee schedule,115% of cms physician fee schedule,82.11,117.3,,,fee schedule,117.3% of cms physician fee schedule,100.63,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.5,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.1,100,,,fee schedule,100% of cigna fee schedule,81.88,100,,,fee schedule,100% of healthlink fee schedule,78.16,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,81.88,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,925.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.5,115,,,fee schedule,115% of cms fee schedule,203.53,175,,,Fee Schedule,175% of CMS Fee Schedule,124.78,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,92.58,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,93.75,100,,,Fee Schedule,100% of UHC Fee Schedule,925.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.5,115,,,Fee Schedule,115% of CMS OPPS Rate,83.55,100,,,Fee Schedule,100% of UMR Fee Schedule,80.5,115,,,Fee Schedule,115% of CMS OPPS Rate,78.16,925.2,
SIMPLE REPAIR:12.6-20cm,P990310018,CDM,981,RC,12005,HCPCS,Outpatient,,,1088.5,544.25,,253.68,175,,,fee schedule,175% of aetna fee schedule,104.26,115,,,fee schedule,115% of cms physician fee schedule,106.34,117.3,,,fee schedule,117.3% of cms physician fee schedule,130.32,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104.26,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.07,100,,,fee schedule,100% of cigna fee schedule,107.24,100,,,fee schedule,100% of healthlink fee schedule,102.36,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,107.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,979.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,979.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,979.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.26,115,,,fee schedule,115% of cms fee schedule,253.68,175,,,Fee Schedule,175% of CMS Fee Schedule,161.6,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,119.9,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,121.86,100,,,Fee Schedule,100% of UHC Fee Schedule,979.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.26,115,,,Fee Schedule,115% of CMS OPPS Rate,108.6,100,,,Fee Schedule,100% of UMR Fee Schedule,104.26,115,,,Fee Schedule,115% of CMS OPPS Rate,102.36,979.65,
SIMPLE REPAIR:0-2.5cm,P990310019,CDM,981,RC,12011,HCPCS,Outpatient,,,565,282.5,,161.26,175,,,fee schedule,175% of aetna fee schedule,60.64,115,,,fee schedule,115% of cms physician fee schedule,61.85,117.3,,,fee schedule,117.3% of cms physician fee schedule,75.8,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.64,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.92,100,,,fee schedule,100% of cigna fee schedule,61.97,100,,,fee schedule,100% of healthlink fee schedule,59.16,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,61.97,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,508.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,508.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.64,115,,,fee schedule,115% of cms fee schedule,161.26,175,,,Fee Schedule,175% of CMS Fee Schedule,93.99,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,69.74,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,70.4,100,,,Fee Schedule,100% of UHC Fee Schedule,508.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.64,115,,,Fee Schedule,115% of CMS OPPS Rate,62.74,100,,,Fee Schedule,100% of UMR Fee Schedule,60.64,115,,,Fee Schedule,115% of CMS OPPS Rate,59.16,508.5,
SIMPLE REPAIR:2.6-5.0cm,P990310020,CDM,981,RC,12013,HCPCS,Outpatient,,,868,434,,183.79,175,,,fee schedule,175% of aetna fee schedule,63.81,115,,,fee schedule,115% of cms physician fee schedule,65.09,117.3,,,fee schedule,117.3% of cms physician fee schedule,79.77,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.81,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70.14,100,,,fee schedule,100% of cigna fee schedule,65.95,100,,,fee schedule,100% of healthlink fee schedule,62.95,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,65.95,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,781.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,781.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.81,115,,,fee schedule,115% of cms fee schedule,183.79,175,,,Fee Schedule,175% of CMS Fee Schedule,98.91,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,73.39,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,74.69,100,,,Fee Schedule,100% of UHC Fee Schedule,781.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.81,115,,,Fee Schedule,115% of CMS OPPS Rate,66.56,100,,,Fee Schedule,100% of UMR Fee Schedule,63.81,115,,,Fee Schedule,115% of CMS OPPS Rate,62.95,781.2,
SIMPLE REPAIR:5.1-7.5cm,P990310021,CDM,981,RC,12014,HCPCS,Outpatient,,,836,418,,221.25,175,,,fee schedule,175% of aetna fee schedule,82.59,115,,,fee schedule,115% of cms physician fee schedule,84.24,117.3,,,fee schedule,117.3% of cms physician fee schedule,103.24,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.59,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,89.76,100,,,fee schedule,100% of cigna fee schedule,84.39,100,,,fee schedule,100% of healthlink fee schedule,80.56,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,84.39,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,752.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,752.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,752.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.59,115,,,fee schedule,115% of cms fee schedule,221.25,175,,,Fee Schedule,175% of CMS Fee Schedule,128.02,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,94.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,96.29,100,,,Fee Schedule,100% of UHC Fee Schedule,752.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.59,115,,,Fee Schedule,115% of CMS OPPS Rate,85.81,100,,,Fee Schedule,100% of UMR Fee Schedule,82.59,115,,,Fee Schedule,115% of CMS OPPS Rate,80.56,752.4,
SIMPLE REPAIR:7.6-12.5cm,P990310022,CDM,981,RC,12015,HCPCS,Outpatient,,,1084.5,542.25,,278.36,175,,,fee schedule,175% of aetna fee schedule,103.66,115,,,fee schedule,115% of cms physician fee schedule,105.73,117.3,,,fee schedule,117.3% of cms physician fee schedule,129.58,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103.66,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.4,100,,,fee schedule,100% of cigna fee schedule,106.62,100,,,fee schedule,100% of healthlink fee schedule,101.78,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,106.62,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,976.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,976.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,976.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.66,115,,,fee schedule,115% of cms fee schedule,278.36,175,,,Fee Schedule,175% of CMS Fee Schedule,160.67,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,119.21,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,121.01,100,,,Fee Schedule,100% of UHC Fee Schedule,976.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.66,115,,,Fee Schedule,115% of CMS OPPS Rate,107.85,100,,,Fee Schedule,100% of UMR Fee Schedule,103.66,115,,,Fee Schedule,115% of CMS OPPS Rate,101.78,976.05,
SIMPLE REPAIR:12.6-20cm,P990310023,CDM,981,RC,12016,HCPCS,Outpatient,,,1326,663,,340.36,175,,,fee schedule,175% of aetna fee schedule,140.52,115,,,fee schedule,115% of cms physician fee schedule,143.33,117.3,,,fee schedule,117.3% of cms physician fee schedule,175.65,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.52,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.77,100,,,fee schedule,100% of cigna fee schedule,144.57,100,,,fee schedule,100% of healthlink fee schedule,138,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,144.57,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1193.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1193.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1193.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.52,115,,,fee schedule,115% of cms fee schedule,340.36,175,,,Fee Schedule,175% of CMS Fee Schedule,217.8,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,161.6,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,165.11,100,,,Fee Schedule,100% of UHC Fee Schedule,1193.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,140.52,115,,,Fee Schedule,115% of CMS OPPS Rate,147.15,100,,,Fee Schedule,100% of UMR Fee Schedule,140.52,115,,,Fee Schedule,115% of CMS OPPS Rate,138,1193.4,
SUPERFICIAL WOUND DEHIS,P990310024,CDM,981,RC,12020,HCPCS,Outpatient,,,392,196,,276.19,175,,,fee schedule,175% of aetna fee schedule,200.8,115,,,fee schedule,115% of cms physician fee schedule,204.82,117.3,,,fee schedule,117.3% of cms physician fee schedule,251,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200.8,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.58,100,,,fee schedule,100% of cigna fee schedule,200.81,100,,,fee schedule,100% of healthlink fee schedule,191.68,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,200.81,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,352.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,352.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,352.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.8,115,,,fee schedule,115% of cms fee schedule,276.19,175,,,Fee Schedule,175% of CMS Fee Schedule,311.24,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,230.92,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,240.39,100,,,Fee Schedule,100% of UHC Fee Schedule,352.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200.8,115,,,Fee Schedule,115% of CMS OPPS Rate,214.23,100,,,Fee Schedule,100% of UMR Fee Schedule,200.8,115,,,Fee Schedule,115% of CMS OPPS Rate,191.68,352.8,
WOUND DEHIS W/PKG,P990310025,CDM,981,RC,12021,HCPCS,Outpatient,,,556.5,278.25,,201.41,175,,,fee schedule,175% of aetna fee schedule,150.13,115,,,fee schedule,115% of cms physician fee schedule,153.14,117.3,,,fee schedule,117.3% of cms physician fee schedule,187.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.13,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.24,100,,,fee schedule,100% of cigna fee schedule,147.83,100,,,fee schedule,100% of healthlink fee schedule,141.11,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,147.83,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,500.85,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,500.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,500.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.13,115,,,fee schedule,115% of cms fee schedule,201.41,175,,,Fee Schedule,175% of CMS Fee Schedule,232.71,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,172.65,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,176.75,100,,,Fee Schedule,100% of UHC Fee Schedule,500.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.13,115,,,Fee Schedule,115% of CMS OPPS Rate,157.52,100,,,Fee Schedule,100% of UMR Fee Schedule,150.13,115,,,Fee Schedule,115% of CMS OPPS Rate,141.11,500.85,
INTERMED REPAIR:0-2.5cm,P990310026,CDM,981,RC,12031,HCPCS,Outpatient,,,712,356,,241.96,175,,,fee schedule,175% of aetna fee schedule,160.13,115,,,fee schedule,115% of cms physician fee schedule,163.33,117.3,,,fee schedule,117.3% of cms physician fee schedule,200.16,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.13,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,170.43,100,,,fee schedule,100% of cigna fee schedule,160.24,100,,,fee schedule,100% of healthlink fee schedule,152.95,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,160.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,640.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,640.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.13,115,,,fee schedule,115% of cms fee schedule,241.96,175,,,Fee Schedule,175% of CMS Fee Schedule,248.2,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,184.14,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,195.1,100,,,Fee Schedule,100% of UHC Fee Schedule,640.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.13,115,,,Fee Schedule,115% of CMS OPPS Rate,173.87,100,,,Fee Schedule,100% of UMR Fee Schedule,160.13,115,,,Fee Schedule,115% of CMS OPPS Rate,152.95,640.8,
INTERM REPAIR:2.6-7.5cm,P990310027,CDM,981,RC,12032,HCPCS,Outpatient,,,1028,514,,287.96,175,,,fee schedule,175% of aetna fee schedule,201.05,115,,,fee schedule,115% of cms physician fee schedule,205.08,117.3,,,fee schedule,117.3% of cms physician fee schedule,251.32,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.05,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.4,100,,,fee schedule,100% of cigna fee schedule,200.63,100,,,fee schedule,100% of healthlink fee schedule,191.51,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,200.63,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,925.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.05,115,,,fee schedule,115% of cms fee schedule,287.96,175,,,Fee Schedule,175% of CMS Fee Schedule,311.63,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,231.21,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,247.33,100,,,Fee Schedule,100% of UHC Fee Schedule,925.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.05,115,,,Fee Schedule,115% of CMS OPPS Rate,220.42,100,,,Fee Schedule,100% of UMR Fee Schedule,201.05,115,,,Fee Schedule,115% of CMS OPPS Rate,191.51,925.2,
INTERM REPAIR:7.6-12.5cm,P990310028,CDM,981,RC,12034,HCPCS,Outpatient,,,958,479,,306.48,175,,,fee schedule,175% of aetna fee schedule,218.48,115,,,fee schedule,115% of cms physician fee schedule,222.85,117.3,,,fee schedule,117.3% of cms physician fee schedule,273.1,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218.48,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.71,100,,,fee schedule,100% of cigna fee schedule,218.79,100,,,fee schedule,100% of healthlink fee schedule,208.85,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,218.79,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,862.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,862.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,862.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.48,115,,,fee schedule,115% of cms fee schedule,306.48,175,,,Fee Schedule,175% of CMS Fee Schedule,338.64,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,251.25,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,264.91,100,,,Fee Schedule,100% of UHC Fee Schedule,862.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.48,115,,,Fee Schedule,115% of CMS OPPS Rate,236.09,100,,,Fee Schedule,100% of UMR Fee Schedule,218.48,115,,,Fee Schedule,115% of CMS OPPS Rate,208.85,862.2,
INTERMED REPAIR:12.6-20cm,P990310029,CDM,981,RC,12035,HCPCS,Outpatient,,,1134.5,567.25,,353.06,175,,,fee schedule,175% of aetna fee schedule,257.5,115,,,fee schedule,115% of cms physician fee schedule,262.65,117.3,,,fee schedule,117.3% of cms physician fee schedule,321.87,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,257.5,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,273.66,100,,,fee schedule,100% of cigna fee schedule,257.28,100,,,fee schedule,100% of healthlink fee schedule,245.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,257.28,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1021.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1021.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1021.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.5,115,,,fee schedule,115% of cms fee schedule,353.06,175,,,Fee Schedule,175% of CMS Fee Schedule,399.12,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,296.12,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,307.49,100,,,Fee Schedule,100% of UHC Fee Schedule,1021.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,257.5,115,,,Fee Schedule,115% of CMS OPPS Rate,274.03,100,,,Fee Schedule,100% of UMR Fee Schedule,257.5,115,,,Fee Schedule,115% of CMS OPPS Rate,245.58,1021.05,
INTERMED REPAIR:0-2.5cm,P990310030,CDM,981,RC,12041,HCPCS,Outpatient,,,1028,514,,257.11,175,,,fee schedule,175% of aetna fee schedule,154.48,115,,,fee schedule,115% of cms physician fee schedule,157.57,117.3,,,fee schedule,117.3% of cms physician fee schedule,193.1,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.48,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.99,100,,,fee schedule,100% of cigna fee schedule,156.06,100,,,fee schedule,100% of healthlink fee schedule,148.96,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,156.06,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,925.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.48,115,,,fee schedule,115% of cms fee schedule,257.11,175,,,Fee Schedule,175% of CMS Fee Schedule,239.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,177.65,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,190.49,100,,,Fee Schedule,100% of UHC Fee Schedule,925.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.48,115,,,Fee Schedule,115% of CMS OPPS Rate,169.76,100,,,Fee Schedule,100% of UMR Fee Schedule,154.48,115,,,Fee Schedule,115% of CMS OPPS Rate,148.96,925.2,
INTERM REPAIR:2.6-7.5cm,P990310031,CDM,981,RC,12042,HCPCS,Outpatient,,,1088.5,544.25,,297.85,175,,,fee schedule,175% of aetna fee schedule,207.86,115,,,fee schedule,115% of cms physician fee schedule,212.02,117.3,,,fee schedule,117.3% of cms physician fee schedule,259.83,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.86,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221.63,100,,,fee schedule,100% of cigna fee schedule,208.37,100,,,fee schedule,100% of healthlink fee schedule,198.9,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,208.37,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,979.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,979.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,979.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.86,115,,,fee schedule,115% of cms fee schedule,297.85,175,,,Fee Schedule,175% of CMS Fee Schedule,322.19,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,239.04,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,255.3,100,,,Fee Schedule,100% of UHC Fee Schedule,979.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,207.86,115,,,Fee Schedule,115% of CMS OPPS Rate,227.52,100,,,Fee Schedule,100% of UMR Fee Schedule,207.86,115,,,Fee Schedule,115% of CMS OPPS Rate,198.9,979.65,
INTERM REPAIR:7.6-12.5cm,P990310032,CDM,981,RC,12044,HCPCS,Outpatient,,,1327.5,663.75,,319.55,175,,,fee schedule,175% of aetna fee schedule,228.62,115,,,fee schedule,115% of cms physician fee schedule,233.19,117.3,,,fee schedule,117.3% of cms physician fee schedule,285.78,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228.62,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.2,100,,,fee schedule,100% of cigna fee schedule,228.65,100,,,fee schedule,100% of healthlink fee schedule,218.25,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,228.65,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1194.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1194.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1194.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.62,115,,,fee schedule,115% of cms fee schedule,319.55,175,,,Fee Schedule,175% of CMS Fee Schedule,354.36,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,262.91,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,274.44,100,,,Fee Schedule,100% of UHC Fee Schedule,1194.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.62,115,,,Fee Schedule,115% of CMS OPPS Rate,244.58,100,,,Fee Schedule,100% of UMR Fee Schedule,228.62,115,,,Fee Schedule,115% of CMS OPPS Rate,218.25,1194.75,
INTERMED REPAIR:12.6-20cm,P990310033,CDM,981,RC,12045,HCPCS,Outpatient,,,1566,783,,365.51,175,,,fee schedule,175% of aetna fee schedule,291.07,115,,,fee schedule,115% of cms physician fee schedule,296.89,117.3,,,fee schedule,117.3% of cms physician fee schedule,363.83,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291.07,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,304.88,100,,,fee schedule,100% of cigna fee schedule,286.64,100,,,fee schedule,100% of healthlink fee schedule,273.61,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,286.64,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1409.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1409.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1409.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.07,115,,,fee schedule,115% of cms fee schedule,365.51,175,,,Fee Schedule,175% of CMS Fee Schedule,451.15,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,334.72,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,342.43,100,,,Fee Schedule,100% of UHC Fee Schedule,1409.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.07,115,,,Fee Schedule,115% of CMS OPPS Rate,305.17,100,,,Fee Schedule,100% of UMR Fee Schedule,291.07,115,,,Fee Schedule,115% of CMS OPPS Rate,273.61,1409.4,
INTERMED REPAIR: 20.1-30.0 CM,P990310034,CDM,981,RC,12046,HCPCS,Outpatient,,,1639.5,819.75,,430.83,175,,,fee schedule,175% of aetna fee schedule,339.39,115,,,fee schedule,115% of cms physician fee schedule,346.18,117.3,,,fee schedule,117.3% of cms physician fee schedule,424.24,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.39,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356.87,100,,,fee schedule,100% of cigna fee schedule,335.51,100,,,fee schedule,100% of healthlink fee schedule,320.26,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,335.51,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1475.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1475.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1475.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.39,115,,,fee schedule,115% of cms fee schedule,430.83,175,,,Fee Schedule,175% of CMS Fee Schedule,526.05,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,390.3,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,401.6,100,,,Fee Schedule,100% of UHC Fee Schedule,1475.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339.39,115,,,Fee Schedule,115% of CMS OPPS Rate,357.91,100,,,Fee Schedule,100% of UMR Fee Schedule,339.39,115,,,Fee Schedule,115% of CMS OPPS Rate,320.26,1475.55,
INTERMED REPAIR:0-2.5cm,P990310035,CDM,981,RC,12051,HCPCS,Outpatient,,,1028,514,,271.3,175,,,fee schedule,175% of aetna fee schedule,179.75,115,,,fee schedule,115% of cms physician fee schedule,183.34,117.3,,,fee schedule,117.3% of cms physician fee schedule,224.68,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,179.75,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.2,100,,,fee schedule,100% of cigna fee schedule,178.82,100,,,fee schedule,100% of healthlink fee schedule,170.69,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,178.82,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,925.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.75,115,,,fee schedule,115% of cms fee schedule,271.3,175,,,Fee Schedule,175% of CMS Fee Schedule,278.6,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,206.71,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,218.34,100,,,Fee Schedule,100% of UHC Fee Schedule,925.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.75,115,,,Fee Schedule,115% of CMS OPPS Rate,194.58,100,,,Fee Schedule,100% of UMR Fee Schedule,179.75,115,,,Fee Schedule,115% of CMS OPPS Rate,170.69,925.2,
INTERM REPAIR:2.6-7.0cm,P990310036,CDM,981,RC,12052,HCPCS,Outpatient,,,1088.5,544.25,,323.82,175,,,fee schedule,175% of aetna fee schedule,211.93,115,,,fee schedule,115% of cms physician fee schedule,216.17,117.3,,,fee schedule,117.3% of cms physician fee schedule,264.92,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,211.93,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.76,100,,,fee schedule,100% of cigna fee schedule,212.25,100,,,fee schedule,100% of healthlink fee schedule,202.6,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,212.25,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,979.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,979.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,979.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.93,115,,,fee schedule,115% of cms fee schedule,323.82,175,,,Fee Schedule,175% of CMS Fee Schedule,328.5,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,243.72,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,259.81,100,,,Fee Schedule,100% of UHC Fee Schedule,979.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,211.93,115,,,Fee Schedule,115% of CMS OPPS Rate,231.54,100,,,Fee Schedule,100% of UMR Fee Schedule,211.93,115,,,Fee Schedule,115% of CMS OPPS Rate,202.6,979.65,
INTERM REPAIR:5.1-7.5cm,P990310037,CDM,981,RC,12053,HCPCS,Outpatient,,,1327.5,663.75,,325.62,175,,,fee schedule,175% of aetna fee schedule,229.08,115,,,fee schedule,115% of cms physician fee schedule,233.66,117.3,,,fee schedule,117.3% of cms physician fee schedule,286.35,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,229.08,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.42,100,,,fee schedule,100% of cigna fee schedule,229.79,100,,,fee schedule,100% of healthlink fee schedule,219.35,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,229.79,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1194.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1194.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1194.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.08,115,,,fee schedule,115% of cms fee schedule,325.62,175,,,Fee Schedule,175% of CMS Fee Schedule,355.07,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,263.44,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,278.29,100,,,Fee Schedule,100% of UHC Fee Schedule,1194.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.08,115,,,Fee Schedule,115% of CMS OPPS Rate,248.01,100,,,Fee Schedule,100% of UMR Fee Schedule,229.08,115,,,Fee Schedule,115% of CMS OPPS Rate,219.35,1194.75,
INTERM REPAIR:7.6-12.5cm,P990310038,CDM,981,RC,12054,HCPCS,Outpatient,,,1566,783,,345.66,175,,,fee schedule,175% of aetna fee schedule,236.03,115,,,fee schedule,115% of cms physician fee schedule,240.75,117.3,,,fee schedule,117.3% of cms physician fee schedule,295.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236.03,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,252.13,100,,,fee schedule,100% of cigna fee schedule,237.04,100,,,fee schedule,100% of healthlink fee schedule,226.26,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,237.04,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1409.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1409.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1409.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.03,115,,,fee schedule,115% of cms fee schedule,345.66,175,,,Fee Schedule,175% of CMS Fee Schedule,365.84,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,271.43,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,283.86,100,,,Fee Schedule,100% of UHC Fee Schedule,1409.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,236.03,115,,,Fee Schedule,115% of CMS OPPS Rate,252.98,100,,,Fee Schedule,100% of UMR Fee Schedule,236.03,115,,,Fee Schedule,115% of CMS OPPS Rate,226.26,1409.4,
INTERMED REPAIR:12.6-20cm,P990310039,CDM,981,RC,12055,HCPCS,Outpatient,,,1724.5,862.25,,418.92,175,,,fee schedule,175% of aetna fee schedule,322.61,115,,,fee schedule,115% of cms physician fee schedule,329.06,117.3,,,fee schedule,117.3% of cms physician fee schedule,403.26,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.61,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,342.32,100,,,fee schedule,100% of cigna fee schedule,321.84,100,,,fee schedule,100% of healthlink fee schedule,307.21,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,321.84,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1552.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1552.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.61,115,,,fee schedule,115% of cms fee schedule,418.92,175,,,Fee Schedule,175% of CMS Fee Schedule,500.04,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,371,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,385.84,100,,,Fee Schedule,100% of UHC Fee Schedule,1552.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.61,115,,,Fee Schedule,115% of CMS OPPS Rate,343.86,100,,,Fee Schedule,100% of UMR Fee Schedule,322.61,115,,,Fee Schedule,115% of CMS OPPS Rate,307.21,1552.05,
COMPLEX REPAIR:1.1-2.5CM,P990310040,CDM,981,RC,13100,HCPCS,Outpatient,,,840,420,,558.78,135,,,fee schedule,135% of aetna fee schedule,213.04,115,,,fee schedule,115% of cms physician fee schedule,217.3,117.3,,,fee schedule,117.3% of cms physician fee schedule,266.3,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.04,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,229.14,100,,,fee schedule,100% of cigna fee schedule,215.44,100,,,fee schedule,100% of healthlink fee schedule,205.64,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,215.44,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,756,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,756,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.04,115,,,fee schedule,115% of cms fee schedule,558.78,135,,,Fee Schedule,135% of CMS Fee Schedule ,330.21,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,244.99,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,262.3,100,,,Fee Schedule,100% of UHC Fee Schedule,756,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.04,115,,,Fee Schedule,115% of CMS OPPS Rate,233.76,100,,,Fee Schedule,100% of UMR Fee Schedule,213.04,115,,,Fee Schedule,115% of CMS OPPS Rate,205.64,756,
CPLX REPAIR:2.6-7.5CM,P990310041,CDM,981,RC,13101,HCPCS,Outpatient,,,1576.5,788.25,,423.48,175,,,fee schedule,175% of aetna fee schedule,261.05,115,,,fee schedule,115% of cms physician fee schedule,266.27,117.3,,,fee schedule,117.3% of cms physician fee schedule,326.31,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,261.05,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,280.38,100,,,fee schedule,100% of cigna fee schedule,263.6,100,,,fee schedule,100% of healthlink fee schedule,251.62,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,263.6,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1418.85,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1418.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1418.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.05,115,,,fee schedule,115% of cms fee schedule,423.48,175,,,Fee Schedule,175% of CMS Fee Schedule,404.63,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,300.21,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,322.75,100,,,Fee Schedule,100% of UHC Fee Schedule,1418.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.05,115,,,Fee Schedule,115% of CMS OPPS Rate,287.63,100,,,Fee Schedule,100% of UMR Fee Schedule,261.05,115,,,Fee Schedule,115% of CMS OPPS Rate,251.62,1418.85,
COMPLEX REPAIR:1.1-2.5CM,P990310042,CDM,981,RC,13120,HCPCS,Outpatient,,,1230,615,,364.77,175,,,fee schedule,175% of aetna fee schedule,244.79,115,,,fee schedule,115% of cms physician fee schedule,249.68,117.3,,,fee schedule,117.3% of cms physician fee schedule,305.99,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.79,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262.08,100,,,fee schedule,100% of cigna fee schedule,246.4,100,,,fee schedule,100% of healthlink fee schedule,235.2,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,246.4,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1107,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1107,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1107,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.79,115,,,fee schedule,115% of cms fee schedule,364.77,175,,,Fee Schedule,175% of CMS Fee Schedule,379.42,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,281.51,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,300.91,100,,,Fee Schedule,100% of UHC Fee Schedule,1107,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,244.79,115,,,Fee Schedule,115% of CMS OPPS Rate,268.17,100,,,Fee Schedule,100% of UMR Fee Schedule,244.79,115,,,Fee Schedule,115% of CMS OPPS Rate,235.2,1107,
CPLX REPAIR:2.6-6.7 CM,P990310043,CDM,981,RC,13121,HCPCS,Outpatient,,,1905.5,952.75,,484.72,175,,,fee schedule,175% of aetna fee schedule,274.39,115,,,fee schedule,115% of cms physician fee schedule,279.88,117.3,,,fee schedule,117.3% of cms physician fee schedule,342.99,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,274.39,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296.52,100,,,fee schedule,100% of cigna fee schedule,278.77,100,,,fee schedule,100% of healthlink fee schedule,266.1,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,278.77,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1714.95,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1714.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.39,115,,,fee schedule,115% of cms fee schedule,484.72,175,,,Fee Schedule,175% of CMS Fee Schedule,425.3,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,315.55,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,341.25,100,,,Fee Schedule,100% of UHC Fee Schedule,1714.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,274.39,115,,,Fee Schedule,115% of CMS OPPS Rate,304.12,100,,,Fee Schedule,100% of UMR Fee Schedule,274.39,115,,,Fee Schedule,115% of CMS OPPS Rate,266.1,1714.95,
COMPLEX REPAIR 1.1-2.5 CM,P990310044,CDM,981,RC,13132,HCPCS,Outpatient,,,1905.5,952.75,,693.91,175,,,fee schedule,175% of aetna fee schedule,322.07,115,,,fee schedule,115% of cms physician fee schedule,328.51,117.3,,,fee schedule,117.3% of cms physician fee schedule,402.59,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.07,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348.81,100,,,fee schedule,100% of cigna fee schedule,327.94,100,,,fee schedule,100% of healthlink fee schedule,313.04,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,327.94,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1714.95,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1714.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.07,115,,,fee schedule,115% of cms fee schedule,693.91,175,,,Fee Schedule,175% of CMS Fee Schedule,499.21,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,370.38,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,401.95,100,,,Fee Schedule,100% of UHC Fee Schedule,1714.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.07,115,,,Fee Schedule,115% of CMS OPPS Rate,358.22,100,,,Fee Schedule,100% of UMR Fee Schedule,322.07,115,,,Fee Schedule,115% of CMS OPPS Rate,313.04,1714.95,
CPLX REPAIR:2.6-7.5 CM,P990310046,CDM,981,RC,13132,HCPCS,Outpatient,,,1649,824.5,,693.91,175,,,fee schedule,175% of aetna fee schedule,322.07,115,,,fee schedule,115% of cms physician fee schedule,328.51,117.3,,,fee schedule,117.3% of cms physician fee schedule,402.59,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.07,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348.81,100,,,fee schedule,100% of cigna fee schedule,327.94,100,,,fee schedule,100% of healthlink fee schedule,313.04,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,327.94,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1484.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1484.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1484.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.07,115,,,fee schedule,115% of cms fee schedule,693.91,175,,,Fee Schedule,175% of CMS Fee Schedule,499.21,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,370.38,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,401.95,100,,,Fee Schedule,100% of UHC Fee Schedule,1484.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.07,115,,,Fee Schedule,115% of CMS OPPS Rate,358.22,100,,,Fee Schedule,100% of UMR Fee Schedule,322.07,115,,,Fee Schedule,115% of CMS OPPS Rate,313.04,1484.1,
COMPLEX REPAIR:1.1-2.5CM,P990310047,CDM,981,RC,13151,HCPCS,Outpatient,,,1084.5,542.25,,473.55,175,,,fee schedule,175% of aetna fee schedule,296.04,115,,,fee schedule,115% of cms physician fee schedule,301.97,117.3,,,fee schedule,117.3% of cms physician fee schedule,370.06,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296.04,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320.1,100,,,fee schedule,100% of cigna fee schedule,300.95,100,,,fee schedule,100% of healthlink fee schedule,287.27,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,300.95,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,976.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,976.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,976.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.04,115,,,fee schedule,115% of cms fee schedule,473.55,175,,,Fee Schedule,175% of CMS Fee Schedule,458.87,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,340.45,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,367.19,100,,,Fee Schedule,100% of UHC Fee Schedule,976.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.04,115,,,Fee Schedule,115% of CMS OPPS Rate,327.24,100,,,Fee Schedule,100% of UMR Fee Schedule,296.04,115,,,Fee Schedule,115% of CMS OPPS Rate,287.27,976.05,
CPLX REPAIR:2.6-7.5 CM,P990310048,CDM,981,RC,13152,HCPCS,Outpatient,,,2846,1423,,637.26,175,,,fee schedule,175% of aetna fee schedule,357.44,115,,,fee schedule,115% of cms physician fee schedule,364.59,117.3,,,fee schedule,117.3% of cms physician fee schedule,446.8,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,357.44,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,386,100,,,fee schedule,100% of cigna fee schedule,362.9,100,,,fee schedule,100% of healthlink fee schedule,346.41,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,362.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,2561.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,2561.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2561.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,357.44,115,,,fee schedule,115% of cms fee schedule,637.26,175,,,Fee Schedule,175% of CMS Fee Schedule,554.04,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,411.06,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,444.84,100,,,Fee Schedule,100% of UHC Fee Schedule,2561.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,357.44,115,,,Fee Schedule,115% of CMS OPPS Rate,396.44,100,,,Fee Schedule,100% of UMR Fee Schedule,357.44,115,,,Fee Schedule,115% of CMS OPPS Rate,346.41,2561.4,
SUTURE REMOVAL,P990310049,CDM,981,RC,15853,HCPCS,Outpatient,,,104,52,,,,,,other,not seperately reimbusable,11.47,115,,,fee schedule,115% of cms physician fee schedule,11.69,117.3,,,fee schedule,117.3% of cms physician fee schedule,14.33,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.47,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.48,62,,,Percent of total Billed Charges,62% of total billed charges,64.48,62,,,Percent of Total Billed Charges,62% of Healthlink HMO Fee Schedule,64.48,62,,,Percent of Total Billed Charges,62% of Total Billed Charges,93.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,93.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.47,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,17.77,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,13.19,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,93.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.47,115,,,Fee Schedule,115% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,11.47,115,,,Fee Schedule,115% of CMS OPPS Rate,11.47,93.6,
1 DEGREE LOCAL TREATMENT,P990310050,CDM,981,RC,16000,HCPCS,Outpatient,,,224.5,112.25,,73.64,175,,,fee schedule,175% of aetna fee schedule,49.69,115,,,fee schedule,115% of cms physician fee schedule,50.69,117.3,,,fee schedule,117.3% of cms physician fee schedule,62.11,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.69,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.77,100,,,fee schedule,100% of cigna fee schedule,50.56,100,,,fee schedule,100% of healthlink fee schedule,48.26,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,50.56,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,202.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,202.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.69,115,,,fee schedule,115% of cms fee schedule,73.64,175,,,Fee Schedule,175% of CMS Fee Schedule,77.02,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,57.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,59.14,100,,,Fee Schedule,100% of UHC Fee Schedule,202.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.69,115,,,Fee Schedule,115% of CMS OPPS Rate,52.7,100,,,Fee Schedule,100% of UMR Fee Schedule,49.69,115,,,Fee Schedule,115% of CMS OPPS Rate,48.26,202.05,
"BURN DEBRIDEMENT, SMALL",P990310051,CDM,981,RC,16020,HCPCS,Outpatient,,,362,181,,145.69,135,,,fee schedule,135% of aetna fee schedule,59.13,115,,,fee schedule,115% of cms physician fee schedule,60.32,117.3,,,fee schedule,117.3% of cms physician fee schedule,73.92,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.13,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.98,100,,,fee schedule,100% of cigna fee schedule,57.33,100,,,fee schedule,100% of healthlink fee schedule,54.73,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,57.33,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,325.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,325.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.13,115,,,fee schedule,115% of cms fee schedule,145.69,135,,,Fee Schedule,135% of CMS Fee Schedule ,91.66,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,68,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,68.7,100,,,Fee Schedule,100% of UHC Fee Schedule,325.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.13,115,,,Fee Schedule,115% of CMS OPPS Rate,61.23,100,,,Fee Schedule,100% of UMR Fee Schedule,59.13,115,,,Fee Schedule,115% of CMS OPPS Rate,54.73,325.8,
MEDIUM (FACE OR WHOLE EXT)BURN,P990310052,CDM,981,RC,16025,HCPCS,Outpatient,,,398.5,199.25,,174.32,175,,,fee schedule,175% of aetna fee schedule,119.49,115,,,fee schedule,115% of cms physician fee schedule,121.87,117.3,,,fee schedule,117.3% of cms physician fee schedule,149.36,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.49,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.21,100,,,fee schedule,100% of cigna fee schedule,118.66,100,,,fee schedule,100% of healthlink fee schedule,113.26,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,118.66,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,358.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,358.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.49,115,,,fee schedule,115% of cms fee schedule,174.32,175,,,Fee Schedule,175% of CMS Fee Schedule,185.2,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,137.41,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,140.84,100,,,Fee Schedule,100% of UHC Fee Schedule,358.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.49,115,,,Fee Schedule,115% of CMS OPPS Rate,125.51,100,,,Fee Schedule,100% of UMR Fee Schedule,119.49,115,,,Fee Schedule,115% of CMS OPPS Rate,113.26,358.65,
LARGE (> 1 EXTREMITY) BURN,P990310053,CDM,981,RC,16030,HCPCS,Outpatient,,,457.5,228.75,,199.24,175,,,fee schedule,175% of aetna fee schedule,141.57,115,,,fee schedule,115% of cms physician fee schedule,144.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,176.96,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.57,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,152.34,100,,,fee schedule,100% of cigna fee schedule,143.23,100,,,fee schedule,100% of healthlink fee schedule,136.72,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,143.23,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,411.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,411.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,411.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.57,115,,,fee schedule,115% of cms fee schedule,199.24,175,,,Fee Schedule,175% of CMS Fee Schedule,219.43,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,162.8,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,170.31,100,,,Fee Schedule,100% of UHC Fee Schedule,411.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.57,115,,,Fee Schedule,115% of CMS OPPS Rate,151.78,100,,,Fee Schedule,100% of UMR Fee Schedule,141.57,115,,,Fee Schedule,115% of CMS OPPS Rate,136.72,411.75,
"DESTRUC PREMALIG LESIONS, 1ST",P990310054,CDM,981,RC,17000,HCPCS,Outpatient,,,398.5,199.25,,79.87,175,,,fee schedule,175% of aetna fee schedule,57.82,115,,,fee schedule,115% of cms physician fee schedule,58.98,117.3,,,fee schedule,117.3% of cms physician fee schedule,72.28,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.82,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.18,100,,,fee schedule,100% of cigna fee schedule,55.64,100,,,fee schedule,100% of healthlink fee schedule,53.11,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,55.64,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,358.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,358.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.82,115,,,fee schedule,115% of cms fee schedule,79.87,175,,,Fee Schedule,175% of CMS Fee Schedule,89.62,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,66.5,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,67.56,100,,,Fee Schedule,100% of UHC Fee Schedule,358.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.82,115,,,Fee Schedule,115% of CMS OPPS Rate,60.21,100,,,Fee Schedule,100% of UMR Fee Schedule,57.82,115,,,Fee Schedule,115% of CMS OPPS Rate,53.11,358.65,
"MASTOTOMY W/EXP,DRNG ABSS DEEP",P990310055,CDM,981,RC,19020,HCPCS,Outpatient,,,1387,693.5,,422.42,175,,,fee schedule,175% of aetna fee schedule,334.48,115,,,fee schedule,115% of cms physician fee schedule,341.17,117.3,,,fee schedule,117.3% of cms physician fee schedule,418.1,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,334.48,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348.2,100,,,fee schedule,100% of cigna fee schedule,327.36,100,,,fee schedule,100% of healthlink fee schedule,312.48,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,327.36,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1248.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1248.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1248.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.48,115,,,fee schedule,115% of cms fee schedule,422.42,175,,,Fee Schedule,175% of CMS Fee Schedule,518.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,384.65,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,392.54,100,,,Fee Schedule,100% of UHC Fee Schedule,1248.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.48,115,,,Fee Schedule,115% of CMS OPPS Rate,349.83,100,,,Fee Schedule,100% of UMR Fee Schedule,334.48,115,,,Fee Schedule,115% of CMS OPPS Rate,312.48,1248.3,
EXP PENETRATING WOUND/EXTREMTY,P990310056,CDM,981,RC,20103,HCPCS,Outpatient,,,1240.5,620.25,,531.06,175,,,fee schedule,175% of aetna fee schedule,371.19,115,,,fee schedule,115% of cms physician fee schedule,378.61,117.3,,,fee schedule,117.3% of cms physician fee schedule,463.98,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,371.19,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,396.62,100,,,fee schedule,100% of cigna fee schedule,423.74,100,,,fee schedule,100% of healthlink fee schedule,406.79,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,423.74,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1116.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,371.19,115,,,fee schedule,115% of cms fee schedule,531.06,175,,,Fee Schedule,175% of CMS Fee Schedule,575.34,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,426.86,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,456.12,100,,,Fee Schedule,100% of UHC Fee Schedule,1116.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,371.19,115,,,Fee Schedule,115% of CMS OPPS Rate,408.01,100,,,Fee Schedule,100% of UMR Fee Schedule,371.19,115,,,Fee Schedule,115% of CMS OPPS Rate,371.19,1116.45,
"RFB MUSCLE, SIMPLE",P990310057,CDM,981,RC,20520,HCPCS,Outpatient,,,444.5,222.25,,360.63,135,,,fee schedule,135% of aetna fee schedule,157.35,115,,,fee schedule,115% of cms physician fee schedule,160.5,117.3,,,fee schedule,117.3% of cms physician fee schedule,196.69,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.35,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164.81,100,,,fee schedule,100% of cigna fee schedule,176.08,100,,,fee schedule,100% of healthlink fee schedule,169.03,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,176.08,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,400.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,400.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.35,115,,,fee schedule,115% of cms fee schedule,360.63,135,,,Fee Schedule,135% of CMS Fee Schedule ,243.9,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,180.96,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,190.53,100,,,Fee Schedule,100% of UHC Fee Schedule,400.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.35,115,,,Fee Schedule,115% of CMS OPPS Rate,170.43,100,,,Fee Schedule,100% of UMR Fee Schedule,157.35,115,,,Fee Schedule,115% of CMS OPPS Rate,157.35,400.05,
"RFB MUSCLE, DEEP OR COMPLEX",P990310058,CDM,981,RC,20525,HCPCS,Outpatient,,,749,374.5,,370.74,175,,,fee schedule,175% of aetna fee schedule,264.65,115,,,fee schedule,115% of cms physician fee schedule,269.94,117.3,,,fee schedule,117.3% of cms physician fee schedule,330.81,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,264.65,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,280.05,100,,,fee schedule,100% of cigna fee schedule,299.2,100,,,fee schedule,100% of healthlink fee schedule,287.23,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,299.2,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,674.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,674.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.65,115,,,fee schedule,115% of cms fee schedule,370.74,175,,,Fee Schedule,175% of CMS Fee Schedule,410.21,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,304.35,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,323.92,100,,,Fee Schedule,100% of UHC Fee Schedule,674.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,264.65,115,,,Fee Schedule,115% of CMS OPPS Rate,289.75,100,,,Fee Schedule,100% of UMR Fee Schedule,264.65,115,,,Fee Schedule,115% of CMS OPPS Rate,264.65,674.1,
INJ SINGLE TENDON/LIGAMENT,P990310059,CDM,981,RC,20550,HCPCS,Outpatient,,,320,160,,131.65,135,,,fee schedule,135% of aetna fee schedule,42.3,115,,,fee schedule,115% of cms physician fee schedule,43.14,117.3,,,fee schedule,117.3% of cms physician fee schedule,52.87,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.3,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.62,100,,,fee schedule,100% of cigna fee schedule,48.74,100,,,fee schedule,100% of healthlink fee schedule,46.79,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,48.74,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,288,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.3,115,,,fee schedule,115% of cms fee schedule,131.65,135,,,Fee Schedule,135% of CMS Fee Schedule ,65.56,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,48.64,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,51.8,100,,,Fee Schedule,100% of UHC Fee Schedule,288,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.3,115,,,Fee Schedule,115% of CMS OPPS Rate,46.34,100,,,Fee Schedule,100% of UMR Fee Schedule,42.3,115,,,Fee Schedule,115% of CMS OPPS Rate,42.3,288,
"INJ, 1 0R 2 MUSCLE TRIGGER PT",P990310060,CDM,981,RC,20552,HCPCS,Outpatient,,,320,160,,58.28,175,,,fee schedule,175% of aetna fee schedule,39.8,115,,,fee schedule,115% of cms physician fee schedule,40.6,117.3,,,fee schedule,117.3% of cms physician fee schedule,49.75,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.8,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.35,100,,,fee schedule,100% of cigna fee schedule,47.39,100,,,fee schedule,100% of healthlink fee schedule,45.49,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,47.39,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,288,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.8,115,,,fee schedule,115% of cms fee schedule,58.28,175,,,Fee Schedule,175% of CMS Fee Schedule,61.69,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,45.77,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,49.77,100,,,Fee Schedule,100% of UHC Fee Schedule,288,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.8,115,,,Fee Schedule,115% of CMS OPPS Rate,44.52,100,,,Fee Schedule,100% of UMR Fee Schedule,39.8,115,,,Fee Schedule,115% of CMS OPPS Rate,39.8,288,
SM JOINT ARTHROCENT/INJ BURSA,P990310061,CDM,981,RC,20600,HCPCS,Outpatient,,,211.5,105.75,,109.01,135,,,fee schedule,135% of aetna fee schedule,38.84,115,,,fee schedule,115% of cms physician fee schedule,39.61,117.3,,,fee schedule,117.3% of cms physician fee schedule,48.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.84,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.82,100,,,fee schedule,100% of cigna fee schedule,44.68,100,,,fee schedule,100% of healthlink fee schedule,42.89,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,44.68,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,190.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,190.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.84,115,,,fee schedule,115% of cms fee schedule,109.01,135,,,Fee Schedule,135% of CMS Fee Schedule ,60.2,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,44.66,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,47.16,100,,,Fee Schedule,100% of UHC Fee Schedule,190.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.84,115,,,Fee Schedule,115% of CMS OPPS Rate,42.18,100,,,Fee Schedule,100% of UMR Fee Schedule,38.84,115,,,Fee Schedule,115% of CMS OPPS Rate,38.84,190.35,
INTER(TMJ/AC/WRIST/ELB/AN,P990310062,CDM,981,RC,20605,HCPCS,Outpatient,,,241,120.5,,112.49,135,,,fee schedule,135% of aetna fee schedule,39.93,115,,,fee schedule,115% of cms physician fee schedule,40.73,117.3,,,fee schedule,117.3% of cms physician fee schedule,49.91,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.93,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.39,100,,,fee schedule,100% of cigna fee schedule,46.35,100,,,fee schedule,100% of healthlink fee schedule,44.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,46.35,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,216.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,216.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.93,115,,,fee schedule,115% of cms fee schedule,112.49,135,,,Fee Schedule,135% of CMS Fee Schedule ,61.89,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,45.92,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,48.97,100,,,Fee Schedule,100% of UHC Fee Schedule,216.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.93,115,,,Fee Schedule,115% of CMS OPPS Rate,43.81,100,,,Fee Schedule,100% of UMR Fee Schedule,39.93,115,,,Fee Schedule,115% of CMS OPPS Rate,39.93,216.9,
ARTHROCENTESIS/INJ MAJ JT,P990310063,CDM,981,RC,20610,HCPCS,Outpatient,,,355,177.5,,134.95,135,,,fee schedule,135% of aetna fee schedule,49.12,115,,,fee schedule,115% of cms physician fee schedule,50.1,117.3,,,fee schedule,117.3% of cms physician fee schedule,61.4,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.12,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.81,100,,,fee schedule,100% of cigna fee schedule,56.41,100,,,fee schedule,100% of healthlink fee schedule,54.16,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,56.41,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,319.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,319.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,115,,,fee schedule,115% of cms fee schedule,134.95,135,,,Fee Schedule,135% of CMS Fee Schedule ,76.13,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,56.48,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,60.42,100,,,Fee Schedule,100% of UHC Fee Schedule,319.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.12,115,,,Fee Schedule,115% of CMS OPPS Rate,54.04,100,,,Fee Schedule,100% of UMR Fee Schedule,49.12,115,,,Fee Schedule,115% of CMS OPPS Rate,49.12,319.5,
"FX, ORBIT",P990310064,CDM,981,RC,21400,HCPCS,Outpatient,,,588,294,,206.55,175,,,fee schedule,175% of aetna fee schedule,178.34,115,,,fee schedule,115% of cms physician fee schedule,181.91,117.3,,,fee schedule,117.3% of cms physician fee schedule,222.93,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.34,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,175.76,100,,,fee schedule,100% of cigna fee schedule,187.78,100,,,fee schedule,100% of healthlink fee schedule,180.26,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,187.78,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,529.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,529.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.34,115,,,fee schedule,115% of cms fee schedule,206.55,175,,,Fee Schedule,175% of CMS Fee Schedule,276.43,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,205.09,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,206.94,100,,,Fee Schedule,100% of UHC Fee Schedule,529.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.34,115,,,Fee Schedule,115% of CMS OPPS Rate,185.11,100,,,Fee Schedule,100% of UMR Fee Schedule,178.34,115,,,Fee Schedule,115% of CMS OPPS Rate,175.76,529.2,
"FX, MANDIBLE",P990310065,CDM,981,RC,21450,HCPCS,Outpatient,,,664.5,332.25,,643.3,175,,,fee schedule,175% of aetna fee schedule,493.19,115,,,fee schedule,115% of cms physician fee schedule,503.05,117.3,,,fee schedule,117.3% of cms physician fee schedule,616.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,493.19,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,508.02,100,,,fee schedule,100% of cigna fee schedule,542.75,100,,,fee schedule,100% of healthlink fee schedule,521.04,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,542.75,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,493.19,115,,,fee schedule,115% of cms fee schedule,643.3,175,,,Fee Schedule,175% of CMS Fee Schedule,764.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,567.17,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,606.09,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,493.19,115,,,Fee Schedule,115% of CMS OPPS Rate,542.17,100,,,Fee Schedule,100% of UMR Fee Schedule,493.19,115,,,Fee Schedule,115% of CMS OPPS Rate,493.19,764.44,
TMJ DISLOCATION,P990310066,CDM,981,RC,21480,HCPCS,Outpatient,,,514,257,,51.08,175,,,fee schedule,175% of aetna fee schedule,34.03,115,,,fee schedule,115% of cms physician fee schedule,34.71,117.3,,,fee schedule,117.3% of cms physician fee schedule,42.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.03,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.22,100,,,fee schedule,100% of cigna fee schedule,39.76,100,,,fee schedule,100% of healthlink fee schedule,38.17,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,39.76,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,462.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,462.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,462.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.03,115,,,fee schedule,115% of cms fee schedule,51.08,175,,,Fee Schedule,175% of CMS Fee Schedule,52.74,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,39.13,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,41.8,100,,,Fee Schedule,100% of UHC Fee Schedule,462.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.03,115,,,Fee Schedule,115% of CMS OPPS Rate,37.4,100,,,Fee Schedule,100% of UMR Fee Schedule,34.03,115,,,Fee Schedule,115% of CMS OPPS Rate,34.03,462.6,
"FX, STERNUM",P990310067,CDM,981,RC,21820,HCPCS,Outpatient,,,615,307.5,,324.39,135,,,fee schedule,135% of aetna fee schedule,158.94,115,,,fee schedule,115% of cms physician fee schedule,162.12,117.3,,,fee schedule,117.3% of cms physician fee schedule,198.68,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,158.94,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,158.99,100,,,fee schedule,100% of cigna fee schedule,169.86,100,,,fee schedule,100% of healthlink fee schedule,163.07,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,169.86,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,553.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,553.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.94,115,,,fee schedule,115% of cms fee schedule,324.39,135,,,Fee Schedule,135% of CMS Fee Schedule ,246.36,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,182.78,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,184.99,100,,,Fee Schedule,100% of UHC Fee Schedule,553.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,158.94,115,,,Fee Schedule,115% of CMS OPPS Rate,165.48,100,,,Fee Schedule,100% of UMR Fee Schedule,158.94,115,,,Fee Schedule,115% of CMS OPPS Rate,158.94,553.5,
"FX, CERVICAL SPINE",P990310068,CDM,981,RC,22310,HCPCS,Outpatient,,,758.5,379.25,,397.53,175,,,fee schedule,175% of aetna fee schedule,318.34,115,,,fee schedule,115% of cms physician fee schedule,324.71,117.3,,,fee schedule,117.3% of cms physician fee schedule,397.93,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318.34,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,325.71,100,,,fee schedule,100% of cigna fee schedule,347.98,100,,,fee schedule,100% of healthlink fee schedule,334.06,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,347.98,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,682.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,682.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,682.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.34,115,,,fee schedule,115% of cms fee schedule,397.53,175,,,Fee Schedule,175% of CMS Fee Schedule,493.43,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,366.09,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,372.3,100,,,Fee Schedule,100% of UHC Fee Schedule,682.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318.34,115,,,Fee Schedule,115% of CMS OPPS Rate,333.03,100,,,Fee Schedule,100% of UMR Fee Schedule,318.34,115,,,Fee Schedule,115% of CMS OPPS Rate,318.34,682.65,
"FX, CLAVICAL W/O MANIP",P990310069,CDM,981,RC,23500,HCPCS,Outpatient,,,747,373.5,,292.71,175,,,fee schedule,175% of aetna fee schedule,248.03,115,,,fee schedule,115% of cms physician fee schedule,252.99,117.3,,,fee schedule,117.3% of cms physician fee schedule,310.04,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248.03,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247.71,100,,,fee schedule,100% of cigna fee schedule,264.65,500,,,fee schedule,500% of healthlink,254.06,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,264.65,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,672.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,672.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.03,115,,,fee schedule,115% of cms fee schedule,292.71,175,,,Fee Schedule,175% of CMS Fee Schedule,384.45,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,285.24,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,287.63,100,,,Fee Schedule,100% of UHC Fee Schedule,672.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.03,115,,,Fee Schedule,115% of CMS OPPS Rate,257.29,100,,,Fee Schedule,100% of UMR Fee Schedule,248.03,115,,,Fee Schedule,115% of CMS OPPS Rate,247.71,672.3,
"FX, CLAVICLE W/MANIP",P990310070,CDM,981,RC,23505,HCPCS,Outpatient,,,1049.5,524.75,,463.05,175,,,fee schedule,175% of aetna fee schedule,363.99,115,,,fee schedule,115% of cms physician fee schedule,371.27,117.3,,,fee schedule,117.3% of cms physician fee schedule,454.98,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,363.99,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,372.58,100,,,fee schedule,100% of cigna fee schedule,398.06,100,,,fee schedule,100% of healthlink fee schedule,382.14,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,398.06,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,944.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,944.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,944.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.99,115,,,fee schedule,115% of cms fee schedule,463.05,175,,,Fee Schedule,175% of CMS Fee Schedule,564.18,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,418.58,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,431.03,100,,,Fee Schedule,100% of UHC Fee Schedule,944.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,363.99,115,,,Fee Schedule,115% of CMS OPPS Rate,385.57,100,,,Fee Schedule,100% of UMR Fee Schedule,363.99,115,,,Fee Schedule,115% of CMS OPPS Rate,363.99,944.55,
TREATMENT A/C DISLOCATION,P990310071,CDM,981,RC,23540,HCPCS,Outpatient,,,731.5,365.75,,300.51,175,,,fee schedule,175% of aetna fee schedule,257.11,115,,,fee schedule,115% of cms physician fee schedule,262.25,117.3,,,fee schedule,117.3% of cms physician fee schedule,321.38,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,257.11,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,255.56,100,,,fee schedule,100% of cigna fee schedule,273.04,100,,,fee schedule,100% of healthlink fee schedule,262.12,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,273.04,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,658.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,658.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,658.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.11,115,,,fee schedule,115% of cms fee schedule,300.51,175,,,Fee Schedule,175% of CMS Fee Schedule,398.51,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,295.67,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,296.41,100,,,Fee Schedule,100% of UHC Fee Schedule,658.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,257.11,115,,,Fee Schedule,115% of CMS OPPS Rate,265.15,100,,,Fee Schedule,100% of UMR Fee Schedule,257.11,115,,,Fee Schedule,115% of CMS OPPS Rate,255.56,658.35,
"FX, SCAPULA",P990310072,CDM,981,RC,23570,HCPCS,Outpatient,,,671.5,335.75,,317.87,175,,,fee schedule,175% of aetna fee schedule,263.33,115,,,fee schedule,115% of cms physician fee schedule,268.59,117.3,,,fee schedule,117.3% of cms physician fee schedule,329.16,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,263.33,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,264.61,100,,,fee schedule,100% of cigna fee schedule,282.7,100,,,fee schedule,100% of healthlink fee schedule,271.39,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,282.7,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,604.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,604.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.33,115,,,fee schedule,115% of cms fee schedule,317.87,175,,,Fee Schedule,175% of CMS Fee Schedule,408.16,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,302.83,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,308.48,100,,,Fee Schedule,100% of UHC Fee Schedule,604.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,263.33,115,,,Fee Schedule,115% of CMS OPPS Rate,275.95,100,,,Fee Schedule,100% of UMR Fee Schedule,263.33,115,,,Fee Schedule,115% of CMS OPPS Rate,263.33,604.35,
"FX, HUMORAL NECK W/O MANIP",P990310073,CDM,981,RC,23600,HCPCS,Outpatient,,,828.5,414.25,,408.68,175,,,fee schedule,175% of aetna fee schedule,342.04,115,,,fee schedule,115% of cms physician fee schedule,348.89,117.3,,,fee schedule,117.3% of cms physician fee schedule,427.56,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,342.04,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,342.18,100,,,fee schedule,100% of cigna fee schedule,365.58,100,,,fee schedule,100% of healthlink fee schedule,350.95,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,365.58,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.04,115,,,fee schedule,115% of cms fee schedule,408.68,175,,,Fee Schedule,175% of CMS Fee Schedule,530.17,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,393.35,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,398.2,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.04,115,,,Fee Schedule,115% of CMS OPPS Rate,356.2,100,,,Fee Schedule,100% of UMR Fee Schedule,342.04,115,,,Fee Schedule,115% of CMS OPPS Rate,342.04,745.65,
"FX, HUMERAL TUBERSITY W/O MANP",P990310074,CDM,981,RC,23620,HCPCS,Outpatient,,,828.5,414.25,,343.14,175,,,fee schedule,175% of aetna fee schedule,281.77,115,,,fee schedule,115% of cms physician fee schedule,287.41,117.3,,,fee schedule,117.3% of cms physician fee schedule,352.22,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,281.77,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,284.28,100,,,fee schedule,100% of cigna fee schedule,303.71,100,,,fee schedule,100% of healthlink fee schedule,291.56,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,303.71,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.77,115,,,fee schedule,115% of cms fee schedule,343.14,175,,,Fee Schedule,175% of CMS Fee Schedule,436.75,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,324.04,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,330.65,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.77,115,,,Fee Schedule,115% of CMS OPPS Rate,295.78,100,,,Fee Schedule,100% of UMR Fee Schedule,281.77,115,,,Fee Schedule,115% of CMS OPPS Rate,281.77,745.65,
TREAT SHOULDER DISLOCAT,P990310075,CDM,981,RC,23650,HCPCS,Outpatient,,,969,484.5,,378.49,175,,,fee schedule,175% of aetna fee schedule,328.53,115,,,fee schedule,115% of cms physician fee schedule,335.1,117.3,,,fee schedule,117.3% of cms physician fee schedule,410.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,328.53,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,325.33,100,,,fee schedule,100% of cigna fee schedule,347.58,100,,,fee schedule,100% of healthlink fee schedule,333.67,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,347.58,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,872.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,872.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,872.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.53,115,,,fee schedule,115% of cms fee schedule,378.49,175,,,Fee Schedule,175% of CMS Fee Schedule,509.22,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,377.81,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,375.72,100,,,Fee Schedule,100% of UHC Fee Schedule,872.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,328.53,115,,,Fee Schedule,115% of CMS OPPS Rate,336.09,100,,,Fee Schedule,100% of UMR Fee Schedule,328.53,115,,,Fee Schedule,115% of CMS OPPS Rate,325.33,872.1,
TREAT SHOULDER DISLOCATION ANE,P990310076,CDM,981,RC,23655,HCPCS,Outpatient,,,1143,571.5,,553.91,175,,,fee schedule,175% of aetna fee schedule,440.52,115,,,fee schedule,115% of cms physician fee schedule,449.33,117.3,,,fee schedule,117.3% of cms physician fee schedule,550.65,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,440.52,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,451.99,100,,,fee schedule,100% of cigna fee schedule,482.9,100,,,fee schedule,100% of healthlink fee schedule,463.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,482.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1028.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1028.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1028.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,440.52,115,,,fee schedule,115% of cms fee schedule,553.91,175,,,Fee Schedule,175% of CMS Fee Schedule,682.8,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,506.6,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,524.79,100,,,Fee Schedule,100% of UHC Fee Schedule,1028.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,440.52,115,,,Fee Schedule,115% of CMS OPPS Rate,469.44,100,,,Fee Schedule,100% of UMR Fee Schedule,440.52,115,,,Fee Schedule,115% of CMS OPPS Rate,440.52,1028.7,
"RFB UPPER ARM, SQ",P990310077,CDM,981,RC,24200,HCPCS,Outpatient,,,582.5,291.25,,194.88,175,,,fee schedule,175% of aetna fee schedule,151.36,115,,,fee schedule,115% of cms physician fee schedule,154.39,117.3,,,fee schedule,117.3% of cms physician fee schedule,189.2,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,151.36,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,158.18,100,,,fee schedule,100% of cigna fee schedule,169,100,,,fee schedule,100% of healthlink fee schedule,162.24,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,169,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,524.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,524.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,524.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.36,115,,,fee schedule,115% of cms fee schedule,194.88,175,,,Fee Schedule,175% of CMS Fee Schedule,234.61,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,174.07,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,181.11,100,,,Fee Schedule,100% of UHC Fee Schedule,524.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,151.36,115,,,Fee Schedule,115% of CMS OPPS Rate,162.01,100,,,Fee Schedule,100% of UMR Fee Schedule,151.36,115,,,Fee Schedule,115% of CMS OPPS Rate,151.36,524.25,
"FX, HUMORAL SHAFT",P990310078,CDM,981,RC,24500,HCPCS,Outpatient,,,747,373.5,,436.54,175,,,fee schedule,175% of aetna fee schedule,363.15,115,,,fee schedule,115% of cms physician fee schedule,370.41,117.3,,,fee schedule,117.3% of cms physician fee schedule,453.93,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,363.15,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364.35,100,,,fee schedule,100% of cigna fee schedule,389.26,500,,,fee schedule,500% of healthlink,373.69,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,389.26,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,672.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,672.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.15,115,,,fee schedule,115% of cms fee schedule,436.54,175,,,Fee Schedule,175% of CMS Fee Schedule,562.88,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,417.62,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,422.73,100,,,Fee Schedule,100% of UHC Fee Schedule,672.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,363.15,115,,,Fee Schedule,115% of CMS OPPS Rate,378.15,100,,,Fee Schedule,100% of UMR Fee Schedule,363.15,115,,,Fee Schedule,115% of CMS OPPS Rate,363.15,672.3,
SUPRA/TRANSCONDYLAR HUM/F,P990310079,CDM,981,RC,24530,HCPCS,Outpatient,,,828.5,414.25,,468.98,175,,,fee schedule,175% of aetna fee schedule,381.48,115,,,fee schedule,115% of cms physician fee schedule,389.11,117.3,,,fee schedule,117.3% of cms physician fee schedule,476.85,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,381.48,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,384.27,100,,,fee schedule,100% of cigna fee schedule,410.54,100,,,fee schedule,100% of healthlink fee schedule,394.12,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,410.54,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,381.48,115,,,fee schedule,115% of cms fee schedule,468.98,175,,,Fee Schedule,175% of CMS Fee Schedule,591.29,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,438.7,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,447.45,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,381.48,115,,,Fee Schedule,115% of CMS OPPS Rate,400.26,100,,,Fee Schedule,100% of UMR Fee Schedule,381.48,115,,,Fee Schedule,115% of CMS OPPS Rate,381.48,745.65,
EPICONDYLAR FX HUM,P990310080,CDM,981,RC,24560,HCPCS,Outpatient,,,828.5,414.25,,385.53,175,,,fee schedule,175% of aetna fee schedule,320,115,,,fee schedule,115% of cms physician fee schedule,326.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,400,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.6,100,,,fee schedule,100% of cigna fee schedule,345.73,100,,,fee schedule,100% of healthlink fee schedule,331.9,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,345.73,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320,115,,,fee schedule,115% of cms fee schedule,385.53,175,,,Fee Schedule,175% of CMS Fee Schedule,496,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,368,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,374.11,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,320,115,,,Fee Schedule,115% of CMS OPPS Rate,334.65,100,,,Fee Schedule,100% of UMR Fee Schedule,320,115,,,Fee Schedule,115% of CMS OPPS Rate,320,745.65,
ELBOW DISLOCATION,P990310081,CDM,981,RC,24600,HCPCS,Outpatient,,,1075,537.5,,465.34,175,,,fee schedule,175% of aetna fee schedule,374.75,115,,,fee schedule,115% of cms physician fee schedule,382.25,117.3,,,fee schedule,117.3% of cms physician fee schedule,468.44,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,374.75,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,379.66,100,,,fee schedule,100% of cigna fee schedule,405.63,100,,,fee schedule,100% of healthlink fee schedule,389.4,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,405.63,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,967.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,967.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,967.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.75,115,,,fee schedule,115% of cms fee schedule,465.34,175,,,Fee Schedule,175% of CMS Fee Schedule,580.86,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,430.96,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,435.9,100,,,Fee Schedule,100% of UHC Fee Schedule,967.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,374.75,115,,,Fee Schedule,115% of CMS OPPS Rate,389.93,100,,,Fee Schedule,100% of UMR Fee Schedule,374.75,115,,,Fee Schedule,115% of CMS OPPS Rate,374.75,967.5,
ELBOW DISLOCATION W/ANES,P990310082,CDM,981,RC,24605,HCPCS,Outpatient,,,1240.5,620.25,,661.71,175,,,fee schedule,175% of aetna fee schedule,515.79,115,,,fee schedule,115% of cms physician fee schedule,526.1,117.3,,,fee schedule,117.3% of cms physician fee schedule,644.73,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,515.79,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,530.08,100,,,fee schedule,100% of cigna fee schedule,566.33,100,,,fee schedule,100% of healthlink fee schedule,543.67,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,566.33,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1116.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.79,115,,,fee schedule,115% of cms fee schedule,661.71,175,,,Fee Schedule,175% of CMS Fee Schedule,799.47,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,593.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,616.68,100,,,Fee Schedule,100% of UHC Fee Schedule,1116.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,515.79,115,,,Fee Schedule,115% of CMS OPPS Rate,551.64,100,,,Fee Schedule,100% of UMR Fee Schedule,515.79,115,,,Fee Schedule,115% of CMS OPPS Rate,515.79,1116.45,
CLSD TX MONTEGA FX DISLOC ELBO,P990310083,CDM,981,RC,24620,HCPCS,Outpatient,,,1075,537.5,,800.63,175,,,fee schedule,175% of aetna fee schedule,634.8,115,,,fee schedule,115% of cms physician fee schedule,647.5,117.3,,,fee schedule,117.3% of cms physician fee schedule,793.5,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,634.8,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,625.33,100,,,fee schedule,100% of cigna fee schedule,668.09,100,,,fee schedule,100% of healthlink fee schedule,641.36,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,668.09,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,967.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,967.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,967.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.8,115,,,fee schedule,115% of cms fee schedule,800.63,175,,,Fee Schedule,175% of CMS Fee Schedule,983.94,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,730.02,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,721.75,100,,,Fee Schedule,100% of UHC Fee Schedule,967.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,634.8,115,,,Fee Schedule,115% of CMS OPPS Rate,645.63,100,,,Fee Schedule,100% of UMR Fee Schedule,634.8,115,,,Fee Schedule,115% of CMS OPPS Rate,625.33,983.94,
NURSEMAIDS ELBOW,P990310084,CDM,981,RC,24640,HCPCS,Outpatient,,,828.5,414.25,,125.48,175,,,fee schedule,175% of aetna fee schedule,86.3,115,,,fee schedule,115% of cms physician fee schedule,88.02,117.3,,,fee schedule,117.3% of cms physician fee schedule,107.87,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.3,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,89.53,100,,,fee schedule,100% of cigna fee schedule,95.65,100,,,fee schedule,100% of healthlink fee schedule,91.82,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,95.65,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.3,115,,,fee schedule,115% of cms fee schedule,125.48,175,,,Fee Schedule,175% of CMS Fee Schedule,133.76,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,99.24,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,101.36,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.3,115,,,Fee Schedule,115% of CMS OPPS Rate,90.67,100,,,Fee Schedule,100% of UMR Fee Schedule,86.3,115,,,Fee Schedule,115% of CMS OPPS Rate,86.3,745.65,
"FX, RADIAL HEAD W/O MANIP",P990310085,CDM,981,RC,24650,HCPCS,Outpatient,,,828.5,414.25,,317.07,175,,,fee schedule,175% of aetna fee schedule,266.94,115,,,fee schedule,115% of cms physician fee schedule,272.28,117.3,,,fee schedule,117.3% of cms physician fee schedule,333.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.94,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.79,100,,,fee schedule,100% of cigna fee schedule,285.04,100,,,fee schedule,100% of healthlink fee schedule,273.64,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,285.04,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.94,115,,,fee schedule,115% of cms fee schedule,317.07,175,,,Fee Schedule,175% of CMS Fee Schedule,413.75,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,306.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,310.91,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,266.94,115,,,Fee Schedule,115% of CMS OPPS Rate,278.12,100,,,Fee Schedule,100% of UMR Fee Schedule,266.94,115,,,Fee Schedule,115% of CMS OPPS Rate,266.79,745.65,
Radial Head Fx w/Manipulation,P990310086,CDM,981,RC,24655,HCPCS,Outpatient,,,1114,557,,554.8,175,,,fee schedule,175% of aetna fee schedule,441.67,115,,,fee schedule,115% of cms physician fee schedule,450.5,117.3,,,fee schedule,117.3% of cms physician fee schedule,552.09,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,441.67,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445.31,100,,,fee schedule,100% of cigna fee schedule,475.76,100,,,fee schedule,100% of healthlink fee schedule,456.73,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,475.76,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1002.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1002.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1002.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.67,115,,,fee schedule,115% of cms fee schedule,554.8,175,,,Fee Schedule,175% of CMS Fee Schedule,684.59,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,507.92,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,519.67,100,,,Fee Schedule,100% of UHC Fee Schedule,1002.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,441.67,115,,,Fee Schedule,115% of CMS OPPS Rate,464.86,100,,,Fee Schedule,100% of UMR Fee Schedule,441.67,115,,,Fee Schedule,115% of CMS OPPS Rate,441.67,1002.6,
ULNAR FX PROX-FOREARM,P990310087,CDM,981,RC,24670,HCPCS,Outpatient,,,828.5,414.25,,353.64,175,,,fee schedule,175% of aetna fee schedule,290.79,115,,,fee schedule,115% of cms physician fee schedule,296.6,117.3,,,fee schedule,117.3% of cms physician fee schedule,363.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290.79,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,293.15,100,,,fee schedule,100% of cigna fee schedule,313.19,100,,,fee schedule,100% of healthlink fee schedule,300.66,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,313.19,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.79,115,,,fee schedule,115% of cms fee schedule,353.64,175,,,Fee Schedule,175% of CMS Fee Schedule,450.72,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,334.41,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,340.25,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290.79,115,,,Fee Schedule,115% of CMS OPPS Rate,304.36,100,,,Fee Schedule,100% of UMR Fee Schedule,290.79,115,,,Fee Schedule,115% of CMS OPPS Rate,290.79,745.65,
"FX, CLSD RADIAL SHAFT W/0 MANI",P990310088,CDM,981,RC,25500,HCPCS,Outpatient,,,1019.5,509.75,,328.63,175,,,fee schedule,175% of aetna fee schedule,280.75,115,,,fee schedule,115% of cms physician fee schedule,286.36,117.3,,,fee schedule,117.3% of cms physician fee schedule,350.94,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,280.75,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,279.13,100,,,fee schedule,100% of cigna fee schedule,298.21,500,,,fee schedule,500% of healthlink,286.28,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,298.21,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,917.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,917.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,917.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.75,115,,,fee schedule,115% of cms fee schedule,328.63,175,,,Fee Schedule,175% of CMS Fee Schedule,435.16,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,322.86,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,323.48,100,,,Fee Schedule,100% of UHC Fee Schedule,917.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,280.75,115,,,Fee Schedule,115% of CMS OPPS Rate,289.36,100,,,Fee Schedule,100% of UMR Fee Schedule,280.75,115,,,Fee Schedule,115% of CMS OPPS Rate,279.13,917.55,
"FX, ULNAR SHAFT W/O MANIP",P990310089,CDM,981,RC,25530,HCPCS,Outpatient,,,828.5,414.25,,310.99,175,,,fee schedule,175% of aetna fee schedule,263.57,115,,,fee schedule,115% of cms physician fee schedule,268.84,117.3,,,fee schedule,117.3% of cms physician fee schedule,329.46,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,263.57,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,263.45,100,,,fee schedule,100% of cigna fee schedule,281.46,100,,,fee schedule,100% of healthlink fee schedule,270.2,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,281.46,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.57,115,,,fee schedule,115% of cms fee schedule,310.99,175,,,Fee Schedule,175% of CMS Fee Schedule,408.53,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,303.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,306.79,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,263.57,115,,,Fee Schedule,115% of CMS OPPS Rate,274.43,100,,,Fee Schedule,100% of UMR Fee Schedule,263.57,115,,,Fee Schedule,115% of CMS OPPS Rate,263.45,745.65,
"FX, RADIAL&ULNA SHFT W/0 MANIP",P990310090,CDM,981,RC,25560,HCPCS,Outpatient,,,828.5,414.25,,328.53,175,,,fee schedule,175% of aetna fee schedule,282.01,115,,,fee schedule,115% of cms physician fee schedule,287.65,117.3,,,fee schedule,117.3% of cms physician fee schedule,352.52,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,282.01,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,281.24,100,,,fee schedule,100% of cigna fee schedule,300.46,100,,,fee schedule,100% of healthlink fee schedule,288.44,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,300.46,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.01,115,,,fee schedule,115% of cms fee schedule,328.53,175,,,Fee Schedule,175% of CMS Fee Schedule,437.12,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,324.32,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,326.12,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,282.01,115,,,Fee Schedule,115% of CMS OPPS Rate,291.72,100,,,Fee Schedule,100% of UMR Fee Schedule,282.01,115,,,Fee Schedule,115% of CMS OPPS Rate,281.24,745.65,
"FX, RADIAL&ULNA SHFT W/MANIP",P990310091,CDM,981,RC,25565,HCPCS,Outpatient,,,979,489.5,,679.04,175,,,fee schedule,175% of aetna fee schedule,506.23,115,,,fee schedule,115% of cms physician fee schedule,516.35,117.3,,,fee schedule,117.3% of cms physician fee schedule,632.79,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,506.23,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,522.03,100,,,fee schedule,100% of cigna fee schedule,557.73,100,,,fee schedule,100% of healthlink fee schedule,535.42,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,557.73,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,881.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,881.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,881.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.23,115,,,fee schedule,115% of cms fee schedule,679.04,175,,,Fee Schedule,175% of CMS Fee Schedule,784.66,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,582.16,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,602.01,100,,,Fee Schedule,100% of UHC Fee Schedule,881.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.23,115,,,Fee Schedule,115% of CMS OPPS Rate,538.52,100,,,Fee Schedule,100% of UMR Fee Schedule,506.23,115,,,Fee Schedule,115% of CMS OPPS Rate,506.23,881.1,
"FX, RADIAL DISTAL W/0 MANIP",P990310092,CDM,981,RC,25600,HCPCS,Outpatient,,,828.5,414.25,,360.47,175,,,fee schedule,175% of aetna fee schedule,349.57,115,,,fee schedule,115% of cms physician fee schedule,356.56,117.3,,,fee schedule,117.3% of cms physician fee schedule,436.96,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,349.57,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,345.8,100,,,fee schedule,100% of cigna fee schedule,369.45,100,,,fee schedule,100% of healthlink fee schedule,354.67,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,369.45,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.57,115,,,fee schedule,115% of cms fee schedule,360.47,175,,,Fee Schedule,175% of CMS Fee Schedule,541.83,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,402,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,402.39,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.57,115,,,Fee Schedule,115% of CMS OPPS Rate,359.95,100,,,Fee Schedule,100% of UMR Fee Schedule,349.57,115,,,Fee Schedule,115% of CMS OPPS Rate,345.8,745.65,
CLSD TX DIST RAD FX W/MANIPULA,P990310093,CDM,981,RC,25605,HCPCS,Outpatient,,,1290,645,,827.28,175,,,fee schedule,175% of aetna fee schedule,554.73,115,,,fee schedule,115% of cms physician fee schedule,565.82,117.3,,,fee schedule,117.3% of cms physician fee schedule,693.41,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,554.73,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,573.54,100,,,fee schedule,100% of cigna fee schedule,612.76,100,,,fee schedule,100% of healthlink fee schedule,588.25,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,612.76,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1161,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.73,115,,,fee schedule,115% of cms fee schedule,827.28,175,,,Fee Schedule,175% of CMS Fee Schedule,859.82,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,637.93,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,661.06,100,,,Fee Schedule,100% of UHC Fee Schedule,1161,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,554.73,115,,,Fee Schedule,115% of CMS OPPS Rate,591.34,100,,,Fee Schedule,100% of UMR Fee Schedule,554.73,115,,,Fee Schedule,115% of CMS OPPS Rate,554.73,1161,
"FX, CAPEL/SCAPHIOD W/0 MANIP",P990310094,CDM,981,RC,25622,HCPCS,Outpatient,,,828.5,414.25,,367.5,175,,,fee schedule,175% of aetna fee schedule,308.36,115,,,fee schedule,115% of cms physician fee schedule,314.53,117.3,,,fee schedule,117.3% of cms physician fee schedule,385.45,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,308.36,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,310.04,100,,,fee schedule,100% of cigna fee schedule,331.24,100,,,fee schedule,100% of healthlink fee schedule,317.99,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,331.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.36,115,,,fee schedule,115% of cms fee schedule,367.5,175,,,Fee Schedule,175% of CMS Fee Schedule,477.96,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,354.62,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,360.35,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,308.36,115,,,Fee Schedule,115% of CMS OPPS Rate,322.34,100,,,Fee Schedule,100% of UMR Fee Schedule,308.36,115,,,Fee Schedule,115% of CMS OPPS Rate,308.36,745.65,
"FX, CARPAL W/0 MANIP EA BONE",P990310095,CDM,981,RC,25630,HCPCS,Outpatient,,,333,166.5,,381.76,175,,,fee schedule,175% of aetna fee schedule,309.45,115,,,fee schedule,115% of cms physician fee schedule,315.64,117.3,,,fee schedule,117.3% of cms physician fee schedule,386.82,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.45,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,313.75,100,,,fee schedule,100% of cigna fee schedule,333,100,,,fee schedule,100% of healthlink fee schedule,321.79,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,333,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.45,115,,,fee schedule,115% of cms fee schedule,381.76,175,,,Fee Schedule,175% of CMS Fee Schedule,479.65,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,355.87,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,363.62,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309.45,115,,,Fee Schedule,115% of CMS OPPS Rate,325.27,100,,,Fee Schedule,100% of UMR Fee Schedule,309.45,115,,,Fee Schedule,115% of CMS OPPS Rate,299.7,479.65,
"FX,RADI/INER CARP DISLOC W/MAN",P990310096,CDM,981,RC,25660,HCPCS,Outpatient,,,664.5,332.25,,565.83,175,,,fee schedule,175% of aetna fee schedule,485.39,115,,,fee schedule,115% of cms physician fee schedule,495.1,117.3,,,fee schedule,117.3% of cms physician fee schedule,606.74,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,485.39,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,464.26,100,,,fee schedule,100% of cigna fee schedule,496.01,100,,,fee schedule,100% of healthlink fee schedule,476.17,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,496.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.39,115,,,fee schedule,115% of cms fee schedule,565.83,175,,,Fee Schedule,175% of CMS Fee Schedule,752.36,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,558.2,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,536.36,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,485.39,115,,,Fee Schedule,115% of CMS OPPS Rate,479.79,100,,,Fee Schedule,100% of UMR Fee Schedule,485.39,115,,,Fee Schedule,115% of CMS OPPS Rate,464.26,752.36,
"DRAINAGE FINGER ASC, SINGLE",P990310097,CDM,981,RC,26010,HCPCS,Outpatient,,,355,177.5,,188.55,175,,,fee schedule,175% of aetna fee schedule,150.03,115,,,fee schedule,115% of cms physician fee schedule,153.03,117.3,,,fee schedule,117.3% of cms physician fee schedule,187.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.03,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.87,100,,,fee schedule,100% of cigna fee schedule,164.39,100,,,fee schedule,100% of healthlink fee schedule,157.81,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,164.39,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,319.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,319.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.03,115,,,fee schedule,115% of cms fee schedule,188.55,175,,,Fee Schedule,175% of CMS Fee Schedule,232.54,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,172.53,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,176.49,100,,,Fee Schedule,100% of UHC Fee Schedule,319.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.03,115,,,Fee Schedule,115% of CMS OPPS Rate,157.87,100,,,Fee Schedule,100% of UMR Fee Schedule,150.03,115,,,Fee Schedule,115% of CMS OPPS Rate,150.03,319.5,
"ARTHROTOMY W EXP,DRAIN, RFB",P990310098,CDM,981,RC,26070,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.44,100,,,fee schedule,100% of cigna fee schedule,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,416.58,100,,,Fee Schedule,100% of UHC Fee Schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,372.64,100,,,Fee Schedule,100% of UMR Fee Schedule,,,,,Other,Not Seperately Reimbusable,358.44,416.58,
"FX, METACARPAL W/0 MANIP EACH",P990310099,CDM,981,RC,26600,HCPCS,Outpatient,,,333,166.5,,355.72,175,,,fee schedule,175% of aetna fee schedule,310.53,115,,,fee schedule,115% of cms physician fee schedule,316.75,117.3,,,fee schedule,117.3% of cms physician fee schedule,388.17,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,310.53,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,308.44,100,,,fee schedule,100% of cigna fee schedule,329.53,100,,,fee schedule,100% of healthlink fee schedule,316.34,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,329.53,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.53,115,,,fee schedule,115% of cms fee schedule,355.72,175,,,Fee Schedule,175% of CMS Fee Schedule,481.33,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,357.11,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,358.04,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,310.53,115,,,Fee Schedule,115% of CMS OPPS Rate,320.28,100,,,Fee Schedule,100% of UMR Fee Schedule,310.53,115,,,Fee Schedule,115% of CMS OPPS Rate,299.7,481.33,
"FX, METACARPAL W/MANIP EA BONE",P990310100,CDM,981,RC,26605,HCPCS,Outpatient,,,664.5,332.25,,397.01,175,,,fee schedule,175% of aetna fee schedule,322.56,115,,,fee schedule,115% of cms physician fee schedule,329.01,117.3,,,fee schedule,117.3% of cms physician fee schedule,403.2,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.56,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,325.33,100,,,fee schedule,100% of cigna fee schedule,347.58,100,,,fee schedule,100% of healthlink fee schedule,333.67,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,347.58,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.56,115,,,fee schedule,115% of cms fee schedule,397.01,175,,,Fee Schedule,175% of CMS Fee Schedule,499.97,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,370.95,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,378.75,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.56,115,,,Fee Schedule,115% of CMS OPPS Rate,338.81,100,,,Fee Schedule,100% of UMR Fee Schedule,322.56,115,,,Fee Schedule,115% of CMS OPPS Rate,322.56,598.05,
"DISLOCATION THUMB, W MANIP",P990310101,CDM,981,RC,26641,HCPCS,Outpatient,,,664.5,332.25,,461.58,175,,,fee schedule,175% of aetna fee schedule,414.58,115,,,fee schedule,115% of cms physician fee schedule,422.87,117.3,,,fee schedule,117.3% of cms physician fee schedule,518.22,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,414.58,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,387.49,100,,,fee schedule,100% of cigna fee schedule,413.99,100,,,fee schedule,100% of healthlink fee schedule,397.43,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,413.99,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.58,115,,,fee schedule,115% of cms fee schedule,461.58,175,,,Fee Schedule,175% of CMS Fee Schedule,642.59,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,476.76,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,440.46,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.58,115,,,Fee Schedule,115% of CMS OPPS Rate,394.01,100,,,Fee Schedule,100% of UMR Fee Schedule,414.58,115,,,Fee Schedule,115% of CMS OPPS Rate,387.49,642.59,
FX & DISLOC THUMB W MANIP,P990310102,CDM,981,RC,26645,HCPCS,Outpatient,,,828.5,414.25,,534.66,175,,,fee schedule,175% of aetna fee schedule,429.34,115,,,fee schedule,115% of cms physician fee schedule,437.93,117.3,,,fee schedule,117.3% of cms physician fee schedule,536.68,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,429.34,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,439.3,100,,,fee schedule,100% of cigna fee schedule,469.34,100,,,fee schedule,100% of healthlink fee schedule,450.56,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,469.34,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,429.34,115,,,fee schedule,115% of cms fee schedule,534.66,175,,,Fee Schedule,175% of CMS Fee Schedule,665.48,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,493.74,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,512.19,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,429.34,115,,,Fee Schedule,115% of CMS OPPS Rate,458.17,100,,,Fee Schedule,100% of UMR Fee Schedule,429.34,115,,,Fee Schedule,115% of CMS OPPS Rate,429.34,745.65,
MCP DISLOC W/MANIP W/O ANES,P990310103,CDM,981,RC,26700,HCPCS,Outpatient,,,661,330.5,,407.82,175,,,fee schedule,175% of aetna fee schedule,343.34,115,,,fee schedule,115% of cms physician fee schedule,350.21,117.3,,,fee schedule,117.3% of cms physician fee schedule,429.18,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,343.34,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,345.37,100,,,fee schedule,100% of cigna fee schedule,368.99,100,,,fee schedule,100% of healthlink fee schedule,354.23,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,368.99,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,594.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,594.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,594.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.34,115,,,fee schedule,115% of cms fee schedule,407.82,175,,,Fee Schedule,175% of CMS Fee Schedule,532.18,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,394.85,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,395.92,100,,,Fee Schedule,100% of UHC Fee Schedule,594.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,343.34,115,,,Fee Schedule,115% of CMS OPPS Rate,354.16,100,,,Fee Schedule,100% of UMR Fee Schedule,343.34,115,,,Fee Schedule,115% of CMS OPPS Rate,343.34,594.9,
"FX,PROX/MIDPHLANX W/O MANIP EA",P990310104,CDM,981,RC,26720,HCPCS,Outpatient,,,333,166.5,,240.54,175,,,fee schedule,175% of aetna fee schedule,205.78,115,,,fee schedule,115% of cms physician fee schedule,209.9,117.3,,,fee schedule,117.3% of cms physician fee schedule,257.23,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205.78,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,203.86,100,,,fee schedule,100% of cigna fee schedule,217.8,100,,,fee schedule,100% of healthlink fee schedule,209.09,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,217.8,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.78,115,,,fee schedule,115% of cms fee schedule,240.54,175,,,Fee Schedule,175% of CMS Fee Schedule,318.96,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,236.65,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,237.2,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,205.78,115,,,Fee Schedule,115% of CMS OPPS Rate,212.18,100,,,Fee Schedule,100% of UMR Fee Schedule,205.78,115,,,Fee Schedule,115% of CMS OPPS Rate,203.86,318.96,
FX PROX/MID PHAL W/MANIP EACH,P990310105,CDM,981,RC,26725,HCPCS,Outpatient,,,499,249.5,,424.01,175,,,fee schedule,175% of aetna fee schedule,332.44,115,,,fee schedule,115% of cms physician fee schedule,339.09,117.3,,,fee schedule,117.3% of cms physician fee schedule,415.55,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,332.44,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.35,100,,,fee schedule,100% of cigna fee schedule,361.49,100,,,fee schedule,100% of healthlink fee schedule,347.03,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,361.49,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,449.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,449.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,449.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,332.44,115,,,fee schedule,115% of cms fee schedule,424.01,175,,,Fee Schedule,175% of CMS Fee Schedule,515.29,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,382.31,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,392.2,100,,,Fee Schedule,100% of UHC Fee Schedule,449.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,332.44,115,,,Fee Schedule,115% of CMS OPPS Rate,350.84,100,,,Fee Schedule,100% of UMR Fee Schedule,332.44,115,,,Fee Schedule,115% of CMS OPPS Rate,332.44,515.29,
FX DISTAL PHALANG W/O MANIP EA,P990310106,CDM,981,RC,26750,HCPCS,Outpatient,,,333,166.5,,239.21,175,,,fee schedule,175% of aetna fee schedule,206.98,115,,,fee schedule,115% of cms physician fee schedule,211.12,117.3,,,fee schedule,117.3% of cms physician fee schedule,258.72,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206.98,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205.23,100,,,fee schedule,100% of cigna fee schedule,219.26,100,,,fee schedule,100% of healthlink fee schedule,210.49,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,219.26,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.98,115,,,fee schedule,115% of cms fee schedule,239.21,175,,,Fee Schedule,175% of CMS Fee Schedule,320.81,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,238.02,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,238.16,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.98,115,,,Fee Schedule,115% of CMS OPPS Rate,213.04,100,,,Fee Schedule,100% of UMR Fee Schedule,206.98,115,,,Fee Schedule,115% of CMS OPPS Rate,205.23,320.81,
FX DISTAL PHALANG W/MANIP EA,P990310107,CDM,981,RC,26755,HCPCS,Outpatient,,,402,201,,378.11,175,,,fee schedule,175% of aetna fee schedule,299.54,115,,,fee schedule,115% of cms physician fee schedule,305.53,117.3,,,fee schedule,117.3% of cms physician fee schedule,374.43,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.54,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,305.64,100,,,fee schedule,100% of cigna fee schedule,326.54,100,,,fee schedule,100% of healthlink fee schedule,313.48,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,326.54,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,361.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,361.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.54,115,,,fee schedule,115% of cms fee schedule,378.11,175,,,Fee Schedule,175% of CMS Fee Schedule,464.29,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,344.47,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,352.05,100,,,Fee Schedule,100% of UHC Fee Schedule,361.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299.54,115,,,Fee Schedule,115% of CMS OPPS Rate,314.92,100,,,Fee Schedule,100% of UMR Fee Schedule,299.54,115,,,Fee Schedule,115% of CMS OPPS Rate,299.54,464.29,
FX OPEN DIST PHALAN FNGR/THUMB,P990310108,CDM,981,RC,26765,HCPCS,Outpatient,,,537,268.5,,686.3,175,,,fee schedule,175% of aetna fee schedule,541.17,115,,,fee schedule,115% of cms physician fee schedule,551.99,117.3,,,fee schedule,117.3% of cms physician fee schedule,676.46,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,541.17,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,559.55,100,,,fee schedule,100% of cigna fee schedule,537,100,,,fee schedule,100% of healthlink fee schedule,537,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,537,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,483.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,483.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,483.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.17,115,,,fee schedule,115% of cms fee schedule,686.3,175,,,Fee Schedule,175% of CMS Fee Schedule,838.81,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,622.34,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,651.88,100,,,Fee Schedule,100% of UHC Fee Schedule,483.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.17,115,,,Fee Schedule,115% of CMS OPPS Rate,583.13,100,,,Fee Schedule,100% of UMR Fee Schedule,541.17,115,,,Fee Schedule,115% of CMS OPPS Rate,483.3,838.81,
DIP/PIP DISLO W/MP W/O ANES EA,P990310109,CDM,981,RC,26770,HCPCS,Outpatient,,,664.5,332.25,,339.26,175,,,fee schedule,175% of aetna fee schedule,288.59,115,,,fee schedule,115% of cms physician fee schedule,294.36,117.3,,,fee schedule,117.3% of cms physician fee schedule,360.74,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288.59,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288.51,100,,,fee schedule,100% of cigna fee schedule,308.24,100,,,fee schedule,100% of healthlink fee schedule,295.91,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,308.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.59,115,,,fee schedule,115% of cms fee schedule,339.26,175,,,Fee Schedule,175% of CMS Fee Schedule,447.32,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,331.88,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,330.32,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,288.59,115,,,Fee Schedule,115% of CMS OPPS Rate,295.48,100,,,Fee Schedule,100% of UMR Fee Schedule,288.59,115,,,Fee Schedule,115% of CMS OPPS Rate,288.51,598.05,
"FX, PELVIC RING W/O MANIP",P990310110,CDM,981,RC,27197,HCPCS,Outpatient,,,828.5,414.25,,,,,,other,not seperately reimbusable,141.27,115,,,fee schedule,115% of cms physician fee schedule,144.09,117.3,,,fee schedule,117.3% of cms physician fee schedule,176.58,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.27,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,143.08,100,,,fee schedule,100% of cigna fee schedule,152.86,100,,,fee schedule,100% of healthlink fee schedule,146.75,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,152.86,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.27,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,218.96,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,162.46,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,162.12,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.27,115,,,Fee Schedule,115% of CMS OPPS Rate,145.03,100,,,Fee Schedule,100% of UMR Fee Schedule,141.27,115,,,Fee Schedule,115% of CMS OPPS Rate,141.27,745.65,
"FX, COCCYX/SACRAL",P990310111,CDM,981,RC,27200,HCPCS,Outpatient,,,629.5,314.75,,433.62,135,,,fee schedule,135% of aetna fee schedule,207.05,115,,,fee schedule,115% of cms physician fee schedule,211.19,117.3,,,fee schedule,117.3% of cms physician fee schedule,258.81,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.05,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.83,100,,,fee schedule,100% of cigna fee schedule,222.04,100,,,fee schedule,100% of healthlink fee schedule,213.16,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,222.04,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,566.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,566.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.05,115,,,fee schedule,115% of cms fee schedule,433.62,135,,,Fee Schedule,135% of CMS Fee Schedule ,320.92,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,238.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,243.6,100,,,Fee Schedule,100% of UHC Fee Schedule,566.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,207.05,115,,,Fee Schedule,115% of CMS OPPS Rate,217.9,100,,,Fee Schedule,100% of UMR Fee Schedule,207.05,115,,,Fee Schedule,115% of CMS OPPS Rate,207.05,566.55,
"FX, FEMUR-PROX, NECK W/O MANIP",P990310112,CDM,981,RC,27230,HCPCS,Outpatient,,,789,394.5,,675.92,175,,,fee schedule,175% of aetna fee schedule,516.49,115,,,fee schedule,115% of cms physician fee schedule,526.82,117.3,,,fee schedule,117.3% of cms physician fee schedule,645.61,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516.49,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,532.64,100,,,fee schedule,100% of cigna fee schedule,569.06,100,,,fee schedule,100% of healthlink fee schedule,546.3,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,569.06,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,710.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,710.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,710.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.49,115,,,fee schedule,115% of cms fee schedule,675.92,175,,,Fee Schedule,175% of CMS Fee Schedule,800.56,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,593.96,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,616.6,100,,,Fee Schedule,100% of UHC Fee Schedule,710.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,516.49,115,,,Fee Schedule,115% of CMS OPPS Rate,551.57,100,,,Fee Schedule,100% of UMR Fee Schedule,516.49,115,,,Fee Schedule,115% of CMS OPPS Rate,516.49,800.56,
"FX,CLSD TX FEMORAL W/O MANIP",P990310113,CDM,981,RC,27238,HCPCS,Outpatient,,,789,394.5,,659.16,175,,,fee schedule,175% of aetna fee schedule,504.99,115,,,fee schedule,115% of cms physician fee schedule,515.09,117.3,,,fee schedule,117.3% of cms physician fee schedule,631.24,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,504.99,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,521.43,100,,,fee schedule,100% of cigna fee schedule,557.08,100,,,fee schedule,100% of healthlink fee schedule,534.79,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,557.08,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,710.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,710.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,710.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.99,115,,,fee schedule,115% of cms fee schedule,659.16,175,,,Fee Schedule,175% of CMS Fee Schedule,782.73,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,580.74,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,602.78,100,,,Fee Schedule,100% of UHC Fee Schedule,710.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,504.99,115,,,Fee Schedule,115% of CMS OPPS Rate,539.2,100,,,Fee Schedule,100% of UMR Fee Schedule,504.99,115,,,Fee Schedule,115% of CMS OPPS Rate,504.99,782.73,
DISLOCATED HIP W/O ANES,P990310114,CDM,981,RC,27250,HCPCS,Outpatient,,,1240.5,620.25,,318.47,175,,,fee schedule,175% of aetna fee schedule,198.35,115,,,fee schedule,115% of cms physician fee schedule,202.32,117.3,,,fee schedule,117.3% of cms physician fee schedule,247.94,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.35,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.66,100,,,fee schedule,100% of cigna fee schedule,232.55,100,,,fee schedule,100% of healthlink fee schedule,223.25,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,232.55,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1116.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.35,115,,,fee schedule,115% of cms fee schedule,318.47,175,,,Fee Schedule,175% of CMS Fee Schedule,307.45,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,228.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,238.45,100,,,Fee Schedule,100% of UHC Fee Schedule,1116.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,198.35,115,,,Fee Schedule,115% of CMS OPPS Rate,213.3,100,,,Fee Schedule,100% of UMR Fee Schedule,198.35,115,,,Fee Schedule,115% of CMS OPPS Rate,198.35,1116.45,
"FX, PATELLA CLOSED W/O MANIP",P990310115,CDM,981,RC,27520,HCPCS,Outpatient,,,828.5,414.25,,397.43,175,,,fee schedule,175% of aetna fee schedule,326.24,115,,,fee schedule,115% of cms physician fee schedule,332.77,117.3,,,fee schedule,117.3% of cms physician fee schedule,407.8,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,326.24,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,328.67,100,,,fee schedule,100% of cigna fee schedule,351.14,100,,,fee schedule,100% of healthlink fee schedule,337.09,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,351.14,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.24,115,,,fee schedule,115% of cms fee schedule,397.43,175,,,Fee Schedule,175% of CMS Fee Schedule,505.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,375.18,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,382.4,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,326.24,115,,,Fee Schedule,115% of CMS OPPS Rate,342.07,100,,,Fee Schedule,100% of UMR Fee Schedule,326.24,115,,,Fee Schedule,115% of CMS OPPS Rate,326.24,745.65,
FX TIBIAL PLATEAU W/O MANIP,P990310116,CDM,981,RC,27530,HCPCS,Outpatient,,,828.5,414.25,25,513.26,175,,,fee schedule,175% of aetna fee schedule,312.16,115,,,fee schedule,115% of cms physician fee schedule,318.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,390.2,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.16,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.06,100,,,fee schedule,100% of cigna fee schedule,333.4,100,,,fee schedule,100% of healthlink fee schedule,320.06,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,333.4,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.16,115,,,fee schedule,115% of cms fee schedule,513.26,175,,,Fee Schedule,175% of CMS Fee Schedule,483.84,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,358.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,363.26,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,312.16,115,,,Fee Schedule,115% of CMS OPPS Rate,324.95,100,,,Fee Schedule,100% of UMR Fee Schedule,312.16,115,,,Fee Schedule,115% of CMS OPPS Rate,312.06,745.65,
FX TIBIAL PLATEAU W/O MANIP,P990310116,CDM,981,RC,27530,HCPCS,Outpatient,,,828.5,414.25,,513.26,175,,,fee schedule,175% of aetna fee schedule,312.16,115,,,fee schedule,115% of cms physician fee schedule,318.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,390.2,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.16,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.06,100,,,fee schedule,100% of cigna fee schedule,333.4,100,,,fee schedule,100% of healthlink fee schedule,320.06,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,333.4,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.16,115,,,fee schedule,115% of cms fee schedule,513.26,175,,,Fee Schedule,175% of CMS Fee Schedule,483.84,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,358.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,363.26,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,312.16,115,,,Fee Schedule,115% of CMS OPPS Rate,324.95,100,,,Fee Schedule,100% of UMR Fee Schedule,312.16,115,,,Fee Schedule,115% of CMS OPPS Rate,312.06,745.65,
FX INTERCON SPINE W-W/O MANIP,P990310117,CDM,981,RC,27538,HCPCS,Outpatient,,,828.5,414.25,,621.27,175,,,fee schedule,175% of aetna fee schedule,486,115,,,fee schedule,115% of cms physician fee schedule,495.72,117.3,,,fee schedule,117.3% of cms physician fee schedule,607.5,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,486,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,495.73,100,,,fee schedule,100% of cigna fee schedule,529.63,100,,,fee schedule,100% of healthlink fee schedule,508.44,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,529.63,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486,115,,,fee schedule,115% of cms fee schedule,621.27,175,,,Fee Schedule,175% of CMS Fee Schedule,753.3,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,558.9,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,578.41,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486,115,,,Fee Schedule,115% of CMS OPPS Rate,517.4,100,,,Fee Schedule,100% of UMR Fee Schedule,486,115,,,Fee Schedule,115% of CMS OPPS Rate,486,753.3,
DISLOCATED KNEE W/O ANES,P990310118,CDM,981,RC,27550,HCPCS,Outpatient,,,1240.5,620.25,,655.81,175,,,fee schedule,175% of aetna fee schedule,510.27,115,,,fee schedule,115% of cms physician fee schedule,520.47,117.3,,,fee schedule,117.3% of cms physician fee schedule,637.83,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,510.27,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,543.91,100,,,fee schedule,100% of cigna fee schedule,581.1,100,,,fee schedule,100% of healthlink fee schedule,557.86,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,581.1,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1116.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,510.27,115,,,fee schedule,115% of cms fee schedule,655.81,175,,,Fee Schedule,175% of CMS Fee Schedule,790.91,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,586.81,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,627.1,100,,,Fee Schedule,100% of UHC Fee Schedule,1116.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,510.27,115,,,Fee Schedule,115% of CMS OPPS Rate,560.96,100,,,Fee Schedule,100% of UMR Fee Schedule,510.27,115,,,Fee Schedule,115% of CMS OPPS Rate,510.27,1116.45,
CLSD TX DISLOC KNEE W/ANES,P990310119,CDM,981,RC,27552,HCPCS,Outpatient,,,1653.5,826.75,,915.86,175,,,fee schedule,175% of aetna fee schedule,683.63,115,,,fee schedule,115% of cms physician fee schedule,697.3,117.3,,,fee schedule,117.3% of cms physician fee schedule,854.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,683.63,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,709.42,100,,,fee schedule,100% of cigna fee schedule,757.93,100,,,fee schedule,100% of healthlink fee schedule,727.61,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,757.93,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1488.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1488.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1488.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,683.63,115,,,fee schedule,115% of cms fee schedule,915.86,175,,,Fee Schedule,175% of CMS Fee Schedule,1059.62,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,786.17,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,820.92,100,,,Fee Schedule,100% of UHC Fee Schedule,1488.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,683.63,115,,,Fee Schedule,115% of CMS OPPS Rate,734.33,100,,,Fee Schedule,100% of UMR Fee Schedule,683.63,115,,,Fee Schedule,115% of CMS OPPS Rate,683.63,1488.15,
DISLOCATED PATELLA W/0 ANES,P990310120,CDM,981,RC,27560,HCPCS,Outpatient,,,874,437,,472.15,175,,,fee schedule,175% of aetna fee schedule,371.83,115,,,fee schedule,115% of cms physician fee schedule,379.27,117.3,,,fee schedule,117.3% of cms physician fee schedule,464.79,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,371.83,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,383.38,100,,,fee schedule,100% of cigna fee schedule,409.6,100,,,fee schedule,100% of healthlink fee schedule,393.22,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,409.6,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,786.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,786.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,371.83,115,,,fee schedule,115% of cms fee schedule,472.15,175,,,Fee Schedule,175% of CMS Fee Schedule,576.34,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,427.6,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,437.84,100,,,Fee Schedule,100% of UHC Fee Schedule,786.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,371.83,115,,,Fee Schedule,115% of CMS OPPS Rate,391.66,100,,,Fee Schedule,100% of UMR Fee Schedule,371.83,115,,,Fee Schedule,115% of CMS OPPS Rate,371.83,786.6,
FX TIB &/OR FIB SHAFT W/O MANI,P990310121,CDM,981,RC,27750,HCPCS,Outpatient,,,828.5,414.25,,434.16,175,,,fee schedule,175% of aetna fee schedule,350.45,115,,,fee schedule,115% of cms physician fee schedule,357.46,117.3,,,fee schedule,117.3% of cms physician fee schedule,438.06,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,350.45,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,353.95,100,,,fee schedule,100% of cigna fee schedule,378.15,100,,,fee schedule,100% of healthlink fee schedule,363.02,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,378.15,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.45,115,,,fee schedule,115% of cms fee schedule,434.16,175,,,Fee Schedule,175% of CMS Fee Schedule,543.2,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,403.02,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,412.03,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,350.45,115,,,Fee Schedule,115% of CMS OPPS Rate,368.58,100,,,Fee Schedule,100% of UMR Fee Schedule,350.45,115,,,Fee Schedule,115% of CMS OPPS Rate,350.45,745.65,
CLSD TX TIBIAL SHAFT FX W/MAN,P990310122,CDM,981,RC,27752,HCPCS,Outpatient,,,1290,645,,719.62,175,,,fee schedule,175% of aetna fee schedule,531.29,115,,,fee schedule,115% of cms physician fee schedule,541.91,117.3,,,fee schedule,117.3% of cms physician fee schedule,664.11,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,531.29,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,554.12,100,,,fee schedule,100% of cigna fee schedule,592.01,100,,,fee schedule,100% of healthlink fee schedule,568.33,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,592.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1161,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,531.29,115,,,fee schedule,115% of cms fee schedule,719.62,175,,,Fee Schedule,175% of CMS Fee Schedule,823.5,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,610.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,642.6,100,,,Fee Schedule,100% of UHC Fee Schedule,1161,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,531.29,115,,,Fee Schedule,115% of CMS OPPS Rate,574.82,100,,,Fee Schedule,100% of UMR Fee Schedule,531.29,115,,,Fee Schedule,115% of CMS OPPS Rate,531.29,1161,
FX MEDIAL MALLEOLUS W/O MANIP,P990310123,CDM,981,RC,27760,HCPCS,Outpatient,,,828.5,414.25,,414.37,175,,,fee schedule,175% of aetna fee schedule,333.67,115,,,fee schedule,115% of cms physician fee schedule,340.35,117.3,,,fee schedule,117.3% of cms physician fee schedule,417.09,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,333.67,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.44,100,,,fee schedule,100% of cigna fee schedule,362.65,100,,,fee schedule,100% of healthlink fee schedule,348.14,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,362.65,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.67,115,,,fee schedule,115% of cms fee schedule,414.37,175,,,Fee Schedule,175% of CMS Fee Schedule,517.19,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,383.72,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,394.09,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.67,115,,,Fee Schedule,115% of CMS OPPS Rate,352.52,100,,,Fee Schedule,100% of UMR Fee Schedule,333.67,115,,,Fee Schedule,115% of CMS OPPS Rate,333.67,745.65,
FX POSTERIOR MALLEOL W/O MANIP,P990310124,CDM,981,RC,27767,HCPCS,Outpatient,,,828.5,414.25,,357.51,175,,,fee schedule,175% of aetna fee schedule,312.03,115,,,fee schedule,115% of cms physician fee schedule,318.27,117.3,,,fee schedule,117.3% of cms physician fee schedule,390.04,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.03,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,313.75,100,,,fee schedule,100% of cigna fee schedule,335.2,100,,,fee schedule,100% of healthlink fee schedule,321.79,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,335.2,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.03,115,,,fee schedule,115% of cms fee schedule,357.51,175,,,Fee Schedule,175% of CMS Fee Schedule,483.65,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,358.83,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,364.39,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,312.03,115,,,Fee Schedule,115% of CMS OPPS Rate,325.96,100,,,Fee Schedule,100% of UMR Fee Schedule,312.03,115,,,Fee Schedule,115% of CMS OPPS Rate,312.03,745.65,
FX PROX FIBULA/SHAFT W/O MANIP,P990310125,CDM,981,RC,27780,HCPCS,Outpatient,,,828.5,414.25,,369.51,175,,,fee schedule,175% of aetna fee schedule,308.6,115,,,fee schedule,115% of cms physician fee schedule,314.77,117.3,,,fee schedule,117.3% of cms physician fee schedule,385.75,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,308.6,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,310.66,100,,,fee schedule,100% of cigna fee schedule,331.9,100,,,fee schedule,100% of healthlink fee schedule,318.62,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,331.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.6,115,,,fee schedule,115% of cms fee schedule,369.51,175,,,Fee Schedule,175% of CMS Fee Schedule,478.33,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,354.89,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,360.46,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,308.6,115,,,Fee Schedule,115% of CMS OPPS Rate,322.44,100,,,Fee Schedule,100% of UMR Fee Schedule,308.6,115,,,Fee Schedule,115% of CMS OPPS Rate,308.6,745.65,
FX DISTAL FIBULA W/0 MANIP,P990310126,CDM,981,RC,27786,HCPCS,Outpatient,,,828.5,414.25,,389.83,175,,,fee schedule,175% of aetna fee schedule,311.29,115,,,fee schedule,115% of cms physician fee schedule,317.52,117.3,,,fee schedule,117.3% of cms physician fee schedule,389.12,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,311.29,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,317.98,100,,,fee schedule,100% of cigna fee schedule,339.73,100,,,fee schedule,100% of healthlink fee schedule,326.14,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,339.73,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.29,115,,,fee schedule,115% of cms fee schedule,389.83,175,,,Fee Schedule,175% of CMS Fee Schedule,482.5,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,357.99,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,369.31,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,311.29,115,,,Fee Schedule,115% of CMS OPPS Rate,330.36,100,,,Fee Schedule,100% of UMR Fee Schedule,311.29,115,,,Fee Schedule,115% of CMS OPPS Rate,311.29,745.65,
FX BIMALLEOLR ANKLE W/O MANIP,P990310127,CDM,981,RC,27808,HCPCS,Outpatient,,,828.5,414.25,,403.81,175,,,fee schedule,175% of aetna fee schedule,331.04,115,,,fee schedule,115% of cms physician fee schedule,337.66,117.3,,,fee schedule,117.3% of cms physician fee schedule,413.8,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.04,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,334.37,100,,,fee schedule,100% of cigna fee schedule,357.24,100,,,fee schedule,100% of healthlink fee schedule,342.95,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,357.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,331.04,115,,,fee schedule,115% of cms fee schedule,403.81,175,,,Fee Schedule,175% of CMS Fee Schedule,513.11,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,380.69,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,389.36,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,331.04,115,,,Fee Schedule,115% of CMS OPPS Rate,348.3,100,,,Fee Schedule,100% of UMR Fee Schedule,331.04,115,,,Fee Schedule,115% of CMS OPPS Rate,331.04,745.65,
FX BIMALLEOLR ANKLE WITH MANIP,P990310128,CDM,981,RC,27810,HCPCS,Outpatient,,,955,477.5,,617.65,175,,,fee schedule,175% of aetna fee schedule,465.78,115,,,fee schedule,115% of cms physician fee schedule,475.1,117.3,,,fee schedule,117.3% of cms physician fee schedule,582.23,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,465.78,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,475.91,100,,,fee schedule,100% of cigna fee schedule,508.45,100,,,fee schedule,100% of healthlink fee schedule,488.11,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,508.45,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,859.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,859.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,859.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,465.78,115,,,fee schedule,115% of cms fee schedule,617.65,175,,,Fee Schedule,175% of CMS Fee Schedule,721.97,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,535.65,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,549.73,100,,,Fee Schedule,100% of UHC Fee Schedule,859.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,465.78,115,,,Fee Schedule,115% of CMS OPPS Rate,491.75,100,,,Fee Schedule,100% of UMR Fee Schedule,465.78,115,,,Fee Schedule,115% of CMS OPPS Rate,465.78,859.5,
FX TRIMALEOLAR W/O MANIP,P990310129,CDM,981,RC,27816,HCPCS,Outpatient,,,828.5,414.25,,383.85,175,,,fee schedule,175% of aetna fee schedule,319.52,115,,,fee schedule,115% of cms physician fee schedule,325.91,117.3,,,fee schedule,117.3% of cms physician fee schedule,399.4,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,319.52,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.31,100,,,fee schedule,100% of cigna fee schedule,344.35,100,,,fee schedule,100% of healthlink fee schedule,330.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,344.35,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.52,115,,,fee schedule,115% of cms fee schedule,383.85,175,,,Fee Schedule,175% of CMS Fee Schedule,495.25,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,367.44,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,374.31,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,319.52,115,,,Fee Schedule,115% of CMS OPPS Rate,334.83,100,,,Fee Schedule,100% of UMR Fee Schedule,319.52,115,,,Fee Schedule,115% of CMS OPPS Rate,319.52,745.65,
DISLOCATED ANKLE W/O ANES,P990310130,CDM,981,RC,27840,HCPCS,Outpatient,,,1240.5,620.25,,506.38,175,,,fee schedule,175% of aetna fee schedule,420.93,115,,,fee schedule,115% of cms physician fee schedule,429.35,117.3,,,fee schedule,117.3% of cms physician fee schedule,526.17,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,420.93,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,423.1,100,,,fee schedule,100% of cigna fee schedule,452.04,100,,,fee schedule,100% of healthlink fee schedule,433.96,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,452.04,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1116.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.93,115,,,fee schedule,115% of cms fee schedule,506.38,175,,,Fee Schedule,175% of CMS Fee Schedule,652.45,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,484.07,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,485.94,100,,,Fee Schedule,100% of UHC Fee Schedule,1116.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,420.93,115,,,Fee Schedule,115% of CMS OPPS Rate,434.69,100,,,Fee Schedule,100% of UMR Fee Schedule,420.93,115,,,Fee Schedule,115% of CMS OPPS Rate,420.93,1116.45,
CLSD TX TRIMALL ANKLE FX W/MAN,P990310131,CDM,981,RC,27881,HCPCS,Outpatient,,,1290,645,,1359.23,175,,,fee schedule,175% of aetna fee schedule,905.36,115,,,fee schedule,115% of cms physician fee schedule,923.47,117.3,,,fee schedule,117.3% of cms physician fee schedule,1131.7,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,905.36,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,986.77,100,,,fee schedule,100% of cigna fee schedule,1054.24,100,,,fee schedule,100% of healthlink fee schedule,1012.07,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,1054.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1161,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1161,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,905.36,115,,,fee schedule,115% of cms fee schedule,1359.23,175,,,Fee Schedule,175% of CMS Fee Schedule,1403.31,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,1041.16,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,1139.64,100,,,Fee Schedule,100% of UHC Fee Schedule,1161,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,905.36,115,,,Fee Schedule,115% of CMS OPPS Rate,1019.44,100,,,Fee Schedule,100% of UMR Fee Schedule,905.36,115,,,Fee Schedule,115% of CMS OPPS Rate,905.36,1403.31,
"RFB, FOOT SQ",P990310132,CDM,981,RC,28190,HCPCS,Outpatient,,,615,307.5,,207.2,175,,,fee schedule,175% of aetna fee schedule,142.43,115,,,fee schedule,115% of cms physician fee schedule,145.28,117.3,,,fee schedule,117.3% of cms physician fee schedule,178.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.43,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,151.93,100,,,fee schedule,100% of cigna fee schedule,162.31,100,,,fee schedule,100% of healthlink fee schedule,155.82,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,162.31,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,553.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,553.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.43,115,,,fee schedule,115% of cms fee schedule,207.2,175,,,Fee Schedule,175% of CMS Fee Schedule,220.76,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,163.79,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,174.9,100,,,Fee Schedule,100% of UHC Fee Schedule,553.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.43,115,,,Fee Schedule,115% of CMS OPPS Rate,156.45,100,,,Fee Schedule,100% of UMR Fee Schedule,142.43,115,,,Fee Schedule,115% of CMS OPPS Rate,142.43,553.5,
"RFB, FOOT DEEP SQ",P990310133,CDM,981,RC,28192,HCPCS,Outpatient,,,1150.5,575.25,,496.07,175,,,fee schedule,175% of aetna fee schedule,334.33,115,,,fee schedule,115% of cms physician fee schedule,341.01,117.3,,,fee schedule,117.3% of cms physician fee schedule,417.91,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,334.33,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,355.98,100,,,fee schedule,100% of cigna fee schedule,380.33,100,,,fee schedule,100% of healthlink fee schedule,365.11,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,380.33,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1035.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1035.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1035.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.33,115,,,fee schedule,115% of cms fee schedule,496.07,175,,,Fee Schedule,175% of CMS Fee Schedule,518.21,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,384.48,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,408.61,100,,,Fee Schedule,100% of UHC Fee Schedule,1035.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.33,115,,,Fee Schedule,115% of CMS OPPS Rate,365.52,100,,,Fee Schedule,100% of UMR Fee Schedule,334.33,115,,,Fee Schedule,115% of CMS OPPS Rate,334.33,1035.45,
"RFB, FOOT COMPLEX SQ",P990310134,CDM,981,RC,28193,HCPCS,Outpatient,,,875.5,437.75,,595.84,175,,,fee schedule,175% of aetna fee schedule,395,115,,,fee schedule,115% of cms physician fee schedule,402.9,117.3,,,fee schedule,117.3% of cms physician fee schedule,493.75,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,395,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,421.5,100,,,fee schedule,100% of cigna fee schedule,450.31,100,,,fee schedule,100% of healthlink fee schedule,432.3,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,450.31,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,787.95,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,787.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395,115,,,fee schedule,115% of cms fee schedule,595.84,175,,,Fee Schedule,175% of CMS Fee Schedule,612.25,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,454.25,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,484.07,100,,,Fee Schedule,100% of UHC Fee Schedule,787.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,395,115,,,Fee Schedule,115% of CMS OPPS Rate,433.02,100,,,Fee Schedule,100% of UMR Fee Schedule,395,115,,,Fee Schedule,115% of CMS OPPS Rate,395,787.95,
FX CALCANEAL W/O MANIP,P990310135,CDM,981,RC,28400,HCPCS,Outpatient,,,828.5,414.25,,310.85,175,,,fee schedule,175% of aetna fee schedule,247.47,115,,,fee schedule,115% of cms physician fee schedule,252.42,117.3,,,fee schedule,117.3% of cms physician fee schedule,309.34,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247.47,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,251.8,100,,,fee schedule,100% of cigna fee schedule,269.01,100,,,fee schedule,100% of healthlink fee schedule,258.25,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,269.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.47,115,,,fee schedule,115% of cms fee schedule,310.85,175,,,Fee Schedule,175% of CMS Fee Schedule,383.58,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,284.59,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,294.32,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247.47,115,,,Fee Schedule,115% of CMS OPPS Rate,263.28,100,,,Fee Schedule,100% of UMR Fee Schedule,247.47,115,,,Fee Schedule,115% of CMS OPPS Rate,247.47,745.65,
FX TALUS W/O MANIP,P990310136,CDM,981,RC,28430,HCPCS,Outpatient,,,828.5,414.25,,284.11,175,,,fee schedule,175% of aetna fee schedule,227.33,115,,,fee schedule,115% of cms physician fee schedule,231.88,117.3,,,fee schedule,117.3% of cms physician fee schedule,284.17,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,227.33,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.39,100,,,fee schedule,100% of cigna fee schedule,248.29,100,,,fee schedule,100% of healthlink fee schedule,238.36,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,248.29,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,745.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.33,115,,,fee schedule,115% of cms fee schedule,284.11,175,,,Fee Schedule,175% of CMS Fee Schedule,352.36,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,261.43,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,271.5,100,,,Fee Schedule,100% of UHC Fee Schedule,745.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,227.33,115,,,Fee Schedule,115% of CMS OPPS Rate,242.87,100,,,Fee Schedule,100% of UMR Fee Schedule,227.33,115,,,Fee Schedule,115% of CMS OPPS Rate,227.33,745.65,
FX TALUS WITH MANIP,P990310137,CDM,981,RC,28435,HCPCS,Outpatient,,,888,444,,418.69,175,,,fee schedule,175% of aetna fee schedule,354.78,115,,,fee schedule,115% of cms physician fee schedule,361.87,117.3,,,fee schedule,117.3% of cms physician fee schedule,443.47,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,354.78,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,359.79,100,,,fee schedule,100% of cigna fee schedule,384.4,100,,,fee schedule,100% of healthlink fee schedule,369.02,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,384.4,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,799.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,799.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,799.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.78,115,,,fee schedule,115% of cms fee schedule,418.69,175,,,Fee Schedule,175% of CMS Fee Schedule,549.9,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,407.99,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,420.8,100,,,Fee Schedule,100% of UHC Fee Schedule,799.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.78,115,,,Fee Schedule,115% of CMS OPPS Rate,376.42,100,,,Fee Schedule,100% of UMR Fee Schedule,354.78,115,,,Fee Schedule,115% of CMS OPPS Rate,354.78,799.2,
FX TARSAL EACH W/O MANIP,P990310138,CDM,981,RC,28450,HCPCS,Outpatient,,,333,166.5,,263.5,175,,,fee schedule,175% of aetna fee schedule,206.15,115,,,fee schedule,115% of cms physician fee schedule,210.27,117.3,,,fee schedule,117.3% of cms physician fee schedule,257.69,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206.15,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.83,100,,,fee schedule,100% of cigna fee schedule,225.24,100,,,fee schedule,100% of healthlink fee schedule,216.23,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,225.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.15,115,,,fee schedule,115% of cms fee schedule,263.5,175,,,Fee Schedule,175% of CMS Fee Schedule,319.53,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,237.07,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,247,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.15,115,,,Fee Schedule,115% of CMS OPPS Rate,220.95,100,,,Fee Schedule,100% of UMR Fee Schedule,206.15,115,,,Fee Schedule,115% of CMS OPPS Rate,206.15,319.53,
"FX METATARSAL, EACH W/O MANIP",P990310139,CDM,981,RC,28470,HCPCS,Outpatient,,,333,166.5,,265.72,175,,,fee schedule,175% of aetna fee schedule,220.59,115,,,fee schedule,115% of cms physician fee schedule,225,117.3,,,fee schedule,117.3% of cms physician fee schedule,275.74,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.59,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.62,100,,,fee schedule,100% of cigna fee schedule,239.98,100,,,fee schedule,100% of healthlink fee schedule,230.38,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,239.98,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.59,115,,,fee schedule,115% of cms fee schedule,265.72,175,,,Fee Schedule,175% of CMS Fee Schedule,341.92,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,253.68,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,262.96,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,220.59,115,,,Fee Schedule,115% of CMS OPPS Rate,235.23,100,,,Fee Schedule,100% of UMR Fee Schedule,220.59,115,,,Fee Schedule,115% of CMS OPPS Rate,220.59,341.92,
FX GREAT TOE W/O MANIP,P990310140,CDM,981,RC,28490,HCPCS,Outpatient,,,416,208,,163.96,175,,,fee schedule,175% of aetna fee schedule,133.43,115,,,fee schedule,115% of cms physician fee schedule,136.1,117.3,,,fee schedule,117.3% of cms physician fee schedule,166.79,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.43,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.89,100,,,fee schedule,100% of cigna fee schedule,145.18,100,,,fee schedule,100% of healthlink fee schedule,139.37,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,145.18,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,374.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,374.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.43,115,,,fee schedule,115% of cms fee schedule,163.96,175,,,Fee Schedule,175% of CMS Fee Schedule,206.82,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,153.45,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,160.79,100,,,Fee Schedule,100% of UHC Fee Schedule,374.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,133.43,115,,,Fee Schedule,115% of CMS OPPS Rate,143.83,100,,,Fee Schedule,100% of UMR Fee Schedule,133.43,115,,,Fee Schedule,115% of CMS OPPS Rate,133.43,374.4,
FX PHALANGES-TOE EACH W/O MANI,P990310141,CDM,981,RC,28510,HCPCS,Outpatient,,,333,166.5,,160.34,175,,,fee schedule,175% of aetna fee schedule,129.47,115,,,fee schedule,115% of cms physician fee schedule,132.06,117.3,,,fee schedule,117.3% of cms physician fee schedule,161.83,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.47,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.75,100,,,fee schedule,100% of cigna fee schedule,139.69,100,,,fee schedule,100% of healthlink fee schedule,134.1,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,139.69,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,299.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.47,115,,,fee schedule,115% of cms fee schedule,160.34,175,,,Fee Schedule,175% of CMS Fee Schedule,200.67,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,148.89,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,154.52,100,,,Fee Schedule,100% of UHC Fee Schedule,299.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.47,115,,,Fee Schedule,115% of CMS OPPS Rate,138.22,100,,,Fee Schedule,100% of UMR Fee Schedule,129.47,115,,,Fee Schedule,115% of CMS OPPS Rate,129.47,299.7,
FX PHALANGES-TOE EACH W/MANIP,P990310142,CDM,981,RC,28515,HCPCS,Outpatient,,,499,249.5,,197.72,175,,,fee schedule,175% of aetna fee schedule,154.61,115,,,fee schedule,115% of cms physician fee schedule,157.7,117.3,,,fee schedule,117.3% of cms physician fee schedule,193.26,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.61,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.46,100,,,fee schedule,100% of cigna fee schedule,168.23,100,,,fee schedule,100% of healthlink fee schedule,161.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,168.23,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,449.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,449.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,449.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.61,115,,,fee schedule,115% of cms fee schedule,197.72,175,,,Fee Schedule,175% of CMS Fee Schedule,239.64,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,177.8,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,184.14,100,,,Fee Schedule,100% of UHC Fee Schedule,449.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.61,115,,,Fee Schedule,115% of CMS OPPS Rate,164.72,100,,,Fee Schedule,100% of UMR Fee Schedule,154.61,115,,,Fee Schedule,115% of CMS OPPS Rate,154.61,449.1,
TOE DISLOC W/O ANES W/MANIP,P990310143,CDM,981,RC,28630,HCPCS,Outpatient,,,499,249.5,,167.77,175,,,fee schedule,175% of aetna fee schedule,120.49,115,,,fee schedule,115% of cms physician fee schedule,122.9,117.3,,,fee schedule,117.3% of cms physician fee schedule,150.61,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120.49,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.97,100,,,fee schedule,100% of cigna fee schedule,135.65,100,,,fee schedule,100% of healthlink fee schedule,130.22,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,135.65,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,449.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,449.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,449.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.49,115,,,fee schedule,115% of cms fee schedule,167.77,175,,,Fee Schedule,175% of CMS Fee Schedule,186.75,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,138.56,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,143.58,100,,,Fee Schedule,100% of UHC Fee Schedule,449.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,120.49,115,,,Fee Schedule,115% of CMS OPPS Rate,128.43,100,,,Fee Schedule,100% of UMR Fee Schedule,120.49,115,,,Fee Schedule,115% of CMS OPPS Rate,120.49,449.1,
CLSD TX METATARSOPH JT W/ANES,P990310144,CDM,981,RC,28635,HCPCS,Outpatient,,,302.5,151.25,,207.08,175,,,fee schedule,175% of aetna fee schedule,141.19,115,,,fee schedule,115% of cms physician fee schedule,144.01,117.3,,,fee schedule,117.3% of cms physician fee schedule,176.48,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.19,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.22,100,,,fee schedule,100% of cigna fee schedule,160.49,100,,,fee schedule,100% of healthlink fee schedule,154.07,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,160.49,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,272.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,272.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.19,115,,,fee schedule,115% of cms fee schedule,207.08,175,,,Fee Schedule,175% of CMS Fee Schedule,218.84,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,162.36,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,173.61,100,,,Fee Schedule,100% of UHC Fee Schedule,272.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.19,115,,,Fee Schedule,115% of CMS OPPS Rate,155.3,100,,,Fee Schedule,100% of UMR Fee Schedule,141.19,115,,,Fee Schedule,115% of CMS OPPS Rate,141.19,272.25,
PIP/DIP DISLOC W/O ANES W/MANI,P990310145,CDM,981,RC,28660,HCPCS,Outpatient,,,664.5,332.25,,127.49,175,,,fee schedule,175% of aetna fee schedule,101.79,115,,,fee schedule,115% of cms physician fee schedule,103.82,117.3,,,fee schedule,117.3% of cms physician fee schedule,127.23,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101.79,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103.05,100,,,fee schedule,100% of cigna fee schedule,110.1,100,,,fee schedule,100% of healthlink fee schedule,105.7,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,110.1,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.79,115,,,fee schedule,115% of cms fee schedule,127.49,175,,,Fee Schedule,175% of CMS Fee Schedule,157.77,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,117.05,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,116.36,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.79,115,,,Fee Schedule,115% of CMS OPPS Rate,104.09,100,,,Fee Schedule,100% of UMR Fee Schedule,101.79,115,,,Fee Schedule,115% of CMS OPPS Rate,101.79,598.05,
SPLINT APPLICATION LONG ARM,P990310146,CDM,981,RC,29105,HCPCS,Outpatient,,,168.5,84.25,,89.92,175,,,fee schedule,175% of aetna fee schedule,45.63,115,,,fee schedule,115% of cms physician fee schedule,46.54,117.3,,,fee schedule,117.3% of cms physician fee schedule,57.04,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.63,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.91,100,,,fee schedule,100% of cigna fee schedule,52.25,100,,,fee schedule,100% of healthlink fee schedule,50.16,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,52.25,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,151.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.63,115,,,fee schedule,115% of cms fee schedule,89.92,175,,,Fee Schedule,175% of CMS Fee Schedule,70.73,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,52.48,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,63.04,100,,,Fee Schedule,100% of UHC Fee Schedule,151.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.63,115,,,Fee Schedule,115% of CMS OPPS Rate,56.39,100,,,Fee Schedule,100% of UMR Fee Schedule,45.63,115,,,Fee Schedule,115% of CMS OPPS Rate,45.63,151.65,
STRAPPING ELBOW OR WRIST,P990310147,CDM,981,RC,29260,HCPCS,Outpatient,,,168.5,84.25,,56.51,175,,,fee schedule,175% of aetna fee schedule,20.54,115,,,fee schedule,115% of cms physician fee schedule,20.95,117.3,,,fee schedule,117.3% of cms physician fee schedule,25.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.54,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.69,100,,,fee schedule,100% of cigna fee schedule,24.24,100,,,fee schedule,100% of healthlink fee schedule,23.27,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,24.24,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,151.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.54,115,,,fee schedule,115% of cms fee schedule,56.51,175,,,Fee Schedule,175% of CMS Fee Schedule,31.84,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,23.62,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,25.64,100,,,Fee Schedule,100% of UHC Fee Schedule,151.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.54,115,,,Fee Schedule,115% of CMS OPPS Rate,22.93,100,,,Fee Schedule,100% of UMR Fee Schedule,20.54,115,,,Fee Schedule,115% of CMS OPPS Rate,20.54,151.65,
STRAPPING HAND OR FINGER,P990310148,CDM,981,RC,29280,HCPCS,Outpatient,,,168.5,84.25,,52.73,175,,,fee schedule,175% of aetna fee schedule,21.88,115,,,fee schedule,115% of cms physician fee schedule,22.32,117.3,,,fee schedule,117.3% of cms physician fee schedule,27.36,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.88,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.18,100,,,fee schedule,100% of cigna fee schedule,25.84,100,,,fee schedule,100% of healthlink fee schedule,24.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,25.84,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,151.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.88,115,,,fee schedule,115% of cms fee schedule,52.73,175,,,Fee Schedule,175% of CMS Fee Schedule,33.92,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,25.17,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,26.52,100,,,Fee Schedule,100% of UHC Fee Schedule,151.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.88,115,,,Fee Schedule,115% of CMS OPPS Rate,23.72,100,,,Fee Schedule,100% of UMR Fee Schedule,21.88,115,,,Fee Schedule,115% of CMS OPPS Rate,21.88,151.65,
SPLINT APP SHORT LEG,P990310149,CDM,981,RC,29515,HCPCS,Outpatient,,,168.5,84.25,,75.04,175,,,fee schedule,175% of aetna fee schedule,53.34,115,,,fee schedule,115% of cms physician fee schedule,54.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,66.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.34,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.04,100,,,fee schedule,100% of cigna fee schedule,59.88,100,,,fee schedule,100% of healthlink fee schedule,57.48,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,59.88,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,151.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.34,115,,,fee schedule,115% of cms fee schedule,75.04,175,,,Fee Schedule,175% of CMS Fee Schedule,82.67,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,61.34,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,64.59,100,,,Fee Schedule,100% of UHC Fee Schedule,151.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.34,115,,,Fee Schedule,115% of CMS OPPS Rate,57.78,100,,,Fee Schedule,100% of UMR Fee Schedule,53.34,115,,,Fee Schedule,115% of CMS OPPS Rate,53.34,151.65,
"REMOVE/BIVALV F-ARM, BOOT CAST",P990310150,CDM,981,RC,29700,HCPCS,Outpatient,,,251.5,125.75,,94.25,135,,,fee schedule,135% of aetna fee schedule,35.74,115,,,fee schedule,115% of cms physician fee schedule,36.46,117.3,,,fee schedule,117.3% of cms physician fee schedule,44.68,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.74,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.38,100,,,fee schedule,100% of cigna fee schedule,41.01,100,,,fee schedule,100% of healthlink fee schedule,39.37,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,41.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,226.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,226.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.74,115,,,fee schedule,115% of cms fee schedule,94.25,135,,,Fee Schedule,135% of CMS Fee Schedule ,55.4,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,41.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,43.89,100,,,Fee Schedule,100% of UHC Fee Schedule,226.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.74,115,,,Fee Schedule,115% of CMS OPPS Rate,39.26,100,,,Fee Schedule,100% of UMR Fee Schedule,35.74,115,,,Fee Schedule,115% of CMS OPPS Rate,35.74,226.35,
REMOVE/BIVALV FULL ARM OR LEG,P990310151,CDM,981,RC,29705,HCPCS,Outpatient,,,251.5,125.75,,75.83,175,,,fee schedule,175% of aetna fee schedule,47.96,115,,,fee schedule,115% of cms physician fee schedule,48.91,117.3,,,fee schedule,117.3% of cms physician fee schedule,59.94,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.96,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.24,100,,,fee schedule,100% of cigna fee schedule,55.81,100,,,fee schedule,100% of healthlink fee schedule,53.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,55.81,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,226.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,226.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.96,115,,,fee schedule,115% of cms fee schedule,75.83,175,,,Fee Schedule,175% of CMS Fee Schedule,74.33,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,55.15,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,60.8,100,,,Fee Schedule,100% of UHC Fee Schedule,226.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.96,115,,,Fee Schedule,115% of CMS OPPS Rate,54.39,100,,,Fee Schedule,100% of UMR Fee Schedule,47.96,115,,,Fee Schedule,115% of CMS OPPS Rate,47.96,226.35,
WINDOWING OF CAST,P990310152,CDM,981,RC,29730,HCPCS,Outpatient,,,251.5,125.75,,73.01,175,,,fee schedule,175% of aetna fee schedule,48.24,115,,,fee schedule,115% of cms physician fee schedule,49.21,117.3,,,fee schedule,117.3% of cms physician fee schedule,60.3,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.24,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.01,100,,,fee schedule,100% of cigna fee schedule,53.43,100,,,fee schedule,100% of healthlink fee schedule,51.29,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,53.43,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,226.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,226.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.24,115,,,fee schedule,115% of cms fee schedule,73.01,175,,,Fee Schedule,175% of CMS Fee Schedule,74.78,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,55.48,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,58.07,100,,,Fee Schedule,100% of UHC Fee Schedule,226.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.24,115,,,Fee Schedule,115% of CMS OPPS Rate,51.95,100,,,Fee Schedule,100% of UMR Fee Schedule,48.24,115,,,Fee Schedule,115% of CMS OPPS Rate,48.24,226.35,
I & D SEPTAL HEMATOMA/ABSCESS,P990310153,CDM,981,RC,30020,HCPCS,Outpatient,,,573,286.5,,170.57,175,,,fee schedule,175% of aetna fee schedule,130.35,115,,,fee schedule,115% of cms physician fee schedule,132.96,117.3,,,fee schedule,117.3% of cms physician fee schedule,162.94,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.35,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,132.46,100,,,fee schedule,100% of cigna fee schedule,175.49,100,,,fee schedule,100% of healthlink fee schedule,169.83,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,175.49,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,515.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,515.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.35,115,,,fee schedule,115% of cms fee schedule,170.57,175,,,Fee Schedule,175% of CMS Fee Schedule,202.05,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,149.91,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,126.53,100,,,Fee Schedule,100% of UHC Fee Schedule,515.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130.35,115,,,Fee Schedule,115% of CMS OPPS Rate,116.51,100,,,Fee Schedule,100% of UMR Fee Schedule,130.35,115,,,Fee Schedule,115% of CMS OPPS Rate,116.51,515.7,
RFB INTRANASAL,P990310154,CDM,981,RC,30300,HCPCS,Outpatient,,,289,144.5,,167.79,175,,,fee schedule,175% of aetna fee schedule,128.09,115,,,fee schedule,115% of cms physician fee schedule,130.65,117.3,,,fee schedule,117.3% of cms physician fee schedule,160.11,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128.09,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,123.76,100,,,fee schedule,100% of cigna fee schedule,163.94,100,,,fee schedule,100% of healthlink fee schedule,158.66,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,163.94,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,260.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,260.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.09,115,,,fee schedule,115% of cms fee schedule,167.79,175,,,Fee Schedule,175% of CMS Fee Schedule,198.53,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,147.3,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,117.25,100,,,Fee Schedule,100% of UHC Fee Schedule,260.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128.09,115,,,Fee Schedule,115% of CMS OPPS Rate,107.96,100,,,Fee Schedule,100% of UMR Fee Schedule,128.09,115,,,Fee Schedule,115% of CMS OPPS Rate,107.96,260.1,
"ANT NOSE BLEED, SIMPLE",P990310155,CDM,981,RC,30901,HCPCS,Outpatient,,,469.5,234.75,,99.87,175,,,fee schedule,175% of aetna fee schedule,61.74,115,,,fee schedule,115% of cms physician fee schedule,62.98,117.3,,,fee schedule,117.3% of cms physician fee schedule,77.18,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.74,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.39,100,,,fee schedule,100% of cigna fee schedule,87.95,100,,,fee schedule,100% of healthlink fee schedule,85.11,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,87.95,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,422.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,422.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.74,115,,,fee schedule,115% of cms fee schedule,99.87,175,,,Fee Schedule,175% of CMS Fee Schedule,95.7,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,71.01,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,61.61,100,,,Fee Schedule,100% of UHC Fee Schedule,422.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.74,115,,,Fee Schedule,115% of CMS OPPS Rate,56.73,100,,,Fee Schedule,100% of UMR Fee Schedule,61.74,115,,,Fee Schedule,115% of CMS OPPS Rate,56.73,422.55,
"ANT NOSE BLEED, COMPLEX",P990310156,CDM,981,RC,30903,HCPCS,Outpatient,,,596.5,298.25,,128.7,175,,,fee schedule,175% of aetna fee schedule,84.28,115,,,fee schedule,115% of cms physician fee schedule,85.97,117.3,,,fee schedule,117.3% of cms physician fee schedule,105.35,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.28,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.41,100,,,fee schedule,100% of cigna fee schedule,122.42,100,,,fee schedule,100% of healthlink fee schedule,118.47,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,122.42,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,536.85,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,536.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,536.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.28,115,,,fee schedule,115% of cms fee schedule,128.7,175,,,Fee Schedule,175% of CMS Fee Schedule,130.64,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,96.93,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,85.63,100,,,Fee Schedule,100% of UHC Fee Schedule,536.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.28,115,,,Fee Schedule,115% of CMS OPPS Rate,78.84,100,,,Fee Schedule,100% of UMR Fee Schedule,84.28,115,,,Fee Schedule,115% of CMS OPPS Rate,78.84,536.85,
POSTERIOR NOSE BLEED,P990310157,CDM,981,RC,30905,HCPCS,Outpatient,,,1075,537.5,,163.01,175,,,fee schedule,175% of aetna fee schedule,114.98,115,,,fee schedule,115% of cms physician fee schedule,117.28,117.3,,,fee schedule,117.3% of cms physician fee schedule,143.72,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.98,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,123.75,100,,,fee schedule,100% of cigna fee schedule,163.94,100,,,fee schedule,100% of healthlink fee schedule,158.66,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,163.94,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,967.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,967.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,967.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.98,115,,,fee schedule,115% of cms fee schedule,163.01,175,,,Fee Schedule,175% of CMS Fee Schedule,178.21,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,132.22,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,114.33,100,,,Fee Schedule,100% of UHC Fee Schedule,967.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114.98,115,,,Fee Schedule,115% of CMS OPPS Rate,105.27,100,,,Fee Schedule,100% of UMR Fee Schedule,114.98,115,,,Fee Schedule,115% of CMS OPPS Rate,105.27,967.5,
INTUBATION-ENDOTRACHEAL,P990310158,CDM,981,RC,31500,HCPCS,Outpatient,,,949,474.5,,180.04,175,,,fee schedule,175% of aetna fee schedule,153.89,115,,,fee schedule,115% of cms physician fee schedule,156.97,117.3,,,fee schedule,117.3% of cms physician fee schedule,192.37,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.89,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.89,100,,,fee schedule,100% of cigna fee schedule,223.74,500,,,fee schedule,500% of healthlink,216.53,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,223.74,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,854.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,854.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.89,115,,,fee schedule,115% of cms fee schedule,180.04,175,,,Fee Schedule,175% of CMS Fee Schedule,238.53,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,176.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,155.1,100,,,Fee Schedule,100% of UHC Fee Schedule,854.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.89,115,,,Fee Schedule,115% of CMS OPPS Rate,142.81,100,,,Fee Schedule,100% of UMR Fee Schedule,153.89,115,,,Fee Schedule,115% of CMS OPPS Rate,142.81,854.1,
TRECH TUBE CHG W/FISTULA TRACT,P990310159,CDM,981,RC,31502,HCPCS,Outpatient,,,949,474.5,,55.56,175,,,fee schedule,175% of aetna fee schedule,37.8,115,,,fee schedule,115% of cms physician fee schedule,38.56,117.3,,,fee schedule,117.3% of cms physician fee schedule,47.25,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.8,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.67,100,,,fee schedule,100% of cigna fee schedule,53.88,100,,,fee schedule,100% of healthlink fee schedule,52.14,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,53.88,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,854.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,854.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,115,,,fee schedule,115% of cms fee schedule,55.56,175,,,Fee Schedule,175% of CMS Fee Schedule,58.59,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,43.47,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,38.31,100,,,Fee Schedule,100% of UHC Fee Schedule,854.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.8,115,,,Fee Schedule,115% of CMS OPPS Rate,35.27,100,,,Fee Schedule,100% of UMR Fee Schedule,37.8,115,,,Fee Schedule,115% of CMS OPPS Rate,35.27,854.1,
"LARYNGOSCOPY, DIREC W/FBR",P990310160,CDM,981,RC,31530,HCPCS,Outpatient,,,1324,662,,308.79,175,,,fee schedule,175% of aetna fee schedule,213.74,115,,,fee schedule,115% of cms physician fee schedule,218.01,117.3,,,fee schedule,117.3% of cms physician fee schedule,267.17,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.74,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,227.75,100,,,fee schedule,100% of cigna fee schedule,301.72,100,,,fee schedule,100% of healthlink fee schedule,291.99,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,301.72,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1191.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1191.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1191.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.74,115,,,fee schedule,115% of cms fee schedule,308.79,175,,,Fee Schedule,175% of CMS Fee Schedule,331.3,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,245.8,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,216.24,100,,,Fee Schedule,100% of UHC Fee Schedule,1191.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.74,115,,,Fee Schedule,115% of CMS OPPS Rate,199.1,100,,,Fee Schedule,100% of UMR Fee Schedule,213.74,115,,,Fee Schedule,115% of CMS OPPS Rate,199.1,1191.6,
TRACHEOSTOMY,P990310161,CDM,981,RC,31603,HCPCS,Outpatient,,,1983,991.5,,355.83,175,,,fee schedule,175% of aetna fee schedule,346.53,115,,,fee schedule,115% of cms physician fee schedule,353.46,117.3,,,fee schedule,117.3% of cms physician fee schedule,433.16,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,346.53,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,375.03,100,,,fee schedule,100% of cigna fee schedule,496.82,100,,,fee schedule,100% of healthlink fee schedule,480.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,496.82,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1784.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1784.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1784.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.53,115,,,fee schedule,115% of cms fee schedule,355.83,175,,,Fee Schedule,175% of CMS Fee Schedule,537.12,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,398.51,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,354.21,100,,,Fee Schedule,100% of UHC Fee Schedule,1784.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,346.53,115,,,Fee Schedule,115% of CMS OPPS Rate,326.14,100,,,Fee Schedule,100% of UMR Fee Schedule,346.53,115,,,Fee Schedule,115% of CMS OPPS Rate,326.14,1784.7,
CRICOTHYROTOMY,P990310162,CDM,981,RC,31605,HCPCS,Outpatient,,,1983,991.5,,296.08,175,,,fee schedule,175% of aetna fee schedule,358.44,115,,,fee schedule,115% of cms physician fee schedule,365.61,117.3,,,fee schedule,117.3% of cms physician fee schedule,448.05,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.44,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,392.73,100,,,fee schedule,100% of cigna fee schedule,520.29,100,,,fee schedule,100% of healthlink fee schedule,503.51,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,520.29,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1784.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1784.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1784.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.44,115,,,fee schedule,115% of cms fee schedule,296.08,175,,,Fee Schedule,175% of CMS Fee Schedule,555.59,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,412.21,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,366.26,100,,,Fee Schedule,100% of UHC Fee Schedule,1784.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.44,115,,,Fee Schedule,115% of CMS OPPS Rate,337.24,100,,,Fee Schedule,100% of UMR Fee Schedule,358.44,115,,,Fee Schedule,115% of CMS OPPS Rate,296.08,1784.7,
CHEST TUBE INSERT W/WATERSEAL,P990310163,CDM,981,RC,32551,HCPCS,Outpatient,,,1439.5,719.75,,289.12,175,,,fee schedule,175% of aetna fee schedule,168.03,115,,,fee schedule,115% of cms physician fee schedule,171.39,117.3,,,fee schedule,117.3% of cms physician fee schedule,210.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.03,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,184.55,100,,,fee schedule,100% of cigna fee schedule,244.5,100,,,fee schedule,100% of healthlink fee schedule,236.61,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,244.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1295.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1295.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1295.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.03,115,,,fee schedule,115% of cms fee schedule,289.12,175,,,Fee Schedule,175% of CMS Fee Schedule,260.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,193.23,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,172.52,100,,,Fee Schedule,100% of UHC Fee Schedule,1295.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.03,115,,,Fee Schedule,115% of CMS OPPS Rate,158.84,100,,,Fee Schedule,100% of UMR Fee Schedule,168.03,115,,,Fee Schedule,115% of CMS OPPS Rate,158.84,1295.55,
PERICARDIOCENTESIS,P990310164,CDM,981,RC,33018,HCPCS,Outpatient,,,1983,991.5,,349.68,135,,,fee schedule,135% of aetna fee schedule,309.37,115,,,fee schedule,115% of cms physician fee schedule,315.56,117.3,,,fee schedule,117.3% of cms physician fee schedule,386.72,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.37,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,327.42,100,,,fee schedule,100% of cigna fee schedule,433.75,100,,,fee schedule,100% of healthlink fee schedule,419.76,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,433.75,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1784.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1784.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1784.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.37,115,,,fee schedule,115% of cms fee schedule,349.68,135,,,Fee Schedule,135% of CMS Fee Schedule ,479.53,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,355.78,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,372.1,100,,,Fee Schedule,100% of UHC Fee Schedule,1784.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309.37,115,,,Fee Schedule,115% of CMS OPPS Rate,338.67,100,,,Fee Schedule,100% of UMR Fee Schedule,309.37,115,,,Fee Schedule,115% of CMS OPPS Rate,309.37,1784.7,
TRANSVENOUS PACEMACKER,P990310165,CDM,981,RC,33210,HCPCS,Outpatient,,,2357.5,1178.75,,306.65,175,,,fee schedule,175% of aetna fee schedule,172.52,115,,,fee schedule,115% of cms physician fee schedule,175.97,117.3,,,fee schedule,117.3% of cms physician fee schedule,215.65,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.52,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,191.33,100,,,fee schedule,100% of cigna fee schedule,253.47,100,,,fee schedule,100% of healthlink fee schedule,245.3,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,253.47,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,2121.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,2121.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2121.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.52,115,,,fee schedule,115% of cms fee schedule,306.65,175,,,Fee Schedule,175% of CMS Fee Schedule,267.41,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,198.4,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,219.16,100,,,Fee Schedule,100% of UHC Fee Schedule,2121.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.52,115,,,Fee Schedule,115% of CMS OPPS Rate,199.47,100,,,Fee Schedule,100% of UMR Fee Schedule,172.52,115,,,Fee Schedule,115% of CMS OPPS Rate,172.52,2121.75,
VENIPUNCTURE >3Y FEM/JUGULAR,P990310166,CDM,981,RC,36400,HCPCS,Outpatient,,,384,192,,29.49,175,,,fee schedule,175% of aetna fee schedule,20.16,115,,,fee schedule,115% of cms physician fee schedule,20.56,117.3,,,fee schedule,117.3% of cms physician fee schedule,25.2,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.16,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.9,100,,,fee schedule,100% of cigna fee schedule,29.02,100,,,fee schedule,100% of healthlink fee schedule,28.08,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,29.02,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,345.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,345.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.16,115,,,fee schedule,115% of cms fee schedule,29.49,175,,,Fee Schedule,175% of CMS Fee Schedule,31.25,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,23.18,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,24.26,100,,,Fee Schedule,100% of UHC Fee Schedule,345.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.16,115,,,Fee Schedule,115% of CMS OPPS Rate,22.08,100,,,Fee Schedule,100% of UMR Fee Schedule,20.16,115,,,Fee Schedule,115% of CMS OPPS Rate,20.16,345.6,
CENTRAL LINE < 5 YEAR OF AGE,P990310167,CDM,981,RC,36555,HCPCS,Outpatient,,,861.5,430.75,,208.2,175,,,fee schedule,175% of aetna fee schedule,92.16,115,,,fee schedule,115% of cms physician fee schedule,94,117.3,,,fee schedule,117.3% of cms physician fee schedule,115.2,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.16,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.28,100,,,fee schedule,100% of cigna fee schedule,132.85,100,,,fee schedule,100% of healthlink fee schedule,128.57,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,132.85,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,775.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,775.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.16,115,,,fee schedule,115% of cms fee schedule,208.2,175,,,Fee Schedule,175% of CMS Fee Schedule,142.85,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,105.99,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,113.13,100,,,Fee Schedule,100% of UHC Fee Schedule,775.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.16,115,,,Fee Schedule,115% of CMS OPPS Rate,102.96,100,,,Fee Schedule,100% of UMR Fee Schedule,92.16,115,,,Fee Schedule,115% of CMS OPPS Rate,92.16,775.35,
CENTRAL LINE > 5 YEARS OF AGE,P990310168,CDM,981,RC,36556,HCPCS,Outpatient,,,861.5,430.75,,200.31,175,,,fee schedule,175% of aetna fee schedule,91.61,115,,,fee schedule,115% of cms physician fee schedule,93.44,117.3,,,fee schedule,117.3% of cms physician fee schedule,114.51,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.61,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.08,100,,,fee schedule,100% of cigna fee schedule,132.59,100,,,fee schedule,100% of healthlink fee schedule,128.31,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,132.59,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,775.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,775.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.61,115,,,fee schedule,115% of cms fee schedule,200.31,175,,,Fee Schedule,175% of CMS Fee Schedule,141.99,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,105.35,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,112.56,100,,,Fee Schedule,100% of UHC Fee Schedule,775.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.61,115,,,Fee Schedule,115% of CMS OPPS Rate,102.45,100,,,Fee Schedule,100% of UMR Fee Schedule,91.61,115,,,Fee Schedule,115% of CMS OPPS Rate,91.61,775.35,
PICC INSERTION,P990310169,CDM,981,RC,36569,HCPCS,Outpatient,,,856,428,,164.64,175,,,fee schedule,175% of aetna fee schedule,102.37,115,,,fee schedule,115% of cms physician fee schedule,104.42,117.3,,,fee schedule,117.3% of cms physician fee schedule,127.97,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.37,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,110.66,100,,,fee schedule,100% of cigna fee schedule,146.61,100,,,fee schedule,100% of healthlink fee schedule,141.89,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,146.61,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,770.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,770.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,770.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.37,115,,,fee schedule,115% of cms fee schedule,164.64,175,,,Fee Schedule,175% of CMS Fee Schedule,158.68,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,117.73,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,124.66,100,,,Fee Schedule,100% of UHC Fee Schedule,770.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.37,115,,,Fee Schedule,115% of CMS OPPS Rate,113.46,100,,,Fee Schedule,100% of UMR Fee Schedule,102.37,115,,,Fee Schedule,115% of CMS OPPS Rate,102.37,770.4,
I/O NEEDLE PLACEMENT,P990310171,CDM,981,RC,36680,HCPCS,Outpatient,,,664.5,332.25,,96.65,175,,,fee schedule,175% of aetna fee schedule,64.98,115,,,fee schedule,115% of cms physician fee schedule,66.27,117.3,,,fee schedule,117.3% of cms physician fee schedule,81.22,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.98,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70.73,100,,,fee schedule,100% of cigna fee schedule,93.7,100,,,fee schedule,100% of healthlink fee schedule,90.68,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,93.7,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,598.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.98,115,,,fee schedule,115% of cms fee schedule,96.65,175,,,Fee Schedule,175% of CMS Fee Schedule,100.71,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,74.72,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,77.81,100,,,Fee Schedule,100% of UHC Fee Schedule,598.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.98,115,,,Fee Schedule,115% of CMS OPPS Rate,70.82,100,,,Fee Schedule,100% of UMR Fee Schedule,64.98,115,,,Fee Schedule,115% of CMS OPPS Rate,64.98,598.05,
"DRAINAGE/ABSCESS OF MOUTH,SIMP",P990310172,CDM,981,RC,40800,HCPCS,Outpatient,,,376,188,,180.71,175,,,fee schedule,175% of aetna fee schedule,124.22,115,,,fee schedule,115% of cms physician fee schedule,126.71,117.3,,,fee schedule,117.3% of cms physician fee schedule,155.28,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124.22,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.52,100,,,fee schedule,100% of cigna fee schedule,198.36,100,,,fee schedule,100% of healthlink fee schedule,192.52,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,198.36,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,338.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,338.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.22,115,,,fee schedule,115% of cms fee schedule,180.71,175,,,Fee Schedule,175% of CMS Fee Schedule,192.55,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,142.86,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,167.76,100,,,Fee Schedule,100% of UHC Fee Schedule,338.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.22,115,,,Fee Schedule,115% of CMS OPPS Rate,150.06,100,,,Fee Schedule,100% of UMR Fee Schedule,124.22,115,,,Fee Schedule,115% of CMS OPPS Rate,124.22,338.4,
"RFB, VESTIBULE OF MOUTH, SIMPL",P990310173,CDM,981,RC,40804,HCPCS,Outpatient,,,393.5,196.75,,181.27,175,,,fee schedule,175% of aetna fee schedule,120.06,115,,,fee schedule,115% of cms physician fee schedule,122.46,117.3,,,fee schedule,117.3% of cms physician fee schedule,150.08,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120.06,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.93,100,,,fee schedule,100% of cigna fee schedule,190.23,100,,,fee schedule,100% of healthlink fee schedule,184.64,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,190.23,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,354.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,354.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.06,115,,,fee schedule,115% of cms fee schedule,181.27,175,,,Fee Schedule,175% of CMS Fee Schedule,186.09,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,138.07,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,152.37,100,,,Fee Schedule,100% of UHC Fee Schedule,354.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,120.06,115,,,Fee Schedule,115% of CMS OPPS Rate,136.3,100,,,Fee Schedule,100% of UMR Fee Schedule,120.06,115,,,Fee Schedule,115% of CMS OPPS Rate,120.06,354.15,
LAC REP VESTIBULE MOUTH <2.5,P990310174,CDM,981,RC,40830,HCPCS,Outpatient,,,1030.5,515.25,,227.41,175,,,fee schedule,175% of aetna fee schedule,153.49,115,,,fee schedule,115% of cms physician fee schedule,156.56,117.3,,,fee schedule,117.3% of cms physician fee schedule,191.86,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.49,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.85,100,,,fee schedule,100% of cigna fee schedule,271.49,100,,,fee schedule,100% of healthlink fee schedule,263.51,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,271.49,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,927.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,927.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.49,115,,,fee schedule,115% of cms fee schedule,227.41,175,,,Fee Schedule,175% of CMS Fee Schedule,237.91,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,176.51,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,216.47,100,,,Fee Schedule,100% of UHC Fee Schedule,927.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.49,115,,,Fee Schedule,115% of CMS OPPS Rate,193.64,100,,,Fee Schedule,100% of UMR Fee Schedule,153.49,115,,,Fee Schedule,115% of CMS OPPS Rate,153.49,927.45,
I&D INTRAORAL ABCES/CYST/HEMAT,P990310175,CDM,981,RC,41000,HCPCS,Outpatient,,,522.5,261.25,,279.29,135,,,fee schedule,135% of aetna fee schedule,110.53,115,,,fee schedule,115% of cms physician fee schedule,112.74,117.3,,,fee schedule,117.3% of cms physician fee schedule,138.16,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,110.53,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.75,100,,,fee schedule,100% of cigna fee schedule,176.9,100,,,fee schedule,100% of healthlink fee schedule,171.7,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,176.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,470.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,470.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,470.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.53,115,,,fee schedule,115% of cms fee schedule,279.29,135,,,Fee Schedule,135% of CMS Fee Schedule ,171.32,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,127.11,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,145.91,100,,,Fee Schedule,100% of UHC Fee Schedule,470.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.53,115,,,Fee Schedule,115% of CMS OPPS Rate,130.52,100,,,Fee Schedule,100% of UMR Fee Schedule,110.53,115,,,Fee Schedule,115% of CMS OPPS Rate,110.53,470.25,
REPAIR TONGUE <2.5 CM,P990310176,CDM,981,RC,41250,HCPCS,Outpatient,,,587,293.5,,214.48,175,,,fee schedule,175% of aetna fee schedule,163.42,115,,,fee schedule,115% of cms physician fee schedule,166.68,117.3,,,fee schedule,117.3% of cms physician fee schedule,204.27,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.42,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.93,100,,,fee schedule,100% of cigna fee schedule,251.26,100,,,fee schedule,100% of healthlink fee schedule,243.87,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,251.26,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,528.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,528.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.42,115,,,fee schedule,115% of cms fee schedule,214.48,175,,,Fee Schedule,175% of CMS Fee Schedule,253.29,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,187.93,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,200.41,100,,,Fee Schedule,100% of UHC Fee Schedule,528.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.42,115,,,Fee Schedule,115% of CMS OPPS Rate,179.27,100,,,Fee Schedule,100% of UMR Fee Schedule,163.42,115,,,Fee Schedule,115% of CMS OPPS Rate,163.42,528.3,
RFB TONGUE,P990310177,CDM,981,RC,41599,HCPCS,Outpatient,,,483.5,241.75,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.77,62,,,Percent of total Billed Charges,62% of total billed charges,299.77,62,,,Fee Schedule,62% of Healthlink HMO Fee Schedule,299.77,62,,,Fee Schedule,62% of Healthlink PPO Fee Schedule,435.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,435.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,435.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,299.77,435.15,
"DRAIN,ABS,CYST,HEMA DENTOALVEO",P990310178,CDM,981,RC,41800,HCPCS,Outpatient,,,884,442,,328,135,,,fee schedule,135% of aetna fee schedule,159.95,115,,,fee schedule,115% of cms physician fee schedule,163.15,117.3,,,fee schedule,117.3% of cms physician fee schedule,199.94,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.95,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,166.3,100,,,fee schedule,100% of cigna fee schedule,241.62,100,,,fee schedule,100% of healthlink fee schedule,234.51,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,241.62,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,795.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,795.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,795.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.95,115,,,fee schedule,115% of cms fee schedule,328,135,,,Fee Schedule,135% of CMS Fee Schedule ,247.93,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,183.95,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,195.57,100,,,Fee Schedule,100% of UHC Fee Schedule,795.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,159.95,115,,,Fee Schedule,115% of CMS OPPS Rate,174.94,100,,,Fee Schedule,100% of UMR Fee Schedule,159.95,115,,,Fee Schedule,115% of CMS OPPS Rate,159.95,795.6,
DRAINAGE OF ABSC PALATE/UVULA,P990310179,CDM,981,RC,42000,HCPCS,Outpatient,,,179.5,89.75,,149.66,175,,,fee schedule,175% of aetna fee schedule,115.77,115,,,fee schedule,115% of cms physician fee schedule,118.09,117.3,,,fee schedule,117.3% of cms physician fee schedule,144.71,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.77,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.97,100,,,fee schedule,100% of cigna fee schedule,168.5,100,,,fee schedule,100% of healthlink fee schedule,163.55,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,168.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,161.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,161.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.77,115,,,fee schedule,115% of cms fee schedule,149.66,175,,,Fee Schedule,175% of CMS Fee Schedule,179.44,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,133.14,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,135.08,100,,,Fee Schedule,100% of UHC Fee Schedule,161.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.77,115,,,Fee Schedule,115% of CMS OPPS Rate,120.83,100,,,Fee Schedule,100% of UMR Fee Schedule,115.77,115,,,Fee Schedule,115% of CMS OPPS Rate,115.77,179.44,
LAC PALATE < 2 CM,P990310180,CDM,981,RC,42180,HCPCS,Outpatient,,,620,310,,270.71,175,,,fee schedule,175% of aetna fee schedule,200.38,115,,,fee schedule,115% of cms physician fee schedule,204.38,117.3,,,fee schedule,117.3% of cms physician fee schedule,250.47,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200.38,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.25,100,,,fee schedule,100% of cigna fee schedule,301.12,100,,,fee schedule,100% of healthlink fee schedule,292.26,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,301.12,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,558,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,558,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.38,115,,,fee schedule,115% of cms fee schedule,270.71,175,,,Fee Schedule,175% of CMS Fee Schedule,310.58,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,230.43,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,240.01,100,,,Fee Schedule,100% of UHC Fee Schedule,558,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200.38,115,,,Fee Schedule,115% of CMS OPPS Rate,214.7,100,,,Fee Schedule,100% of UMR Fee Schedule,200.38,115,,,Fee Schedule,115% of CMS OPPS Rate,200.38,558,
RFB PHARYNX,P990310181,CDM,981,RC,42809,HCPCS,Outpatient,,,483.5,241.75,,194.48,175,,,fee schedule,175% of aetna fee schedule,136.53,115,,,fee schedule,115% of cms physician fee schedule,139.26,117.3,,,fee schedule,117.3% of cms physician fee schedule,170.66,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.53,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.68,100,,,fee schedule,100% of cigna fee schedule,204.41,100,,,fee schedule,100% of healthlink fee schedule,198.4,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,204.41,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,435.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,435.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.53,115,,,fee schedule,115% of cms fee schedule,194.48,175,,,Fee Schedule,175% of CMS Fee Schedule,211.62,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,157.01,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,160.86,100,,,Fee Schedule,100% of UHC Fee Schedule,435.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.53,115,,,Fee Schedule,115% of CMS OPPS Rate,143.89,100,,,Fee Schedule,100% of UMR Fee Schedule,136.53,115,,,Fee Schedule,115% of CMS OPPS Rate,136.53,435.15,
NASO/ORO GASTRIC TUBE PLCMENT,P990310182,CDM,981,RC,43752,HCPCS,Outpatient,,,300,150,,67.41,175,,,fee schedule,175% of aetna fee schedule,43.29,115,,,fee schedule,115% of cms physician fee schedule,44.15,117.3,,,fee schedule,117.3% of cms physician fee schedule,54.11,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.29,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.79,100,,,fee schedule,100% of cigna fee schedule,69.45,100,,,fee schedule,100% of healthlink fee schedule,67.4,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,69.45,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,270,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,270,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.29,115,,,fee schedule,115% of cms fee schedule,67.41,175,,,Fee Schedule,175% of CMS Fee Schedule,67.09,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,49.78,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,53.63,100,,,Fee Schedule,100% of UHC Fee Schedule,270,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.29,115,,,Fee Schedule,115% of CMS OPPS Rate,47.98,100,,,Fee Schedule,100% of UMR Fee Schedule,43.29,115,,,Fee Schedule,115% of CMS OPPS Rate,43.29,270,
GASTRIC INTUBATION/LAVAGE,P990310183,CDM,981,RC,43753,HCPCS,Outpatient,,,796.5,398.25,,,,,,other,not seperately reimbusable,23.58,115,,,fee schedule,115% of cms physician fee schedule,24.05,117.3,,,fee schedule,117.3% of cms physician fee schedule,29.47,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.58,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.44,100,,,fee schedule,100% of cigna fee schedule,38.42,100,,,fee schedule,100% of healthlink fee schedule,37.29,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,38.42,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,716.85,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,716.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,716.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.58,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,36.54,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,27.11,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,28.98,100,,,Fee Schedule,100% of UHC Fee Schedule,716.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.58,115,,,Fee Schedule,115% of CMS OPPS Rate,25.92,100,,,Fee Schedule,100% of UMR Fee Schedule,23.58,115,,,Fee Schedule,115% of CMS OPPS Rate,23.58,716.85,
REPOSITION-GASTRIC FEED TUBE,P990310184,CDM,981,RC,43761,HCPCS,Outpatient,,,300,150,,300.27,135,,,fee schedule,135% of aetna fee schedule,112.92,115,,,fee schedule,115% of cms physician fee schedule,115.18,117.3,,,fee schedule,117.3% of cms physician fee schedule,141.15,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.92,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.66,100,,,fee schedule,100% of cigna fee schedule,176.78,100,,,fee schedule,100% of healthlink fee schedule,171.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,176.78,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,270,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,270,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.92,115,,,fee schedule,115% of cms fee schedule,300.27,135,,,Fee Schedule,135% of CMS Fee Schedule ,175.02,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,129.86,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,136.72,100,,,Fee Schedule,100% of UHC Fee Schedule,270,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.92,115,,,Fee Schedule,115% of CMS OPPS Rate,122.3,100,,,Fee Schedule,100% of UMR Fee Schedule,112.92,115,,,Fee Schedule,115% of CMS OPPS Rate,112.92,300.27,
GASTROSTOMY REPLACEMENT,P990310185,CDM,981,RC,43762,HCPCS,Outpatient,,,923,461.5,,47.57,135,,,fee schedule,135% of aetna fee schedule,40.73,115,,,fee schedule,115% of cms physician fee schedule,41.55,117.3,,,fee schedule,117.3% of cms physician fee schedule,50.92,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.73,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.6,100,,,fee schedule,100% of cigna fee schedule,64.8,100,,,fee schedule,100% of healthlink fee schedule,62.9,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,64.8,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,830.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,830.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,830.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.73,115,,,fee schedule,115% of cms fee schedule,47.57,135,,,Fee Schedule,135% of CMS Fee Schedule ,63.14,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,46.84,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,50.11,100,,,Fee Schedule,100% of UHC Fee Schedule,830.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.73,115,,,Fee Schedule,115% of CMS OPPS Rate,44.83,100,,,Fee Schedule,100% of UMR Fee Schedule,40.73,115,,,Fee Schedule,115% of CMS OPPS Rate,40.73,830.7,
I & D ISCHIO/PERIRECTAL ABSCES,P990310187,CDM,981,RC,46040,HCPCS,Outpatient,,,639.5,319.75,,578.27,175,,,fee schedule,175% of aetna fee schedule,454.08,115,,,fee schedule,115% of cms physician fee schedule,463.16,117.3,,,fee schedule,117.3% of cms physician fee schedule,567.6,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,454.08,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,474.98,100,,,fee schedule,100% of cigna fee schedule,639.5,100,,,fee schedule,100% of healthlink fee schedule,639.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,639.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.08,115,,,fee schedule,115% of cms fee schedule,578.27,175,,,Fee Schedule,175% of CMS Fee Schedule,703.82,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,522.19,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,547.65,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,454.08,115,,,Fee Schedule,115% of CMS OPPS Rate,489.89,100,,,Fee Schedule,100% of UMR Fee Schedule,454.08,115,,,Fee Schedule,115% of CMS OPPS Rate,454.08,703.82,
I & D PERIANAL ABSCESS,P990310188,CDM,981,RC,46050,HCPCS,Outpatient,,,639.5,319.75,,135.96,175,,,fee schedule,175% of aetna fee schedule,107.78,115,,,fee schedule,115% of cms physician fee schedule,109.93,117.3,,,fee schedule,117.3% of cms physician fee schedule,134.72,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,107.78,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.18,100,,,fee schedule,100% of cigna fee schedule,161.53,100,,,fee schedule,100% of healthlink fee schedule,156.78,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,161.53,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.78,115,,,fee schedule,115% of cms fee schedule,135.96,175,,,Fee Schedule,175% of CMS Fee Schedule,167.06,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,123.94,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,128.09,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.78,115,,,Fee Schedule,115% of CMS OPPS Rate,114.58,100,,,Fee Schedule,100% of UMR Fee Schedule,107.78,115,,,Fee Schedule,115% of CMS OPPS Rate,107.78,575.55,
I&D THROMBOSED EXT HEMORRHOID,P990310189,CDM,981,RC,46083,HCPCS,Outpatient,,,639.5,319.75,,151.92,175,,,fee schedule,175% of aetna fee schedule,117.51,115,,,fee schedule,115% of cms physician fee schedule,119.86,117.3,,,fee schedule,117.3% of cms physician fee schedule,146.88,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.51,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,122.62,100,,,fee schedule,100% of cigna fee schedule,178.18,100,,,fee schedule,100% of healthlink fee schedule,172.94,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,178.18,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.51,115,,,fee schedule,115% of cms fee schedule,151.92,175,,,Fee Schedule,175% of CMS Fee Schedule,182.14,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,135.13,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,140.03,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.51,115,,,Fee Schedule,115% of CMS OPPS Rate,125.26,100,,,Fee Schedule,100% of UMR Fee Schedule,117.51,115,,,Fee Schedule,115% of CMS OPPS Rate,117.51,575.55,
SURGICAL EXC CONDYLOMA,P990310190,CDM,981,RC,46922,HCPCS,Outpatient,,,639.5,319.75,,195.72,175,,,fee schedule,175% of aetna fee schedule,147.72,115,,,fee schedule,115% of cms physician fee schedule,150.67,117.3,,,fee schedule,117.3% of cms physician fee schedule,184.65,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,147.72,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.53,100,,,fee schedule,100% of cigna fee schedule,224.54,100,,,fee schedule,100% of healthlink fee schedule,217.93,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,224.54,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.72,115,,,fee schedule,115% of cms fee schedule,195.72,175,,,Fee Schedule,175% of CMS Fee Schedule,228.96,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,169.88,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,178.64,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.72,115,,,Fee Schedule,115% of CMS OPPS Rate,159.8,100,,,Fee Schedule,100% of UMR Fee Schedule,147.72,115,,,Fee Schedule,115% of CMS OPPS Rate,147.72,575.55,
ABDOMINAL PARACENTESIS,P990310191,CDM,981,RC,49082,HCPCS,Outpatient,,,990.5,495.25,,194.47,135,,,fee schedule,135% of aetna fee schedule,78.57,115,,,fee schedule,115% of cms physician fee schedule,80.14,117.3,,,fee schedule,117.3% of cms physician fee schedule,98.21,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.57,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.33,100,,,fee schedule,100% of cigna fee schedule,123.98,100,,,fee schedule,100% of healthlink fee schedule,120.33,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,123.98,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,891.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,891.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,891.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.57,115,,,fee schedule,115% of cms fee schedule,194.47,135,,,Fee Schedule,135% of CMS Fee Schedule ,121.78,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,90.35,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,96.82,100,,,Fee Schedule,100% of UHC Fee Schedule,891.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.57,115,,,Fee Schedule,115% of CMS OPPS Rate,86.61,100,,,Fee Schedule,100% of UMR Fee Schedule,78.57,115,,,Fee Schedule,115% of CMS OPPS Rate,78.57,891.45,
"INSERTION FOLEY, SIMPLE",P990310192,CDM,981,RC,51702,HCPCS,Outpatient,,,232,116,,52.2,175,,,fee schedule,175% of aetna fee schedule,27.43,115,,,fee schedule,115% of cms physician fee schedule,27.98,117.3,,,fee schedule,117.3% of cms physician fee schedule,34.28,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.43,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.93,100,,,fee schedule,100% of cigna fee schedule,29.42,100,,,fee schedule,100% of healthlink fee schedule,28.14,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,29.42,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,208.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,208.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.43,115,,,fee schedule,115% of cms fee schedule,52.2,175,,,Fee Schedule,175% of CMS Fee Schedule,42.51,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,31.54,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,52.54,100,,,Fee Schedule,100% of UHC Fee Schedule,208.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.43,115,,,Fee Schedule,115% of CMS OPPS Rate,47.29,100,,,Fee Schedule,100% of UMR Fee Schedule,27.43,115,,,Fee Schedule,115% of CMS OPPS Rate,27.43,208.8,
CHG SYSTOSTOMY TUBE; SIMP,P990310193,CDM,981,RC,51705,HCPCS,Outpatient,,,243.5,121.75,,114.49,175,,,fee schedule,175% of aetna fee schedule,55.59,115,,,fee schedule,115% of cms physician fee schedule,56.7,117.3,,,fee schedule,117.3% of cms physician fee schedule,69.49,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.59,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.96,100,,,fee schedule,100% of cigna fee schedule,58.94,100,,,fee schedule,100% of healthlink fee schedule,56.38,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,58.94,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,219.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,219.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.59,115,,,fee schedule,115% of cms fee schedule,114.49,175,,,Fee Schedule,175% of CMS Fee Schedule,86.17,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,63.93,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,107.56,100,,,Fee Schedule,100% of UHC Fee Schedule,219.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.59,115,,,Fee Schedule,115% of CMS OPPS Rate,96.8,100,,,Fee Schedule,100% of UMR Fee Schedule,55.59,115,,,Fee Schedule,115% of CMS OPPS Rate,55.59,219.15,
EXC PENILE POST CIRCUMCIS ADHS,P990310194,CDM,981,RC,54162,HCPCS,Outpatient,,,436,218,,340.85,175,,,fee schedule,175% of aetna fee schedule,216.17,115,,,fee schedule,115% of cms physician fee schedule,220.49,117.3,,,fee schedule,117.3% of cms physician fee schedule,270.21,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,216.17,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228.99,100,,,fee schedule,100% of cigna fee schedule,225.08,100,,,fee schedule,100% of healthlink fee schedule,215.29,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,225.08,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,392.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,392.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.17,115,,,fee schedule,115% of cms fee schedule,340.85,175,,,Fee Schedule,175% of CMS Fee Schedule,335.06,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,248.59,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,238.51,100,,,Fee Schedule,100% of UHC Fee Schedule,392.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,216.17,115,,,Fee Schedule,115% of CMS OPPS Rate,219.59,100,,,Fee Schedule,100% of UMR Fee Schedule,216.17,115,,,Fee Schedule,115% of CMS OPPS Rate,215.29,392.4,
IRRIG OF CORP CAV FOR PRIAPISM,P990310195,CDM,981,RC,54220,HCPCS,Outpatient,,,725,362.5,,235.97,175,,,fee schedule,175% of aetna fee schedule,145.71,115,,,fee schedule,115% of cms physician fee schedule,148.62,117.3,,,fee schedule,117.3% of cms physician fee schedule,182.13,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.71,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.08,100,,,fee schedule,100% of cigna fee schedule,152.42,100,,,fee schedule,100% of healthlink fee schedule,145.79,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,152.42,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,652.5,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,652.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,652.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.71,115,,,fee schedule,115% of cms fee schedule,235.97,175,,,Fee Schedule,175% of CMS Fee Schedule,225.84,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,167.56,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,160.52,100,,,Fee Schedule,100% of UHC Fee Schedule,652.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.71,115,,,Fee Schedule,115% of CMS OPPS Rate,147.79,100,,,Fee Schedule,100% of UMR Fee Schedule,145.71,115,,,Fee Schedule,115% of CMS OPPS Rate,145.71,652.5,
INJ CORP CAVERNOSA W/PHA AGENT,P990310196,CDM,981,RC,54235,HCPCS,Outpatient,,,737.5,368.75,,128.33,175,,,fee schedule,175% of aetna fee schedule,79.2,115,,,fee schedule,115% of cms physician fee schedule,80.78,117.3,,,fee schedule,117.3% of cms physician fee schedule,99,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,79.2,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83.47,100,,,fee schedule,100% of cigna fee schedule,82.04,100,,,fee schedule,100% of healthlink fee schedule,78.47,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,82.04,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,663.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,663.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,663.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.2,115,,,fee schedule,115% of cms fee schedule,128.33,175,,,Fee Schedule,175% of CMS Fee Schedule,122.76,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,91.08,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,87.14,100,,,Fee Schedule,100% of UHC Fee Schedule,663.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.2,115,,,Fee Schedule,115% of CMS OPPS Rate,80.23,100,,,Fee Schedule,100% of UMR Fee Schedule,79.2,115,,,Fee Schedule,115% of CMS OPPS Rate,78.47,663.75,
"I & D EPIDID, TESTIS &/OR SCRO",P990310197,CDM,981,RC,54700,HCPCS,Outpatient,,,613,306.5,,361.17,175,,,fee schedule,175% of aetna fee schedule,229.89,115,,,fee schedule,115% of cms physician fee schedule,234.48,117.3,,,fee schedule,117.3% of cms physician fee schedule,287.36,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,229.89,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,245.64,100,,,fee schedule,100% of cigna fee schedule,241.44,100,,,fee schedule,100% of healthlink fee schedule,230.95,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,241.44,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,551.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,551.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.89,115,,,fee schedule,115% of cms fee schedule,361.17,175,,,Fee Schedule,175% of CMS Fee Schedule,356.32,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,264.37,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,254.6,100,,,Fee Schedule,100% of UHC Fee Schedule,551.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.89,115,,,Fee Schedule,115% of CMS OPPS Rate,234.4,100,,,Fee Schedule,100% of UMR Fee Schedule,229.89,115,,,Fee Schedule,115% of CMS OPPS Rate,229.89,551.7,
I & D VULVA R PERINEAL ABSCESS,P990310198,CDM,981,RC,56405,HCPCS,Outpatient,,,639.5,319.75,,162.94,175,,,fee schedule,175% of aetna fee schedule,134.71,115,,,fee schedule,115% of cms physician fee schedule,137.41,117.3,,,fee schedule,117.3% of cms physician fee schedule,168.39,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.71,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.7,100,,,fee schedule,100% of cigna fee schedule,169.12,100,,,fee schedule,100% of healthlink fee schedule,163.41,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,169.12,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.71,115,,,fee schedule,115% of cms fee schedule,162.94,175,,,Fee Schedule,175% of CMS Fee Schedule,208.8,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,154.92,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,141.52,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.71,115,,,Fee Schedule,115% of CMS OPPS Rate,137.64,100,,,Fee Schedule,100% of UMR Fee Schedule,134.71,115,,,Fee Schedule,115% of CMS OPPS Rate,133.7,575.55,
I & D BARTHOLIN'S ABCESS,P990310199,CDM,981,RC,56420,HCPCS,Outpatient,,,639.5,319.75,,139.98,175,,,fee schedule,175% of aetna fee schedule,118.06,115,,,fee schedule,115% of cms physician fee schedule,120.42,117.3,,,fee schedule,117.3% of cms physician fee schedule,147.57,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,118.06,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.73,100,,,fee schedule,100% of cigna fee schedule,147.66,100,,,fee schedule,100% of healthlink fee schedule,142.67,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,147.66,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.06,115,,,fee schedule,115% of cms fee schedule,139.98,175,,,Fee Schedule,175% of CMS Fee Schedule,182.99,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,135.77,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,121.25,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.06,115,,,Fee Schedule,115% of CMS OPPS Rate,117.92,100,,,Fee Schedule,100% of UMR Fee Schedule,118.06,115,,,Fee Schedule,115% of CMS OPPS Rate,116.73,575.55,
INTRO HEMOSTATIC AGENT PACKING,P990310200,CDM,981,RC,57180,HCPCS,Outpatient,,,1085.5,542.75,,162.16,175,,,fee schedule,175% of aetna fee schedule,129.29,115,,,fee schedule,115% of cms physician fee schedule,131.88,117.3,,,fee schedule,117.3% of cms physician fee schedule,161.62,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.29,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.56,100,,,fee schedule,100% of cigna fee schedule,165.15,100,,,fee schedule,100% of healthlink fee schedule,159.57,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,165.15,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,976.95,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,976.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,976.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.29,115,,,fee schedule,115% of cms fee schedule,162.16,175,,,Fee Schedule,175% of CMS Fee Schedule,200.41,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,148.69,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,137.07,100,,,Fee Schedule,100% of UHC Fee Schedule,976.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.29,115,,,Fee Schedule,115% of CMS OPPS Rate,133.31,100,,,Fee Schedule,100% of UMR Fee Schedule,129.29,115,,,Fee Schedule,115% of CMS OPPS Rate,129.29,976.95,
REMOVAL OF IUD,P990310201,CDM,981,RC,58301,HCPCS,Outpatient,,,462.5,231.25,,108.76,175,,,fee schedule,175% of aetna fee schedule,72.22,115,,,fee schedule,115% of cms physician fee schedule,73.66,117.3,,,fee schedule,117.3% of cms physician fee schedule,90.28,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72.22,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.66,100,,,fee schedule,100% of cigna fee schedule,99.5,100,,,fee schedule,100% of healthlink fee schedule,96.14,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,99.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,416.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,416.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,115,,,fee schedule,115% of cms fee schedule,108.76,175,,,Fee Schedule,175% of CMS Fee Schedule,111.94,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,83.05,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,84.82,100,,,Fee Schedule,100% of UHC Fee Schedule,416.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.22,115,,,Fee Schedule,115% of CMS OPPS Rate,82.49,100,,,Fee Schedule,100% of UMR Fee Schedule,72.22,115,,,Fee Schedule,115% of CMS OPPS Rate,72.22,416.25,
VAGINAL DELIVERY,P990310202,CDM,981,RC,59409,HCPCS,Outpatient,,,3521.5,1760.75,,1257.59,175,,,fee schedule,175% of aetna fee schedule,872.49,115,,,fee schedule,115% of cms physician fee schedule,889.94,117.3,,,fee schedule,117.3% of cms physician fee schedule,1090.62,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,872.49,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,946.27,100,,,fee schedule,100% of cigna fee schedule,946.27,100,,,fee schedule,100% of healthlink fee schedule,905.83,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,946.27,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,3169.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,3169.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3169.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,872.49,115,,,fee schedule,115% of cms fee schedule,1257.59,175,,,Fee Schedule,175% of CMS Fee Schedule,1352.36,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,1003.37,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,823.64,100,,,Fee Schedule,100% of UHC Fee Schedule,3169.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,872.49,115,,,Fee Schedule,115% of CMS OPPS Rate,737.07,100,,,Fee Schedule,100% of UMR Fee Schedule,872.49,115,,,Fee Schedule,115% of CMS OPPS Rate,737.07,3169.35,
LUMBAR SPINE PUNCTURE,P990310203,CDM,981,RC,62270,HCPCS,Outpatient,,,639.5,319.75,,122.59,175,,,fee schedule,175% of aetna fee schedule,69.43,115,,,fee schedule,115% of cms physician fee schedule,70.81,117.3,,,fee schedule,117.3% of cms physician fee schedule,86.78,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.43,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72.5,100,,,fee schedule,100% of cigna fee schedule,97.9,100,,,fee schedule,100% of healthlink fee schedule,94.8,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,97.9,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,575.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,575.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.43,115,,,fee schedule,115% of cms fee schedule,122.59,175,,,Fee Schedule,175% of CMS Fee Schedule,107.61,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,79.84,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,107.61,100,,,Fee Schedule,100% of UHC Fee Schedule,575.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.43,115,,,Fee Schedule,115% of CMS OPPS Rate,100.2,100,,,Fee Schedule,100% of UMR Fee Schedule,69.43,115,,,Fee Schedule,115% of CMS OPPS Rate,69.43,575.55,
INJ ANES AGENT TRIG NERVE BRAN,P990310204,CDM,981,RC,64400,HCPCS,Outpatient,,,872.5,436.25,,97.77,175,,,fee schedule,175% of aetna fee schedule,55.26,115,,,fee schedule,115% of cms physician fee schedule,56.36,117.3,,,fee schedule,117.3% of cms physician fee schedule,69.07,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.26,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.04,100,,,fee schedule,100% of cigna fee schedule,77.03,100,,,fee schedule,100% of healthlink fee schedule,74.59,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,77.03,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,785.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,785.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,785.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.26,115,,,fee schedule,115% of cms fee schedule,97.77,175,,,Fee Schedule,175% of CMS Fee Schedule,85.65,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,63.55,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,100.4,100,,,Fee Schedule,100% of UHC Fee Schedule,785.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.26,115,,,Fee Schedule,115% of CMS OPPS Rate,93.48,100,,,Fee Schedule,100% of UMR Fee Schedule,55.26,115,,,Fee Schedule,115% of CMS OPPS Rate,55.26,785.25,
PERIPHERAL NERVE/OTH BLOCK,P990310206,CDM,981,RC,64450,HCPCS,Outpatient,,,321,160.5,,113.72,175,,,fee schedule,175% of aetna fee schedule,45.23,115,,,fee schedule,115% of cms physician fee schedule,46.13,117.3,,,fee schedule,117.3% of cms physician fee schedule,56.54,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.23,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.24,100,,,fee schedule,100% of cigna fee schedule,66.5,100,,,fee schedule,100% of healthlink fee schedule,64.4,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,66.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,288.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,288.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,115,,,fee schedule,115% of cms fee schedule,113.72,175,,,Fee Schedule,175% of CMS Fee Schedule,70.11,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,52.01,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,61.53,100,,,Fee Schedule,100% of UHC Fee Schedule,288.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,115,,,Fee Schedule,115% of CMS OPPS Rate,57.29,100,,,Fee Schedule,100% of UMR Fee Schedule,45.23,115,,,Fee Schedule,115% of CMS OPPS Rate,45.23,288.9,
"INJ, ANES AGENT, FACIAL NERVE",P990310207,CDM,981,RC,64999,HCPCS,Outpatient,,,241,120.5,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,149.42,62,,,Percent of total Billed Charges,62% of total billed charges,149.42,62,,,Fee Schedule,62% of Healthlink HMO Fee Schedule,149.42,62,,,Fee Schedule,62% of Healthlink PPO Fee Schedule,216.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,216.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,216.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,149.42,216.9,
RFB SUPERFICIAL EYE CONJUNCTIV,P990310208,CDM,981,RC,65205,HCPCS,Outpatient,,,243.5,121.75,,63.79,175,,,fee schedule,175% of aetna fee schedule,30.91,115,,,fee schedule,115% of cms physician fee schedule,31.53,117.3,,,fee schedule,117.3% of cms physician fee schedule,38.64,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.91,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.04,100,,,fee schedule,100% of cigna fee schedule,44.62,100,,,fee schedule,100% of healthlink fee schedule,43.21,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,44.62,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,219.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,219.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.91,115,,,fee schedule,115% of cms fee schedule,63.79,175,,,Fee Schedule,175% of CMS Fee Schedule,47.91,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,35.55,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,52.32,100,,,Fee Schedule,100% of UHC Fee Schedule,219.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.91,115,,,Fee Schedule,115% of CMS OPPS Rate,40.59,100,,,Fee Schedule,100% of UMR Fee Schedule,30.91,115,,,Fee Schedule,115% of CMS OPPS Rate,30.91,219.15,
RFB EMBEDDED SCLERA/CONJUNCTIV,P990310209,CDM,981,RC,65210,HCPCS,Outpatient,,,344.5,172.25,,76.77,175,,,fee schedule,175% of aetna fee schedule,38.12,115,,,fee schedule,115% of cms physician fee schedule,38.88,117.3,,,fee schedule,117.3% of cms physician fee schedule,47.65,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.12,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.38,100,,,fee schedule,100% of cigna fee schedule,55.88,100,,,fee schedule,100% of healthlink fee schedule,54.12,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,55.88,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,310.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,310.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.12,115,,,fee schedule,115% of cms fee schedule,76.77,175,,,Fee Schedule,175% of CMS Fee Schedule,59.09,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,43.84,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,62.64,100,,,Fee Schedule,100% of UHC Fee Schedule,310.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.12,115,,,Fee Schedule,115% of CMS OPPS Rate,48.6,100,,,Fee Schedule,100% of UMR Fee Schedule,38.12,115,,,Fee Schedule,115% of CMS OPPS Rate,38.12,310.05,
"RFB,CORNEAL W/O SLIT LAMP",P990310210,CDM,981,RC,65220,HCPCS,Outpatient,,,400,200,,62.98,175,,,fee schedule,175% of aetna fee schedule,44.36,115,,,fee schedule,115% of cms physician fee schedule,45.24,117.3,,,fee schedule,117.3% of cms physician fee schedule,55.44,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.36,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.55,100,,,fee schedule,100% of cigna fee schedule,64.21,100,,,fee schedule,100% of healthlink fee schedule,62.18,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,64.21,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,360,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,360,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.36,115,,,fee schedule,115% of cms fee schedule,62.98,175,,,Fee Schedule,175% of CMS Fee Schedule,68.75,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,51.01,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,61.49,100,,,Fee Schedule,100% of UHC Fee Schedule,360,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.36,115,,,Fee Schedule,115% of CMS OPPS Rate,47.71,100,,,Fee Schedule,100% of UMR Fee Schedule,44.36,115,,,Fee Schedule,115% of CMS OPPS Rate,44.36,360,
"RFB, CORNEAL W/SLIT LAMP",P990310211,CDM,981,RC,65222,HCPCS,Outpatient,,,479.5,239.75,,84,175,,,fee schedule,175% of aetna fee schedule,53.51,115,,,fee schedule,115% of cms physician fee schedule,54.58,117.3,,,fee schedule,117.3% of cms physician fee schedule,66.89,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.51,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.02,100,,,fee schedule,100% of cigna fee schedule,78.35,100,,,fee schedule,100% of healthlink fee schedule,75.87,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,78.35,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,431.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,431.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,431.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,115,,,fee schedule,115% of cms fee schedule,84,175,,,Fee Schedule,175% of CMS Fee Schedule,82.94,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,61.54,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,76.21,100,,,Fee Schedule,100% of UHC Fee Schedule,431.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,115,,,Fee Schedule,115% of CMS OPPS Rate,59.13,100,,,Fee Schedule,100% of UMR Fee Schedule,53.51,115,,,Fee Schedule,115% of CMS OPPS Rate,53.51,431.55,
"BLEPHAROT, DRAIN OF ABSC, EYEL",P990310212,CDM,981,RC,67700,HCPCS,Outpatient,,,620,310,,153.56,175,,,fee schedule,175% of aetna fee schedule,121.53,115,,,fee schedule,115% of cms physician fee schedule,123.96,117.3,,,fee schedule,117.3% of cms physician fee schedule,151.92,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.53,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,127.39,100,,,fee schedule,100% of cigna fee schedule,172.03,100,,,fee schedule,100% of healthlink fee schedule,166.59,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,172.03,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,558,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,558,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.53,115,,,fee schedule,115% of cms fee schedule,153.56,175,,,Fee Schedule,175% of CMS Fee Schedule,188.37,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,139.76,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,169.42,100,,,Fee Schedule,100% of UHC Fee Schedule,558,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.53,115,,,Fee Schedule,115% of CMS OPPS Rate,131.45,100,,,Fee Schedule,100% of UMR Fee Schedule,121.53,115,,,Fee Schedule,115% of CMS OPPS Rate,121.53,558,
"RFB, EYELID EMBEDDED",P990310213,CDM,981,RC,67938,HCPCS,Outpatient,,,324.5,162.25,,153.76,175,,,fee schedule,175% of aetna fee schedule,122.69,115,,,fee schedule,115% of cms physician fee schedule,125.15,117.3,,,fee schedule,117.3% of cms physician fee schedule,153.37,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,122.69,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,127.23,100,,,fee schedule,100% of cigna fee schedule,171.81,100,,,fee schedule,100% of healthlink fee schedule,166.37,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,171.81,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,292.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,292.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.69,115,,,fee schedule,115% of cms fee schedule,153.76,175,,,Fee Schedule,175% of CMS Fee Schedule,190.17,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,141.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,169.27,100,,,Fee Schedule,100% of UHC Fee Schedule,292.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.69,115,,,Fee Schedule,115% of CMS OPPS Rate,131.33,100,,,Fee Schedule,100% of UMR Fee Schedule,122.69,115,,,Fee Schedule,115% of CMS OPPS Rate,122.69,292.05,
"RFB, EXT EAR, W/O ANES",P990310214,CDM,981,RC,69200,HCPCS,Outpatient,,,329,164.5,,84.49,175,,,fee schedule,175% of aetna fee schedule,50.93,115,,,fee schedule,115% of cms physician fee schedule,51.95,117.3,,,fee schedule,117.3% of cms physician fee schedule,63.67,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.93,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.75,100,,,fee schedule,100% of cigna fee schedule,72.59,100,,,fee schedule,100% of healthlink fee schedule,70.29,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,72.59,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,296.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,296.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,115,,,fee schedule,115% of cms fee schedule,84.49,175,,,Fee Schedule,175% of CMS Fee Schedule,78.95,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,58.57,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,59.68,100,,,Fee Schedule,100% of UHC Fee Schedule,296.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,115,,,Fee Schedule,115% of CMS OPPS Rate,55.11,100,,,Fee Schedule,100% of UMR Fee Schedule,50.93,115,,,Fee Schedule,115% of CMS OPPS Rate,50.93,296.1,
REM IMPAC CERUMEN W/IRIG/LAV U,P990310215,CDM,981,RC,69209,HCPCS,Outpatient,,,204,102,,,,,,other,not seperately reimbusable,15.72,115,,,fee schedule,115% of cms physician fee schedule,16.03,117.3,,,fee schedule,117.3% of cms physician fee schedule,19.65,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.72,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.5,100,,,fee schedule,100% of cigna fee schedule,19.58,100,,,fee schedule,100% of healthlink fee schedule,18.96,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,19.58,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,183.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,183.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.72,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,24.37,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,18.08,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,17.19,100,,,Fee Schedule,100% of UHC Fee Schedule,183.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.72,115,,,Fee Schedule,115% of CMS OPPS Rate,15.87,100,,,Fee Schedule,100% of UMR Fee Schedule,15.72,115,,,Fee Schedule,115% of CMS OPPS Rate,14.5,183.6,
REMOVE IMPACT CERUMEN EAR,P990310216,CDM,981,RC,69210,HCPCS,Outpatient,,,153.5,76.75,,87.8,135,,,fee schedule,135% of aetna fee schedule,35.27,115,,,fee schedule,115% of cms physician fee schedule,35.98,117.3,,,fee schedule,117.3% of cms physician fee schedule,44.09,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.27,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.62,100,,,fee schedule,100% of cigna fee schedule,52.16,100,,,fee schedule,100% of healthlink fee schedule,50.51,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,52.16,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,138.15,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,138.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.27,115,,,fee schedule,115% of cms fee schedule,87.8,135,,,Fee Schedule,135% of CMS Fee Schedule ,54.67,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,40.56,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,41.7,100,,,Fee Schedule,100% of UHC Fee Schedule,138.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.27,115,,,Fee Schedule,115% of CMS OPPS Rate,38.51,100,,,Fee Schedule,100% of UMR Fee Schedule,35.27,115,,,Fee Schedule,115% of CMS OPPS Rate,35.27,138.15,
FLUORSCEIN ANGIOGRAPHY,P990310217,CDM,981,RC,92235,HCPCS,Outpatient,,,400,200,,133.66,175,,,fee schedule,175% of aetna fee schedule,163.59,115,,,fee schedule,115% of cms physician fee schedule,166.86,117.3,,,fee schedule,117.3% of cms physician fee schedule,204.48,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.59,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,110.6,100,,,fee schedule,100% of cigna fee schedule,138.01,100,,,fee schedule,100% of healthlink fee schedule,128.56,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,138.01,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,360,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,360,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.59,115,,,fee schedule,115% of cms fee schedule,133.66,135,,,Fee Schedule,135% of CMS Fee Schedule ,253.56,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,188.13,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,87.97,100,,,Fee Schedule,100% of UHC Fee Schedule,360,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.59,115,,,Fee Schedule,115% of CMS OPPS Rate,117.26,100,,,Fee Schedule,100% of UMR Fee Schedule,163.59,115,,,Fee Schedule,115% of CMS OPPS Rate,87.97,360,
CARDIAC ARREST,P990310218,CDM,981,RC,92950,HCPCS,Outpatient,,,1398,699,,443.24,135,,,fee schedule,135% of aetna fee schedule,199.97,115,,,fee schedule,115% of cms physician fee schedule,203.97,117.3,,,fee schedule,117.3% of cms physician fee schedule,249.97,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.97,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218.99,100,,,fee schedule,100% of cigna fee schedule,273.27,100,,,fee schedule,100% of healthlink fee schedule,254.55,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,273.27,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,1258.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,1258.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1258.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.97,115,,,fee schedule,115% of cms fee schedule,443.24,135,,,Fee Schedule,135% of CMS Fee Schedule ,309.96,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,229.97,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,253.48,100,,,Fee Schedule,100% of UHC Fee Schedule,1258.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.97,115,,,Fee Schedule,115% of CMS OPPS Rate,225.83,100,,,Fee Schedule,100% of UMR Fee Schedule,199.97,115,,,Fee Schedule,115% of CMS OPPS Rate,199.97,1258.2,
TEMP TRANSCUTANEOUS PACING,P990310219,CDM,981,RC,92953,HCPCS,Outpatient,,,711,355.5,,15.36,175,,,fee schedule,175% of aetna fee schedule,1.05,115,,,fee schedule,115% of cms physician fee schedule,1.07,117.3,,,fee schedule,117.3% of cms physician fee schedule,1.31,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1.05,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1.17,100,,,fee schedule,100% of cigna fee schedule,1.46,100,,,fee schedule,100% of healthlink fee schedule,1.36,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,1.46,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,639.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,639.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,639.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.05,115,,,fee schedule,115% of cms fee schedule,15.36,135,,,Fee Schedule,135% of CMS Fee Schedule ,1.62,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,1.2,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,1.44,100,,,Fee Schedule,100% of UHC Fee Schedule,639.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.05,115,,,Fee Schedule,115% of CMS OPPS Rate,1.28,100,,,Fee Schedule,100% of UMR Fee Schedule,1.05,115,,,Fee Schedule,115% of CMS OPPS Rate,1.05,639.9,
CARDIOVERSION PHYS FEE,P990310220,CDM,981,RC,92960,HCPCS,Outpatient,,,919,459.5,,170.91,175,,,fee schedule,175% of aetna fee schedule,115.44,115,,,fee schedule,115% of cms physician fee schedule,117.75,117.3,,,fee schedule,117.3% of cms physician fee schedule,144.3,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.44,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.27,100,,,fee schedule,100% of cigna fee schedule,156.32,100,,,fee schedule,100% of healthlink fee schedule,145.62,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,156.32,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,827.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,827.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.44,115,,,fee schedule,115% of cms fee schedule,170.91,135,,,Fee Schedule,135% of CMS Fee Schedule ,178.93,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,132.75,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,147.33,100,,,Fee Schedule,100% of UHC Fee Schedule,827.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.44,115,,,Fee Schedule,115% of CMS OPPS Rate,131.25,100,,,Fee Schedule,100% of UMR Fee Schedule,115.44,115,,,Fee Schedule,115% of CMS OPPS Rate,115.44,827.1,
CANALITH REPOS(EPLEY MANEUVER),P990310221,CDM,981,RC,95992,HCPCS,Outpatient,,,328,164,,47.48,175,,,fee schedule,175% of aetna fee schedule,38.9,115,,,fee schedule,115% of cms physician fee schedule,39.68,117.3,,,fee schedule,117.3% of cms physician fee schedule,48.63,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.9,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.03,100,,,fee schedule,100% of cigna fee schedule,54.56,100,,,fee schedule,100% of healthlink fee schedule,50.82,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,54.56,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,295.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,295.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.9,115,,,fee schedule,115% of cms fee schedule,47.48,135,,,Fee Schedule,135% of CMS Fee Schedule ,60.3,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,44.74,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,50.45,100,,,Fee Schedule,100% of UHC Fee Schedule,295.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.9,115,,,Fee Schedule,115% of CMS OPPS Rate,46.51,100,,,Fee Schedule,100% of UMR Fee Schedule,38.9,115,,,Fee Schedule,115% of CMS OPPS Rate,28.03,295.2,
WOUND DEBRIDEMENT,P990310222,CDM,981,RC,97597,HCPCS,Outpatient,,,224.5,112.25,,35.86,175,,,fee schedule,175% of aetna fee schedule,38.74,115,,,fee schedule,115% of cms physician fee schedule,39.52,117.3,,,fee schedule,117.3% of cms physician fee schedule,48.43,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.74,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.42,100,,,fee schedule,100% of cigna fee schedule,53.38,100,,,fee schedule,100% of healthlink fee schedule,49.72,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,53.38,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,202.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,202.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.74,115,,,fee schedule,115% of cms fee schedule,35.86,135,,,Fee Schedule,135% of CMS Fee Schedule ,60.05,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,44.56,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,19.46,100,,,Fee Schedule,100% of UHC Fee Schedule,202.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.74,115,,,Fee Schedule,115% of CMS OPPS Rate,20.67,100,,,Fee Schedule,100% of UMR Fee Schedule,38.74,115,,,Fee Schedule,115% of CMS OPPS Rate,19.46,202.05,
OSTEO MANIPULATIVE TX 1-2 AREA,P990310223,CDM,981,RC,98925,HCPCS,Outpatient,,,438.5,219.25,,28.07,175,,,fee schedule,175% of aetna fee schedule,24.85,115,,,fee schedule,115% of cms physician fee schedule,25.35,117.3,,,fee schedule,117.3% of cms physician fee schedule,31.06,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.85,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.45,100,,,fee schedule,100% of cigna fee schedule,34.25,100,,,fee schedule,100% of healthlink fee schedule,31.91,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,34.25,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,394.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,394.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.85,115,,,fee schedule,115% of cms fee schedule,28.07,135,,,Fee Schedule,135% of CMS Fee Schedule ,38.52,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,28.58,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,32.05,100,,,Fee Schedule,100% of UHC Fee Schedule,394.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.85,115,,,Fee Schedule,115% of CMS OPPS Rate,29.55,100,,,Fee Schedule,100% of UMR Fee Schedule,24.85,115,,,Fee Schedule,115% of CMS OPPS Rate,24.85,394.65,
MOD SED <5 YEAR; 1ST 15,P990310224,CDM,981,RC,99151,HCPCS,Outpatient,,,382,191,,34.1,135,,,fee schedule,135% of aetna fee schedule,26.06,115,,,fee schedule,115% of cms physician fee schedule,26.58,117.3,,,fee schedule,117.3% of cms physician fee schedule,32.57,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.06,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.38,100,,,fee schedule,100% of cigna fee schedule,34.16,100,,,fee schedule,100% of healthlink fee schedule,31.82,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,34.16,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,343.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,343.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.06,115,,,fee schedule,115% of cms fee schedule,34.1,135,,,Fee Schedule,135% of CMS Fee Schedule ,40.39,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,29.97,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,34.04,100,,,Fee Schedule,100% of UHC Fee Schedule,343.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.06,115,,,Fee Schedule,115% of CMS OPPS Rate,31.39,100,,,Fee Schedule,100% of UMR Fee Schedule,26.06,115,,,Fee Schedule,115% of CMS OPPS Rate,26.06,343.8,
MOD SED >5 YEAR; EA 15,P990310225,CDM,981,RC,99152,HCPCS,Outpatient,,,382,191,,15.15,135,,,fee schedule,135% of aetna fee schedule,13.21,115,,,fee schedule,115% of cms physician fee schedule,13.48,117.3,,,fee schedule,117.3% of cms physician fee schedule,16.52,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.21,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.22,100,,,fee schedule,100% of cigna fee schedule,17.74,100,,,fee schedule,100% of healthlink fee schedule,16.52,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,17.74,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,343.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,343.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.21,115,,,fee schedule,115% of cms fee schedule,15.15,135,,,Fee Schedule,135% of CMS Fee Schedule ,20.48,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,15.2,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,16.54,100,,,Fee Schedule,100% of UHC Fee Schedule,343.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.21,115,,,Fee Schedule,115% of CMS OPPS Rate,15.25,100,,,Fee Schedule,100% of UMR Fee Schedule,13.21,115,,,Fee Schedule,115% of CMS OPPS Rate,13.21,343.8,
MOD SED; MONITOR PT,P990310228,CDM,981,RC,99153,HCPCS,Outpatient,,,541,270.5,,12.97,135,,,fee schedule,135% of aetna fee schedule,11.49,115,,,fee schedule,115% of cms physician fee schedule,11.72,117.3,,,fee schedule,117.3% of cms physician fee schedule,14.36,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.49,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.88,100,,,fee schedule,100% of cigna fee schedule,13.58,100,,,fee schedule,100% of healthlink fee schedule,12.65,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,13.58,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,486.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,486.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.49,115,,,fee schedule,115% of cms fee schedule,12.97,135,,,Fee Schedule,135% of CMS Fee Schedule ,17.81,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,13.21,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,13.73,100,,,Fee Schedule,100% of UHC Fee Schedule,486.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.49,115,,,Fee Schedule,115% of CMS OPPS Rate,12.66,100,,,Fee Schedule,100% of UMR Fee Schedule,11.49,115,,,Fee Schedule,115% of CMS OPPS Rate,10.88,486.9,
IPECAC ADMIN/OBSERVATION,P990310229,CDM,981,RC,99175,HCPCS,Outpatient,,,362,181,,19.24,175,,,fee schedule,175% of aetna fee schedule,29.47,115,,,fee schedule,115% of cms physician fee schedule,30.06,117.3,,,fee schedule,117.3% of cms physician fee schedule,36.84,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.47,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.35,100,,,fee schedule,100% of cigna fee schedule,31.64,100,,,fee schedule,100% of healthlink fee schedule,29.47,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,31.64,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,325.8,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,325.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.47,115,,,fee schedule,115% of cms fee schedule,19.24,135,,,Fee Schedule,135% of CMS Fee Schedule ,45.69,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,33.9,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,33.34,100,,,Fee Schedule,100% of UHC Fee Schedule,325.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.47,115,,,Fee Schedule,115% of CMS OPPS Rate,30.74,100,,,Fee Schedule,100% of UMR Fee Schedule,29.47,115,,,Fee Schedule,115% of CMS OPPS Rate,19.24,325.8,
ER PHYS FEE: MINOR,P990310230,CDM,981,RC,99281,HCPCS,Outpatient,,,151.5,75.75,,51.62,135,,,fee schedule,135% of aetna fee schedule,12.56,115,,,fee schedule,115% of cms physician fee schedule,12.81,117.3,,,fee schedule,117.3% of cms physician fee schedule,15.7,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.56,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.17,100,,,fee schedule,100% of cigna fee schedule,25.05,100,,,fee schedule,100% of healthlink fee schedule,22.82,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,25.05,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,136.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,136.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.56,115,,,fee schedule,115% of cms fee schedule,51.62,135,,,Fee Schedule,135% of CMS Fee Schedule ,19.46,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,14.44,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,20.89,100,,,Fee Schedule,100% of UHC Fee Schedule,136.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.56,115,,,Fee Schedule,115% of CMS OPPS Rate,18.4,100,,,Fee Schedule,100% of UMR Fee Schedule,12.56,115,,,Fee Schedule,115% of CMS OPPS Rate,12.56,136.35,
ER PHYS: LIMITED,P990310231,CDM,981,RC,99282,HCPCS,Outpatient,,,281,140.5,,51.98,175,,,fee schedule,175% of aetna fee schedule,45.92,115,,,fee schedule,115% of cms physician fee schedule,46.84,117.3,,,fee schedule,117.3% of cms physician fee schedule,57.4,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.92,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.33,100,,,fee schedule,100% of cigna fee schedule,48.17,100,,,fee schedule,100% of healthlink fee schedule,43.87,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,48.17,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,252.9,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,252.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.92,115,,,fee schedule,115% of cms fee schedule,51.98,135,,,Fee Schedule,135% of CMS Fee Schedule ,71.18,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,52.81,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,40.75,100,,,Fee Schedule,100% of UHC Fee Schedule,252.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.92,115,,,Fee Schedule,115% of CMS OPPS Rate,35.88,100,,,Fee Schedule,100% of UMR Fee Schedule,45.92,115,,,Fee Schedule,115% of CMS OPPS Rate,35.88,252.9,
ER PHYSCIAN:INTERMEDIATE,P990310232,CDM,981,RC,99283,HCPCS,Outpatient,,,346.5,173.25,,79.6,175,,,fee schedule,175% of aetna fee schedule,78.23,115,,,fee schedule,115% of cms physician fee schedule,79.8,117.3,,,fee schedule,117.3% of cms physician fee schedule,97.79,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.23,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.45,100,,,fee schedule,100% of cigna fee schedule,72.23,100,,,fee schedule,100% of healthlink fee schedule,65.78,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,72.23,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,311.85,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.23,115,,,fee schedule,115% of cms fee schedule,79.6,135,,,Fee Schedule,135% of CMS Fee Schedule ,121.26,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,89.97,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,60.98,100,,,Fee Schedule,100% of UHC Fee Schedule,311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.23,115,,,Fee Schedule,115% of CMS OPPS Rate,53.69,100,,,Fee Schedule,100% of UMR Fee Schedule,78.23,115,,,Fee Schedule,115% of CMS OPPS Rate,53.69,311.85,
ER PHYSCIAN:EXTENDED,P990310233,CDM,981,RC,99284,HCPCS,Outpatient,,,573,286.5,,150.62,175,,,fee schedule,175% of aetna fee schedule,133.22,115,,,fee schedule,115% of cms physician fee schedule,135.88,117.3,,,fee schedule,117.3% of cms physician fee schedule,166.52,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.22,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,138.61,100,,,fee schedule,100% of cigna fee schedule,132.69,100,,,fee schedule,100% of healthlink fee schedule,120.84,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,132.69,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,515.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,515.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.22,115,,,fee schedule,115% of cms fee schedule,150.62,135,,,Fee Schedule,135% of CMS Fee Schedule ,206.48,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,153.2,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,115.73,100,,,Fee Schedule,100% of UHC Fee Schedule,515.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,133.22,115,,,Fee Schedule,115% of CMS OPPS Rate,101.89,100,,,Fee Schedule,100% of UMR Fee Schedule,133.22,115,,,Fee Schedule,115% of CMS OPPS Rate,101.89,515.7,
ER PHYS. COMPREHENSIVE,P990310234,CDM,981,RC,99285,HCPCS,Outpatient,,,705.5,352.75,,223.36,175,,,fee schedule,175% of aetna fee schedule,193.13,115,,,fee schedule,115% of cms physician fee schedule,196.99,117.3,,,fee schedule,117.3% of cms physician fee schedule,241.41,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,193.13,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.52,100,,,fee schedule,100% of cigna fee schedule,192.91,100,,,fee schedule,100% of healthlink fee schedule,175.68,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,192.91,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,634.95,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,634.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.13,115,,,fee schedule,115% of cms fee schedule,223.36,135,,,Fee Schedule,135% of CMS Fee Schedule ,299.35,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,222.1,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,170.54,100,,,Fee Schedule,100% of UHC Fee Schedule,634.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,193.13,115,,,Fee Schedule,115% of CMS OPPS Rate,150.14,100,,,Fee Schedule,100% of UMR Fee Schedule,193.13,115,,,Fee Schedule,115% of CMS OPPS Rate,150.14,634.95,
ER CRITICAL CARE EVAL,P990310235,CDM,981,RC,99291,HCPCS,Outpatient,,,874,437,,274.47,175,,,fee schedule,175% of aetna fee schedule,232.24,115,,,fee schedule,115% of cms physician fee schedule,236.89,117.3,,,fee schedule,117.3% of cms physician fee schedule,290.3,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.24,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,255.32,100,,,fee schedule,100% of cigna fee schedule,244.41,100,,,fee schedule,100% of healthlink fee schedule,222.58,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,244.41,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,786.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,786.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.24,115,,,fee schedule,115% of cms fee schedule,274.47,135,,,Fee Schedule,135% of CMS Fee Schedule ,359.98,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,267.08,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,218.27,100,,,Fee Schedule,100% of UHC Fee Schedule,786.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.24,115,,,Fee Schedule,115% of CMS OPPS Rate,192.17,100,,,Fee Schedule,100% of UMR Fee Schedule,232.24,115,,,Fee Schedule,115% of CMS OPPS Rate,192.17,786.6,
ER CRITICAL CARE-SUB 30MN,P990310236,CDM,981,RC,99292,HCPCS,Outpatient,,,388,194,,137.27,175,,,fee schedule,175% of aetna fee schedule,116.97,115,,,fee schedule,115% of cms physician fee schedule,119.31,117.3,,,fee schedule,117.3% of cms physician fee schedule,146.21,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.97,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128.41,100,,,fee schedule,100% of cigna fee schedule,122.92,100,,,fee schedule,100% of healthlink fee schedule,111.95,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,122.92,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,349.2,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,349.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.97,115,,,fee schedule,115% of cms fee schedule,137.27,135,,,Fee Schedule,135% of CMS Fee Schedule ,181.3,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,134.51,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,109.48,100,,,Fee Schedule,100% of UHC Fee Schedule,349.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.97,115,,,Fee Schedule,115% of CMS OPPS Rate,96.39,100,,,Fee Schedule,100% of UMR Fee Schedule,116.97,115,,,Fee Schedule,115% of CMS OPPS Rate,96.39,349.2,
Clsd Fx Medial Malleous W/Manp,P990310237,CDM,981,RC,27762,HCPCS,Outpatient,,,624,312,,633.43,175,,,fee schedule,175% of aetna fee schedule,479.44,115,,,fee schedule,115% of cms physician fee schedule,489.02,117.3,,,fee schedule,117.3% of cms physician fee schedule,599.29,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,479.44,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,487.33,100,,,fee schedule,100% of cigna fee schedule,520.65,100,,,fee schedule,100% of healthlink fee schedule,499.82,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,520.65,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,561.6,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,561.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.44,115,,,fee schedule,115% of cms fee schedule,633.43,175,,,Fee Schedule,175% of CMS Fee Schedule,743.12,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,551.35,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,561.09,100,,,Fee Schedule,100% of UHC Fee Schedule,561.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,479.44,115,,,Fee Schedule,115% of CMS OPPS Rate,501.91,100,,,Fee Schedule,100% of UMR Fee Schedule,479.44,115,,,Fee Schedule,115% of CMS OPPS Rate,479.44,743.12,
EMP WELL HEARTSCORE(PF),P990400001,CDM,350,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,889,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,770,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,770,889,
PNEUMONIA VACCINE ADM,P990550001,CDM,771,RC,G0009,HCPCS,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.62,74,,,Percent of Total Billed Charges,74% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,84,,,Percent of Total Billed Charges,84% of total billed charges,51.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.07,89,,,Percent of total Billed Charges,89% of total Billed charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,
FNA BX W/US GDN 1ST LES,P991500001,CDM,521,RC,10005,HCPCS,Outpatient,,,261,130.5,,200.97,77,,,Percent of Total Billed Charges,77% of total billed charges,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.29,89,,,Percent of total Billed Charges,89% of total Billed charges,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.97,77,,,Percent of total Billed charges,77% of total billed charges,221.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,106.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,232.29,
FNA BX W/US GDN EA ADDL,P991500002,CDM,521,RC,10006,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,112.14,
FNA BX W/O IMG GDN 1ST LES,P991500003,CDM,521,RC,10021,HCPCS,Outpatient,,,429,214.5,,330.33,77,,,Percent of Total Billed Charges,77% of total billed charges,109.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,381.81,89,,,Percent of total Billed Charges,89% of total Billed charges,381.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,381.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.13,120,,,Fee Schedule,120% of MO Medicaid Rate,96.13,120,,,Fee Schedule,120% of MO Medicaid Rate,96.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.33,77,,,Percent of total Billed charges,77% of total billed charges,364.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.13,120,,,Fee Schedule,120% of MO Medicaid Rate,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.13,381.81,
GUIDE CATHET FLUID DRAINAGE,P991500004,CDM,521,RC,10030,HCPCS,Outpatient,,,1137,568.5,,875.49,77,,,Percent of Total Billed Charges,77% of total billed charges,289.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,284.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1011.93,89,,,Percent of total Billed Charges,89% of total Billed charges,1011.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,875.49,77,,,Percent of total Billed charges,77% of total billed charges,966.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,463.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,284.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.25,1011.93,
ACNE SURGERY,P991500005,CDM,521,RC,10040,HCPCS,Outpatient,,,212,106,,163.24,77,,,Percent of Total Billed Charges,77% of total billed charges,54.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,188.68,89,,,Percent of total Billed Charges,89% of total Billed charges,188.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.24,77,,,Percent of total Billed charges,77% of total billed charges,180.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53,188.68,
I&D ABSCESS SIMP/SINGLE,P991500006,CDM,521,RC,10060,HCPCS,Outpatient,,,376,188,,289.52,77,,,Percent of Total Billed Charges,77% of total billed charges,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,334.64,89,,,Percent of total Billed Charges,89% of total Billed charges,334.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.52,77,,,Percent of total Billed charges,77% of total billed charges,319.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94,334.64,
I&D ABSCESS COMP/MULTIPLE,P991500007,CDM,521,RC,10061,HCPCS,Outpatient,,,524,262,,403.48,77,,,Percent of Total Billed Charges,77% of total billed charges,133.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,466.36,89,,,Percent of total Billed Charges,89% of total Billed charges,466.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.48,77,,,Percent of total Billed charges,77% of total billed charges,445.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,213.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131,466.36,
I & D PILONIDAL CYST SIMPLE,P991500008,CDM,521,RC,10080,HCPCS,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
I&D PILONIDAL CYST COMP,P991500009,CDM,521,RC,10081,HCPCS,Outpatient,,,642,321,,494.34,77,,,Percent of Total Billed Charges,77% of total billed charges,163.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,571.38,89,,,Percent of total Billed Charges,89% of total Billed charges,571.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,571.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,494.34,77,,,Percent of total Billed charges,77% of total billed charges,545.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,184.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,261.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.5,571.38,
INCISION&REM FB SUBQ TISS SIMP,P991500010,CDM,521,RC,10120,HCPCS,Outpatient,,,373,186.5,,287.21,77,,,Percent of Total Billed Charges,77% of total billed charges,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.97,89,,,Percent of total Billed Charges,89% of total Billed charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.21,77,,,Percent of total Billed charges,77% of total billed charges,317.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.25,331.97,
REMOVE FOREIGN BODY,P991500011,CDM,521,RC,10121,HCPCS,Outpatient,,,621,310.5,,478.17,77,,,Percent of Total Billed Charges,77% of total billed charges,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552.69,89,,,Percent of total Billed Charges,89% of total Billed charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.17,77,,,Percent of total Billed charges,77% of total billed charges,527.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.25,552.69,
I & D HEMATOMA,P991500012,CDM,521,RC,10140,HCPCS,Outpatient,,,372,186,,286.44,77,,,Percent of Total Billed Charges,77% of total billed charges,94.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.08,89,,,Percent of total Billed Charges,89% of total Billed charges,331.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.44,77,,,Percent of total Billed charges,77% of total billed charges,316.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93,331.08,
PUNCTURE ASPIRATION OF ABSCESS,P991500013,CDM,521,RC,10160,HCPCS,Outpatient,,,277,138.5,,213.29,77,,,Percent of Total Billed Charges,77% of total billed charges,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,246.53,89,,,Percent of total Billed Charges,89% of total Billed charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.29,77,,,Percent of total Billed charges,77% of total billed charges,235.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.25,246.53,
COMPLEX DRAINAGE WOUND,P991500014,CDM,521,RC,10180,HCPCS,Outpatient,,,745,372.5,,573.65,77,,,Percent of Total Billed Charges,77% of total billed charges,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,663.05,89,,,Percent of total Billed Charges,89% of total Billed charges,663.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,663.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.65,77,,,Percent of total Billed charges,77% of total billed charges,633.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,214.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,303.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.25,663.05,
DEBRIDEMENT OF INFECTED SKIN,P991500016,CDM,521,RC,11000,HCPCS,Outpatient,,,141,70.5,,108.57,77,,,Percent of Total Billed Charges,77% of total billed charges,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.49,89,,,Percent of total Billed Charges,89% of total Billed charges,125.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.57,77,,,Percent of total Billed charges,77% of total billed charges,119.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.25,125.49,
DEBRIDE INFECTED SKIN ADD-ON,P991500017,CDM,521,RC,11001,HCPCS,Outpatient,,,51,25.5,,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.39,89,,,Percent of total Billed Charges,89% of total Billed charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.75,45.39,
DEBRIDE GENITALIA & PERINEUM,P991500018,CDM,521,RC,11004,HCPCS,Outpatient,,,1270,635,,977.9,77,,,Percent of Total Billed Charges,77% of total billed charges,323.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1130.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1130.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1130.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,977.9,77,,,Percent of total Billed charges,77% of total billed charges,1079.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.5,1130.3,
DEBRIDEMENT ABDOMINAL WALL,P991500019,CDM,521,RC,11005,HCPCS,Outpatient,,,1359,679.5,,1046.43,77,,,Percent of Total Billed Charges,77% of total billed charges,346.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1209.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1046.43,77,,,Percent of total Billed charges,77% of total billed charges,1155.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,390.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,554.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.75,1209.51,
DEBRIDE GENIT/PER/ABDOM WALL,P991500020,CDM,521,RC,11006,HCPCS,Outpatient,,,1006,503,,774.62,77,,,Percent of Total Billed Charges,77% of total billed charges,256.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,314.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,895.34,89,,,Percent of total Billed Charges,89% of total Billed charges,895.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,895.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,410.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,410.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.62,77,,,Percent of total Billed charges,77% of total billed charges,855.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,289.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,410.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.5,895.34,
DEBRIDE SKIN AT FX SITE,P991500021,CDM,521,RC,11010,HCPCS,Outpatient,,,842,421,,648.34,77,,,Percent of Total Billed Charges,77% of total billed charges,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,749.38,89,,,Percent of total Billed Charges,89% of total Billed charges,749.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,749.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.34,77,,,Percent of total Billed charges,77% of total billed charges,715.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.5,749.38,
DEBRIDEMENT SKIN SUBCU,P991500022,CDM,521,RC,11011,HCPCS,Outpatient,,,1100,550,,847,77,,,Percent of Total Billed Charges,77% of total billed charges,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,979,89,,,Percent of total Billed Charges,89% of total Billed charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,847,77,,,Percent of total Billed charges,77% of total billed charges,935,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,316.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275,979,
DEB SKIN BONE AT FX SITE,P991500023,CDM,521,RC,11012,HCPCS,Outpatient,,,1432,716,,1102.64,77,,,Percent of Total Billed Charges,77% of total billed charges,365.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,447.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1274.48,89,,,Percent of total Billed Charges,89% of total Billed charges,1274.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1274.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,584.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1102.64,77,,,Percent of total Billed charges,77% of total billed charges,1217.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,411.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,584.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358,1274.48,
DEB SUBQ TISSUE 20 SQ CM/<,P991500024,CDM,521,RC,11042,HCPCS,Outpatient,,,247,123.5,,190.19,77,,,Percent of Total Billed Charges,77% of total billed charges,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,219.83,89,,,Percent of total Billed Charges,89% of total Billed charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.19,77,,,Percent of total Billed charges,77% of total billed charges,209.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.75,219.83,
DEBRIDEMENT SKIN SUBQ & MUSCLE,P991500025,CDM,521,RC,11043,HCPCS,Outpatient,,,479,239.5,,368.83,77,,,Percent of Total Billed Charges,77% of total billed charges,122.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,426.31,89,,,Percent of total Billed Charges,89% of total Billed charges,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.83,77,,,Percent of total Billed charges,77% of total billed charges,407.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.75,426.31,
DEB BONE 20 SQ CM/<,P991500026,CDM,521,RC,11044,HCPCS,Outpatient,,,579,289.5,,445.83,77,,,Percent of Total Billed Charges,77% of total billed charges,147.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,515.31,89,,,Percent of total Billed Charges,89% of total Billed charges,515.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,515.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.83,77,,,Percent of total Billed charges,77% of total billed charges,492.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,236.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.75,515.31,
DEB SUBQ TISSUE ADD-ON,P991500027,CDM,521,RC,11045,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.86,89,,,Percent of total Billed Charges,89% of total Billed charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,65.86,
DEB MUSC/FASCIA ADD-ON,P991500028,CDM,521,RC,11046,HCPCS,Outpatient,,,136,68,,104.72,77,,,Percent of Total Billed Charges,77% of total billed charges,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.04,89,,,Percent of total Billed Charges,89% of total Billed charges,121.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.72,77,,,Percent of total Billed charges,77% of total billed charges,115.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34,121.04,
"DEBRIDE, BONE EACH ADDTL 20CM",P991500029,CDM,521,RC,11047,HCPCS,Outpatient,,,227,113.5,,174.79,77,,,Percent of Total Billed Charges,77% of total billed charges,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.03,89,,,Percent of total Billed Charges,89% of total Billed charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.79,77,,,Percent of total Billed charges,77% of total billed charges,192.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.75,202.03,
REMOVAL CORNS,P991500030,CDM,521,RC,11055,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99.68,89,,,Percent of total Billed Charges,89% of total Billed charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,99.68,
TRIM SKIN LESIONS 2 TO 4,P991500031,CDM,521,RC,11056,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.26,89,,,Percent of total Billed Charges,89% of total Billed charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,119.26,
TRIM SKIN LESIONS OVER 4,P991500032,CDM,521,RC,11057,HCPCS,Outpatient,,,80,40,,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.2,89,,,Percent of total Billed Charges,89% of total Billed charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,71.2,
TANGNTL BX SKIN SINGLE LES,P991500033,CDM,521,RC,11102,HCPCS,Outpatient,,,188,94,,144.76,77,,,Percent of Total Billed Charges,77% of total billed charges,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,167.32,89,,,Percent of total Billed Charges,89% of total Billed charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.76,77,,,Percent of total Billed charges,77% of total billed charges,159.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47,167.32,
TANGNTL BX SKIN EA SEP/ADDL,P991500034,CDM,521,RC,11103,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
PUNCH BX SKIN SINGLE LESION,P991500035,CDM,521,RC,11104,HCPCS,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221.61,89,,,Percent of total Billed Charges,89% of total Billed charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.25,221.61,
PUNCH BX SKIN EA SEP/ADDTL,P991500036,CDM,521,RC,11105,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,109.47,89,,,Percent of total Billed Charges,89% of total Billed charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.75,109.47,
INCAL BX SKN SINGLE LES,P991500037,CDM,521,RC,11106,HCPCS,Outpatient,,,287,143.5,,220.99,77,,,Percent of Total Billed Charges,77% of total billed charges,73.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,255.43,89,,,Percent of total Billed Charges,89% of total Billed charges,255.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.99,77,,,Percent of total Billed charges,77% of total billed charges,243.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.75,255.43,
EACH SEPERATE/ADDL LESION,P991500038,CDM,521,RC,11107,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.48,89,,,Percent of total Billed Charges,89% of total Billed charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33,117.48,
REMOVAL OF SKIN TAGS,P991500039,CDM,521,RC,11200,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,107.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.75,234.07,
REMOVE SKIN TAGS ADD-ON,P991500040,CDM,521,RC,11201,HCPCS,Outpatient,,,35,17.5,,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.15,89,,,Percent of total Billed Charges,89% of total Billed charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,31.15,
SHAVE SKIN LESION 0.5 CM/<,P991500041,CDM,521,RC,11300,HCPCS,Outpatient,,,202,101,,155.54,77,,,Percent of Total Billed Charges,77% of total billed charges,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,179.78,89,,,Percent of total Billed Charges,89% of total Billed charges,179.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.54,77,,,Percent of total Billed charges,77% of total billed charges,171.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.5,179.78,
"SHAVING LESION TRUNK,LEGS,ARMS",P991500042,CDM,521,RC,11301,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,234.96,89,,,Percent of total Billed Charges,89% of total Billed charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,107.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66,234.96,
"SHAVING LESION ARMS,TRUNK,LEGS",P991500043,CDM,521,RC,11302,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222.5,89,,,Percent of total Billed Charges,89% of total Billed charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.5,222.5,
"SHAVING LESION TRUNK,LEGS,ARMS",P991500044,CDM,521,RC,11303,HCPCS,Outpatient,,,383,191.5,,294.91,77,,,Percent of Total Billed Charges,77% of total billed charges,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.87,89,,,Percent of total Billed Charges,89% of total Billed charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.91,77,,,Percent of total Billed charges,77% of total billed charges,325.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.75,340.87,
SHAVE SKIN LESION 0.5 CM/<,P991500045,CDM,521,RC,11305,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,183.34,89,,,Percent of total Billed Charges,89% of total Billed charges,183.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.5,183.34,
SHAVE SKIN LESION 0.6-1.0 CM,P991500046,CDM,521,RC,11306,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,249.2,
SHAVE SKIN LESION 1.1-2.0 CM,P991500047,CDM,521,RC,11307,HCPCS,Outpatient,,,255,127.5,,196.35,77,,,Percent of Total Billed Charges,77% of total billed charges,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,226.95,89,,,Percent of total Billed Charges,89% of total Billed charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.35,77,,,Percent of total Billed charges,77% of total billed charges,216.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.75,226.95,
SHAVE SKIN LESION >2.0 CM,P991500048,CDM,521,RC,11308,HCPCS,Outpatient,,,270,135,,207.9,77,,,Percent of Total Billed Charges,77% of total billed charges,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.3,89,,,Percent of total Billed Charges,89% of total Billed charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.9,77,,,Percent of total Billed charges,77% of total billed charges,229.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.5,240.3,
SHAVE SKIN LESION 0.5 CM/<,P991500049,CDM,521,RC,11310,HCPCS,Outpatient,,,244,122,,187.88,77,,,Percent of Total Billed Charges,77% of total billed charges,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.16,89,,,Percent of total Billed Charges,89% of total Billed charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.88,77,,,Percent of total Billed charges,77% of total billed charges,207.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,217.16,
SHAVE SKIN LESION 0.6-1.0 CM,P991500050,CDM,521,RC,11311,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222.5,89,,,Percent of total Billed Charges,89% of total Billed charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.5,222.5,
SHAVE SKIN LESION 1.1-2.0 CM,P991500051,CDM,521,RC,11312,HCPCS,Outpatient,,,286,143,,220.22,77,,,Percent of Total Billed Charges,77% of total billed charges,72.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,254.54,89,,,Percent of total Billed Charges,89% of total Billed charges,254.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.22,77,,,Percent of total Billed charges,77% of total billed charges,243.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.5,254.54,
SHAVE SKIN LESION >2.0 CM,P991500052,CDM,521,RC,11313,HCPCS,Outpatient,,,333,166.5,,256.41,77,,,Percent of Total Billed Charges,77% of total billed charges,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296.37,89,,,Percent of total Billed Charges,89% of total Billed charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.41,77,,,Percent of total Billed charges,77% of total billed charges,283.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.25,296.37,
EXC TR-EXT B9+MARG 0.5 CM<,P991500053,CDM,521,RC,11400,HCPCS,Outpatient,,,380,190,,292.6,77,,,Percent of Total Billed Charges,77% of total billed charges,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.2,89,,,Percent of total Billed Charges,89% of total Billed charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.6,77,,,Percent of total Billed charges,77% of total billed charges,323,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95,338.2,
EXC TR-EXT B9+MARG 0.6-1 CM,P991500054,CDM,521,RC,11401,HCPCS,Outpatient,,,444,222,,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,395.16,89,,,Percent of total Billed Charges,89% of total Billed charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111,395.16,
EXC TR-EXT B9+MARG 1.1-2 CM,P991500055,CDM,521,RC,11402,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.56,89,,,Percent of total Billed Charges,89% of total Billed charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126,448.56,
EXC TR-EXT B9+MARG 2.1-3CM,P991500056,CDM,521,RC,11403,HCPCS,Outpatient,,,575,287.5,,442.75,77,,,Percent of Total Billed Charges,77% of total billed charges,146.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,143.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,511.75,89,,,Percent of total Billed Charges,89% of total Billed charges,511.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.75,77,,,Percent of total Billed charges,77% of total billed charges,488.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,234.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,143.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,143.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.75,511.75,
EXC TR-EXT B9+MARG 3.1-4 CM,P991500057,CDM,521,RC,11404,HCPCS,Outpatient,,,652,326,,502.04,77,,,Percent of Total Billed Charges,77% of total billed charges,166.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,580.28,89,,,Percent of total Billed Charges,89% of total Billed charges,580.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,580.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502.04,77,,,Percent of total Billed charges,77% of total billed charges,554.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163,580.28,
EXC TR-EXT B9+MARG >4.0 CM,P991500058,CDM,521,RC,11406,HCPCS,Outpatient,,,807,403.5,,621.39,77,,,Percent of Total Billed Charges,77% of total billed charges,205.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,718.23,89,,,Percent of total Billed Charges,89% of total Billed charges,718.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,718.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,621.39,77,,,Percent of total Billed charges,77% of total billed charges,685.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.75,718.23,
EXC H-F-NK-SP B9+MARG 0.5/<,P991500059,CDM,521,RC,11420,HCPCS,Outpatient,,,369,184.5,,284.13,77,,,Percent of Total Billed Charges,77% of total billed charges,94.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,328.41,89,,,Percent of total Billed Charges,89% of total Billed charges,328.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.13,77,,,Percent of total Billed charges,77% of total billed charges,313.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.25,328.41,
EXC H-F-NK-SP B9+MARG 0.6-1,P991500060,CDM,521,RC,11421,HCPCS,Outpatient,,,470,235,,361.9,77,,,Percent of Total Billed Charges,77% of total billed charges,119.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,418.3,89,,,Percent of total Billed Charges,89% of total Billed charges,418.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,418.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.9,77,,,Percent of total Billed charges,77% of total billed charges,399.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.5,418.3,
EXC H-F-NK-SP B9+MARG 1.1-2,P991500061,CDM,521,RC,11422,HCPCS,Outpatient,,,522,261,,401.94,77,,,Percent of Total Billed Charges,77% of total billed charges,133.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,464.58,89,,,Percent of total Billed Charges,89% of total Billed charges,464.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.94,77,,,Percent of total Billed charges,77% of total billed charges,443.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,464.58,
EXC H-F-NK-SP B9+MARG 2.1-3,P991500062,CDM,521,RC,11423,HCPCS,Outpatient,,,625,312.5,,481.25,77,,,Percent of Total Billed Charges,77% of total billed charges,159.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,556.25,89,,,Percent of total Billed Charges,89% of total Billed charges,556.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.25,77,,,Percent of total Billed charges,77% of total billed charges,531.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.25,556.25,
EXC H-F-NK-SP B9+MARG 3.1-4,P991500063,CDM,521,RC,11424,HCPCS,Outpatient,,,722,361,,555.94,77,,,Percent of Total Billed Charges,77% of total billed charges,184.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,642.58,89,,,Percent of total Billed Charges,89% of total Billed charges,642.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.94,77,,,Percent of total Billed charges,77% of total billed charges,613.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.5,642.58,
EXC H-F-NK-SP B9+MARG >4 CM,P991500064,CDM,521,RC,11426,HCPCS,Outpatient,,,1020,510,,785.4,77,,,Percent of Total Billed Charges,77% of total billed charges,260.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,260.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,255,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,907.8,89,,,Percent of total Billed Charges,89% of total Billed charges,907.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,416.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.4,77,,,Percent of total Billed charges,77% of total billed charges,867,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,293.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,416.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,255,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255,907.8,
EXC FACE-MM B9+MARG 0.5 CM/<,P991500065,CDM,521,RC,11440,HCPCS,Outpatient,,,438,219,,337.26,77,,,Percent of Total Billed Charges,77% of total billed charges,111.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,109.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,389.82,89,,,Percent of total Billed Charges,89% of total Billed charges,389.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,389.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.26,77,,,Percent of total Billed charges,77% of total billed charges,372.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,109.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.5,389.82,
EXC FACE-MM B9+MARG 0.6-1 CM,P991500066,CDM,521,RC,11441,HCPCS,Outpatient,,,512,256,,394.24,77,,,Percent of Total Billed Charges,77% of total billed charges,130.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,455.68,89,,,Percent of total Billed Charges,89% of total Billed charges,455.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,394.24,77,,,Percent of total Billed charges,77% of total billed charges,435.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,208.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128,455.68,
EXC FACE-MM B9+MARG 1.1-2 CM,P991500067,CDM,521,RC,11442,HCPCS,Outpatient,,,580,290,,446.6,77,,,Percent of Total Billed Charges,77% of total billed charges,147.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516.2,89,,,Percent of total Billed Charges,89% of total Billed charges,516.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,516.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.6,77,,,Percent of total Billed charges,77% of total billed charges,493,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,236.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145,516.2,
EXC FACE-MM B9+MARG 2.1-3 CM,P991500068,CDM,521,RC,11443,HCPCS,Outpatient,,,710,355,,546.7,77,,,Percent of Total Billed Charges,77% of total billed charges,181.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,631.9,89,,,Percent of total Billed Charges,89% of total Billed charges,631.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,631.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,546.7,77,,,Percent of total Billed charges,77% of total billed charges,603.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.5,631.9,
EXC FACE-MM B9+MARG 3.1-4 CM,P991500069,CDM,521,RC,11444,HCPCS,Outpatient,,,909,454.5,,699.93,77,,,Percent of Total Billed Charges,77% of total billed charges,231.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,809.01,89,,,Percent of total Billed Charges,89% of total Billed charges,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,699.93,77,,,Percent of total Billed charges,77% of total billed charges,772.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,261.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,370.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.25,809.01,
EXC FACE-MM B9+MARG >4 CM,P991500070,CDM,521,RC,11446,HCPCS,Outpatient,,,1575,787.5,,1212.75,77,,,Percent of Total Billed Charges,77% of total billed charges,401.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1401.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1401.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1401.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1212.75,77,,,Percent of total Billed charges,77% of total billed charges,1338.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,452.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,642.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.75,1401.75,
REMOVAL SWEAT GLAND LESION,P991500071,CDM,521,RC,11450,HCPCS,Outpatient,,,806,403,,620.62,77,,,Percent of Total Billed Charges,77% of total billed charges,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,717.34,89,,,Percent of total Billed Charges,89% of total Billed charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,620.62,77,,,Percent of total Billed charges,77% of total billed charges,685.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.5,717.34,
EXC HIDRADENITIS AX COMP REP,P991500072,CDM,521,RC,11451,HCPCS,Outpatient,,,968,484,,745.36,77,,,Percent of Total Billed Charges,77% of total billed charges,246.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,246.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,861.52,89,,,Percent of total Billed Charges,89% of total Billed charges,861.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,745.36,77,,,Percent of total Billed charges,77% of total billed charges,822.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,278.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,394.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242,861.52,
REMOVAL SWEAT GLAND LESION,P991500073,CDM,521,RC,11462,HCPCS,Outpatient,,,750,375,,577.5,77,,,Percent of Total Billed Charges,77% of total billed charges,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,667.5,89,,,Percent of total Billed Charges,89% of total Billed charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.5,77,,,Percent of total Billed charges,77% of total billed charges,637.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,667.5,
EXC HIDRADENITIS ING COMP REP,P991500074,CDM,521,RC,11463,HCPCS,Outpatient,,,981,490.5,,755.37,77,,,Percent of Total Billed Charges,77% of total billed charges,250.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,245.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,873.09,89,,,Percent of total Billed Charges,89% of total Billed charges,873.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,873.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.37,77,,,Percent of total Billed charges,77% of total billed charges,833.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,400.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,245.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,245.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.25,873.09,
REMOVAL SWEAT GLAND LESION,P991500075,CDM,521,RC,11470,HCPCS,Outpatient,,,904,452,,696.08,77,,,Percent of Total Billed Charges,77% of total billed charges,230.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,282.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,804.56,89,,,Percent of total Billed Charges,89% of total Billed charges,804.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,368.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,696.08,77,,,Percent of total Billed charges,77% of total billed charges,768.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,259.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226,804.56,
EXCISION H/P/P/U COMPLEX REP,P991500076,CDM,521,RC,11471,HCPCS,Outpatient,,,995,497.5,,766.15,77,,,Percent of Total Billed Charges,77% of total billed charges,253.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,885.55,89,,,Percent of total Billed Charges,89% of total Billed charges,885.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,885.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.15,77,,,Percent of total Billed charges,77% of total billed charges,845.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,405.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.75,885.55,
EXC TR-EXT MAL+MARG 0.5 CM/<,P991500077,CDM,521,RC,11600,HCPCS,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
EXC MALIG LES TRUNK .6 TO 1 CM,P991500078,CDM,521,RC,11601,HCPCS,Outpatient,,,580,290,,446.6,77,,,Percent of Total Billed Charges,77% of total billed charges,147.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516.2,89,,,Percent of total Billed Charges,89% of total Billed charges,516.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,516.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.6,77,,,Percent of total Billed charges,77% of total billed charges,493,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,236.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145,516.2,
EXC TR-EXT MAL+MARG 1.1-2 CM,P991500079,CDM,521,RC,11602,HCPCS,Outpatient,,,621,310.5,,478.17,77,,,Percent of Total Billed Charges,77% of total billed charges,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552.69,89,,,Percent of total Billed Charges,89% of total Billed charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.17,77,,,Percent of total Billed charges,77% of total billed charges,527.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.25,552.69,
EXC TR-EXT MAL+MARG 2.1-3 CM,P991500080,CDM,521,RC,11603,HCPCS,Outpatient,,,683,341.5,,525.91,77,,,Percent of Total Billed Charges,77% of total billed charges,174.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,607.87,89,,,Percent of total Billed Charges,89% of total Billed charges,607.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,607.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,525.91,77,,,Percent of total Billed charges,77% of total billed charges,580.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.75,607.87,
EXC TR-EXT MAL+MARG 3.1-4 CM,P991500081,CDM,521,RC,11604,HCPCS,Outpatient,,,753,376.5,,579.81,77,,,Percent of Total Billed Charges,77% of total billed charges,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,670.17,89,,,Percent of total Billed Charges,89% of total Billed charges,670.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,670.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.81,77,,,Percent of total Billed charges,77% of total billed charges,640.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.25,670.17,
EXC MALIG LES TRUNK OVER 4 CM,P991500082,CDM,521,RC,11606,HCPCS,Outpatient,,,988,494,,760.76,77,,,Percent of Total Billed Charges,77% of total billed charges,251.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,308.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,879.32,89,,,Percent of total Billed Charges,89% of total Billed charges,879.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,879.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,760.76,77,,,Percent of total Billed charges,77% of total billed charges,839.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247,879.32,
EXC H-F-NK-SP MAL+MARG 0.5/<,P991500083,CDM,521,RC,11620,HCPCS,Outpatient,,,480,240,,369.6,77,,,Percent of Total Billed Charges,77% of total billed charges,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.2,89,,,Percent of total Billed Charges,89% of total Billed charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.6,77,,,Percent of total Billed charges,77% of total billed charges,408,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,138,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120,427.2,
EXC S/N/H/F/G MAL+MRG 0.6-1,P991500084,CDM,521,RC,11621,HCPCS,Outpatient,,,578,289,,445.06,77,,,Percent of Total Billed Charges,77% of total billed charges,147.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,514.42,89,,,Percent of total Billed Charges,89% of total Billed charges,514.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.06,77,,,Percent of total Billed charges,77% of total billed charges,491.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.5,514.42,
EXC S/N/H/F/G MAL+MRG 1.1-2,P991500085,CDM,521,RC,11622,HCPCS,Outpatient,,,657,328.5,,505.89,77,,,Percent of Total Billed Charges,77% of total billed charges,167.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,584.73,89,,,Percent of total Billed Charges,89% of total Billed charges,584.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,584.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,505.89,77,,,Percent of total Billed charges,77% of total billed charges,558.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,268.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,164.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.25,584.73,
EXC S/N/H/F/G MAL+MRG 2.1-3,P991500086,CDM,521,RC,11623,HCPCS,Outpatient,,,552,276,,425.04,77,,,Percent of Total Billed Charges,77% of total billed charges,140.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,491.28,89,,,Percent of total Billed Charges,89% of total Billed charges,491.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.04,77,,,Percent of total Billed charges,77% of total billed charges,469.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,225.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,491.28,
EXC S/N/H/F/G MAL+MRG 3.1-4,P991500087,CDM,521,RC,11624,HCPCS,Outpatient,,,891,445.5,,686.07,77,,,Percent of Total Billed Charges,77% of total billed charges,227.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,792.99,89,,,Percent of total Billed Charges,89% of total Billed charges,792.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.07,77,,,Percent of total Billed charges,77% of total billed charges,757.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,256.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,363.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,222.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.75,792.99,
EXC S/N/H/F/G MAL+MRG >4 CM,P991500088,CDM,521,RC,11626,HCPCS,Outpatient,,,1192,596,,917.84,77,,,Percent of Total Billed Charges,77% of total billed charges,303.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,372.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1060.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1060.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1060.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,917.84,77,,,Percent of total Billed charges,77% of total billed charges,1013.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,342.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,486.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298,1060.88,
EXC F/E/E/N/L MAL+MRG 0.5CM<,P991500089,CDM,521,RC,11640,HCPCS,Outpatient,,,507,253.5,,390.39,77,,,Percent of Total Billed Charges,77% of total billed charges,129.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,451.23,89,,,Percent of total Billed Charges,89% of total Billed charges,451.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,451.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.39,77,,,Percent of total Billed charges,77% of total billed charges,430.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.75,451.23,
EXC F/E/E/N/L MAL+MRG 0.6-1,P991500090,CDM,521,RC,11641,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,599.86,89,,,Percent of total Billed Charges,89% of total Billed charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.5,599.86,
EXC F/E/E/N/L MAL+MRG 1.1-2,P991500091,CDM,521,RC,11642,HCPCS,Outpatient,,,785,392.5,,604.45,77,,,Percent of Total Billed Charges,77% of total billed charges,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,698.65,89,,,Percent of total Billed Charges,89% of total Billed charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,320.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.45,77,,,Percent of total Billed charges,77% of total billed charges,667.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,320.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.25,698.65,
EXC F/E/E/N/L MAL+MRG 2.1-3,P991500092,CDM,521,RC,11643,HCPCS,Outpatient,,,909,454.5,,699.93,77,,,Percent of Total Billed Charges,77% of total billed charges,231.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,809.01,89,,,Percent of total Billed Charges,89% of total Billed charges,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,699.93,77,,,Percent of total Billed charges,77% of total billed charges,772.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,261.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,370.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.25,809.01,
EXC F/E/E/N/L MAL+MRG 3.1-4,P991500093,CDM,521,RC,11644,HCPCS,Outpatient,,,1160,580,,893.2,77,,,Percent of Total Billed Charges,77% of total billed charges,295.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1032.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1032.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1032.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,893.2,77,,,Percent of total Billed charges,77% of total billed charges,986,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,473.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,1032.4,
EXC F/E/E/N/L MAL+MRG >4 CM,P991500094,CDM,521,RC,11646,HCPCS,Outpatient,,,1301,650.5,,1001.77,77,,,Percent of Total Billed Charges,77% of total billed charges,331.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,325.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1157.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1157.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.77,77,,,Percent of total Billed charges,77% of total billed charges,1105.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,530.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,325.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.25,1157.89,
TRIMMING NAILS,P991500095,CDM,521,RC,11719,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
DEBRIDEMENT OF NAIL 1 TO 5,P991500096,CDM,521,RC,11720,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54.29,89,,,Percent of total Billed Charges,89% of total Billed charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,54.29,
DEBRIDE NAIL 6 OR MORE,P991500097,CDM,521,RC,11721,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.65,89,,,Percent of total Billed Charges,89% of total Billed charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,75.65,
REMOVAL OF NAIL PLATE,P991500098,CDM,521,RC,11730,HCPCS,Outpatient,,,267,133.5,,205.59,77,,,Percent of Total Billed Charges,77% of total billed charges,68.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,237.63,89,,,Percent of total Billed Charges,89% of total Billed charges,237.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.59,77,,,Percent of total Billed charges,77% of total billed charges,226.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.75,237.63,
REMOVE NAIL PLATE ADD-ON,P991500099,CDM,521,RC,11732,HCPCS,Outpatient,,,62,31,,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.18,89,,,Percent of total Billed Charges,89% of total Billed charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,55.18,
DRAIN BLOOD FROM UNDER NAIL,P991500100,CDM,521,RC,11740,HCPCS,Outpatient,,,164,82,,126.28,77,,,Percent of Total Billed Charges,77% of total billed charges,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.96,89,,,Percent of total Billed Charges,89% of total Billed charges,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.28,77,,,Percent of total Billed charges,77% of total billed charges,139.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41,145.96,
REMOVAL OF NAIL BED,P991500101,CDM,521,RC,11750,HCPCS,Outpatient,,,490,245,,377.3,77,,,Percent of Total Billed Charges,77% of total billed charges,124.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,436.1,89,,,Percent of total Billed Charges,89% of total Billed charges,436.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.3,77,,,Percent of total Billed charges,77% of total billed charges,416.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,199.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.5,436.1,
REPAIR NAILBED,P991500102,CDM,521,RC,11760,HCPCS,Outpatient,,,342,171,,263.34,77,,,Percent of Total Billed Charges,77% of total billed charges,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,304.38,89,,,Percent of total Billed Charges,89% of total Billed charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.34,77,,,Percent of total Billed charges,77% of total billed charges,290.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,139.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.5,304.38,
EXCISION OF PILONIDAL CYST,P991500103,CDM,521,RC,11770,HCPCS,Outpatient,,,355,177.5,,273.35,77,,,Percent of Total Billed Charges,77% of total billed charges,90.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,315.95,89,,,Percent of total Billed Charges,89% of total Billed charges,315.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.35,77,,,Percent of total Billed charges,77% of total billed charges,301.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.75,315.95,
EXC PILONIDAL CYST EXTENSIVE,P991500104,CDM,521,RC,11771,HCPCS,Outpatient,,,830,415,,639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,211.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,738.7,89,,,Percent of total Billed Charges,89% of total Billed charges,738.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,639.1,77,,,Percent of total Billed charges,77% of total billed charges,705.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,338.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,207.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,207.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.5,738.7,
EXC PILONIDAL CYST COMPLICATED,P991500105,CDM,521,RC,11772,HCPCS,Outpatient,,,1100,550,,847,77,,,Percent of Total Billed Charges,77% of total billed charges,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,979,89,,,Percent of total Billed Charges,89% of total Billed charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,847,77,,,Percent of total Billed charges,77% of total billed charges,935,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,316.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275,979,
INJ SKIN LESIONS </W 7 BILAT,P991500106,CDM,521,RC,11900,HCPCS,Outpatient,,,290,145,50,223.3,77,,,Percent of Total Billed Charges,77% of total billed charges,73.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,258.1,89,,,Percent of total Billed Charges,89% of total Billed charges,258.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.3,77,,,Percent of total Billed charges,77% of total billed charges,246.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,118.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.5,258.1,
INJECT SKIN LESIONS </W 7,P991500107,CDM,521,RC,11900,HCPCS,Outpatient,,,145,72.5,,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.05,89,,,Percent of total Billed Charges,89% of total Billed charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.25,129.05,
INJ INTRALESIONAL;>7 LESIONS,P991500108,CDM,521,RC,11901,HCPCS,Outpatient,,,129,64.5,,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.81,89,,,Percent of total Billed Charges,89% of total Billed charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,114.81,
RMVL TIS XPNDR WO INSJ IMPLT,P991500109,CDM,521,RC,11971,HCPCS,Outpatient,,,961,480.5,,739.97,77,,,Percent of Total Billed Charges,77% of total billed charges,245.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,855.29,89,,,Percent of total Billed Charges,89% of total Billed charges,855.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,855.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,739.97,77,,,Percent of total Billed charges,77% of total billed charges,816.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,392.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.25,855.29,
NORPLANT REMOVAL,P991500110,CDM,521,RC,11976,HCPCS,Outpatient,,,270,135,,207.9,77,,,Percent of Total Billed Charges,77% of total billed charges,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.3,89,,,Percent of total Billed Charges,89% of total Billed charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.9,77,,,Percent of total Billed charges,77% of total billed charges,229.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.5,240.3,
INSERTION DRUG DLVR IMPLANT,P991500111,CDM,521,RC,11981,HCPCS,Outpatient,,,319,159.5,,245.63,77,,,Percent of Total Billed Charges,77% of total billed charges,81.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,79.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,283.91,89,,,Percent of total Billed Charges,89% of total Billed charges,283.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.63,77,,,Percent of total Billed charges,77% of total billed charges,271.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.75,283.91,
IMPLANON REMOVAL,P991500112,CDM,521,RC,11982,HCPCS,Outpatient,,,327,163.5,,251.79,77,,,Percent of Total Billed Charges,77% of total billed charges,83.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291.03,89,,,Percent of total Billed Charges,89% of total Billed charges,291.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,77,,,Percent of total Billed charges,77% of total billed charges,277.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.75,291.03,
REMOVAL AND REINS IMPLANON,P991500113,CDM,521,RC,11983,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432.54,89,,,Percent of total Billed Charges,89% of total Billed charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,198.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.5,432.54,
RPR S/N/AX/GEN/TRNK 2.5CM/<,P991500114,CDM,521,RC,12001,HCPCS,Outpatient,,,517,258.5,,398.09,77,,,Percent of Total Billed Charges,77% of total billed charges,131.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,460.13,89,,,Percent of total Billed Charges,89% of total Billed charges,460.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.09,77,,,Percent of total Billed charges,77% of total billed charges,439.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,129.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.25,460.13,
RPR S/N/AX/GEN/TRNK2.6-7.5CM,P991500115,CDM,521,RC,12002,HCPCS,Outpatient,,,551,275.5,,424.27,77,,,Percent of Total Billed Charges,77% of total billed charges,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,490.39,89,,,Percent of total Billed Charges,89% of total Billed charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.27,77,,,Percent of total Billed charges,77% of total billed charges,468.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,490.39,
RPR S/N/AX/GEN/TRNK2.6-7.5CM,P991500115,CDM,521,RC,12002,HCPCS,Outpatient,,,551,275.5,,424.27,77,,,Percent of Total Billed Charges,77% of total billed charges,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,490.39,89,,,Percent of total Billed Charges,89% of total Billed charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.27,77,,,Percent of total Billed charges,77% of total billed charges,468.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,490.39,
RPR S/N/AX/GEN/TRK7.6-12.5CM,P991500116,CDM,521,RC,12004,HCPCS,Outpatient,,,245,122.5,,188.65,77,,,Percent of Total Billed Charges,77% of total billed charges,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218.05,89,,,Percent of total Billed Charges,89% of total Billed charges,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.65,77,,,Percent of total Billed charges,77% of total billed charges,208.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.05,
RPR S/N/A/GEN/TRK12.6-20.0CM,P991500117,CDM,521,RC,12005,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291.92,89,,,Percent of total Billed Charges,89% of total Billed charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82,291.92,
RPR S/N/A/GEN/TRK20.1-30.0CM,P991500118,CDM,521,RC,12006,HCPCS,Outpatient,,,382,191,,294.14,77,,,Percent of Total Billed Charges,77% of total billed charges,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.98,89,,,Percent of total Billed Charges,89% of total Billed charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.14,77,,,Percent of total Billed charges,77% of total billed charges,324.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.5,339.98,
RPR S/N/AX/GEN/TRNK >30.0 CM,P991500119,CDM,521,RC,12007,HCPCS,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
RPR F/E/E/N/L/M 5.1-7.5 CM,P991500120,CDM,521,RC,12014,HCPCS,Outpatient,,,266,133,,204.82,77,,,Percent of Total Billed Charges,77% of total billed charges,67.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236.74,89,,,Percent of total Billed Charges,89% of total Billed charges,236.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.82,77,,,Percent of total Billed charges,77% of total billed charges,226.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.5,236.74,
RPR F/E/E/N/L/M 7.6-12.5 CM,P991500121,CDM,521,RC,12015,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,285.69,89,,,Percent of total Billed Charges,89% of total Billed charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,285.69,
RPR FE/E/EN/L/M 12.6-20.0 CM,P991500122,CDM,521,RC,12016,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.5,364.9,
RPR FE/E/EN/L/M 20.1-30.0 CM,P991500123,CDM,521,RC,12017,HCPCS,Outpatient,,,298,149,,229.46,77,,,Percent of Total Billed Charges,77% of total billed charges,75.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,265.22,89,,,Percent of total Billed Charges,89% of total Billed charges,265.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.46,77,,,Percent of total Billed charges,77% of total billed charges,253.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.5,265.22,
RPR F/E/E/N/L/M >30.0 CM,P991500124,CDM,521,RC,12018,HCPCS,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.93,89,,,Percent of total Billed Charges,89% of total Billed charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.25,299.93,
CLOSURE OF SPLIT WOUND,P991500125,CDM,521,RC,12020,HCPCS,Outpatient,,,551,275.5,,424.27,77,,,Percent of Total Billed Charges,77% of total billed charges,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,490.39,89,,,Percent of total Billed Charges,89% of total Billed charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.27,77,,,Percent of total Billed charges,77% of total billed charges,468.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,490.39,
CLOSURE OF SPLIT WOUND,P991500126,CDM,521,RC,12021,HCPCS,Outpatient,,,390,195,,300.3,77,,,Percent of Total Billed Charges,77% of total billed charges,99.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,347.1,89,,,Percent of total Billed Charges,89% of total Billed charges,347.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.3,77,,,Percent of total Billed charges,77% of total billed charges,331.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.5,347.1,
INTMD RPR S/A/T/EXT 2.5 CM/<,P991500127,CDM,521,RC,12031,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,249.2,
WOUND REPAIR 2.6CM 7.5CM,P991500128,CDM,521,RC,12032,HCPCS,Outpatient,,,618,309,,475.86,77,,,Percent of Total Billed Charges,77% of total billed charges,157.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,550.02,89,,,Percent of total Billed Charges,89% of total Billed charges,550.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,550.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,252.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.86,77,,,Percent of total Billed charges,77% of total billed charges,525.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,252.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.5,550.02,
INTMD RPR S/TR/EXT 7.6-12.5,P991500129,CDM,521,RC,12034,HCPCS,Outpatient,,,613,306.5,,472.01,77,,,Percent of Total Billed Charges,77% of total billed charges,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,545.57,89,,,Percent of total Billed Charges,89% of total Billed charges,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.01,77,,,Percent of total Billed charges,77% of total billed charges,521.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,250.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.25,545.57,
INTMD RPR S/A/T/EXT 12.6-20,P991500130,CDM,521,RC,12035,HCPCS,Outpatient,,,715,357.5,,550.55,77,,,Percent of Total Billed Charges,77% of total billed charges,182.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,636.35,89,,,Percent of total Billed Charges,89% of total Billed charges,636.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,636.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.55,77,,,Percent of total Billed charges,77% of total billed charges,607.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,205.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,291.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.75,636.35,
INTMD RPR N-HF/GENIT7.6-12.5,P991500131,CDM,521,RC,12044,HCPCS,Outpatient,,,697,348.5,,536.69,77,,,Percent of Total Billed Charges,77% of total billed charges,177.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,174.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,620.33,89,,,Percent of total Billed Charges,89% of total Billed charges,620.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,620.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,536.69,77,,,Percent of total Billed charges,77% of total billed charges,592.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,200.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,284.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,174.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,174.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.25,620.33,
INTMD RPR FACE/MM 2.5 CM/<,P991500132,CDM,521,RC,12051,HCPCS,Outpatient,,,541,270.5,,416.57,77,,,Percent of Total Billed Charges,77% of total billed charges,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,481.49,89,,,Percent of total Billed Charges,89% of total Billed charges,481.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,481.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.57,77,,,Percent of total Billed charges,77% of total billed charges,459.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.25,481.49,
INTMD RPR FACE/MM 2.6-5.0 CM,P991500133,CDM,521,RC,12052,HCPCS,Outpatient,,,616,308,,474.32,77,,,Percent of Total Billed Charges,77% of total billed charges,157.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,548.24,89,,,Percent of total Billed Charges,89% of total Billed charges,548.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,548.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,474.32,77,,,Percent of total Billed charges,77% of total billed charges,523.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,251.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,548.24,
INTMD RPR FACE/MM 5.1-7.5 CM,P991500134,CDM,521,RC,12053,HCPCS,Outpatient,,,668,334,,514.36,77,,,Percent of Total Billed Charges,77% of total billed charges,170.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,167,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,594.52,89,,,Percent of total Billed Charges,89% of total Billed charges,594.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,594.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.36,77,,,Percent of total Billed charges,77% of total billed charges,567.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,192.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,272.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,167,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167,594.52,
INTMD RPR FACE/MM 7.6-12.5CM,P991500135,CDM,521,RC,12054,HCPCS,Outpatient,,,708,354,,545.16,77,,,Percent of Total Billed Charges,77% of total billed charges,180.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,630.12,89,,,Percent of total Billed Charges,89% of total Billed charges,630.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.16,77,,,Percent of total Billed charges,77% of total billed charges,601.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177,630.12,
CMPLX RPR TRUNK 1.1-2.5 CM,P991500136,CDM,521,RC,13100,HCPCS,Outpatient,,,713,356.5,,549.01,77,,,Percent of Total Billed Charges,77% of total billed charges,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,634.57,89,,,Percent of total Billed Charges,89% of total Billed charges,634.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.01,77,,,Percent of total Billed charges,77% of total billed charges,606.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.25,634.57,
CMPLX RPR TRUNK 2.6-7.5 CM,P991500137,CDM,521,RC,13101,HCPCS,Outpatient,,,728,364,,560.56,77,,,Percent of Total Billed Charges,77% of total billed charges,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,647.92,89,,,Percent of total Billed Charges,89% of total Billed charges,647.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,647.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,297.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.56,77,,,Percent of total Billed charges,77% of total billed charges,618.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,297.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,647.92,
EACH ADDL 5 CM OR LESS,P991500138,CDM,521,RC,13102,HCPCS,Outpatient,,,216,108,,166.32,77,,,Percent of Total Billed Charges,77% of total billed charges,55.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,192.24,89,,,Percent of total Billed Charges,89% of total Billed charges,192.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.32,77,,,Percent of total Billed charges,77% of total billed charges,183.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,192.24,
CMPLX RPR S/A/L 1.1-2.5 CM,P991500139,CDM,521,RC,13120,HCPCS,Outpatient,,,750,375,,577.5,77,,,Percent of Total Billed Charges,77% of total billed charges,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,667.5,89,,,Percent of total Billed Charges,89% of total Billed charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.5,77,,,Percent of total Billed charges,77% of total billed charges,637.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,667.5,
CMPLX RPR S/A/L 2.6-7.5 CM,P991500140,CDM,521,RC,13121,HCPCS,Outpatient,,,781,390.5,,601.37,77,,,Percent of Total Billed Charges,77% of total billed charges,199.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,195.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,695.09,89,,,Percent of total Billed Charges,89% of total Billed charges,695.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,695.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,318.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.37,77,,,Percent of total Billed charges,77% of total billed charges,663.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,224.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,195.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.25,695.09,
EACH ADDL 5 CM OR LESS,P991500141,CDM,521,RC,13122,HCPCS,Outpatient,,,236,118,,181.72,77,,,Percent of Total Billed Charges,77% of total billed charges,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.04,89,,,Percent of total Billed Charges,89% of total Billed charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.72,77,,,Percent of total Billed charges,77% of total billed charges,200.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59,210.04,
CMPLX RPR F/C/C/M/N/AX/G/H/F,P991500142,CDM,521,RC,13131,HCPCS,Outpatient,,,714,357,,549.78,77,,,Percent of Total Billed Charges,77% of total billed charges,182.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,635.46,89,,,Percent of total Billed Charges,89% of total Billed charges,635.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,635.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.78,77,,,Percent of total Billed charges,77% of total billed charges,606.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,205.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,291.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.5,635.46,
CMPLX RPR F/C/C/M/N/AX/G/H/F,P991500143,CDM,521,RC,13132,HCPCS,Outpatient,,,869,434.5,,669.13,77,,,Percent of Total Billed Charges,77% of total billed charges,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,773.41,89,,,Percent of total Billed Charges,89% of total Billed charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.13,77,,,Percent of total Billed charges,77% of total billed charges,738.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.25,773.41,
"REPAIR, COMPLEX, EA ADDT 5 CM",P991500144,CDM,521,RC,13133,HCPCS,Outpatient,,,314,157,,241.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,279.46,89,,,Percent of total Billed Charges,89% of total Billed charges,279.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,279.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.78,77,,,Percent of total Billed charges,77% of total billed charges,266.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.5,279.46,
CMPLX RPR E/N/E/L 1.1-2.5 CM,P991500145,CDM,521,RC,13151,HCPCS,Outpatient,,,1027,513.5,,790.79,77,,,Percent of Total Billed Charges,77% of total billed charges,261.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,320.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,256.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,914.03,89,,,Percent of total Billed Charges,89% of total Billed charges,914.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,790.79,77,,,Percent of total Billed charges,77% of total billed charges,872.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,295.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,419.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,256.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.75,914.03,
CMPLX RPR E/N/E/L 2.6-7.5 CM,P991500146,CDM,521,RC,13152,HCPCS,Outpatient,,,801,400.5,,616.77,77,,,Percent of Total Billed Charges,77% of total billed charges,204.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,712.89,89,,,Percent of total Billed Charges,89% of total Billed charges,712.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,712.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,326.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616.77,77,,,Percent of total Billed charges,77% of total billed charges,680.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,326.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,200.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.25,712.89,
LATE CLOSURE OF WOUND,P991500147,CDM,521,RC,13160,HCPCS,Outpatient,,,1921,960.5,,1479.17,77,,,Percent of Total Billed Charges,77% of total billed charges,489.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,489.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,600.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1709.69,89,,,Percent of total Billed Charges,89% of total Billed charges,1709.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1709.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,783.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,783.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,783.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1479.17,77,,,Percent of total Billed charges,77% of total billed charges,1632.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,552.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,783.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.25,1709.69,
TIS TRNFR TRUNK 10 SQ CM/<,P991500148,CDM,521,RC,14000,HCPCS,Outpatient,,,1289,644.5,,992.53,77,,,Percent of Total Billed Charges,77% of total billed charges,328.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,402.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1147.21,89,,,Percent of total Billed Charges,89% of total Billed charges,1147.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,525.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,525.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,525.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,992.53,77,,,Percent of total Billed charges,77% of total billed charges,1095.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,370.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,525.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,322.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.25,1147.21,
TIS TRNFR TRUNK 10.1-30SQCM,P991500149,CDM,521,RC,14001,HCPCS,Outpatient,,,1662,831,,1279.74,77,,,Percent of Total Billed Charges,77% of total billed charges,423.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,519.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,415.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,678.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,415.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1279.74,77,,,Percent of total Billed charges,77% of total billed charges,1412.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,477.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,678.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,415.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,415.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.5,1479.18,
TIS TRNFR S/A/L 10 SQ CM/<,P991500150,CDM,521,RC,14020,HCPCS,Outpatient,,,1577,788.5,,1214.29,77,,,Percent of Total Billed Charges,77% of total billed charges,402.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,402.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1403.53,89,,,Percent of total Billed Charges,89% of total Billed charges,1403.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1403.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1214.29,77,,,Percent of total Billed charges,77% of total billed charges,1340.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,643.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,394.25,1403.53,
TIS TRNFR F/C/C/M/N/A/G/H/F,P991500151,CDM,521,RC,14040,HCPCS,Outpatient,,,1318,659,,1014.86,77,,,Percent of Total Billed Charges,77% of total billed charges,336.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,411.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,329.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1173.02,89,,,Percent of total Billed Charges,89% of total Billed charges,1173.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1173.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,537.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,537.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,537.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1014.86,77,,,Percent of total Billed charges,77% of total billed charges,1120.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,378.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,537.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.5,1173.02,
TIS TRNFR F/C/C/M/N/A/G/H/F,P991500152,CDM,521,RC,14041,HCPCS,Outpatient,,,1649,824.5,,1269.73,77,,,Percent of Total Billed Charges,77% of total billed charges,420.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,420.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,515.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,412.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1467.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1467.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1467.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,672.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.73,77,,,Percent of total Billed charges,77% of total billed charges,1401.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,474.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,412.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,412.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412.25,1467.61,
TIS TRNFR E/N/E/L 10 SQ CM/<,P991500153,CDM,521,RC,14060,HCPCS,Outpatient,,,1868,934,,1438.36,77,,,Percent of Total Billed Charges,77% of total billed charges,476.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,583.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1662.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1662.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1438.36,77,,,Percent of total Billed charges,77% of total billed charges,1587.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,762.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467,1662.52,
WOUND PREP TRK/ARM/LEG,P991500154,CDM,521,RC,15002,HCPCS,Outpatient,,,638,319,,491.26,77,,,Percent of Total Billed Charges,77% of total billed charges,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,567.82,89,,,Percent of total Billed Charges,89% of total Billed charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.26,77,,,Percent of total Billed charges,77% of total billed charges,542.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.5,567.82,
PINCH GRAFT 2CM,P991500155,CDM,521,RC,15050,HCPCS,Outpatient,,,629,314.5,,484.33,77,,,Percent of Total Billed Charges,77% of total billed charges,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,559.81,89,,,Percent of total Billed Charges,89% of total Billed charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,484.33,77,,,Percent of total Billed charges,77% of total billed charges,534.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.25,559.81,
SKIN SPLT GRFT TRNK/ARM/LEG,P991500156,CDM,521,RC,15100,HCPCS,Outpatient,,,2222,1111,,1710.94,77,,,Percent of Total Billed Charges,77% of total billed charges,566.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1977.58,89,,,Percent of total Billed Charges,89% of total Billed charges,1977.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1710.94,77,,,Percent of total Billed charges,77% of total billed charges,1888.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,906.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.5,1977.58,
SKN SPLT A-GRFT FAC/NCK/HF/G,P991500157,CDM,521,RC,15120,HCPCS,Outpatient,,,2056,1028,,1583.12,77,,,Percent of Total Billed Charges,77% of total billed charges,524.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,642.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1829.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1829.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1829.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.12,77,,,Percent of total Billed charges,77% of total billed charges,1747.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,591.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,838.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514,1829.84,
SKIN FULL GRAFT SCLP/ARM/LEG,P991500158,CDM,521,RC,15220,HCPCS,Outpatient,,,1278,639,,984.06,77,,,Percent of Total Billed Charges,77% of total billed charges,325.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,399.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1137.42,89,,,Percent of total Billed Charges,89% of total Billed charges,1137.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1137.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,521.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,521.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,521.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,984.06,77,,,Percent of total Billed charges,77% of total billed charges,1086.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,367.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,521.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.5,1137.42,
SKIN GRAFT W/DIRECT CLOSURE,P991500159,CDM,521,RC,15240,HCPCS,Outpatient,,,2019,1009.5,,1554.63,77,,,Percent of Total Billed Charges,77% of total billed charges,514.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,514.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,504.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1796.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1796.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1796.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,823.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,823.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,823.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.63,77,,,Percent of total Billed charges,77% of total billed charges,1716.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,580.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,823.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,504.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,504.75,1796.91,
SKIN FULL GRAFT EEN & LIPS,P991500160,CDM,521,RC,15260,HCPCS,Outpatient,,,2105,1052.5,,1620.85,77,,,Percent of Total Billed Charges,77% of total billed charges,536.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,536.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,657.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,526.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1873.45,89,,,Percent of total Billed Charges,89% of total Billed charges,1873.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1873.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,858.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,858.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,858.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,526.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.85,77,,,Percent of total Billed charges,77% of total billed charges,1789.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,605.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,858.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,526.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,526.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,526.25,1873.45,
SKIN SUB GRAFT TRNK/ARM/LEG,P991500161,CDM,521,RC,15271,HCPCS,Outpatient,,,299,149.5,,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,266.11,
SKIN SUB GRAFT T/A/L ADD-ON,P991500162,CDM,521,RC,15272,HCPCS,Outpatient,,,55,27.5,,42.35,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.95,89,,,Percent of total Billed Charges,89% of total Billed charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,77,,,Percent of total Billed charges,77% of total billed charges,46.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.95,
SKIN SUB GRFT T/ARM/LG CHILD,P991500163,CDM,521,RC,15273,HCPCS,Outpatient,,,576,288,,443.52,77,,,Percent of Total Billed Charges,77% of total billed charges,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,512.64,89,,,Percent of total Billed Charges,89% of total Billed charges,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443.52,77,,,Percent of total Billed charges,77% of total billed charges,489.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144,512.64,
SKN SUB GRFT T/A/L CHILD ADD,P991500164,CDM,521,RC,15274,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.28,89,,,Percent of total Billed Charges,89% of total Billed charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38,135.28,
SKIN SUB GRAFT FACE/NK/HF/G,P991500165,CDM,510,RC,15275,HCPCS,Outpatient,,,399,199.5,,307.23,77,,,Percent of Total Billed Charges,77% of total billed charges,101.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,162.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.23,77,,,Percent of total Billed charges,77% of total billed charges,339.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,114.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,199.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,162.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.75,355.11,
SKIN SUB GRAFT F/N/HF/G ADDL,P991500166,CDM,521,RC,15276,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54.29,89,,,Percent of total Billed Charges,89% of total Billed charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,54.29,
SKN SUB GRFT F/N/HF/G CHILD,P991500167,CDM,521,RC,15277,HCPCS,Outpatient,,,641,320.5,,493.57,77,,,Percent of Total Billed Charges,77% of total billed charges,163.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,570.49,89,,,Percent of total Billed Charges,89% of total Billed charges,570.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,493.57,77,,,Percent of total Billed charges,77% of total billed charges,544.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,184.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,261.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.25,570.49,
SKN SUB GRFT F/N/HF/G CH ADD,P991500168,CDM,521,RC,15278,HCPCS,Outpatient,,,176,88,,135.52,77,,,Percent of Total Billed Charges,77% of total billed charges,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.64,89,,,Percent of total Billed Charges,89% of total Billed charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.52,77,,,Percent of total Billed charges,77% of total billed charges,149.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,156.64,
SKIN PEDICLE FLAP ARMS/LEGS,P991500169,CDM,521,RC,15572,HCPCS,Outpatient,,,1554,777,,1196.58,77,,,Percent of Total Billed Charges,77% of total billed charges,396.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,388.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1383.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1383.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1383.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1196.58,77,,,Percent of total Billed charges,77% of total billed charges,1320.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,446.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,634.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,388.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.5,1383.06,
PEDCLE FH/CH/CH/M/N/AX/G/H/F,P991500170,CDM,521,RC,15574,HCPCS,Outpatient,,,1603,801.5,,1234.31,77,,,Percent of Total Billed Charges,77% of total billed charges,408.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,400.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1426.67,89,,,Percent of total Billed Charges,89% of total Billed charges,1426.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1426.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,654.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,654.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.31,77,,,Percent of total Billed charges,77% of total billed charges,1362.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,654.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,400.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.75,1426.67,
PEDICLE E/N/E/L/NTRORAL,P991500171,CDM,521,RC,15576,HCPCS,Outpatient,,,1400,700,,1078,77,,,Percent of Total Billed Charges,77% of total billed charges,357,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1246,89,,,Percent of total Billed Charges,89% of total Billed charges,1246,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1246,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,571.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,571.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,571.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078,77,,,Percent of total Billed charges,77% of total billed charges,1190,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,571.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350,1246,
TRANSFER SKIN PEDICLE FLAP,P991500172,CDM,521,RC,15650,HCPCS,Outpatient,,,992,496,,763.84,77,,,Percent of Total Billed Charges,77% of total billed charges,252.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,882.88,89,,,Percent of total Billed Charges,89% of total Billed charges,882.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,882.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,763.84,77,,,Percent of total Billed charges,77% of total billed charges,843.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,404.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248,882.88,
MUSCLE-SKIN GRAFT TRUNK,P991500173,CDM,521,RC,15734,HCPCS,Outpatient,,,2785,1392.5,,2144.45,77,,,Percent of Total Billed Charges,77% of total billed charges,710.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,710.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,870.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,696.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2478.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2478.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2478.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1136.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1136.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1136.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,696.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2144.45,77,,,Percent of total Billed charges,77% of total billed charges,2367.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,800.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1136.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,696.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,696.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,696.25,2478.65,
ACELLULAR DERM MATRIX IMPLT,P991500174,CDM,521,RC,15777,HCPCS,Outpatient,,,407,203.5,,313.39,77,,,Percent of Total Billed Charges,77% of total billed charges,103.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,362.23,89,,,Percent of total Billed Charges,89% of total Billed charges,362.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.39,77,,,Percent of total Billed charges,77% of total billed charges,345.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,166.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.75,362.23,
EXC EXCESS SKIN SITE SPEC,P991500175,CDM,521,RC,15839,HCPCS,Outpatient,,,1569,784.5,,1208.13,77,,,Percent of Total Billed Charges,77% of total billed charges,400.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,400.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,490.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,392.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1396.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1396.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1396.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1208.13,77,,,Percent of total Billed charges,77% of total billed charges,1333.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,451.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,640.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,392.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,392.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.25,1396.41,
REMOVAL SUTR/STAPLE REQ ANES,P991500176,CDM,521,RC,15851,HCPCS,Outpatient,,,109,54.5,,83.93,77,,,Percent of Total Billed Charges,77% of total billed charges,27.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.01,89,,,Percent of total Billed Charges,89% of total Billed charges,97.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.93,77,,,Percent of total Billed charges,77% of total billed charges,92.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,97.01,
DRESSING CHANGE NOT FOR BURN,P991500177,CDM,521,RC,15852,HCPCS,Outpatient,,,101,50.5,,77.77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,89.89,89,,,Percent of total Billed Charges,89% of total Billed charges,89.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.77,77,,,Percent of total Billed charges,77% of total billed charges,85.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.25,89.89,
REMOVE HIP PRESSURE SORE,P991500178,CDM,521,RC,15944,HCPCS,Outpatient,,,1319,659.5,,1015.63,77,,,Percent of Total Billed Charges,77% of total billed charges,336.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1173.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1173.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1173.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1015.63,77,,,Percent of total Billed charges,77% of total billed charges,1121.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,538.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.75,1173.91,
BURN INITIAL TRTMT 1ST DEGREE,P991500179,CDM,521,RC,16000,HCPCS,Outpatient,,,145,72.5,,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.05,89,,,Percent of total Billed Charges,89% of total Billed charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.25,129.05,
DRESS/DEBRID P-THICK BURN S,P991500180,CDM,510,RC,16020,HCPCS,Outpatient,,,190,95,,146.3,77,,,Percent of Total Billed Charges,77% of total billed charges,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.3,77,,,Percent of total Billed charges,77% of total billed charges,161.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.5,169.1,
DRESS/DEBRID P-THICK BURN M,P991500181,CDM,521,RC,16025,HCPCS,Outpatient,,,289,144.5,,222.53,77,,,Percent of Total Billed Charges,77% of total billed charges,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,257.21,89,,,Percent of total Billed Charges,89% of total Billed charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,77,,,Percent of total Billed charges,77% of total billed charges,245.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.25,257.21,
DRESS/DEBRID P-THICK BURN L,P991500182,CDM,521,RC,16030,HCPCS,Outpatient,,,363,181.5,,279.51,77,,,Percent of Total Billed Charges,77% of total billed charges,92.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.07,89,,,Percent of total Billed Charges,89% of total Billed charges,323.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.51,77,,,Percent of total Billed charges,77% of total billed charges,308.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.75,323.07,
ESCHAROTOMY INITAL INCISION,P991500183,CDM,521,RC,16035,HCPCS,Outpatient,,,372,186,,286.44,77,,,Percent of Total Billed Charges,77% of total billed charges,94.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.08,89,,,Percent of total Billed Charges,89% of total Billed charges,331.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.44,77,,,Percent of total Billed charges,77% of total billed charges,316.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93,331.08,
DESTRUCT BENGN/LESION/WART 1ST,P991500184,CDM,521,RC,17000,HCPCS,Outpatient,,,220,110,,169.4,77,,,Percent of Total Billed Charges,77% of total billed charges,56.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,195.8,89,,,Percent of total Billed Charges,89% of total Billed charges,195.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.4,77,,,Percent of total Billed charges,77% of total billed charges,187,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,89.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,195.8,
DESTRUCT PREMALG LES 2-14,P991500185,CDM,521,RC,17003,HCPCS,Outpatient,,,176,88,,135.52,77,,,Percent of Total Billed Charges,77% of total billed charges,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.64,89,,,Percent of total Billed Charges,89% of total Billed charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.52,77,,,Percent of total Billed charges,77% of total billed charges,149.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,156.64,
DESTRUCT BENGN/LESION/WART 15+,P991500186,CDM,521,RC,17004,HCPCS,Outpatient,,,700,350,,539,77,,,Percent of Total Billed Charges,77% of total billed charges,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,623,89,,,Percent of total Billed Charges,89% of total Billed charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539,77,,,Percent of total Billed charges,77% of total billed charges,595,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,201.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175,623,
DESTR CUTAN VASC PROLIF <10CM,P991500187,CDM,521,RC,17106,HCPCS,Outpatient,,,633,316.5,,487.41,77,,,Percent of Total Billed Charges,77% of total billed charges,161.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,158.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,563.37,89,,,Percent of total Billed Charges,89% of total Billed charges,563.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,258.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,258.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,487.41,77,,,Percent of total Billed charges,77% of total billed charges,538.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,181.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,258.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,158.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,158.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.25,563.37,
DSTR VASC LES 10.0-50.0 SQ CM,P991500188,CDM,521,RC,17107,HCPCS,Outpatient,,,821,410.5,,632.17,77,,,Percent of Total Billed Charges,77% of total billed charges,209.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,730.69,89,,,Percent of total Billed Charges,89% of total Billed charges,730.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,730.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.17,77,,,Percent of total Billed charges,77% of total billed charges,697.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,334.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.25,730.69,
DSTR VASC LESIONS >50.0 SQ CM,P991500189,CDM,521,RC,17108,HCPCS,Outpatient,,,1272,636,,979.44,77,,,Percent of Total Billed Charges,77% of total billed charges,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.44,77,,,Percent of total Billed charges,77% of total billed charges,1081.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318,1132.08,
DESTRUCT B9 LESION 1-14,P991500190,CDM,521,RC,17110,HCPCS,Outpatient,,,306,153,,235.62,77,,,Percent of Total Billed Charges,77% of total billed charges,78.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,272.34,89,,,Percent of total Billed Charges,89% of total Billed charges,272.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.62,77,,,Percent of total Billed charges,77% of total billed charges,260.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.5,272.34,
DESTRUCT LESION 15 OR MORE,P991500191,CDM,521,RC,17111,HCPCS,Outpatient,,,240,120,,184.8,77,,,Percent of Total Billed Charges,77% of total billed charges,61.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.6,89,,,Percent of total Billed Charges,89% of total Billed charges,213.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.8,77,,,Percent of total Billed charges,77% of total billed charges,204,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60,213.6,
CHEM CAUT OF GRANLTJ TISSUE,P991500192,CDM,521,RC,17250,HCPCS,Outpatient,,,213,106.5,,164.01,77,,,Percent of Total Billed Charges,77% of total billed charges,54.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,189.57,89,,,Percent of total Billed Charges,89% of total Billed charges,189.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.01,77,,,Percent of total Billed charges,77% of total billed charges,181.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.25,189.57,
DRAINAGE OF BREAST LESION,P991500193,CDM,521,RC,19000,HCPCS,Outpatient,,,253,126.5,,194.81,77,,,Percent of Total Billed Charges,77% of total billed charges,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.17,89,,,Percent of total Billed Charges,89% of total Billed charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.81,77,,,Percent of total Billed charges,77% of total billed charges,215.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.25,225.17,
DRAIN BREAST LESION ADD-ON,P991500194,CDM,521,RC,19001,HCPCS,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
INCISION OF BREAST LESION,P991500195,CDM,521,RC,19020,HCPCS,Outpatient,,,1152,576,,887.04,77,,,Percent of Total Billed Charges,77% of total billed charges,293.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,360,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1025.28,89,,,Percent of total Billed Charges,89% of total Billed charges,1025.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1025.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,470.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,470.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,887.04,77,,,Percent of total Billed charges,77% of total billed charges,979.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,331.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,470.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288,1025.28,
INJECTION FOR BREAST X-RAY,P991500196,CDM,521,RC,19030,HCPCS,Outpatient,,,303,151.5,,233.31,77,,,Percent of Total Billed Charges,77% of total billed charges,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,269.67,89,,,Percent of total Billed Charges,89% of total Billed charges,269.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.31,77,,,Percent of total Billed charges,77% of total billed charges,257.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.75,269.67,
BX BREAST 1ST LESION STRTCTC,P991500197,CDM,521,RC,19081,HCPCS,Outpatient,,,1290,645,,993.3,77,,,Percent of Total Billed Charges,77% of total billed charges,328.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,403.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1148.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1148.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,526.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,526.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,526.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,993.3,77,,,Percent of total Billed charges,77% of total billed charges,1096.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,370.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,526.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,322.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.5,1148.1,
BX BREAST LESION STRTCTC BILAT,P991500198,CDM,521,RC,19081,HCPCS,Outpatient,,,2580,1290,50,1986.6,77,,,Percent of Total Billed Charges,77% of total billed charges,657.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,657.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,806.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,645,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2296.2,89,,,Percent of total Billed Charges,89% of total Billed charges,2296.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2296.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1052.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1052.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1052.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,645,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1986.6,77,,,Percent of total Billed charges,77% of total billed charges,2193,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,741.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1052.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,645,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,645,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,645,2296.2,
BX BREAST ADD LESION STRTCTC,P991500199,CDM,521,RC,19082,HCPCS,Outpatient,,,1041,520.5,,801.57,77,,,Percent of Total Billed Charges,77% of total billed charges,265.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,260.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,926.49,89,,,Percent of total Billed Charges,89% of total Billed charges,926.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,926.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,801.57,77,,,Percent of total Billed charges,77% of total billed charges,884.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,299.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,424.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,260.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.25,926.49,
BX BREAST 1ST LESION US BILAT,P991500200,CDM,521,RC,19083,HCPCS,Outpatient,,,2632,1316,50,2026.64,77,,,Percent of Total Billed Charges,77% of total billed charges,671.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,671.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,822.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,658,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2342.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2342.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2342.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1073.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1073.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1073.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,658,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2026.64,77,,,Percent of total Billed charges,77% of total billed charges,2237.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,756.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1073.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,658,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,658,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,658,2342.48,
BX BREAST 1ST LESION US IMAG,P991500201,CDM,521,RC,19083,HCPCS,Outpatient,,,1316,658,,1013.32,77,,,Percent of Total Billed Charges,77% of total billed charges,335.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,335.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,411.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,329,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,1171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,536.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,536.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,536.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.32,77,,,Percent of total Billed charges,77% of total billed charges,1118.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,378.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,536.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329,1171.24,
BX BREAST ADD LESION US IMAG,P991500202,CDM,521,RC,19084,HCPCS,Outpatient,,,688,344,,529.76,77,,,Percent of Total Billed Charges,77% of total billed charges,175.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,612.32,89,,,Percent of total Billed Charges,89% of total Billed charges,612.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,529.76,77,,,Percent of total Billed charges,77% of total billed charges,584.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,197.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,280.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,612.32,
BX BREAST PERCUT W/O IMAGE,P991500203,CDM,521,RC,19100,HCPCS,Outpatient,,,277,138.5,,213.29,77,,,Percent of Total Billed Charges,77% of total billed charges,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,246.53,89,,,Percent of total Billed Charges,89% of total Billed charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.29,77,,,Percent of total Billed charges,77% of total billed charges,235.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.25,246.53,
BIOPSY BREAST OPEN INCISIONAL,P991500204,CDM,521,RC,19101,HCPCS,Outpatient,,,898,449,,691.46,77,,,Percent of Total Billed Charges,77% of total billed charges,228.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,799.22,89,,,Percent of total Billed Charges,89% of total Billed charges,799.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,799.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.46,77,,,Percent of total Billed charges,77% of total billed charges,763.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,366.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.5,799.22,
BIOPSY OF BREAST OPEN BILAT,P991500205,CDM,521,RC,19101,HCPCS,Outpatient,,,1796,898,50,1382.92,77,,,Percent of Total Billed Charges,77% of total billed charges,457.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,561.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,449,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1598.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1598.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1598.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,449,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1382.92,77,,,Percent of total Billed charges,77% of total billed charges,1526.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,516.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,732.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,449,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,449,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449,1598.44,
NIPPLE EXPLORATION,P991500206,CDM,521,RC,19110,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
EX BREAST DUCT FISTULA BILAT,P991500207,CDM,521,RC,19112,HCPCS,Outpatient,,,3666,1833,50,2822.82,77,,,Percent of Total Billed Charges,77% of total billed charges,934.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,934.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1145.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,916.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3262.74,89,,,Percent of total Billed Charges,89% of total Billed charges,3262.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3262.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1495.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1495.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1495.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,916.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2822.82,77,,,Percent of total Billed charges,77% of total billed charges,3116.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1053.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1495.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,916.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,916.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,916.5,3262.74,
EXCISE BREAST DUCT FISTULA,P991500208,CDM,521,RC,19112,HCPCS,Outpatient,,,1833,916.5,,1411.41,77,,,Percent of Total Billed Charges,77% of total billed charges,467.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,572.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,458.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1631.37,89,,,Percent of total Billed Charges,89% of total Billed charges,1631.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1631.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,747.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,747.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,747.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,458.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.41,77,,,Percent of total Billed charges,77% of total billed charges,1558.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,526.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,747.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,458.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,458.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.25,1631.37,
REMOVAL OF BREAST LESION,P991500209,CDM,521,RC,19120,HCPCS,Outpatient,,,1198,599,,922.46,77,,,Percent of Total Billed Charges,77% of total billed charges,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1066.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.46,77,,,Percent of total Billed charges,77% of total billed charges,1018.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,344.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.5,1066.22,
REMOVAL OF BREAST LESION BILAT,P991500210,CDM,521,RC,19120,HCPCS,Outpatient,,,2396,1198,50,1844.92,77,,,Percent of Total Billed Charges,77% of total billed charges,610.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,610.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,748.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,599,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2132.44,89,,,Percent of total Billed Charges,89% of total Billed charges,2132.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2132.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,977.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,977.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,977.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1844.92,77,,,Percent of total Billed charges,77% of total billed charges,2036.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,688.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,977.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,599,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599,2132.44,
EXCISION BREAST LESION,P991500211,CDM,521,RC,19125,HCPCS,Outpatient,,,1165,582.5,,897.05,77,,,Percent of Total Billed Charges,77% of total billed charges,297.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1036.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1036.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1036.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.05,77,,,Percent of total Billed charges,77% of total billed charges,990.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,334.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,475.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.25,1036.85,
EXCISION BREAST LESION BILAT,P991500212,CDM,521,RC,19125,HCPCS,Outpatient,,,1082,541,50,833.14,77,,,Percent of Total Billed Charges,77% of total billed charges,275.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,962.98,89,,,Percent of total Billed Charges,89% of total Billed charges,962.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,962.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.14,77,,,Percent of total Billed charges,77% of total billed charges,919.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,441.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.5,962.98,
EXCISION ADDL BREAST LESION,P991500213,CDM,521,RC,19126,HCPCS,Outpatient,,,451,225.5,,347.27,77,,,Percent of Total Billed Charges,77% of total billed charges,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,401.39,89,,,Percent of total Billed Charges,89% of total Billed charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.27,77,,,Percent of total Billed charges,77% of total billed charges,383.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.75,401.39,
PERQ DEVICE BREAST 1ST IMAG,P991500214,CDM,521,RC,19281,HCPCS,Outpatient,,,492,246,,378.84,77,,,Percent of Total Billed Charges,77% of total billed charges,125.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,437.88,89,,,Percent of total Billed Charges,89% of total Billed charges,437.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,437.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.84,77,,,Percent of total Billed charges,77% of total billed charges,418.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,200.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,437.88,
PERQ DVC BRST 1ST IMAG BILAT,P991500215,CDM,521,RC,19281,HCPCS,Outpatient,,,984,492,,757.68,77,,,Percent of Total Billed Charges,77% of total billed charges,250.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,875.76,89,,,Percent of total Billed Charges,89% of total Billed charges,875.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,875.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,401.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,401.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,757.68,77,,,Percent of total Billed charges,77% of total billed charges,836.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,401.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246,875.76,
PERQ DEVICE BREAST EA IMAG,P991500216,CDM,521,RC,19282,HCPCS,Outpatient,,,339,169.5,,261.03,77,,,Percent of Total Billed Charges,77% of total billed charges,86.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,301.71,89,,,Percent of total Billed Charges,89% of total Billed charges,301.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.03,77,,,Percent of total Billed charges,77% of total billed charges,288.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.75,301.71,
PERQ DEV BREAST 1ST US BILAT,P991500217,CDM,521,RC,19285,HCPCS,Outpatient,,,224,112,50,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
PERQ DEV BREAST 1ST US IMAG,P991500218,CDM,521,RC,19285,HCPCS,Outpatient,,,957,478.5,,736.89,77,,,Percent of Total Billed Charges,77% of total billed charges,244.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,851.73,89,,,Percent of total Billed Charges,89% of total Billed charges,851.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,851.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.89,77,,,Percent of total Billed charges,77% of total billed charges,813.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,275.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,390.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.25,851.73,
PERQ DEV BREAST ADD US IMAG,P991500219,CDM,521,RC,19286,HCPCS,Outpatient,,,54,27,,41.58,77,,,Percent of Total Billed Charges,77% of total billed charges,13.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.06,89,,,Percent of total Billed Charges,89% of total Billed charges,48.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.58,77,,,Percent of total Billed charges,77% of total billed charges,45.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.5,48.06,
REMOVAL OF BREAST TISSUE BILAT,P991500220,CDM,521,RC,19300,HCPCS,Outpatient,,,2224,1112,,1712.48,77,,,Percent of Total Billed Charges,77% of total billed charges,567.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,567.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,695,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,556,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1979.36,89,,,Percent of total Billed Charges,89% of total Billed charges,1979.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1979.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,556,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1712.48,77,,,Percent of total Billed charges,77% of total billed charges,1890.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,639.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,907.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,556,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,556,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556,1979.36,
SURAREOLAR MASTECTOMY,P991500221,CDM,521,RC,19300,HCPCS,Outpatient,,,1112,556,,856.24,77,,,Percent of Total Billed Charges,77% of total billed charges,283.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,347.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,278,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,989.68,89,,,Percent of total Billed Charges,89% of total Billed charges,989.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,989.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,453.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,453.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,453.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.24,77,,,Percent of total Billed charges,77% of total billed charges,945.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,453.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,278,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278,989.68,
"MASTECTOMY, PARTIAL BILAT",P991500222,CDM,521,RC,19301,HCPCS,Outpatient,,,2830,1415,,2179.1,77,,,Percent of Total Billed Charges,77% of total billed charges,721.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,721.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,884.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,707.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2518.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2518.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2518.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1154.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1154.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1154.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2179.1,77,,,Percent of total Billed charges,77% of total billed charges,2405.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,813.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1154.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,707.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.5,2518.7,
"MASTECTOMY,PARTIAL",P991500223,CDM,521,RC,19301,HCPCS,Outpatient,,,1415,707.5,,1089.55,77,,,Percent of Total Billed Charges,77% of total billed charges,360.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,360.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,353.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1259.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1259.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1259.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,577.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1089.55,77,,,Percent of total Billed charges,77% of total billed charges,1202.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,406.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,577.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,353.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,353.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,353.75,1259.35,
P-MASTECTOMY W/LN REMOVAL,P991500224,CDM,521,RC,19302,HCPCS,Outpatient,,,1305,652.5,,1004.85,77,,,Percent of Total Billed Charges,77% of total billed charges,332.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,407.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1161.45,89,,,Percent of total Billed Charges,89% of total Billed charges,1161.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1161.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1004.85,77,,,Percent of total Billed charges,77% of total billed charges,1109.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,375.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,532.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.25,1161.45,
"MAST SIMPLE COMPLETE, BILAT",P991500225,CDM,521,RC,19303,HCPCS,Outpatient,,,2488,1244,50,1915.76,77,,,Percent of Total Billed Charges,77% of total billed charges,634.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,634.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,777.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,622,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2214.32,89,,,Percent of total Billed Charges,89% of total Billed charges,2214.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2214.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1015.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1015.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1015.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,622,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1915.76,77,,,Percent of total Billed charges,77% of total billed charges,2114.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,715.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1015.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,622,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,622,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,622,2214.32,
"MASTECTOMY, SIMPLE, COMPLETE",P991500226,CDM,521,RC,19303,HCPCS,Outpatient,,,2080,1040,,1601.6,77,,,Percent of Total Billed Charges,77% of total billed charges,530.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,530.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1851.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1851.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1851.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1601.6,77,,,Percent of total Billed charges,77% of total billed charges,1768,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,848.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520,1851.2,
MAST RADICAL,P991500227,CDM,521,RC,19305,HCPCS,Outpatient,,,2987,1493.5,,2299.99,77,,,Percent of Total Billed Charges,77% of total billed charges,761.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2658.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2658.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2658.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1218.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,746.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.99,77,,,Percent of total Billed charges,77% of total billed charges,2538.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,858.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1218.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,746.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,746.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.75,2658.43,
"MAST RADICAL, BILAT",P991500228,CDM,521,RC,19305,HCPCS,Outpatient,,,5974,2987,50,4599.98,77,,,Percent of Total Billed Charges,77% of total billed charges,1523.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1523.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1866.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1493.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5316.86,89,,,Percent of total Billed Charges,89% of total Billed charges,5316.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5316.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2437.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2437.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2437.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1493.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4599.98,77,,,Percent of total Billed charges,77% of total billed charges,5077.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1717.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2437.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1493.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1493.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1493.5,5316.86,
"MASTECTOMY, RADICAL",P991500229,CDM,521,RC,19306,HCPCS,Outpatient,,,2597,1298.5,,1999.69,77,,,Percent of Total Billed Charges,77% of total billed charges,662.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,662.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,811.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,649.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2311.33,89,,,Percent of total Billed Charges,89% of total Billed charges,2311.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1059.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1999.69,77,,,Percent of total Billed charges,77% of total billed charges,2207.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,746.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1059.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,649.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.25,2311.33,
MAST MOD RAD,P991500230,CDM,521,RC,19307,HCPCS,Outpatient,,,2593,1296.5,,1996.61,77,,,Percent of Total Billed Charges,77% of total billed charges,661.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,661.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,810.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,648.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2307.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2307.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2307.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1057.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1057.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1057.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,648.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1996.61,77,,,Percent of total Billed charges,77% of total billed charges,2204.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,745.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1057.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,648.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,648.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.25,2307.77,
MASTOPEXY,P991500231,CDM,521,RC,19316,HCPCS,Outpatient,,,975,487.5,,750.75,77,,,Percent of Total Billed Charges,77% of total billed charges,248.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,867.75,89,,,Percent of total Billed Charges,89% of total Billed charges,867.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,867.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,750.75,77,,,Percent of total Billed charges,77% of total billed charges,828.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,397.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.75,867.75,
"BREAST REDUCTION, BILAT",P991500232,CDM,521,RC,19318,HCPCS,Outpatient,,,3700,1850,50,2849,77,,,Percent of Total Billed Charges,77% of total billed charges,943.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,943.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1156.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,925,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3293,89,,,Percent of total Billed Charges,89% of total Billed charges,3293,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3293,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1509.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1509.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1509.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2849,77,,,Percent of total Billed charges,77% of total billed charges,3145,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1063.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1509.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,925,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,925,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,925,3293,
REDUCTION MAMMAPLASTY,P991500233,CDM,521,RC,19318,HCPCS,Outpatient,,,2347,1173.5,,1807.19,77,,,Percent of Total Billed Charges,77% of total billed charges,598.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,733.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,586.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2088.83,89,,,Percent of total Billed Charges,89% of total Billed charges,2088.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2088.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,957.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,957.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,957.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,586.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1807.19,77,,,Percent of total Billed charges,77% of total billed charges,1994.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,674.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,957.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,586.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,586.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.75,2088.83,
BREAST AUGMENTATION W/IMPLT,P991500234,CDM,521,RC,19325,HCPCS,Outpatient,,,1362,681,,1048.74,77,,,Percent of Total Billed Charges,77% of total billed charges,347.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,347.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,425.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1212.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1212.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1212.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1048.74,77,,,Percent of total Billed charges,77% of total billed charges,1157.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,391.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,555.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.5,1212.18,
"RMVL BREAST IMPLNT, BILAT",P991500235,CDM,521,RC,19328,HCPCS,Outpatient,,,1710,855,50,1316.7,77,,,Percent of Total Billed Charges,77% of total billed charges,436.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,534.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1521.9,89,,,Percent of total Billed Charges,89% of total Billed charges,1521.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1521.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1316.7,77,,,Percent of total Billed charges,77% of total billed charges,1453.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,491.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,697.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,427.5,1521.9,
RMVL INTACT BREAST IMPLANT,P991500236,CDM,521,RC,19328,HCPCS,Outpatient,,,1051,525.5,,809.27,77,,,Percent of Total Billed Charges,77% of total billed charges,268.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,935.39,89,,,Percent of total Billed Charges,89% of total Billed charges,935.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,935.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,809.27,77,,,Percent of total Billed charges,77% of total billed charges,893.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,302.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,428.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.75,935.39,
REMOVAL OF A BREAST IMPLANT,P991500237,CDM,521,RC,19330,HCPCS,Outpatient,,,1342,671,,1033.34,77,,,Percent of Total Billed Charges,77% of total billed charges,342.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,342.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,419.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,335.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,1194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,547.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,547.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,547.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,335.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1033.34,77,,,Percent of total Billed charges,77% of total billed charges,1140.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,385.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,547.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,335.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,335.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.5,1194.38,
RMV RPTRED BREAST IMPLNT BILAT,P991500238,CDM,521,RC,19330,HCPCS,Outpatient,,,2684,1342,,2066.68,77,,,Percent of Total Billed Charges,77% of total billed charges,684.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,684.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,838.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,671,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2388.76,89,,,Percent of total Billed Charges,89% of total Billed charges,2388.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,671,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2066.68,77,,,Percent of total Billed charges,77% of total billed charges,2281.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,771.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1095.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,671,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,671,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671,2388.76,
INSJ BREAST IMPLT SM D MAST,P991500239,CDM,521,RC,19340,HCPCS,Outpatient,,,1248,624,,960.96,77,,,Percent of Total Billed Charges,77% of total billed charges,318.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,390,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1110.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1110.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,509.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,509.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,509.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.96,77,,,Percent of total Billed charges,77% of total billed charges,1060.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,358.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,509.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,312,1110.72,
INSJ/RPLCMT BRST IMPLT SEP D,P991500240,CDM,521,RC,19342,HCPCS,Outpatient,,,1960,980,,1509.2,77,,,Percent of Total Billed Charges,77% of total billed charges,499.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,499.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,612.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,490,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1744.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1744.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1744.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,799.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,799.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,799.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,490,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1509.2,77,,,Percent of total Billed charges,77% of total billed charges,1666,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,563.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,799.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,490,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,490,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490,1744.4,
TISS XPNDR PLMT BRST RCNSTJ,P991500241,CDM,521,RC,19357,HCPCS,Outpatient,,,3164,1582,,2436.28,77,,,Percent of Total Billed Charges,77% of total billed charges,806.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,806.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,988.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,791,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2815.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2815.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2815.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1290.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1290.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1290.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,791,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2436.28,77,,,Percent of total Billed charges,77% of total billed charges,2689.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,909.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1290.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,791,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,791,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,791,2815.96,
REVJ PERI-IMPLT CAPSULE BRST,P991500242,CDM,521,RC,19370,HCPCS,Outpatient,,,2910,1455,,2240.7,77,,,Percent of Total Billed Charges,77% of total billed charges,742.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,742.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,909.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,727.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2589.9,89,,,Percent of total Billed Charges,89% of total Billed charges,2589.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2589.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1187.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1187.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,727.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2240.7,77,,,Percent of total Billed charges,77% of total billed charges,2473.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,836.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1187.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,727.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,727.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,727.5,2589.9,
PERI CAPSLC BRST COMPL BILAT,P991500243,CDM,521,RC,19371,HCPCS,Outpatient,,,1700,850,50,1309,77,,,Percent of Total Billed Charges,77% of total billed charges,433.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,433.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1513,89,,,Percent of total Billed Charges,89% of total Billed charges,1513,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1513,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,693.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,693.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,693.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1309,77,,,Percent of total Billed charges,77% of total billed charges,1445,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,488.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,693.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425,1513,
PERIPROSTHETIC CAPSULECTOMY,P991500244,CDM,521,RC,19371,HCPCS,Outpatient,,,1666,833,,1282.82,77,,,Percent of Total Billed Charges,77% of total billed charges,424.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,520.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1482.74,89,,,Percent of total Billed Charges,89% of total Billed charges,1482.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1482.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,679.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,679.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1282.82,77,,,Percent of total Billed charges,77% of total billed charges,1416.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,478.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,679.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.5,1482.74,
EXPL PENETRATING WND NECK,P991500246,CDM,521,RC,20100,HCPCS,Outpatient,,,1868,934,,1438.36,77,,,Percent of Total Billed Charges,77% of total billed charges,476.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,583.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1662.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1662.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1438.36,77,,,Percent of total Billed charges,77% of total billed charges,1587.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,762.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467,1662.52,
EXPL PENETRATING WND CHEST,P991500247,CDM,521,RC,20101,HCPCS,Outpatient,,,683,341.5,,525.91,77,,,Percent of Total Billed Charges,77% of total billed charges,174.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,607.87,89,,,Percent of total Billed Charges,89% of total Billed charges,607.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,607.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,525.91,77,,,Percent of total Billed charges,77% of total billed charges,580.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.75,607.87,
EXPL PENETRATING WND ABD/FLANK,P991500248,CDM,521,RC,20102,HCPCS,Outpatient,,,1006,503,,774.62,77,,,Percent of Total Billed Charges,77% of total billed charges,256.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,314.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,895.34,89,,,Percent of total Billed Charges,89% of total Billed charges,895.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,895.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,410.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,410.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.62,77,,,Percent of total Billed charges,77% of total billed charges,855.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,289.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,410.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,251.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.5,895.34,
EXPL PENETRATING WND EXTREMITY,P991500249,CDM,521,RC,20103,HCPCS,Outpatient,,,1196,598,,920.92,77,,,Percent of Total Billed Charges,77% of total billed charges,304.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1064.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.92,77,,,Percent of total Billed charges,77% of total billed charges,1016.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,487.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299,1064.44,
BIOPSY MUSCLE SUPERFICIAL,P991500250,CDM,521,RC,20200,HCPCS,Outpatient,,,396,198,,304.92,77,,,Percent of Total Billed Charges,77% of total billed charges,100.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,352.44,89,,,Percent of total Billed Charges,89% of total Billed charges,352.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,352.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.92,77,,,Percent of total Billed charges,77% of total billed charges,336.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99,352.44,
BIOPSY MUSCLE DEEP,P991500251,CDM,521,RC,20205,HCPCS,Outpatient,,,690,345,,531.3,77,,,Percent of Total Billed Charges,77% of total billed charges,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,614.1,89,,,Percent of total Billed Charges,89% of total Billed charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.3,77,,,Percent of total Billed charges,77% of total billed charges,586.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,281.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,614.1,
NEEDLE BIOPSY MUSCLE,P991500252,CDM,521,RC,20206,HCPCS,Outpatient,,,401,200.5,,308.77,77,,,Percent of Total Billed Charges,77% of total billed charges,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356.89,89,,,Percent of total Billed Charges,89% of total Billed charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.77,77,,,Percent of total Billed charges,77% of total billed charges,340.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.25,356.89,
BIOPSY BONE TROCAR OR NEEDLE,P991500253,CDM,521,RC,20220,HCPCS,Outpatient,,,428,214,,329.56,77,,,Percent of Total Billed Charges,77% of total billed charges,109.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,380.92,89,,,Percent of total Billed Charges,89% of total Billed charges,380.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.56,77,,,Percent of total Billed charges,77% of total billed charges,363.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,174.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107,380.92,
BIOPSY BONE SUPERFICIAL,P991500254,CDM,521,RC,20240,HCPCS,Outpatient,,,266,133,,204.82,77,,,Percent of Total Billed Charges,77% of total billed charges,67.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236.74,89,,,Percent of total Billed Charges,89% of total Billed charges,236.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.82,77,,,Percent of total Billed charges,77% of total billed charges,226.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.5,236.74,
BIOPSY BONE DEEP,P991500255,CDM,521,RC,20245,HCPCS,Outpatient,,,655,327.5,,504.35,77,,,Percent of Total Billed Charges,77% of total billed charges,167.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,582.95,89,,,Percent of total Billed Charges,89% of total Billed charges,582.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,582.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,504.35,77,,,Percent of total Billed charges,77% of total billed charges,556.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,267.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.75,582.95,
BIOPSY SACRAL LESION,P991500256,CDM,521,RC,20251,HCPCS,Outpatient,,,795,397.5,,612.15,77,,,Percent of Total Billed Charges,77% of total billed charges,202.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,707.55,89,,,Percent of total Billed Charges,89% of total Billed charges,707.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,612.15,77,,,Percent of total Billed charges,77% of total billed charges,675.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,228.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,324.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,198.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,198.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.75,707.55,
FLUID DRAINAGE,P991500257,CDM,521,RC,20500,HCPCS,Outpatient,,,229,114.5,,176.33,77,,,Percent of Total Billed Charges,77% of total billed charges,58.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,203.81,89,,,Percent of total Billed Charges,89% of total Billed charges,203.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.33,77,,,Percent of total Billed charges,77% of total billed charges,194.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.25,203.81,
REMOVAL OF FOREIGN BODY,P991500258,CDM,521,RC,20520,HCPCS,Outpatient,,,779,389.5,,599.83,77,,,Percent of Total Billed Charges,77% of total billed charges,198.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,693.31,89,,,Percent of total Billed Charges,89% of total Billed charges,693.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,693.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.83,77,,,Percent of total Billed charges,77% of total billed charges,662.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,194.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.75,693.31,
REMOVAL OF FOREIGN BODY,P991500259,CDM,521,RC,20525,HCPCS,Outpatient,,,849,424.5,,653.73,77,,,Percent of Total Billed Charges,77% of total billed charges,216.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,755.61,89,,,Percent of total Billed Charges,89% of total Billed charges,755.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.73,77,,,Percent of total Billed charges,77% of total billed charges,721.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,346.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.25,755.61,
"THER INJ CARP TUNNEL, BILAT",P991500260,CDM,521,RC,20526,HCPCS,Outpatient,,,374,187,50,287.98,77,,,Percent of Total Billed Charges,77% of total billed charges,95.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,332.86,89,,,Percent of total Billed Charges,89% of total Billed charges,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.98,77,,,Percent of total Billed charges,77% of total billed charges,317.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,332.86,
THER INJECTION CARP TUNNEL,P991500261,CDM,521,RC,20526,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,166.43,89,,,Percent of total Billed Charges,89% of total Billed charges,166.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.75,166.43,
DUPYTRN CORD W/ENZYME BILAT,P991500262,CDM,521,RC,20527,HCPCS,Outpatient,,,180,90,,138.6,77,,,Percent of Total Billed Charges,77% of total billed charges,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.2,89,,,Percent of total Billed Charges,89% of total Billed charges,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.6,77,,,Percent of total Billed charges,77% of total billed charges,153,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45,160.2,
INJ DUPUYTREN CORD W/ENZYME,P991500263,CDM,521,RC,20527,HCPCS,Outpatient,,,176,88,,135.52,77,,,Percent of Total Billed Charges,77% of total billed charges,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.64,89,,,Percent of total Billed Charges,89% of total Billed charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.52,77,,,Percent of total Billed charges,77% of total billed charges,149.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,156.64,
INJ TENDON SHEATH/LIG BILAT,P991500264,CDM,521,RC,20550,HCPCS,Outpatient,,,326,163,50,251.02,77,,,Percent of Total Billed Charges,77% of total billed charges,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290.14,89,,,Percent of total Billed Charges,89% of total Billed charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.02,77,,,Percent of total Billed charges,77% of total billed charges,277.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.5,290.14,
INJ TENDON SHEATH/LIGAMENT,P991500265,CDM,521,RC,20550,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.07,89,,,Percent of total Billed Charges,89% of total Billed charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
INJ TENDON ORIGIN/INSERTION,P991500266,CDM,521,RC,20551,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.62,89,,,Percent of total Billed Charges,89% of total Billed charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,140.62,
INJ TRIGGER POINT 1/2 MUSCL,P991500267,CDM,521,RC,20552,HCPCS,Outpatient,,,98,49,,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.22,89,,,Percent of total Billed Charges,89% of total Billed charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,87.22,
INJECT TRIGGER POINTS 3/>,P991500268,CDM,521,RC,20553,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.07,89,,,Percent of total Billed Charges,89% of total Billed charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
DRAIN/INJ JOINT/BURSA W/O US,P991500269,CDM,521,RC,20600,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.28,89,,,Percent of total Billed Charges,89% of total Billed charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38,135.28,
INJ JNT/BURSA W/O US BILAT,P991500270,CDM,521,RC,20600,HCPCS,Outpatient,,,304,152,50,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76,270.56,
DRAIN/INJ JOINT/BURSA W/US,P991500271,CDM,510,RC,20604,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.85,
ARTHROCENTESIS INTERM JOINT,P991500272,CDM,521,RC,20605,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,147.74,89,,,Percent of total Billed Charges,89% of total Billed charges,147.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.5,147.74,
INJ JOINT/BURSA W/O US BILAT,P991500273,CDM,521,RC,20605,HCPCS,Outpatient,,,332,166,50,255.64,77,,,Percent of Total Billed Charges,77% of total billed charges,84.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,295.48,89,,,Percent of total Billed Charges,89% of total Billed charges,295.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.64,77,,,Percent of total Billed charges,77% of total billed charges,282.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83,295.48,
DRAIN/INJ JOINT/BURSA W/US,P991500274,CDM,521,RC,20606,HCPCS,Outpatient,,,169,84.5,,130.13,77,,,Percent of Total Billed Charges,77% of total billed charges,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.41,89,,,Percent of total Billed Charges,89% of total Billed charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.13,77,,,Percent of total Billed charges,77% of total billed charges,143.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.25,150.41,
ASPIRATION OR INJECTION JOINT,P991500275,CDM,521,RC,20610,HCPCS,Outpatient,,,151,75.5,,116.27,77,,,Percent of Total Billed Charges,77% of total billed charges,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.39,89,,,Percent of total Billed Charges,89% of total Billed charges,134.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,77,,,Percent of total Billed charges,77% of total billed charges,128.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.75,134.39,
BILATERAL ASPIRATION JOINT,P991500276,CDM,521,RC,20610,HCPCS,Outpatient,,,302,151,50,232.54,77,,,Percent of Total Billed Charges,77% of total billed charges,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,268.78,89,,,Percent of total Billed Charges,89% of total Billed charges,268.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.54,77,,,Percent of total Billed charges,77% of total billed charges,256.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.5,268.78,
ASP/INJECTION MAJOR JT W/US,P991500277,CDM,510,RC,20611,HCPCS,Outpatient,,,190,95,,146.3,77,,,Percent of Total Billed Charges,77% of total billed charges,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.3,77,,,Percent of total Billed charges,77% of total billed charges,161.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.5,169.1,
DRAIN/INJ JOINT/BURSA W/US,P991500278,CDM,521,RC,20611,HCPCS,Outpatient,,,340,170,50,261.8,77,,,Percent of Total Billed Charges,77% of total billed charges,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,302.6,89,,,Percent of total Billed Charges,89% of total Billed charges,302.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,302.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.8,77,,,Percent of total Billed charges,77% of total billed charges,289,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85,302.6,
ASPIRATE/INJ GANGLION CYST,P991500279,CDM,521,RC,20612,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,143.29,89,,,Percent of total Billed Charges,89% of total Billed charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.25,143.29,
INSERT AND REMOVE BONE PIN,P991500280,CDM,521,RC,20650,HCPCS,Outpatient,,,418,209,,321.86,77,,,Percent of Total Billed Charges,77% of total billed charges,106.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,372.02,89,,,Percent of total Billed Charges,89% of total Billed charges,372.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.86,77,,,Percent of total Billed charges,77% of total billed charges,355.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.5,372.02,
REM IMPLANT SUPF SEPARATE PROC,P991500281,CDM,521,RC,20670,HCPCS,Outpatient,,,642,321,,494.34,77,,,Percent of Total Billed Charges,77% of total billed charges,163.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,571.38,89,,,Percent of total Billed Charges,89% of total Billed charges,571.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,571.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,494.34,77,,,Percent of total Billed charges,77% of total billed charges,545.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,184.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,261.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.5,571.38,
REMOVAL IMPLANT DEEP,P991500282,CDM,521,RC,20680,HCPCS,Outpatient,,,1271,635.5,,978.67,77,,,Percent of Total Billed Charges,77% of total billed charges,324.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1131.19,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.67,77,,,Percent of total Billed charges,77% of total billed charges,1080.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.75,1131.19,
REMOVE BONE FIXATION DEVICE,P991500283,CDM,521,RC,20694,HCPCS,Outpatient,,,797,398.5,,613.69,77,,,Percent of Total Billed Charges,77% of total billed charges,203.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,709.33,89,,,Percent of total Billed Charges,89% of total Billed charges,709.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.69,77,,,Percent of total Billed charges,77% of total billed charges,677.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,325.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,199.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.25,709.33,
MNL PREP&INSJ DP RX DLVR DEV,P991500284,CDM,521,RC,20700,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,143.29,89,,,Percent of total Billed Charges,89% of total Billed charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.25,143.29,
"REMOVAL FOR BONE GRAFT, BILAT",P991500285,CDM,521,RC,20900,HCPCS,Outpatient,,,806,403,50,620.62,77,,,Percent of Total Billed Charges,77% of total billed charges,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,717.34,89,,,Percent of total Billed Charges,89% of total Billed charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,620.62,77,,,Percent of total Billed charges,77% of total billed charges,685.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.5,717.34,
REMOVAL OF BONE FOR GRAFT,P991500286,CDM,521,RC,20900,HCPCS,Outpatient,,,403,201.5,,310.31,77,,,Percent of Total Billed Charges,77% of total billed charges,102.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.67,89,,,Percent of total Billed Charges,89% of total Billed charges,358.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.31,77,,,Percent of total Billed charges,77% of total billed charges,342.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.75,358.67,
BONE/SKIN GRAFT MICROVASC,P991500287,CDM,521,RC,20969,HCPCS,Outpatient,,,5157,2578.5,,3970.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1315.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1315.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1611.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1289.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4589.73,89,,,Percent of total Billed Charges,89% of total Billed charges,4589.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4589.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2104.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2104.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2104.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1289.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3970.89,77,,,Percent of total Billed charges,77% of total billed charges,4383.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2104.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1289.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1289.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1289.25,4589.73,
EXC FACE LES SC <2 CM,P991500288,CDM,521,RC,21011,HCPCS,Outpatient,,,725,362.5,,558.25,77,,,Percent of Total Billed Charges,77% of total billed charges,184.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,645.25,89,,,Percent of total Billed Charges,89% of total Billed charges,645.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,645.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.25,77,,,Percent of total Billed charges,77% of total billed charges,616.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,295.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.25,645.25,
EXCSN TUMOR 2 CM OR GREATER,P991500289,CDM,521,RC,21012,HCPCS,Outpatient,,,719,359.5,,553.63,77,,,Percent of Total Billed Charges,77% of total billed charges,183.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,639.91,89,,,Percent of total Billed Charges,89% of total Billed charges,639.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,639.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.63,77,,,Percent of total Billed charges,77% of total billed charges,611.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.75,639.91,
RESECT FACE/SCALP TUM < 2 CM,P991500290,CDM,521,RC,21015,HCPCS,Outpatient,,,1421,710.5,,1094.17,77,,,Percent of Total Billed Charges,77% of total billed charges,362.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,444.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1264.69,89,,,Percent of total Billed Charges,89% of total Billed charges,1264.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1264.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,579.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,579.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1094.17,77,,,Percent of total Billed charges,77% of total billed charges,1207.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,408.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,579.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,355.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.25,1264.69,
REMOVE EXOSTOSIS MANDIBLE,P991500291,CDM,521,RC,21031,HCPCS,Outpatient,,,699,349.5,,538.23,77,,,Percent of Total Billed Charges,77% of total billed charges,178.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,174.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,622.11,89,,,Percent of total Billed Charges,89% of total Billed charges,622.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,622.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,538.23,77,,,Percent of total Billed charges,77% of total billed charges,594.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,200.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,174.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,174.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.75,622.11,
REMOVE EXOSTOSIS MAXILLA,P991500292,CDM,521,RC,21032,HCPCS,Outpatient,,,678,339,,522.06,77,,,Percent of Total Billed Charges,77% of total billed charges,172.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,603.42,89,,,Percent of total Billed Charges,89% of total Billed charges,603.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,603.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,276.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,276.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,276.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.06,77,,,Percent of total Billed charges,77% of total billed charges,576.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,276.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.5,603.42,
EXCISE MAX/ZYGOMA MAL TUMOR,P991500293,CDM,521,RC,21034,HCPCS,Outpatient,,,2763,1381.5,,2127.51,77,,,Percent of Total Billed Charges,77% of total billed charges,704.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,704.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,863.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2459.07,89,,,Percent of total Billed Charges,89% of total Billed charges,2459.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2459.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2127.51,77,,,Percent of total Billed charges,77% of total billed charges,2348.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,794.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1127.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.75,2459.07,
EXCISE MANDIBLE LESION,P991500294,CDM,521,RC,21040,HCPCS,Outpatient,,,858,429,,660.66,77,,,Percent of Total Billed Charges,77% of total billed charges,218.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,214.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,763.62,89,,,Percent of total Billed Charges,89% of total Billed charges,763.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,763.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,660.66,77,,,Percent of total Billed charges,77% of total billed charges,729.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,246.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,350.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,214.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,214.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.5,763.62,
EAR CARTILAGE GRAFT,P991500295,CDM,521,RC,21235,HCPCS,Outpatient,,,1189,594.5,,915.53,77,,,Percent of Total Billed Charges,77% of total billed charges,303.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,371.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,297.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1058.21,89,,,Percent of total Billed Charges,89% of total Billed charges,1058.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1058.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,485.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,915.53,77,,,Percent of total Billed charges,77% of total billed charges,1010.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,485.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,297.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,297.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.25,1058.21,
CLSD TX NSL FX MNPJ WO STBLJ,P991500296,CDM,521,RC,21315,HCPCS,Outpatient,,,274,137,,210.98,77,,,Percent of Total Billed Charges,77% of total billed charges,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.86,89,,,Percent of total Billed Charges,89% of total Billed charges,243.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.98,77,,,Percent of total Billed charges,77% of total billed charges,232.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.5,243.86,
CLSD TX NSL FX W/MNPJ&STABLJ,P991500297,CDM,521,RC,21320,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,249.2,
OPEN TX NOSE FX W/SKELE FIXJ,P991500298,CDM,521,RC,21330,HCPCS,Outpatient,,,994,497,,765.38,77,,,Percent of Total Billed Charges,77% of total billed charges,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,884.66,89,,,Percent of total Billed Charges,89% of total Billed charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.38,77,,,Percent of total Billed charges,77% of total billed charges,844.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,405.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.5,884.66,
OPEN TX SEPTAL FX W/WO STABJ,P991500299,CDM,521,RC,21336,HCPCS,Outpatient,,,1333,666.5,,1026.41,77,,,Percent of Total Billed Charges,77% of total billed charges,339.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,333.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1186.37,89,,,Percent of total Billed Charges,89% of total Billed charges,1186.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1186.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,543.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,543.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,543.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1026.41,77,,,Percent of total Billed charges,77% of total billed charges,1133.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,543.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,333.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.25,1186.37,
DRAIN NECK/CHEST LESION,P991500300,CDM,521,RC,21501,HCPCS,Outpatient,,,976,488,,751.52,77,,,Percent of Total Billed Charges,77% of total billed charges,248.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,868.64,89,,,Percent of total Billed Charges,89% of total Billed charges,868.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,751.52,77,,,Percent of total Billed charges,77% of total billed charges,829.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,398.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,244,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244,868.64,
BIOPSY OF NECK SOFT TISSUE,P991500301,CDM,521,RC,21550,HCPCS,Outpatient,,,488,244,,375.76,77,,,Percent of Total Billed Charges,77% of total billed charges,124.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,434.32,89,,,Percent of total Billed Charges,89% of total Billed charges,434.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.76,77,,,Percent of total Billed charges,77% of total billed charges,414.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,199.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122,434.32,
EXC NECK LES SC 3 CM/>,P991500302,CDM,521,RC,21552,HCPCS,Outpatient,,,958,479,,737.66,77,,,Percent of Total Billed Charges,77% of total billed charges,244.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,852.62,89,,,Percent of total Billed Charges,89% of total Billed charges,852.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,852.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,737.66,77,,,Percent of total Billed charges,77% of total billed charges,814.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,275.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,390.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.5,852.62,
EXC NECK TUM DEEP 5 CM/>,P991500303,CDM,521,RC,21554,HCPCS,Outpatient,,,912,456,,702.24,77,,,Percent of Total Billed Charges,77% of total billed charges,232.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,811.68,89,,,Percent of total Billed Charges,89% of total Billed charges,811.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,811.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,702.24,77,,,Percent of total Billed charges,77% of total billed charges,775.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,372.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,228,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228,811.68,
EXC NECK LES SC < 3 CM,P991500304,CDM,521,RC,21555,HCPCS,Outpatient,,,973,486.5,,749.21,77,,,Percent of Total Billed Charges,77% of total billed charges,248.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,865.97,89,,,Percent of total Billed Charges,89% of total Billed charges,865.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,865.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,749.21,77,,,Percent of total Billed charges,77% of total billed charges,827.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,279.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,396.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.25,865.97,
EXC NECK TUM DEEP < 5 CM,P991500305,CDM,521,RC,21556,HCPCS,Outpatient,,,1129,564.5,,869.33,77,,,Percent of Total Billed Charges,77% of total billed charges,287.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1004.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1004.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1004.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,869.33,77,,,Percent of total Billed charges,77% of total billed charges,959.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,460.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.25,1004.81,
RESECT NECK THORAX TUMOR<5CM,P991500306,CDM,521,RC,21557,HCPCS,Outpatient,,,2056,1028,,1583.12,77,,,Percent of Total Billed Charges,77% of total billed charges,524.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,642.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1829.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1829.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1829.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.12,77,,,Percent of total Billed charges,77% of total billed charges,1747.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,591.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,838.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514,1829.84,
BX SOFT TISSUE BACK/FLANK SUPF,P991500307,CDM,521,RC,21920,HCPCS,Outpatient,,,469,234.5,,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.25,417.41,
EXC BACK LES SC < 3 CM,P991500308,CDM,521,RC,21930,HCPCS,Outpatient,,,1003,501.5,,772.31,77,,,Percent of Total Billed Charges,77% of total billed charges,255.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,250.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,892.67,89,,,Percent of total Billed Charges,89% of total Billed charges,892.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,892.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,409.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,409.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.31,77,,,Percent of total Billed charges,77% of total billed charges,852.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,288.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,409.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,250.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.75,892.67,
EXC BACK LES SC 3 CM/>,P991500309,CDM,521,RC,21931,HCPCS,Outpatient,,,1010,505,,777.7,77,,,Percent of Total Billed Charges,77% of total billed charges,257.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,252.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,898.9,89,,,Percent of total Billed Charges,89% of total Billed charges,898.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,898.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.7,77,,,Percent of total Billed charges,77% of total billed charges,858.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,290.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,412.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,252.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,252.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.5,898.9,
EXC BACK TUM DEEP < 5 CM,P991500310,CDM,521,RC,21932,HCPCS,Outpatient,,,940,470,,723.8,77,,,Percent of Total Billed Charges,77% of total billed charges,239.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,235,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,836.6,89,,,Percent of total Billed Charges,89% of total Billed charges,836.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.8,77,,,Percent of total Billed charges,77% of total billed charges,799,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,383.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,235,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,836.6,
EXC BACK TUM DEEP 5 CM/>,P991500311,CDM,521,RC,21933,HCPCS,Outpatient,,,1592,796,,1225.84,77,,,Percent of Total Billed Charges,77% of total billed charges,405.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1416.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1416.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.84,77,,,Percent of total Billed charges,77% of total billed charges,1353.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398,1416.88,
CLOSED TX VERT FX W/O MANJ,P991500312,CDM,521,RC,22310,HCPCS,Outpatient,,,582,291,,448.14,77,,,Percent of Total Billed Charges,77% of total billed charges,148.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,517.98,89,,,Percent of total Billed Charges,89% of total Billed charges,517.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,517.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.14,77,,,Percent of total Billed charges,77% of total billed charges,494.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.5,517.98,
EXC ABDL TUM DEEP < 5 CM,P991500313,CDM,521,RC,22900,HCPCS,Outpatient,,,1212,606,,933.24,77,,,Percent of Total Billed Charges,77% of total billed charges,309.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1078.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1078.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.24,77,,,Percent of total Billed charges,77% of total billed charges,1030.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,494.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303,1078.68,
EXC ABDL TUM DEEP 5 CM/>,P991500314,CDM,521,RC,22901,HCPCS,Outpatient,,,585,292.5,,450.45,77,,,Percent of Total Billed Charges,77% of total billed charges,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,520.65,89,,,Percent of total Billed Charges,89% of total Billed charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.45,77,,,Percent of total Billed charges,77% of total billed charges,497.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.25,520.65,
EXC ABD LES SC < 3 CM,P991500315,CDM,521,RC,22902,HCPCS,Outpatient,,,931,465.5,,716.87,77,,,Percent of Total Billed Charges,77% of total billed charges,237.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,828.59,89,,,Percent of total Billed Charges,89% of total Billed charges,828.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,828.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.87,77,,,Percent of total Billed charges,77% of total billed charges,791.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.75,828.59,
EXC ABD LES SC 3 CM/>,P991500316,CDM,521,RC,22903,HCPCS,Outpatient,,,840,420,,646.8,77,,,Percent of Total Billed Charges,77% of total billed charges,214.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,747.6,89,,,Percent of total Billed Charges,89% of total Billed charges,747.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,747.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.8,77,,,Percent of total Billed charges,77% of total billed charges,714,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,241.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210,747.6,
INCISION AND DRAINAGE SHOULDER,P991500317,CDM,521,RC,23030,HCPCS,Outpatient,,,806,403,,620.62,77,,,Percent of Total Billed Charges,77% of total billed charges,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,717.34,89,,,Percent of total Billed Charges,89% of total Billed charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,620.62,77,,,Percent of total Billed charges,77% of total billed charges,685.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.5,717.34,
BX SOFT TISSUE SHOULDER DEEP,P991500318,CDM,521,RC,23066,HCPCS,Outpatient,,,1155,577.5,,889.35,77,,,Percent of Total Billed Charges,77% of total billed charges,294.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,294.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,360.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1027.95,89,,,Percent of total Billed Charges,89% of total Billed charges,1027.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1027.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,471.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,889.35,77,,,Percent of total Billed charges,77% of total billed charges,981.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,332.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,471.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,288.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.75,1027.95,
EXC SOFT TISSUE SHOULDER 3CM/>,P991500319,CDM,521,RC,23071,HCPCS,Outpatient,,,898,449,,691.46,77,,,Percent of Total Billed Charges,77% of total billed charges,228.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,799.22,89,,,Percent of total Billed Charges,89% of total Billed charges,799.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,799.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.46,77,,,Percent of total Billed charges,77% of total billed charges,763.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,366.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.5,799.22,
EXC SHOULDER TUM DEEP 5CM/>,P991500320,CDM,521,RC,23073,HCPCS,Outpatient,,,1490,745,,1147.3,77,,,Percent of Total Billed Charges,77% of total billed charges,379.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,379.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,465.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,372.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1326.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1326.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1326.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,607.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,607.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,607.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1147.3,77,,,Percent of total Billed charges,77% of total billed charges,1266.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,428.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,607.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,372.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,372.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.5,1326.1,
EXC SHOULDER LES SC < 3 CM,P991500321,CDM,521,RC,23075,HCPCS,Outpatient,,,620,310,,477.4,77,,,Percent of Total Billed Charges,77% of total billed charges,158.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,551.8,89,,,Percent of total Billed Charges,89% of total Billed charges,551.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,477.4,77,,,Percent of total Billed charges,77% of total billed charges,527,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,252.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155,551.8,
EXC SHOULDER TUM DEEP < 5 CM,P991500322,CDM,521,RC,23076,HCPCS,Outpatient,,,1156,578,,890.12,77,,,Percent of Total Billed Charges,77% of total billed charges,294.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,294.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1028.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1028.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1028.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,471.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.12,77,,,Percent of total Billed charges,77% of total billed charges,982.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,332.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,471.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289,1028.84,
RESECT SHOULDER TUMOR < 5 CM,P991500323,CDM,521,RC,23077,HCPCS,Outpatient,,,3324,1662,,2559.48,77,,,Percent of Total Billed Charges,77% of total billed charges,847.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,847.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1038.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,831,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2958.36,89,,,Percent of total Billed Charges,89% of total Billed charges,2958.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2958.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1356.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1356.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1356.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,831,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2559.48,77,,,Percent of total Billed charges,77% of total billed charges,2825.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,955.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1356.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,831,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,831,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,831,2958.36,
SHOULDER JOINT SURGERY,P991500324,CDM,521,RC,23101,HCPCS,Outpatient,,,863,431.5,,664.51,77,,,Percent of Total Billed Charges,77% of total billed charges,220.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,215.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,768.07,89,,,Percent of total Billed Charges,89% of total Billed charges,768.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,768.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,352.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,352.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,352.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,664.51,77,,,Percent of total Billed charges,77% of total billed charges,733.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,248.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,352.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,215.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,215.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.75,768.07,
CLAVICULECTOMY-PARTIAL,P991500325,CDM,521,RC,23120,HCPCS,Outpatient,,,1236,618,,951.72,77,,,Percent of Total Billed Charges,77% of total billed charges,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1100.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.72,77,,,Percent of total Billed charges,77% of total billed charges,1050.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309,1100.04,
REMOVE SHOULDER BONE PART,P991500326,CDM,521,RC,23130,HCPCS,Outpatient,,,1908,954,,1469.16,77,,,Percent of Total Billed Charges,77% of total billed charges,486.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,477,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1698.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1698.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1698.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,778.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,477,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1469.16,77,,,Percent of total Billed charges,77% of total billed charges,1621.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,548.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,778.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,477,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,477,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,477,1698.12,
REMOVAL OF BONE LESION,P991500327,CDM,521,RC,23140,HCPCS,Outpatient,,,745,372.5,,573.65,77,,,Percent of Total Billed Charges,77% of total billed charges,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,663.05,89,,,Percent of total Billed Charges,89% of total Billed charges,663.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,663.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.65,77,,,Percent of total Billed charges,77% of total billed charges,633.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,214.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,303.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.25,663.05,
REMOVAL OF HUMERUS LESION,P991500328,CDM,521,RC,23150,HCPCS,Outpatient,,,1114,557,,857.78,77,,,Percent of Total Billed Charges,77% of total billed charges,284.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,278.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,991.46,89,,,Percent of total Billed Charges,89% of total Billed charges,991.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,991.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,857.78,77,,,Percent of total Billed charges,77% of total billed charges,946.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,320.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,454.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,278.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.5,991.46,
PARTIAL EXCISION BONE CLAVICLE,P991500329,CDM,521,RC,23180,HCPCS,Outpatient,,,2659,1329.5,,2047.43,77,,,Percent of Total Billed Charges,77% of total billed charges,678.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,678.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,830.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,664.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2366.51,89,,,Percent of total Billed Charges,89% of total Billed charges,2366.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2366.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1084.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1084.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1084.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,664.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2047.43,77,,,Percent of total Billed charges,77% of total billed charges,2260.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,764.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1084.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,664.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,664.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,664.75,2366.51,
REMOVE SHOULDER FOREIGN BODY,P991500330,CDM,521,RC,23330,HCPCS,Outpatient,,,547,273.5,,421.19,77,,,Percent of Total Billed Charges,77% of total billed charges,139.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,486.83,89,,,Percent of total Billed Charges,89% of total Billed charges,486.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.19,77,,,Percent of total Billed charges,77% of total billed charges,464.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.75,486.83,
INJ CT/MRI ARTHROGRAPHY,P991500331,CDM,521,RC,23350,HCPCS,Outpatient,,,111,55.5,,85.47,77,,,Percent of Total Billed Charges,77% of total billed charges,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98.79,89,,,Percent of total Billed Charges,89% of total Billed charges,98.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.47,77,,,Percent of total Billed charges,77% of total billed charges,94.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,98.79,
INCISION OF TENDON & MUSCLE,P991500332,CDM,521,RC,23405,HCPCS,Outpatient,,,1311,655.5,,1009.47,77,,,Percent of Total Billed Charges,77% of total billed charges,334.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,334.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,409.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1166.79,89,,,Percent of total Billed Charges,89% of total Billed charges,1166.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1166.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,534.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,534.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1009.47,77,,,Percent of total Billed charges,77% of total billed charges,1114.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,376.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,534.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.75,1166.79,
REPAIR ROTATOR CUFF ACUTE,P991500333,CDM,521,RC,23410,HCPCS,Outpatient,,,1734,867,,1335.18,77,,,Percent of Total Billed Charges,77% of total billed charges,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1543.26,89,,,Percent of total Billed Charges,89% of total Billed charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.18,77,,,Percent of total Billed charges,77% of total billed charges,1473.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.5,1543.26,
REPAIR ROTATOR CUFF CHRONIC,P991500334,CDM,521,RC,23412,HCPCS,Outpatient,,,1819,909.5,,1400.63,77,,,Percent of Total Billed Charges,77% of total billed charges,463.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,568.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,454.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1618.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1618.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1618.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,742.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,742.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,742.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1400.63,77,,,Percent of total Billed charges,77% of total billed charges,1546.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,522.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,742.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,454.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,454.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.75,1618.91,
RELEASE OF SHOULDER LIGAMENT,P991500335,CDM,521,RC,23415,HCPCS,Outpatient,,,1295,647.5,,997.15,77,,,Percent of Total Billed Charges,77% of total billed charges,330.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,330.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,404.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1152.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1152.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1152.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,997.15,77,,,Percent of total Billed charges,77% of total billed charges,1100.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,372.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,528.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.75,1152.55,
REPAIR OF SHOULDER,P991500336,CDM,521,RC,23420,HCPCS,Outpatient,,,3008,1504,,2316.16,77,,,Percent of Total Billed Charges,77% of total billed charges,767.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,767.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,940,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,752,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2677.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2677.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2677.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1227.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1227.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,752,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2316.16,77,,,Percent of total Billed charges,77% of total billed charges,2556.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,864.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1227.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,752,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,752,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,752,2677.12,
REPAIR BICEPS TENDON,P991500337,CDM,521,RC,23430,HCPCS,Outpatient,,,1575,787.5,,1212.75,77,,,Percent of Total Billed Charges,77% of total billed charges,401.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1401.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1401.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1401.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1212.75,77,,,Percent of total Billed charges,77% of total billed charges,1338.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,452.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,642.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,393.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.75,1401.75,
REMOVE/TRANSPLANT TENDON,P991500338,CDM,521,RC,23440,HCPCS,Outpatient,,,1433,716.5,,1103.41,77,,,Percent of Total Billed Charges,77% of total billed charges,365.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,447.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1275.37,89,,,Percent of total Billed Charges,89% of total Billed charges,1275.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1275.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,584.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.41,77,,,Percent of total Billed charges,77% of total billed charges,1218.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,411.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,584.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,358.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.25,1275.37,
REPAIR SHOULDER CAPSULE,P991500339,CDM,521,RC,23450,HCPCS,Outpatient,,,2921,1460.5,,2249.17,77,,,Percent of Total Billed Charges,77% of total billed charges,744.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,744.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,912.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,730.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2599.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2599.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2599.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1191.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1191.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1191.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,730.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2249.17,77,,,Percent of total Billed charges,77% of total billed charges,2482.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,839.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1191.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,730.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,730.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,730.25,2599.69,
REPAIR SHOULDER CAPSULE,P991500340,CDM,521,RC,23455,HCPCS,Outpatient,,,3100,1550,,2387,77,,,Percent of Total Billed Charges,77% of total billed charges,790.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,775,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2759,89,,,Percent of total Billed Charges,89% of total Billed charges,2759,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2759,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1264.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1264.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1264.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2387,77,,,Percent of total Billed charges,77% of total billed charges,2635,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1264.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,775,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775,2759,
REPAIR SHOULDER CAPSULE,P991500341,CDM,521,RC,23466,HCPCS,Outpatient,,,1664,832,,1281.28,77,,,Percent of Total Billed Charges,77% of total billed charges,424.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,520,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1480.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1480.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,678.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1281.28,77,,,Percent of total Billed charges,77% of total billed charges,1414.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,478.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,678.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416,1480.96,
TOTAL SHLDR REPLACEMENT,P991500342,CDM,521,RC,23472,HCPCS,Outpatient,,,3082,1541,,2373.14,77,,,Percent of Total Billed Charges,77% of total billed charges,785.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,785.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,963.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,770.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2742.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2742.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2742.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1257.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1257.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1257.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,770.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2373.14,77,,,Percent of total Billed charges,77% of total billed charges,2619.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,886.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1257.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,770.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,770.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.5,2742.98,
OSTEOTOMY OF CLAVICLE,P991500343,CDM,521,RC,23480,HCPCS,Outpatient,,,1570,785,,1208.9,77,,,Percent of Total Billed Charges,77% of total billed charges,400.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,400.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,490.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1397.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1397.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1397.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1208.9,77,,,Percent of total Billed charges,77% of total billed charges,1334.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,451.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,640.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.5,1397.3,
REVISION OF COLLAR BONE,P991500344,CDM,521,RC,23485,HCPCS,Outpatient,,,1450,725,,1116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,369.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1290.5,89,,,Percent of total Billed Charges,89% of total Billed charges,1290.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1290.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.5,77,,,Percent of total Billed charges,77% of total billed charges,1232.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,416.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,591.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.5,1290.5,
CLTX CLAVICULAR FX W/O MNPJ,P991500345,CDM,521,RC,23500,HCPCS,Outpatient,,,505,252.5,,388.85,77,,,Percent of Total Billed Charges,77% of total billed charges,128.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,449.45,89,,,Percent of total Billed Charges,89% of total Billed charges,449.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,449.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.85,77,,,Percent of total Billed charges,77% of total billed charges,429.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.25,449.45,
CLSD TRTMNT CLVCL FX W MNPLTN,P991500346,CDM,521,RC,23505,HCPCS,Outpatient,,,679,339.5,,522.83,77,,,Percent of Total Billed Charges,77% of total billed charges,173.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,604.31,89,,,Percent of total Billed Charges,89% of total Billed charges,604.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.83,77,,,Percent of total Billed charges,77% of total billed charges,577.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,195.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,277.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.75,604.31,
OPTX CLAVICULAR FX W/INT FIX,P991500347,CDM,521,RC,23515,HCPCS,Outpatient,,,1735,867.5,,1335.95,77,,,Percent of Total Billed Charges,77% of total billed charges,442.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1544.15,89,,,Percent of total Billed Charges,89% of total Billed charges,1544.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.95,77,,,Percent of total Billed charges,77% of total billed charges,1474.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.75,1544.15,
CLTX STRNCLAV DISLC W/O MNPJ,P991500348,CDM,521,RC,23520,HCPCS,Outpatient,,,454,227,,349.58,77,,,Percent of Total Billed Charges,77% of total billed charges,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.06,89,,,Percent of total Billed Charges,89% of total Billed charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.58,77,,,Percent of total Billed charges,77% of total billed charges,385.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.5,404.06,
CLTX STRNCLAV DISLC W/MNPJ,P991500349,CDM,521,RC,23525,HCPCS,Outpatient,,,745,372.5,,573.65,77,,,Percent of Total Billed Charges,77% of total billed charges,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,663.05,89,,,Percent of total Billed Charges,89% of total Billed charges,663.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,663.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.65,77,,,Percent of total Billed charges,77% of total billed charges,633.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,214.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,303.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.25,663.05,
CLTX ACROMCLAV DISLC WO MNPJ,P991500350,CDM,521,RC,23540,HCPCS,Outpatient,,,453,226.5,,348.81,77,,,Percent of Total Billed Charges,77% of total billed charges,115.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,403.17,89,,,Percent of total Billed Charges,89% of total Billed charges,403.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.81,77,,,Percent of total Billed charges,77% of total billed charges,385.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.25,403.17,
CLTX ACROMCLAV DISLC W/MNPJ,P991500351,CDM,521,RC,23545,HCPCS,Outpatient,,,678,339,,522.06,77,,,Percent of Total Billed Charges,77% of total billed charges,172.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,603.42,89,,,Percent of total Billed Charges,89% of total Billed charges,603.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,603.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,276.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,276.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,276.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.06,77,,,Percent of total Billed charges,77% of total billed charges,576.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,276.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.5,603.42,
OPTX ACROMCLV DISLC AQT/CHRN,P991500352,CDM,521,RC,23550,HCPCS,Outpatient,,,1688,844,,1299.76,77,,,Percent of Total Billed Charges,77% of total billed charges,430.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,527.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,422,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1502.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1502.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1502.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,688.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,688.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,688.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1299.76,77,,,Percent of total Billed charges,77% of total billed charges,1434.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,485.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,688.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,422,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422,1502.32,
CLTX SCAPULAR FX W/O MNPJ,P991500353,CDM,521,RC,23570,HCPCS,Outpatient,,,444,222,,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,395.16,89,,,Percent of total Billed Charges,89% of total Billed charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111,395.16,
CLTX SCAP FX W/MNPJ +-TRACTJ,P991500354,CDM,521,RC,23575,HCPCS,Outpatient,,,774,387,,595.98,77,,,Percent of Total Billed Charges,77% of total billed charges,197.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,193.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,688.86,89,,,Percent of total Billed Charges,89% of total Billed charges,688.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,688.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,315.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,315.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,595.98,77,,,Percent of total Billed charges,77% of total billed charges,657.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,222.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,315.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,193.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,193.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.5,688.86,
CLTX PROX HUMRL FX W/O MNPJ,P991500355,CDM,521,RC,23600,HCPCS,Outpatient,,,720,360,,554.4,77,,,Percent of Total Billed Charges,77% of total billed charges,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,640.8,89,,,Percent of total Billed Charges,89% of total Billed charges,640.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.4,77,,,Percent of total Billed charges,77% of total billed charges,612,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180,640.8,
CLTX PRX HMRL FX MNPJ+-TRACT,P991500356,CDM,521,RC,23605,HCPCS,Outpatient,,,888,444,,683.76,77,,,Percent of Total Billed Charges,77% of total billed charges,226.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,790.32,89,,,Percent of total Billed Charges,89% of total Billed charges,790.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,790.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,683.76,77,,,Percent of total Billed charges,77% of total billed charges,754.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,362.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222,790.32,
OPTX PROX HUMRL FX W/INT FIX,P991500357,CDM,521,RC,23615,HCPCS,Outpatient,,,2157,1078.5,,1660.89,77,,,Percent of Total Billed Charges,77% of total billed charges,550.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,550.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,674.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1919.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1919.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1919.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.89,77,,,Percent of total Billed charges,77% of total billed charges,1833.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,620.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,880.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539.25,1919.73,
CLTX GR HMRL TBRS FX WO MNPJ,P991500358,CDM,521,RC,23620,HCPCS,Outpatient,,,496,248,,381.92,77,,,Percent of Total Billed Charges,77% of total billed charges,126.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,441.44,89,,,Percent of total Billed Charges,89% of total Billed charges,441.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,381.92,77,,,Percent of total Billed charges,77% of total billed charges,421.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,142.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,202.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124,441.44,
CLTX GR HMRL TBRS FX W/MNPJ,P991500359,CDM,521,RC,23625,HCPCS,Outpatient,,,734,367,,565.18,77,,,Percent of Total Billed Charges,77% of total billed charges,187.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,183.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,653.26,89,,,Percent of total Billed Charges,89% of total Billed charges,653.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.18,77,,,Percent of total Billed charges,77% of total billed charges,623.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,183.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.5,653.26,
TX HUMERUS FRACTURE,P991500360,CDM,521,RC,23630,HCPCS,Outpatient,,,1475,737.5,,1135.75,77,,,Percent of Total Billed Charges,77% of total billed charges,376.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,460.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1312.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1312.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1135.75,77,,,Percent of total Billed charges,77% of total billed charges,1253.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,424.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,601.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.75,1312.75,
CLTX SHO DSLC W/MNPJ WO ANES,P991500361,CDM,521,RC,23650,HCPCS,Outpatient,,,629,314.5,,484.33,77,,,Percent of Total Billed Charges,77% of total billed charges,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,559.81,89,,,Percent of total Billed Charges,89% of total Billed charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,484.33,77,,,Percent of total Billed charges,77% of total billed charges,534.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.25,559.81,
CLTX SHO DSLC W/MNPJ W/ANES,P991500362,CDM,521,RC,23655,HCPCS,Outpatient,,,770,385,,592.9,77,,,Percent of Total Billed Charges,77% of total billed charges,196.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,240.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,685.3,89,,,Percent of total Billed Charges,89% of total Billed charges,685.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,592.9,77,,,Percent of total Billed charges,77% of total billed charges,654.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,685.3,
CLTX SHO DSLC FX GR HMRL TBR,P991500363,CDM,521,RC,23665,HCPCS,Outpatient,,,820,410,,631.4,77,,,Percent of Total Billed Charges,77% of total billed charges,209.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,729.8,89,,,Percent of total Billed Charges,89% of total Billed charges,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,631.4,77,,,Percent of total Billed charges,77% of total billed charges,697,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,334.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205,729.8,
CLTX SHO DISLC NECK FX MNPJ,P991500364,CDM,521,RC,23675,HCPCS,Outpatient,,,1403,701.5,,1080.31,77,,,Percent of Total Billed Charges,77% of total billed charges,357.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,438.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,350.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1248.67,89,,,Percent of total Billed Charges,89% of total Billed charges,1248.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1248.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,572.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,572.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1080.31,77,,,Percent of total Billed charges,77% of total billed charges,1192.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,403.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,572.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,350.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,350.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.75,1248.67,
MNPJ ANES SHO JT FIXJ APRATS,P991500365,CDM,521,RC,23700,HCPCS,Outpatient,,,445,222.5,,342.65,77,,,Percent of Total Billed Charges,77% of total billed charges,113.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,396.05,89,,,Percent of total Billed Charges,89% of total Billed charges,396.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.65,77,,,Percent of total Billed charges,77% of total billed charges,378.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.25,396.05,
I&D UPR A/E DP ABSC/HMTMA,P991500366,CDM,521,RC,23930,HCPCS,Outpatient,,,728,364,,560.56,77,,,Percent of Total Billed Charges,77% of total billed charges,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,647.92,89,,,Percent of total Billed Charges,89% of total Billed charges,647.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,647.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,297.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.56,77,,,Percent of total Billed charges,77% of total billed charges,618.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,297.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,647.92,
I&D ELBOW DEEP ABSCESS BURSA,P991500367,CDM,521,RC,23931,HCPCS,Outpatient,,,551,275.5,,424.27,77,,,Percent of Total Billed Charges,77% of total billed charges,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,490.39,89,,,Percent of total Billed Charges,89% of total Billed charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,490.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.27,77,,,Percent of total Billed charges,77% of total billed charges,468.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,490.39,
ARTHROTOMY ELBOW,P991500368,CDM,521,RC,24006,HCPCS,Outpatient,,,2004,1002,,1543.08,77,,,Percent of Total Billed Charges,77% of total billed charges,511.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,511.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,626.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,501,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1783.56,89,,,Percent of total Billed Charges,89% of total Billed charges,1783.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1783.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,817.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,817.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1543.08,77,,,Percent of total Billed charges,77% of total billed charges,1703.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,576.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,817.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,501,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,501,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501,1783.56,
BIOPSY ARM/ELBOW SOFT TISSUE,P991500369,CDM,521,RC,24065,HCPCS,Outpatient,,,473,236.5,,364.21,77,,,Percent of Total Billed Charges,77% of total billed charges,120.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,118.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,420.97,89,,,Percent of total Billed Charges,89% of total Billed charges,420.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.21,77,,,Percent of total Billed charges,77% of total billed charges,402.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,192.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,118.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.25,420.97,
EXC ARM/ELBOW LES SC 3 CM/>,P991500370,CDM,521,RC,24071,HCPCS,Outpatient,,,869,434.5,,669.13,77,,,Percent of Total Billed Charges,77% of total billed charges,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,773.41,89,,,Percent of total Billed Charges,89% of total Billed charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.13,77,,,Percent of total Billed charges,77% of total billed charges,738.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.25,773.41,
EXC ARM/ELBOW < 3 CM BILAT,P991500371,CDM,521,RC,24075,HCPCS,Outpatient,,,1494,747,,1150.38,77,,,Percent of Total Billed Charges,77% of total billed charges,380.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,380.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,466.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1329.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1329.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1329.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1150.38,77,,,Percent of total Billed charges,77% of total billed charges,1269.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.5,1329.66,
EXC ARM/ELBOW LES SC < 3 CM,P991500372,CDM,521,RC,24075,HCPCS,Outpatient,,,996,498,,766.92,77,,,Percent of Total Billed Charges,77% of total billed charges,253.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,311.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,886.44,89,,,Percent of total Billed Charges,89% of total Billed charges,886.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,886.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,406.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,406.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,406.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.92,77,,,Percent of total Billed charges,77% of total billed charges,846.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,406.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249,886.44,
EX ARM/ELBOW TUM DEEP < 5 CM,P991500373,CDM,521,RC,24076,HCPCS,Outpatient,,,1140,570,,877.8,77,,,Percent of Total Billed Charges,77% of total billed charges,290.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,285,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1014.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1014.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1014.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,465.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,465.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,465.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.8,77,,,Percent of total Billed charges,77% of total billed charges,969,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,465.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,285,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285,1014.6,
ARTHRT ELBW JT EXPL BX RMVL,P991500374,CDM,521,RC,24101,HCPCS,Outpatient,,,952,476,,733.04,77,,,Percent of Total Billed Charges,77% of total billed charges,242.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,847.28,89,,,Percent of total Billed Charges,89% of total Billed charges,847.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,847.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.04,77,,,Percent of total Billed charges,77% of total billed charges,809.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,388.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238,847.28,
EXCISION OLECRANON BURSA,P991500375,CDM,521,RC,24105,HCPCS,Outpatient,,,961,480.5,,739.97,77,,,Percent of Total Billed Charges,77% of total billed charges,245.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,855.29,89,,,Percent of total Billed Charges,89% of total Billed charges,855.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,855.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,739.97,77,,,Percent of total Billed charges,77% of total billed charges,816.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,392.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.25,855.29,
EXCISION BENIGN TUMOR HUMERUS,P991500376,CDM,521,RC,24110,HCPCS,Outpatient,,,2020,1010,,1555.4,77,,,Percent of Total Billed Charges,77% of total billed charges,515.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,515.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,631.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,505,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1797.8,89,,,Percent of total Billed Charges,89% of total Billed charges,1797.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,505,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1555.4,77,,,Percent of total Billed charges,77% of total billed charges,1717,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,580.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,824.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,505,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,505,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,505,1797.8,
EXCISION RADIAL HEAD,P991500377,CDM,521,RC,24130,HCPCS,Outpatient,,,969,484.5,,746.13,77,,,Percent of Total Billed Charges,77% of total billed charges,247.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,862.41,89,,,Percent of total Billed Charges,89% of total Billed charges,862.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,862.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.13,77,,,Percent of total Billed charges,77% of total billed charges,823.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,278.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,395.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,242.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,242.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.25,862.41,
"PARTIAL EXCISION BONE, HUMERUS",P991500378,CDM,521,RC,24140,HCPCS,Outpatient,,,1464,732,,1127.28,77,,,Percent of Total Billed Charges,77% of total billed charges,373.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,366,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,597.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,597.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,597.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1127.28,77,,,Percent of total Billed charges,77% of total billed charges,1244.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,420.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,597.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,366,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,366,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366,1302.96,
PRTL EXC BONE OLECRN PROCESS,P991500379,CDM,521,RC,24147,HCPCS,Outpatient,,,1319,659.5,,1015.63,77,,,Percent of Total Billed Charges,77% of total billed charges,336.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1173.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1173.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1173.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1015.63,77,,,Percent of total Billed charges,77% of total billed charges,1121.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,538.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.75,1173.91,
RELEASE OF FLEXION CONTRACTURE,P991500380,CDM,521,RC,24149,HCPCS,Outpatient,,,2735,1367.5,,2105.95,77,,,Percent of Total Billed Charges,77% of total billed charges,697.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,697.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,854.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,683.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2434.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2434.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2434.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1115.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1115.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1115.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,683.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2105.95,77,,,Percent of total Billed charges,77% of total billed charges,2324.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,786.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1115.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,683.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,683.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,683.75,2434.15,
REMOVAL OF SCREWS,P991500381,CDM,521,RC,24160,HCPCS,Outpatient,,,1584,792,,1219.68,77,,,Percent of Total Billed Charges,77% of total billed charges,403.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,403.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,495,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,396,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1409.76,89,,,Percent of total Billed Charges,89% of total Billed charges,1409.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1409.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1219.68,77,,,Percent of total Billed charges,77% of total billed charges,1346.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,455.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,646.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,396,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,396,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396,1409.76,
REVISION OF ARM TENDON,P991500382,CDM,521,RC,24310,HCPCS,Outpatient,,,899,449.5,,692.23,77,,,Percent of Total Billed Charges,77% of total billed charges,229.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,800.11,89,,,Percent of total Billed Charges,89% of total Billed charges,800.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,800.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.23,77,,,Percent of total Billed charges,77% of total billed charges,764.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,366.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,224.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.75,800.11,
FLEXOR-PLASTY ELBOW,P991500383,CDM,521,RC,24330,HCPCS,Outpatient,,,1075,537.5,,827.75,77,,,Percent of Total Billed Charges,77% of total billed charges,274.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,335.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,956.75,89,,,Percent of total Billed Charges,89% of total Billed charges,956.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,956.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,438.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.75,77,,,Percent of total Billed charges,77% of total billed charges,913.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,309.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,438.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.75,956.75,
TENOLYSIS TRICEPS,P991500384,CDM,521,RC,24332,HCPCS,Outpatient,,,1162,581,,894.74,77,,,Percent of Total Billed Charges,77% of total billed charges,296.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,363.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1034.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1034.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1034.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,474.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,474.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,474.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,894.74,77,,,Percent of total Billed charges,77% of total billed charges,987.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,334.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,474.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.5,1034.18,
REPAIR OF RUPTURED TENDON,P991500385,CDM,521,RC,24342,HCPCS,Outpatient,,,2210,1105,,1701.7,77,,,Percent of Total Billed Charges,77% of total billed charges,563.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,690.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1966.9,89,,,Percent of total Billed Charges,89% of total Billed charges,1966.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1966.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,901.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,901.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,901.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1701.7,77,,,Percent of total Billed charges,77% of total billed charges,1878.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,635.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,901.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,552.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,552.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,552.5,1966.9,
REPAIR ELBOW W/DEB OPEN,P991500386,CDM,521,RC,24358,HCPCS,Outpatient,,,998,499,,768.46,77,,,Percent of Total Billed Charges,77% of total billed charges,254.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,311.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,888.22,89,,,Percent of total Billed Charges,89% of total Billed charges,888.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,768.46,77,,,Percent of total Billed charges,77% of total billed charges,848.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,407.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.5,888.22,
REPAIR ELBOW LAT OR MED,P991500387,CDM,521,RC,24359,HCPCS,Outpatient,,,1374,687,,1057.98,77,,,Percent of Total Billed Charges,77% of total billed charges,350.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,343.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1222.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1222.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1222.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1057.98,77,,,Percent of total Billed charges,77% of total billed charges,1167.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,395.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,343.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.5,1222.86,
REVISION OF HUMERUS,P991500388,CDM,521,RC,24400,HCPCS,Outpatient,,,2605,1302.5,,2005.85,77,,,Percent of Total Billed Charges,77% of total billed charges,664.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,664.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,814.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,651.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2318.45,89,,,Percent of total Billed Charges,89% of total Billed charges,2318.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2318.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1062.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1062.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1062.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,651.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2005.85,77,,,Percent of total Billed charges,77% of total billed charges,2214.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,748.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1062.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,651.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,651.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,651.25,2318.45,
TREAT HUMERUS FRACTURE,P991500389,CDM,521,RC,24500,HCPCS,Outpatient,,,682,341,,525.14,77,,,Percent of Total Billed Charges,77% of total billed charges,173.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,606.98,89,,,Percent of total Billed Charges,89% of total Billed charges,606.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,606.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,525.14,77,,,Percent of total Billed charges,77% of total billed charges,579.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.5,606.98,
TREAT HUMERUS FRACTURE,P991500390,CDM,521,RC,24505,HCPCS,Outpatient,,,950,475,,731.5,77,,,Percent of Total Billed Charges,77% of total billed charges,242.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,845.5,89,,,Percent of total Billed Charges,89% of total Billed charges,845.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,845.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,731.5,77,,,Percent of total Billed charges,77% of total billed charges,807.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,387.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.5,845.5,
TREAT HUMERUS FRACTURE,P991500391,CDM,521,RC,24515,HCPCS,Outpatient,,,1299,649.5,,1000.23,77,,,Percent of Total Billed Charges,77% of total billed charges,331.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1156.11,89,,,Percent of total Billed Charges,89% of total Billed charges,1156.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1156.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.23,77,,,Percent of total Billed charges,77% of total billed charges,1104.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,373.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,529.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.75,1156.11,
TREAT HUMERUS FRACTURE,P991500392,CDM,521,RC,24530,HCPCS,Outpatient,,,722,361,,555.94,77,,,Percent of Total Billed Charges,77% of total billed charges,184.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,642.58,89,,,Percent of total Billed Charges,89% of total Billed charges,642.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.94,77,,,Percent of total Billed charges,77% of total billed charges,613.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.5,642.58,
TREAT HUMERUS FRACTURE,P991500393,CDM,521,RC,24535,HCPCS,Outpatient,,,1258,629,,968.66,77,,,Percent of Total Billed Charges,77% of total billed charges,320.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,320.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1119.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1119.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,968.66,77,,,Percent of total Billed charges,77% of total billed charges,1069.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,361.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,513.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.5,1119.62,
TREAT HUMERUS FRACTURE,P991500394,CDM,521,RC,24545,HCPCS,Outpatient,,,2281,1140.5,,1756.37,77,,,Percent of Total Billed Charges,77% of total billed charges,581.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,581.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,712.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2030.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2030.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2030.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,930.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,930.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,930.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1756.37,77,,,Percent of total Billed charges,77% of total billed charges,1938.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,655.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,930.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,570.25,2030.09,
TREAT HUMERUS FRACTURE,P991500395,CDM,521,RC,24560,HCPCS,Outpatient,,,627,313.5,,482.79,77,,,Percent of Total Billed Charges,77% of total billed charges,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,558.03,89,,,Percent of total Billed Charges,89% of total Billed charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,482.79,77,,,Percent of total Billed charges,77% of total billed charges,532.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.75,558.03,
TREAT HUMERUS FRACTURE,P991500396,CDM,521,RC,24565,HCPCS,Outpatient,,,1080,540,,831.6,77,,,Percent of Total Billed Charges,77% of total billed charges,275.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,337.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,961.2,89,,,Percent of total Billed Charges,89% of total Billed charges,961.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,961.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,440.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,440.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,440.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,831.6,77,,,Percent of total Billed charges,77% of total billed charges,918,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,310.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,440.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270,961.2,
TREAT HUMERUS FRACTURE,P991500397,CDM,521,RC,24576,HCPCS,Outpatient,,,681,340.5,,524.37,77,,,Percent of Total Billed Charges,77% of total billed charges,173.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,170.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,606.09,89,,,Percent of total Billed Charges,89% of total Billed charges,606.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,606.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.37,77,,,Percent of total Billed charges,77% of total billed charges,578.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,195.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,277.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,170.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.25,606.09,
TREAT HUMERUS FRACTURE,P991500398,CDM,521,RC,24577,HCPCS,Outpatient,,,1110,555,,854.7,77,,,Percent of Total Billed Charges,77% of total billed charges,283.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,277.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,987.9,89,,,Percent of total Billed Charges,89% of total Billed charges,987.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.7,77,,,Percent of total Billed charges,77% of total billed charges,943.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,452.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,277.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.5,987.9,
OP TX HUMERAL CONDYLAR FX,P991500399,CDM,521,RC,24579,HCPCS,Outpatient,,,2514,1257,,1935.78,77,,,Percent of Total Billed Charges,77% of total billed charges,641.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,641.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,785.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2237.46,89,,,Percent of total Billed Charges,89% of total Billed charges,2237.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2237.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1025.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1025.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1025.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1935.78,77,,,Percent of total Billed charges,77% of total billed charges,2136.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,722.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1025.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,628.5,2237.46,
TREAT HUMERUS FRACTURE,P991500400,CDM,521,RC,24582,HCPCS,Outpatient,,,2086,1043,,1606.22,77,,,Percent of Total Billed Charges,77% of total billed charges,531.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,651.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,521.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1856.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1856.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1856.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,851.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,851.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,851.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,521.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1606.22,77,,,Percent of total Billed charges,77% of total billed charges,1773.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,599.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,851.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,521.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,521.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.5,1856.54,
TREAT ELBOW DISLOCATION,P991500401,CDM,521,RC,24600,HCPCS,Outpatient,,,719,359.5,,553.63,77,,,Percent of Total Billed Charges,77% of total billed charges,183.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,639.91,89,,,Percent of total Billed Charges,89% of total Billed charges,639.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,639.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.63,77,,,Percent of total Billed charges,77% of total billed charges,611.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.75,639.91,
TREAT ELBOW DISLOCATION,P991500402,CDM,521,RC,24605,HCPCS,Outpatient,,,903,451.5,,695.31,77,,,Percent of Total Billed Charges,77% of total billed charges,230.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,282.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,803.67,89,,,Percent of total Billed Charges,89% of total Billed charges,803.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,803.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,368.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,695.31,77,,,Percent of total Billed charges,77% of total billed charges,767.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,259.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,225.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,225.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.75,803.67,
TREAT ELBOW FRACTURE,P991500403,CDM,521,RC,24620,HCPCS,Outpatient,,,1138,569,,876.26,77,,,Percent of Total Billed Charges,77% of total billed charges,290.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1012.82,89,,,Percent of total Billed Charges,89% of total Billed charges,1012.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1012.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.26,77,,,Percent of total Billed charges,77% of total billed charges,967.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,464.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.5,1012.82,
NURSE MAID ELBOW REDUCTION,P991500404,CDM,521,RC,24640,HCPCS,Outpatient,,,194,97,,149.38,77,,,Percent of Total Billed Charges,77% of total billed charges,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.66,89,,,Percent of total Billed Charges,89% of total Billed charges,172.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,77,,,Percent of total Billed charges,77% of total billed charges,164.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.5,172.66,
TREAT RADIUS FRACTURE,P991500405,CDM,521,RC,24650,HCPCS,Outpatient,,,549,274.5,,422.73,77,,,Percent of Total Billed Charges,77% of total billed charges,140,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,488.61,89,,,Percent of total Billed Charges,89% of total Billed charges,488.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.73,77,,,Percent of total Billed charges,77% of total billed charges,466.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.25,488.61,
CL TX RAD HEAD/NECK FX W/MANIP,P991500406,CDM,521,RC,24655,HCPCS,Outpatient,,,845,422.5,,650.65,77,,,Percent of Total Billed Charges,77% of total billed charges,215.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,264.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,211.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,752.05,89,,,Percent of total Billed Charges,89% of total Billed charges,752.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,752.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,650.65,77,,,Percent of total Billed charges,77% of total billed charges,718.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,344.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,211.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,211.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.25,752.05,
OP TX RAD HEAD/NECK FX PROSTH,P991500407,CDM,920,RC,24666,HCPCS,Outpatient,,,1278,639,,984.06,77,,,Percent of Total Billed Charges,77% of total billed charges,325.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,399.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,945.72,74,,,Percent of Total Billed Charges,74% of total billed charges,881.82,69,,,Percent of Total Billed Charges,69% of total billed charges,881.82,69,,,Percent of Total Billed Charges,69% of total billed charges,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,881.82,69,,,Percent of Total Billed Charges,69% of total billed charges,881.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.52,84,,,Percent of Total Billed Charges,84% of total billed charges,1047.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,1137.42,89,,,Percent of total Billed Charges,89% of total Billed charges,1137.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1137.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,521.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,521.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,521.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,984.06,77,,,Percent of total Billed charges,77% of total billed charges,1086.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,367.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,521.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,319.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,1137.42,
TREAT ULNAR FRACTURE,P991500408,CDM,521,RC,24670,HCPCS,Outpatient,,,612,306,,471.24,77,,,Percent of Total Billed Charges,77% of total billed charges,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,544.68,89,,,Percent of total Billed Charges,89% of total Billed charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,471.24,77,,,Percent of total Billed charges,77% of total billed charges,520.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,544.68,
TREAT ULNAR FRACTURE,P991500409,CDM,521,RC,24675,HCPCS,Outpatient,,,869,434.5,,669.13,77,,,Percent of Total Billed Charges,77% of total billed charges,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,773.41,89,,,Percent of total Billed Charges,89% of total Billed charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.13,77,,,Percent of total Billed charges,77% of total billed charges,738.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.25,773.41,
OP TX ULNAR FX PROXIMAL END,P991500410,CDM,521,RC,24685,HCPCS,Outpatient,,,1356,678,,1044.12,77,,,Percent of Total Billed Charges,77% of total billed charges,345.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1206.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1206.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1206.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,553.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,553.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1044.12,77,,,Percent of total Billed charges,77% of total billed charges,1152.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,553.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339,1206.84,
INCISION OF TENDON SHEATH,P991500411,CDM,521,RC,25000,HCPCS,Outpatient,,,1150,575,,885.5,77,,,Percent of Total Billed Charges,77% of total billed charges,293.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,359.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,287.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1023.5,89,,,Percent of total Billed Charges,89% of total Billed charges,1023.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,469.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,469.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,469.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,287.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,885.5,77,,,Percent of total Billed charges,77% of total billed charges,977.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,330.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,469.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,287.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,287.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.5,1023.5,
DECOMPRESS FOREARM 1 SPACE,P991500412,CDM,521,RC,25020,HCPCS,Outpatient,,,870,435,,669.9,77,,,Percent of Total Billed Charges,77% of total billed charges,221.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,774.3,89,,,Percent of total Billed Charges,89% of total Billed charges,774.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,77,,,Percent of total Billed charges,77% of total billed charges,739.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.5,774.3,
DRAINAGE OF FOREARM LESION,P991500413,CDM,521,RC,25028,HCPCS,Outpatient,,,1577,788.5,,1214.29,77,,,Percent of Total Billed Charges,77% of total billed charges,402.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,402.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1403.53,89,,,Percent of total Billed Charges,89% of total Billed charges,1403.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1403.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1214.29,77,,,Percent of total Billed charges,77% of total billed charges,1340.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,643.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,394.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,394.25,1403.53,
DRAINAGE OF FOREARM BURSA,P991500414,CDM,521,RC,25031,HCPCS,Outpatient,,,694,347,,534.38,77,,,Percent of Total Billed Charges,77% of total billed charges,176.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,617.66,89,,,Percent of total Billed Charges,89% of total Billed charges,617.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,534.38,77,,,Percent of total Billed charges,77% of total billed charges,589.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,199.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,283.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.5,617.66,
BIOPSY FOREARM SOFT TISSUES,P991500415,CDM,521,RC,25065,HCPCS,Outpatient,,,467,233.5,,359.59,77,,,Percent of Total Billed Charges,77% of total billed charges,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,415.63,89,,,Percent of total Billed Charges,89% of total Billed charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.59,77,,,Percent of total Billed charges,77% of total billed charges,396.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.75,415.63,
BIOPSY FOREARM SOFT TISSUES,P991500416,CDM,521,RC,25066,HCPCS,Outpatient,,,691,345.5,,532.07,77,,,Percent of Total Billed Charges,77% of total billed charges,176.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,614.99,89,,,Percent of total Billed Charges,89% of total Billed charges,614.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.07,77,,,Percent of total Billed charges,77% of total billed charges,587.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,281.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.75,614.99,
EXC FOREARM LES SC 3 CM/>,P991500417,CDM,521,RC,25071,HCPCS,Outpatient,,,907,453.5,,698.39,77,,,Percent of Total Billed Charges,77% of total billed charges,231.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,226.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,807.23,89,,,Percent of total Billed Charges,89% of total Billed charges,807.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,698.39,77,,,Percent of total Billed charges,77% of total billed charges,770.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,260.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,370.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,226.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,226.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.75,807.23,
EXC FOREARM LES SC < 3 CM,P991500418,CDM,521,RC,25075,HCPCS,Outpatient,,,656,328,,505.12,77,,,Percent of Total Billed Charges,77% of total billed charges,167.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,583.84,89,,,Percent of total Billed Charges,89% of total Billed charges,583.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,505.12,77,,,Percent of total Billed charges,77% of total billed charges,557.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,267.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164,583.84,
EXC FOREARM TUM DEEP < 3 CM,P991500419,CDM,521,RC,25076,HCPCS,Outpatient,,,1809,904.5,,1392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,461.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,461.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,565.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,452.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1610.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1610.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1610.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.93,77,,,Percent of total Billed charges,77% of total billed charges,1537.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,520.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,738.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,452.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,452.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.25,1610.01,
REMOVE WRIST JOINT CARTILAGE,P991500420,CDM,521,RC,25107,HCPCS,Outpatient,,,1901,950.5,,1463.77,77,,,Percent of Total Billed Charges,77% of total billed charges,484.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,484.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,475.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1691.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1691.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1691.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.77,77,,,Percent of total Billed charges,77% of total billed charges,1615.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,546.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,775.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,475.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,475.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.25,1691.89,
EXCISION TENDON FOREARM/WRIST,P991500421,CDM,521,RC,25109,HCPCS,Outpatient,,,1138,569,,876.26,77,,,Percent of Total Billed Charges,77% of total billed charges,290.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1012.82,89,,,Percent of total Billed Charges,89% of total Billed charges,1012.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1012.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.26,77,,,Percent of total Billed charges,77% of total billed charges,967.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,464.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,284.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.5,1012.82,
REMOVE WRIST TENDON LESION,P991500422,CDM,521,RC,25110,HCPCS,Outpatient,,,654,327,,503.58,77,,,Percent of Total Billed Charges,77% of total billed charges,166.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,582.06,89,,,Percent of total Billed Charges,89% of total Billed charges,582.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,582.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.58,77,,,Percent of total Billed charges,77% of total billed charges,555.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.5,582.06,
REMOVE WRIST TENDON LESION,P991500423,CDM,521,RC,25111,HCPCS,Outpatient,,,604,302,,465.08,77,,,Percent of Total Billed Charges,77% of total billed charges,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,537.56,89,,,Percent of total Billed Charges,89% of total Billed charges,537.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,537.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.08,77,,,Percent of total Billed charges,77% of total billed charges,513.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151,537.56,
REREMOVE WRIST TENDON LESION,P991500424,CDM,521,RC,25112,HCPCS,Outpatient,,,736,368,,566.72,77,,,Percent of Total Billed Charges,77% of total billed charges,187.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,655.04,89,,,Percent of total Billed Charges,89% of total Billed charges,655.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,655.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.72,77,,,Percent of total Billed charges,77% of total billed charges,625.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,300.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184,655.04,
REMOVE WRIST/FOREARM LESION,P991500425,CDM,521,RC,25115,HCPCS,Outpatient,,,1608,804,,1238.16,77,,,Percent of Total Billed Charges,77% of total billed charges,410.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,410.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,502.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,402,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1431.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1431.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1431.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,656.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,656.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,656.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,402,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1238.16,77,,,Percent of total Billed charges,77% of total billed charges,1366.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,462.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,656.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,402,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,402,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,402,1431.12,
REMOVE WRIST/FOREARM LESION,P991500426,CDM,521,RC,25116,HCPCS,Outpatient,,,1251,625.5,,963.27,77,,,Percent of Total Billed Charges,77% of total billed charges,319.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,319.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,390.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1113.39,89,,,Percent of total Billed Charges,89% of total Billed charges,1113.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1113.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,510.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,510.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,510.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.27,77,,,Percent of total Billed charges,77% of total billed charges,1063.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,359.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,510.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,312.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,312.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,312.75,1113.39,
SYNOVECTOMY WRIST EXT TENDON,P991500427,CDM,521,RC,25118,HCPCS,Outpatient,,,721,360.5,,555.17,77,,,Percent of Total Billed Charges,77% of total billed charges,183.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,641.69,89,,,Percent of total Billed Charges,89% of total Billed charges,641.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,641.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.17,77,,,Percent of total Billed charges,77% of total billed charges,612.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.25,641.69,
REMOVAL OF WRIST LESION,P991500428,CDM,521,RC,25130,HCPCS,Outpatient,,,851,425.5,,655.27,77,,,Percent of Total Billed Charges,77% of total billed charges,217.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,757.39,89,,,Percent of total Billed Charges,89% of total Billed charges,757.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,757.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.27,77,,,Percent of total Billed charges,77% of total billed charges,723.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,347.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.75,757.39,
INJECTION FOR WRIST X-RAY,P991500429,CDM,521,RC,25246,HCPCS,Outpatient,,,359,179.5,,276.43,77,,,Percent of Total Billed Charges,77% of total billed charges,91.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,319.51,89,,,Percent of total Billed Charges,89% of total Billed charges,319.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,319.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.43,77,,,Percent of total Billed charges,77% of total billed charges,305.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.75,319.51,
REPAIR FLEXOR TENDON FINGER,P991500430,CDM,521,RC,25260,HCPCS,Outpatient,,,1955,977.5,,1505.35,77,,,Percent of Total Billed Charges,77% of total billed charges,498.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,498.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,610.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1739.95,89,,,Percent of total Billed Charges,89% of total Billed charges,1739.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1739.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,797.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,797.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,797.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1505.35,77,,,Percent of total Billed charges,77% of total billed charges,1661.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,562.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,797.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.75,1739.95,
REPAIR FOREARM TENDON/MUSCLE,P991500431,CDM,521,RC,25270,HCPCS,Outpatient,,,933,466.5,,718.41,77,,,Percent of Total Billed Charges,77% of total billed charges,237.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,830.37,89,,,Percent of total Billed Charges,89% of total Billed charges,830.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,830.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,718.41,77,,,Percent of total Billed charges,77% of total billed charges,793.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,380.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.25,830.37,
RECONSTRUCT ULNA/RADIOULNAR,P991500432,CDM,521,RC,25337,HCPCS,Outpatient,,,1270,635,,977.9,77,,,Percent of Total Billed Charges,77% of total billed charges,323.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1130.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1130.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1130.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,977.9,77,,,Percent of total Billed charges,77% of total billed charges,1079.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.5,1130.3,
OSTEOTOMY RADIUS DISTAL THIRD,P991500433,CDM,521,RC,25350,HCPCS,Outpatient,,,2702,1351,,2080.54,77,,,Percent of Total Billed Charges,77% of total billed charges,689.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,689.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,675.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2404.78,89,,,Percent of total Billed Charges,89% of total Billed charges,2404.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2404.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1102.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1102.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1102.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2080.54,77,,,Percent of total Billed charges,77% of total billed charges,2296.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1102.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,675.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,675.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,675.5,2404.78,
SHORTEN RADIUS OR ULNA,P991500434,CDM,521,RC,25390,HCPCS,Outpatient,,,1681,840.5,,1294.37,77,,,Percent of Total Billed Charges,77% of total billed charges,428.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,525.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,420.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1496.09,89,,,Percent of total Billed Charges,89% of total Billed charges,1496.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1496.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.37,77,,,Percent of total Billed charges,77% of total billed charges,1428.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,483.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,685.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,420.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,420.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.25,1496.09,
REPAIR/GRAFT RADIUS OR ULNA,P991500435,CDM,521,RC,25405,HCPCS,Outpatient,,,1734,867,,1335.18,77,,,Percent of Total Billed Charges,77% of total billed charges,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1543.26,89,,,Percent of total Billed Charges,89% of total Billed charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.18,77,,,Percent of total Billed charges,77% of total billed charges,1473.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.5,1543.26,
REPAIR NONUNION CARPAL BONE,P991500436,CDM,521,RC,25431,HCPCS,Outpatient,,,1286,643,,990.22,77,,,Percent of Total Billed Charges,77% of total billed charges,327.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1144.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1144.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1144.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,524.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,524.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.22,77,,,Percent of total Billed charges,77% of total billed charges,1093.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,369.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,524.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.5,1144.54,
REPAIR/GRAFT WRIST BONE,P991500437,CDM,521,RC,25440,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
RECONSTRUCT WRIST JOINT,P991500438,CDM,521,RC,25445,HCPCS,Outpatient,,,1210,605,,931.7,77,,,Percent of Total Billed Charges,77% of total billed charges,308.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,308.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,302.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1076.9,89,,,Percent of total Billed Charges,89% of total Billed charges,1076.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1076.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,493.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,493.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,493.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,302.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.7,77,,,Percent of total Billed charges,77% of total billed charges,1028.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,347.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,493.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,302.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,302.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.5,1076.9,
ARTHROPLASTY INTERCARPAL,P991500439,CDM,521,RC,25447,HCPCS,Outpatient,,,1720,860,,1324.4,77,,,Percent of Total Billed Charges,77% of total billed charges,438.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,438.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,537.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1530.8,89,,,Percent of total Billed Charges,89% of total Billed charges,1530.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1530.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1324.4,77,,,Percent of total Billed charges,77% of total billed charges,1462,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,494.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,701.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430,1530.8,
CL TX RAD SHAFT FX W/O MANIP,P991500440,CDM,521,RC,25500,HCPCS,Outpatient,,,536,268,,412.72,77,,,Percent of Total Billed Charges,77% of total billed charges,136.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,477.04,89,,,Percent of total Billed Charges,89% of total Billed charges,477.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,477.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412.72,77,,,Percent of total Billed charges,77% of total billed charges,455.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134,477.04,
CL TX RAD SHAFT FX W/MANIP,P991500441,CDM,521,RC,25505,HCPCS,Outpatient,,,959,479.5,,738.43,77,,,Percent of Total Billed Charges,77% of total billed charges,244.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,239.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,853.51,89,,,Percent of total Billed Charges,89% of total Billed charges,853.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,853.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.43,77,,,Percent of total Billed charges,77% of total billed charges,815.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,275.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,391.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,239.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.75,853.51,
OP TX RADIAL SHAFT FX,P991500442,CDM,521,RC,25515,HCPCS,Outpatient,,,1420,710,,1093.4,77,,,Percent of Total Billed Charges,77% of total billed charges,362.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,443.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,355,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1263.8,89,,,Percent of total Billed Charges,89% of total Billed charges,1263.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1263.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,579.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,579.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1093.4,77,,,Percent of total Billed charges,77% of total billed charges,1207,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,408.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,579.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,355,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,355,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355,1263.8,
TREAT FRACTURE OF RADIUS,P991500443,CDM,521,RC,25526,HCPCS,Outpatient,,,1889,944.5,,1454.53,77,,,Percent of Total Billed Charges,77% of total billed charges,481.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,590.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,472.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1681.21,89,,,Percent of total Billed Charges,89% of total Billed charges,1681.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1681.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,770.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,770.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,770.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,472.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1454.53,77,,,Percent of total Billed charges,77% of total billed charges,1605.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,543.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,770.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,472.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,472.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.25,1681.21,
CL TX ULN SHAFT FX W/O MANIP,P991500444,CDM,521,RC,25530,HCPCS,Outpatient,,,496,248,,381.92,77,,,Percent of Total Billed Charges,77% of total billed charges,126.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,441.44,89,,,Percent of total Billed Charges,89% of total Billed charges,441.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,381.92,77,,,Percent of total Billed charges,77% of total billed charges,421.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,142.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,202.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124,441.44,
CL TX ULN SHAFT FX W/MANIP,P991500445,CDM,521,RC,25535,HCPCS,Outpatient,,,935,467.5,,719.95,77,,,Percent of Total Billed Charges,77% of total billed charges,238.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,233.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,832.15,89,,,Percent of total Billed Charges,89% of total Billed charges,832.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,832.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,381.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,381.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,381.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,233.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,719.95,77,,,Percent of total Billed charges,77% of total billed charges,794.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,381.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,233.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.75,832.15,
OP TX OF ULNAR SHAFT FX,P991500446,CDM,521,RC,25545,HCPCS,Outpatient,,,2066,1033,,1590.82,77,,,Percent of Total Billed Charges,77% of total billed charges,526.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,526.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,645.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1838.74,89,,,Percent of total Billed Charges,89% of total Billed charges,1838.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1838.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,842.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,842.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,842.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1590.82,77,,,Percent of total Billed charges,77% of total billed charges,1756.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,593.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,842.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,516.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,516.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.5,1838.74,
TREAT FRACTURE RADIUS & ULNA,P991500447,CDM,521,RC,25560,HCPCS,Outpatient,,,546,273,,420.42,77,,,Percent of Total Billed Charges,77% of total billed charges,139.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,485.94,89,,,Percent of total Billed Charges,89% of total Billed charges,485.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,485.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.42,77,,,Percent of total Billed charges,77% of total billed charges,464.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,156.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,222.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.5,485.94,
CL TX RAD&ULN SHAFT FXS W/MANJ,P991500448,CDM,521,RC,25565,HCPCS,Outpatient,,,1267,633.5,,975.59,77,,,Percent of Total Billed Charges,77% of total billed charges,323.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,316.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1127.63,89,,,Percent of total Billed Charges,89% of total Billed charges,1127.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1127.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,516.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.59,77,,,Percent of total Billed charges,77% of total billed charges,1076.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,364.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,516.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,316.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.75,1127.63,
TREAT FRACTURE RADIUS & ULNA,P991500449,CDM,521,RC,25574,HCPCS,Outpatient,,,1732,866,,1333.64,77,,,Percent of Total Billed Charges,77% of total billed charges,441.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,441.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1541.48,89,,,Percent of total Billed Charges,89% of total Billed charges,1541.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1541.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,706.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,706.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,706.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1333.64,77,,,Percent of total Billed charges,77% of total billed charges,1472.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,497.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,706.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433,1541.48,
TREAT FRACTURE RADIUS/ULNA,P991500450,CDM,521,RC,25575,HCPCS,Outpatient,,,2341,1170.5,,1802.57,77,,,Percent of Total Billed Charges,77% of total billed charges,596.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,731.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,585.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2083.49,89,,,Percent of total Billed Charges,89% of total Billed charges,2083.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2083.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,955.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,955.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,955.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.57,77,,,Percent of total Billed charges,77% of total billed charges,1989.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,673.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,955.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,585.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,585.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.25,2083.49,
TREAT FRACTURE RADIUS/ULNA,P991500451,CDM,521,RC,25600,HCPCS,Outpatient,,,672,336,,517.44,77,,,Percent of Total Billed Charges,77% of total billed charges,171.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,598.08,89,,,Percent of total Billed Charges,89% of total Billed charges,598.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,598.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.44,77,,,Percent of total Billed charges,77% of total billed charges,571.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168,598.08,
TREAT FRACTURE RADIUS/ULNA,P991500452,CDM,521,RC,25605,HCPCS,Outpatient,,,1315,657.5,,1012.55,77,,,Percent of Total Billed Charges,77% of total billed charges,335.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,335.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,410.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,328.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1170.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1170.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1170.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,536.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,536.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,536.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1012.55,77,,,Percent of total Billed charges,77% of total billed charges,1117.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,378.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,536.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,328.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.75,1170.35,
FX DISTAL RADIUS W/PERC,P991500453,CDM,521,RC,25606,HCPCS,Outpatient,,,1372,686,,1056.44,77,,,Percent of Total Billed Charges,77% of total billed charges,349.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,349.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,343,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1221.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1221.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1221.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,559.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,559.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,559.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1056.44,77,,,Percent of total Billed charges,77% of total billed charges,1166.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,394.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,559.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,343,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343,1221.08,
TREAT FX RAD EXTRA-ARTICUL,P991500454,CDM,521,RC,25607,HCPCS,Outpatient,,,1539,769.5,,1185.03,77,,,Percent of Total Billed Charges,77% of total billed charges,392.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1369.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.03,77,,,Percent of total Billed charges,77% of total billed charges,1308.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,627.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.75,1369.71,
TREAT FX RAD INTRA-ARTICUL,P991500455,CDM,521,RC,25608,HCPCS,Outpatient,,,1714,857,,1319.78,77,,,Percent of Total Billed Charges,77% of total billed charges,437.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,535.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,428.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1525.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1525.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1525.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,699.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,699.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,699.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1319.78,77,,,Percent of total Billed charges,77% of total billed charges,1456.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,492.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,699.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,428.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,428.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.5,1525.46,
TREAT FX RADIAL 3+ FRAG,P991500456,CDM,521,RC,25609,HCPCS,Outpatient,,,2228,1114,,1715.56,77,,,Percent of Total Billed Charges,77% of total billed charges,568.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,568.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,696.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,557,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1982.92,89,,,Percent of total Billed Charges,89% of total Billed charges,1982.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1982.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,909.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,909.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,909.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,557,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1715.56,77,,,Percent of total Billed charges,77% of total billed charges,1893.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,640.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,909.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,557,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,557,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557,1982.92,
TREAT WRIST BONE FRACTURE,P991500457,CDM,521,RC,25622,HCPCS,Outpatient,,,532,266,,409.64,77,,,Percent of Total Billed Charges,77% of total billed charges,135.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,473.48,89,,,Percent of total Billed Charges,89% of total Billed charges,473.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,409.64,77,,,Percent of total Billed charges,77% of total billed charges,452.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133,473.48,
TREAT WRIST BONE FRACTURE,P991500458,CDM,521,RC,25624,HCPCS,Outpatient,,,923,461.5,,710.71,77,,,Percent of Total Billed Charges,77% of total billed charges,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,821.47,89,,,Percent of total Billed Charges,89% of total Billed charges,821.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,821.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,710.71,77,,,Percent of total Billed charges,77% of total billed charges,784.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,376.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.75,821.47,
TREAT WRIST BONE FRACTURE,P991500459,CDM,521,RC,25628,HCPCS,Outpatient,,,1526,763,,1175.02,77,,,Percent of Total Billed Charges,77% of total billed charges,389.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,381.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1358.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1358.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1358.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,622.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,622.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,622.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,381.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1175.02,77,,,Percent of total Billed charges,77% of total billed charges,1297.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,438.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,622.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,381.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,381.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,381.5,1358.14,
CLOSED TREATMENT CARPAL BONE,P991500460,CDM,521,RC,25630,HCPCS,Outpatient,,,628,314,,483.56,77,,,Percent of Total Billed Charges,77% of total billed charges,160.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,558.92,89,,,Percent of total Billed Charges,89% of total Billed charges,558.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,483.56,77,,,Percent of total Billed charges,77% of total billed charges,533.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157,558.92,
TREAT WRIST BONE FRACTURE,P991500461,CDM,521,RC,25635,HCPCS,Outpatient,,,876,438,,674.52,77,,,Percent of Total Billed Charges,77% of total billed charges,223.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,219,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,779.64,89,,,Percent of total Billed Charges,89% of total Billed charges,779.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,779.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,357.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,357.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,357.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.52,77,,,Percent of total Billed charges,77% of total billed charges,744.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,251.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,357.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,219,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219,779.64,
CLSD TRTMNT ULNR STYLD FX,P991500462,CDM,521,RC,25650,HCPCS,Outpatient,,,679,339.5,,522.83,77,,,Percent of Total Billed Charges,77% of total billed charges,173.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,604.31,89,,,Percent of total Billed Charges,89% of total Billed charges,604.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.83,77,,,Percent of total Billed charges,77% of total billed charges,577.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,195.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,277.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.75,604.31,
PIN ULNAR STYLOID FRACTURE,P991500463,CDM,521,RC,25651,HCPCS,Outpatient,,,923,461.5,,710.71,77,,,Percent of Total Billed Charges,77% of total billed charges,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,821.47,89,,,Percent of total Billed Charges,89% of total Billed charges,821.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,821.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,710.71,77,,,Percent of total Billed charges,77% of total billed charges,784.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,376.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.75,821.47,
OPEN TRMT OF ULNAR STYLOID FX,P991500464,CDM,521,RC,25652,HCPCS,Outpatient,,,1305,652.5,,1004.85,77,,,Percent of Total Billed Charges,77% of total billed charges,332.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,407.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1161.45,89,,,Percent of total Billed Charges,89% of total Billed charges,1161.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1161.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1004.85,77,,,Percent of total Billed charges,77% of total billed charges,1109.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,375.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,532.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.25,1161.45,
TREAT WRIST DISLOCATION,P991500465,CDM,521,RC,25660,HCPCS,Outpatient,,,847,423.5,,652.19,77,,,Percent of Total Billed Charges,77% of total billed charges,215.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,264.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,211.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,753.83,89,,,Percent of total Billed Charges,89% of total Billed charges,753.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,753.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,652.19,77,,,Percent of total Billed charges,77% of total billed charges,719.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,243.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,345.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,211.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,211.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.75,753.83,
TREAT WRIST DISLOCATION,P991500466,CDM,521,RC,25690,HCPCS,Outpatient,,,928,464,,714.56,77,,,Percent of Total Billed Charges,77% of total billed charges,236.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,825.92,89,,,Percent of total Billed Charges,89% of total Billed charges,825.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,825.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,378.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,378.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,714.56,77,,,Percent of total Billed charges,77% of total billed charges,788.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,266.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,378.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232,825.92,
DRAINAGE FINGER ABSCESS SIMPLE,P991500467,CDM,521,RC,26010,HCPCS,Outpatient,,,621,310.5,,478.17,77,,,Percent of Total Billed Charges,77% of total billed charges,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552.69,89,,,Percent of total Billed Charges,89% of total Billed charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.17,77,,,Percent of total Billed charges,77% of total billed charges,527.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.25,552.69,
DRAINAGE FINGER ABSCESS COMP,P991500468,CDM,521,RC,26011,HCPCS,Outpatient,,,869,434.5,,669.13,77,,,Percent of Total Billed Charges,77% of total billed charges,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,773.41,89,,,Percent of total Billed Charges,89% of total Billed charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.13,77,,,Percent of total Billed charges,77% of total billed charges,738.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.25,773.41,
INCISION-HAND AND FINGERS,P991500469,CDM,521,RC,26034,HCPCS,Outpatient,,,1145,572.5,,881.65,77,,,Percent of Total Billed Charges,77% of total billed charges,291.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,286.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1019.05,89,,,Percent of total Billed Charges,89% of total Billed charges,1019.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1019.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,286.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,881.65,77,,,Percent of total Billed charges,77% of total billed charges,973.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,329.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,467.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,286.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,286.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.25,1019.05,
FASCIOTOMY PALMAR PERCUTANEOUS,P991500470,CDM,521,RC,26040,HCPCS,Outpatient,,,595,297.5,,458.15,77,,,Percent of Total Billed Charges,77% of total billed charges,151.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,529.55,89,,,Percent of total Billed Charges,89% of total Billed charges,529.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,529.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.15,77,,,Percent of total Billed charges,77% of total billed charges,505.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,242.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.75,529.55,
FASCIOTOMY PALMAR OPEN PARTIAL,P991500471,CDM,521,RC,26045,HCPCS,Outpatient,,,1191,595.5,,917.07,77,,,Percent of Total Billed Charges,77% of total billed charges,303.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,372.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,297.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1059.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1059.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1059.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,485.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,917.07,77,,,Percent of total Billed charges,77% of total billed charges,1012.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,342.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,485.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,297.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,297.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.75,1059.99,
INCISE FINGER TENDON SHEATH,P991500472,CDM,521,RC,26055,HCPCS,Outpatient,,,1139,569.5,,877.03,77,,,Percent of Total Billed Charges,77% of total billed charges,290.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,284.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1013.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.03,77,,,Percent of total Billed charges,77% of total billed charges,968.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,464.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,284.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.75,1013.71,
EXPLORE/TREAT HAND JOINT,P991500473,CDM,521,RC,26070,HCPCS,Outpatient,,,609,304.5,,468.93,77,,,Percent of Total Billed Charges,77% of total billed charges,155.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,542.01,89,,,Percent of total Billed Charges,89% of total Billed charges,542.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,542.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.93,77,,,Percent of total Billed charges,77% of total billed charges,517.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.25,542.01,
ARTHRTMY INTRPHLNGL JT,P991500474,CDM,521,RC,26080,HCPCS,Outpatient,,,749,374.5,,576.73,77,,,Percent of Total Billed Charges,77% of total billed charges,191,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,666.61,89,,,Percent of total Billed Charges,89% of total Billed charges,666.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,666.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.73,77,,,Percent of total Billed charges,77% of total billed charges,636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,305.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.25,666.61,
BIOPSY FINGER JOINT LINING,P991500475,CDM,521,RC,26105,HCPCS,Outpatient,,,644,322,,495.88,77,,,Percent of Total Billed Charges,77% of total billed charges,164.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,161,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,573.16,89,,,Percent of total Billed Charges,89% of total Billed charges,573.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.88,77,,,Percent of total Billed charges,77% of total billed charges,547.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161,573.16,
EXC HAND LES SC 1.5 CM/>,P991500476,CDM,521,RC,26111,HCPCS,Outpatient,,,784,392,,603.68,77,,,Percent of Total Billed Charges,77% of total billed charges,199.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,697.76,89,,,Percent of total Billed Charges,89% of total Billed charges,697.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,319.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,196,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.68,77,,,Percent of total Billed charges,77% of total billed charges,666.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,319.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,196,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,196,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196,697.76,
EXCISION HAND TUM DEEP 1.5 CM>,P991500477,CDM,521,RC,26113,HCPCS,Outpatient,,,1162,581,,894.74,77,,,Percent of Total Billed Charges,77% of total billed charges,296.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,363.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1034.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1034.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1034.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,474.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,474.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,474.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,894.74,77,,,Percent of total Billed charges,77% of total billed charges,987.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,334.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,474.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.5,1034.18,
EXC HAND LES SC < 1.5 CM,P991500478,CDM,521,RC,26115,HCPCS,Outpatient,,,1832,916,,1410.64,77,,,Percent of Total Billed Charges,77% of total billed charges,467.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,572.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,458,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1630.48,89,,,Percent of total Billed Charges,89% of total Billed charges,1630.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1630.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,747.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,747.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,747.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,458,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1410.64,77,,,Percent of total Billed charges,77% of total billed charges,1557.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,526.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,747.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,458,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,458,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458,1630.48,
EXCISION HAND TUM DEEP <1.5 CM,P991500479,CDM,521,RC,26116,HCPCS,Outpatient,,,1115,557.5,,858.55,77,,,Percent of Total Billed Charges,77% of total billed charges,284.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,992.35,89,,,Percent of total Billed Charges,89% of total Billed charges,992.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,992.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,858.55,77,,,Percent of total Billed charges,77% of total billed charges,947.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,320.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,454.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.75,992.35,
FASCIECTOMY PALM ONLY,P991500480,CDM,521,RC,26121,HCPCS,Outpatient,,,1236,618,,951.72,77,,,Percent of Total Billed Charges,77% of total billed charges,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1100.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.72,77,,,Percent of total Billed charges,77% of total billed charges,1050.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309,1100.04,
RELEASE PALM CONTRACTURE,P991500481,CDM,521,RC,26123,HCPCS,Outpatient,,,1729,864.5,,1331.33,77,,,Percent of Total Billed Charges,77% of total billed charges,440.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,440.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,540.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1538.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1538.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1538.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,432.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1331.33,77,,,Percent of total Billed charges,77% of total billed charges,1469.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,497.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,705.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,432.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,432.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,432.25,1538.81,
RELEASE PALM CONTRACTURE,P991500482,CDM,521,RC,26125,HCPCS,Outpatient,,,510,255,,392.7,77,,,Percent of Total Billed Charges,77% of total billed charges,130.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,453.9,89,,,Percent of total Billed Charges,89% of total Billed charges,453.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,453.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.7,77,,,Percent of total Billed charges,77% of total billed charges,433.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,208.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.5,453.9,
REVISE FINGER JOINT EACH,P991500483,CDM,521,RC,26135,HCPCS,Outpatient,,,1148,574,,883.96,77,,,Percent of Total Billed Charges,77% of total billed charges,292.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,358.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,287,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1021.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1021.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1021.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,287,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,883.96,77,,,Percent of total Billed charges,77% of total billed charges,975.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,330.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,468.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,287,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,287,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287,1021.72,
TENDON EXCISION PALM/FINGER,P991500484,CDM,521,RC,26145,HCPCS,Outpatient,,,974,487,,749.98,77,,,Percent of Total Billed Charges,77% of total billed charges,248.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,866.86,89,,,Percent of total Billed Charges,89% of total Billed charges,866.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,749.98,77,,,Percent of total Billed charges,77% of total billed charges,827.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,397.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.5,866.86,
EXCISION GNGLN HAND OR FINGER,P991500485,CDM,521,RC,26160,HCPCS,Outpatient,,,1177,588.5,,906.29,77,,,Percent of Total Billed Charges,77% of total billed charges,300.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,294.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1047.53,89,,,Percent of total Billed Charges,89% of total Billed charges,1047.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1047.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,480.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,480.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,480.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,906.29,77,,,Percent of total Billed charges,77% of total billed charges,1000.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,338.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,480.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,294.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.25,1047.53,
REMOVAL OF FINGER LESION,P991500486,CDM,521,RC,26210,HCPCS,Outpatient,,,1119,559.5,,861.63,77,,,Percent of Total Billed Charges,77% of total billed charges,285.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,349.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,279.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,995.91,89,,,Percent of total Billed Charges,89% of total Billed charges,995.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,995.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,456.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,456.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,456.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.63,77,,,Percent of total Billed charges,77% of total billed charges,951.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,321.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,456.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,279.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,279.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.75,995.91,
PARTIAL REMOVAL FINGER BONE,P991500487,CDM,521,RC,26235,HCPCS,Outpatient,,,931,465.5,,716.87,77,,,Percent of Total Billed Charges,77% of total billed charges,237.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,828.59,89,,,Percent of total Billed Charges,89% of total Billed charges,828.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,828.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.87,77,,,Percent of total Billed charges,77% of total billed charges,791.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.75,828.59,
EXCISION DISTAL PHALANX FINGER,P991500488,CDM,521,RC,26236,HCPCS,Outpatient,,,930,465,,716.1,77,,,Percent of Total Billed Charges,77% of total billed charges,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,827.7,89,,,Percent of total Billed Charges,89% of total Billed charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.1,77,,,Percent of total Billed charges,77% of total billed charges,790.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.5,827.7,
REMOVAL OF PINS,P991500489,CDM,521,RC,26320,HCPCS,Outpatient,,,659,329.5,,507.43,77,,,Percent of Total Billed Charges,77% of total billed charges,168.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,586.51,89,,,Percent of total Billed Charges,89% of total Billed charges,586.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,586.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.43,77,,,Percent of total Billed charges,77% of total billed charges,560.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,189.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,268.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,164.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.75,586.51,
MANIPULAT PALM CORD POST INJ,P991500490,CDM,521,RC,26341,HCPCS,Outpatient,,,204,102,,157.08,77,,,Percent of Total Billed Charges,77% of total billed charges,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,181.56,89,,,Percent of total Billed Charges,89% of total Billed charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.08,77,,,Percent of total Billed charges,77% of total billed charges,173.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51,181.56,
REPAIR OF FLEXOR TENDON,P991500491,CDM,521,RC,26350,HCPCS,Outpatient,,,2648,1324,,2038.96,77,,,Percent of Total Billed Charges,77% of total billed charges,675.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,675.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,827.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,662,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2356.72,89,,,Percent of total Billed Charges,89% of total Billed charges,2356.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2356.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1080.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1080.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1080.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2038.96,77,,,Percent of total Billed charges,77% of total billed charges,2250.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,761.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1080.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,662,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662,2356.72,
REPAIR/GRAFT HAND TENDON,P991500492,CDM,521,RC,26352,HCPCS,Outpatient,,,1502,751,,1156.54,77,,,Percent of Total Billed Charges,77% of total billed charges,383.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,383.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,469.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1336.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1336.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1156.54,77,,,Percent of total Billed charges,77% of total billed charges,1276.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,431.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,612.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.5,1336.78,
"REPAIR,EXTENSOR TENDON, HAND",P991500493,CDM,521,RC,26410,HCPCS,Outpatient,,,1129,564.5,,869.33,77,,,Percent of Total Billed Charges,77% of total billed charges,287.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1004.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1004.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1004.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,869.33,77,,,Percent of total Billed charges,77% of total billed charges,959.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,460.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.25,1004.81,
REPAIR EXTENSOR TENDON FINGER,P991500494,CDM,521,RC,26418,HCPCS,Outpatient,,,2062,1031,,1587.74,77,,,Percent of Total Billed Charges,77% of total billed charges,525.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,525.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,644.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1835.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1835.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,841.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,841.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,841.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1587.74,77,,,Percent of total Billed charges,77% of total billed charges,1752.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,592.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,841.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,515.5,1835.18,
REPAIR FINGER/HAND TENDON,P991500495,CDM,521,RC,26426,HCPCS,Outpatient,,,952,476,,733.04,77,,,Percent of Total Billed Charges,77% of total billed charges,242.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,847.28,89,,,Percent of total Billed Charges,89% of total Billed charges,847.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,847.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.04,77,,,Percent of total Billed charges,77% of total billed charges,809.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,388.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238,847.28,
REPAIR FINGER TENDON,P991500496,CDM,521,RC,26432,HCPCS,Outpatient,,,1773,886.5,,1365.21,77,,,Percent of Total Billed Charges,77% of total billed charges,452.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,452.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,554.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,443.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1577.97,89,,,Percent of total Billed Charges,89% of total Billed charges,1577.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1577.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,723.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,723.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,723.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1365.21,77,,,Percent of total Billed charges,77% of total billed charges,1507.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,509.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,723.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,443.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,443.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443.25,1577.97,
REPAIR FINGER TENDON,P991500497,CDM,521,RC,26433,HCPCS,Outpatient,,,1044,522,,803.88,77,,,Percent of Total Billed Charges,77% of total billed charges,266.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,326.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,929.16,89,,,Percent of total Billed Charges,89% of total Billed charges,929.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,929.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,803.88,77,,,Percent of total Billed charges,77% of total billed charges,887.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261,929.16,
RELEASE FINGER CONTRACTURE,P991500498,CDM,521,RC,26525,HCPCS,Outpatient,,,2472,1236,,1903.44,77,,,Percent of Total Billed Charges,77% of total billed charges,630.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2200.08,89,,,Percent of total Billed Charges,89% of total Billed charges,2200.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2200.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1903.44,77,,,Percent of total Billed charges,77% of total billed charges,2101.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1008.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,618,2200.08,
REVISE KNUCKLE JOINT,P991500499,CDM,510,RC,26530,HCPCS,Outpatient,,,1018,509,,783.86,77,,,Percent of Total Billed Charges,77% of total billed charges,259.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,415.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,415.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,415.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.86,77,,,Percent of total Billed charges,77% of total billed charges,865.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,292.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,509,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,415.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,906.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.5,906.02,
REVISE KNUCKLE W IMPLANT,P991500500,CDM,510,RC,26531,HCPCS,Outpatient,,,1193,596.5,,918.61,77,,,Percent of Total Billed Charges,77% of total billed charges,304.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,372.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,298.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,486.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,918.61,77,,,Percent of total Billed charges,77% of total billed charges,1014.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,342.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,596.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,486.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.25,1061.77,
LIGAMENT RECONSTRUCTION,P991500501,CDM,521,RC,26541,HCPCS,Outpatient,,,2880,1440,,2217.6,77,,,Percent of Total Billed Charges,77% of total billed charges,734.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,900,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,720,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2563.2,89,,,Percent of total Billed Charges,89% of total Billed charges,2563.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2563.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1175.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1175.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1175.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,720,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2217.6,77,,,Percent of total Billed charges,77% of total billed charges,2448,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,828,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1175.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,720,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,720,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,720,2563.2,
RECONSTRUCT FINGER JOINT,P991500502,CDM,521,RC,26548,HCPCS,Outpatient,,,2514,1257,,1935.78,77,,,Percent of Total Billed Charges,77% of total billed charges,641.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,641.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,785.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2237.46,89,,,Percent of total Billed Charges,89% of total Billed charges,2237.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2237.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1025.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1025.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1025.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1935.78,77,,,Percent of total Billed charges,77% of total billed charges,2136.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,722.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1025.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,628.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,628.5,2237.46,
OSTEOTOMY PHALANX OF FINGER,P991500503,CDM,521,RC,26567,HCPCS,Outpatient,,,2257,1128.5,,1737.89,77,,,Percent of Total Billed Charges,77% of total billed charges,575.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,575.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,564.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2008.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2008.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2008.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,920.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,920.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,920.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1737.89,77,,,Percent of total Billed charges,77% of total billed charges,1918.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,648.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,920.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,564.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,564.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,564.25,2008.73,
TREAT METACARPAL FRACTURE,P991500504,CDM,521,RC,26600,HCPCS,Outpatient,,,516,258,,397.32,77,,,Percent of Total Billed Charges,77% of total billed charges,131.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,459.24,89,,,Percent of total Billed Charges,89% of total Billed charges,459.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.32,77,,,Percent of total Billed charges,77% of total billed charges,438.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,129,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129,459.24,
CLSD TRTMNT MTCRPL FX W MNPLTN,P991500505,CDM,521,RC,26605,HCPCS,Outpatient,,,593,296.5,,456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,151.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,527.77,89,,,Percent of total Billed Charges,89% of total Billed charges,527.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.61,77,,,Percent of total Billed charges,77% of total billed charges,504.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.25,527.77,
TREAT METACARPAL FRACTURE,P991500506,CDM,521,RC,26607,HCPCS,Outpatient,,,956,478,,736.12,77,,,Percent of Total Billed Charges,77% of total billed charges,243.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,298.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,239,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,850.84,89,,,Percent of total Billed Charges,89% of total Billed charges,850.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,850.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.12,77,,,Percent of total Billed charges,77% of total billed charges,812.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,274.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,390.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,239,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239,850.84,
TREAT METACARPAL FRACTURE,P991500507,CDM,521,RC,26608,HCPCS,Outpatient,,,1121,560.5,,863.17,77,,,Percent of Total Billed Charges,77% of total billed charges,285.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,997.69,89,,,Percent of total Billed Charges,89% of total Billed charges,997.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,997.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,457.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,457.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,457.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,863.17,77,,,Percent of total Billed charges,77% of total billed charges,952.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,322.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,457.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.25,997.69,
TREAT METACARPAL FRACTURE,P991500508,CDM,521,RC,26615,HCPCS,Outpatient,,,1467,733.5,,1129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,374.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,458.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,366.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1305.63,89,,,Percent of total Billed Charges,89% of total Billed charges,1305.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,598.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.59,77,,,Percent of total Billed charges,77% of total billed charges,1246.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,421.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,598.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,366.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,366.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,1305.63,
TREAT THUMB FRACTURE,P991500509,CDM,521,RC,26645,HCPCS,Outpatient,,,818,409,,629.86,77,,,Percent of Total Billed Charges,77% of total billed charges,208.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,728.02,89,,,Percent of total Billed Charges,89% of total Billed charges,728.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,728.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,629.86,77,,,Percent of total Billed charges,77% of total billed charges,695.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,333.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.5,728.02,
TREAT THUMB FRACTURE,P991500510,CDM,521,RC,26665,HCPCS,Outpatient,,,1841,920.5,,1417.57,77,,,Percent of Total Billed Charges,77% of total billed charges,469.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,469.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,575.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,460.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1638.49,89,,,Percent of total Billed Charges,89% of total Billed charges,1638.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1638.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,751.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,751.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,751.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.57,77,,,Percent of total Billed charges,77% of total billed charges,1564.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,529.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,751.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,460.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,460.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.25,1638.49,
TREAT HAND DISLOCATION,P991500511,CDM,521,RC,26670,HCPCS,Outpatient,,,662,331,,509.74,77,,,Percent of Total Billed Charges,77% of total billed charges,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,589.18,89,,,Percent of total Billed Charges,89% of total Billed charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,509.74,77,,,Percent of total Billed charges,77% of total billed charges,562.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.5,589.18,
TREAT HAND DISLOCATION,P991500512,CDM,521,RC,26675,HCPCS,Outpatient,,,872,436,,671.44,77,,,Percent of Total Billed Charges,77% of total billed charges,222.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,776.08,89,,,Percent of total Billed Charges,89% of total Billed charges,776.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.44,77,,,Percent of total Billed charges,77% of total billed charges,741.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,355.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218,776.08,
PERCUTANEOUS SKELETAL FIXATION,P991500513,CDM,521,RC,26676,HCPCS,Outpatient,,,960,480,,739.2,77,,,Percent of Total Billed Charges,77% of total billed charges,244.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,854.4,89,,,Percent of total Billed Charges,89% of total Billed charges,854.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,739.2,77,,,Percent of total Billed charges,77% of total billed charges,816,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,391.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240,854.4,
TREAT FINGER FRACTURE EACH,P991500514,CDM,521,RC,26720,HCPCS,Outpatient,,,368,184,,283.36,77,,,Percent of Total Billed Charges,77% of total billed charges,93.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,327.52,89,,,Percent of total Billed Charges,89% of total Billed charges,327.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,327.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.36,77,,,Percent of total Billed charges,77% of total billed charges,312.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92,327.52,
TREAT FINGER FRACTURE EACH,P991500515,CDM,521,RC,26725,HCPCS,Outpatient,,,647,323.5,,498.19,77,,,Percent of Total Billed Charges,77% of total billed charges,164.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,575.83,89,,,Percent of total Billed Charges,89% of total Billed charges,575.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,575.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.19,77,,,Percent of total Billed charges,77% of total billed charges,549.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,263.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.75,575.83,
FXTN PHLNGL SHFT FX W MNPLTN,P991500516,CDM,521,RC,26727,HCPCS,Outpatient,,,1522,761,,1171.94,77,,,Percent of Total Billed Charges,77% of total billed charges,388.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,388.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,475.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,380.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1354.58,89,,,Percent of total Billed Charges,89% of total Billed charges,1354.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1354.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,620.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,620.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,620.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1171.94,77,,,Percent of total Billed charges,77% of total billed charges,1293.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,437.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,620.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,380.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,380.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,380.5,1354.58,
TREAT FINGER FRACTURE EACH,P991500517,CDM,521,RC,26735,HCPCS,Outpatient,,,1590,795,,1224.3,77,,,Percent of Total Billed Charges,77% of total billed charges,405.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,397.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1415.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1415.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1415.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,648.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,648.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,648.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1224.3,77,,,Percent of total Billed charges,77% of total billed charges,1351.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,648.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,397.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,397.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.5,1415.1,
TREAT FINGER FRACTURE EACH,P991500518,CDM,521,RC,26740,HCPCS,Outpatient,,,460,230,,354.2,77,,,Percent of Total Billed Charges,77% of total billed charges,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,409.4,89,,,Percent of total Billed Charges,89% of total Billed charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.2,77,,,Percent of total Billed charges,77% of total billed charges,391,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115,409.4,
TREAT FINGER FRACTURE EACH,P991500519,CDM,521,RC,26750,HCPCS,Outpatient,,,434,217,,334.18,77,,,Percent of Total Billed Charges,77% of total billed charges,110.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,386.26,89,,,Percent of total Billed Charges,89% of total Billed charges,386.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,386.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.18,77,,,Percent of total Billed charges,77% of total billed charges,368.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.5,386.26,
TREAT FINGER FRACTURE EACH,P991500520,CDM,920,RC,26755,HCPCS,Outpatient,,,606,303,,466.62,77,,,Percent of Total Billed Charges,77% of total billed charges,154.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,448.44,74,,,Percent of Total Billed Charges,74% of total billed charges,418.14,69,,,Percent of Total Billed Charges,69% of total billed charges,418.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,418.14,69,,,Percent of Total Billed Charges,69% of total billed charges,418.14,69,,,Percent of Total Billed Charges,69% of total billed charges,509.04,84,,,Percent of Total Billed Charges,84% of total billed charges,496.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,539.34,89,,,Percent of total Billed Charges,89% of total Billed charges,539.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,539.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,247.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.62,77,,,Percent of total Billed charges,77% of total billed charges,515.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,174.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,247.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,151.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,151.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,539.34,
PIN FINGER FRACTURE EACH,P991500521,CDM,521,RC,26756,HCPCS,Outpatient,,,799,399.5,,615.23,77,,,Percent of Total Billed Charges,77% of total billed charges,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,711.11,89,,,Percent of total Billed Charges,89% of total Billed charges,711.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,615.23,77,,,Percent of total Billed charges,77% of total billed charges,679.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,325.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.75,711.11,
TREAT FINGER FRACTURE EACH,P991500522,CDM,521,RC,26765,HCPCS,Outpatient,,,946,473,,728.42,77,,,Percent of Total Billed Charges,77% of total billed charges,241.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,841.94,89,,,Percent of total Billed Charges,89% of total Billed charges,841.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,841.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,728.42,77,,,Percent of total Billed charges,77% of total billed charges,804.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,271.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,385.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,236.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,236.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.5,841.94,
TREAT FINGER DISLOCATION,P991500523,CDM,521,RC,26770,HCPCS,Outpatient,,,547,273.5,,421.19,77,,,Percent of Total Billed Charges,77% of total billed charges,139.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,486.83,89,,,Percent of total Billed Charges,89% of total Billed charges,486.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.19,77,,,Percent of total Billed charges,77% of total billed charges,464.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.75,486.83,
FUSION OF KNUCKLE,P991500524,CDM,521,RC,26850,HCPCS,Outpatient,,,1229,614.5,,946.33,77,,,Percent of Total Billed Charges,77% of total billed charges,313.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1093.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1093.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1093.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.33,77,,,Percent of total Billed charges,77% of total billed charges,1044.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,353.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,501.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.25,1093.81,
FUSION OF FINGER JOINT,P991500525,CDM,521,RC,26860,HCPCS,Outpatient,,,1024,512,,788.48,77,,,Percent of Total Billed Charges,77% of total billed charges,261.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,320,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,256,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,911.36,89,,,Percent of total Billed Charges,89% of total Billed charges,911.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,911.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,417.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,417.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.48,77,,,Percent of total Billed charges,77% of total billed charges,870.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,294.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,417.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,256,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,911.36,
AMPUTATE METACARPAL BONE,P991500526,CDM,521,RC,26910,HCPCS,Outpatient,,,2269,1134.5,,1747.13,77,,,Percent of Total Billed Charges,77% of total billed charges,578.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,709.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,567.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2019.41,89,,,Percent of total Billed Charges,89% of total Billed charges,2019.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2019.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,567.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1747.13,77,,,Percent of total Billed charges,77% of total billed charges,1928.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,925.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,567.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,567.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,567.25,2019.41,
AMPUTATION OF FINGER/THUMB,P991500527,CDM,521,RC,26951,HCPCS,Outpatient,,,1811,905.5,,1394.47,77,,,Percent of Total Billed Charges,77% of total billed charges,461.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,461.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,565.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1611.79,89,,,Percent of total Billed Charges,89% of total Billed charges,1611.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1611.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.47,77,,,Percent of total Billed charges,77% of total billed charges,1539.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,520.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,738.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.75,1611.79,
AMPUTATION OF FINGER/THUMB,P991500528,CDM,521,RC,26952,HCPCS,Outpatient,,,1286,643,,990.22,77,,,Percent of Total Billed Charges,77% of total billed charges,327.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1144.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1144.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1144.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,524.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,524.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.22,77,,,Percent of total Billed charges,77% of total billed charges,1093.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,369.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,524.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,321.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.5,1144.54,
UNLISTED PX HANDS/FINGERS,P991500529,CDM,521,RC,26989,HCPCS,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,311.5,89,,,Percent of total Billed Charges,89% of total Billed charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.5,311.5,
DRAINAGE OF PELVIS LESION,P991500530,CDM,521,RC,26990,HCPCS,Outpatient,,,1275,637.5,,981.75,77,,,Percent of Total Billed Charges,77% of total billed charges,325.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1134.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1134.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1134.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,981.75,77,,,Percent of total Billed charges,77% of total billed charges,1083.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,366.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,520.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.75,1134.75,
BIOPSY OF SOFT TISSUES,P991500531,CDM,521,RC,27040,HCPCS,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
BIOPSY PELVIS/HIP AREA DEEP,P991500532,CDM,521,RC,27041,HCPCS,Outpatient,,,2008,1004,,1546.16,77,,,Percent of Total Billed Charges,77% of total billed charges,512.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,512.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,627.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,502,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1787.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1787.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,819.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,819.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,819.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,502,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.16,77,,,Percent of total Billed charges,77% of total billed charges,1706.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,577.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,819.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,502,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,502,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502,1787.12,
EXC HIP/PELVIS LESION 3CM/>,P991500533,CDM,521,RC,27043,HCPCS,Outpatient,,,993,496.5,,764.61,77,,,Percent of Total Billed Charges,77% of total billed charges,253.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,883.77,89,,,Percent of total Billed Charges,89% of total Billed charges,883.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,883.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,764.61,77,,,Percent of total Billed charges,77% of total billed charges,844.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,405.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.25,883.77,
EXCISION TUMOR PELVIS/HIP SUBQ,P991500534,CDM,521,RC,27047,HCPCS,Outpatient,,,682,341,,525.14,77,,,Percent of Total Billed Charges,77% of total billed charges,173.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,606.98,89,,,Percent of total Billed Charges,89% of total Billed charges,606.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,606.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,525.14,77,,,Percent of total Billed charges,77% of total billed charges,579.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.5,606.98,
EXC HIP/PELV TUM DEEP < 5 CM,P991500535,CDM,521,RC,27048,HCPCS,Outpatient,,,777,388.5,,598.29,77,,,Percent of Total Billed Charges,77% of total billed charges,198.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,691.53,89,,,Percent of total Billed Charges,89% of total Billed charges,691.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,598.29,77,,,Percent of total Billed charges,77% of total billed charges,660.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.25,691.53,
BIOPSY OF SACROILIAC JOINT,P991500536,CDM,521,RC,27050,HCPCS,Outpatient,,,762,381,,586.74,77,,,Percent of Total Billed Charges,77% of total billed charges,194.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,678.18,89,,,Percent of total Billed Charges,89% of total Billed charges,678.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,678.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.74,77,,,Percent of total Billed charges,77% of total billed charges,647.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,310.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.5,678.18,
REMOVE HIP BONE LES SUPER,P991500537,CDM,521,RC,27065,HCPCS,Outpatient,,,994,497,,765.38,77,,,Percent of Total Billed Charges,77% of total billed charges,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,884.66,89,,,Percent of total Billed Charges,89% of total Billed charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.38,77,,,Percent of total Billed charges,77% of total billed charges,844.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,405.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.5,884.66,
REMOVE HIP FOREIGN BODY,P991500538,CDM,521,RC,27086,HCPCS,Outpatient,,,565,282.5,,435.05,77,,,Percent of Total Billed Charges,77% of total billed charges,144.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,502.85,89,,,Percent of total Billed Charges,89% of total Billed charges,502.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,502.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.05,77,,,Percent of total Billed charges,77% of total billed charges,480.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,162.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,502.85,
INJECTION FOR HIP X-RAY,P991500539,CDM,521,RC,27093,HCPCS,Outpatient,,,423,211.5,,325.71,77,,,Percent of Total Billed Charges,77% of total billed charges,107.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,376.47,89,,,Percent of total Billed Charges,89% of total Billed charges,376.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.71,77,,,Percent of total Billed charges,77% of total billed charges,359.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.75,376.47,
INJECT SACROILIAC JOINT,P991500540,CDM,521,RC,27096,HCPCS,Outpatient,,,585,292.5,,450.45,77,,,Percent of Total Billed Charges,77% of total billed charges,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,520.65,89,,,Percent of total Billed Charges,89% of total Billed charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.45,77,,,Percent of total Billed charges,77% of total billed charges,497.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.25,520.65,
"INJECT SACROILIAC JOINT, BILAT",P991500541,CDM,521,RC,27096,HCPCS,Outpatient,,,600,300,50,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
HEMIARTHROPLASTY HIP PARTIAL,P991500542,CDM,521,RC,27125,HCPCS,Outpatient,,,2837,1418.5,,2184.49,77,,,Percent of Total Billed Charges,77% of total billed charges,723.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,723.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,886.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,709.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2524.93,89,,,Percent of total Billed Charges,89% of total Billed charges,2524.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2524.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,709.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2184.49,77,,,Percent of total Billed charges,77% of total billed charges,2411.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,815.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1157.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,709.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,709.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.25,2524.93,
TOTAL HIP REPLACEMENT,P991500543,CDM,521,RC,27130,HCPCS,Outpatient,,,2872,1436,,2211.44,77,,,Percent of Total Billed Charges,77% of total billed charges,732.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,732.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,897.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2556.08,89,,,Percent of total Billed Charges,89% of total Billed charges,2556.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2556.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1171.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1171.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1171.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2211.44,77,,,Percent of total Billed charges,77% of total billed charges,2441.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,825.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1171.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,718,2556.08,
TOTAL HIP ARTHROPLASTY,P991500544,CDM,521,RC,27132,HCPCS,Outpatient,,,6309,3154.5,,4857.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1608.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1608.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1971.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1577.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5615.01,89,,,Percent of total Billed Charges,89% of total Billed charges,5615.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5615.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2574.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2574.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2574.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1577.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4857.93,77,,,Percent of total Billed charges,77% of total billed charges,5362.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1813.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2574.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1577.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1577.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1577.25,5615.01,
REVISE HIP JOINT REPLACEMENT,P991500545,CDM,510,RC,27134,HCPCS,Outpatient,,,3622,1811,,2788.94,77,,,Percent of Total Billed Charges,77% of total billed charges,923.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1477.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1477.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1477.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2788.94,77,,,Percent of total Billed charges,77% of total billed charges,3078.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1041.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1811,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1477.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3223.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,905.5,3223.58,
REVISE HIP JOINT REPLACEMENT,P991500546,CDM,521,RC,27138,HCPCS,Outpatient,,,5585,2792.5,,4300.45,77,,,Percent of Total Billed Charges,77% of total billed charges,1424.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1424.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1745.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1396.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4970.65,89,,,Percent of total Billed Charges,89% of total Billed charges,4970.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4970.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2278.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2278.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2278.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1396.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.45,77,,,Percent of total Billed charges,77% of total billed charges,4747.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1605.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2278.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1396.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1396.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1396.25,4970.65,
TREAT SLIPPED EPIPHYSIS,P991500547,CDM,521,RC,27177,HCPCS,Outpatient,,,2909,1454.5,,2239.93,77,,,Percent of Total Billed Charges,77% of total billed charges,741.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,741.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,909.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2589.01,89,,,Percent of total Billed Charges,89% of total Billed charges,2589.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2589.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1186.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1186.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1186.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2239.93,77,,,Percent of total Billed charges,77% of total billed charges,2472.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,836.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1186.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,727.25,2589.01,
PINNING FEMORAL NECK PRX FEMUR,P991500548,CDM,521,RC,27187,HCPCS,Outpatient,,,3668,1834,,2824.36,77,,,Percent of Total Billed Charges,77% of total billed charges,935.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,935.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,917,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3264.52,89,,,Percent of total Billed Charges,89% of total Billed charges,3264.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3264.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1496.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1496.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1496.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,917,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.36,77,,,Percent of total Billed charges,77% of total billed charges,3117.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1054.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1496.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,917,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,917,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,917,3264.52,
CLSD TX PELVIC RING FX,P991500549,CDM,521,RC,27197,HCPCS,Outpatient,,,244,122,,187.88,77,,,Percent of Total Billed Charges,77% of total billed charges,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.16,89,,,Percent of total Billed Charges,89% of total Billed charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.88,77,,,Percent of total Billed charges,77% of total billed charges,207.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,217.16,
TREAT HIP SOCKET FRACTURE,P991500550,CDM,521,RC,27220,HCPCS,Outpatient,,,793,396.5,,610.61,77,,,Percent of Total Billed Charges,77% of total billed charges,202.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,705.77,89,,,Percent of total Billed Charges,89% of total Billed charges,705.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,610.61,77,,,Percent of total Billed charges,77% of total billed charges,674.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,227.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,323.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,198.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,198.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.25,705.77,
TREAT HIP WALL FRACTURE,P991500551,CDM,521,RC,27226,HCPCS,Outpatient,,,3769,1884.5,,2902.13,77,,,Percent of Total Billed Charges,77% of total billed charges,961.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,961.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1177.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,942.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3354.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3354.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3354.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1537.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1537.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1537.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,942.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2902.13,77,,,Percent of total Billed charges,77% of total billed charges,3203.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1083.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1537.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,942.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,942.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,942.25,3354.41,
TREAT THIGH FRACTURE,P991500552,CDM,521,RC,27230,HCPCS,Outpatient,,,919,459.5,,707.63,77,,,Percent of Total Billed Charges,77% of total billed charges,234.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,229.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,817.91,89,,,Percent of total Billed Charges,89% of total Billed charges,817.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.63,77,,,Percent of total Billed charges,77% of total billed charges,781.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,374.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,229.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.75,817.91,
TREAT THIGH FRACTURE,P991500553,CDM,521,RC,27232,HCPCS,Outpatient,,,3942,1971,,3035.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1231.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3508.38,89,,,Percent of total Billed Charges,89% of total Billed charges,3508.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3508.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1608.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3035.34,77,,,Percent of total Billed charges,77% of total billed charges,3350.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1608.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,985.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.5,3508.38,
TREAT THIGH FRACTURE,P991500554,CDM,521,RC,27235,HCPCS,Outpatient,,,1541,770.5,,1186.57,77,,,Percent of Total Billed Charges,77% of total billed charges,392.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,385.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1371.49,89,,,Percent of total Billed Charges,89% of total Billed charges,1371.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,628.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,628.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,628.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1186.57,77,,,Percent of total Billed charges,77% of total billed charges,1309.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,628.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,385.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.25,1371.49,
TREAT THIGH FRACTURE,P991500555,CDM,521,RC,27236,HCPCS,Outpatient,,,2524,1262,,1943.48,77,,,Percent of Total Billed Charges,77% of total billed charges,643.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,643.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,788.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,631,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2246.36,89,,,Percent of total Billed Charges,89% of total Billed charges,2246.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2246.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1029.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1029.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1029.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,631,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1943.48,77,,,Percent of total Billed charges,77% of total billed charges,2145.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,725.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1029.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,631,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,631,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,631,2246.36,
TREAT THIGH FRACTURE,P991500556,CDM,521,RC,27238,HCPCS,Outpatient,,,883,441.5,,679.91,77,,,Percent of Total Billed Charges,77% of total billed charges,225.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,785.87,89,,,Percent of total Billed Charges,89% of total Billed charges,785.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,785.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.91,77,,,Percent of total Billed charges,77% of total billed charges,750.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,253.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,360.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.75,785.87,
TREAT THIGH FRACTURE,P991500557,CDM,521,RC,27240,HCPCS,Outpatient,,,2599,1299.5,,2001.23,77,,,Percent of Total Billed Charges,77% of total billed charges,662.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,662.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,812.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,649.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2313.11,89,,,Percent of total Billed Charges,89% of total Billed charges,2313.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2313.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1060.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1060.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1060.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2001.23,77,,,Percent of total Billed charges,77% of total billed charges,2209.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,747.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1060.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,649.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.75,2313.11,
TREAT THIGH FRACTURE,P991500558,CDM,521,RC,27244,HCPCS,Outpatient,,,3891,1945.5,,2996.07,77,,,Percent of Total Billed Charges,77% of total billed charges,992.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,992.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1215.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,972.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3462.99,89,,,Percent of total Billed Charges,89% of total Billed charges,3462.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3462.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1587.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1587.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1587.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,972.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2996.07,77,,,Percent of total Billed charges,77% of total billed charges,3307.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1118.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1587.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,972.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,972.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,972.75,3462.99,
OPEN TRTM FEM FX W/INTR IMP,P991500559,CDM,521,RC,27245,HCPCS,Outpatient,,,2598,1299,,2000.46,77,,,Percent of Total Billed Charges,77% of total billed charges,662.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,662.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,811.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,649.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2312.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2312.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2312.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1059.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2000.46,77,,,Percent of total Billed charges,77% of total billed charges,2208.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,746.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1059.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,649.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.5,2312.22,
FX TROCHANTERIC GRTR CLO,P991500560,CDM,521,RC,27246,HCPCS,Outpatient,,,740,370,,569.8,77,,,Percent of Total Billed Charges,77% of total billed charges,188.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,658.6,89,,,Percent of total Billed Charges,89% of total Billed charges,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.8,77,,,Percent of total Billed charges,77% of total billed charges,629,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,212.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,301.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185,658.6,
OP TX GREATER TROCHANTERIC FX,P991500561,CDM,521,RC,27248,HCPCS,Outpatient,,,1595,797.5,,1228.15,77,,,Percent of Total Billed Charges,77% of total billed charges,406.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,498.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,398.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1419.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1419.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1419.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,650.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,650.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,650.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1228.15,77,,,Percent of total Billed charges,77% of total billed charges,1355.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,458.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,650.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,398.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.75,1419.55,
TREAT HIP DISLOCATION,P991500562,CDM,521,RC,27252,HCPCS,Outpatient,,,1605,802.5,,1235.85,77,,,Percent of Total Billed Charges,77% of total billed charges,409.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,409.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,501.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,401.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1428.45,89,,,Percent of total Billed Charges,89% of total Billed charges,1428.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1428.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,654.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,654.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,401.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1235.85,77,,,Percent of total Billed charges,77% of total billed charges,1364.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,461.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,654.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,401.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,401.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.25,1428.45,
TREAT HIP DISLOCATION,P991500563,CDM,521,RC,27266,HCPCS,Outpatient,,,1656,828,,1275.12,77,,,Percent of Total Billed Charges,77% of total billed charges,422.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1473.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1473.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.12,77,,,Percent of total Billed charges,77% of total billed charges,1407.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,675.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414,1473.84,
DRAIN THIGH/KNEE LESION,P991500564,CDM,521,RC,27301,HCPCS,Outpatient,,,1250,625,,962.5,77,,,Percent of Total Billed Charges,77% of total billed charges,318.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,390.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1112.5,89,,,Percent of total Billed Charges,89% of total Billed charges,1112.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1112.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,510,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,510,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,510,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.5,77,,,Percent of total Billed charges,77% of total billed charges,1062.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,359.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,510,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,312.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,312.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,312.5,1112.5,
REMOVAL FOREIGN BODY KNEE,P991500565,CDM,521,RC,27310,HCPCS,Outpatient,,,2025,1012.5,,1559.25,77,,,Percent of Total Billed Charges,77% of total billed charges,516.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,506.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1802.25,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.25,77,,,Percent of total Billed charges,77% of total billed charges,1721.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,826.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,506.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.25,1802.25,
BIOPSY THIGH SOFT TISSUES,P991500566,CDM,521,RC,27323,HCPCS,Outpatient,,,501,250.5,,385.77,77,,,Percent of Total Billed Charges,77% of total billed charges,127.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445.89,89,,,Percent of total Billed Charges,89% of total Billed charges,445.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.77,77,,,Percent of total Billed charges,77% of total billed charges,425.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.25,445.89,
BIOPSY THIGH SOFT TISSUES,P991500567,CDM,521,RC,27324,HCPCS,Outpatient,,,772,386,,594.44,77,,,Percent of Total Billed Charges,77% of total billed charges,196.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,193,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,687.08,89,,,Percent of total Billed Charges,89% of total Billed charges,687.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,687.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.44,77,,,Percent of total Billed charges,77% of total billed charges,656.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,193,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,193,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193,687.08,
EXC THIGH/KNEE LES SC < 3 CM,P991500568,CDM,521,RC,27327,HCPCS,Outpatient,,,592,296,,455.84,77,,,Percent of Total Billed Charges,77% of total billed charges,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,526.88,89,,,Percent of total Billed Charges,89% of total Billed charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.84,77,,,Percent of total Billed charges,77% of total billed charges,503.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148,526.88,
EXCISION TUMOR THIGH/KNEE DEEP,P991500569,CDM,521,RC,27328,HCPCS,Outpatient,,,1375,687.5,,1058.75,77,,,Percent of Total Billed Charges,77% of total billed charges,350.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1223.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1223.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1223.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1058.75,77,,,Percent of total Billed charges,77% of total billed charges,1168.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,395.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,561,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.75,1223.75,
REMOVAL OF KNEE CARTILAGE,P991500570,CDM,521,RC,27332,HCPCS,Outpatient,,,1362,681,,1048.74,77,,,Percent of Total Billed Charges,77% of total billed charges,347.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,347.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,425.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1212.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1212.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1212.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1048.74,77,,,Percent of total Billed charges,77% of total billed charges,1157.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,391.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,555.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.5,1212.18,
EXC THIGH/KNEE LES SC 3 CM/>,P991500571,CDM,521,RC,27337,HCPCS,Outpatient,,,896,448,,689.92,77,,,Percent of Total Billed Charges,77% of total billed charges,228.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,797.44,89,,,Percent of total Billed Charges,89% of total Billed charges,797.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,797.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,365.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,365.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,365.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.92,77,,,Percent of total Billed charges,77% of total billed charges,761.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,365.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224,797.44,
EXC THIGH/KNEE TUM DEP 5CM/>,P991500572,CDM,521,RC,27339,HCPCS,Outpatient,,,960,480,,739.2,77,,,Percent of Total Billed Charges,77% of total billed charges,244.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,854.4,89,,,Percent of total Billed Charges,89% of total Billed charges,854.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,739.2,77,,,Percent of total Billed charges,77% of total billed charges,816,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,391.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240,854.4,
EXCISION PREPATELLAR BURSA,P991500573,CDM,521,RC,27340,HCPCS,Outpatient,,,2206,1103,,1698.62,77,,,Percent of Total Billed Charges,77% of total billed charges,562.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,562.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,689.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,551.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1963.34,89,,,Percent of total Billed Charges,89% of total Billed charges,1963.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,900.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,900.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,900.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1698.62,77,,,Percent of total Billed charges,77% of total billed charges,1875.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,634.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,900.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,551.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,551.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551.5,1963.34,
REMOVAL OF KNEE CYST,P991500574,CDM,521,RC,27345,HCPCS,Outpatient,,,917,458.5,,706.09,77,,,Percent of Total Billed Charges,77% of total billed charges,233.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,286.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,816.13,89,,,Percent of total Billed Charges,89% of total Billed charges,816.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,816.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,706.09,77,,,Percent of total Billed charges,77% of total billed charges,779.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,263.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,374.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.25,816.13,
REMOVE KNEE CYST,P991500575,CDM,521,RC,27347,HCPCS,Outpatient,,,996,498,,766.92,77,,,Percent of Total Billed Charges,77% of total billed charges,253.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,311.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,886.44,89,,,Percent of total Billed Charges,89% of total Billed charges,886.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,886.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,406.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,406.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,406.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.92,77,,,Percent of total Billed charges,77% of total billed charges,846.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,406.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249,886.44,
REMOVAL OF KNEECAP,P991500576,CDM,521,RC,27350,HCPCS,Outpatient,,,1382,691,,1064.14,77,,,Percent of Total Billed Charges,77% of total billed charges,352.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,345.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1229.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1229.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1229.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.14,77,,,Percent of total Billed charges,77% of total billed charges,1174.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,563.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,345.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.5,1229.98,
PARTIAL REMOVAL LEG BONE(S),P991500577,CDM,521,RC,27360,HCPCS,Outpatient,,,1794,897,,1381.38,77,,,Percent of Total Billed Charges,77% of total billed charges,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,560.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1596.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1381.38,77,,,Percent of total Billed charges,77% of total billed charges,1524.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,515.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,1596.66,
NJX CNTRST KNE ARTHG/CT/MRI,P991500578,CDM,521,RC,27369,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.75,
REM FB DEEP THIGH/KNEE,P991500579,CDM,521,RC,27372,HCPCS,Outpatient,,,767,383.5,,590.59,77,,,Percent of Total Billed Charges,77% of total billed charges,195.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,191.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,682.63,89,,,Percent of total Billed Charges,89% of total Billed charges,682.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,682.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,312.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.59,77,,,Percent of total Billed charges,77% of total billed charges,651.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,220.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,312.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,191.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.75,682.63,
SUTURE QUADRICEP RUPTURE,P991500580,CDM,521,RC,27385,HCPCS,Outpatient,,,1186,593,,913.22,77,,,Percent of Total Billed Charges,77% of total billed charges,302.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1055.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,483.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,483.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,483.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.22,77,,,Percent of total Billed charges,77% of total billed charges,1008.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,340.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,483.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,296.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.5,1055.54,
REPAIR/GRAFT OF THIGH MUSCLE,P991500581,CDM,521,RC,27386,HCPCS,Outpatient,,,1782,891,,1372.14,77,,,Percent of Total Billed Charges,77% of total billed charges,454.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,454.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,556.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1585.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1585.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1585.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,727.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,727.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,727.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,445.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.14,77,,,Percent of total Billed charges,77% of total billed charges,1514.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,512.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,727.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,445.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,445.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.5,1585.98,
REPAIR OF KNEE CARTILAGE,P991500582,CDM,510,RC,27403,HCPCS,Outpatient,,,1200,600,,924,77,,,Percent of Total Billed Charges,77% of total billed charges,306,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,375,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924,77,,,Percent of total Billed charges,77% of total billed charges,1020,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,345,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,600,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300,1068,
REPAIR TORN LIGAMENT KNEE,P991500583,CDM,521,RC,27405,HCPCS,Outpatient,,,2314,1157,,1781.78,77,,,Percent of Total Billed Charges,77% of total billed charges,590.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,590.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,723.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,578.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2059.46,89,,,Percent of total Billed Charges,89% of total Billed charges,2059.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2059.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,944.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,944.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,944.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1781.78,77,,,Percent of total Billed charges,77% of total billed charges,1966.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,665.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,944.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,578.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,578.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,578.5,2059.46,
REPAIR OF KNEE LIGAMENT,P991500584,CDM,521,RC,27407,HCPCS,Outpatient,,,1206,603,,928.62,77,,,Percent of Total Billed Charges,77% of total billed charges,307.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1073.34,89,,,Percent of total Billed Charges,89% of total Billed charges,1073.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1073.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,492.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,492.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,492.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,928.62,77,,,Percent of total Billed charges,77% of total billed charges,1025.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,492.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.5,1073.34,
REPAIR OF KNEE LIGAMENTS,P991500585,CDM,521,RC,27409,HCPCS,Outpatient,,,1580,790,,1216.6,77,,,Percent of Total Billed Charges,77% of total billed charges,402.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,402.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,493.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,395,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1406.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1406.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,644.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,644.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1216.6,77,,,Percent of total Billed charges,77% of total billed charges,1343,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,454.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,644.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,395,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,395,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395,1406.2,
OSTEOCHONDRAL KNEE ALLOGRAFT,P991500586,CDM,521,RC,27415,HCPCS,Outpatient,,,2866,1433,,2206.82,77,,,Percent of Total Billed Charges,77% of total billed charges,730.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,730.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,895.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,716.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2550.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2550.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2550.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1169.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1169.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1169.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,716.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2206.82,77,,,Percent of total Billed charges,77% of total billed charges,2436.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,823.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1169.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,716.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,716.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.5,2550.74,
RCNSTJ DISLOCATING PATELLA,P991500587,CDM,521,RC,27420,HCPCS,Outpatient,,,1309,654.5,,1007.93,77,,,Percent of Total Billed Charges,77% of total billed charges,333.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,409.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,327.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1165.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1165.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1165.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,534.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,534.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1007.93,77,,,Percent of total Billed charges,77% of total billed charges,1112.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,376.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,534.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,327.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.25,1165.01,
REVISION OF UNSTABLE KNEECAP,P991500588,CDM,521,RC,27422,HCPCS,Outpatient,,,1550,775,,1193.5,77,,,Percent of Total Billed Charges,77% of total billed charges,395.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,484.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,387.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1379.5,89,,,Percent of total Billed Charges,89% of total Billed charges,1379.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1379.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,632.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,632.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1193.5,77,,,Percent of total Billed charges,77% of total billed charges,1317.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,445.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,632.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,387.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,387.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.5,1379.5,
REPAIR WITH PATELLECTOMY,P991500589,CDM,521,RC,27424,HCPCS,Outpatient,,,1135,567.5,,873.95,77,,,Percent of Total Billed Charges,77% of total billed charges,289.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,283.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1010.15,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,873.95,77,,,Percent of total Billed charges,77% of total billed charges,964.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,463.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,283.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.75,1010.15,
LAT RETINACULAR RELEASE OPEN,P991500590,CDM,521,RC,27425,HCPCS,Outpatient,,,855,427.5,,658.35,77,,,Percent of Total Billed Charges,77% of total billed charges,218.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,760.95,89,,,Percent of total Billed Charges,89% of total Billed charges,760.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,760.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,658.35,77,,,Percent of total Billed charges,77% of total billed charges,726.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,348.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,213.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,760.95,
RECONSTRUCTION KNEE,P991500591,CDM,521,RC,27427,HCPCS,Outpatient,,,1180,590,,908.6,77,,,Percent of Total Billed Charges,77% of total billed charges,300.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,368.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,295,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1050.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1050.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1050.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,481.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,481.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,481.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,908.6,77,,,Percent of total Billed charges,77% of total billed charges,1003,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,339.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,481.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,295,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,295,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295,1050.2,
REVISION OF KNEE JOINT,P991500592,CDM,521,RC,27442,HCPCS,Outpatient,,,1824,912,,1404.48,77,,,Percent of Total Billed Charges,77% of total billed charges,465.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,465.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,570,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,456,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1623.36,89,,,Percent of total Billed Charges,89% of total Billed charges,1623.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1623.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,744.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,744.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,744.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,456,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1404.48,77,,,Percent of total Billed charges,77% of total billed charges,1550.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,524.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,744.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,456,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,456,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456,1623.36,
ARTHROPLASTY UNICOMPART KNEE,P991500593,CDM,521,RC,27446,HCPCS,Outpatient,,,2451,1225.5,,1887.27,77,,,Percent of Total Billed Charges,77% of total billed charges,625.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,625.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,765.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,612.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2181.39,89,,,Percent of total Billed Charges,89% of total Billed charges,2181.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2181.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1000.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1000.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1000.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1887.27,77,,,Percent of total Billed charges,77% of total billed charges,2083.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,704.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1000.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,612.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,612.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,612.75,2181.39,
TOTAL KNEE ARTHROPLASTY BILAT,P991500594,CDM,521,RC,27447,HCPCS,Outpatient,,,5744,2872,50,4422.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1464.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1464.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1795,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1436,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5112.16,89,,,Percent of total Billed Charges,89% of total Billed charges,5112.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5112.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2343.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2343.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2343.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1436,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4422.88,77,,,Percent of total Billed charges,77% of total billed charges,4882.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1651.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2343.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1436,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1436,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436,5112.16,
TOTAL KNEE REPLACEMENT,P991500595,CDM,521,RC,27447,HCPCS,Outpatient,,,2872,1436,,2211.44,77,,,Percent of Total Billed Charges,77% of total billed charges,732.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,732.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,897.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2556.08,89,,,Percent of total Billed Charges,89% of total Billed charges,2556.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2556.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1171.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1171.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1171.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2211.44,77,,,Percent of total Billed charges,77% of total billed charges,2441.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,825.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1171.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,718,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,718,2556.08,
REVISE/REPLACE KNEE JOINT,P991500596,CDM,521,RC,27486,HCPCS,Outpatient,,,2974,1487,,2289.98,77,,,Percent of Total Billed Charges,77% of total billed charges,758.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,758.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,929.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,743.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2646.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2646.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2646.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1213.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1213.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1213.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,743.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2289.98,77,,,Percent of total Billed charges,77% of total billed charges,2527.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,855.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1213.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,743.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,743.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.5,2646.86,
REVISE/REPLACE KNEE JOINT,P991500597,CDM,521,RC,27487,HCPCS,Outpatient,,,2624,1312,,2020.48,77,,,Percent of Total Billed Charges,77% of total billed charges,669.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,669.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,656,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2335.36,89,,,Percent of total Billed Charges,89% of total Billed charges,2335.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2335.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1070.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1070.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1070.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,656,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2020.48,77,,,Percent of total Billed charges,77% of total billed charges,2230.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,754.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1070.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,656,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,656,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,656,2335.36,
TREATMENT OF THIGH FRACTURE,P991500598,CDM,521,RC,27500,HCPCS,Outpatient,,,989,494.5,,761.53,77,,,Percent of Total Billed Charges,77% of total billed charges,252.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,880.21,89,,,Percent of total Billed Charges,89% of total Billed charges,880.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.53,77,,,Percent of total Billed charges,77% of total billed charges,840.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.25,880.21,
TREATMENT OF THIGH FRACTURE,P991500599,CDM,521,RC,27501,HCPCS,Outpatient,,,957,478.5,,736.89,77,,,Percent of Total Billed Charges,77% of total billed charges,244.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,851.73,89,,,Percent of total Billed Charges,89% of total Billed charges,851.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,851.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.89,77,,,Percent of total Billed charges,77% of total billed charges,813.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,275.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,390.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.25,851.73,
TREATMENT OF THIGH FRACTURE,P991500600,CDM,521,RC,27502,HCPCS,Outpatient,,,2417,1208.5,,1861.09,77,,,Percent of Total Billed Charges,77% of total billed charges,616.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,616.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,755.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,604.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2151.13,89,,,Percent of total Billed Charges,89% of total Billed charges,2151.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2151.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,986.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,986.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,986.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1861.09,77,,,Percent of total Billed charges,77% of total billed charges,2054.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,694.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,986.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,604.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,604.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.25,2151.13,
OPN TRTMNT FMRL SHFT FX W FXTN,P991500601,CDM,521,RC,27506,HCPCS,Outpatient,,,4196,2098,,3230.92,77,,,Percent of Total Billed Charges,77% of total billed charges,1069.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1069.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1311.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1049,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3734.44,89,,,Percent of total Billed Charges,89% of total Billed charges,3734.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3734.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1711.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1711.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1711.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.92,77,,,Percent of total Billed charges,77% of total billed charges,3566.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1206.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1711.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1049,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049,3734.44,
TREATMENT OF THIGH FRACTURE,P991500602,CDM,521,RC,27507,HCPCS,Outpatient,,,1710,855,,1316.7,77,,,Percent of Total Billed Charges,77% of total billed charges,436.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,534.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1521.9,89,,,Percent of total Billed Charges,89% of total Billed charges,1521.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1521.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1316.7,77,,,Percent of total Billed charges,77% of total billed charges,1453.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,491.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,697.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,427.5,1521.9,
TREATMENT OF THIGH FRACTURE,P991500603,CDM,521,RC,27508,HCPCS,Outpatient,,,990,495,,762.3,77,,,Percent of Total Billed Charges,77% of total billed charges,252.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,881.1,89,,,Percent of total Billed Charges,89% of total Billed charges,881.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,881.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,762.3,77,,,Percent of total Billed charges,77% of total billed charges,841.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.5,881.1,
TREATMENT OF THIGH FRACTURE,P991500604,CDM,521,RC,27510,HCPCS,Outpatient,,,1431,715.5,,1101.87,77,,,Percent of Total Billed Charges,77% of total billed charges,364.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,447.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,357.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1273.59,89,,,Percent of total Billed Charges,89% of total Billed charges,1273.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1273.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,357.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.87,77,,,Percent of total Billed charges,77% of total billed charges,1216.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,411.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,583.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,357.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,357.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.75,1273.59,
TREATMENT OF THIGH FRACTURE,P991500605,CDM,521,RC,27511,HCPCS,Outpatient,,,3622,1811,,2788.94,77,,,Percent of Total Billed Charges,77% of total billed charges,923.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3223.58,89,,,Percent of total Billed Charges,89% of total Billed charges,3223.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3223.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1477.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1477.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1477.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2788.94,77,,,Percent of total Billed charges,77% of total billed charges,3078.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1041.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1477.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,905.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,905.5,3223.58,
OPEN TREATMENT FEMUR FX,P991500606,CDM,521,RC,27513,HCPCS,Outpatient,,,4928,2464,,3794.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1256.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1256.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1540,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4385.92,89,,,Percent of total Billed Charges,89% of total Billed charges,4385.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4385.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2010.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2010.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2010.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3794.56,77,,,Percent of total Billed charges,77% of total billed charges,4188.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1416.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2010.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1232,4385.92,
TREATMENT OF THIGH FRACTURE,P991500607,CDM,521,RC,27514,HCPCS,Outpatient,,,4022,2011,,3096.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1025.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1256.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1005.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3579.58,89,,,Percent of total Billed Charges,89% of total Billed charges,3579.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3579.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1640.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1640.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1640.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1005.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3096.94,77,,,Percent of total Billed charges,77% of total billed charges,3418.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1156.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1640.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1005.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1005.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1005.5,3579.58,
TREAT THIGH FX GROWTH PLATE,P991500608,CDM,521,RC,27516,HCPCS,Outpatient,,,975,487.5,,750.75,77,,,Percent of Total Billed Charges,77% of total billed charges,248.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,867.75,89,,,Percent of total Billed Charges,89% of total Billed charges,867.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,867.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,750.75,77,,,Percent of total Billed charges,77% of total billed charges,828.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,397.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.75,867.75,
TREAT THIGH FX GROWTH PLATE,P991500609,CDM,521,RC,27517,HCPCS,Outpatient,,,1409,704.5,,1084.93,77,,,Percent of Total Billed Charges,77% of total billed charges,359.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,359.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,440.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,352.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1254.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1254.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1254.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,352.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1084.93,77,,,Percent of total Billed charges,77% of total billed charges,1197.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,405.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,574.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,352.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,352.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.25,1254.01,
CL TX PATELLAR FX W/O MANIP,P991500610,CDM,521,RC,27520,HCPCS,Outpatient,,,725,362.5,,558.25,77,,,Percent of Total Billed Charges,77% of total billed charges,184.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,645.25,89,,,Percent of total Billed Charges,89% of total Billed charges,645.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,645.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.25,77,,,Percent of total Billed charges,77% of total billed charges,616.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,295.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.25,645.25,
OPN TRTMNT PATELLAR FX W FXTN,P991500611,CDM,521,RC,27524,HCPCS,Outpatient,,,2503,1251.5,,1927.31,77,,,Percent of Total Billed Charges,77% of total billed charges,638.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,638.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,782.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,625.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2227.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2227.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2227.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1021.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1021.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1021.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,625.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.31,77,,,Percent of total Billed charges,77% of total billed charges,2127.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,719.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1021.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,625.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,625.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,625.75,2227.67,
TREAT KNEE FRACTURE,P991500612,CDM,521,RC,27530,HCPCS,Outpatient,,,585,292.5,,450.45,77,,,Percent of Total Billed Charges,77% of total billed charges,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,520.65,89,,,Percent of total Billed Charges,89% of total Billed charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.45,77,,,Percent of total Billed charges,77% of total billed charges,497.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.25,520.65,
TREAT KNEE FRACTURE,P991500613,CDM,521,RC,27532,HCPCS,Outpatient,,,1579,789.5,,1215.83,77,,,Percent of Total Billed Charges,77% of total billed charges,402.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,402.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,493.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,394.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1405.31,89,,,Percent of total Billed Charges,89% of total Billed charges,1405.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1405.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,644.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,644.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1215.83,77,,,Percent of total Billed charges,77% of total billed charges,1342.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,644.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,394.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,394.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,394.75,1405.31,
TREAT KNEE FRACTURE,P991500614,CDM,521,RC,27535,HCPCS,Outpatient,,,1700,850,,1309,77,,,Percent of Total Billed Charges,77% of total billed charges,433.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,433.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1513,89,,,Percent of total Billed Charges,89% of total Billed charges,1513,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1513,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,693.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,693.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,693.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1309,77,,,Percent of total Billed charges,77% of total billed charges,1445,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,488.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,693.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425,1513,
TREAT KNEE FRACTURE,P991500615,CDM,521,RC,27536,HCPCS,Outpatient,,,3312,1656,,2550.24,77,,,Percent of Total Billed Charges,77% of total billed charges,844.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1035,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,828,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2947.68,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,828,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2550.24,77,,,Percent of total Billed charges,77% of total billed charges,2815.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1351.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,828,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,828,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,828,2947.68,
TREAT KNEE DISLOCATION,P991500616,CDM,521,RC,27550,HCPCS,Outpatient,,,973,486.5,,749.21,77,,,Percent of Total Billed Charges,77% of total billed charges,248.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,865.97,89,,,Percent of total Billed Charges,89% of total Billed charges,865.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,865.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,749.21,77,,,Percent of total Billed charges,77% of total billed charges,827.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,279.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,396.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.25,865.97,
TREAT KNEE DISLOCATION,P991500617,CDM,521,RC,27556,HCPCS,Outpatient,,,3210,1605,,2471.7,77,,,Percent of Total Billed Charges,77% of total billed charges,818.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,818.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,802.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2856.9,89,,,Percent of total Billed Charges,89% of total Billed charges,2856.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2856.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1309.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1309.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1309.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,802.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2471.7,77,,,Percent of total Billed charges,77% of total billed charges,2728.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,922.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1309.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,802.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,802.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,802.5,2856.9,
TREAT KNEECAP DISLOCATION,P991500618,CDM,521,RC,27560,HCPCS,Outpatient,,,708,354,,545.16,77,,,Percent of Total Billed Charges,77% of total billed charges,180.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,630.12,89,,,Percent of total Billed Charges,89% of total Billed charges,630.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.16,77,,,Percent of total Billed charges,77% of total billed charges,601.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177,630.12,
TX KNEECAP DISLOCATION,P991500619,CDM,521,RC,27562,HCPCS,Outpatient,,,924,462,,711.48,77,,,Percent of Total Billed Charges,77% of total billed charges,235.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,231,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,822.36,89,,,Percent of total Billed Charges,89% of total Billed charges,822.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,822.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.48,77,,,Percent of total Billed charges,77% of total billed charges,785.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,376.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,231,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,231,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,822.36,
FIXATION OF KNEE JOINT,P991500620,CDM,521,RC,27570,HCPCS,Outpatient,,,248,124,,190.96,77,,,Percent of Total Billed Charges,77% of total billed charges,63.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.72,89,,,Percent of total Billed Charges,89% of total Billed charges,220.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,77,,,Percent of total Billed charges,77% of total billed charges,210.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62,220.72,
DECOMPRESSION OF LOWER LEG,P991500621,CDM,521,RC,27601,HCPCS,Outpatient,,,832,416,,640.64,77,,,Percent of Total Billed Charges,77% of total billed charges,212.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,260,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,740.48,89,,,Percent of total Billed Charges,89% of total Billed charges,740.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,740.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.64,77,,,Percent of total Billed charges,77% of total billed charges,707.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,239.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208,740.48,
DRAIN LOWER LEG LESION,P991500622,CDM,521,RC,27603,HCPCS,Outpatient,,,977,488.5,,752.29,77,,,Percent of Total Billed Charges,77% of total billed charges,249.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,869.53,89,,,Percent of total Billed Charges,89% of total Billed charges,869.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,869.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,752.29,77,,,Percent of total Billed charges,77% of total billed charges,830.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,398.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.25,869.53,
RADICAL RESECTION TUMOR,P991500623,CDM,521,RC,27615,HCPCS,Outpatient,,,1519,759.5,,1169.63,77,,,Percent of Total Billed Charges,77% of total billed charges,387.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,387.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,474.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1351.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1351.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,619.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,619.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,619.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1169.63,77,,,Percent of total Billed charges,77% of total billed charges,1291.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,436.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,619.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.75,1351.91,
EXCISION TUMOR LEG SUBQ,P991500624,CDM,521,RC,27618,HCPCS,Outpatient,,,916,458,,705.32,77,,,Percent of Total Billed Charges,77% of total billed charges,233.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,286.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,229,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,815.24,89,,,Percent of total Billed Charges,89% of total Billed charges,815.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,815.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,373.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.32,77,,,Percent of total Billed charges,77% of total billed charges,778.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,263.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,229,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229,815.24,
EXCISION TUMOR LEG SUB Q,P991500625,CDM,521,RC,27619,HCPCS,Outpatient,,,886,443,,682.22,77,,,Percent of Total Billed Charges,77% of total billed charges,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,788.54,89,,,Percent of total Billed Charges,89% of total Billed charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.22,77,,,Percent of total Billed charges,77% of total billed charges,753.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,361.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.5,788.54,
EXPLORE/TREAT ANKLE JOINT,P991500626,CDM,521,RC,27620,HCPCS,Outpatient,,,837,418.5,,644.49,77,,,Percent of Total Billed Charges,77% of total billed charges,213.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,744.93,89,,,Percent of total Billed Charges,89% of total Billed charges,744.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,744.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.49,77,,,Percent of total Billed charges,77% of total billed charges,711.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,341.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.25,744.93,
REMOVAL OF TENDON LESION,P991500627,CDM,521,RC,27630,HCPCS,Outpatient,,,982,491,,756.14,77,,,Percent of Total Billed Charges,77% of total billed charges,250.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,245.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,873.98,89,,,Percent of total Billed Charges,89% of total Billed charges,873.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,873.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.14,77,,,Percent of total Billed charges,77% of total billed charges,834.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,400.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,245.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,245.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.5,873.98,
EXC LEG/ANKLE LES SC 3 CM/>,P991500628,CDM,521,RC,27632,HCPCS,Outpatient,,,776,388,,597.52,77,,,Percent of Total Billed Charges,77% of total billed charges,197.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,690.64,89,,,Percent of total Billed Charges,89% of total Billed charges,690.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,690.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.52,77,,,Percent of total Billed charges,77% of total billed charges,659.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,194,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194,690.64,
REMOVE/GRAFT LEG BONE LESION,P991500629,CDM,521,RC,27638,HCPCS,Outpatient,,,1359,679.5,,1046.43,77,,,Percent of Total Billed Charges,77% of total billed charges,346.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1209.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1046.43,77,,,Percent of total Billed charges,77% of total billed charges,1155.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,390.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,554.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.75,1209.51,
PARTIAL EXCISION BONE TIBIA,P991500630,CDM,521,RC,27640,HCPCS,Outpatient,,,1564,782,,1204.28,77,,,Percent of Total Billed Charges,77% of total billed charges,398.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1391.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1391.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1391.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.28,77,,,Percent of total Billed charges,77% of total billed charges,1329.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,638.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391,1391.96,
REPAIR ACHILLES TENDON,P991500631,CDM,521,RC,27650,HCPCS,Outpatient,,,1129,564.5,,869.33,77,,,Percent of Total Billed Charges,77% of total billed charges,287.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1004.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1004.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1004.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,869.33,77,,,Percent of total Billed charges,77% of total billed charges,959.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,460.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,282.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.25,1004.81,
REPAIR OF ANKLE LIGAMENT,P991500632,CDM,521,RC,27698,HCPCS,Outpatient,,,1061,530.5,,816.97,77,,,Percent of Total Billed Charges,77% of total billed charges,270.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,944.29,89,,,Percent of total Billed Charges,89% of total Billed charges,944.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,944.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,816.97,77,,,Percent of total Billed charges,77% of total billed charges,901.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,432.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.25,944.29,
REMOVAL OF ANKLE IMPLANT,P991500633,CDM,521,RC,27704,HCPCS,Outpatient,,,1882,941,,1449.14,77,,,Percent of Total Billed Charges,77% of total billed charges,479.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,479.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,588.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,470.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1674.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1674.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1674.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,767.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,767.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,767.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,470.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1449.14,77,,,Percent of total Billed charges,77% of total billed charges,1599.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,541.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,767.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,470.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,470.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.5,1674.98,
REINFORCE TIBIA,P991500634,CDM,521,RC,27745,HCPCS,Outpatient,,,2456,1228,,1891.12,77,,,Percent of Total Billed Charges,77% of total billed charges,626.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,626.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,767.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,614,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2185.84,89,,,Percent of total Billed Charges,89% of total Billed charges,2185.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1002.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1002.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,614,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1891.12,77,,,Percent of total Billed charges,77% of total billed charges,2087.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,706.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1002.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,614,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,614,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614,2185.84,
CLTX TIBIAL SHAFT FX W/O MANIP,P991500635,CDM,521,RC,27750,HCPCS,Outpatient,,,605,302.5,,465.85,77,,,Percent of Total Billed Charges,77% of total billed charges,154.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,151.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,538.45,89,,,Percent of total Billed Charges,89% of total Billed charges,538.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.85,77,,,Percent of total Billed charges,77% of total billed charges,514.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,151.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.25,538.45,
TREATMENT OF TIBIA FRACTURE,P991500636,CDM,521,RC,27752,HCPCS,Outpatient,,,1375,687.5,,1058.75,77,,,Percent of Total Billed Charges,77% of total billed charges,350.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1223.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1223.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1223.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1058.75,77,,,Percent of total Billed charges,77% of total billed charges,1168.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,395.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,561,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.75,1223.75,
TREATMENT OF TIBIA FRACTURE,P991500637,CDM,521,RC,27759,HCPCS,Outpatient,,,1720,860,,1324.4,77,,,Percent of Total Billed Charges,77% of total billed charges,438.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,438.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,537.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1530.8,89,,,Percent of total Billed Charges,89% of total Billed charges,1530.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1530.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1324.4,77,,,Percent of total Billed charges,77% of total billed charges,1462,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,494.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,701.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430,1530.8,
CLTX MEDIAL ANKLE FX,P991500638,CDM,521,RC,27760,HCPCS,Outpatient,,,775,387.5,,596.75,77,,,Percent of Total Billed Charges,77% of total billed charges,197.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,689.75,89,,,Percent of total Billed Charges,89% of total Billed charges,689.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,596.75,77,,,Percent of total Billed charges,77% of total billed charges,658.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,222.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.75,689.75,
CLTX MED ANKLE FX W/MNPJ,P991500639,CDM,521,RC,27762,HCPCS,Outpatient,,,915,457.5,,704.55,77,,,Percent of Total Billed Charges,77% of total billed charges,233.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,814.35,89,,,Percent of total Billed Charges,89% of total Billed charges,814.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,814.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,373.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,704.55,77,,,Percent of total Billed charges,77% of total billed charges,777.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,263.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.75,814.35,
OPTX MEDIAL ANKLE FX,P991500640,CDM,521,RC,27766,HCPCS,Outpatient,,,1163,581.5,,895.51,77,,,Percent of Total Billed Charges,77% of total billed charges,296.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,363.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1035.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1035.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1035.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,474.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,474.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,474.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,895.51,77,,,Percent of total Billed charges,77% of total billed charges,988.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,334.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,474.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.75,1035.07,
TREATMENT OF FIBULA FRACTURE,P991500641,CDM,521,RC,27780,HCPCS,Outpatient,,,712,356,,548.24,77,,,Percent of Total Billed Charges,77% of total billed charges,181.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,633.68,89,,,Percent of total Billed Charges,89% of total Billed charges,633.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,633.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,548.24,77,,,Percent of total Billed charges,77% of total billed charges,605.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178,633.68,
TREATMENT OF FIBULA FRACTURE,P991500642,CDM,521,RC,27781,HCPCS,Outpatient,,,827,413.5,,636.79,77,,,Percent of Total Billed Charges,77% of total billed charges,210.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,736.03,89,,,Percent of total Billed Charges,89% of total Billed charges,736.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,736.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.79,77,,,Percent of total Billed charges,77% of total billed charges,702.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,337.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.75,736.03,
OP TX PROXIMAL FIBULA/SHAFT FX,P991500643,CDM,521,RC,27784,HCPCS,Outpatient,,,926,463,,713.02,77,,,Percent of Total Billed Charges,77% of total billed charges,236.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,231.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,824.14,89,,,Percent of total Billed Charges,89% of total Billed charges,824.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,713.02,77,,,Percent of total Billed charges,77% of total billed charges,787.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,266.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,377.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,231.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,231.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.5,824.14,
TREATMENT OF ANKLE FRACTURE,P991500644,CDM,521,RC,27786,HCPCS,Outpatient,,,743,371.5,,572.11,77,,,Percent of Total Billed Charges,77% of total billed charges,189.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,661.27,89,,,Percent of total Billed Charges,89% of total Billed charges,661.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,661.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.11,77,,,Percent of total Billed charges,77% of total billed charges,631.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,303.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.75,661.27,
TREATMENT OF ANKLE FRACTURE,P991500645,CDM,521,RC,27788,HCPCS,Outpatient,,,805,402.5,,619.85,77,,,Percent of Total Billed Charges,77% of total billed charges,205.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,716.45,89,,,Percent of total Billed Charges,89% of total Billed charges,716.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,716.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,619.85,77,,,Percent of total Billed charges,77% of total billed charges,684.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.25,716.45,
TREATMENT OF ANKLE FRACTURE,P991500646,CDM,521,RC,27792,HCPCS,Outpatient,,,1362,681,,1048.74,77,,,Percent of Total Billed Charges,77% of total billed charges,347.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,347.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,425.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1212.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1212.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1212.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1048.74,77,,,Percent of total Billed charges,77% of total billed charges,1157.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,391.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,555.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,340.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.5,1212.18,
TREATMENT OF ANKLE FRACTURE,P991500647,CDM,521,RC,27808,HCPCS,Outpatient,,,629,314.5,,484.33,77,,,Percent of Total Billed Charges,77% of total billed charges,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,559.81,89,,,Percent of total Billed Charges,89% of total Billed charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,484.33,77,,,Percent of total Billed charges,77% of total billed charges,534.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.25,559.81,
TREATMENT OF ANKLE FRACTURE,P991500648,CDM,521,RC,27810,HCPCS,Outpatient,,,898,449,,691.46,77,,,Percent of Total Billed Charges,77% of total billed charges,228.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,799.22,89,,,Percent of total Billed Charges,89% of total Billed charges,799.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,799.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,366.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.46,77,,,Percent of total Billed charges,77% of total billed charges,763.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,366.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.5,799.22,
OP TX BIMALLEOLAR ANKLE FX,P991500649,CDM,521,RC,27814,HCPCS,Outpatient,,,2472,1236,,1903.44,77,,,Percent of Total Billed Charges,77% of total billed charges,630.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2200.08,89,,,Percent of total Billed Charges,89% of total Billed charges,2200.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2200.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1903.44,77,,,Percent of total Billed charges,77% of total billed charges,2101.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1008.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,618,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,618,2200.08,
TREATMENT OF ANKLE FRACTURE,P991500650,CDM,521,RC,27816,HCPCS,Outpatient,,,621,310.5,,478.17,77,,,Percent of Total Billed Charges,77% of total billed charges,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552.69,89,,,Percent of total Billed Charges,89% of total Billed charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.17,77,,,Percent of total Billed charges,77% of total billed charges,527.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.25,552.69,
TREATMENT OF ANKLE FRACTURE,P991500651,CDM,521,RC,27818,HCPCS,Outpatient,,,933,466.5,,718.41,77,,,Percent of Total Billed Charges,77% of total billed charges,237.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,830.37,89,,,Percent of total Billed Charges,89% of total Billed charges,830.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,830.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,718.41,77,,,Percent of total Billed charges,77% of total billed charges,793.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,380.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.25,830.37,
TREATMENT OF ANKLE FRACTURE,P991500652,CDM,521,RC,27822,HCPCS,Outpatient,,,1519,759.5,,1169.63,77,,,Percent of Total Billed Charges,77% of total billed charges,387.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,387.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,474.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1351.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1351.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,619.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,619.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,619.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1169.63,77,,,Percent of total Billed charges,77% of total billed charges,1291.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,436.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,619.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.75,1351.91,
TREAT LOWER LEG FRACTURE,P991500653,CDM,521,RC,27824,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
TREAT LOWER LEG FRACTURE,P991500654,CDM,521,RC,27825,HCPCS,Outpatient,,,1477,738.5,,1137.29,77,,,Percent of Total Billed Charges,77% of total billed charges,376.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,461.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,369.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1314.53,89,,,Percent of total Billed Charges,89% of total Billed charges,1314.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1314.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,369.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1137.29,77,,,Percent of total Billed charges,77% of total billed charges,1255.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,424.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,602.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,369.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,369.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.25,1314.53,
OP TX FX DISTAL TIBIA FIBULA,P991500655,CDM,521,RC,27826,HCPCS,Outpatient,,,1734,867,,1335.18,77,,,Percent of Total Billed Charges,77% of total billed charges,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1543.26,89,,,Percent of total Billed Charges,89% of total Billed charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.18,77,,,Percent of total Billed charges,77% of total billed charges,1473.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.5,1543.26,
OP TX FX DISTAL TIBIA ONLY,P991500656,CDM,521,RC,27827,HCPCS,Outpatient,,,2260,1130,,1740.2,77,,,Percent of Total Billed Charges,77% of total billed charges,576.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,576.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,706.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,565,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2011.4,89,,,Percent of total Billed Charges,89% of total Billed charges,2011.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2011.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,922.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,922.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,922.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,565,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1740.2,77,,,Percent of total Billed charges,77% of total billed charges,1921,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,649.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,922.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,565,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,565,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565,2011.4,
TREAT LOWER LEG JOINT,P991500657,CDM,521,RC,27829,HCPCS,Outpatient,,,840,420,,646.8,77,,,Percent of Total Billed Charges,77% of total billed charges,214.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,747.6,89,,,Percent of total Billed Charges,89% of total Billed charges,747.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,747.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.8,77,,,Percent of total Billed charges,77% of total billed charges,714,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,241.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210,747.6,
TREAT ANKLE DISLOCATION,P991500658,CDM,521,RC,27842,HCPCS,Outpatient,,,930,465,,716.1,77,,,Percent of Total Billed Charges,77% of total billed charges,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,827.7,89,,,Percent of total Billed Charges,89% of total Billed charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.1,77,,,Percent of total Billed charges,77% of total billed charges,790.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.5,827.7,
"ARTHRODESIS, ANKLE, OPEN",P991500659,CDM,521,RC,27870,HCPCS,Outpatient,,,1514,757,,1165.78,77,,,Percent of Total Billed Charges,77% of total billed charges,386.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,473.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,378.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1347.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1347.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1347.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,378.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1165.78,77,,,Percent of total Billed charges,77% of total billed charges,1286.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,435.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,617.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,378.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,378.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.5,1347.46,
AMPUTATION LOWER LEG,P991500660,CDM,521,RC,27880,HCPCS,Outpatient,,,2700,1350,,2079,77,,,Percent of Total Billed Charges,77% of total billed charges,688.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2403,89,,,Percent of total Billed Charges,89% of total Billed charges,2403,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2403,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2079,77,,,Percent of total Billed charges,77% of total billed charges,2295,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1101.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,675,2403,
AMPUTATION OF LOWER LEG,P991500661,CDM,521,RC,27882,HCPCS,Outpatient,,,2715,1357.5,,2090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,692.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,692.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,848.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,678.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2416.35,89,,,Percent of total Billed Charges,89% of total Billed charges,2416.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2416.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1107.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1107.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1107.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.55,77,,,Percent of total Billed charges,77% of total billed charges,2307.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,780.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1107.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,678.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,678.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,678.75,2416.35,
DECOMPRESSION OF LEG,P991500662,CDM,510,RC,27892,HCPCS,Outpatient,,,1000,500,,770,77,,,Percent of Total Billed Charges,77% of total billed charges,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,77,,,Percent of total Billed charges,77% of total billed charges,850,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250,890,
EXCISION BURSA,P991500663,CDM,521,RC,28001,HCPCS,Outpatient,,,316,158,,243.32,77,,,Percent of Total Billed Charges,77% of total billed charges,80.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,281.24,89,,,Percent of total Billed Charges,89% of total Billed charges,281.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.32,77,,,Percent of total Billed charges,77% of total billed charges,268.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79,281.24,
TREATMENT OF FOOT INFECTION,P991500664,CDM,521,RC,28003,HCPCS,Outpatient,,,711,355.5,,547.47,77,,,Percent of Total Billed Charges,77% of total billed charges,181.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,632.79,89,,,Percent of total Billed Charges,89% of total Billed charges,632.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.47,77,,,Percent of total Billed charges,77% of total billed charges,604.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.75,632.79,
INCISION OF FOOT/TOES,P991500665,CDM,521,RC,28005,HCPCS,Outpatient,,,1087,543.5,,836.99,77,,,Percent of Total Billed Charges,77% of total billed charges,277.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,967.43,89,,,Percent of total Billed Charges,89% of total Billed charges,967.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,967.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,443.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.99,77,,,Percent of total Billed charges,77% of total billed charges,923.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,312.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,443.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.75,967.43,
RELEASE PLANTAR FASCIA,P991500666,CDM,521,RC,28008,HCPCS,Outpatient,,,785,392.5,,604.45,77,,,Percent of Total Billed Charges,77% of total billed charges,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,698.65,89,,,Percent of total Billed Charges,89% of total Billed charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,320.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.45,77,,,Percent of total Billed charges,77% of total billed charges,667.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,320.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.25,698.65,
TARSAL TUNNEL RELEASE,P991500667,CDM,521,RC,28035,HCPCS,Outpatient,,,1388,694,,1068.76,77,,,Percent of Total Billed Charges,77% of total billed charges,353.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,433.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1235.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1235.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1235.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.76,77,,,Percent of total Billed charges,77% of total billed charges,1179.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,399.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,566.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347,1235.32,
EXCISION SEBACEOUS CYST,P991500668,CDM,521,RC,28043,HCPCS,Outpatient,,,949,474.5,,730.73,77,,,Percent of Total Billed Charges,77% of total billed charges,242,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,844.61,89,,,Percent of total Billed Charges,89% of total Billed charges,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,730.73,77,,,Percent of total Billed charges,77% of total billed charges,806.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,272.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,387.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,844.61,
EXC FOOT/TOE TUM DEEP <1.5CM,P991500669,CDM,521,RC,28045,HCPCS,Outpatient,,,886,443,,682.22,77,,,Percent of Total Billed Charges,77% of total billed charges,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,788.54,89,,,Percent of total Billed Charges,89% of total Billed charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.22,77,,,Percent of total Billed charges,77% of total billed charges,753.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,361.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.5,788.54,
NEURECTOMY FOOT,P991500670,CDM,521,RC,28055,HCPCS,Outpatient,,,727,363.5,,559.79,77,,,Percent of Total Billed Charges,77% of total billed charges,185.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,181.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,647.03,89,,,Percent of total Billed Charges,89% of total Billed charges,647.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,647.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.79,77,,,Percent of total Billed charges,77% of total billed charges,617.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,296.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.75,647.03,
RELEASE PLANTAR FASCIA,P991500671,CDM,521,RC,28060,HCPCS,Outpatient,,,947,473.5,,729.19,77,,,Percent of Total Billed Charges,77% of total billed charges,241.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,842.83,89,,,Percent of total Billed Charges,89% of total Billed charges,842.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,842.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,386.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,386.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,386.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.19,77,,,Percent of total Billed charges,77% of total billed charges,804.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,272.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,386.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,236.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,236.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.75,842.83,
EXCISION MORTON'S NEUROMA,P991500672,CDM,521,RC,28080,HCPCS,Outpatient,,,1663,831.5,,1280.51,77,,,Percent of Total Billed Charges,77% of total billed charges,424.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,519.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,415.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1480.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1480.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,678.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,415.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280.51,77,,,Percent of total Billed charges,77% of total billed charges,1413.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,478.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,678.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,415.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,415.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.75,1480.07,
EXCISION LESION FOOT,P991500673,CDM,521,RC,28090,HCPCS,Outpatient,,,1131,565.5,,870.87,77,,,Percent of Total Billed Charges,77% of total billed charges,288.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,282.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1006.59,89,,,Percent of total Billed Charges,89% of total Billed charges,1006.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1006.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,461.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,461.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,870.87,77,,,Percent of total Billed charges,77% of total billed charges,961.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,325.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,461.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,282.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,282.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.75,1006.59,
REMOVAL OF TOE LESIONS,P991500674,CDM,521,RC,28092,HCPCS,Outpatient,,,765,382.5,,589.05,77,,,Percent of Total Billed Charges,77% of total billed charges,195.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,680.85,89,,,Percent of total Billed Charges,89% of total Billed charges,680.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,589.05,77,,,Percent of total Billed charges,77% of total billed charges,650.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,312.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.25,680.85,
REMOVAL OF ANKLE/HEEL LESION,P991500675,CDM,521,RC,28100,HCPCS,Outpatient,,,1502,751,,1156.54,77,,,Percent of Total Billed Charges,77% of total billed charges,383.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,383.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,469.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1336.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1336.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1156.54,77,,,Percent of total Billed charges,77% of total billed charges,1276.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,431.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,612.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.5,1336.78,
EXCISION HETEROTOPIC BONE,P991500676,CDM,521,RC,28104,HCPCS,Outpatient,,,957,478.5,,736.89,77,,,Percent of Total Billed Charges,77% of total billed charges,244.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,851.73,89,,,Percent of total Billed Charges,89% of total Billed charges,851.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,851.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,390.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.89,77,,,Percent of total Billed charges,77% of total billed charges,813.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,275.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,390.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.25,851.73,
REMOVAL OF TOE LESIONS,P991500677,CDM,521,RC,28108,HCPCS,Outpatient,,,791,395.5,,609.07,77,,,Percent of Total Billed Charges,77% of total billed charges,201.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,703.99,89,,,Percent of total Billed Charges,89% of total Billed charges,703.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.07,77,,,Percent of total Billed charges,77% of total billed charges,672.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,227.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,322.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.75,703.99,
REMOVAL OF HEEL BONE,P991500678,CDM,521,RC,28118,HCPCS,Outpatient,,,792,396,,609.84,77,,,Percent of Total Billed Charges,77% of total billed charges,201.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,704.88,89,,,Percent of total Billed Charges,89% of total Billed charges,704.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,704.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.84,77,,,Percent of total Billed charges,77% of total billed charges,673.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,227.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,323.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,198,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,198,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198,704.88,
OSTECTOMY CALCANEUS FOR SPUR,P991500679,CDM,521,RC,28119,HCPCS,Outpatient,,,960,480,,739.2,77,,,Percent of Total Billed Charges,77% of total billed charges,244.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,854.4,89,,,Percent of total Billed Charges,89% of total Billed charges,854.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,739.2,77,,,Percent of total Billed charges,77% of total billed charges,816,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,391.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240,854.4,
PARTIAL EXCISION BONE TALUS,P991500680,CDM,521,RC,28120,HCPCS,Outpatient,,,780,390,,600.6,77,,,Percent of Total Billed Charges,77% of total billed charges,198.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,195,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,694.2,89,,,Percent of total Billed Charges,89% of total Billed charges,694.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,694.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,318.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.6,77,,,Percent of total Billed charges,77% of total billed charges,663,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,224.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,195,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195,694.2,
PARTIAL REMOVAL OF FOOT BONE,P991500681,CDM,521,RC,28122,HCPCS,Outpatient,,,828,414,,637.56,77,,,Percent of Total Billed Charges,77% of total billed charges,211.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,736.92,89,,,Percent of total Billed Charges,89% of total Billed charges,736.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,736.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.56,77,,,Percent of total Billed charges,77% of total billed charges,703.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,337.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207,736.92,
EXCISION PHALANX TOE,P991500682,CDM,521,RC,28124,HCPCS,Outpatient,,,1087,543.5,,836.99,77,,,Percent of Total Billed Charges,77% of total billed charges,277.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,967.43,89,,,Percent of total Billed Charges,89% of total Billed charges,967.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,967.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,443.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.99,77,,,Percent of total Billed charges,77% of total billed charges,923.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,312.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,443.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.75,967.43,
RESECTION 1ST RAY,P991500683,CDM,521,RC,28126,HCPCS,Outpatient,,,709,354.5,,545.93,77,,,Percent of Total Billed Charges,77% of total billed charges,180.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,631.01,89,,,Percent of total Billed Charges,89% of total Billed charges,631.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,631.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.93,77,,,Percent of total Billed charges,77% of total billed charges,602.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.25,631.01,
INTERPHALANGEAL JOINT EXCISION,P991500684,CDM,521,RC,28160,HCPCS,Outpatient,,,742,371,,571.34,77,,,Percent of Total Billed Charges,77% of total billed charges,189.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,660.38,89,,,Percent of total Billed Charges,89% of total Billed charges,660.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,660.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,302.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,302.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,302.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.34,77,,,Percent of total Billed charges,77% of total billed charges,630.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,302.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.5,660.38,
REMOVAL FOREIGN BODY FOOT,P991500685,CDM,521,RC,28190,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
REMOVAL OF FOOT FOREIGN BODY,P991500686,CDM,521,RC,28192,HCPCS,Outpatient,,,583,291.5,,448.91,77,,,Percent of Total Billed Charges,77% of total billed charges,148.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,518.87,89,,,Percent of total Billed Charges,89% of total Billed charges,518.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.91,77,,,Percent of total Billed charges,77% of total billed charges,495.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.75,518.87,
EXCISION OF SPUR (HEEL),P991500687,CDM,521,RC,28250,HCPCS,Outpatient,,,874,437,,672.98,77,,,Percent of Total Billed Charges,77% of total billed charges,222.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,777.86,89,,,Percent of total Billed Charges,89% of total Billed charges,777.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,356.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,356.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.98,77,,,Percent of total Billed charges,77% of total billed charges,742.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,251.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,356.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.5,777.86,
SYNDACTYLIZATION TOES,P991500688,CDM,521,RC,28280,HCPCS,Outpatient,,,933,466.5,,718.41,77,,,Percent of Total Billed Charges,77% of total billed charges,237.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,830.37,89,,,Percent of total Billed Charges,89% of total Billed charges,830.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,830.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,718.41,77,,,Percent of total Billed charges,77% of total billed charges,793.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,380.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.25,830.37,
CORRECTION HAMMERTOE,P991500689,CDM,521,RC,28285,HCPCS,Outpatient,,,1271,635.5,,978.67,77,,,Percent of Total Billed Charges,77% of total billed charges,324.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1131.19,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.67,77,,,Percent of total Billed charges,77% of total billed charges,1080.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.75,1131.19,
PARTIAL REMOVAL OF FOOT BONE,P991500690,CDM,521,RC,28288,HCPCS,Outpatient,,,1417,708.5,,1091.09,77,,,Percent of Total Billed Charges,77% of total billed charges,361.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,354.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1261.13,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.09,77,,,Percent of total Billed charges,77% of total billed charges,1204.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,578.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.25,1261.13,
CORRJ HALUX RIGDUS W/O IMPLT,P991500691,CDM,521,RC,28289,HCPCS,Outpatient,,,1264,632,,973.28,77,,,Percent of Total Billed Charges,77% of total billed charges,322.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,316,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1124.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1124.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,515.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.28,77,,,Percent of total Billed charges,77% of total billed charges,1074.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,363.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,515.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,316,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316,1124.96,
CORRJ HALUX RIGDUS w/IMPLT,P991500692,CDM,521,RC,28291,HCPCS,Outpatient,,,1388,694,,1068.76,77,,,Percent of Total Billed Charges,77% of total billed charges,353.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,433.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1235.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1235.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1235.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.76,77,,,Percent of total Billed charges,77% of total billed charges,1179.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,399.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,566.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,347,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347,1235.32,
CORRECTION HALLUX VALGUS,P991500693,CDM,521,RC,28292,HCPCS,Outpatient,,,1500,750,,1155,77,,,Percent of Total Billed Charges,77% of total billed charges,382.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,382.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,468.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,375,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1335,500,,,fee schedule,500% of healthlink,1335,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1335,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1155,77,,,Percent of total Billed charges,77% of total billed charges,1275,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,431.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,612,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,375,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375,1335,
CORRECTION HALLUX VALGUS,P991500694,CDM,521,RC,28296,HCPCS,Outpatient,,,2157,1078.5,,1660.89,77,,,Percent of Total Billed Charges,77% of total billed charges,550.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,550.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,674.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1919.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1919.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1919.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.89,77,,,Percent of total Billed charges,77% of total billed charges,1833.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,620.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,880.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,539.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539.25,1919.73,
CORRECTION HALLUX VALGUS,P991500695,CDM,521,RC,28298,HCPCS,Outpatient,,,953,476.5,,733.81,77,,,Percent of Total Billed Charges,77% of total billed charges,243.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,848.17,89,,,Percent of total Billed Charges,89% of total Billed charges,848.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.81,77,,,Percent of total Billed charges,77% of total billed charges,810.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,388.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.25,848.17,
CORRECTION HALLUX VALGUS,P991500696,CDM,521,RC,28299,HCPCS,Outpatient,,,1900,950,,1463,77,,,Percent of Total Billed Charges,77% of total billed charges,484.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,484.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,593.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,475,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1691,89,,,Percent of total Billed Charges,89% of total Billed charges,1691,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1691,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463,77,,,Percent of total Billed charges,77% of total billed charges,1615,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,546.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,775.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,475,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,475,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475,1691,
"OSTEOTOMY,TARSAL BONES",P991500697,CDM,521,RC,28304,HCPCS,Outpatient,,,1218,609,,937.86,77,,,Percent of Total Billed Charges,77% of total billed charges,310.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,380.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1084.02,89,,,Percent of total Billed Charges,89% of total Billed charges,1084.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1084.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,496.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,496.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,496.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,937.86,77,,,Percent of total Billed charges,77% of total billed charges,1035.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,350.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,496.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.5,1084.02,
INCISION OF METATARSAL,P991500698,CDM,521,RC,28308,HCPCS,Outpatient,,,1075,537.5,,827.75,77,,,Percent of Total Billed Charges,77% of total billed charges,274.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,335.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,956.75,89,,,Percent of total Billed Charges,89% of total Billed charges,956.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,956.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,438.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.75,77,,,Percent of total Billed charges,77% of total billed charges,913.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,309.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,438.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,268.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.75,956.75,
REVISION OF TOE,P991500699,CDM,521,RC,28312,HCPCS,Outpatient,,,970,485,,746.9,77,,,Percent of Total Billed Charges,77% of total billed charges,247.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,863.3,89,,,Percent of total Billed Charges,89% of total Billed charges,863.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,863.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.9,77,,,Percent of total Billed charges,77% of total billed charges,824.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,278.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,395.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,242.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,242.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.5,863.3,
REPAIR DEFORMITY OF TOE,P991500700,CDM,521,RC,28313,HCPCS,Outpatient,,,966,483,,743.82,77,,,Percent of Total Billed Charges,77% of total billed charges,246.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,246.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,301.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,859.74,89,,,Percent of total Billed Charges,89% of total Billed charges,859.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,859.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,394.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.82,77,,,Percent of total Billed charges,77% of total billed charges,821.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,277.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,394.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.5,859.74,
CL TX CALCANEAL FX W/O MANIP,P991500701,CDM,521,RC,28400,HCPCS,Outpatient,,,758,379,,583.66,77,,,Percent of Total Billed Charges,77% of total billed charges,193.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,189.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,674.62,89,,,Percent of total Billed Charges,89% of total Billed charges,674.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.66,77,,,Percent of total Billed charges,77% of total billed charges,644.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,189.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.5,674.62,
CL TX CALCANEAL FX W/MANIP,P991500702,CDM,521,RC,28405,HCPCS,Outpatient,,,848,424,,652.96,77,,,Percent of Total Billed Charges,77% of total billed charges,216.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,754.72,89,,,Percent of total Billed Charges,89% of total Billed charges,754.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,754.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,652.96,77,,,Percent of total Billed charges,77% of total billed charges,720.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,243.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,345.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212,754.72,
TREATMENT OF HEEL FRACTURE,P991500703,CDM,521,RC,28406,HCPCS,Outpatient,,,1686,843,,1298.22,77,,,Percent of Total Billed Charges,77% of total billed charges,429.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,526.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1500.54,500,,,fee schedule,500% of healthlink,1500.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1500.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,687.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,687.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,687.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1298.22,77,,,Percent of total Billed charges,77% of total billed charges,1433.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,484.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,687.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.5,1500.54,
OPEN TXTMT CALCANEAL FRACTURE,P991500704,CDM,521,RC,28415,HCPCS,Outpatient,,,1664,832,,1281.28,77,,,Percent of Total Billed Charges,77% of total billed charges,424.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,520,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1480.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1480.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,678.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,678.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1281.28,77,,,Percent of total Billed charges,77% of total billed charges,1414.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,478.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,678.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,416,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416,1480.96,
CL TX TALUS FX W/O MANIP,P991500705,CDM,521,RC,28430,HCPCS,Outpatient,,,479,239.5,,368.83,77,,,Percent of Total Billed Charges,77% of total billed charges,122.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,426.31,89,,,Percent of total Billed Charges,89% of total Billed charges,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.83,77,,,Percent of total Billed charges,77% of total billed charges,407.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.75,426.31,
CL TX TALUS FX W/MANIPULATION,P991500706,CDM,521,RC,28435,HCPCS,Outpatient,,,694,347,,534.38,77,,,Percent of Total Billed Charges,77% of total billed charges,176.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,617.66,89,,,Percent of total Billed Charges,89% of total Billed charges,617.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,534.38,77,,,Percent of total Billed charges,77% of total billed charges,589.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,199.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,283.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.5,617.66,
TREAT MIDFOOT FRACTURE EACH,P991500707,CDM,521,RC,28450,HCPCS,Outpatient,,,392,196,,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348.88,89,,,Percent of total Billed Charges,89% of total Billed charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98,348.88,
TREAT MIDFOOT FRACTURE EACH,P991500708,CDM,521,RC,28455,HCPCS,Outpatient,,,548,274,,421.96,77,,,Percent of Total Billed Charges,77% of total billed charges,139.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,487.72,89,,,Percent of total Billed Charges,89% of total Billed charges,487.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.96,77,,,Percent of total Billed charges,77% of total billed charges,465.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137,487.72,
TREAT MIDFOOT FRACTURE,P991500709,CDM,521,RC,28456,HCPCS,Outpatient,,,685,342.5,,527.45,77,,,Percent of Total Billed Charges,77% of total billed charges,174.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,171.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,609.65,89,,,Percent of total Billed Charges,89% of total Billed charges,609.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,279.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.45,77,,,Percent of total Billed charges,77% of total billed charges,582.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,279.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,171.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.25,609.65,
TREAT MIDFOOT FRACTURE EACH,P991500710,CDM,521,RC,28465,HCPCS,Outpatient,,,868,434,,668.36,77,,,Percent of Total Billed Charges,77% of total billed charges,221.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,772.52,89,,,Percent of total Billed Charges,89% of total Billed charges,772.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.36,77,,,Percent of total Billed charges,77% of total billed charges,737.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217,772.52,
CL TX METATARSAL FX W/O MANIP,P991500711,CDM,521,RC,28470,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
CLTX METAR FX W/MANJ,P991500712,CDM,521,RC,28475,HCPCS,Outpatient,,,484,242,,372.68,77,,,Percent of Total Billed Charges,77% of total billed charges,123.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,430.76,89,,,Percent of total Billed Charges,89% of total Billed charges,430.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,430.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,197.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.68,77,,,Percent of total Billed charges,77% of total billed charges,411.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,197.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121,430.76,
PRQ SKEL FIXJ METAR FX W/MANJ,P991500713,CDM,521,RC,28476,HCPCS,Outpatient,,,720,360,,554.4,77,,,Percent of Total Billed Charges,77% of total billed charges,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,640.8,89,,,Percent of total Billed Charges,89% of total Billed charges,640.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.4,77,,,Percent of total Billed charges,77% of total billed charges,612,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180,640.8,
OP TX METATARSAL FX EACH,P991500714,CDM,521,RC,28485,HCPCS,Outpatient,,,1555,777.5,,1197.35,77,,,Percent of Total Billed Charges,77% of total billed charges,396.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,388.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1383.95,89,,,Percent of total Billed Charges,89% of total Billed charges,1383.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1383.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.35,77,,,Percent of total Billed charges,77% of total billed charges,1321.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,634.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,388.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.75,1383.95,
TREAT BIG TOE FRACTURE,P991500715,CDM,521,RC,28490,HCPCS,Outpatient,,,364,182,,280.28,77,,,Percent of Total Billed Charges,77% of total billed charges,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.96,89,,,Percent of total Billed Charges,89% of total Billed charges,323.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.28,77,,,Percent of total Billed charges,77% of total billed charges,309.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91,323.96,
TREAT BIG TOE FRACTURE,P991500716,CDM,521,RC,28495,HCPCS,Outpatient,,,330,165,,254.1,77,,,Percent of Total Billed Charges,77% of total billed charges,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,293.7,89,,,Percent of total Billed Charges,89% of total Billed charges,293.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.1,77,,,Percent of total Billed charges,77% of total billed charges,280.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.5,293.7,
TREAT BIG TOE FRACTURE,P991500717,CDM,521,RC,28496,HCPCS,Outpatient,,,817,408.5,,629.09,77,,,Percent of Total Billed Charges,77% of total billed charges,208.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,727.13,89,,,Percent of total Billed Charges,89% of total Billed charges,727.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,727.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,629.09,77,,,Percent of total Billed charges,77% of total billed charges,694.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,234.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,333.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,204.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.25,727.13,
TREAT BIG TOE FRACTURE,P991500718,CDM,521,RC,28505,HCPCS,Outpatient,,,1165,582.5,,897.05,77,,,Percent of Total Billed Charges,77% of total billed charges,297.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1036.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1036.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1036.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.05,77,,,Percent of total Billed charges,77% of total billed charges,990.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,334.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,475.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,291.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.25,1036.85,
TREATMENT OF TOE FRACTURE,P991500719,CDM,521,RC,28510,HCPCS,Outpatient,,,331,165.5,,254.87,77,,,Percent of Total Billed Charges,77% of total billed charges,84.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,294.59,89,,,Percent of total Billed Charges,89% of total Billed charges,294.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.87,77,,,Percent of total Billed charges,77% of total billed charges,281.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.75,294.59,
TREAT FOOT DISLOCATION,P991500720,CDM,521,RC,28540,HCPCS,Outpatient,,,363,181.5,,279.51,77,,,Percent of Total Billed Charges,77% of total billed charges,92.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.07,89,,,Percent of total Billed Charges,89% of total Billed charges,323.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.51,77,,,Percent of total Billed charges,77% of total billed charges,308.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.75,323.07,
OP TX TARSAL BONE DISLOCATION,P991500721,CDM,521,RC,28555,HCPCS,Outpatient,,,2667,1333.5,,2053.59,77,,,Percent of Total Billed Charges,77% of total billed charges,680.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,833.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2373.63,89,,,Percent of total Billed Charges,89% of total Billed charges,2373.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2373.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1088.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1088.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1088.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.59,77,,,Percent of total Billed charges,77% of total billed charges,2266.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,766.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1088.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,666.75,2373.63,
TREAT FOOT DISLOCATION,P991500722,CDM,521,RC,28606,HCPCS,Outpatient,,,726,363,,559.02,77,,,Percent of Total Billed Charges,77% of total billed charges,185.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,181.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,646.14,89,,,Percent of total Billed Charges,89% of total Billed charges,646.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.02,77,,,Percent of total Billed charges,77% of total billed charges,617.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,296.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.5,646.14,
TREAT TOE DISLOCATION,P991500723,CDM,521,RC,28660,HCPCS,Outpatient,,,231,115.5,,177.87,77,,,Percent of Total Billed Charges,77% of total billed charges,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205.59,89,,,Percent of total Billed Charges,89% of total Billed charges,205.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.87,77,,,Percent of total Billed charges,77% of total billed charges,196.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,205.59,
"ARTHRODESIS, TRIPLE",P991500724,CDM,521,RC,28715,HCPCS,Outpatient,,,1416,708,,1090.32,77,,,Percent of Total Billed Charges,77% of total billed charges,361.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1260.24,89,,,Percent of total Billed Charges,89% of total Billed charges,1260.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1260.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,577.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1090.32,77,,,Percent of total Billed charges,77% of total billed charges,1203.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,577.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354,1260.24,
ARTHRODESIS; SUBTALAR,P991500725,CDM,521,RC,28725,HCPCS,Outpatient,,,1229,614.5,,946.33,77,,,Percent of Total Billed Charges,77% of total billed charges,313.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1093.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1093.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1093.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.33,77,,,Percent of total Billed charges,77% of total billed charges,1044.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,353.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,501.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.25,1093.81,
FUSION OF FOOT BONES,P991500726,CDM,521,RC,28740,HCPCS,Outpatient,,,1308,654,,1007.16,77,,,Percent of Total Billed Charges,77% of total billed charges,333.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1164.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1164.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1164.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1007.16,77,,,Percent of total Billed charges,77% of total billed charges,1111.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,376.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,533.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327,1164.12,
ARTHRODESIS GREAT TOE MP JOINT,P991500727,CDM,521,RC,28750,HCPCS,Outpatient,,,1859,929.5,,1431.43,77,,,Percent of Total Billed Charges,77% of total billed charges,474.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,474.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,580.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,464.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1654.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1654.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1654.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1431.43,77,,,Percent of total Billed charges,77% of total billed charges,1580.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,534.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,758.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,464.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,464.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,464.75,1654.51,
ARTHRODESIS GREAT TOE IP JOINT,P991500728,CDM,521,RC,28755,HCPCS,Outpatient,,,921,460.5,,709.17,77,,,Percent of Total Billed Charges,77% of total billed charges,234.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,230.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,819.69,89,,,Percent of total Billed Charges,89% of total Billed charges,819.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,819.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.17,77,,,Percent of total Billed charges,77% of total billed charges,782.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.25,819.69,
AMPUTATION TOE & METATARSAL,P991500729,CDM,521,RC,28810,HCPCS,Outpatient,,,807,403.5,,621.39,77,,,Percent of Total Billed Charges,77% of total billed charges,205.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,718.23,89,,,Percent of total Billed Charges,89% of total Billed charges,718.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,718.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,621.39,77,,,Percent of total Billed charges,77% of total billed charges,685.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.75,718.23,
AMPUTATION OF TOE,P991500730,CDM,521,RC,28820,HCPCS,Outpatient,,,804,402,,619.08,77,,,Percent of Total Billed Charges,77% of total billed charges,205.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,715.56,89,,,Percent of total Billed Charges,89% of total Billed charges,715.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,715.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,619.08,77,,,Percent of total Billed charges,77% of total billed charges,683.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201,715.56,
PARTIAL AMPUTATION OF TOE,P991500731,CDM,521,RC,28825,HCPCS,Outpatient,,,340,170,,261.8,77,,,Percent of Total Billed Charges,77% of total billed charges,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,302.6,89,,,Percent of total Billed Charges,89% of total Billed charges,302.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,302.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.8,77,,,Percent of total Billed charges,77% of total billed charges,289,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85,302.6,
APPLICATION OF LONG ARM SPLINT,P991500732,CDM,521,RC,29105,HCPCS,Outpatient,,,153,76.5,,117.81,77,,,Percent of Total Billed Charges,77% of total billed charges,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.17,89,,,Percent of total Billed Charges,89% of total Billed charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.81,77,,,Percent of total Billed charges,77% of total billed charges,130.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.25,136.17,
APP FINGER SPLINT STATIC,P991500733,CDM,521,RC,29130,HCPCS,Outpatient,,,78,39,,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.42,89,,,Percent of total Billed Charges,89% of total Billed charges,69.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,69.42,
STRAPPING ELBOW OR WRIST,P991500734,CDM,521,RC,29260,HCPCS,Outpatient,,,55,27.5,,42.35,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.95,89,,,Percent of total Billed Charges,89% of total Billed charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,77,,,Percent of total Billed charges,77% of total billed charges,46.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.95,
STRAPPING HAND OR FINGER,P991500735,CDM,521,RC,29280,HCPCS,Outpatient,,,56,28,,43.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.84,89,,,Percent of total Billed Charges,89% of total Billed charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.12,77,,,Percent of total Billed charges,77% of total billed charges,47.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,49.84,
APPLICATION OF CYLINDER CAST,P991500736,CDM,521,RC,29365,HCPCS,Outpatient,,,228,114,,175.56,77,,,Percent of Total Billed Charges,77% of total billed charges,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.92,89,,,Percent of total Billed Charges,89% of total Billed charges,202.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.56,77,,,Percent of total Billed charges,77% of total billed charges,193.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57,202.92,
DRAINAGE OF ARM BURSA,P991500737,CDM,521,RC,29391,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267,89,,,Percent of total Billed Charges,89% of total Billed charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
APPLICATION OF WALKING CAST,P991500738,CDM,521,RC,29425,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,123.71,89,,,Percent of total Billed Charges,89% of total Billed charges,123.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.75,123.71,
APPLICATION OF LEG CAST,P991500739,CDM,521,RC,29450,HCPCS,Outpatient,,,273,136.5,,210.21,77,,,Percent of Total Billed Charges,77% of total billed charges,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.97,89,,,Percent of total Billed Charges,89% of total Billed charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.21,77,,,Percent of total Billed charges,77% of total billed charges,232.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,242.97,
APPLICATION OF LONG LEG SPLINT,P991500740,CDM,521,RC,29505,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,143.29,89,,,Percent of total Billed Charges,89% of total Billed charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.25,143.29,
STRAPPING KNEE,P991500741,CDM,521,RC,29530,HCPCS,Outpatient,,,55,27.5,,42.35,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.95,89,,,Percent of total Billed Charges,89% of total Billed charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,77,,,Percent of total Billed charges,77% of total billed charges,46.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.95,
STRAPPING ANKLE,P991500742,CDM,521,RC,29540,HCPCS,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.17,89,,,Percent of total Billed Charges,89% of total Billed charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.17,
APPLICATION OF UNNA BOOT,P991500743,CDM,521,RC,29580,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.07,89,,,Percent of total Billed Charges,89% of total Billed charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
APP MULT COMPRS LWR LEG BILAT,P991500744,CDM,521,RC,29581,HCPCS,Outpatient,,,160,80,50,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.4,89,,,Percent of total Billed Charges,89% of total Billed charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,142.4,
APPLY MULTLAY COMPRS LWR LEG,P991500745,CDM,521,RC,29581,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.1,89,,,Percent of total Billed Charges,89% of total Billed charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.5,80.1,
REMOVAL/REVISION OF CAST,P991500746,CDM,521,RC,29700,HCPCS,Outpatient,,,114,57,,87.78,77,,,Percent of Total Billed Charges,77% of total billed charges,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101.46,89,,,Percent of total Billed Charges,89% of total Billed charges,101.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.78,77,,,Percent of total Billed charges,77% of total billed charges,96.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.5,101.46,
REMOVAL/REVISION OF CAST,P991500747,CDM,521,RC,29705,HCPCS,Outpatient,,,117,58.5,,90.09,77,,,Percent of Total Billed Charges,77% of total billed charges,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104.13,89,,,Percent of total Billed Charges,89% of total Billed charges,104.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.09,77,,,Percent of total Billed charges,77% of total billed charges,99.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.13,
WINDOWING OF CAST,P991500748,CDM,521,RC,29730,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.02,89,,,Percent of total Billed Charges,89% of total Billed charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,105.02,
SHO ARTHRS DX +- SYNOVIAL BX,P991500749,CDM,521,RC,29805,HCPCS,Outpatient,,,884,442,,680.68,77,,,Percent of Total Billed Charges,77% of total billed charges,225.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,786.76,89,,,Percent of total Billed Charges,89% of total Billed charges,786.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.68,77,,,Percent of total Billed charges,77% of total billed charges,751.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,360.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221,786.76,
SHO ARTHRS SRG CAPSULORRAPHY,P991500750,CDM,521,RC,29806,HCPCS,Outpatient,,,2270,1135,,1747.9,77,,,Percent of Total Billed Charges,77% of total billed charges,578.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,709.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,567.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2020.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2020.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,926.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,926.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,926.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,567.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1747.9,77,,,Percent of total Billed charges,77% of total billed charges,1929.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,926.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,567.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,567.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,567.5,2020.3,
SHO ARTHRS SRG RMVL LOOSE/FB,P991500751,CDM,521,RC,29819,HCPCS,Outpatient,,,1247,623.5,,960.19,77,,,Percent of Total Billed Charges,77% of total billed charges,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1109.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1109.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1109.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.19,77,,,Percent of total Billed charges,77% of total billed charges,1059.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,358.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,508.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.75,1109.83,
SHO ARTHRS SRG PRTL SYNVCT,P991500752,CDM,521,RC,29820,HCPCS,Outpatient,,,1122,561,,863.94,77,,,Percent of Total Billed Charges,77% of total billed charges,286.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,286.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,280.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,998.58,89,,,Percent of total Billed Charges,89% of total Billed charges,998.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,998.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,457.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,457.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,457.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,863.94,77,,,Percent of total Billed charges,77% of total billed charges,953.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,322.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,457.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,280.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,280.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.5,998.58,
SHO ARTHRS SRG LMTD DBRDMT,P991500753,CDM,521,RC,29822,HCPCS,Outpatient,,,1206,603,,928.62,77,,,Percent of Total Billed Charges,77% of total billed charges,307.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1073.34,89,,,Percent of total Billed Charges,89% of total Billed charges,1073.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1073.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,492.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,492.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,492.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,928.62,77,,,Percent of total Billed charges,77% of total billed charges,1025.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,492.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.5,1073.34,
SHO ARTHRS SRG XTNSV DBRDMT,P991500754,CDM,521,RC,29823,HCPCS,Outpatient,,,1299,649.5,,1000.23,77,,,Percent of Total Billed Charges,77% of total billed charges,331.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1156.11,89,,,Percent of total Billed Charges,89% of total Billed charges,1156.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1156.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.23,77,,,Percent of total Billed charges,77% of total billed charges,1104.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,373.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,529.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.75,1156.11,
SHO ARTHRS SRG DSTL CLAVICLC,P991500755,CDM,920,RC,29824,HCPCS,Outpatient,,,1390,695,,1070.3,77,,,Percent of Total Billed Charges,77% of total billed charges,354.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,434.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1028.6,74,,,Percent of Total Billed Charges,74% of total billed charges,959.1,69,,,Percent of Total Billed Charges,69% of total billed charges,959.1,69,,,Percent of Total Billed Charges,69% of total billed charges,347.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,959.1,69,,,Percent of Total Billed Charges,69% of total billed charges,959.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1167.6,84,,,Percent of Total Billed Charges,84% of total billed charges,1139.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,1237.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1237.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,567.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,567.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,567.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1070.3,77,,,Percent of total Billed charges,77% of total billed charges,1181.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,399.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,567.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,347.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,347.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,1237.1,
SHO ARTHRS SRG LSS&RESCJ ADS,P991500756,CDM,521,RC,29825,HCPCS,Outpatient,,,1043,521.5,,803.11,77,,,Percent of Total Billed Charges,77% of total billed charges,265.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,928.27,89,,,Percent of total Billed Charges,89% of total Billed charges,928.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,928.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,425.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,803.11,77,,,Percent of total Billed charges,77% of total billed charges,886.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,299.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.75,928.27,
SHO ARTHRS SRG DECOMPRESSION,P991500757,CDM,521,RC,29826,HCPCS,Outpatient,,,377,188.5,,290.29,77,,,Percent of Total Billed Charges,77% of total billed charges,96.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,335.53,89,,,Percent of total Billed Charges,89% of total Billed charges,335.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.29,77,,,Percent of total Billed charges,77% of total billed charges,320.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.25,335.53,
D&S ARTHRO SHOULDER,P991500758,CDM,521,RC,29827,HCPCS,Outpatient,,,2222,1111,,1710.94,77,,,Percent of Total Billed Charges,77% of total billed charges,566.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1977.58,89,,,Percent of total Billed Charges,89% of total Billed charges,1977.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1710.94,77,,,Percent of total Billed charges,77% of total billed charges,1888.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,906.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,555.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.5,1977.58,
ARTHROSCOPY BICEPS TENODESIS,P991500759,CDM,521,RC,29828,HCPCS,Outpatient,,,1951,975.5,,1502.27,77,,,Percent of Total Billed Charges,77% of total billed charges,497.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,609.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1736.39,89,,,Percent of total Billed Charges,89% of total Billed charges,1736.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1736.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,796.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,796.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,796.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.27,77,,,Percent of total Billed charges,77% of total billed charges,1658.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,560.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,796.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,487.75,1736.39,
WRIST ENDOSCOPY/SURGERY,P991500760,CDM,521,RC,29848,HCPCS,Outpatient,,,1081,540.5,,832.37,77,,,Percent of Total Billed Charges,77% of total billed charges,275.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,337.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,962.09,89,,,Percent of total Billed Charges,89% of total Billed charges,962.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,962.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,832.37,77,,,Percent of total Billed charges,77% of total billed charges,918.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,310.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,441.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.25,962.09,
OSTEOCHONDRAL ALLOGRAFT,P991500761,CDM,521,RC,29867,HCPCS,Outpatient,,,2746,1373,,2114.42,77,,,Percent of Total Billed Charges,77% of total billed charges,700.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,686.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2443.94,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.42,77,,,Percent of total Billed charges,77% of total billed charges,2334.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1120.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,686.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.5,2443.94,
KNEE ARTHROSCOPY DX,P991500762,CDM,521,RC,29870,HCPCS,Outpatient,,,1280,640,,985.6,77,,,Percent of Total Billed Charges,77% of total billed charges,326.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,326.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,400,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1139.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1139.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1139.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,522.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,522.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,522.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.6,77,,,Percent of total Billed charges,77% of total billed charges,1088,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,368,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,522.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,320,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,320,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320,1139.2,
KNEE ARTHROSCOPY/DRAINAGE,P991500763,CDM,521,RC,29871,HCPCS,Outpatient,,,972,486,,748.44,77,,,Percent of Total Billed Charges,77% of total billed charges,247.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,865.08,89,,,Percent of total Billed Charges,89% of total Billed charges,865.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,865.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.44,77,,,Percent of total Billed charges,77% of total billed charges,826.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,279.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,396.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243,865.08,
ARTHRO KNEE LATERAL RELEASE,P991500764,CDM,521,RC,29873,HCPCS,Outpatient,,,1354,677,,1042.58,77,,,Percent of Total Billed Charges,77% of total billed charges,345.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1205.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.58,77,,,Percent of total Billed charges,77% of total billed charges,1150.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,552.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,338.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.5,1205.06,
ARTHRO KNEE REM LOOSE/FB,P991500765,CDM,521,RC,29874,HCPCS,Outpatient,,,1986,993,,1529.22,77,,,Percent of Total Billed Charges,77% of total billed charges,506.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,506.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,620.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,496.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1767.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1767.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,810.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,810.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,810.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,496.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1529.22,77,,,Percent of total Billed charges,77% of total billed charges,1688.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,570.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,810.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,496.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,496.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.5,1767.54,
"SYNOVECTOMY, LIMITED",P991500766,CDM,521,RC,29875,HCPCS,Outpatient,,,1051,525.5,,809.27,77,,,Percent of Total Billed Charges,77% of total billed charges,268.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,935.39,89,,,Percent of total Billed Charges,89% of total Billed charges,935.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,935.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,809.27,77,,,Percent of total Billed charges,77% of total billed charges,893.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,302.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,428.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.75,935.39,
KNEE ARTHRO 2 COMP BILAT,P991500767,CDM,521,RC,29876,HCPCS,Outpatient,,,2752,1376,50,2119.04,77,,,Percent of Total Billed Charges,77% of total billed charges,701.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,701.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,860,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,688,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2449.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2449.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2449.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1122.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1122.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1122.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,688,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2119.04,77,,,Percent of total Billed charges,77% of total billed charges,2339.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,791.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1122.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,688,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,688,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688,2449.28,
KNEE ARTHRO/SURGERY 2 COMP,P991500768,CDM,521,RC,29876,HCPCS,Outpatient,,,1376,688,,1059.52,77,,,Percent of Total Billed Charges,77% of total billed charges,350.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,344,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1224.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1224.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1224.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,561.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1059.52,77,,,Percent of total Billed charges,77% of total billed charges,1169.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,395.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,561.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,344,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344,1224.64,
KNEE ARTHRO/SURGERY,P991500769,CDM,521,RC,29877,HCPCS,Outpatient,,,1299,649.5,,1000.23,77,,,Percent of Total Billed Charges,77% of total billed charges,331.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1156.11,89,,,Percent of total Billed Charges,89% of total Billed charges,1156.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1156.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,529.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.23,77,,,Percent of total Billed charges,77% of total billed charges,1104.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,373.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,529.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,324.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.75,1156.11,
KNEE ARTHRO/SURGERY,P991500770,CDM,521,RC,29879,HCPCS,Outpatient,,,1385,692.5,,1066.45,77,,,Percent of Total Billed Charges,77% of total billed charges,353.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,346.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1232.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1232.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1232.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,565.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,565.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,565.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1066.45,77,,,Percent of total Billed charges,77% of total billed charges,1177.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,398.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,565.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,346.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,346.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.25,1232.65,
KNEE ARTHRO W/MENISCCTMY BILAT,P991500771,CDM,521,RC,29880,HCPCS,Outpatient,,,4984,2492,,3837.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1270.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1270.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1557.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4435.76,89,,,Percent of total Billed Charges,89% of total Billed charges,4435.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4435.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2033.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2033.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2033.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3837.68,77,,,Percent of total Billed charges,77% of total billed charges,4236.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1432.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2033.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1246,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1246,4435.76,
KNEE ARTHRO W/MENISCECTOMY,P991500772,CDM,521,RC,29880,HCPCS,Outpatient,,,2492,1246,,1918.84,77,,,Percent of Total Billed Charges,77% of total billed charges,635.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,778.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,623,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2217.88,89,,,Percent of total Billed Charges,89% of total Billed charges,2217.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2217.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1016.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1016.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1016.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,623,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1918.84,77,,,Percent of total Billed charges,77% of total billed charges,2118.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,716.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1016.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,623,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,623,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623,2217.88,
KNE ARTH W/MENISC W/SHAV BILAT,P991500773,CDM,521,RC,29881,HCPCS,Outpatient,,,4408,2204,50,3394.16,77,,,Percent of Total Billed Charges,77% of total billed charges,1124.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1124.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1102,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3923.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3923.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3923.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1798.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1798.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1798.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1102,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3394.16,77,,,Percent of total Billed charges,77% of total billed charges,3746.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1267.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1798.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1102,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1102,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1102,3923.12,
KNEE ARTH W/MENISC W/ SHAVING,P991500774,CDM,521,RC,29881,HCPCS,Outpatient,,,2204,1102,,1697.08,77,,,Percent of Total Billed Charges,77% of total billed charges,562.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,562.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,551,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1961.56,89,,,Percent of total Billed Charges,89% of total Billed charges,1961.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1961.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,899.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,899.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,899.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1697.08,77,,,Percent of total Billed charges,77% of total billed charges,1873.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,633.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,899.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,551,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,551,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551,1961.56,
KNEE ARTHRO/SURGERY,P991500775,CDM,521,RC,29882,HCPCS,Outpatient,,,1489,744.5,,1146.53,77,,,Percent of Total Billed Charges,77% of total billed charges,379.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,379.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,465.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,372.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1325.21,89,,,Percent of total Billed Charges,89% of total Billed charges,1325.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1325.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,607.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,607.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,607.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1146.53,77,,,Percent of total Billed charges,77% of total billed charges,1265.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,428.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,607.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,372.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,372.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.25,1325.21,
KNEE ARTHRO/SURGERY,P991500776,CDM,521,RC,29883,HCPCS,Outpatient,,,2898,1449,,2231.46,77,,,Percent of Total Billed Charges,77% of total billed charges,738.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,738.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,905.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,724.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2579.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2579.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2579.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1182.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1182.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1182.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2231.46,77,,,Percent of total Billed charges,77% of total billed charges,2463.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,833.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1182.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,724.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,724.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.5,2579.22,
KNEE ARTHROSCOPY/SURGERY,P991500777,CDM,522,RC,29884,HCPCS,Outpatient,,,1170,585,,900.9,77,,,Percent of Total Billed Charges,77% of total billed charges,298.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,298.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,292.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1041.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1041.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1041.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,477.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,477.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,477.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,900.9,77,,,Percent of total Billed charges,77% of total billed charges,994.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,336.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,477.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,292.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.5,1041.3,
KNEE ARTHRO/SURGERY,P991500778,CDM,521,RC,29888,HCPCS,Outpatient,,,2077,1038.5,,1599.29,77,,,Percent of Total Billed Charges,77% of total billed charges,529.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,529.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,649.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,519.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1848.53,89,,,Percent of total Billed Charges,89% of total Billed charges,1848.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1848.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,847.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,847.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,519.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1599.29,77,,,Percent of total Billed charges,77% of total billed charges,1765.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,597.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,847.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,519.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,519.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.25,1848.53,
"BIOPSY, INTRANASAL",P991500779,CDM,521,RC,30100,HCPCS,Outpatient,,,283,141.5,,217.91,77,,,Percent of Total Billed Charges,77% of total billed charges,72.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,251.87,89,,,Percent of total Billed Charges,89% of total Billed charges,251.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.91,77,,,Percent of total Billed charges,77% of total billed charges,240.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.75,251.87,
EXCISION NASAL POLYP SIMPLE,P991500780,CDM,521,RC,30110,HCPCS,Outpatient,,,538,269,50,414.26,77,,,Percent of Total Billed Charges,77% of total billed charges,137.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,478.82,89,,,Percent of total Billed Charges,89% of total Billed charges,478.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.26,77,,,Percent of total Billed charges,77% of total billed charges,457.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,219.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.5,478.82,
REMOVAL OF INTRANASAL LESION,P991500781,CDM,521,RC,30117,HCPCS,Outpatient,,,1708,854,,1315.16,77,,,Percent of Total Billed Charges,77% of total billed charges,435.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,435.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,533.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1520.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1520.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1520.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,696.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,696.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,696.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.16,77,,,Percent of total Billed charges,77% of total billed charges,1451.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,491.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,696.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,427,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,427,1520.12,
EXCISE INFERIOR TURBINATE,P991500782,CDM,521,RC,30130,HCPCS,Outpatient,,,770,385,,592.9,77,,,Percent of Total Billed Charges,77% of total billed charges,196.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,240.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,685.3,89,,,Percent of total Billed Charges,89% of total Billed charges,685.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,592.9,77,,,Percent of total Billed charges,77% of total billed charges,654.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,192.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,685.3,
RESECT INFER TURBINATE BILAT,P991500783,CDM,521,RC,30140,HCPCS,Outpatient,,,1766,883,50,1359.82,77,,,Percent of Total Billed Charges,77% of total billed charges,450.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,450.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,551.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,441.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1571.74,89,,,Percent of total Billed Charges,89% of total Billed charges,1571.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1571.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,720.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,720.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,720.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1359.82,77,,,Percent of total Billed charges,77% of total billed charges,1501.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,507.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,720.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,441.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,441.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,441.5,1571.74,
RESECT INFERIOR TURBINATE,P991500784,CDM,521,RC,30140,HCPCS,Outpatient,,,883,441.5,,679.91,77,,,Percent of Total Billed Charges,77% of total billed charges,225.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,785.87,89,,,Percent of total Billed Charges,89% of total Billed charges,785.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,785.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.91,77,,,Percent of total Billed charges,77% of total billed charges,750.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,253.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,360.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.75,785.87,
INSERT NASAL SEPTAL BUTTON,P991500785,CDM,521,RC,30220,HCPCS,Outpatient,,,552,276,,425.04,77,,,Percent of Total Billed Charges,77% of total billed charges,140.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,491.28,89,,,Percent of total Billed Charges,89% of total Billed charges,491.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.04,77,,,Percent of total Billed charges,77% of total billed charges,469.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,225.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,491.28,
REMOVAL FOREIGN BODY NOSE,P991500786,CDM,521,RC,30300,HCPCS,Outpatient,,,371,185.5,,285.67,77,,,Percent of Total Billed Charges,77% of total billed charges,94.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,330.19,89,,,Percent of total Billed Charges,89% of total Billed charges,330.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.67,77,,,Percent of total Billed charges,77% of total billed charges,315.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.75,330.19,
REMOVE NASAL FOREIGN BODY,P991500787,CDM,521,RC,30310,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
RECONSTRUCTION OF NOSE,P991500788,CDM,521,RC,30420,HCPCS,Outpatient,,,2824,1412,,2174.48,77,,,Percent of Total Billed Charges,77% of total billed charges,720.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,720.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,882.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,706,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2513.36,89,,,Percent of total Billed Charges,89% of total Billed charges,2513.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2513.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1152.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1152.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1152.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,706,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2174.48,77,,,Percent of total Billed charges,77% of total billed charges,2400.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1152.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,706,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,706,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,706,2513.36,
RECONSTRUCTION OF NOSE BILAT,P991500789,CDM,521,RC,30420,HCPCS,Outpatient,,,5648,2824,,4348.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1440.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1440.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1765,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5026.72,89,,,Percent of total Billed Charges,89% of total Billed charges,5026.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5026.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2304.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2304.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2304.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4348.96,77,,,Percent of total Billed charges,77% of total billed charges,4800.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1623.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2304.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1412,5026.72,
REPAIR NASAL STENOSIS,P991500790,CDM,521,RC,30465,HCPCS,Outpatient,,,2023,1011.5,,1557.71,77,,,Percent of Total Billed Charges,77% of total billed charges,515.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,515.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,505.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1800.47,89,,,Percent of total Billed Charges,89% of total Billed charges,1800.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1800.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,825.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,825.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,825.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,505.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1557.71,77,,,Percent of total Billed charges,77% of total billed charges,1719.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,581.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,825.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,505.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,505.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,505.75,1800.47,
SEPTOPLASTY,P991500791,CDM,521,RC,30520,HCPCS,Outpatient,,,1247,623.5,,960.19,77,,,Percent of Total Billed Charges,77% of total billed charges,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1109.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1109.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1109.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.19,77,,,Percent of total Billed charges,77% of total billed charges,1059.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,358.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,508.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.75,1109.83,
SEPTOPLASTY BILAT,P991500792,CDM,521,RC,30520,HCPCS,Outpatient,,,2550,1275,,1963.5,77,,,Percent of Total Billed Charges,77% of total billed charges,650.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,796.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,637.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2269.5,89,,,Percent of total Billed Charges,89% of total Billed charges,2269.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2269.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1040.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1040.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1040.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,637.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1963.5,77,,,Percent of total Billed charges,77% of total billed charges,2167.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,733.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1040.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,637.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,637.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.5,2269.5,
RELEASE OF NASAL AHDESION,P991500793,CDM,521,RC,30560,HCPCS,Outpatient,,,583,291.5,,448.91,77,,,Percent of Total Billed Charges,77% of total billed charges,148.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,518.87,89,,,Percent of total Billed Charges,89% of total Billed charges,518.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.91,77,,,Percent of total Billed charges,77% of total billed charges,495.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.75,518.87,
MUCOSAL GRAFT (INPUT),P991500794,CDM,521,RC,30620,HCPCS,Outpatient,,,1265,632.5,,974.05,77,,,Percent of Total Billed Charges,77% of total billed charges,322.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1125.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1125.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1125.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,516.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,974.05,77,,,Percent of total Billed charges,77% of total billed charges,1075.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,363.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,516.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.25,1125.85,
REPAIR NASAL SEPTUM DEFECT,P991500795,CDM,521,RC,30630,HCPCS,Outpatient,,,1272,636,,979.44,77,,,Percent of Total Billed Charges,77% of total billed charges,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.44,77,,,Percent of total Billed charges,77% of total billed charges,1081.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318,1132.08,
ABLATE INF TURBINATE SUBMUC,P991500796,CDM,521,RC,30802,HCPCS,Outpatient,,,571,285.5,,439.67,77,,,Percent of Total Billed Charges,77% of total billed charges,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,508.19,89,,,Percent of total Billed Charges,89% of total Billed charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439.67,77,,,Percent of total Billed charges,77% of total billed charges,485.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,164.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.75,508.19,
CONTROL OF NOSEBLEED,P991500797,CDM,521,RC,30901,HCPCS,Outpatient,,,194,97,,149.38,77,,,Percent of Total Billed Charges,77% of total billed charges,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.66,89,,,Percent of total Billed Charges,89% of total Billed charges,172.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,77,,,Percent of total Billed charges,77% of total billed charges,164.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.5,172.66,
SPHENOPALATINE ARTERY LIGATION,P991500798,CDM,521,RC,30920,HCPCS,Outpatient,,,1733,866.5,,1334.41,77,,,Percent of Total Billed Charges,77% of total billed charges,441.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,441.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1542.37,89,,,Percent of total Billed Charges,89% of total Billed charges,1542.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1542.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1334.41,77,,,Percent of total Billed charges,77% of total billed charges,1473.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.25,1542.37,
FX NASAL INF TURBINATE BILAT,P991500799,CDM,521,RC,30930,HCPCS,Outpatient,,,502,251,50,386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,128.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,446.78,89,,,Percent of total Billed Charges,89% of total Billed charges,446.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.54,77,,,Percent of total Billed charges,77% of total billed charges,426.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.5,446.78,
FX NASAL INFERIOR TURBINATE(S),P991500800,CDM,521,RC,30930,HCPCS,Outpatient,,,251,125.5,,193.27,77,,,Percent of Total Billed Charges,77% of total billed charges,64.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,223.39,89,,,Percent of total Billed Charges,89% of total Billed charges,223.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.27,77,,,Percent of total Billed charges,77% of total billed charges,213.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.39,
SPHENOID LAVAGE,P991500801,CDM,521,RC,31002,HCPCS,Outpatient,,,355,177.5,,273.35,77,,,Percent of Total Billed Charges,77% of total billed charges,90.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,315.95,89,,,Percent of total Billed Charges,89% of total Billed charges,315.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.35,77,,,Percent of total Billed charges,77% of total billed charges,301.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.75,315.95,
NASAL ENDOSCOPY DX,P991500802,CDM,521,RC,31231,HCPCS,Outpatient,,,412,206,,317.24,77,,,Percent of Total Billed Charges,77% of total billed charges,105.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,366.68,89,,,Percent of total Billed Charges,89% of total Billed charges,366.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.24,77,,,Percent of total Billed charges,77% of total billed charges,350.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,366.68,
NASAL ENDOSCOPY DX BILAT,P991500803,CDM,521,RC,31231,HCPCS,Outpatient,,,824,412,,634.48,77,,,Percent of Total Billed Charges,77% of total billed charges,210.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,733.36,89,,,Percent of total Billed Charges,89% of total Billed charges,733.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.48,77,,,Percent of total Billed charges,77% of total billed charges,700.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,336.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206,733.36,
NSL/SINS NDSC DX MAX SINUSC,P991500804,CDM,521,RC,31233,HCPCS,Outpatient,,,502,251,,386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,128.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,446.78,89,,,Percent of total Billed Charges,89% of total Billed charges,446.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.54,77,,,Percent of total Billed charges,77% of total billed charges,426.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.5,446.78,
NSL/SINS NDSC DX SPHN SINUSC,P991500805,CDM,521,RC,31235,HCPCS,Outpatient,,,570,285,,438.9,77,,,Percent of Total Billed Charges,77% of total billed charges,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,507.3,89,,,Percent of total Billed Charges,89% of total Billed charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.9,77,,,Percent of total Billed charges,77% of total billed charges,484.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.5,507.3,
NASAL SCPE W/BX POLYP/DBMNT BI,P991500806,CDM,521,RC,31237,HCPCS,Outpatient,,,1050,525,,808.5,77,,,Percent of Total Billed Charges,77% of total billed charges,267.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,934.5,89,,,Percent of total Billed Charges,89% of total Billed charges,934.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.5,77,,,Percent of total Billed charges,77% of total billed charges,892.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,428.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.5,934.5,
NASAL SCPE W/BX POLYP/DBRDMT,P991500807,CDM,521,RC,31237,HCPCS,Outpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,467.25,89,,,Percent of total Billed Charges,89% of total Billed charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,214.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.25,467.25,
NASAL SCOPE CONTROL HEMRRG,P991500808,CDM,521,RC,31238,HCPCS,Outpatient,,,526,263,,405.02,77,,,Percent of Total Billed Charges,77% of total billed charges,134.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,468.14,89,,,Percent of total Billed Charges,89% of total Billed charges,468.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.02,77,,,Percent of total Billed charges,77% of total billed charges,447.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,214.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.5,468.14,
NASAL SCOPE CONTROL HEMRRG BI,P991500809,CDM,521,RC,31238,HCPCS,Outpatient,,,1052,526,,810.04,77,,,Percent of Total Billed Charges,77% of total billed charges,268.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,263,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,936.28,89,,,Percent of total Billed Charges,89% of total Billed charges,936.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,429.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,429.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,429.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,810.04,77,,,Percent of total Billed charges,77% of total billed charges,894.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,302.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,429.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,263,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,263,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263,936.28,
NASAL/SINUS ENDOSCOPY SURG,P991500810,CDM,521,RC,31239,HCPCS,Outpatient,,,1283,641.5,,987.91,77,,,Percent of Total Billed Charges,77% of total billed charges,327.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,400.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1141.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1141.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1141.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,523.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,523.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,523.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.91,77,,,Percent of total Billed charges,77% of total billed charges,1090.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,368.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,523.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,320.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,320.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.75,1141.87,
NASAL CONCHA BULLOSA RESECT BI,P991500811,CDM,521,RC,31240,HCPCS,Outpatient,,,684,342,50,526.68,77,,,Percent of Total Billed Charges,77% of total billed charges,174.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,171,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,608.76,89,,,Percent of total Billed Charges,89% of total Billed charges,608.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,608.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,279.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,526.68,77,,,Percent of total Billed charges,77% of total billed charges,581.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,279.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,171,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171,608.76,
NASAL CONCHA BULLOSA RESECTION,P991500812,CDM,521,RC,31240,HCPCS,Outpatient,,,342,171,,263.34,77,,,Percent of Total Billed Charges,77% of total billed charges,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,304.38,89,,,Percent of total Billed Charges,89% of total Billed charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.34,77,,,Percent of total Billed charges,77% of total billed charges,290.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,139.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.5,304.38,
NSL/SINS NDSC TOTAL,P991500813,CDM,521,RC,31253,HCPCS,Outpatient,,,988,494,,760.76,77,,,Percent of Total Billed Charges,77% of total billed charges,251.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,308.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,879.32,89,,,Percent of total Billed Charges,89% of total Billed charges,879.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,879.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,760.76,77,,,Percent of total Billed charges,77% of total billed charges,839.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,247,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247,879.32,
NSL/SINS NDSC TOTAL BILAT,P991500814,CDM,521,RC,31253,HCPCS,Outpatient,,,1907.2,953.6,50,1468.54,77,,,Percent of Total Billed Charges,77% of total billed charges,486.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,476.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1697.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1697.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1697.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,778.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.54,77,,,Percent of total Billed charges,77% of total billed charges,1621.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,548.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,778.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,476.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.8,1697.41,
NASAL NDSC W/PRTL ETHMDCT BI,P991500815,CDM,521,RC,31254,HCPCS,Outpatient,,,1166,583,50,897.82,77,,,Percent of Total Billed Charges,77% of total billed charges,297.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1037.74,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,77,,,Percent of total Billed charges,77% of total billed charges,991.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,475.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,291.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.5,1037.74,
NSL/SINS NDSC W/PRTL ETHMDCT,P991500816,CDM,521,RC,31254,HCPCS,Outpatient,,,852,426,,656.04,77,,,Percent of Total Billed Charges,77% of total billed charges,217.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,758.28,89,,,Percent of total Billed Charges,89% of total Billed charges,758.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,656.04,77,,,Percent of total Billed charges,77% of total billed charges,724.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,347.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213,758.28,
NSL/SINS NDSC W/TOT ETHMDCT,P991500817,CDM,521,RC,31255,HCPCS,Outpatient,,,856,428,,659.12,77,,,Percent of Total Billed Charges,77% of total billed charges,218.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,214,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,761.84,89,,,Percent of total Billed Charges,89% of total Billed charges,761.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,761.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659.12,77,,,Percent of total Billed charges,77% of total billed charges,727.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,246.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,349.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,214,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,214,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214,761.84,
NSL/SINS NDSC W/TOT ETHMDCT BI,P991500818,CDM,521,RC,31255,HCPCS,Outpatient,,,1712,856,50,1318.24,77,,,Percent of Total Billed Charges,77% of total billed charges,436.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,535,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1523.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1523.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1523.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.24,77,,,Percent of total Billed charges,77% of total billed charges,1455.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,492.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,698.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,428,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428,1523.68,
EXPLORATION MAX SINUS BI,P991500819,CDM,521,RC,31256,HCPCS,Outpatient,,,842,421,50,648.34,77,,,Percent of Total Billed Charges,77% of total billed charges,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,749.38,89,,,Percent of total Billed Charges,89% of total Billed charges,749.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,749.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.34,77,,,Percent of total Billed charges,77% of total billed charges,715.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.5,749.38,
NASAL ENDO W/ MAX ANTROSTOMY,P991500820,CDM,521,RC,31256,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,374.69,89,,,Percent of total Billed Charges,89% of total Billed charges,374.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.25,374.69,
NSL/SINS NDSC TOT w/ SPHENDT,P991500821,CDM,521,RC,31257,HCPCS,Outpatient,,,850,425,,654.5,77,,,Percent of Total Billed Charges,77% of total billed charges,216.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,756.5,89,,,Percent of total Billed Charges,89% of total Billed charges,756.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.5,77,,,Percent of total Billed charges,77% of total billed charges,722.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,346.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.5,756.5,
NSL/SINS NDSC TOT W/SPHENDT BI,P991500822,CDM,521,RC,31257,HCPCS,Outpatient,,,1275,637.5,,981.75,77,,,Percent of Total Billed Charges,77% of total billed charges,325.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1134.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1134.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1134.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,981.75,77,,,Percent of total Billed charges,77% of total billed charges,1083.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,366.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,520.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.75,1134.75,
NSL/SINS NDSC SPHN TISS RMVL,P991500823,CDM,521,RC,31259,HCPCS,Outpatient,,,902,451,,694.54,77,,,Percent of Total Billed Charges,77% of total billed charges,230.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,281.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,802.78,89,,,Percent of total Billed Charges,89% of total Billed charges,802.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,802.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,368.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,694.54,77,,,Percent of total Billed charges,77% of total billed charges,766.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,259.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,225.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,225.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.5,802.78,
ENDOSCOPY MAXILLARY SINUS,P991500824,CDM,521,RC,31267,HCPCS,Outpatient,,,679,339.5,,522.83,77,,,Percent of Total Billed Charges,77% of total billed charges,173.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,604.31,89,,,Percent of total Billed Charges,89% of total Billed charges,604.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.83,77,,,Percent of total Billed charges,77% of total billed charges,577.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,195.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,277.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.75,604.31,
ENDOSCOPY MAXILLARY SINUS BI,P991500825,CDM,521,RC,31267,HCPCS,Outpatient,,,1358,679,50,1045.66,77,,,Percent of Total Billed Charges,77% of total billed charges,346.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1208.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1208.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1208.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,554.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1045.66,77,,,Percent of total Billed charges,77% of total billed charges,1154.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,390.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,554.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.5,1208.62,
NSL/SINS FRNT TISS RMVL BI,P991500826,CDM,521,RC,31276,HCPCS,Outpatient,,,1648,824,50,1268.96,77,,,Percent of Total Billed Charges,77% of total billed charges,420.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,420.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,515,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1466.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1466.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1466.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,672.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1268.96,77,,,Percent of total Billed charges,77% of total billed charges,1400.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,473.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,412,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412,1466.72,
NSL/SINS NDSC FRNT TISS RMVL,P991500827,CDM,521,RC,31276,HCPCS,Outpatient,,,824,412,,634.48,77,,,Percent of Total Billed Charges,77% of total billed charges,210.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,733.36,89,,,Percent of total Billed Charges,89% of total Billed charges,733.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.48,77,,,Percent of total Billed charges,77% of total billed charges,700.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,336.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206,733.36,
NASAL/SINUS ENDOSCOPY SURG,P991500828,CDM,521,RC,31287,HCPCS,Outpatient,,,990,495,50,762.3,77,,,Percent of Total Billed Charges,77% of total billed charges,252.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,881.1,89,,,Percent of total Billed Charges,89% of total Billed charges,881.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,881.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,762.3,77,,,Percent of total Billed charges,77% of total billed charges,841.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.5,881.1,
NSL RMVL TISS SPHENOID,P991500829,CDM,521,RC,31288,HCPCS,Outpatient,,,574,287,,441.98,77,,,Percent of Total Billed Charges,77% of total billed charges,146.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,143.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,510.86,89,,,Percent of total Billed Charges,89% of total Billed charges,510.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,510.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,441.98,77,,,Percent of total Billed charges,77% of total billed charges,487.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,234.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,143.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,143.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.5,510.86,
NSL RMVL TISS SPHENOID BILAT,P991500830,CDM,521,RC,31288,HCPCS,Outpatient,,,1160,580,,893.2,77,,,Percent of Total Billed Charges,77% of total billed charges,295.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1032.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1032.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1032.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,893.2,77,,,Percent of total Billed charges,77% of total billed charges,986,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,473.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,1032.4,
NSL/SINS NDSC SURG MAX SINS,P991500831,CDM,521,RC,31295,HCPCS,Outpatient,,,1953,976.5,,1503.81,77,,,Percent of Total Billed Charges,77% of total billed charges,498.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,498.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,610.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,488.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1738.17,89,,,Percent of total Billed Charges,89% of total Billed charges,1738.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,796.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,796.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,796.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1503.81,77,,,Percent of total Billed charges,77% of total billed charges,1660.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,561.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,796.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,488.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.25,1738.17,
NSL/SINS NDSC SURG FRNT SINS,P991500832,CDM,521,RC,31296,HCPCS,Outpatient,,,1995,997.5,,1536.15,77,,,Percent of Total Billed Charges,77% of total billed charges,508.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,508.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,623.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,498.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1775.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1775.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1775.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,813.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,813.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,813.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,498.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1536.15,77,,,Percent of total Billed charges,77% of total billed charges,1695.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,573.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,813.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,498.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,498.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.75,1775.55,
NSL/SINS NDSC SURG SPHN SINS,P991500833,CDM,521,RC,31297,HCPCS,Outpatient,,,1955,977.5,,1505.35,77,,,Percent of Total Billed Charges,77% of total billed charges,498.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,498.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,610.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1739.95,89,,,Percent of total Billed Charges,89% of total Billed charges,1739.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1739.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,797.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,797.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,797.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1505.35,77,,,Percent of total Billed charges,77% of total billed charges,1661.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,562.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,797.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.75,1739.95,
INSERT EMERGENCY AIRWAY,P991500834,CDM,521,RC,31500,HCPCS,Outpatient,,,272,136,,209.44,77,,,Percent of Total Billed Charges,77% of total billed charges,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.08,89,,,Percent of total Billed Charges,89% of total Billed charges,242.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.44,77,,,Percent of total Billed charges,77% of total billed charges,231.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68,242.08,
LARYNGOSCOPY DIAGNOSTIC,P991500835,CDM,521,RC,31525,HCPCS,Outpatient,,,463,231.5,,356.51,77,,,Percent of Total Billed Charges,77% of total billed charges,118.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,412.07,89,,,Percent of total Billed Charges,89% of total Billed charges,412.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.51,77,,,Percent of total Billed charges,77% of total billed charges,393.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,412.07,
DX LARYNGOSCOPY W/OPER SCOPE,P991500836,CDM,521,RC,31526,HCPCS,Outpatient,,,296,148,,227.92,77,,,Percent of Total Billed Charges,77% of total billed charges,75.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,263.44,89,,,Percent of total Billed Charges,89% of total Billed charges,263.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.92,77,,,Percent of total Billed charges,77% of total billed charges,251.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74,263.44,
LARYNGOSCOPY AND DIALATION,P991500837,CDM,521,RC,31528,HCPCS,Outpatient,,,273,136.5,,210.21,77,,,Percent of Total Billed Charges,77% of total billed charges,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.97,89,,,Percent of total Billed Charges,89% of total Billed charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.21,77,,,Percent of total Billed charges,77% of total billed charges,232.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,242.97,
LARYNGOSCOPY W/FB & OP SCOPE,P991500838,CDM,521,RC,31531,HCPCS,Outpatient,,,401,200.5,,308.77,77,,,Percent of Total Billed Charges,77% of total billed charges,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356.89,89,,,Percent of total Billed Charges,89% of total Billed charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.77,77,,,Percent of total Billed charges,77% of total billed charges,340.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.25,356.89,
LARYNGOSCOPY W/BIOPSY,P991500839,CDM,521,RC,31535,HCPCS,Outpatient,,,357,178.5,,274.89,77,,,Percent of Total Billed Charges,77% of total billed charges,91.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,317.73,89,,,Percent of total Billed Charges,89% of total Billed charges,317.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.89,77,,,Percent of total Billed charges,77% of total billed charges,303.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.25,317.73,
LARYNGOSCOPY W/BX & OP SCOPE,P991500840,CDM,521,RC,31536,HCPCS,Outpatient,,,452,226,,348.04,77,,,Percent of Total Billed Charges,77% of total billed charges,115.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,402.28,89,,,Percent of total Billed Charges,89% of total Billed charges,402.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,402.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.04,77,,,Percent of total Billed charges,77% of total billed charges,384.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113,402.28,
LARYNGOSCOPY W/BX&OP SCOPE BI,P991500841,CDM,521,RC,31536,HCPCS,Outpatient,,,904,452,50,696.08,77,,,Percent of Total Billed Charges,77% of total billed charges,230.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,282.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,804.56,89,,,Percent of total Billed Charges,89% of total Billed charges,804.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,368.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,696.08,77,,,Percent of total Billed charges,77% of total billed charges,768.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,259.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226,804.56,
LARYNGOSCOPY W/ EXC OF TUMOR,P991500842,CDM,521,RC,31540,HCPCS,Outpatient,,,458,229,,352.66,77,,,Percent of Total Billed Charges,77% of total billed charges,116.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,407.62,89,,,Percent of total Billed Charges,89% of total Billed charges,407.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.66,77,,,Percent of total Billed charges,77% of total billed charges,389.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,186.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.5,407.62,
LARYNSCOP W/TUMR EXC + SCOPE,P991500843,CDM,521,RC,31541,HCPCS,Outpatient,,,500,250,,385,77,,,Percent of Total Billed Charges,77% of total billed charges,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445,500,,,fee schedule,500% of healthlink,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385,77,,,Percent of total Billed charges,77% of total billed charges,425,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125,445,
REMOVE VC LESION W/SCOPE,P991500844,CDM,521,RC,31545,HCPCS,Outpatient,,,686,343,,528.22,77,,,Percent of Total Billed Charges,77% of total billed charges,174.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,171.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,610.54,89,,,Percent of total Billed Charges,89% of total Billed charges,610.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,610.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,279.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,528.22,77,,,Percent of total Billed charges,77% of total billed charges,583.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,197.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,279.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,171.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.5,610.54,
LARYNGOSCOPE w/VC INJ + SCOPE,P991500845,CDM,521,RC,31571,HCPCS,Outpatient,,,471,235.5,,362.67,77,,,Percent of Total Billed Charges,77% of total billed charges,120.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,419.19,89,,,Percent of total Billed Charges,89% of total Billed charges,419.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.67,77,,,Percent of total Billed charges,77% of total billed charges,400.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,192.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.75,419.19,
DIAGNOSTIC LARYNGOSCOPY,P991500846,CDM,521,RC,31575,HCPCS,Outpatient,,,231,115.5,,177.87,77,,,Percent of Total Billed Charges,77% of total billed charges,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205.59,89,,,Percent of total Billed Charges,89% of total Billed charges,205.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.87,77,,,Percent of total Billed charges,77% of total billed charges,196.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,205.59,
DIAGNOSTIC LARYNGOSCOPY BILAT,P991500847,CDM,521,RC,31575,HCPCS,Outpatient,,,462,231,50,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,411.18,89,,,Percent of total Billed Charges,89% of total Billed charges,411.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,411.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,411.18,
"TRACHEOSTOMY, PLANNED",P991500848,CDM,521,RC,31600,HCPCS,Outpatient,,,583,291.5,,448.91,77,,,Percent of Total Billed Charges,77% of total billed charges,148.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,518.87,89,,,Percent of total Billed Charges,89% of total Billed charges,518.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.91,77,,,Percent of total Billed charges,77% of total billed charges,495.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.75,518.87,
INCISION OF WINDPIPE,P991500849,CDM,521,RC,31603,HCPCS,Outpatient,,,613,306.5,,472.01,77,,,Percent of Total Billed Charges,77% of total billed charges,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,545.57,89,,,Percent of total Billed Charges,89% of total Billed charges,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.01,77,,,Percent of total Billed charges,77% of total billed charges,521.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,250.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.25,545.57,
SURGERY/SPEECH PROSTHESIS,P991500850,CDM,521,RC,31611,HCPCS,Outpatient,,,999,499.5,,769.23,77,,,Percent of Total Billed Charges,77% of total billed charges,254.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,889.11,89,,,Percent of total Billed Charges,89% of total Billed charges,889.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,889.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,769.23,77,,,Percent of total Billed charges,77% of total billed charges,849.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,407.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,249.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.75,889.11,
DX BRONCHOSCOPE/WASH,P991500851,CDM,521,RC,31622,HCPCS,Outpatient,,,454,227,,349.58,77,,,Percent of Total Billed Charges,77% of total billed charges,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.06,89,,,Percent of total Billed Charges,89% of total Billed charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.58,77,,,Percent of total Billed charges,77% of total billed charges,385.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.5,404.06,
DX BRONCHOSCOPE/LAVAGE,P991500852,CDM,521,RC,31624,HCPCS,Outpatient,,,467,233.5,,359.59,77,,,Percent of Total Billed Charges,77% of total billed charges,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,415.63,89,,,Percent of total Billed Charges,89% of total Billed charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.59,77,,,Percent of total Billed charges,77% of total billed charges,396.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.75,415.63,
"ENDOSCOPY, BRONCH W/ BIOPSY",P991500853,CDM,521,RC,31625,HCPCS,Outpatient,,,635,317.5,,488.95,77,,,Percent of Total Billed Charges,77% of total billed charges,161.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,158.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,565.15,89,,,Percent of total Billed Charges,89% of total Billed charges,565.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,565.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.95,77,,,Percent of total Billed charges,77% of total billed charges,539.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,182.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,259.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,158.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,158.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.75,565.15,
CLEARANCE OF AIRWAYS,P991500854,CDM,521,RC,31720,HCPCS,Outpatient,,,94,47,,72.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83.66,89,,,Percent of total Billed Charges,89% of total Billed charges,83.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.38,77,,,Percent of total Billed charges,77% of total billed charges,79.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.5,83.66,
CLOSURE OF WINDPIPE LESION,P991500855,CDM,521,RC,31820,HCPCS,Outpatient,,,826,413,,636.02,77,,,Percent of Total Billed Charges,77% of total billed charges,210.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,735.14,89,,,Percent of total Billed Charges,89% of total Billed charges,735.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.02,77,,,Percent of total Billed charges,77% of total billed charges,702.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,337.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.5,735.14,
DRAIN OPEN LUNG LESION,P991500856,CDM,521,RC,32200,HCPCS,Outpatient,,,2986,1493,,2299.22,77,,,Percent of Total Billed Charges,77% of total billed charges,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2657.54,89,,,Percent of total Billed Charges,89% of total Billed charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.22,77,,,Percent of total Billed charges,77% of total billed charges,2538.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,858.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1218.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.5,2657.54,
INSERTION OF CHEST TUBE,P991500857,CDM,521,RC,32551,HCPCS,Outpatient,,,297,148.5,,228.69,77,,,Percent of Total Billed Charges,77% of total billed charges,75.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,264.33,89,,,Percent of total Billed Charges,89% of total Billed charges,264.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.69,77,,,Percent of total Billed charges,77% of total billed charges,252.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.25,264.33,
INSERT CATH PLEURA W/O IMG,P991500858,CDM,521,RC,32556,HCPCS,Outpatient,,,270,135,,207.9,77,,,Percent of Total Billed Charges,77% of total billed charges,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.3,89,,,Percent of total Billed Charges,89% of total Billed charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.9,77,,,Percent of total Billed charges,77% of total billed charges,229.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.5,240.3,
REMOVAL SUBQ CARD RHYTHM MNTR,P991500859,CDM,521,RC,33286,HCPCS,Outpatient,,,182,91,,140.14,77,,,Percent of Total Billed Charges,77% of total billed charges,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,161.98,89,,,Percent of total Billed Charges,89% of total Billed charges,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.14,77,,,Percent of total Billed charges,77% of total billed charges,154.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.5,161.98,
EXPLORATION THROMBOSIS NECK,P991500860,CDM,521,RC,35800,HCPCS,Outpatient,,,540,270,,415.8,77,,,Percent of Total Billed Charges,77% of total billed charges,137.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,480.6,89,,,Percent of total Billed Charges,89% of total Billed charges,480.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,480.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.8,77,,,Percent of total Billed charges,77% of total billed charges,459,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135,480.6,
EXPLORE ABDOMINAL VESSELS,P991500861,CDM,920,RC,35840,HCPCS,Outpatient,,,1115,557.5,,858.55,77,,,Percent of Total Billed Charges,77% of total billed charges,284.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,825.1,74,,,Percent of Total Billed Charges,74% of total billed charges,769.35,69,,,Percent of Total Billed Charges,69% of total billed charges,769.35,69,,,Percent of Total Billed Charges,69% of total billed charges,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,769.35,69,,,Percent of Total Billed Charges,69% of total billed charges,769.35,69,,,Percent of Total Billed Charges,69% of total billed charges,936.6,84,,,Percent of Total Billed Charges,84% of total billed charges,914.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,992.35,89,,,Percent of total Billed Charges,89% of total Billed charges,992.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,992.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,454.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,858.55,77,,,Percent of total Billed charges,77% of total billed charges,947.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,320.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,454.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,278.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,992.35,
VENIPUNCTURE,P991500862,CDM,521,RC,36415,HCPCS,Outpatient,,,29,14.5,,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,500,,,fee schedule,500% of healthlink,15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,24.65,
NJX SCLRSNT 1 INCMPTNT VEIN,P991500864,CDM,521,RC,36470,HCPCS,Outpatient,,,208,104,,160.16,77,,,Percent of Total Billed Charges,77% of total billed charges,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185.12,89,,,Percent of total Billed Charges,89% of total Billed charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.16,77,,,Percent of total Billed charges,77% of total billed charges,176.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52,185.12,
NJX SCLRSNT MLT INCMPTNT VN,P991500865,CDM,521,RC,36471,HCPCS,Outpatient,,,362,181,,278.74,77,,,Percent of Total Billed Charges,77% of total billed charges,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322.18,89,,,Percent of total Billed Charges,89% of total Billed charges,322.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.74,77,,,Percent of total Billed charges,77% of total billed charges,307.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,147.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,322.18,
INSERTION OF CATHETER VEIN,P991500866,CDM,521,RC,36510,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.51,89,,,Percent of total Billed Charges,89% of total Billed charges,141.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.75,141.51,
INSERT NON-TUNNEL CV CATH,P991500867,CDM,521,RC,36556,HCPCS,Outpatient,,,389,194.5,,299.53,77,,,Percent of Total Billed Charges,77% of total billed charges,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,346.21,89,,,Percent of total Billed Charges,89% of total Billed charges,346.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.53,77,,,Percent of total Billed charges,77% of total billed charges,330.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,158.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.25,346.21,
INSERT TUNNELED CV CATH,P991500868,CDM,521,RC,36561,HCPCS,Outpatient,,,2235,1117.5,,1720.95,77,,,Percent of Total Billed Charges,77% of total billed charges,569.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,569.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,698.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,558.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1989.15,89,,,Percent of total Billed Charges,89% of total Billed charges,1989.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1989.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,911.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,911.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,911.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1720.95,77,,,Percent of total Billed charges,77% of total billed charges,1899.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,642.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,911.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,558.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,558.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.75,1989.15,
INSERT TUNNELED CV CATH,P991500869,CDM,521,RC,36563,HCPCS,Outpatient,,,2366,1183,,1821.82,77,,,Percent of Total Billed Charges,77% of total billed charges,603.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,603.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,739.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2105.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2105.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2105.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,965.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,965.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,965.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1821.82,77,,,Percent of total Billed charges,77% of total billed charges,2011.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,680.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,965.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,591.5,2105.74,
INSERT TUNNELED CV CATH,P991500870,CDM,521,RC,36565,HCPCS,Outpatient,,,1781,890.5,,1371.37,77,,,Percent of Total Billed Charges,77% of total billed charges,454.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,454.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,556.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1585.09,89,,,Percent of total Billed Charges,89% of total Billed charges,1585.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1585.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,726.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,726.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,726.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,445.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1371.37,77,,,Percent of total Billed charges,77% of total billed charges,1513.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,512.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,726.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,445.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,445.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.25,1585.09,
INSJ PICC 5 YR+ W/O IMAGING,P991500871,CDM,521,RC,36569,HCPCS,Outpatient,,,648,324,,498.96,77,,,Percent of Total Billed Charges,77% of total billed charges,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,576.72,89,,,Percent of total Billed Charges,89% of total Billed charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.96,77,,,Percent of total Billed charges,77% of total billed charges,550.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,264.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162,576.72,
INSERT PICVAD CATH,P991500872,CDM,521,RC,36571,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,601.64,89,,,Percent of total Billed Charges,89% of total Billed charges,601.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,275.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,275.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,601.64,
INSJ PICC RS&I 5 YR+,P991500873,CDM,521,RC,36573,HCPCS,Outpatient,,,688,344,,529.76,77,,,Percent of Total Billed Charges,77% of total billed charges,175.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,612.32,89,,,Percent of total Billed Charges,89% of total Billed charges,612.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,529.76,77,,,Percent of total Billed charges,77% of total billed charges,584.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,197.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,280.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,612.32,
RMVL TUN CVC W/O SUBQ PORT/PMP,P991500874,CDM,521,RC,36589,HCPCS,Outpatient,,,309,154.5,,237.93,77,,,Percent of Total Billed Charges,77% of total billed charges,78.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,275.01,89,,,Percent of total Billed Charges,89% of total Billed charges,275.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,275.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.93,77,,,Percent of total Billed charges,77% of total billed charges,262.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.25,275.01,
REMOVAL TUNNELED CV CATH,P991500875,CDM,521,RC,36590,HCPCS,Outpatient,,,469,234.5,,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.25,417.41,
DECLOT VASCULAR DEVICE,P991500876,CDM,521,RC,36593,HCPCS,Outpatient,,,57,28.5,,43.89,77,,,Percent of Total Billed Charges,77% of total billed charges,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.73,89,,,Percent of total Billed Charges,89% of total Billed charges,50.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.89,77,,,Percent of total Billed charges,77% of total billed charges,48.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,50.73,
REPOSITION VENOUS CATHETER,P991500877,CDM,521,RC,36597,HCPCS,Outpatient,,,229,114.5,,176.33,77,,,Percent of Total Billed Charges,77% of total billed charges,58.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,203.81,89,,,Percent of total Billed Charges,89% of total Billed charges,203.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.33,77,,,Percent of total Billed charges,77% of total billed charges,194.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.25,203.81,
INJ W/FLUOR EVAL CV DEVICE,P991500878,CDM,521,RC,36598,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,194.02,
BIOPSY TEMPORAL ARTERY,P991500879,CDM,521,RC,37609,HCPCS,Outpatient,,,576,288,,443.52,77,,,Percent of Total Billed Charges,77% of total billed charges,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,512.64,89,,,Percent of total Billed Charges,89% of total Billed charges,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443.52,77,,,Percent of total Billed charges,77% of total billed charges,489.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144,512.64,
DRAINAGE LYMPH NODE LESION,P991500880,CDM,521,RC,38300,HCPCS,Outpatient,,,617,308.5,,475.09,77,,,Percent of Total Billed Charges,77% of total billed charges,157.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,549.13,89,,,Percent of total Billed Charges,89% of total Billed charges,549.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.09,77,,,Percent of total Billed charges,77% of total billed charges,524.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,251.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.25,549.13,
BX/EXC LYMPH NODE OP SUPF,P991500881,CDM,521,RC,38500,HCPCS,Outpatient,,,713,356.5,,549.01,77,,,Percent of Total Billed Charges,77% of total billed charges,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,634.57,89,,,Percent of total Billed Charges,89% of total Billed charges,634.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.01,77,,,Percent of total Billed charges,77% of total billed charges,606.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.25,634.57,
"BIOPSY OF LYMPH NODE,BY NEEDLE",P991500882,CDM,521,RC,38505,HCPCS,Outpatient,,,169,84.5,,130.13,77,,,Percent of Total Billed Charges,77% of total billed charges,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.41,89,,,Percent of total Billed Charges,89% of total Billed charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.13,77,,,Percent of total Billed charges,77% of total billed charges,143.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.25,150.41,
BIOPSY/REMOVAL LYMPH NODES,P991500883,CDM,521,RC,38510,HCPCS,Outpatient,,,1236,618,,951.72,77,,,Percent of Total Billed Charges,77% of total billed charges,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1100.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.72,77,,,Percent of total Billed charges,77% of total billed charges,1050.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309,1100.04,
BIOPSY/REMOVAL LYMPH NODES,P991500884,CDM,521,RC,38525,HCPCS,Outpatient,,,1121,560.5,,863.17,77,,,Percent of Total Billed Charges,77% of total billed charges,285.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,997.69,89,,,Percent of total Billed Charges,89% of total Billed charges,997.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,997.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,457.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,457.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,457.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,863.17,77,,,Percent of total Billed charges,77% of total billed charges,952.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,322.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,457.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,280.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.25,997.69,
BX/REMOVAL LYMPH NODES BILAT,P991500885,CDM,521,RC,38525,HCPCS,Outpatient,,,2242,1121,50,1726.34,77,,,Percent of Total Billed Charges,77% of total billed charges,571.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1995.38,89,,,Percent of total Billed Charges,89% of total Billed charges,1995.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1995.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1726.34,77,,,Percent of total Billed charges,77% of total billed charges,1905.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,914.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.5,1995.38,
OPEN BX/EXC INGUINOFEM NODES,P991500886,CDM,521,RC,38531,HCPCS,Outpatient,,,848,424,,652.96,77,,,Percent of Total Billed Charges,77% of total billed charges,216.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,754.72,89,,,Percent of total Billed Charges,89% of total Billed charges,754.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,754.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,652.96,77,,,Percent of total Billed charges,77% of total billed charges,720.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,243.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,345.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212,754.72,
LAP RETROPERI LYMPH NODE BX,P991500887,CDM,521,RC,38570,HCPCS,Outpatient,,,977,488.5,,752.29,77,,,Percent of Total Billed Charges,77% of total billed charges,249.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,869.53,89,,,Percent of total Billed Charges,89% of total Billed charges,869.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,869.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,752.29,77,,,Percent of total Billed charges,77% of total billed charges,830.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,398.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.25,869.53,
LAP PELVIC LYMPHADENECTOMY,P991500888,CDM,521,RC,38571,HCPCS,Outpatient,,,1158,579,,891.66,77,,,Percent of Total Billed Charges,77% of total billed charges,295.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,289.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1030.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1030.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1030.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,472.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,472.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,472.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,891.66,77,,,Percent of total Billed charges,77% of total billed charges,984.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,332.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,472.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,289.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.5,1030.62,
LAP PELVIC LYMPHADENECTOMY BX,P991500889,CDM,521,RC,38572,HCPCS,Outpatient,,,1345,672.5,,1035.65,77,,,Percent of Total Billed Charges,77% of total billed charges,342.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,342.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,420.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,336.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1197.05,89,,,Percent of total Billed Charges,89% of total Billed charges,1197.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1197.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,548.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,548.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,548.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1035.65,77,,,Percent of total Billed charges,77% of total billed charges,1143.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,386.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,548.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,336.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,336.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.25,1197.05,
SUPERHYOID LYMPHADENECTOMY,P991500890,CDM,521,RC,38700,HCPCS,Outpatient,,,1715,857.5,,1320.55,77,,,Percent of Total Billed Charges,77% of total billed charges,437.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,535.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,428.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1526.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1526.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1526.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,699.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,699.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,699.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1320.55,77,,,Percent of total Billed charges,77% of total billed charges,1457.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,493.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,699.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,428.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,428.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.75,1526.35,
CERVICAL LYMPHADENECTOMY,P991500891,CDM,521,RC,38720,HCPCS,Outpatient,,,2876,1438,,2214.52,77,,,Percent of Total Billed Charges,77% of total billed charges,733.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,733.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,719,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2559.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2559.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2559.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1173.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1173.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1173.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,719,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2214.52,77,,,Percent of total Billed charges,77% of total billed charges,2444.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,826.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1173.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,719,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,719,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,719,2559.64,
REMOVAL OF LYMPH NODES NECK,P991500892,CDM,521,RC,38724,HCPCS,Outpatient,,,3108,1554,,2393.16,77,,,Percent of Total Billed Charges,77% of total billed charges,792.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,777,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2766.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2766.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2766.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2393.16,77,,,Percent of total Billed charges,77% of total billed charges,2641.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1268.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,777,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777,2766.12,
AX LYMPHADENECTOMY SUPF,P991500893,CDM,521,RC,38740,HCPCS,Outpatient,,,1794,897,,1381.38,77,,,Percent of Total Billed Charges,77% of total billed charges,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,560.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1596.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1381.38,77,,,Percent of total Billed charges,77% of total billed charges,1524.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,515.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,1596.66,
AX LYMPHADENECTOMY COMPLETE,P991500894,CDM,521,RC,38745,HCPCS,Outpatient,,,2131,1065.5,,1640.87,77,,,Percent of Total Billed Charges,77% of total billed charges,543.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,532.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1896.59,89,,,Percent of total Billed Charges,89% of total Billed charges,1896.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1896.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,869.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,869.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,869.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1640.87,77,,,Percent of total Billed charges,77% of total billed charges,1811.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,869.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,532.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.75,1896.59,
SENTINEL NODE IDENTIFICATION,P991500895,CDM,521,RC,38792,HCPCS,Outpatient,,,150,75,,115.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.5,89,,,Percent of total Billed Charges,89% of total Billed charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,77,,,Percent of total Billed charges,77% of total billed charges,127.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.5,133.5,
IO MAP OF SENT LYMPH NODE,P991500896,CDM,521,RC,38900,HCPCS,Outpatient,,,304,152,,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76,270.56,
IO MAP SENT LYMPH NODE BILAT,P991500897,CDM,521,RC,38900,HCPCS,Outpatient,,,324,162,50,249.48,77,,,Percent of Total Billed Charges,77% of total billed charges,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288.36,89,,,Percent of total Billed Charges,89% of total Billed charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.48,77,,,Percent of total Billed charges,77% of total billed charges,275.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,132.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81,288.36,
BIOPSY OF LIP,P991500898,CDM,521,RC,40490,HCPCS,Outpatient,,,253,126.5,,194.81,77,,,Percent of Total Billed Charges,77% of total billed charges,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.17,89,,,Percent of total Billed Charges,89% of total Billed charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.81,77,,,Percent of total Billed charges,77% of total billed charges,215.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.25,225.17,
PARTIAL EXCISION OF LIP,P991500899,CDM,521,RC,40520,HCPCS,Outpatient,,,932,466,,717.64,77,,,Percent of Total Billed Charges,77% of total billed charges,237.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,829.48,89,,,Percent of total Billed Charges,89% of total Billed charges,829.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.64,77,,,Percent of total Billed charges,77% of total billed charges,792.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,380.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233,829.48,
DRAINAGE OF MOUTH LESION,P991500900,CDM,521,RC,40800,HCPCS,Outpatient,,,365,182.5,,281.05,77,,,Percent of Total Billed Charges,77% of total billed charges,93.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,324.85,89,,,Percent of total Billed Charges,89% of total Billed charges,324.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.05,77,,,Percent of total Billed charges,77% of total billed charges,310.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.25,324.85,
INCISION OF LIP FOLD,P991500901,CDM,521,RC,40806,HCPCS,Outpatient,,,176,88,,135.52,77,,,Percent of Total Billed Charges,77% of total billed charges,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.64,89,,,Percent of total Billed Charges,89% of total Billed charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.52,77,,,Percent of total Billed charges,77% of total billed charges,149.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,156.64,
BIOPSY OF MOUTH LESION,P991500902,CDM,521,RC,40808,HCPCS,Outpatient,,,306,153,,235.62,77,,,Percent of Total Billed Charges,77% of total billed charges,78.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,272.34,89,,,Percent of total Billed Charges,89% of total Billed charges,272.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.62,77,,,Percent of total Billed charges,77% of total billed charges,260.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.5,272.34,
EXCISION OF MOUTH LESION,P991500903,CDM,521,RC,40810,HCPCS,Outpatient,,,393,196.5,,302.61,77,,,Percent of Total Billed Charges,77% of total billed charges,100.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,349.77,89,,,Percent of total Billed Charges,89% of total Billed charges,349.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.61,77,,,Percent of total Billed charges,77% of total billed charges,334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.25,349.77,
EXCISE/REPAIR MOUTH LESION,P991500904,CDM,521,RC,40812,HCPCS,Outpatient,,,515,257.5,,396.55,77,,,Percent of Total Billed Charges,77% of total billed charges,131.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,458.35,89,,,Percent of total Billed Charges,89% of total Billed charges,458.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,458.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.55,77,,,Percent of total Billed charges,77% of total billed charges,437.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.75,458.35,
EXCISE LIP OR CHEEK FOLD,P991500905,CDM,521,RC,40819,HCPCS,Outpatient,,,588,294,,452.76,77,,,Percent of Total Billed Charges,77% of total billed charges,149.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,147,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,523.32,89,,,Percent of total Billed Charges,89% of total Billed charges,523.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,523.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.76,77,,,Percent of total Billed charges,77% of total billed charges,499.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,239.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,147,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147,523.32,
INCISION OF TONGUE FOLD,P991500906,CDM,521,RC,41010,HCPCS,Outpatient,,,380,190,,292.6,77,,,Percent of Total Billed Charges,77% of total billed charges,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.2,89,,,Percent of total Billed Charges,89% of total Billed charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.6,77,,,Percent of total Billed charges,77% of total billed charges,323,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95,338.2,
"BIOPSY OF TONGUE, ANTERIOR",P991500907,CDM,521,RC,41100,HCPCS,Outpatient,,,343,171.5,,264.11,77,,,Percent of Total Billed Charges,77% of total billed charges,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,305.27,89,,,Percent of total Billed Charges,89% of total Billed charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.11,77,,,Percent of total Billed charges,77% of total billed charges,291.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,139.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.75,305.27,
"BIOPSY OF TONUGE, POSTERIOR",P991500908,CDM,521,RC,41105,HCPCS,Outpatient,,,343,171.5,,264.11,77,,,Percent of Total Billed Charges,77% of total billed charges,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,305.27,89,,,Percent of total Billed Charges,89% of total Billed charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.11,77,,,Percent of total Billed charges,77% of total billed charges,291.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,139.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.75,305.27,
BIOPSY OF FLOOR OF MOUTH,P991500909,CDM,521,RC,41108,HCPCS,Outpatient,,,307,153.5,,236.39,77,,,Percent of Total Billed Charges,77% of total billed charges,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,273.23,89,,,Percent of total Billed Charges,89% of total Billed charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.39,77,,,Percent of total Billed charges,77% of total billed charges,260.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.75,273.23,
EXCISION OF TONGUE LESION,P991500910,CDM,521,RC,41110,HCPCS,Outpatient,,,461,230.5,,354.97,77,,,Percent of Total Billed Charges,77% of total billed charges,117.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,410.29,89,,,Percent of total Billed Charges,89% of total Billed charges,410.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.97,77,,,Percent of total Billed charges,77% of total billed charges,391.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.25,410.29,
EXCISION OF TONGUE LESION,P991500911,CDM,521,RC,41112,HCPCS,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
EXCISION OF TONGUE FOLD,P991500912,CDM,521,RC,41115,HCPCS,Outpatient,,,509,254.5,,391.93,77,,,Percent of Total Billed Charges,77% of total billed charges,129.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,127.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,453.01,89,,,Percent of total Billed Charges,89% of total Billed charges,453.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,453.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.93,77,,,Percent of total Billed charges,77% of total billed charges,432.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,207.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.25,453.01,
EXCISION OF MOUTH LESION,P991500913,CDM,521,RC,41116,HCPCS,Outpatient,,,612,306,,471.24,77,,,Percent of Total Billed Charges,77% of total billed charges,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,544.68,89,,,Percent of total Billed Charges,89% of total Billed charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,471.24,77,,,Percent of total Billed charges,77% of total billed charges,520.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,544.68,
FRENULOPLASTY,P991500914,CDM,521,RC,41520,HCPCS,Outpatient,,,671,335.5,,516.67,77,,,Percent of Total Billed Charges,77% of total billed charges,171.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,167.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,597.19,89,,,Percent of total Billed Charges,89% of total Billed charges,597.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,597.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,273.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,273.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,273.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.67,77,,,Percent of total Billed charges,77% of total billed charges,570.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,192.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,273.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,167.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.75,597.19,
BIOPSY ROOF OF MOUTH,P991500915,CDM,521,RC,42100,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,274.12,89,,,Percent of total Billed Charges,89% of total Billed charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,274.12,
EXCISION LESION MOUTH ROOF,P991500916,CDM,521,RC,42104,HCPCS,Outpatient,,,397,198.5,,305.69,77,,,Percent of Total Billed Charges,77% of total billed charges,101.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,353.33,89,,,Percent of total Billed Charges,89% of total Billed charges,353.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,353.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.69,77,,,Percent of total Billed charges,77% of total billed charges,337.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,114.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.25,353.33,
EXCISION LESION MOUTH ROOF,P991500917,CDM,521,RC,42106,HCPCS,Outpatient,,,466,233,,358.82,77,,,Percent of Total Billed Charges,77% of total billed charges,118.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,414.74,89,,,Percent of total Billed Charges,89% of total Billed charges,414.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.82,77,,,Percent of total Billed charges,77% of total billed charges,396.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,414.74,
EXCISION LESION MOUTH ROOF,P991500918,CDM,521,RC,42107,HCPCS,Outpatient,,,837,418.5,,644.49,77,,,Percent of Total Billed Charges,77% of total billed charges,213.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,744.93,89,,,Percent of total Billed Charges,89% of total Billed charges,744.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,744.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.49,77,,,Percent of total Billed charges,77% of total billed charges,711.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,341.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.25,744.93,
REMOVE PALATE/LESION,P991500919,CDM,521,RC,42120,HCPCS,Outpatient,,,2138,1069,,1646.26,77,,,Percent of Total Billed Charges,77% of total billed charges,545.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,545.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,668.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1902.82,89,,,Percent of total Billed Charges,89% of total Billed charges,1902.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1902.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,872.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,872.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,872.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,534.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1646.26,77,,,Percent of total Billed charges,77% of total billed charges,1817.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,614.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,872.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,534.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,534.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,534.5,1902.82,
EXCISION OF UVULA,P991500920,CDM,521,RC,42140,HCPCS,Outpatient,,,565,282.5,,435.05,77,,,Percent of Total Billed Charges,77% of total billed charges,144.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,502.85,89,,,Percent of total Billed Charges,89% of total Billed charges,502.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,502.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.05,77,,,Percent of total Billed charges,77% of total billed charges,480.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,162.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,502.85,
PALATOPHARYNGOPLASTY,P991500921,CDM,521,RC,42145,HCPCS,Outpatient,,,1487,743.5,,1144.99,77,,,Percent of Total Billed Charges,77% of total billed charges,379.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,379.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,464.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,371.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1323.43,89,,,Percent of total Billed Charges,89% of total Billed charges,1323.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1323.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,606.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,606.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,606.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,371.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1144.99,77,,,Percent of total Billed charges,77% of total billed charges,1263.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,427.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,606.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,371.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,371.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,371.75,1323.43,
REMOVAL OF SALIVARY STONE,P991500922,CDM,521,RC,42330,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,384.48,89,,,Percent of total Billed Charges,89% of total Billed charges,384.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,176.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108,384.48,
EXCISE PAROTID GLAND/LESION,P991500923,CDM,521,RC,42415,HCPCS,Outpatient,,,2259,1129.5,,1739.43,77,,,Percent of Total Billed Charges,77% of total billed charges,576.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,576.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,564.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2010.51,89,,,Percent of total Billed Charges,89% of total Billed charges,2010.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2010.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,921.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,921.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,921.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1739.43,77,,,Percent of total Billed charges,77% of total billed charges,1920.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,649.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,921.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,564.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,564.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,564.75,2010.51,
EXCISE PAROTID GLAND/LESION,P991500924,CDM,521,RC,42420,HCPCS,Outpatient,,,2541,1270.5,,1956.57,77,,,Percent of Total Billed Charges,77% of total billed charges,647.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,647.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,794.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,635.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2261.49,89,,,Percent of total Billed Charges,89% of total Billed charges,2261.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2261.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1036.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1036.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1036.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,635.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1956.57,77,,,Percent of total Billed charges,77% of total billed charges,2159.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,730.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1036.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,635.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,635.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.25,2261.49,
EXC SUBMANDIBULAR GLAND,P991500925,CDM,521,RC,42440,HCPCS,Outpatient,,,786,393,,605.22,77,,,Percent of Total Billed Charges,77% of total billed charges,200.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,699.54,89,,,Percent of total Billed Charges,89% of total Billed charges,699.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,699.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,320.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,320.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,196.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,605.22,77,,,Percent of total Billed charges,77% of total billed charges,668.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,320.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,196.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,196.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.5,699.54,
DRAINAGE OF TONSIL ABSCESS,P991500926,CDM,521,RC,42700,HCPCS,Outpatient,,,388,194,,298.76,77,,,Percent of Total Billed Charges,77% of total billed charges,98.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,345.32,89,,,Percent of total Billed Charges,89% of total Billed charges,345.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.76,77,,,Percent of total Billed charges,77% of total billed charges,329.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,158.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97,345.32,
BIOPSY OROPHARYN,P991500927,CDM,521,RC,42800,HCPCS,Outpatient,,,292,146,,224.84,77,,,Percent of Total Billed Charges,77% of total billed charges,74.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,259.88,89,,,Percent of total Billed Charges,89% of total Billed charges,259.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.84,77,,,Percent of total Billed charges,77% of total billed charges,248.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73,259.88,
BIOPSY OF UPPER NOSE/THROAT,P991500928,CDM,521,RC,42804,HCPCS,Outpatient,,,392,196,,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348.88,89,,,Percent of total Billed Charges,89% of total Billed charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98,348.88,
BIOPSY OF UPPER NOSE/THROAT,P991500929,CDM,521,RC,42806,HCPCS,Outpatient,,,439,219.5,,338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,111.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,109.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,390.71,89,,,Percent of total Billed Charges,89% of total Billed charges,390.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.03,77,,,Percent of total Billed charges,77% of total billed charges,373.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,179.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,109.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.75,390.71,
EXCISION OF NECK CYST,P991500930,CDM,521,RC,42815,HCPCS,Outpatient,,,1175,587.5,,904.75,77,,,Percent of Total Billed Charges,77% of total billed charges,299.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1045.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1045.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1045.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.75,77,,,Percent of total Billed charges,77% of total billed charges,998.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,337.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,479.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.75,1045.75,
REMOVE TONSILS AND ADENOIDS,P991500931,CDM,521,RC,42820,HCPCS,Outpatient,,,615,307.5,,473.55,77,,,Percent of Total Billed Charges,77% of total billed charges,156.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,547.35,89,,,Percent of total Billed Charges,89% of total Billed charges,547.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,547.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473.55,77,,,Percent of total Billed charges,77% of total billed charges,522.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,250.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.75,547.35,
REMOVE TONSILS AND ADENOIDS,P991500932,CDM,521,RC,42821,HCPCS,Outpatient,,,638,319,,491.26,77,,,Percent of Total Billed Charges,77% of total billed charges,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,567.82,89,,,Percent of total Billed Charges,89% of total Billed charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.26,77,,,Percent of total Billed charges,77% of total billed charges,542.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.5,567.82,
TONSILLECTOMY UNDER 12 Y/O,P991500933,CDM,521,RC,42825,HCPCS,Outpatient,,,505,252.5,,388.85,77,,,Percent of Total Billed Charges,77% of total billed charges,128.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,449.45,89,,,Percent of total Billed Charges,89% of total Billed charges,449.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,449.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.85,77,,,Percent of total Billed charges,77% of total billed charges,429.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.25,449.45,
TONSILLECTOMY 12 AND OVER,P991500934,CDM,521,RC,42826,HCPCS,Outpatient,,,530,265,,408.1,77,,,Percent of Total Billed Charges,77% of total billed charges,135.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,471.7,89,,,Percent of total Billed Charges,89% of total Billed charges,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.1,77,,,Percent of total Billed charges,77% of total billed charges,450.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,216.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.5,471.7,
ADENOIDECTOMY PRIMARY <AGE 12,P991500935,CDM,521,RC,42830,HCPCS,Outpatient,,,434,217,,334.18,77,,,Percent of Total Billed Charges,77% of total billed charges,110.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,386.26,89,,,Percent of total Billed Charges,89% of total Billed charges,386.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,386.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.18,77,,,Percent of total Billed charges,77% of total billed charges,368.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.5,386.26,
ADENOIDECTOMY PRIMARY AGE 12/>,P991500936,CDM,521,RC,42831,HCPCS,Outpatient,,,469,234.5,,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.25,417.41,
ADENOIDECTOMY SECONDARY<AGE 12,P991500937,CDM,521,RC,42835,HCPCS,Outpatient,,,371,185.5,,285.67,77,,,Percent of Total Billed Charges,77% of total billed charges,94.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,330.19,89,,,Percent of total Billed Charges,89% of total Billed charges,330.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.67,77,,,Percent of total Billed charges,77% of total billed charges,315.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.75,330.19,
REMOVAL OF ADENOIDS,P991500938,CDM,521,RC,42836,HCPCS,Outpatient,,,462,231,,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,411.18,89,,,Percent of total Billed Charges,89% of total Billed charges,411.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,411.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,411.18,
EXCISION OF TONSIL TAGS,P991500939,CDM,521,RC,42860,HCPCS,Outpatient,,,363,181.5,,279.51,77,,,Percent of Total Billed Charges,77% of total billed charges,92.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.07,89,,,Percent of total Billed Charges,89% of total Billed charges,323.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.51,77,,,Percent of total Billed charges,77% of total billed charges,308.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.75,323.07,
LINGUAL TONSILLECTOMY,P991500940,CDM,521,RC,42870,HCPCS,Outpatient,,,1239,619.5,,954.03,77,,,Percent of Total Billed Charges,77% of total billed charges,315.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,387.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1102.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1102.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1102.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,505.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,505.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,505.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,954.03,77,,,Percent of total Billed charges,77% of total billed charges,1053.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,356.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,505.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.75,1102.71,
CONTROL THROAT BLEEDING,P991500941,CDM,521,RC,42960,HCPCS,Outpatient,,,304,152,,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76,270.56,
CONTROL THROAT BLEEDING,P991500942,CDM,521,RC,42962,HCPCS,Outpatient,,,1100,550,,847,77,,,Percent of Total Billed Charges,77% of total billed charges,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,979,89,,,Percent of total Billed Charges,89% of total Billed charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,847,77,,,Percent of total Billed charges,77% of total billed charges,935,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,316.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275,979,
ESOPHAGOSCP RIG TRNSO BIOPSY,P991500943,CDM,521,RC,43193,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,285.69,89,,,Percent of total Billed Charges,89% of total Billed charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,285.69,
ESOPHAGOSCOPY DIAG,P991500944,CDM,521,RC,43200,HCPCS,Outpatient,,,476,238,,366.52,77,,,Percent of Total Billed Charges,77% of total billed charges,121.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,423.64,89,,,Percent of total Billed Charges,89% of total Billed charges,423.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,423.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.52,77,,,Percent of total Billed charges,77% of total billed charges,404.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,194.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119,423.64,
ESOPHAGOSCOPY W/ BIOPSY,P991500945,CDM,521,RC,43202,HCPCS,Outpatient,,,642,321,,494.34,77,,,Percent of Total Billed Charges,77% of total billed charges,163.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,571.38,89,,,Percent of total Billed Charges,89% of total Billed charges,571.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,571.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,494.34,77,,,Percent of total Billed charges,77% of total billed charges,545.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,184.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,261.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.5,571.38,
ESOPHAGOSCOPY FLEX REMOVE FB,P991500946,CDM,521,RC,43215,HCPCS,Outpatient,,,712,356,,548.24,77,,,Percent of Total Billed Charges,77% of total billed charges,181.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,633.68,89,,,Percent of total Billed Charges,89% of total Billed charges,633.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,633.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,548.24,77,,,Percent of total Billed charges,77% of total billed charges,605.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178,633.68,
ESOPHAGOSCOPY BALLOON <30MM,P991500947,CDM,521,RC,43220,HCPCS,Outpatient,,,346,173,,266.42,77,,,Percent of Total Billed Charges,77% of total billed charges,88.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.94,89,,,Percent of total Billed Charges,89% of total Billed charges,307.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.42,77,,,Percent of total Billed charges,77% of total billed charges,294.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,307.94,
EGD BALLOON DIL ESOPH 30mm/>,P991500948,CDM,521,RC,43233,HCPCS,Outpatient,,,440,220,,338.8,77,,,Percent of Total Billed Charges,77% of total billed charges,112.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,391.6,89,,,Percent of total Billed Charges,89% of total Billed charges,391.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.8,77,,,Percent of total Billed charges,77% of total billed charges,374,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,179.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,391.6,
EGD,P991500949,CDM,521,RC,43235,HCPCS,Outpatient,,,344,172,,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86,306.16,
EGD WITH BIOPSY,P991500950,CDM,521,RC,43239,HCPCS,Outpatient,,,518,259,,398.86,77,,,Percent of Total Billed Charges,77% of total billed charges,132.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,461.02,89,,,Percent of total Billed Charges,89% of total Billed charges,461.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.86,77,,,Percent of total Billed charges,77% of total billed charges,440.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,211.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,129.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.5,461.02,
EGD TUBE/CATH INSERTION,P991500951,CDM,521,RC,43241,HCPCS,Outpatient,,,266,133,,204.82,77,,,Percent of Total Billed Charges,77% of total billed charges,67.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236.74,89,,,Percent of total Billed Charges,89% of total Billed charges,236.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.82,77,,,Percent of total Billed charges,77% of total billed charges,226.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.5,236.74,
EGD DILATE STRICTURE,P991500952,CDM,521,RC,43245,HCPCS,Outpatient,,,1720,860,,1324.4,77,,,Percent of Total Billed Charges,77% of total billed charges,438.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,438.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,537.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1530.8,89,,,Percent of total Billed Charges,89% of total Billed charges,1530.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1530.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1324.4,77,,,Percent of total Billed charges,77% of total billed charges,1462,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,494.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,701.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,430,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430,1530.8,
EGD PLACE GASTROSTOMY TUBE,P991500953,CDM,521,RC,43246,HCPCS,Outpatient,,,1666,833,,1282.82,77,,,Percent of Total Billed Charges,77% of total billed charges,424.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,520.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1482.74,89,,,Percent of total Billed Charges,89% of total Billed charges,1482.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1482.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,679.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,679.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1282.82,77,,,Percent of total Billed charges,77% of total billed charges,1416.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,478.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,679.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,416.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.5,1482.74,
EGD W REMOVAL FOREIGN BODY,P991500954,CDM,521,RC,43247,HCPCS,Outpatient,,,700,350,,539,77,,,Percent of Total Billed Charges,77% of total billed charges,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,623,89,,,Percent of total Billed Charges,89% of total Billed charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539,77,,,Percent of total Billed charges,77% of total billed charges,595,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,201.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175,623,
ESOPH EGD DILATION <30 MM,P991500955,CDM,521,RC,43249,HCPCS,Outpatient,,,888,444,,683.76,77,,,Percent of Total Billed Charges,77% of total billed charges,226.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,790.32,89,,,Percent of total Billed Charges,89% of total Billed charges,790.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,790.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,683.76,77,,,Percent of total Billed charges,77% of total billed charges,754.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,362.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,222,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222,790.32,
EGD W REMOVAL TUMOR POLYP,P991500956,CDM,521,RC,43250,HCPCS,Outpatient,,,818,409,,629.86,77,,,Percent of Total Billed Charges,77% of total billed charges,208.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,728.02,89,,,Percent of total Billed Charges,89% of total Billed charges,728.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,728.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,629.86,77,,,Percent of total Billed charges,77% of total billed charges,695.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,333.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.5,728.02,
EGD REMOVE LESION SNARE,P991500957,CDM,521,RC,43251,HCPCS,Outpatient,,,900,450,,693,77,,,Percent of Total Billed Charges,77% of total billed charges,229.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,281.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,801,89,,,Percent of total Billed Charges,89% of total Billed charges,801,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,801,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,367.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,693,77,,,Percent of total Billed charges,77% of total billed charges,765,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,367.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,225,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,225,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225,801,
EGD W CONTROL OF BLEEDING,P991500958,CDM,521,RC,43255,HCPCS,Outpatient,,,1419,709.5,,1092.63,77,,,Percent of Total Billed Charges,77% of total billed charges,361.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,443.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,354.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1262.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1262.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1262.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1092.63,77,,,Percent of total Billed charges,77% of total billed charges,1206.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,578.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.75,1262.91,
LAP PARAESOPHAG HERN REPAIR,P991500959,CDM,521,RC,43281,HCPCS,Outpatient,,,2936,1468,,2260.72,77,,,Percent of Total Billed Charges,77% of total billed charges,748.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,748.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,917.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,734,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2613.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2613.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2613.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1197.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1197.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1197.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,734,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2260.72,77,,,Percent of total Billed charges,77% of total billed charges,2495.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,844.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1197.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,734,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,734,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734,2613.04,
LAP PARAESOPH HER RPR W/MESH,P991500960,CDM,521,RC,43282,HCPCS,Outpatient,,,3304,1652,,2544.08,77,,,Percent of Total Billed Charges,77% of total billed charges,842.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,842.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1032.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,826,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2940.56,89,,,Percent of total Billed Charges,89% of total Billed charges,2940.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2940.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1348.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1348.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1348.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2544.08,77,,,Percent of total Billed charges,77% of total billed charges,2808.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,949.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1348.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,826,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,826,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,826,2940.56,
REPAIR OF ESOPHAGUS,P991500961,CDM,521,RC,43300,HCPCS,Outpatient,,,1302,651,,1002.54,77,,,Percent of Total Billed Charges,77% of total billed charges,332.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,325.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1158.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,531.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,531.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,531.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.54,77,,,Percent of total Billed charges,77% of total billed charges,1106.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,531.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,325.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.5,1158.78,
REPAIR ESOPHAGUS AND FISTULA,P991500962,CDM,521,RC,43305,HCPCS,Outpatient,,,2329,1164.5,,1793.33,77,,,Percent of Total Billed Charges,77% of total billed charges,593.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,593.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,727.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,582.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2072.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2072.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,950.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,950.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,582.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1793.33,77,,,Percent of total Billed charges,77% of total billed charges,1979.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,669.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,950.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,582.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,582.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.25,2072.81,
DILATION OF ESOPHAGUS,P991500963,CDM,521,RC,43450,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,274.12,89,,,Percent of total Billed Charges,89% of total Billed charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,274.12,
SURGICAL REPAIR OF STOMACH,P991500964,CDM,521,RC,43501,HCPCS,Outpatient,,,2986,1493,,2299.22,77,,,Percent of Total Billed Charges,77% of total billed charges,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2657.54,89,,,Percent of total Billed Charges,89% of total Billed charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.22,77,,,Percent of total Billed charges,77% of total billed charges,2538.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,858.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1218.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.5,2657.54,
TX GASTRO INTUB W/ASP,P991500965,CDM,521,RC,43753,HCPCS,Outpatient,,,42,21,,32.34,77,,,Percent of Total Billed Charges,77% of total billed charges,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.38,89,,,Percent of total Billed Charges,89% of total Billed charges,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.34,77,,,Percent of total Billed charges,77% of total billed charges,35.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.5,37.38,
RPLC GTUBE NO REVJ TRC,P991500966,CDM,521,RC,43762,HCPCS,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
PLACE GASTROSTOMY TUBE,P991500967,CDM,521,RC,43830,HCPCS,Outpatient,,,690,345,,531.3,77,,,Percent of Total Billed Charges,77% of total billed charges,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,614.1,89,,,Percent of total Billed Charges,89% of total Billed charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.3,77,,,Percent of total Billed charges,77% of total billed charges,586.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,281.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,614.1,
PLACE GASTROSTOMY TUBE,P991500968,CDM,521,RC,43832,HCPCS,Outpatient,,,1623,811.5,,1249.71,77,,,Percent of Total Billed Charges,77% of total billed charges,413.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,413.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,507.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,405.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1444.47,89,,,Percent of total Billed Charges,89% of total Billed charges,1444.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1249.71,77,,,Percent of total Billed charges,77% of total billed charges,1379.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,466.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,662.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,405.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,405.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.75,1444.47,
REPAIR STOMACH OPENING,P991500969,CDM,521,RC,43870,HCPCS,Outpatient,,,1549,774.5,,1192.73,77,,,Percent of Total Billed Charges,77% of total billed charges,395,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,484.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,387.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1378.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1378.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1378.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1192.73,77,,,Percent of total Billed charges,77% of total billed charges,1316.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,445.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,387.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,387.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.25,1378.61,
ENTEROLYSIS,P991500970,CDM,521,RC,44005,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
INSERT NEEDLE CATH BOWEL,P991500971,CDM,521,RC,44015,HCPCS,Outpatient,,,272,136,,209.44,77,,,Percent of Total Billed Charges,77% of total billed charges,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.08,89,,,Percent of total Billed Charges,89% of total Billed charges,242.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.44,77,,,Percent of total Billed charges,77% of total billed charges,231.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68,242.08,
ENTEROTOMY SM INTESTINE,P991500972,CDM,521,RC,44020,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
REDUCE BOWEL OBSTRUCTION,P991500973,CDM,521,RC,44050,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
EXCISION LESION COLON,P991500974,CDM,521,RC,44110,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
REMOVAL OF SMALL INTESTINE,P991500975,CDM,521,RC,44120,HCPCS,Outpatient,,,2572,1286,,1980.44,77,,,Percent of Total Billed Charges,77% of total billed charges,655.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,643,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2289.08,89,,,Percent of total Billed Charges,89% of total Billed charges,2289.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2289.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1980.44,77,,,Percent of total Billed charges,77% of total billed charges,2186.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1049.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,643,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,643,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643,2289.08,
PARTIAL REMOVAL OF COLON,P991500976,CDM,521,RC,44140,HCPCS,Outpatient,,,3733,1866.5,,2874.41,77,,,Percent of Total Billed Charges,77% of total billed charges,951.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,951.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1166.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,933.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3322.37,89,,,Percent of total Billed Charges,89% of total Billed charges,3322.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3322.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1523.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1523.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1523.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,933.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2874.41,77,,,Percent of total Billed charges,77% of total billed charges,3173.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1073.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1523.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,933.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,933.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.25,3322.37,
COLECTOMY W/RESECTION,P991500977,CDM,521,RC,44145,HCPCS,Outpatient,,,3809,1904.5,,2932.93,77,,,Percent of Total Billed Charges,77% of total billed charges,971.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1190.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3390.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3390.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3390.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1554.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1554.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1554.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2932.93,77,,,Percent of total Billed charges,77% of total billed charges,3237.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1095.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1554.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,952.25,3390.01,
LAPAROTOMY WITH ENTEROLYSIS,P991500978,CDM,521,RC,44180,HCPCS,Outpatient,,,2000,1000,,1540,77,,,Percent of Total Billed Charges,77% of total billed charges,510,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,510,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,625,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,500,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1780,89,,,Percent of total Billed Charges,89% of total Billed charges,1780,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1780,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,816,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,500,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1540,77,,,Percent of total Billed charges,77% of total billed charges,1700,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,575,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,816,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,500,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,500,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,500,1780,
COLOSTOMY,P991500979,CDM,521,RC,44320,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
SMALL INTESTINAL ENDOSCOPY,P991500980,CDM,521,RC,44376,HCPCS,Outpatient,,,535,267.5,,411.95,77,,,Percent of Total Billed Charges,77% of total billed charges,136.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,476.15,89,,,Percent of total Billed Charges,89% of total Billed charges,476.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.95,77,,,Percent of total Billed charges,77% of total billed charges,454.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,153.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,133.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.75,476.15,
ENDOSCOPY OF BOWEL POUCH,P991500981,CDM,521,RC,44385,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.93,89,,,Percent of total Billed Charges,89% of total Billed charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,121.93,
COLONOSCOPY THROUGH STOMA,P991500982,CDM,521,RC,44388,HCPCS,Outpatient,,,578,289,,445.06,77,,,Percent of Total Billed Charges,77% of total billed charges,147.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,514.42,89,,,Percent of total Billed Charges,89% of total Billed charges,514.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.06,77,,,Percent of total Billed charges,77% of total billed charges,491.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.5,514.42,
COLONOSCOPY WITH BIOPSY,P991500983,CDM,521,RC,44389,HCPCS,Outpatient,,,750,375,,577.5,77,,,Percent of Total Billed Charges,77% of total billed charges,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,667.5,89,,,Percent of total Billed Charges,89% of total Billed charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.5,77,,,Percent of total Billed charges,77% of total billed charges,637.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,667.5,
SUTURE SMALL INTESTINE MULT,P991500984,CDM,521,RC,44603,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
SUTURE LARGE INTESTINE,P991500985,CDM,521,RC,44604,HCPCS,Outpatient,,,1524,762,,1173.48,77,,,Percent of Total Billed Charges,77% of total billed charges,388.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,388.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,381,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1356.36,89,,,Percent of total Billed Charges,89% of total Billed charges,1356.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1356.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,621.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,621.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,621.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,381,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1173.48,77,,,Percent of total Billed charges,77% of total billed charges,1295.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,438.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,621.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,381,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,381,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,381,1356.36,
REPAIR OF BOWEL LESION,P991500986,CDM,521,RC,44605,HCPCS,Outpatient,,,3137,1568.5,,2415.49,77,,,Percent of Total Billed Charges,77% of total billed charges,799.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,799.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,980.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,784.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2791.93,89,,,Percent of total Billed Charges,89% of total Billed charges,2791.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2791.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1279.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1279.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1279.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,784.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2415.49,77,,,Percent of total Billed charges,77% of total billed charges,2666.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,901.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1279.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,784.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,784.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,784.25,2791.93,
ENTEROTOMY & RPR/INTEST,P991500987,CDM,521,RC,44615,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
REPAIR BOWEL-SKIN FISTUAL,P991500988,CDM,521,RC,44640,HCPCS,Outpatient,,,3077,1538.5,,2369.29,77,,,Percent of Total Billed Charges,77% of total billed charges,784.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,784.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,961.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,769.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2738.53,89,,,Percent of total Billed Charges,89% of total Billed charges,2738.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2738.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,769.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2369.29,77,,,Percent of total Billed charges,77% of total billed charges,2615.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,884.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1255.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,769.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,769.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,769.25,2738.53,
I & D APPENDICEAL ABSCESS OPEN,P991500989,CDM,521,RC,44900,HCPCS,Outpatient,,,1570,785,,1208.9,77,,,Percent of Total Billed Charges,77% of total billed charges,400.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,400.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,490.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1397.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1397.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1397.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,640.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1208.9,77,,,Percent of total Billed charges,77% of total billed charges,1334.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,451.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,640.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,392.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.5,1397.3,
APPENDECTOMY,P991500990,CDM,521,RC,44950,HCPCS,Outpatient,,,1981,990.5,,1525.37,77,,,Percent of Total Billed Charges,77% of total billed charges,505.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,619.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,495.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1763.09,89,,,Percent of total Billed Charges,89% of total Billed charges,1763.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1763.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,808.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,808.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,808.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1525.37,77,,,Percent of total Billed charges,77% of total billed charges,1683.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,808.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,495.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.25,1763.09,
APPEND INDICATED & W/OTHER OP,P991500991,CDM,521,RC,44955,HCPCS,Outpatient,,,160,80,,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.4,89,,,Percent of total Billed Charges,89% of total Billed charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,142.4,
APPENDECTOMY,P991500992,CDM,521,RC,44960,HCPCS,Outpatient,,,2281,1140.5,,1756.37,77,,,Percent of Total Billed Charges,77% of total billed charges,581.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,581.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,712.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2030.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2030.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2030.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,930.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,930.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,930.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1756.37,77,,,Percent of total Billed charges,77% of total billed charges,1938.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,655.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,930.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,570.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,570.25,2030.09,
"LAPAROSCOPY,SURG,APPENDECTOMY",P991500993,CDM,521,RC,44970,HCPCS,Outpatient,,,1308,654,,1007.16,77,,,Percent of Total Billed Charges,77% of total billed charges,333.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1164.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1164.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1164.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1007.16,77,,,Percent of total Billed charges,77% of total billed charges,1111.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,376.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,533.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327,1164.12,
I&D SUBMUCOSAL ABSCESS RECTUM,P991500994,CDM,521,RC,45005,HCPCS,Outpatient,,,577,288.5,,444.29,77,,,Percent of Total Billed Charges,77% of total billed charges,147.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,513.53,89,,,Percent of total Billed Charges,89% of total Billed charges,513.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,513.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.29,77,,,Percent of total Billed charges,77% of total billed charges,490.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,235.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.25,513.53,
DRAINAGE OF RECTAL ABSCESS,P991500995,CDM,521,RC,45020,HCPCS,Outpatient,,,1237,618.5,,952.49,77,,,Percent of Total Billed Charges,77% of total billed charges,315.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1100.93,89,,,Percent of total Billed Charges,89% of total Billed charges,1100.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1100.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,952.49,77,,,Percent of total Billed charges,77% of total billed charges,1051.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.25,1100.93,
EXC RECTAL TUMOR,P991500996,CDM,521,RC,45160,HCPCS,Outpatient,,,2391,1195.5,,1841.07,77,,,Percent of Total Billed Charges,77% of total billed charges,609.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,609.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2127.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2127.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2127.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1841.07,77,,,Percent of total Billed charges,77% of total billed charges,2032.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,687.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,975.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.75,2127.99,
EXC RECT TUM TRANSANAL PART,P991500997,CDM,521,RC,45171,HCPCS,Outpatient,,,1288,644,,991.76,77,,,Percent of Total Billed Charges,77% of total billed charges,328.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,402.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,322,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1146.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1146.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1146.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,525.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,525.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,525.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,991.76,77,,,Percent of total Billed charges,77% of total billed charges,1094.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,370.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,525.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,322,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322,1146.32,
PROCTOSIGMOIDOSCOPY,P991500998,CDM,521,RC,45300,HCPCS,Outpatient,,,253,126.5,,194.81,77,,,Percent of Total Billed Charges,77% of total billed charges,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.17,89,,,Percent of total Billed Charges,89% of total Billed charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.81,77,,,Percent of total Billed charges,77% of total billed charges,215.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.25,225.17,
PROCTOSIGMOIDOSCOPY DILATE,P991500999,CDM,521,RC,45303,HCPCS,Outpatient,,,259,129.5,,199.43,77,,,Percent of Total Billed Charges,77% of total billed charges,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,230.51,89,,,Percent of total Billed Charges,89% of total Billed charges,230.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,77,,,Percent of total Billed charges,77% of total billed charges,220.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.75,230.51,
PROCOSIGMOIDOSCOPY WITH BIOPSY,P991501000,CDM,521,RC,45305,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,249.2,
PROCTOSIGMOIDOSCOPY FB,P991501001,CDM,521,RC,45307,HCPCS,Outpatient,,,392,196,,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348.88,89,,,Percent of total Billed Charges,89% of total Billed charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98,348.88,
PROCTOSIGMOIDOSCOPY REMOVAL,P991501002,CDM,521,RC,45308,HCPCS,Outpatient,,,373,186.5,,287.21,77,,,Percent of Total Billed Charges,77% of total billed charges,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.97,89,,,Percent of total Billed Charges,89% of total Billed charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.21,77,,,Percent of total Billed charges,77% of total billed charges,317.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.25,331.97,
PROCTO W REM POLYP BY SNARE,P991501003,CDM,521,RC,45309,HCPCS,Outpatient,,,385,192.5,,296.45,77,,,Percent of Total Billed Charges,77% of total billed charges,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,342.65,89,,,Percent of total Billed Charges,89% of total Billed charges,342.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.45,77,,,Percent of total Billed charges,77% of total billed charges,327.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,342.65,
PROCTOSIGMOIDOSCOPY REMOVAL,P991501004,CDM,521,RC,45315,HCPCS,Outpatient,,,417,208.5,,321.09,77,,,Percent of Total Billed Charges,77% of total billed charges,106.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,371.13,89,,,Percent of total Billed Charges,89% of total Billed charges,371.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,371.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.09,77,,,Percent of total Billed charges,77% of total billed charges,354.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.25,371.13,
PROCTO W CONTROL BLDG,P991501005,CDM,521,RC,45317,HCPCS,Outpatient,,,405,202.5,,311.85,77,,,Percent of Total Billed Charges,77% of total billed charges,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,360.45,89,,,Percent of total Billed Charges,89% of total Billed charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.85,77,,,Percent of total Billed charges,77% of total billed charges,344.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.25,360.45,
PROCTO W ABLATION OF TUMOR(S),P991501006,CDM,521,RC,45320,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.5,364.9,
SIGMOIDOSCOPY,P991501007,CDM,521,RC,45330,HCPCS,Outpatient,,,338,169,,260.26,77,,,Percent of Total Billed Charges,77% of total billed charges,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300.82,89,,,Percent of total Billed Charges,89% of total Billed charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.26,77,,,Percent of total Billed charges,77% of total billed charges,287.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.5,300.82,
SIGMOIDOSCOPY WITH BIOPSY,P991501008,CDM,521,RC,45331,HCPCS,Outpatient,,,513,256.5,,395.01,77,,,Percent of Total Billed Charges,77% of total billed charges,130.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,456.57,89,,,Percent of total Billed Charges,89% of total Billed charges,456.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,456.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.01,77,,,Percent of total Billed charges,77% of total billed charges,436.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.25,456.57,
SIGMOIDOSCOPY W/FB REMOVAL,P991501009,CDM,521,RC,45332,HCPCS,Outpatient,,,501,250.5,,385.77,77,,,Percent of Total Billed Charges,77% of total billed charges,127.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445.89,89,,,Percent of total Billed Charges,89% of total Billed charges,445.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.77,77,,,Percent of total Billed charges,77% of total billed charges,425.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.25,445.89,
SIGMOIDOSCOPY & POLYPECTOMY,P991501010,CDM,521,RC,45333,HCPCS,Outpatient,,,591,295.5,,455.07,77,,,Percent of Total Billed Charges,77% of total billed charges,150.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,525.99,89,,,Percent of total Billed Charges,89% of total Billed charges,525.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,525.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,77,,,Percent of total Billed charges,77% of total billed charges,502.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,147.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.75,525.99,
SIGMOIDOSCOPY FOR BLEEDING,P991501011,CDM,521,RC,45334,HCPCS,Outpatient,,,883,441.5,,679.91,77,,,Percent of Total Billed Charges,77% of total billed charges,225.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,785.87,89,,,Percent of total Billed Charges,89% of total Billed charges,785.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,785.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.91,77,,,Percent of total Billed charges,77% of total billed charges,750.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,253.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,360.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.75,785.87,
SIGMOIDOSCOPY W/TUMR REMOVE,P991501012,CDM,521,RC,45338,HCPCS,Outpatient,,,542,271,,417.34,77,,,Percent of Total Billed Charges,77% of total billed charges,138.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,482.38,89,,,Percent of total Billed Charges,89% of total Billed charges,482.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,482.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,417.34,77,,,Percent of total Billed charges,77% of total billed charges,460.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,221.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,135.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.5,482.38,
COLONOSCOPY,P991501013,CDM,521,RC,45378,HCPCS,Outpatient,,,1295,647.5,,997.15,77,,,Percent of Total Billed Charges,77% of total billed charges,330.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,330.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,404.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1152.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1152.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1152.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,997.15,77,,,Percent of total Billed charges,77% of total billed charges,1100.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,372.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,528.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.75,1152.55,
COLONOSCOPY W/FB REMOVAL,P991501014,CDM,521,RC,45379,HCPCS,Outpatient,,,800,400,,616,77,,,Percent of Total Billed Charges,77% of total billed charges,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,712,89,,,Percent of total Billed Charges,89% of total Billed charges,712,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,712,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616,77,,,Percent of total Billed charges,77% of total billed charges,680,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,326.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,712,
COLONOSCOPY WITH BIOPSY,P991501015,CDM,521,RC,45380,HCPCS,Outpatient,,,1539,769.5,,1185.03,77,,,Percent of Total Billed Charges,77% of total billed charges,392.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1369.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.03,77,,,Percent of total Billed charges,77% of total billed charges,1308.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,627.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,384.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.75,1369.71,
COLONOSCOPY W/CONTROL BLEED,P991501016,CDM,521,RC,45382,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
COLONOSCOPY W/LESION REMOVAL,P991501017,CDM,521,RC,45384,HCPCS,Outpatient,,,1384,692,,1065.68,77,,,Percent of Total Billed Charges,77% of total billed charges,352.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,346,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1231.76,89,,,Percent of total Billed Charges,89% of total Billed charges,1231.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1231.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.68,77,,,Percent of total Billed charges,77% of total billed charges,1176.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,564.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,346,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,346,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346,1231.76,
COLONOSCOPY W/LESION REMOVAL,P991501018,CDM,521,RC,45385,HCPCS,Outpatient,,,1734,867,,1335.18,77,,,Percent of Total Billed Charges,77% of total billed charges,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1543.26,89,,,Percent of total Billed Charges,89% of total Billed charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1543.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,707.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.18,77,,,Percent of total Billed charges,77% of total billed charges,1473.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,498.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,707.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,433.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.5,1543.26,
COLONOSCOPY W/BALLOON DILAT,P991501019,CDM,521,RC,45386,HCPCS,Outpatient,,,1942,971,,1495.34,77,,,Percent of Total Billed Charges,77% of total billed charges,495.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,495.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,606.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1728.38,89,,,Percent of total Billed Charges,89% of total Billed charges,1728.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1728.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.34,77,,,Percent of total Billed charges,77% of total billed charges,1650.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,558.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,792.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,485.5,1728.38,
REPAIR OF RECTOCELE,P991501020,CDM,521,RC,45560,HCPCS,Outpatient,,,1083,541.5,,833.91,77,,,Percent of Total Billed Charges,77% of total billed charges,276.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,963.87,89,,,Percent of total Billed Charges,89% of total Billed charges,963.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.91,77,,,Percent of total Billed charges,77% of total billed charges,920.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,441.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.75,963.87,
RPR AA HRN 1ST 3-10 NCR/STRN,P991501021,CDM,521,RC,45594,HCPCS,Outpatient,,,1434,717,,1104.18,77,,,Percent of Total Billed Charges,77% of total billed charges,365.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1276.26,89,,,Percent of total Billed Charges,89% of total Billed charges,1276.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1276.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.18,77,,,Percent of total Billed charges,77% of total billed charges,1218.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,585.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,358.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.5,1276.26,
RECTOVESICAL FISTULA,P991501022,CDM,521,RC,45800,HCPCS,Outpatient,,,3958,1979,,3047.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1009.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1009.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1236.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3522.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3522.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3522.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3047.66,77,,,Percent of total Billed charges,77% of total billed charges,3364.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1137.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1614.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,989.5,3522.62,
REDUCTION OF RECTAL PROLAPSE,P991501023,CDM,521,RC,45900,HCPCS,Outpatient,,,402,201,,309.54,77,,,Percent of Total Billed Charges,77% of total billed charges,102.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,357.78,89,,,Percent of total Billed Charges,89% of total Billed charges,357.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,357.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.54,77,,,Percent of total Billed charges,77% of total billed charges,341.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.5,357.78,
DILATION OF ANAL SPHINCTER,P991501024,CDM,521,RC,45905,HCPCS,Outpatient,,,1346,673,,1036.42,77,,,Percent of Total Billed Charges,77% of total billed charges,343.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,420.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,336.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1197.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1197.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1197.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,549.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,549.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1036.42,77,,,Percent of total Billed charges,77% of total billed charges,1144.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,386.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,549.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,336.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,336.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.5,1197.94,
DILATION OF RECTAL NARROWING,P991501025,CDM,521,RC,45910,HCPCS,Outpatient,,,364,182,,280.28,77,,,Percent of Total Billed Charges,77% of total billed charges,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.96,89,,,Percent of total Billed Charges,89% of total Billed charges,323.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.28,77,,,Percent of total Billed charges,77% of total billed charges,309.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91,323.96,
REMOVE RECTAL OBSTRUCTION,P991501026,CDM,521,RC,45915,HCPCS,Outpatient,,,648,324,,498.96,77,,,Percent of Total Billed Charges,77% of total billed charges,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,576.72,89,,,Percent of total Billed Charges,89% of total Billed charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.96,77,,,Percent of total Billed charges,77% of total billed charges,550.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,264.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162,576.72,
SURG DX EXAM ANORECTAL,P991501027,CDM,521,RC,45990,HCPCS,Outpatient,,,259,129.5,,199.43,77,,,Percent of Total Billed Charges,77% of total billed charges,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,230.51,89,,,Percent of total Billed Charges,89% of total Billed charges,230.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,77,,,Percent of total Billed charges,77% of total billed charges,220.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.75,230.51,
"UNLISTED PROCEDURE, RECTUM",P991501028,CDM,521,RC,45999,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,178,
PLACEMENT OF SETON,P991501029,CDM,521,RC,46020,HCPCS,Outpatient,,,638,319,,491.26,77,,,Percent of Total Billed Charges,77% of total billed charges,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,567.82,89,,,Percent of total Billed Charges,89% of total Billed charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.26,77,,,Percent of total Billed charges,77% of total billed charges,542.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.5,567.82,
I & D PERIRECTAL ABSCESS,P991501030,CDM,521,RC,46040,HCPCS,Outpatient,,,1198,599,,922.46,77,,,Percent of Total Billed Charges,77% of total billed charges,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1066.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.46,77,,,Percent of total Billed charges,77% of total billed charges,1018.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,344.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.5,1066.22,
INCISION OF ANAL ABSCESS,P991501031,CDM,521,RC,46050,HCPCS,Outpatient,,,427,213.5,,328.79,77,,,Percent of Total Billed Charges,77% of total billed charges,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,380.03,89,,,Percent of total Billed Charges,89% of total Billed charges,380.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,77,,,Percent of total Billed charges,77% of total billed charges,362.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,174.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.75,380.03,
INCISION OF RECTAL ABSCESS,P991501032,CDM,521,RC,46060,HCPCS,Outpatient,,,915,457.5,,704.55,77,,,Percent of Total Billed Charges,77% of total billed charges,233.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,814.35,89,,,Percent of total Billed Charges,89% of total Billed charges,814.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,814.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,373.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,704.55,77,,,Percent of total Billed charges,77% of total billed charges,777.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,263.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,228.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.75,814.35,
ANAL SPHINCTEROTOMY,P991501033,CDM,521,RC,46080,HCPCS,Outpatient,,,638,319,,491.26,77,,,Percent of Total Billed Charges,77% of total billed charges,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,567.82,89,,,Percent of total Billed Charges,89% of total Billed charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,567.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.26,77,,,Percent of total Billed charges,77% of total billed charges,542.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.5,567.82,
INCISE EXTERNAL HEMORRHOID,P991501034,CDM,521,RC,46083,HCPCS,Outpatient,,,339,169.5,,261.03,77,,,Percent of Total Billed Charges,77% of total billed charges,86.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,301.71,89,,,Percent of total Billed Charges,89% of total Billed charges,301.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.03,77,,,Percent of total Billed charges,77% of total billed charges,288.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.75,301.71,
REMOVAL OF ANAL FISSURE,P991501035,CDM,521,RC,46200,HCPCS,Outpatient,,,867,433.5,,667.59,77,,,Percent of Total Billed Charges,77% of total billed charges,221.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,771.63,89,,,Percent of total Billed Charges,89% of total Billed charges,771.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,771.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,353.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,667.59,77,,,Percent of total Billed charges,77% of total billed charges,736.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,353.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,216.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.75,771.63,
EXCISION RECTAL TAG,P991501036,CDM,521,RC,46220,HCPCS,Outpatient,,,202,101,,155.54,77,,,Percent of Total Billed Charges,77% of total billed charges,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,179.78,89,,,Percent of total Billed Charges,89% of total Billed charges,179.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.54,77,,,Percent of total Billed charges,77% of total billed charges,171.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.5,179.78,
HEMORRHOIDAL BANDING,P991501037,CDM,521,RC,46221,HCPCS,Outpatient,,,690,345,,531.3,77,,,Percent of Total Billed Charges,77% of total billed charges,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,614.1,89,,,Percent of total Billed Charges,89% of total Billed charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.3,77,,,Percent of total Billed charges,77% of total billed charges,586.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,281.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,614.1,
EXC EXTERNAL HEMORRHOIDAL TAG,P991501038,CDM,521,RC,46230,HCPCS,Outpatient,,,690,345,,531.3,77,,,Percent of Total Billed Charges,77% of total billed charges,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,614.1,89,,,Percent of total Billed Charges,89% of total Billed charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.3,77,,,Percent of total Billed charges,77% of total billed charges,586.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,281.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,614.1,
REMOVE EXT HEM GROUPS 2+,P991501039,CDM,521,RC,46250,HCPCS,Outpatient,,,1011,505.5,,778.47,77,,,Percent of Total Billed Charges,77% of total billed charges,257.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,899.79,89,,,Percent of total Billed Charges,89% of total Billed charges,899.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,899.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.47,77,,,Percent of total Billed charges,77% of total billed charges,859.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,290.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,412.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.75,899.79,
REMOVE INT/EXT HEM 1 GROUP,P991501040,CDM,521,RC,46255,HCPCS,Outpatient,,,1198,599,,922.46,77,,,Percent of Total Billed Charges,77% of total billed charges,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1066.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.46,77,,,Percent of total Billed charges,77% of total billed charges,1018.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,344.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.5,1066.22,
REMOVE IN/EX HEM GROUPS 2+,P991501041,CDM,521,RC,46260,HCPCS,Outpatient,,,1272,636,,979.44,77,,,Percent of Total Billed Charges,77% of total billed charges,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.44,77,,,Percent of total Billed charges,77% of total billed charges,1081.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318,1132.08,
REMOVE ANAL FIST SUBQ,P991501042,CDM,521,RC,46270,HCPCS,Outpatient,,,1069,534.5,,823.13,77,,,Percent of Total Billed Charges,77% of total billed charges,272.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,334.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,951.41,89,,,Percent of total Billed Charges,89% of total Billed charges,951.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,436.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,436.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,823.13,77,,,Percent of total Billed charges,77% of total billed charges,908.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,436.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,267.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.25,951.41,
EXCISION SUBMUSCULAR,P991501043,CDM,521,RC,46275,HCPCS,Outpatient,,,1130,565,,870.1,77,,,Percent of Total Billed Charges,77% of total billed charges,288.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,282.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1005.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1005.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1005.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,461.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,461.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,870.1,77,,,Percent of total Billed charges,77% of total billed charges,960.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,461.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,282.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,282.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.5,1005.7,
REMOVE ANAL FIST COMPLEX,P991501044,CDM,521,RC,46280,HCPCS,Outpatient,,,909.82,454.91,,700.56,77,,,Percent of Total Billed Charges,77% of total billed charges,232,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,227.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,809.74,89,,,Percent of total Billed Charges,89% of total Billed charges,809.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,809.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,371.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,371.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,371.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,700.56,77,,,Percent of total Billed charges,77% of total billed charges,773.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,261.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,371.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,227.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,227.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.46,809.74,
REMOVAL OF HEMORRHOID CLOT,P991501045,CDM,521,RC,46320,HCPCS,Outpatient,,,389,194.5,,299.53,77,,,Percent of Total Billed Charges,77% of total billed charges,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,346.21,89,,,Percent of total Billed Charges,89% of total Billed charges,346.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.53,77,,,Percent of total Billed charges,77% of total billed charges,330.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,158.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.25,346.21,
ANOSCOPY,P991501046,CDM,521,RC,46600,HCPCS,Outpatient,,,214,107,,164.78,77,,,Percent of Total Billed Charges,77% of total billed charges,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.46,89,,,Percent of total Billed Charges,89% of total Billed charges,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.78,77,,,Percent of total Billed charges,77% of total billed charges,181.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.5,190.46,
ANOSCOPY WITH DILATION,P991501047,CDM,521,RC,46604,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222.5,89,,,Percent of total Billed Charges,89% of total Billed charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.5,222.5,
ANOSCOPY WITH BIOPSY,P991501048,CDM,521,RC,46606,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.56,89,,,Percent of total Billed Charges,89% of total Billed charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126,448.56,
ANOSCOPY REMOVE FOR BODY,P991501049,CDM,521,RC,46608,HCPCS,Outpatient,,,527,263.5,,405.79,77,,,Percent of Total Billed Charges,77% of total billed charges,134.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,131.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,469.03,89,,,Percent of total Billed Charges,89% of total Billed charges,469.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,469.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.79,77,,,Percent of total Billed charges,77% of total billed charges,447.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,215.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,131.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,469.03,
ANOSCOPY REMOVE LESION,P991501050,CDM,521,RC,46610,HCPCS,Outpatient,,,500,250,,385,77,,,Percent of Total Billed Charges,77% of total billed charges,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445,500,,,fee schedule,500% of healthlink,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385,77,,,Percent of total Billed charges,77% of total billed charges,425,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125,445,
ANOSCOPY W REM POLYP BY SNARE,P991501051,CDM,521,RC,46611,HCPCS,Outpatient,,,404,202,,311.08,77,,,Percent of Total Billed Charges,77% of total billed charges,103.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,359.56,89,,,Percent of total Billed Charges,89% of total Billed charges,359.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,359.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.08,77,,,Percent of total Billed charges,77% of total billed charges,343.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101,359.56,
ANOSCOPY W REM MULT POLYPS,P991501052,CDM,521,RC,46612,HCPCS,Outpatient,,,602,301,,463.54,77,,,Percent of Total Billed Charges,77% of total billed charges,153.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,535.78,89,,,Percent of total Billed Charges,89% of total Billed charges,535.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.54,77,,,Percent of total Billed charges,77% of total billed charges,511.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,245.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.5,535.78,
ANOSCOPY W CONTROL BLEEDING,P991501053,CDM,521,RC,46614,HCPCS,Outpatient,,,451,225.5,,347.27,77,,,Percent of Total Billed Charges,77% of total billed charges,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,401.39,89,,,Percent of total Billed Charges,89% of total Billed charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.27,77,,,Percent of total Billed charges,77% of total billed charges,383.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.75,401.39,
ANOSCOPY ABLATION LESION,P991501054,CDM,521,RC,46615,HCPCS,Outpatient,,,325,162.5,,250.25,77,,,Percent of Total Billed Charges,77% of total billed charges,82.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,289.25,89,,,Percent of total Billed Charges,89% of total Billed charges,289.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.25,77,,,Percent of total Billed charges,77% of total billed charges,276.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,132.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.25,289.25,
REPAIR OF ANAL STRICTURE,P991501055,CDM,521,RC,46700,HCPCS,Outpatient,,,880,440,,677.6,77,,,Percent of Total Billed Charges,77% of total billed charges,224.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,783.2,89,,,Percent of total Billed Charges,89% of total Billed charges,783.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,783.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,359.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,359.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,359.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.6,77,,,Percent of total Billed charges,77% of total billed charges,748,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,253,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,359.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220,783.2,
REPAIR ANORECTAL FIST W/PLUG,P991501056,CDM,521,RC,46707,HCPCS,Outpatient,,,627,313.5,,482.79,77,,,Percent of Total Billed Charges,77% of total billed charges,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,558.03,89,,,Percent of total Billed Charges,89% of total Billed charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,482.79,77,,,Percent of total Billed charges,77% of total billed charges,532.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.75,558.03,
SPINCTEROPLASTY ANAL FOR 1,P991501057,CDM,521,RC,46750,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
DEST LESIONS ANAL SIMPLE,P991501058,CDM,521,RC,46900,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.35,89,,,Percent of total Billed Charges,89% of total Billed charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.75,102.35,
DEST LESIONS ANAL ELECTRODE,P991501059,CDM,521,RC,46910,HCPCS,Outpatient,,,415,207.5,,319.55,77,,,Percent of Total Billed Charges,77% of total billed charges,105.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,369.35,89,,,Percent of total Billed Charges,89% of total Billed charges,369.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,369.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.55,77,,,Percent of total Billed charges,77% of total billed charges,352.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.75,369.35,
CRYOSURGERY,P991501060,CDM,521,RC,46916,HCPCS,Outpatient,,,487,243.5,,374.99,77,,,Percent of Total Billed Charges,77% of total billed charges,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,433.43,89,,,Percent of total Billed Charges,89% of total Billed charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.99,77,,,Percent of total Billed charges,77% of total billed charges,413.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,198.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.75,433.43,
DEST LESIONS ANAL LASER,P991501061,CDM,521,RC,46917,HCPCS,Outpatient,,,1085,542.5,,835.45,77,,,Percent of Total Billed Charges,77% of total billed charges,276.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,271.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,965.65,89,,,Percent of total Billed Charges,89% of total Billed charges,965.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,965.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,77,,,Percent of total Billed charges,77% of total billed charges,922.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,442.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,271.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.25,965.65,
EXCISION LESION OF ANUS,P991501062,CDM,521,RC,46922,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
DEST LES ANAL EXT ANY METHOD,P991501063,CDM,521,RC,46924,HCPCS,Outpatient,,,750,375,,577.5,77,,,Percent of Total Billed Charges,77% of total billed charges,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,667.5,89,,,Percent of total Billed Charges,89% of total Billed charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.5,77,,,Percent of total Billed charges,77% of total billed charges,637.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,667.5,
TREATMENT OF ANAL FISSURE,P991501064,CDM,521,RC,46940,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267,89,,,Percent of total Billed Charges,89% of total Billed charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
INT HRHC LIG 1 HROID W/O IMG,P991501065,CDM,521,RC,46945,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
"UNLISTED PROCEDURE, ANUS",P991501066,CDM,521,RC,46999,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267,89,,,Percent of total Billed Charges,89% of total Billed charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
NEEDLE BIOPSY LIVER ADD-ON,P991501067,CDM,521,RC,47001,HCPCS,Outpatient,,,301,150.5,,231.77,77,,,Percent of Total Billed Charges,77% of total billed charges,76.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267.89,89,,,Percent of total Billed Charges,89% of total Billed charges,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.77,77,,,Percent of total Billed charges,77% of total billed charges,255.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.25,267.89,
INJECT/ASPIRATE LIVER CYST,P991501068,CDM,521,RC,47015,HCPCS,Outpatient,,,2467,1233.5,,1899.59,77,,,Percent of Total Billed Charges,77% of total billed charges,629.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,629.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,770.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,616.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2195.63,89,,,Percent of total Billed Charges,89% of total Billed charges,2195.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2195.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1006.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1006.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1006.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,616.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1899.59,77,,,Percent of total Billed charges,77% of total billed charges,2096.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,709.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1006.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,616.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,616.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616.75,2195.63,
WEDGE BIOPSY OF LIVER,P991501069,CDM,521,RC,47100,HCPCS,Outpatient,,,1811,905.5,,1394.47,77,,,Percent of Total Billed Charges,77% of total billed charges,461.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,461.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,565.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1611.79,89,,,Percent of total Billed Charges,89% of total Billed charges,1611.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1611.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.47,77,,,Percent of total Billed charges,77% of total billed charges,1539.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,520.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,738.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,452.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.75,1611.79,
CHOLEDOCHOTOMY,P991501070,CDM,521,RC,47420,HCPCS,Outpatient,,,1903,951.5,,1465.31,77,,,Percent of Total Billed Charges,77% of total billed charges,485.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,475.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1693.67,89,,,Percent of total Billed Charges,89% of total Billed charges,1693.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1693.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,776.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,776.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1465.31,77,,,Percent of total Billed charges,77% of total billed charges,1617.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,776.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,475.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,475.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.75,1693.67,
INCISION OF GALLBLADDER,P991501071,CDM,521,RC,47480,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
PERCUTANEOUS CHOLECYSTOSTOMY,P991501072,CDM,521,RC,47490,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
"INJ CHOLANGIOGRAPHY, W/IMAGING",P991501073,CDM,521,RC,47531,HCPCS,Outpatient,,,155,77.5,,119.35,77,,,Percent of Total Billed Charges,77% of total billed charges,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.95,89,,,Percent of total Billed Charges,89% of total Billed charges,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.35,77,,,Percent of total Billed charges,77% of total billed charges,131.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,137.95,
LAPAROSCOPIC CHOLECYSTECTOMY,P991501074,CDM,521,RC,47562,HCPCS,Outpatient,,,1757,878.5,,1352.89,77,,,Percent of Total Billed Charges,77% of total billed charges,448.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,549.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,439.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4765,100,,,Case rate,Pays based on per visit rate,4420,100,,,Case Rate,Pays based on per visit rate,4765,100,,,Case Rate,Pays based on per visit rate,716.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,716.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,716.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,439.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1352.89,77,,,Percent of total Billed charges,77% of total billed charges,1493.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,505.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,716.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,439.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,439.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439.25,4765,
LAPARO CHOLECYSTECTOMY/GRAPH,P991501075,CDM,521,RC,47563,HCPCS,Outpatient,,,1380.6,690.3,,1063.06,77,,,Percent of Total Billed Charges,77% of total billed charges,352.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,345.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4765,100,,,Case rate,Pays based on per visit rate,4420,100,,,Case Rate,Pays based on per visit rate,4765,100,,,Case Rate,Pays based on per visit rate,563.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.06,77,,,Percent of total Billed charges,77% of total billed charges,1173.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,563.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,345.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.15,4765,
CHOLECYSTECTOMY,P991501076,CDM,521,RC,47600,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
REMOVAL OF GALLBLADDER,P991501077,CDM,521,RC,47605,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
REMOVAL OF GALLBLADDER,P991501078,CDM,521,RC,47610,HCPCS,Outpatient,,,1711,855.5,,1317.47,77,,,Percent of Total Billed Charges,77% of total billed charges,436.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,534.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1522.79,89,,,Percent of total Billed Charges,89% of total Billed charges,1522.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1522.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1317.47,77,,,Percent of total Billed charges,77% of total billed charges,1454.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,491.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,698.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,427.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,427.75,1522.79,
PLACEMENT OF CHOLEDOCHAL STENT,P991501079,CDM,521,RC,47801,HCPCS,Outpatient,,,1044,522,,803.88,77,,,Percent of Total Billed Charges,77% of total billed charges,266.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,326.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,929.16,89,,,Percent of total Billed Charges,89% of total Billed charges,929.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,929.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,803.88,77,,,Percent of total Billed charges,77% of total billed charges,887.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261,929.16,
PLACEMENT OF DRAIN PANCREAS,P991501080,CDM,521,RC,48001,HCPCS,Outpatient,,,5070,2535,,3903.9,77,,,Percent of Total Billed Charges,77% of total billed charges,1292.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1292.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1267.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4512.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3903.9,77,,,Percent of total Billed charges,77% of total billed charges,4309.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2068.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1267.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.5,4512.3,
EXPLORATORY LAPAROTOMY,P991501081,CDM,521,RC,49000,HCPCS,Outpatient,,,1942,971,,1495.34,77,,,Percent of Total Billed Charges,77% of total billed charges,495.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,495.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,606.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1728.38,89,,,Percent of total Billed Charges,89% of total Billed charges,1728.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1728.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.34,77,,,Percent of total Billed charges,77% of total billed charges,1650.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,558.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,792.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,485.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,485.5,1728.38,
LAPAROTOMY REOPEN OF RECENT,P991501082,CDM,521,RC,49002,HCPCS,Outpatient,,,2092,1046,,1610.84,77,,,Percent of Total Billed Charges,77% of total billed charges,533.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,533.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,653.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1861.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1861.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1861.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1610.84,77,,,Percent of total Billed charges,77% of total billed charges,1778.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,601.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,853.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,523,1861.88,
EXPLORATION BEHIND ABDOMEN,P991501083,CDM,521,RC,49010,HCPCS,Outpatient,,,1218,609,,937.86,77,,,Percent of Total Billed Charges,77% of total billed charges,310.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,380.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1084.02,89,,,Percent of total Billed Charges,89% of total Billed charges,1084.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1084.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,496.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,496.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,496.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,937.86,77,,,Percent of total Billed charges,77% of total billed charges,1035.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,350.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,496.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.5,1084.02,
REEXPLORATION PELVIC WOUND,P991501084,CDM,521,RC,49014,HCPCS,Outpatient,,,791,395.5,,609.07,77,,,Percent of Total Billed Charges,77% of total billed charges,201.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,703.99,89,,,Percent of total Billed Charges,89% of total Billed charges,703.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.07,77,,,Percent of total Billed charges,77% of total billed charges,672.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,227.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,322.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.75,703.99,
DRAIN PERITONEAL ABSCESS OP,P991501085,CDM,521,RC,49020,HCPCS,Outpatient,,,4033,2016.5,,3105.41,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3589.37,89,,,Percent of total Billed Charges,89% of total Billed charges,3589.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3589.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3105.41,77,,,Percent of total Billed charges,77% of total billed charges,3428.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1159.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1645.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.25,3589.37,
DRAIN PERITONEAL ABSCESS,P991501086,CDM,521,RC,49060,HCPCS,Outpatient,,,4033,2016.5,,3105.41,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3589.37,89,,,Percent of total Billed Charges,89% of total Billed charges,3589.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3589.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3105.41,77,,,Percent of total Billed charges,77% of total billed charges,3428.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1159.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1645.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1008.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.25,3589.37,
BX NEEDLE PELVIC MASS,P991501087,CDM,521,RC,49180,HCPCS,Outpatient,,,973,486.5,,749.21,77,,,Percent of Total Billed Charges,77% of total billed charges,248.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,865.97,89,,,Percent of total Billed Charges,89% of total Billed charges,865.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,865.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,396.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,749.21,77,,,Percent of total Billed charges,77% of total billed charges,827.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,279.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,396.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.25,865.97,
EXC ABD TUM OVER 5 CM,P991501088,CDM,521,RC,49204,HCPCS,Outpatient,,,2903,1451.5,,2235.31,77,,,Percent of Total Billed Charges,77% of total billed charges,740.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,740.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,907.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,725.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2583.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2583.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2583.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,725.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2235.31,77,,,Percent of total Billed charges,77% of total billed charges,2467.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,834.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1184.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,725.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,725.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,725.75,2583.67,
EXC ABD TUM OVER 10 CM,P991501089,CDM,521,RC,49205,HCPCS,Outpatient,,,2436,1218,,1875.72,77,,,Percent of Total Billed Charges,77% of total billed charges,621.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,609,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2168.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2168.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2168.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,993.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,993.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,993.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.72,77,,,Percent of total Billed charges,77% of total billed charges,2070.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,993.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,609,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609,2168.04,
UMBILECTOMY,P991501090,CDM,521,RC,49250,HCPCS,Outpatient,,,1435,717.5,,1104.95,77,,,Percent of Total Billed Charges,77% of total billed charges,365.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1277.15,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.95,77,,,Percent of total Billed charges,77% of total billed charges,1219.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,585.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,358.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.75,1277.15,
OMENTECTOMY/EPIPLOECTOMY,P991501091,CDM,521,RC,49255,HCPCS,Outpatient,,,1272,636,,979.44,77,,,Percent of Total Billed Charges,77% of total billed charges,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.44,77,,,Percent of total Billed charges,77% of total billed charges,1081.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318,1132.08,
LAPAROSC DX W/WO PELV WASH,P991501092,CDM,521,RC,49320,HCPCS,Outpatient,,,2188,1094,,1684.76,77,,,Percent of Total Billed Charges,77% of total billed charges,557.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,557.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,683.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,547,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1947.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1947.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1947.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,892.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,892.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,892.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,547,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1684.76,77,,,Percent of total Billed charges,77% of total billed charges,1859.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,629.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,892.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,547,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,547,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547,1947.32,
LAP W/ BX,P991501093,CDM,521,RC,49321,HCPCS,Outpatient,,,2442,1221,,1880.34,77,,,Percent of Total Billed Charges,77% of total billed charges,622.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,622.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,763.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,610.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2173.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2173.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2173.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,996.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,996.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,996.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,610.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1880.34,77,,,Percent of total Billed charges,77% of total billed charges,2075.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,702.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,996.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,610.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,610.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,610.5,2173.38,
LAP W/ASPIRATION OF CYST,P991501094,CDM,521,RC,49322,HCPCS,Outpatient,,,802,401,,617.54,77,,,Percent of Total Billed Charges,77% of total billed charges,204.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,713.78,89,,,Percent of total Billed Charges,89% of total Billed charges,713.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,713.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,327.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.54,77,,,Percent of total Billed charges,77% of total billed charges,681.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,200.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.5,713.78,
LAP W/DRAINAGE LYMPHOCELE,P991501095,CDM,521,RC,49323,HCPCS,Outpatient,,,764,382,,588.28,77,,,Percent of Total Billed Charges,77% of total billed charges,194.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,191,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,679.96,89,,,Percent of total Billed Charges,89% of total Billed charges,679.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.28,77,,,Percent of total Billed charges,77% of total billed charges,649.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,311.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,191,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191,679.96,
UNLSTD LAPS PX ABD PERTM&OMN,P991501096,CDM,521,RC,49329,HCPCS,Outpatient,,,2180,1090,,1678.6,77,,,Percent of Total Billed Charges,77% of total billed charges,555.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,681.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1940.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1940.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1940.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,889.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,889.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,889.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1678.6,77,,,Percent of total Billed charges,77% of total billed charges,1853,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,889.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545,1940.2,
REMOVE FOREIGN BODY ADBOMEN,P991501097,CDM,521,RC,49402,HCPCS,Outpatient,,,750,375,,577.5,77,,,Percent of Total Billed Charges,77% of total billed charges,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,667.5,89,,,Percent of total Billed Charges,89% of total Billed charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,667.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.5,77,,,Percent of total Billed charges,77% of total billed charges,637.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,667.5,
INSERTION OF GASTOSTOMY TUBE,P991501098,CDM,521,RC,49440,HCPCS,Outpatient,,,1066,533,,820.82,77,,,Percent of Total Billed Charges,77% of total billed charges,271.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,948.74,89,,,Percent of total Billed Charges,89% of total Billed charges,948.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,434.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,434.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.82,77,,,Percent of total Billed charges,77% of total billed charges,906.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,306.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,434.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,266.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,948.74,
FLUORO EXAM OF G/COLON TUBE,P991501099,CDM,521,RC,49465,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,235.85,89,,,Percent of total Billed Charges,89% of total Billed charges,235.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.25,235.85,
PRP I/HERN INIT REDUC >5 YR,P991501100,CDM,521,RC,49505,HCPCS,Outpatient,,,1272,636,,979.44,77,,,Percent of Total Billed Charges,77% of total billed charges,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.44,77,,,Percent of total Billed charges,77% of total billed charges,1081.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318,1132.08,
PRP I/HERN INIT BLOCK >5 YR,P991501101,CDM,521,RC,49507,HCPCS,Outpatient,,,1794,897,,1381.38,77,,,Percent of Total Billed Charges,77% of total billed charges,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,560.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1596.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1381.38,77,,,Percent of total Billed charges,77% of total billed charges,1524.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,515.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,1596.66,
REREPAIR ING HERNIA REDUCE,P991501102,CDM,521,RC,49520,HCPCS,Outpatient,,,1794,897,,1381.38,77,,,Percent of Total Billed Charges,77% of total billed charges,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,560.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1596.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1381.38,77,,,Percent of total Billed charges,77% of total billed charges,1524.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,515.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,1596.66,
REREPAIR ING HERNIA BLOCKED,P991501103,CDM,521,RC,49521,HCPCS,Outpatient,,,1033,516.5,,795.41,77,,,Percent of Total Billed Charges,77% of total billed charges,263.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,258.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,919.37,89,,,Percent of total Billed Charges,89% of total Billed charges,919.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,421.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,258.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.41,77,,,Percent of total Billed charges,77% of total billed charges,878.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,296.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,421.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,258.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,258.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.25,919.37,
RPR REM HERNIA INIT REDUCE,P991501104,CDM,920,RC,49550,HCPCS,Outpatient,,,953,476.5,,733.81,77,,,Percent of Total Billed Charges,77% of total billed charges,243.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,705.22,74,,,Percent of Total Billed Charges,74% of total billed charges,657.57,69,,,Percent of Total Billed Charges,69% of total billed charges,657.57,69,,,Percent of Total Billed Charges,69% of total billed charges,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.57,69,,,Percent of Total Billed Charges,69% of total billed charges,657.57,69,,,Percent of Total Billed Charges,69% of total billed charges,800.52,84,,,Percent of Total Billed Charges,84% of total billed charges,781.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,848.17,89,,,Percent of total Billed Charges,89% of total Billed charges,848.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.81,77,,,Percent of total Billed charges,77% of total billed charges,810.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,388.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,238.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,848.17,
RPR FEM HERNIA INIT BLOCKED,P991501105,CDM,521,RC,49553,HCPCS,Outpatient,,,1375,687.5,,1058.75,77,,,Percent of Total Billed Charges,77% of total billed charges,350.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,350.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1223.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1223.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1223.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,561,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1058.75,77,,,Percent of total Billed charges,77% of total billed charges,1168.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,395.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,561,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.75,1223.75,
REREPAIR FEM HERNIA REDUCE,P991501106,CDM,521,RC,49555,HCPCS,Outpatient,,,1645,822.5,,1266.65,77,,,Percent of Total Billed Charges,77% of total billed charges,419.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,419.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,514.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1464.05,89,,,Percent of total Billed Charges,89% of total Billed charges,1464.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1464.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,671.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,671.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1266.65,77,,,Percent of total Billed charges,77% of total billed charges,1398.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,472.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,671.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.25,1464.05,
REREPAIR FEM HERNIA BLOCKED,P991501107,CDM,521,RC,49557,HCPCS,Outpatient,,,1031,515.5,,793.87,77,,,Percent of Total Billed Charges,77% of total billed charges,262.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,257.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,917.59,89,,,Percent of total Billed Charges,89% of total Billed charges,917.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,917.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,793.87,77,,,Percent of total Billed charges,77% of total billed charges,876.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,296.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,420.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,257.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,257.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.75,917.59,
REPAIR AA HRN 1ST <3CM RDC,P991501108,CDM,521,RC,49591,HCPCS,Outpatient,,,654,327,,503.58,77,,,Percent of Total Billed Charges,77% of total billed charges,166.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,582.06,89,,,Percent of total Billed Charges,89% of total Billed charges,582.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,582.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.58,77,,,Percent of total Billed charges,77% of total billed charges,555.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.5,582.06,
UMBILICAL HERNIA INCARCERATED,P991501109,CDM,521,RC,49592,HCPCS,Outpatient,,,1100,550,,847,77,,,Percent of Total Billed Charges,77% of total billed charges,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,979,89,,,Percent of total Billed Charges,89% of total Billed charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,979,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,847,77,,,Percent of total Billed charges,77% of total billed charges,935,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,316.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,275,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275,979,
REPAIR AA HRN 1ST 3-10CM RDC,P991501110,CDM,521,RC,49593,HCPCS,Outpatient,,,1099,549.5,,846.23,77,,,Percent of Total Billed Charges,77% of total billed charges,280.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,274.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,978.11,89,,,Percent of total Billed Charges,89% of total Billed charges,978.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,846.23,77,,,Percent of total Billed charges,77% of total billed charges,934.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,315.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,274.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.75,978.11,
RPR AA HRN 1ST 3-10 NCR/STRN,P991501111,CDM,521,RC,49594,HCPCS,Outpatient,,,1432,716,,1102.64,77,,,Percent of Total Billed Charges,77% of total billed charges,365.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,447.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1274.48,89,,,Percent of total Billed Charges,89% of total Billed charges,1274.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1274.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,584.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1102.64,77,,,Percent of total Billed charges,77% of total billed charges,1217.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,411.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,584.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,358,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358,1274.48,
REPAIR AA HRN 1ST > 10 RDC,P991501112,CDM,521,RC,49595,HCPCS,Outpatient,,,1478,739,,1138.06,77,,,Percent of Total Billed Charges,77% of total billed charges,376.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,461.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,369.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1315.42,89,,,Percent of total Billed Charges,89% of total Billed charges,1315.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1315.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,603.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,603.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,603.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,369.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1138.06,77,,,Percent of total Billed charges,77% of total billed charges,1256.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,424.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,603.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,369.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,369.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.5,1315.42,
RPR AA HRN 1ST > 10 NCR/STRN,P991501113,CDM,521,RC,49596,HCPCS,Outpatient,,,1965,982.5,,1513.05,77,,,Percent of Total Billed Charges,77% of total billed charges,501.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,501.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,491.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1748.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1748.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1748.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,801.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,801.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,801.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1513.05,77,,,Percent of total Billed charges,77% of total billed charges,1670.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,564.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,801.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,491.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,491.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.25,1748.85,
LAP ING HERNIA REPAIR INIT,P991501114,CDM,521,RC,49650,HCPCS,Outpatient,,,821,410.5,,632.17,77,,,Percent of Total Billed Charges,77% of total billed charges,209.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,730.69,89,,,Percent of total Billed Charges,89% of total Billed charges,730.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,730.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.17,77,,,Percent of total Billed charges,77% of total billed charges,697.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,334.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.25,730.69,
SUTURE 2ND ABD WALL DEHISCE,P991501115,CDM,521,RC,49900,HCPCS,Outpatient,,,1272,636,,979.44,77,,,Percent of Total Billed Charges,77% of total billed charges,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.44,77,,,Percent of total Billed charges,77% of total billed charges,1081.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,518.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318,1132.08,
UNLISTED PX ABD PERTM&OMN,P991501116,CDM,521,RC,49999,HCPCS,Outpatient,,,650,325,,500.5,77,,,Percent of Total Billed Charges,77% of total billed charges,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,578.5,89,,,Percent of total Billed Charges,89% of total Billed charges,578.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,500.5,77,,,Percent of total Billed charges,77% of total billed charges,552.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,265.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.5,578.5,
CHANGE NEPHROURETERAL CATH,P991501117,CDM,521,RC,50387,HCPCS,Outpatient,,,1160,580,,893.2,77,,,Percent of Total Billed Charges,77% of total billed charges,295.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1032.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1032.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1032.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,893.2,77,,,Percent of total Billed charges,77% of total billed charges,986,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,473.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,1032.4,
FRAGMENTING KIDNEY STONE BILAT,P991501118,CDM,521,RC,50590,HCPCS,Outpatient,,,1630,815,,1255.1,77,,,Percent of Total Billed Charges,77% of total billed charges,415.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,407.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1450.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1450.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1450.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.1,77,,,Percent of total Billed charges,77% of total billed charges,1385.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,665.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,407.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.5,1450.7,
LITHOTRIPSY,P991501119,CDM,521,RC,50590,HCPCS,Outpatient,,,1450,725,,1116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,369.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1290.5,89,,,Percent of total Billed Charges,89% of total Billed charges,1290.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1290.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.5,77,,,Percent of total Billed charges,77% of total billed charges,1232.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,416.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,591.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,362.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.5,1290.5,
URETEROLYSIS FOR RETROPERIF,P991501120,CDM,521,RC,50715,HCPCS,Outpatient,,,2391,1195.5,,1841.07,77,,,Percent of Total Billed Charges,77% of total billed charges,609.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,609.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2127.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2127.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2127.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1841.07,77,,,Percent of total Billed charges,77% of total billed charges,2032.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,687.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,975.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,597.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.75,2127.99,
CYSTOSTOMY W/DRAIN SUP PUBC,P991501121,CDM,521,RC,51040,HCPCS,Outpatient,,,930,465,,716.1,77,,,Percent of Total Billed Charges,77% of total billed charges,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,827.7,89,,,Percent of total Billed Charges,89% of total Billed charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.1,77,,,Percent of total Billed charges,77% of total billed charges,790.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.5,827.7,
DRAIN BL W/CATH INSERTION,P991501122,CDM,521,RC,51102,HCPCS,Outpatient,,,480,240,,369.6,77,,,Percent of Total Billed Charges,77% of total billed charges,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.2,89,,,Percent of total Billed Charges,89% of total Billed charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.6,77,,,Percent of total Billed charges,77% of total billed charges,408,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,138,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120,427.2,
REMOVAL OF BLADDER CYST,P991501123,CDM,521,RC,51500,HCPCS,Outpatient,,,1381,690.5,,1063.37,77,,,Percent of Total Billed Charges,77% of total billed charges,352.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,345.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1229.09,89,,,Percent of total Billed Charges,89% of total Billed charges,1229.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1229.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.37,77,,,Percent of total Billed charges,77% of total billed charges,1173.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,563.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,345.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.25,1229.09,
REPAIR OF URETER LESION,P991501124,CDM,521,RC,51535,HCPCS,Outpatient,,,1079,539.5,,830.83,77,,,Percent of Total Billed Charges,77% of total billed charges,275.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,337.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,269.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,960.31,89,,,Percent of total Billed Charges,89% of total Billed charges,960.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,960.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,440.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,440.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,440.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,269.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.83,77,,,Percent of total Billed charges,77% of total billed charges,917.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,310.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,440.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,269.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,269.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.75,960.31,
"CYSTECTOMY,PARTIAL;SIMPLE",P991501125,CDM,521,RC,51550,HCPCS,Outpatient,,,1043,521.5,,803.11,77,,,Percent of Total Billed Charges,77% of total billed charges,265.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,928.27,89,,,Percent of total Billed Charges,89% of total Billed charges,928.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,928.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,425.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,803.11,77,,,Percent of total Billed charges,77% of total billed charges,886.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,299.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.75,928.27,
INJ FOR BLADDER XRAY,P991501126,CDM,521,RC,51600,HCPCS,Outpatient,,,380,190,,292.6,77,,,Percent of Total Billed Charges,77% of total billed charges,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.2,89,,,Percent of total Billed Charges,89% of total Billed charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.6,77,,,Percent of total Billed charges,77% of total billed charges,323,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95,338.2,
IRRIGATION OF BLADDER,P991501127,CDM,521,RC,51700,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,112.14,
INSERT BLADDER CATHETER,P991501128,CDM,521,RC,51701,HCPCS,Outpatient,,,33,16.5,,25.41,77,,,Percent of Total Billed Charges,77% of total billed charges,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.37,89,,,Percent of total Billed Charges,89% of total Billed charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.41,77,,,Percent of total Billed charges,77% of total billed charges,28.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,29.37,
INSERT TEMP BLADDER CATH,P991501129,CDM,521,RC,51702,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
INSERT BLADDER CATH COMPLEX,P991501130,CDM,521,RC,51703,HCPCS,Outpatient,,,275,137.5,,211.75,77,,,Percent of Total Billed Charges,77% of total billed charges,70.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.75,89,,,Percent of total Billed Charges,89% of total Billed charges,244.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.75,77,,,Percent of total Billed charges,77% of total billed charges,233.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.75,244.75,
CHANGE OF CYSTOTOMY TUBE,P991501131,CDM,521,RC,51705,HCPCS,Outpatient,,,169,84.5,,130.13,77,,,Percent of Total Billed Charges,77% of total billed charges,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.41,89,,,Percent of total Billed Charges,89% of total Billed charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.13,77,,,Percent of total Billed charges,77% of total billed charges,143.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.25,150.41,
CHANGE OF BLADDER TUBE,P991501132,CDM,521,RC,51710,HCPCS,Outpatient,,,248,124,,190.96,77,,,Percent of Total Billed Charges,77% of total billed charges,63.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.72,89,,,Percent of total Billed Charges,89% of total Billed charges,220.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,77,,,Percent of total Billed charges,77% of total billed charges,210.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62,220.72,
ENDOSCOPIC INJECTION/IMPLANT,P991501133,CDM,521,RC,51715,HCPCS,Outpatient,,,660,330,,508.2,77,,,Percent of Total Billed Charges,77% of total billed charges,168.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,587.4,89,,,Percent of total Billed Charges,89% of total Billed charges,587.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,269.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,269.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.2,77,,,Percent of total Billed charges,77% of total billed charges,561,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,189.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,269.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165,587.4,
TREATMENT OF BLADDER LESION,P991501134,CDM,521,RC,51720,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
SIMPLE CYSTOMETROGRAM,P991501135,CDM,521,RC,51725,HCPCS,Outpatient,,,338,169,,260.26,77,,,Percent of Total Billed Charges,77% of total billed charges,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300.82,89,,,Percent of total Billed Charges,89% of total Billed charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.51,120,,,Fee Schedule,120% of MO Medicaid Rate,142.51,120,,,Fee Schedule,120% of MO Medicaid Rate,142.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.26,77,,,Percent of total Billed charges,77% of total billed charges,287.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.51,120,,,Fee Schedule,120% of MO Medicaid Rate,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.5,300.82,
COMPLEX CYSTOMETROGRAM,P991501136,CDM,521,RC,51726,HCPCS,Outpatient,,,493,246.5,26,379.61,77,,,Percent of Total Billed Charges,77% of total billed charges,125.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,438.77,89,,,Percent of total Billed Charges,89% of total Billed charges,438.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,438.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.4,120,,,Fee Schedule,120% of MO Medicaid Rate,202.4,120,,,Fee Schedule,120% of MO Medicaid Rate,202.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.61,77,,,Percent of total Billed charges,77% of total billed charges,419.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,202.4,120,,,Fee Schedule,120% of MO Medicaid Rate,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.25,438.77,
CYSTOMETROGRAM W/UP,P991501137,CDM,521,RC,51727,HCPCS,Outpatient,,,662,331,26,509.74,77,,,Percent of Total Billed Charges,77% of total billed charges,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,589.18,89,,,Percent of total Billed Charges,89% of total Billed charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.7,120,,,Fee Schedule,120% of MO Medicaid Rate,240.7,120,,,Fee Schedule,120% of MO Medicaid Rate,240.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,509.74,77,,,Percent of total Billed charges,77% of total billed charges,562.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240.7,120,,,Fee Schedule,120% of MO Medicaid Rate,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.5,589.18,
CYSTOMETROGRAM W/VP,P991501138,CDM,521,RC,51728,HCPCS,Outpatient,,,673,336.5,26,518.21,77,,,Percent of Total Billed Charges,77% of total billed charges,171.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,598.97,89,,,Percent of total Billed Charges,89% of total Billed charges,598.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,598.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.96,120,,,Fee Schedule,120% of MO Medicaid Rate,244.96,120,,,Fee Schedule,120% of MO Medicaid Rate,244.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,168.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.21,77,,,Percent of total Billed charges,77% of total billed charges,572.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.96,120,,,Fee Schedule,120% of MO Medicaid Rate,168.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.25,598.97,
CYSTOMETROGRAM W/VP&UP,P991501139,CDM,521,RC,51729,HCPCS,Outpatient,,,244,122,26,187.88,77,,,Percent of Total Billed Charges,77% of total billed charges,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.16,89,,,Percent of total Billed Charges,89% of total Billed charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.64,120,,,Fee Schedule,120% of MO Medicaid Rate,244.64,120,,,Fee Schedule,120% of MO Medicaid Rate,244.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.88,77,,,Percent of total Billed charges,77% of total billed charges,207.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.64,120,,,Fee Schedule,120% of MO Medicaid Rate,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,244.64,
COMPLEX UROFLOWMETRY,P991501140,CDM,521,RC,51741,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.27,120,,,Fee Schedule,120% of MO Medicaid Rate,17.27,120,,,Fee Schedule,120% of MO Medicaid Rate,17.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.27,120,,,Fee Schedule,120% of MO Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
COMPLEX UROFLOWMETRY,P991501141,CDM,521,RC,51741,HCPCS,Outpatient,,,26,13,26,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.27,120,,,Fee Schedule,120% of MO Medicaid Rate,17.27,120,,,Fee Schedule,120% of MO Medicaid Rate,17.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.27,120,,,Fee Schedule,120% of MO Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
ANAL/URINARY MUSCLE STUDY,P991501142,CDM,521,RC,51784,HCPCS,Outpatient,,,72,36,26,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.08,89,,,Percent of total Billed Charges,89% of total Billed charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.96,120,,,Fee Schedule,120% of MO Medicaid Rate,95.96,120,,,Fee Schedule,120% of MO Medicaid Rate,95.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.96,120,,,Fee Schedule,120% of MO Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,95.96,
ANAL/URINARY MUSCLE STUDY,P991501143,CDM,521,RC,51784,HCPCS,Outpatient,,,72,36,26,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.08,89,,,Percent of total Billed Charges,89% of total Billed charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.96,120,,,Fee Schedule,120% of MO Medicaid Rate,95.96,120,,,Fee Schedule,120% of MO Medicaid Rate,95.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.96,120,,,Fee Schedule,120% of MO Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,95.96,
INTRAABDOMINAL PRESSURE TEST,P991501144,CDM,521,RC,51797,HCPCS,Outpatient,,,232,116,26,178.64,77,,,Percent of Total Billed Charges,77% of total billed charges,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206.48,89,,,Percent of total Billed Charges,89% of total Billed charges,206.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.7,120,,,Fee Schedule,120% of MO Medicaid Rate,144.7,120,,,Fee Schedule,120% of MO Medicaid Rate,144.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.64,77,,,Percent of total Billed charges,77% of total billed charges,197.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.7,120,,,Fee Schedule,120% of MO Medicaid Rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58,206.48,
US URINE CAPACITY MEASURE,P991501145,CDM,521,RC,51798,HCPCS,Outpatient,,,18,9,,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.02,89,,,Percent of total Billed Charges,89% of total Billed charges,16.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,16.02,
ANT VESICOUR MMK SIMPLE,P991501146,CDM,521,RC,51840,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
ANT VESICOUR MMK COMPLICATE,P991501147,CDM,521,RC,51841,HCPCS,Outpatient,,,4182,2091,,3220.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1066.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1066.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1306.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1045.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3721.98,89,,,Percent of total Billed Charges,89% of total Billed charges,3721.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3721.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1706.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1706.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1706.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1045.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3220.14,77,,,Percent of total Billed charges,77% of total billed charges,3554.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1202.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1706.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1045.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1045.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1045.5,3721.98,
ABD/VAG VESICAL NECK SUSPEN,P991501148,CDM,521,RC,51845,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
REPAIR OF BLADDER WOUND,P991501149,CDM,521,RC,51860,HCPCS,Outpatient,,,1619,809.5,,1246.63,77,,,Percent of Total Billed Charges,77% of total billed charges,412.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1440.91,89,,,Percent of total Billed Charges,89% of total Billed charges,1440.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1440.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,660.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,660.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,660.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1246.63,77,,,Percent of total Billed charges,77% of total billed charges,1376.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,465.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,660.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,404.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.75,1440.91,
CYSTORRHAPHY SUTR BLDR COMP,P991501150,CDM,521,RC,51865,HCPCS,Outpatient,,,1101,550.5,,847.77,77,,,Percent of Total Billed Charges,77% of total billed charges,280.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,275.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,979.89,89,,,Percent of total Billed Charges,89% of total Billed charges,979.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,979.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,449.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,449.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,449.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,847.77,77,,,Percent of total Billed charges,77% of total billed charges,935.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,316.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,449.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,275.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,275.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.25,979.89,
CLOSURE OF CYSTOSTOMY,P991501151,CDM,521,RC,51880,HCPCS,Outpatient,,,663,331.5,,510.51,77,,,Percent of Total Billed Charges,77% of total billed charges,169.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,590.07,89,,,Percent of total Billed Charges,89% of total Billed charges,590.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.51,77,,,Percent of total Billed charges,77% of total billed charges,563.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.75,590.07,
LAP URETHRAL SUSPENSION,P991501152,CDM,521,RC,51990,HCPCS,Outpatient,,,1794,897,,1381.38,77,,,Percent of Total Billed Charges,77% of total billed charges,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,560.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1596.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1381.38,77,,,Percent of total Billed charges,77% of total billed charges,1524.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,515.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,1596.66,
CYSTOURETHROSCOPY,P991501153,CDM,521,RC,52000,HCPCS,Outpatient,,,549,274.5,,422.73,77,,,Percent of Total Billed Charges,77% of total billed charges,140,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,488.61,89,,,Percent of total Billed Charges,89% of total Billed charges,488.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.73,77,,,Percent of total Billed charges,77% of total billed charges,466.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.25,488.61,
CYSTOSCOPY REMOVAL OF CLOTS,P991501154,CDM,521,RC,52001,HCPCS,Outpatient,,,629,314.5,,484.33,77,,,Percent of Total Billed Charges,77% of total billed charges,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,559.81,89,,,Percent of total Billed Charges,89% of total Billed charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,484.33,77,,,Percent of total Billed charges,77% of total billed charges,534.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.25,559.81,
CYSTOSCOPY,P991501155,CDM,521,RC,52005,HCPCS,Outpatient,,,713,356.5,,549.01,77,,,Percent of Total Billed Charges,77% of total billed charges,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,634.57,89,,,Percent of total Billed Charges,89% of total Billed charges,634.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.01,77,,,Percent of total Billed charges,77% of total billed charges,606.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,290.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.25,634.57,
CYSTO W/URETERAL CATH,P991501156,CDM,521,RC,52007,HCPCS,Outpatient,,,700,350,,539,77,,,Percent of Total Billed Charges,77% of total billed charges,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,623,89,,,Percent of total Billed Charges,89% of total Billed charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539,77,,,Percent of total Billed charges,77% of total billed charges,595,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,201.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175,623,
CYSTOSCOPY WITH BIOPSY,P991501157,CDM,521,RC,52204,HCPCS,Outpatient,,,765,382.5,,589.05,77,,,Percent of Total Billed Charges,77% of total billed charges,195.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,680.85,89,,,Percent of total Billed Charges,89% of total Billed charges,680.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,589.05,77,,,Percent of total Billed charges,77% of total billed charges,650.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,312.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.25,680.85,
CYSTO WITH FULGURATION,P991501158,CDM,521,RC,52214,HCPCS,Outpatient,,,372,186,,286.44,77,,,Percent of Total Billed Charges,77% of total billed charges,94.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.08,89,,,Percent of total Billed Charges,89% of total Billed charges,331.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.44,77,,,Percent of total Billed charges,77% of total billed charges,316.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93,331.08,
CYSTOSCOPY WITH BLADDER BIOPSY,P991501159,CDM,521,RC,52224,HCPCS,Outpatient,,,1468,734,,1130.36,77,,,Percent of Total Billed Charges,77% of total billed charges,374.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,458.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,367,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1306.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1306.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1306.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,598.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,598.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1130.36,77,,,Percent of total Billed charges,77% of total billed charges,1247.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,422.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,598.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,367,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,367,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,367,1306.52,
CYSTO W/REM OF TUMORS SMALL,P991501160,CDM,521,RC,52234,HCPCS,Outpatient,,,538,269,,414.26,77,,,Percent of Total Billed Charges,77% of total billed charges,137.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,478.82,89,,,Percent of total Billed Charges,89% of total Billed charges,478.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.26,77,,,Percent of total Billed charges,77% of total billed charges,457.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,219.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.5,478.82,
CYSTO W/FULG OF MINOR LESION,P991501161,CDM,521,RC,52235,HCPCS,Outpatient,,,631,315.5,,485.87,77,,,Percent of Total Billed Charges,77% of total billed charges,160.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,561.59,89,,,Percent of total Billed Charges,89% of total Billed charges,561.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,561.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,485.87,77,,,Percent of total Billed charges,77% of total billed charges,536.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,181.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,257.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.75,561.59,
CYSTOSCOPY AND TREATMENT,P991501162,CDM,521,RC,52260,HCPCS,Outpatient,,,464,232,,357.28,77,,,Percent of Total Billed Charges,77% of total billed charges,118.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,412.96,89,,,Percent of total Billed Charges,89% of total Billed charges,412.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.28,77,,,Percent of total Billed charges,77% of total billed charges,394.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,189.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116,412.96,
CYSTOSCOPY AND TREATMENT,P991501163,CDM,521,RC,52281,HCPCS,Outpatient,,,612,306,,471.24,77,,,Percent of Total Billed Charges,77% of total billed charges,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,544.68,89,,,Percent of total Billed Charges,89% of total Billed charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,471.24,77,,,Percent of total Billed charges,77% of total billed charges,520.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,544.68,
CYSTOSCOPY IMPLANT STENT,P991501164,CDM,521,RC,52282,HCPCS,Outpatient,,,364,182,,280.28,77,,,Percent of Total Billed Charges,77% of total billed charges,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.96,89,,,Percent of total Billed Charges,89% of total Billed charges,323.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,323.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.28,77,,,Percent of total Billed charges,77% of total billed charges,309.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91,323.96,
CYSTOSCOPY AND TREATMENT,P991501165,CDM,521,RC,52285,HCPCS,Outpatient,,,450,225,,346.5,77,,,Percent of Total Billed Charges,77% of total billed charges,114.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,400.5,89,,,Percent of total Billed Charges,89% of total Billed charges,400.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.5,77,,,Percent of total Billed charges,77% of total billed charges,382.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,183.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,400.5,
CYSTOSCOPY CHEMODENERVATION,P991501166,CDM,521,RC,52287,HCPCS,Outpatient,,,360,180,,277.2,77,,,Percent of Total Billed Charges,77% of total billed charges,91.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320.4,89,,,Percent of total Billed Charges,89% of total Billed charges,320.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,320.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.2,77,,,Percent of total Billed charges,77% of total billed charges,306,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90,320.4,
CYSTO W/SIMP REM BILAT,P991501167,CDM,521,RC,52310,HCPCS,Outpatient,,,522,261,50,401.94,77,,,Percent of Total Billed Charges,77% of total billed charges,133.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,464.58,89,,,Percent of total Billed Charges,89% of total Billed charges,464.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.94,77,,,Percent of total Billed charges,77% of total billed charges,443.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,464.58,
CYSTO W/SIMP REM STONE&STENT,P991501168,CDM,521,RC,52310,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
CYSTOSCOPY AND TREATMENT,P991501169,CDM,521,RC,52315,HCPCS,Outpatient,,,866,433,,666.82,77,,,Percent of Total Billed Charges,77% of total billed charges,220.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,216.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,770.74,89,,,Percent of total Billed Charges,89% of total Billed charges,770.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,770.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,353.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,353.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,666.82,77,,,Percent of total Billed charges,77% of total billed charges,736.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,248.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,353.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,216.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,216.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.5,770.74,
LITHOLAPAXY SMPL/SM <2.5 CM,P991501170,CDM,521,RC,52317,HCPCS,Outpatient,,,762,381,,586.74,77,,,Percent of Total Billed Charges,77% of total billed charges,194.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,678.18,89,,,Percent of total Billed Charges,89% of total Billed charges,678.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,678.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.74,77,,,Percent of total Billed charges,77% of total billed charges,647.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,310.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.5,678.18,
LITHOLAPAXY COMP/LG > 2.5 CM,P991501171,CDM,521,RC,52318,HCPCS,Outpatient,,,539,269.5,,415.03,77,,,Percent of Total Billed Charges,77% of total billed charges,137.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,479.71,89,,,Percent of total Billed Charges,89% of total Billed charges,479.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,479.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.03,77,,,Percent of total Billed charges,77% of total billed charges,458.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,479.71,
CYSTOSCOPY AND TREATMENT,P991501172,CDM,521,RC,52320,HCPCS,Outpatient,,,540,270,,415.8,77,,,Percent of Total Billed Charges,77% of total billed charges,137.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,480.6,89,,,Percent of total Billed Charges,89% of total Billed charges,480.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,480.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.8,77,,,Percent of total Billed charges,77% of total billed charges,459,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135,480.6,
CYSTOSCOPY INJECT MATERIAL,P991501173,CDM,521,RC,52327,HCPCS,Outpatient,,,335,167.5,,257.95,77,,,Percent of Total Billed Charges,77% of total billed charges,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,298.15,89,,,Percent of total Billed Charges,89% of total Billed charges,298.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.95,77,,,Percent of total Billed charges,77% of total billed charges,284.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.75,298.15,
CYSTO W/INSERT URETERAL STENT,P991501174,CDM,521,RC,52332,HCPCS,Outpatient,,,627,313.5,,482.79,77,,,Percent of Total Billed Charges,77% of total billed charges,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,558.03,89,,,Percent of total Billed Charges,89% of total Billed charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,482.79,77,,,Percent of total Billed charges,77% of total billed charges,532.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.75,558.03,
CYSTO W/INST URETERAL STNT BI,P991501175,CDM,521,RC,52332,HCPCS,Outpatient,,,1254,627,50,965.58,77,,,Percent of Total Billed Charges,77% of total billed charges,319.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,319.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,391.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,313.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1116.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1116.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,313.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965.58,77,,,Percent of total Billed charges,77% of total billed charges,1065.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,360.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,511.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,313.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,313.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.5,1116.06,
CREATE PASSAGE TO KIDNEY,P991501176,CDM,521,RC,52334,HCPCS,Outpatient,,,503,251.5,,387.31,77,,,Percent of Total Billed Charges,77% of total billed charges,128.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,447.67,89,,,Percent of total Billed Charges,89% of total Billed charges,447.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,447.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.31,77,,,Percent of total Billed charges,77% of total billed charges,427.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.75,447.67,
CYSTO W/ URETER STRICTURE TX,P991501177,CDM,521,RC,52341,HCPCS,Outpatient,,,536,268,,412.72,77,,,Percent of Total Billed Charges,77% of total billed charges,136.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,477.04,89,,,Percent of total Billed Charges,89% of total Billed charges,477.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,477.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412.72,77,,,Percent of total Billed charges,77% of total billed charges,455.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134,477.04,
CYSTO W/UP STRICTURE TX,P991501178,CDM,521,RC,52342,HCPCS,Outpatient,,,345,172.5,,265.65,77,,,Percent of Total Billed Charges,77% of total billed charges,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.05,89,,,Percent of total Billed Charges,89% of total Billed charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,77,,,Percent of total Billed charges,77% of total billed charges,293.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,307.05,
CYSTOURETERO & OR PYELOSCOPE,P991501179,CDM,521,RC,52351,HCPCS,Outpatient,,,663,331.5,,510.51,77,,,Percent of Total Billed Charges,77% of total billed charges,169.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,590.07,89,,,Percent of total Billed Charges,89% of total Billed charges,590.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.51,77,,,Percent of total Billed charges,77% of total billed charges,563.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.75,590.07,
CYSTOURETERO W/STONE REMOVE,P991501180,CDM,521,RC,52352,HCPCS,Outpatient,,,777,388.5,,598.29,77,,,Percent of Total Billed Charges,77% of total billed charges,198.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,691.53,89,,,Percent of total Billed Charges,89% of total Billed charges,691.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,598.29,77,,,Percent of total Billed charges,77% of total billed charges,660.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,317.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,194.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.25,691.53,
CYSTO WITH LITHOTRIPSY,P991501181,CDM,521,RC,52353,HCPCS,Outpatient,,,859,429.5,,661.43,77,,,Percent of Total Billed Charges,77% of total billed charges,219.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,214.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,764.51,89,,,Percent of total Billed Charges,89% of total Billed charges,764.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,661.43,77,,,Percent of total Billed charges,77% of total billed charges,730.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,246.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,350.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,214.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,214.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.75,764.51,
CYSTOURETERO W/BIOPSY,P991501182,CDM,521,RC,52354,HCPCS,Outpatient,,,893,446.5,,687.61,77,,,Percent of Total Billed Charges,77% of total billed charges,227.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,223.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,794.77,89,,,Percent of total Billed Charges,89% of total Billed charges,794.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,794.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,687.61,77,,,Percent of total Billed charges,77% of total billed charges,759.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,256.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,364.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,223.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.25,794.77,
CYSTOURETERO W/EXCISE TUMOR,P991501183,CDM,521,RC,52355,HCPCS,Outpatient,,,480,240,,369.6,77,,,Percent of Total Billed Charges,77% of total billed charges,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.2,89,,,Percent of total Billed Charges,89% of total Billed charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.6,77,,,Percent of total Billed charges,77% of total billed charges,408,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,138,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120,427.2,
CYSTO/URETERO W/LITHOTRIPSY,P991501184,CDM,521,RC,52356,HCPCS,Outpatient,,,914,457,,703.78,77,,,Percent of Total Billed Charges,77% of total billed charges,233.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,813.46,89,,,Percent of total Billed Charges,89% of total Billed charges,813.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,813.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.78,77,,,Percent of total Billed charges,77% of total billed charges,776.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,372.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,228.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.5,813.46,
CYSTOURETHRO CUT EJACUL DUCT,P991501185,CDM,521,RC,52402,HCPCS,Outpatient,,,380,190,,292.6,77,,,Percent of Total Billed Charges,77% of total billed charges,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.2,89,,,Percent of total Billed Charges,89% of total Billed charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.6,77,,,Percent of total Billed charges,77% of total billed charges,323,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95,338.2,
REVISION OF BLADDER NECK,P991501186,CDM,521,RC,52500,HCPCS,Outpatient,,,1057,528.5,,813.89,77,,,Percent of Total Billed Charges,77% of total billed charges,269.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,330.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,264.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,940.73,89,,,Percent of total Billed Charges,89% of total Billed charges,940.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,940.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,431.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,431.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,431.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,813.89,77,,,Percent of total Billed charges,77% of total billed charges,898.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,303.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,431.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,264.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,264.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.25,940.73,
PROSTATECTOMY (TURP),P991501187,CDM,521,RC,52601,HCPCS,Outpatient,,,963,481.5,,741.51,77,,,Percent of Total Billed Charges,77% of total billed charges,245.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,857.07,89,,,Percent of total Billed Charges,89% of total Billed charges,857.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,857.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,741.51,77,,,Percent of total Billed charges,77% of total billed charges,818.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,392.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,240.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.75,857.07,
REMOVE PROSTATE REGROWTH,P991501188,CDM,521,RC,52630,HCPCS,Outpatient,,,627,313.5,,482.79,77,,,Percent of Total Billed Charges,77% of total billed charges,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,558.03,89,,,Percent of total Billed Charges,89% of total Billed charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,482.79,77,,,Percent of total Billed charges,77% of total billed charges,532.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.75,558.03,
LASER VAPORIZATION OF PROSTATE,P991501189,CDM,521,RC,52648,HCPCS,Outpatient,,,1501,750.5,,1155.77,77,,,Percent of Total Billed Charges,77% of total billed charges,382.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,382.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,469.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,375.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1335.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1335.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1335.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1155.77,77,,,Percent of total Billed charges,77% of total billed charges,1275.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,431.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,612.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,375.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.25,1335.89,
DRAINAGE OF URETHRA ABSCESS,P991501190,CDM,521,RC,53060,HCPCS,Outpatient,,,351,175.5,,270.27,77,,,Percent of Total Billed Charges,77% of total billed charges,89.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312.39,89,,,Percent of total Billed Charges,89% of total Billed charges,312.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,312.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.27,77,,,Percent of total Billed charges,77% of total billed charges,298.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,143.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.75,312.39,
EXC URETHRAL DIVERTICULUM,P991501191,CDM,521,RC,53230,HCPCS,Outpatient,,,227,113.5,,174.79,77,,,Percent of Total Billed Charges,77% of total billed charges,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.03,89,,,Percent of total Billed Charges,89% of total Billed charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.79,77,,,Percent of total Billed charges,77% of total billed charges,192.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.75,202.03,
TREATMENT OF URETHRA LESION,P991501192,CDM,521,RC,53260,HCPCS,Outpatient,,,389,194.5,,299.53,77,,,Percent of Total Billed Charges,77% of total billed charges,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,346.21,89,,,Percent of total Billed Charges,89% of total Billed charges,346.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.53,77,,,Percent of total Billed charges,77% of total billed charges,330.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,158.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.25,346.21,
TREATMENT OF URETHRA LESION,P991501193,CDM,521,RC,53265,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.7,89,,,Percent of total Billed Charges,89% of total Billed charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,204.7,
URETHRORRHAPHY FEMALE,P991501194,CDM,521,RC,53502,HCPCS,Outpatient,,,395,197.5,,304.15,77,,,Percent of Total Billed Charges,77% of total billed charges,100.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,351.55,89,,,Percent of total Billed Charges,89% of total Billed charges,351.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,351.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.15,77,,,Percent of total Billed charges,77% of total billed charges,335.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.75,351.55,
DILATE URETHRA STRICTURE,P991501195,CDM,521,RC,53600,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.07,89,,,Percent of total Billed Charges,89% of total Billed charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
DILATE URETHRA STRICTURE,P991501196,CDM,521,RC,53605,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,109.47,89,,,Percent of total Billed Charges,89% of total Billed charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.75,109.47,
DILATE URETHRA STRICTURE,P991501197,CDM,521,RC,53620,HCPCS,Outpatient,,,304,152,,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76,270.56,
"DILATION OF URETHRA, FEMALE",P991501198,CDM,521,RC,53660,HCPCS,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120.15,89,,,Percent of total Billed Charges,89% of total Billed charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,120.15,
DILATION OF URETHRA,P991501199,CDM,521,RC,53661,HCPCS,Outpatient,,,120,60,,92.4,77,,,Percent of Total Billed Charges,77% of total billed charges,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,106.8,89,,,Percent of total Billed Charges,89% of total Billed charges,106.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.4,77,,,Percent of total Billed charges,77% of total billed charges,102,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30,106.8,
UNLISTED PX URINARY SYSTEM,P991501200,CDM,521,RC,53899,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.25,89,,,Percent of total Billed Charges,89% of total Billed charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,111.25,
SLITTING OF PREPUCE,P991501201,CDM,521,RC,54000,HCPCS,Outpatient,,,207,103.5,,159.39,77,,,Percent of Total Billed Charges,77% of total billed charges,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,184.23,89,,,Percent of total Billed Charges,89% of total Billed charges,184.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.39,77,,,Percent of total Billed charges,77% of total billed charges,175.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,184.23,
SLITTING OF PREPUCE,P991501202,CDM,521,RC,54001,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,235.85,89,,,Percent of total Billed Charges,89% of total Billed charges,235.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.25,235.85,
INCISION AND DRAINAGE OF PENIS,P991501203,CDM,521,RC,54015,HCPCS,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
"DESTRUCTION LESION(S), PENIS",P991501204,CDM,521,RC,54050,HCPCS,Outpatient,,,273,136.5,,210.21,77,,,Percent of Total Billed Charges,77% of total billed charges,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.97,89,,,Percent of total Billed Charges,89% of total Billed charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.21,77,,,Percent of total Billed charges,77% of total billed charges,232.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,242.97,
LASER SURG PENIS LESION(S),P991501205,CDM,521,RC,54057,HCPCS,Outpatient,,,262,131,,201.74,77,,,Percent of Total Billed Charges,77% of total billed charges,66.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,233.18,89,,,Percent of total Billed Charges,89% of total Billed charges,233.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,233.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.74,77,,,Percent of total Billed charges,77% of total billed charges,222.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,106.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,233.18,
EXCISION OF PENIS LESION(S),P991501206,CDM,521,RC,54060,HCPCS,Outpatient,,,383,191.5,,294.91,77,,,Percent of Total Billed Charges,77% of total billed charges,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.87,89,,,Percent of total Billed Charges,89% of total Billed charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.91,77,,,Percent of total Billed charges,77% of total billed charges,325.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.75,340.87,
"DESTRUCTION OF LESION, PENIS",P991501207,CDM,521,RC,54065,HCPCS,Outpatient,,,322,161,,247.94,77,,,Percent of Total Billed Charges,77% of total billed charges,82.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,286.58,89,,,Percent of total Billed Charges,89% of total Billed charges,286.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,286.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.94,77,,,Percent of total Billed charges,77% of total billed charges,273.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,131.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.5,286.58,
BIOPSY OF PENIS,P991501208,CDM,521,RC,54100,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222.5,89,,,Percent of total Billed Charges,89% of total Billed charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.5,222.5,
CIRCUMCISION NEWBORN,P991501209,CDM,521,RC,54150,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.9,89,,,Percent of total Billed Charges,89% of total Billed charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.5,186.9,
CIRCUM 28 DAYS OR OLDER,P991501210,CDM,521,RC,54161,HCPCS,Outpatient,,,427,213.5,,328.79,77,,,Percent of Total Billed Charges,77% of total billed charges,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,380.03,89,,,Percent of total Billed Charges,89% of total Billed charges,380.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,77,,,Percent of total Billed charges,77% of total billed charges,362.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,174.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.75,380.03,
INJ CORPORA CAVERNOSA,P991501211,CDM,521,RC,54235,HCPCS,Outpatient,,,121,60.5,,93.17,77,,,Percent of Total Billed Charges,77% of total billed charges,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,107.69,89,,,Percent of total Billed Charges,89% of total Billed charges,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.17,77,,,Percent of total Billed charges,77% of total billed charges,102.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.25,107.69,
REVISION OF PENIS,P991501212,CDM,521,RC,54300,HCPCS,Outpatient,,,1230,615,,947.1,77,,,Percent of Total Billed Charges,77% of total billed charges,313.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1094.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1094.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1094.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,501.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,947.1,77,,,Percent of total Billed charges,77% of total billed charges,1045.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,353.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,501.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,307.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.5,1094.7,
PLASTIC OPERATION OF PENIS,P991501213,CDM,521,RC,54440,HCPCS,Outpatient,,,520,260,,400.4,77,,,Percent of Total Billed Charges,77% of total billed charges,132.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,462.8,89,,,Percent of total Billed Charges,89% of total Billed charges,462.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,462.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.4,77,,,Percent of total Billed charges,77% of total billed charges,442,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130,462.8,
PREPUTIAL STRETCHING,P991501214,CDM,969,RC,54450,HCPCS,Outpatient,,,110,55,,102.66,175,,,fee schedule,175% of aetna fee schedule,61.77,115,,,fee schedule,115% of cms physician fee schedule,63,117.3,,,fee schedule,117.3% of cms physician fee schedule,77.21,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.77,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67.12,100,,,fee schedule,100% of cigna fee schedule,65.98,100,,,fee schedule,100% of healthlink fee schedule,63.11,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,65.98,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,99,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.77,115,,,fee schedule,115% of cms fee schedule,102.66,175,,,Fee Schedule,175% of CMS Fee Schedule,95.74,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,71.03,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,69.38,100,,,Fee Schedule,100% of UHC Fee Schedule,99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.77,115,,,Fee Schedule,115% of CMS OPPS Rate,63.88,100,,,Fee Schedule,100% of UMR Fee Schedule,61.77,115,,,Fee Schedule,115% of CMS OPPS Rate,61.77,102.66,
EXCISE LESION TESTIS,P991501215,CDM,521,RC,54512,HCPCS,Outpatient,,,1176,588,,905.52,77,,,Percent of Total Billed Charges,77% of total billed charges,299.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,294,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1046.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1046.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1046.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,479.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,905.52,77,,,Percent of total Billed charges,77% of total billed charges,999.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,338.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,479.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,294,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294,1046.64,
"ORCHIECTOMY,SIMPLE",P991501216,CDM,521,RC,54520,HCPCS,Outpatient,,,707,353.5,,544.39,77,,,Percent of Total Billed Charges,77% of total billed charges,180.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,176.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,629.23,89,,,Percent of total Billed Charges,89% of total Billed charges,629.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,288.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.39,77,,,Percent of total Billed charges,77% of total billed charges,600.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,176.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,176.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.75,629.23,
REMOVAL OF TESTIS,P991501217,CDM,521,RC,54530,HCPCS,Outpatient,,,1095,547.5,,843.15,77,,,Percent of Total Billed Charges,77% of total billed charges,279.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,342.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,273.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,974.55,89,,,Percent of total Billed Charges,89% of total Billed charges,974.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,974.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,446.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,446.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,273.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,843.15,77,,,Percent of total Billed charges,77% of total billed charges,930.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,314.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,446.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,273.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,273.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.75,974.55,
DRAINAGE OF SCROTUM,P991501218,CDM,521,RC,54700,HCPCS,Outpatient,,,382,191,,294.14,77,,,Percent of Total Billed Charges,77% of total billed charges,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.98,89,,,Percent of total Billed Charges,89% of total Billed charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.14,77,,,Percent of total Billed charges,77% of total billed charges,324.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.5,339.98,
EXCISION OF SPERMATOCELE,P991501219,CDM,521,RC,54840,HCPCS,Outpatient,,,694,347,,534.38,77,,,Percent of Total Billed Charges,77% of total billed charges,176.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,617.66,89,,,Percent of total Billed Charges,89% of total Billed charges,617.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,534.38,77,,,Percent of total Billed charges,77% of total billed charges,589.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,199.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,283.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,173.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.5,617.66,
EPIDIDYMECTOMY:UNILATERAL,P991501220,CDM,521,RC,54860,HCPCS,Outpatient,,,908,454,,699.16,77,,,Percent of Total Billed Charges,77% of total billed charges,231.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,227,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,808.12,89,,,Percent of total Billed Charges,89% of total Billed charges,808.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,808.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,699.16,77,,,Percent of total Billed charges,77% of total billed charges,771.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,261.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,370.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,227,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,227,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227,808.12,
DRAINAGE OF HYDROCELE,P991501221,CDM,521,RC,55000,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
EXCISION HYDROCELE UNILATERAL,P991501222,CDM,521,RC,55040,HCPCS,Outpatient,,,729,364.5,,561.33,77,,,Percent of Total Billed Charges,77% of total billed charges,185.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,182.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,648.81,89,,,Percent of total Billed Charges,89% of total Billed charges,648.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,648.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,297.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,561.33,77,,,Percent of total Billed charges,77% of total billed charges,619.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,297.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,182.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,182.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.25,648.81,
REPAIR OF HYDROCELE,P991501223,CDM,521,RC,55060,HCPCS,Outpatient,,,500,250,,385,77,,,Percent of Total Billed Charges,77% of total billed charges,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,445,500,,,fee schedule,500% of healthlink,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385,77,,,Percent of total Billed charges,77% of total billed charges,425,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125,445,
DRAINAGE OF SCROTUM ABSCESS,P991501224,CDM,521,RC,55100,HCPCS,Outpatient,,,456,228,,351.12,77,,,Percent of Total Billed Charges,77% of total billed charges,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,405.84,89,,,Percent of total Billed Charges,89% of total Billed charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.12,77,,,Percent of total Billed charges,77% of total billed charges,387.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,186.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114,405.84,
SCROTAL EXPLORATION,P991501225,CDM,521,RC,55110,HCPCS,Outpatient,,,838,419,,645.26,77,,,Percent of Total Billed Charges,77% of total billed charges,213.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,209.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,745.82,89,,,Percent of total Billed Charges,89% of total Billed charges,745.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,745.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,341.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,645.26,77,,,Percent of total Billed charges,77% of total billed charges,712.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,341.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.5,745.82,
REMOVAL OF SCROTUM,P991501226,CDM,521,RC,55150,HCPCS,Outpatient,,,966,483,,743.82,77,,,Percent of Total Billed Charges,77% of total billed charges,246.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,246.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,301.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,859.74,89,,,Percent of total Billed Charges,89% of total Billed charges,859.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,859.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,394.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.82,77,,,Percent of total Billed charges,77% of total billed charges,821.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,277.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,394.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.5,859.74,
REMOVAL OF SPERM DUCT(S),P991501227,CDM,521,RC,55250,HCPCS,Outpatient,,,653,326.5,,502.81,77,,,Percent of Total Billed Charges,77% of total billed charges,166.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,581.17,89,,,Percent of total Billed Charges,89% of total Billed charges,581.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502.81,77,,,Percent of total Billed charges,77% of total billed charges,555.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.25,581.17,
REMOVAL OF HYDROCELE,P991501228,CDM,521,RC,55500,HCPCS,Outpatient,,,630,315,,485.1,77,,,Percent of Total Billed Charges,77% of total billed charges,160.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560.7,89,,,Percent of total Billed Charges,89% of total Billed charges,560.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,485.1,77,,,Percent of total Billed charges,77% of total billed charges,535.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,181.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,257.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,157.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.5,560.7,
REMOVAL OF SPERM CORD LESION,P991501229,CDM,521,RC,55520,HCPCS,Outpatient,,,975,487.5,,750.75,77,,,Percent of Total Billed Charges,77% of total billed charges,248.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,867.75,89,,,Percent of total Billed Charges,89% of total Billed charges,867.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,867.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,397.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,750.75,77,,,Percent of total Billed charges,77% of total billed charges,828.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,280.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,397.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.75,867.75,
REVISE SPERMATIC CORD VEINS,P991501230,CDM,521,RC,55530,HCPCS,Outpatient,,,978,489,,753.06,77,,,Percent of Total Billed Charges,77% of total billed charges,249.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,870.42,89,,,Percent of total Billed Charges,89% of total Billed charges,870.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,753.06,77,,,Percent of total Billed charges,77% of total billed charges,831.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,399.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.5,870.42,
REVISE HERNIA & SPERM VEINS,P991501231,CDM,521,RC,55540,HCPCS,Outpatient,,,964,482,,742.28,77,,,Percent of Total Billed Charges,77% of total billed charges,245.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,301.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,241,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,857.96,89,,,Percent of total Billed Charges,89% of total Billed charges,857.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,857.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,742.28,77,,,Percent of total Billed charges,77% of total billed charges,819.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,277.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,393.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,241,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241,857.96,
LAPARO LIGATE SPERMATIC VEIN,P991501232,CDM,521,RC,55550,HCPCS,Outpatient,,,920,460,,708.4,77,,,Percent of Total Billed Charges,77% of total billed charges,234.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,230,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,818.8,89,,,Percent of total Billed Charges,89% of total Billed charges,818.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,818.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,708.4,77,,,Percent of total Billed charges,77% of total billed charges,782,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230,818.8,
BIOPSY OF PROSTATE,P991501233,CDM,521,RC,55700,HCPCS,Outpatient,,,759,379.5,,584.43,77,,,Percent of Total Billed Charges,77% of total billed charges,193.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,189.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,675.51,89,,,Percent of total Billed Charges,89% of total Billed charges,675.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,584.43,77,,,Percent of total Billed charges,77% of total billed charges,645.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,218.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,189.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.75,675.51,
PROSTATE SATURATION SAMPLING,P991501234,CDM,521,RC,55706,HCPCS,Outpatient,,,807,403.5,,621.39,77,,,Percent of Total Billed Charges,77% of total billed charges,205.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,718.23,89,,,Percent of total Billed Charges,89% of total Billed charges,718.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,718.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,621.39,77,,,Percent of total Billed charges,77% of total billed charges,685.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.75,718.23,
TPRNL PLMT BIODEGRADABL MATRL,P991501235,CDM,521,RC,55874,HCPCS,Outpatient,,,313,156.5,,241.01,77,,,Percent of Total Billed Charges,77% of total billed charges,79.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,278.57,89,,,Percent of total Billed Charges,89% of total Billed charges,278.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.01,77,,,Percent of total Billed charges,77% of total billed charges,266.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.25,278.57,
PLACE RT DEVICE/MARKER PROS,P991501236,CDM,521,RC,55876,HCPCS,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.75,262.55,
UNLISTED PX MALE GENITAL SYS,P991501237,CDM,521,RC,55899,HCPCS,Outpatient,,,325,162.5,,250.25,77,,,Percent of Total Billed Charges,77% of total billed charges,82.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,289.25,89,,,Percent of total Billed Charges,89% of total Billed charges,289.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.25,77,,,Percent of total Billed charges,77% of total billed charges,276.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.25,289.25,
I&D VULVAR/PERINEAL ABSCESS,P991501238,CDM,521,RC,56405,HCPCS,Outpatient,,,451,225.5,,347.27,77,,,Percent of Total Billed Charges,77% of total billed charges,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,401.39,89,,,Percent of total Billed Charges,89% of total Billed charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.27,77,,,Percent of total Billed charges,77% of total billed charges,383.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.75,401.39,
I&D BARTHOLIN CYST,P991501239,CDM,521,RC,56420,HCPCS,Outpatient,,,454,227,,349.58,77,,,Percent of Total Billed Charges,77% of total billed charges,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.06,89,,,Percent of total Billed Charges,89% of total Billed charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.58,77,,,Percent of total Billed charges,77% of total billed charges,385.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.5,404.06,
MARSUPIALIZATION OF BARTHOLIN,P991501240,CDM,521,RC,56440,HCPCS,Outpatient,,,1018,509,,783.86,77,,,Percent of Total Billed Charges,77% of total billed charges,259.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,906.02,89,,,Percent of total Billed Charges,89% of total Billed charges,906.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,415.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,415.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.86,77,,,Percent of total Billed charges,77% of total billed charges,865.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,292.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,415.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.5,906.02,
LYSIS LABIAL ADHESIONS,P991501241,CDM,521,RC,56441,HCPCS,Outpatient,,,563,281.5,,433.51,77,,,Percent of Total Billed Charges,77% of total billed charges,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,501.07,89,,,Percent of total Billed Charges,89% of total Billed charges,501.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.51,77,,,Percent of total Billed charges,77% of total billed charges,478.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,229.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.75,501.07,
DESTROY VULVA LESIONS SIM,P991501242,CDM,521,RC,56501,HCPCS,Outpatient,,,227,113.5,,174.79,77,,,Percent of Total Billed Charges,77% of total billed charges,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.03,89,,,Percent of total Billed Charges,89% of total Billed charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.79,77,,,Percent of total Billed charges,77% of total billed charges,192.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.75,202.03,
DEST VULVAR LES EXT ANY METHOD,P991501243,CDM,521,RC,56515,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
BX VULVAR/PERINEUM ONE LESION,P991501244,CDM,521,RC,56605,HCPCS,Outpatient,,,307,153.5,,236.39,77,,,Percent of Total Billed Charges,77% of total billed charges,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,273.23,89,,,Percent of total Billed Charges,89% of total Billed charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.39,77,,,Percent of total Billed charges,77% of total billed charges,260.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.75,273.23,
BX VULVAR/PERINEUM EA ADDL LES,P991501245,CDM,521,RC,56606,HCPCS,Outpatient,,,157,78.5,,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,139.73,89,,,Percent of total Billed Charges,89% of total Billed charges,139.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.73,
VULVECTOMY PARTIAL SIMPLE,P991501246,CDM,521,RC,56620,HCPCS,Outpatient,,,2056,1028,,1583.12,77,,,Percent of Total Billed Charges,77% of total billed charges,524.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,642.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1829.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1829.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1829.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,838.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.12,77,,,Percent of total Billed charges,77% of total billed charges,1747.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,591.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,838.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,514,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514,1829.84,
VULVECTOMY PARTIAL RADICAL,P991501247,CDM,521,RC,56630,HCPCS,Outpatient,,,2332,1166,,1795.64,77,,,Percent of Total Billed Charges,77% of total billed charges,594.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,728.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,583,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2075.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2075.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2075.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1795.64,77,,,Percent of total Billed charges,77% of total billed charges,1982.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,951.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,583,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583,2075.48,
"VULVECTOMY,RADICAL,COMPLETE;",P991501248,CDM,521,RC,56633,HCPCS,Outpatient,,,1504,752,,1158.08,77,,,Percent of Total Billed Charges,77% of total billed charges,383.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,383.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,470,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,376,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1338.56,89,,,Percent of total Billed Charges,89% of total Billed charges,1338.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1338.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,613.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,613.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,613.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.08,77,,,Percent of total Billed charges,77% of total billed charges,1278.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,432.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,613.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,376,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,376,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376,1338.56,
HYMENECTOMY PARTIAL,P991501249,CDM,521,RC,56700,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
EXC BARTHOLINS GLAND,P991501250,CDM,521,RC,56740,HCPCS,Outpatient,,,1094,547,,842.38,77,,,Percent of Total Billed Charges,77% of total billed charges,278.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,341.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,273.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,973.66,89,,,Percent of total Billed Charges,89% of total Billed charges,973.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,446.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,446.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,273.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,842.38,77,,,Percent of total Billed charges,77% of total billed charges,929.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,314.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,446.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,273.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,273.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.5,973.66,
REPAIR OF VAGINA,P991501251,CDM,521,RC,56800,HCPCS,Outpatient,,,510,255,,392.7,77,,,Percent of Total Billed Charges,77% of total billed charges,130.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,453.9,89,,,Percent of total Billed Charges,89% of total Billed charges,453.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,453.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.7,77,,,Percent of total Billed charges,77% of total billed charges,433.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,208.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.5,453.9,
PERINEOPLASTY NON OB,P991501252,CDM,521,RC,56810,HCPCS,Outpatient,,,552,276,,425.04,77,,,Percent of Total Billed Charges,77% of total billed charges,140.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,491.28,89,,,Percent of total Billed Charges,89% of total Billed charges,491.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.04,77,,,Percent of total Billed charges,77% of total billed charges,469.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,225.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,491.28,
"COLPOSCOPY, VULVA",P991501253,CDM,521,RC,56820,HCPCS,Outpatient,,,169,84.5,,130.13,77,,,Percent of Total Billed Charges,77% of total billed charges,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150.41,89,,,Percent of total Billed Charges,89% of total Billed charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.13,77,,,Percent of total Billed charges,77% of total billed charges,143.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.25,150.41,
EXAM/BIOPSY OF VULVA W/SCOPE,P991501254,CDM,521,RC,56821,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,249.2,
COLPOTOMY W/EXPLORATION,P991501255,CDM,521,RC,57000,HCPCS,Outpatient,,,1011,505.5,,778.47,77,,,Percent of Total Billed Charges,77% of total billed charges,257.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,899.79,89,,,Percent of total Billed Charges,89% of total Billed charges,899.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,899.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.47,77,,,Percent of total Billed charges,77% of total billed charges,859.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,290.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,412.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,252.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.75,899.79,
COLPOTOMY W/DRAINAGE PEL ABSC,P991501256,CDM,521,RC,57010,HCPCS,Outpatient,,,1236,618,,951.72,77,,,Percent of Total Billed Charges,77% of total billed charges,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1100.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.72,77,,,Percent of total Billed charges,77% of total billed charges,1050.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,504.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309,1100.04,
I&D VAGINAL HEMATOMA OB,P991501257,CDM,521,RC,57022,HCPCS,Outpatient,,,567,283.5,,436.59,77,,,Percent of Total Billed Charges,77% of total billed charges,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,504.63,89,,,Percent of total Billed Charges,89% of total Billed charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.59,77,,,Percent of total Billed charges,77% of total billed charges,481.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,231.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.75,504.63,
I & D VAG HEMATOMA NON-OB,P991501258,CDM,521,RC,57023,HCPCS,Outpatient,,,662,331,,509.74,77,,,Percent of Total Billed Charges,77% of total billed charges,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,589.18,89,,,Percent of total Billed Charges,89% of total Billed charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,509.74,77,,,Percent of total Billed charges,77% of total billed charges,562.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,270.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.5,589.18,
DEST VAG LESION SIMPLE ANY,P991501259,CDM,521,RC,57061,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.28,89,,,Percent of total Billed Charges,89% of total Billed charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38,135.28,
DEST VAG LESION EXTEN ANY,P991501260,CDM,521,RC,57065,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,599.86,89,,,Percent of total Billed Charges,89% of total Billed charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.5,599.86,
VAGINAL BX SIMPLE,P991501261,CDM,521,RC,57100,HCPCS,Outpatient,,,348,174,,267.96,77,,,Percent of Total Billed Charges,77% of total billed charges,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.72,89,,,Percent of total Billed Charges,89% of total Billed charges,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.96,77,,,Percent of total Billed charges,77% of total billed charges,295.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87,309.72,
EXC OF VAG MUCOSA EXTEN,P991501262,CDM,521,RC,57105,HCPCS,Outpatient,,,852,426,,656.04,77,,,Percent of Total Billed Charges,77% of total billed charges,217.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,758.28,89,,,Percent of total Billed Charges,89% of total Billed charges,758.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,656.04,77,,,Percent of total Billed charges,77% of total billed charges,724.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,347.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,213,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213,758.28,
VAGINECTOMY,P991501263,CDM,521,RC,57106,HCPCS,Outpatient,,,2997,1498.5,,2307.69,77,,,Percent of Total Billed Charges,77% of total billed charges,764.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,764.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,936.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,749.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2667.33,89,,,Percent of total Billed Charges,89% of total Billed charges,2667.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2667.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1222.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1222.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1222.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,749.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2307.69,77,,,Percent of total Billed charges,77% of total billed charges,2547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,861.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1222.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,749.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,749.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,749.25,2667.33,
COLPOCLEISIS,P991501264,CDM,521,RC,57120,HCPCS,Outpatient,,,3342,1671,,2573.34,77,,,Percent of Total Billed Charges,77% of total billed charges,852.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,852.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1044.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,835.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2974.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2974.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2974.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1363.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1363.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1363.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,835.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2573.34,77,,,Percent of total Billed charges,77% of total billed charges,2840.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,960.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1363.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,835.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,835.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.5,2974.38,
EXC OF VAGINAL SEPTUM,P991501265,CDM,521,RC,57130,HCPCS,Outpatient,,,1502,751,,1156.54,77,,,Percent of Total Billed Charges,77% of total billed charges,383.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,383.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,469.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1336.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1336.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,612.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1156.54,77,,,Percent of total Billed charges,77% of total billed charges,1276.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,431.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,612.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,375.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.5,1336.78,
EXC OF VAGINAL CYST,P991501266,CDM,521,RC,57135,HCPCS,Outpatient,,,1156,578,,890.12,77,,,Percent of Total Billed Charges,77% of total billed charges,294.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,294.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1028.84,89,,,Percent of total Billed Charges,89% of total Billed charges,1028.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1028.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,471.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,471.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.12,77,,,Percent of total Billed charges,77% of total billed charges,982.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,332.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,471.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289,1028.84,
E-STRING,P991501267,CDM,521,RC,57150,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.65,89,,,Percent of total Billed Charges,89% of total Billed charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,75.65,
PESSARY INSERTION,P991501268,CDM,521,RC,57160,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.25,89,,,Percent of total Billed Charges,89% of total Billed charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,111.25,
DIAPH FIT AND INSTRUCTION,P991501269,CDM,521,RC,57170,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.25,89,,,Percent of total Billed Charges,89% of total Billed charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,111.25,
COLPORRHARPHY NONOB INJURY,P991501270,CDM,521,RC,57200,HCPCS,Outpatient,,,1525,762.5,,1174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,388.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,388.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,381.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1357.25,89,,,Percent of total Billed Charges,89% of total Billed charges,1357.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1357.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,622.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,622.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,622.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,381.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.25,77,,,Percent of total Billed charges,77% of total billed charges,1296.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,438.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,622.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,381.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,381.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,381.25,1357.25,
COLPORRHARPHY NONOB 1,P991501271,CDM,521,RC,57210,HCPCS,Outpatient,,,1807,903.5,,1391.39,77,,,Percent of Total Billed Charges,77% of total billed charges,460.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,460.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,564.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,451.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1608.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1608.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1608.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,737.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,737.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,737.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,451.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1391.39,77,,,Percent of total Billed charges,77% of total billed charges,1535.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,519.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,737.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,451.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,451.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,451.75,1608.23,
REPAIR ANTERIOR/CYSTOCELE,P991501272,CDM,521,RC,57240,HCPCS,Outpatient,,,2500,1250,,1925,77,,,Percent of Total Billed Charges,77% of total billed charges,637.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,637.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2225,500,,,fee schedule,500% of healthlink,2225,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2225,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1020,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1020,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1020,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925,77,,,Percent of total Billed charges,77% of total billed charges,2125,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,718.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1020,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,625,2225,
REPAIR POSTERIOR/RECTOCELE,P991501273,CDM,521,RC,57250,HCPCS,Outpatient,,,1794,897,,1381.38,77,,,Percent of Total Billed Charges,77% of total billed charges,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,560.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1596.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1596.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,731.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1381.38,77,,,Percent of total Billed charges,77% of total billed charges,1524.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,515.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,731.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,448.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,1596.66,
CMBN ANT PST COLPRHY,P991501274,CDM,521,RC,57260,HCPCS,Outpatient,,,3775,1887.5,,2906.75,77,,,Percent of Total Billed Charges,77% of total billed charges,962.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,943.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3359.75,89,,,Percent of total Billed Charges,89% of total Billed charges,3359.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3359.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1540.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1540.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1540.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.75,77,,,Percent of total Billed charges,77% of total billed charges,3208.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1540.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,943.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.75,3359.75,
REPAIR A&P W/ENTEROCELE,P991501275,CDM,521,RC,57265,HCPCS,Outpatient,,,4331,2165.5,,3334.87,77,,,Percent of Total Billed Charges,77% of total billed charges,1104.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1104.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1353.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1082.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3854.59,89,,,Percent of total Billed Charges,89% of total Billed charges,3854.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3854.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1082.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3334.87,77,,,Percent of total Billed charges,77% of total billed charges,3681.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1245.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1767.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1082.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1082.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1082.75,3854.59,
INSERTION OF MESH,P991501276,CDM,521,RC,57267,HCPCS,Outpatient,,,340,170,,261.8,77,,,Percent of Total Billed Charges,77% of total billed charges,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,302.6,89,,,Percent of total Billed Charges,89% of total Billed charges,302.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,302.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.8,77,,,Percent of total Billed charges,77% of total billed charges,289,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85,302.6,
REPAIR ENTEROCELE VAG APPRO,P991501277,CDM,521,RC,57268,HCPCS,Outpatient,,,3027,1513.5,,2330.79,77,,,Percent of Total Billed Charges,77% of total billed charges,771.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,756.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2694.03,89,,,Percent of total Billed Charges,89% of total Billed charges,2694.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2694.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1235.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1235.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1235.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2330.79,77,,,Percent of total Billed charges,77% of total billed charges,2572.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,870.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1235.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,756.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.75,2694.03,
REPAIR ENTEROCELE ABD APPR,P991501278,CDM,521,RC,57270,HCPCS,Outpatient,,,2337,1168.5,,1799.49,77,,,Percent of Total Billed Charges,77% of total billed charges,595.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,730.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2079.93,89,,,Percent of total Billed Charges,89% of total Billed charges,2079.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2079.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,953.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,953.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,953.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1799.49,77,,,Percent of total Billed charges,77% of total billed charges,1986.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,671.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,953.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,584.25,2079.93,
COLPOPEXY ABDOMINAL APPROACH,P991501279,CDM,521,RC,57280,HCPCS,Outpatient,,,3888,1944,,2993.76,77,,,Percent of Total Billed Charges,77% of total billed charges,991.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,991.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1215,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3460.32,89,,,Percent of total Billed Charges,89% of total Billed charges,3460.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3460.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1586.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1586.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1586.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2993.76,77,,,Percent of total Billed charges,77% of total billed charges,3304.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1117.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1586.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,972,3460.32,
SACROSPINOUS LIGAMENT FIX,P991501280,CDM,521,RC,57282,HCPCS,Outpatient,,,3888,1944,,2993.76,77,,,Percent of Total Billed Charges,77% of total billed charges,991.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,991.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1215,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3460.32,89,,,Percent of total Billed Charges,89% of total Billed charges,3460.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3460.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1586.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1586.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1586.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2993.76,77,,,Percent of total Billed charges,77% of total billed charges,3304.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1117.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1586.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,972,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,972,3460.32,
COLPOPEXY INTRAPERITONEAL,P991501281,CDM,521,RC,57283,HCPCS,Outpatient,,,1473,736.5,,1134.21,77,,,Percent of Total Billed Charges,77% of total billed charges,375.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,375.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,460.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,368.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1310.97,89,,,Percent of total Billed Charges,89% of total Billed charges,1310.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1310.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,600.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,600.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,600.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1134.21,77,,,Percent of total Billed charges,77% of total billed charges,1252.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,423.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,600.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,368.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.25,1310.97,
PARAVAGINAL DEFECT REPAIR,P991501282,CDM,521,RC,57284,HCPCS,Outpatient,,,4109,2054.5,,3163.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1047.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1047.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1284.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1027.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3657.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3657.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3657.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1676.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1676.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1676.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1027.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3163.93,77,,,Percent of total Billed charges,77% of total billed charges,3492.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1181.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1676.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1027.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1027.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.25,3657.01,
REVISE/REMOVE SLING REPAIR,P991501283,CDM,521,RC,57287,HCPCS,Outpatient,,,1416,708,,1090.32,77,,,Percent of Total Billed Charges,77% of total billed charges,361.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1260.24,89,,,Percent of total Billed Charges,89% of total Billed charges,1260.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1260.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,577.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,577.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1090.32,77,,,Percent of total Billed charges,77% of total billed charges,1203.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,577.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354,1260.24,
REPAIR BLADDER DEFECT,P991501284,CDM,521,RC,57288,HCPCS,Outpatient,,,1546,773,,1190.42,77,,,Percent of Total Billed Charges,77% of total billed charges,394.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,394.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,483.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1375.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1375.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1375.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,630.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,630.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1190.42,77,,,Percent of total Billed charges,77% of total billed charges,1314.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,444.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,630.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,386.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.5,1375.94,
CLOSURE RECTO-VAG FISTULA,P991501285,CDM,521,RC,57300,HCPCS,Outpatient,,,3586,1793,,2761.22,77,,,Percent of Total Billed Charges,77% of total billed charges,914.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,914.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1120.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,896.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3191.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3191.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3191.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,896.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2761.22,77,,,Percent of total Billed charges,77% of total billed charges,3048.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1030.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1463.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,896.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,896.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,896.5,3191.54,
DILATION OF VAGINA,P991501286,CDM,521,RC,57400,HCPCS,Outpatient,,,286,143,,220.22,77,,,Percent of Total Billed Charges,77% of total billed charges,72.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,254.54,89,,,Percent of total Billed Charges,89% of total Billed charges,254.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.22,77,,,Percent of total Billed charges,77% of total billed charges,243.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.5,254.54,
PELVIC EXAMINATION,P991501287,CDM,521,RC,57410,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.56,89,,,Percent of total Billed Charges,89% of total Billed charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,205.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126,448.56,
REMOVE VAGINAL FOREIGN BODY,P991501288,CDM,521,RC,57415,HCPCS,Outpatient,,,655,327.5,,504.35,77,,,Percent of Total Billed Charges,77% of total billed charges,167.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,582.95,89,,,Percent of total Billed Charges,89% of total Billed charges,582.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,582.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,504.35,77,,,Percent of total Billed charges,77% of total billed charges,556.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,267.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.75,582.95,
COLPOSCOPY VAGINA,P991501289,CDM,521,RC,57420,HCPCS,Outpatient,,,248,124,,190.96,77,,,Percent of Total Billed Charges,77% of total billed charges,63.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220.72,89,,,Percent of total Billed Charges,89% of total Billed charges,220.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,77,,,Percent of total Billed charges,77% of total billed charges,210.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62,220.72,
COLPOSCOPY VAGINA WITH BIOPSY,P991501290,CDM,521,RC,57421,HCPCS,Outpatient,,,331,165.5,,254.87,77,,,Percent of Total Billed Charges,77% of total billed charges,84.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,294.59,89,,,Percent of total Billed Charges,89% of total Billed charges,294.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.87,77,,,Percent of total Billed charges,77% of total billed charges,281.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.75,294.59,
LAPAROSCOPY SURG COLPOPEXY,P991501291,CDM,521,RC,57425,HCPCS,Outpatient,,,2085,1042.5,,1605.45,77,,,Percent of Total Billed Charges,77% of total billed charges,531.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,651.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,521.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1855.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1855.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1855.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,850.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,850.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,850.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,521.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1605.45,77,,,Percent of total Billed charges,77% of total billed charges,1772.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,599.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,850.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,521.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,521.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.25,1855.65,
"COLPOSCOPY CERVIX, W/O BIOPSY",P991501292,CDM,521,RC,57452,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
COLPOSCOPY WITH BIOPSY AND EEC,P991501293,CDM,521,RC,57454,HCPCS,Outpatient,,,584,292,,449.68,77,,,Percent of Total Billed Charges,77% of total billed charges,148.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,146,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,519.76,89,,,Percent of total Billed Charges,89% of total Billed charges,519.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,519.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.68,77,,,Percent of total Billed charges,77% of total billed charges,496.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,519.76,
BIOPSY OF CERVIX W/SCOPE,P991501294,CDM,521,RC,57455,HCPCS,Outpatient,,,226,113,,174.02,77,,,Percent of Total Billed Charges,77% of total billed charges,57.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,201.14,89,,,Percent of total Billed Charges,89% of total Billed charges,201.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.02,77,,,Percent of total Billed charges,77% of total billed charges,192.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.5,201.14,
COLPOSCOPY CERVIX AND ECC,P991501295,CDM,521,RC,57456,HCPCS,Outpatient,,,563,281.5,,433.51,77,,,Percent of Total Billed Charges,77% of total billed charges,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,501.07,89,,,Percent of total Billed Charges,89% of total Billed charges,501.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.51,77,,,Percent of total Billed charges,77% of total billed charges,478.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,229.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.75,501.07,
BX OF CERVIX W/SCOPE LEEP,P991501296,CDM,521,RC,57460,HCPCS,Outpatient,,,1592,796,,1225.84,77,,,Percent of Total Billed Charges,77% of total billed charges,405.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1416.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1416.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.84,77,,,Percent of total Billed charges,77% of total billed charges,1353.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,649.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,398,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398,1416.88,
CONZ OF CERVIX W/SCOPE LEEP,P991501297,CDM,521,RC,57461,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,532.22,89,,,Percent of total Billed Charges,89% of total Billed charges,532.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,532.22,
CERVICAL BIOPSY ONLY,P991501298,CDM,521,RC,57500,HCPCS,Outpatient,,,420,210,,323.4,77,,,Percent of Total Billed Charges,77% of total billed charges,107.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.8,89,,,Percent of total Billed Charges,89% of total Billed charges,373.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,373.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.4,77,,,Percent of total Billed charges,77% of total billed charges,357,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105,373.8,
ENDOCERVICAL CURETTAGE,P991501299,CDM,521,RC,57505,HCPCS,Outpatient,,,297,148.5,,228.69,77,,,Percent of Total Billed Charges,77% of total billed charges,75.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,264.33,89,,,Percent of total Billed Charges,89% of total Billed charges,264.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.69,77,,,Percent of total Billed charges,77% of total billed charges,252.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.25,264.33,
CERVICAL CAUTERY,P991501300,CDM,521,RC,57510,HCPCS,Outpatient,,,446,223,,343.42,77,,,Percent of Total Billed Charges,77% of total billed charges,113.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,396.94,89,,,Percent of total Billed Charges,89% of total Billed charges,396.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.42,77,,,Percent of total Billed charges,77% of total billed charges,379.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,396.94,
CRYOCAUTERY,P991501301,CDM,521,RC,57511,HCPCS,Outpatient,,,420,210,,323.4,77,,,Percent of Total Billed Charges,77% of total billed charges,107.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.8,89,,,Percent of total Billed Charges,89% of total Billed charges,373.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,373.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.4,77,,,Percent of total Billed charges,77% of total billed charges,357,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105,373.8,
CERVICAL LASER ABLATION,P991501302,CDM,521,RC,57513,HCPCS,Outpatient,,,1475,737.5,,1135.75,77,,,Percent of Total Billed Charges,77% of total billed charges,376.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,460.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1312.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1312.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1135.75,77,,,Percent of total Billed charges,77% of total billed charges,1253.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,424.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,601.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,368.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.75,1312.75,
CONE OF CX COLD KNIFE/LASER,P991501303,CDM,521,RC,57520,HCPCS,Outpatient,,,1772,886,,1364.44,77,,,Percent of Total Billed Charges,77% of total billed charges,451.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,451.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,553.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1577.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1577.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1577.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,722.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,722.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,722.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1364.44,77,,,Percent of total Billed charges,77% of total billed charges,1506.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,509.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,722.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443,1577.08,
CONE OF CX LEEP,P991501304,CDM,521,RC,57522,HCPCS,Outpatient,,,1772,886,,1364.44,77,,,Percent of Total Billed Charges,77% of total billed charges,451.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,451.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,553.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1577.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1577.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1577.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,722.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,722.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,722.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1364.44,77,,,Percent of total Billed charges,77% of total billed charges,1506.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,509.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,722.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,443,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443,1577.08,
EXCISION CERVICAL STUMP,P991501305,CDM,521,RC,57550,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
REMOVE CERVIX/REPAIR VAGINA,P991501306,CDM,521,RC,57555,HCPCS,Outpatient,,,3361,1680.5,,2587.97,77,,,Percent of Total Billed Charges,77% of total billed charges,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2991.29,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.97,77,,,Percent of total Billed charges,77% of total billed charges,2856.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1371.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.25,2991.29,
D & C CERVICAL STUMP,P991501307,CDM,521,RC,57558,HCPCS,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124.6,89,,,Percent of total Billed Charges,89% of total Billed charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,124.6,
DILATION OF CERVICAL CANAL,P991501308,CDM,521,RC,57800,HCPCS,Outpatient,,,157,78.5,,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,139.73,89,,,Percent of total Billed Charges,89% of total Billed charges,139.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.73,
ENDOMETRIAL BIOPSY,P991501309,CDM,521,RC,58100,HCPCS,Outpatient,,,395,197.5,,304.15,77,,,Percent of Total Billed Charges,77% of total billed charges,100.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,351.55,89,,,Percent of total Billed Charges,89% of total Billed charges,351.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,351.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.15,77,,,Percent of total Billed charges,77% of total billed charges,335.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.75,351.55,
BX DONE W/COLPOSCOPY ADD-ON,P991501310,CDM,521,RC,58110,HCPCS,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.4,89,,,Percent of total Billed Charges,89% of total Billed charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,53.4,
D&C NONOBSTETRICAL,P991501311,CDM,521,RC,58120,HCPCS,Outpatient,,,1265,632.5,,974.05,77,,,Percent of Total Billed Charges,77% of total billed charges,322.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1125.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1125.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1125.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,516.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,516.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,974.05,77,,,Percent of total Billed charges,77% of total billed charges,1075.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,363.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,516.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.25,1125.85,
MYOMECTOMY ABD APPR 1 OR MONTH,P991501312,CDM,521,RC,58140,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
MYOMECTOMY VAG APPR 1 OR MONTH,P991501313,CDM,521,RC,58145,HCPCS,Outpatient,,,2691,1345.5,,2072.07,77,,,Percent of Total Billed Charges,77% of total billed charges,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,686.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2394.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2394.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1097.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2072.07,77,,,Percent of total Billed charges,77% of total billed charges,2287.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,773.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1097.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,672.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.75,2394.99,
HYST ABDOMINAL TAH,P991501314,CDM,521,RC,58150,HCPCS,Outpatient,,,4110,2055,,3164.7,77,,,Percent of Total Billed Charges,77% of total billed charges,1048.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1048.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1284.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1027.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3657.9,89,,,Percent of total Billed Charges,89% of total Billed charges,3657.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3657.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1676.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1676.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1676.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1027.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3164.7,77,,,Percent of total Billed charges,77% of total billed charges,3493.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1181.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1676.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1027.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1027.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.5,3657.9,
HYST ABDOMINAL W/MMK TAH,P991501315,CDM,521,RC,58152,HCPCS,Outpatient,,,5152,2576,,3967.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1313.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1313.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4585.28,89,,,Percent of total Billed Charges,89% of total Billed charges,4585.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4585.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2102.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2102.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2102.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3967.04,77,,,Percent of total Billed charges,77% of total billed charges,4379.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1481.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2102.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1288,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288,4585.28,
HYST SUPRACERVICAL TAH,P991501316,CDM,521,RC,58180,HCPCS,Outpatient,,,3361,1680.5,,2587.97,77,,,Percent of Total Billed Charges,77% of total billed charges,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2991.29,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.97,77,,,Percent of total Billed charges,77% of total billed charges,2856.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1371.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.25,2991.29,
HYST ABD RADICAL W/NODE BIOPSY,P991501317,CDM,521,RC,58210,HCPCS,Outpatient,,,4854,2427,,3737.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1237.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1237.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1516.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1213.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4320.06,89,,,Percent of total Billed Charges,89% of total Billed charges,4320.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4320.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1980.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1980.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1980.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1213.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3737.58,77,,,Percent of total Billed charges,77% of total billed charges,4125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1395.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1980.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1213.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1213.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,4320.06,
HYST VAGINAL,P991501318,CDM,521,RC,58260,HCPCS,Outpatient,,,3962,1981,,3050.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1010.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1010.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1238.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,990.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3526.18,89,,,Percent of total Billed Charges,89% of total Billed charges,3526.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3526.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1616.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1616.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1616.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,990.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3050.74,77,,,Percent of total Billed charges,77% of total billed charges,3367.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1139.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1616.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,990.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,990.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.5,3526.18,
HYST VAGINAL WITH BSO,P991501319,CDM,521,RC,58262,HCPCS,Outpatient,,,4471,2235.5,,3442.67,77,,,Percent of Total Billed Charges,77% of total billed charges,1140.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1140.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1397.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3979.19,89,,,Percent of total Billed Charges,89% of total Billed charges,3979.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3979.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3442.67,77,,,Percent of total Billed charges,77% of total billed charges,3800.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1285.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1824.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1117.75,3979.19,
HYST VAGINAL W/BSO AND ENTERO,P991501320,CDM,521,RC,58263,HCPCS,Outpatient,,,4928,2464,,3794.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1256.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1256.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1540,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4385.92,89,,,Percent of total Billed Charges,89% of total Billed charges,4385.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4385.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2010.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2010.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2010.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3794.56,77,,,Percent of total Billed charges,77% of total billed charges,4188.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1416.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2010.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1232,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1232,4385.92,
HYST VAGINAL W/MMK,P991501321,CDM,521,RC,58267,HCPCS,Outpatient,,,5311,2655.5,,4089.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1354.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1354.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1659.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4726.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4726.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4726.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2166.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2166.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2166.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.47,77,,,Percent of total Billed charges,77% of total billed charges,4514.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1526.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2166.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1327.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1327.75,4726.79,
HYST VAGINAL W/ENTEROCELE REPR,P991501322,CDM,521,RC,58270,HCPCS,Outpatient,,,4602,2301,,3543.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1173.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1173.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1438.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4095.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4095.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4095.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1877.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1877.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1877.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3543.54,77,,,Percent of total Billed charges,77% of total billed charges,3911.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1323.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1877.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1150.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1150.5,4095.78,
HYST VAG W/COLPECTOMY,P991501323,CDM,521,RC,58275,HCPCS,Outpatient,,,4647,2323.5,,3578.19,77,,,Percent of Total Billed Charges,77% of total billed charges,1184.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1184.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4135.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4135.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4135.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1895.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1895.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1895.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3578.19,77,,,Percent of total Billed charges,77% of total billed charges,3949.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1336.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1895.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1161.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1161.75,4135.83,
HYST VAG W/COPECT AND ENTERO,P991501324,CDM,521,RC,58280,HCPCS,Outpatient,,,5088,2544,,3917.76,77,,,Percent of Total Billed Charges,77% of total billed charges,1297.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1297.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4528.32,89,,,Percent of total Billed Charges,89% of total Billed charges,4528.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4528.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2075.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2075.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2075.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3917.76,77,,,Percent of total Billed charges,77% of total billed charges,4324.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1462.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2075.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272,4528.32,
VAG HYST INCL T/O COMPLEX,P991501325,CDM,521,RC,58291,HCPCS,Outpatient,,,1827,913.5,,1406.79,77,,,Percent of Total Billed Charges,77% of total billed charges,465.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,465.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,570.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,456.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1626.03,89,,,Percent of total Billed Charges,89% of total Billed charges,1626.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1626.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,745.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,456.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1406.79,77,,,Percent of total Billed charges,77% of total billed charges,1552.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,525.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,745.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,456.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,456.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.75,1626.03,
IUD INSERT,P991501326,CDM,521,RC,58300,HCPCS,Outpatient,,,403,201.5,,310.31,77,,,Percent of Total Billed Charges,77% of total billed charges,102.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.67,89,,,Percent of total Billed Charges,89% of total Billed charges,358.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.31,77,,,Percent of total Billed charges,77% of total billed charges,342.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.75,358.67,
IUD REMOVAL,P991501327,CDM,521,RC,58301,HCPCS,Outpatient,,,329,164.5,,253.33,77,,,Percent of Total Billed Charges,77% of total billed charges,83.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,292.81,89,,,Percent of total Billed Charges,89% of total Billed charges,292.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.33,77,,,Percent of total Billed charges,77% of total billed charges,279.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.25,292.81,
ARTIFICIAL INSEMINATION,P991501328,CDM,521,RC,58321,HCPCS,Outpatient,,,329,164.5,,253.33,77,,,Percent of Total Billed Charges,77% of total billed charges,83.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,292.81,89,,,Percent of total Billed Charges,89% of total Billed charges,292.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.33,77,,,Percent of total Billed charges,77% of total billed charges,279.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.25,292.81,
ARTIFICIAL INSEMINATION,P991501329,CDM,521,RC,58322,HCPCS,Outpatient,,,174,87,,133.98,77,,,Percent of Total Billed Charges,77% of total billed charges,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.86,89,,,Percent of total Billed Charges,89% of total Billed charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.98,77,,,Percent of total Billed charges,77% of total billed charges,147.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.5,154.86,
SPERM WASHING FOR IUI,P991501330,CDM,521,RC,58323,HCPCS,Outpatient,,,279,139.5,,214.83,77,,,Percent of Total Billed Charges,77% of total billed charges,71.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248.31,89,,,Percent of total Billed Charges,89% of total Billed charges,248.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.83,77,,,Percent of total Billed charges,77% of total billed charges,237.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.75,248.31,
HYSTEROSALPINGOGRAPHY,P991501331,CDM,521,RC,58340,HCPCS,Outpatient,,,390,195,,300.3,77,,,Percent of Total Billed Charges,77% of total billed charges,99.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,347.1,89,,,Percent of total Billed Charges,89% of total Billed charges,347.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.3,77,,,Percent of total Billed charges,77% of total billed charges,331.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.5,347.1,
CHROMOTUBATION OF OVIDUCT,P991501332,CDM,521,RC,58350,HCPCS,Outpatient,,,454,227,,349.58,77,,,Percent of Total Billed Charges,77% of total billed charges,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.06,89,,,Percent of total Billed Charges,89% of total Billed charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.58,77,,,Percent of total Billed charges,77% of total billed charges,385.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.5,404.06,
ENDO ABLATION W/O HYSTEROSC,P991501333,CDM,521,RC,58353,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
UTERINE SUSPENSION,P991501334,CDM,521,RC,58400,HCPCS,Outpatient,,,2957,1478.5,,2276.89,77,,,Percent of Total Billed Charges,77% of total billed charges,754.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,754.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,924.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,739.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2631.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2631.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2631.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1206.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,739.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2276.89,77,,,Percent of total Billed charges,77% of total billed charges,2513.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,850.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1206.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,739.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,739.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,739.25,2631.73,
LSH UTERUS 250 G OR LESS,P991501335,CDM,521,RC,58541,HCPCS,Outpatient,,,1529,764.5,,1177.33,77,,,Percent of Total Billed Charges,77% of total billed charges,389.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1360.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1360.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1360.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,623.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,623.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,623.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1177.33,77,,,Percent of total Billed charges,77% of total billed charges,1299.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,439.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,623.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,382.25,1360.81,
LSH W/T/O UT 250 G OR LESS,P991501336,CDM,521,RC,58542,HCPCS,Outpatient,,,1752,876,,1349.04,77,,,Percent of Total Billed Charges,77% of total billed charges,446.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,446.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,547.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,438,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1559.28,89,,,Percent of total Billed Charges,89% of total Billed charges,1559.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1559.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,714.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,714.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,714.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1349.04,77,,,Percent of total Billed charges,77% of total billed charges,1489.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,503.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,714.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,438,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,438,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438,1559.28,
LAPAROSCOPY HYST W/W/O BSO,P991501337,CDM,521,RC,58550,HCPCS,Outpatient,,,5059,2529.5,,3895.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1290.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1290.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1580.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1264.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4502.51,89,,,Percent of total Billed Charges,89% of total Billed charges,4502.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4502.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2064.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2064.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2064.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1264.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3895.43,77,,,Percent of total Billed charges,77% of total billed charges,4300.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1454.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2064.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1264.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1264.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1264.75,4502.51,
LAPARO-VAG HYST INCL T/O,P991501338,CDM,521,RC,58552,HCPCS,Outpatient,,,2112,1056,,1626.24,77,,,Percent of Total Billed Charges,77% of total billed charges,538.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,538.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,660,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,528,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1879.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1879.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1879.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1626.24,77,,,Percent of total Billed charges,77% of total billed charges,1795.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,607.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,861.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,528,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,528,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,528,1879.68,
LAPARO-VAG HYST W/T/O COMPL,P991501339,CDM,521,RC,58554,HCPCS,Outpatient,,,1665,832.5,,1282.05,77,,,Percent of Total Billed Charges,77% of total billed charges,424.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,520.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1481.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1481.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1481.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,679.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,679.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,416.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1282.05,77,,,Percent of total Billed charges,77% of total billed charges,1415.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,478.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,679.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,416.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,416.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.25,1481.85,
"HYSTEROSCOPY, DIAG",P991501340,CDM,521,RC,58555,HCPCS,Outpatient,,,626,313,,482.02,77,,,Percent of Total Billed Charges,77% of total billed charges,159.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,557.14,89,,,Percent of total Billed Charges,89% of total Billed charges,557.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,557.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,482.02,77,,,Percent of total Billed charges,77% of total billed charges,532.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,255.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.5,557.14,
HYSTEROSCOPY W/BX OR POLYP,P991501341,CDM,521,RC,58558,HCPCS,Outpatient,,,819,409.5,,630.63,77,,,Percent of Total Billed Charges,77% of total billed charges,208.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,728.91,89,,,Percent of total Billed Charges,89% of total Billed charges,728.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,728.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.63,77,,,Percent of total Billed charges,77% of total billed charges,696.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,334.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.75,728.91,
"HYSTEROSCOPY, LYSIS ADHESIONS",P991501342,CDM,521,RC,58559,HCPCS,Outpatient,,,2805,1402.5,,2159.85,77,,,Percent of Total Billed Charges,77% of total billed charges,715.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,715.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,876.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,701.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2496.45,89,,,Percent of total Billed Charges,89% of total Billed charges,2496.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2496.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1144.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1144.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1144.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2159.85,77,,,Percent of total Billed charges,77% of total billed charges,2384.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,806.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1144.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,701.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,701.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,701.25,2496.45,
HYSTEROSCOPY W/UTERINE SEPT,P991501343,CDM,521,RC,58560,HCPCS,Outpatient,,,3057,1528.5,,2353.89,77,,,Percent of Total Billed Charges,77% of total billed charges,779.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,779.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,955.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,764.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2720.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2720.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2720.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1247.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1247.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1247.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2353.89,77,,,Percent of total Billed charges,77% of total billed charges,2598.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,878.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1247.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,764.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,764.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,764.25,2720.73,
HYSTEROSCOPY REMOVE MYOMA,P991501344,CDM,521,RC,58561,HCPCS,Outpatient,,,3608,1804,,2778.16,77,,,Percent of Total Billed Charges,77% of total billed charges,920.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3211.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3211.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3211.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1472.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1472.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1472.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2778.16,77,,,Percent of total Billed charges,77% of total billed charges,3066.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1037.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1472.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902,3211.12,
HYSTEROSCOPY REMOVE FB,P991501345,CDM,521,RC,58562,HCPCS,Outpatient,,,2707,1353.5,,2084.39,77,,,Percent of Total Billed Charges,77% of total billed charges,690.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,690.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,845.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,676.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2409.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2409.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2409.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1104.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1104.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1104.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,676.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2084.39,77,,,Percent of total Billed charges,77% of total billed charges,2300.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,778.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1104.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,676.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,676.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.75,2409.23,
HYSTEROSCOPY ENDO ABLATION,P991501346,CDM,521,RC,58563,HCPCS,Outpatient,,,3073,1536.5,,2366.21,77,,,Percent of Total Billed Charges,77% of total billed charges,783.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,783.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,768.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2734.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2734.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2734.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,768.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2366.21,77,,,Percent of total Billed charges,77% of total billed charges,2612.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,883.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,768.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,768.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,768.25,2734.97,
ESSURE PROCEDURE,P991501347,CDM,521,RC,58565,HCPCS,Outpatient,,,3605,1802.5,,2775.85,77,,,Percent of Total Billed Charges,77% of total billed charges,919.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,919.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,901.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,3208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1470.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1470.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1470.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,901.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2775.85,77,,,Percent of total Billed charges,77% of total billed charges,3064.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1036.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1470.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,901.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,901.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,901.25,3208.45,
TLH UTERUS 250 G OR LESS,P991501348,CDM,521,RC,58570,HCPCS,Outpatient,,,1686,843,,1298.22,77,,,Percent of Total Billed Charges,77% of total billed charges,429.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,526.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1500.54,500,,,fee schedule,500% of healthlink,1500.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1500.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,687.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,687.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,687.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1298.22,77,,,Percent of total Billed charges,77% of total billed charges,1433.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,484.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,687.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,421.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.5,1500.54,
TLH W/T/O 250 G OR LESS,P991501349,CDM,521,RC,58571,HCPCS,Outpatient,,,1943,971.5,,1496.11,77,,,Percent of Total Billed Charges,77% of total billed charges,495.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,495.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,485.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1729.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1729.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1729.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1496.11,77,,,Percent of total Billed charges,77% of total billed charges,1651.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,558.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,792.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,485.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,485.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,485.75,1729.27,
TLH UTERUS OVER 250 G,P991501350,CDM,521,RC,58572,HCPCS,Outpatient,,,2229,1114.5,,1716.33,77,,,Percent of Total Billed Charges,77% of total billed charges,568.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,568.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,696.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,557.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1983.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1983.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1983.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,909.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,909.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,909.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,557.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1716.33,77,,,Percent of total Billed charges,77% of total billed charges,1894.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,640.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,909.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,557.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,557.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.25,1983.81,
TLH W/T/O UTERUS OVER 250 G,P991501351,CDM,521,RC,58573,HCPCS,Outpatient,,,2615,1307.5,,2013.55,77,,,Percent of Total Billed Charges,77% of total billed charges,666.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,653.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2327.35,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.55,77,,,Percent of total Billed charges,77% of total billed charges,2222.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1066.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,653.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.75,2327.35,
UNLISTED LAPS PX UTERUS,P991501352,CDM,521,RC,58578,HCPCS,Outpatient,,,1392,696,,1071.84,77,,,Percent of Total Billed Charges,77% of total billed charges,354.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,435,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1238.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1238.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1238.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,567.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,567.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,567.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.84,77,,,Percent of total Billed charges,77% of total billed charges,1183.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,400.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,567.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348,1238.88,
TUBAL LIGATION ABD/VAG,P991501353,CDM,521,RC,58600,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
DIVISION OF FALLOPIAN TUBE,P991501354,CDM,521,RC,58605,HCPCS,Outpatient,,,1684,842,,1296.68,77,,,Percent of Total Billed Charges,77% of total billed charges,429.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,429.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,526.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,421,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1498.76,89,,,Percent of total Billed Charges,89% of total Billed charges,1498.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1498.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,687.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,687.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,687.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1296.68,77,,,Percent of total Billed charges,77% of total billed charges,1431.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,484.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,687.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,421,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,421,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421,1498.76,
TUBAL WITH SURGERY/C-SECTION,P991501355,CDM,521,RC,58611,HCPCS,Outpatient,,,1645,822.5,,1266.65,77,,,Percent of Total Billed Charges,77% of total billed charges,419.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,419.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,514.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1464.05,89,,,Percent of total Billed Charges,89% of total Billed charges,1464.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1464.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,671.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,671.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1266.65,77,,,Percent of total Billed charges,77% of total billed charges,1398.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,472.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,671.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,411.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.25,1464.05,
TUBAL DEVICE VAG OR SUPRAPU,P991501356,CDM,521,RC,58615,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
LAPAROSCOPY/LYSIS ADHESIONS,P991501357,CDM,521,RC,58660,HCPCS,Outpatient,,,4530,2265,,3488.1,77,,,Percent of Total Billed Charges,77% of total billed charges,1155.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1155.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1415.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4031.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4031.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4031.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1848.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1848.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1848.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3488.1,77,,,Percent of total Billed charges,77% of total billed charges,3850.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1302.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1848.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1132.5,4031.7,
LAPAROSCOPY/REM ADNEXAL STRCTR,P991501358,CDM,521,RC,58661,HCPCS,Outpatient,,,1400,700,,1078,77,,,Percent of Total Billed Charges,77% of total billed charges,357,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1246,89,,,Percent of total Billed Charges,89% of total Billed charges,1246,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1246,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,571.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,571.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,571.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078,77,,,Percent of total Billed charges,77% of total billed charges,1190,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,571.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,350,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350,1246,
LAPSCOPY REMOVE ADNEXA BILAT,P991501359,CDM,521,RC,58661,HCPCS,Outpatient,,,2800,1400,,2156,77,,,Percent of Total Billed Charges,77% of total billed charges,714,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,714,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,875,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,700,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2492,89,,,Percent of total Billed Charges,89% of total Billed charges,2492,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2492,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1142.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1142.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1142.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,700,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2156,77,,,Percent of total Billed charges,77% of total billed charges,2380,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,805,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1142.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,700,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,700,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,700,2492,
LAPAROSCOPY FULG/EXC LESION,P991501360,CDM,521,RC,58662,HCPCS,Outpatient,,,1510,755,,1162.7,77,,,Percent of Total Billed Charges,77% of total billed charges,385.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,385.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,377.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1343.9,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,616.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,616.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,616.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.7,77,,,Percent of total Billed charges,77% of total billed charges,1283.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,434.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,616.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,377.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.5,1343.9,
LAPAROSCOPY/TUBAL/FULG,P991501361,CDM,521,RC,58670,HCPCS,Outpatient,,,2793,1396.5,,2150.61,77,,,Percent of Total Billed Charges,77% of total billed charges,712.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,712.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2485.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2485.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2485.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2150.61,77,,,Percent of total Billed charges,77% of total billed charges,2374.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1139.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,698.25,2485.77,
LAPAROSCOPY/TUBAL/WITH RINGS,P991501362,CDM,521,RC,58671,HCPCS,Outpatient,,,2793,1396.5,,2150.61,77,,,Percent of Total Billed Charges,77% of total billed charges,712.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,712.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2485.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2485.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2485.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2150.61,77,,,Percent of total Billed charges,77% of total billed charges,2374.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1139.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,698.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,698.25,2485.77,
LAPAROSCOPY FIMBROPLASTY,P991501363,CDM,521,RC,58672,HCPCS,Outpatient,,,3809,1904.5,,2932.93,77,,,Percent of Total Billed Charges,77% of total billed charges,971.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1190.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3390.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3390.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3390.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1554.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1554.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1554.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2932.93,77,,,Percent of total Billed charges,77% of total billed charges,3237.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1095.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1554.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,952.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,952.25,3390.01,
LAPAROSCOPY SALPINGOSTOMY,P991501364,CDM,521,RC,58673,HCPCS,Outpatient,,,1600,800,,1232,77,,,Percent of Total Billed Charges,77% of total billed charges,408,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,400,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1424,89,,,Percent of total Billed Charges,89% of total Billed charges,1424,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,652.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,652.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,652.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1232,77,,,Percent of total Billed charges,77% of total billed charges,1360,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,652.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,400,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400,1424,
SALPINGECTOMY,P991501365,CDM,521,RC,58700,HCPCS,Outpatient,,,2699,1349.5,,2078.23,77,,,Percent of Total Billed Charges,77% of total billed charges,688.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,674.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2402.11,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.23,77,,,Percent of total Billed charges,77% of total billed charges,2294.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,775.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1101.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,674.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.75,2402.11,
SAPINGO-OOPHORECTOMY,P991501366,CDM,521,RC,58720,HCPCS,Outpatient,,,3148,1574,,2423.96,77,,,Percent of Total Billed Charges,77% of total billed charges,802.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,802.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,983.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,787,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2801.72,89,,,Percent of total Billed Charges,89% of total Billed charges,2801.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2801.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1284.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1284.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1284.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,787,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.96,77,,,Percent of total Billed charges,77% of total billed charges,2675.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,905.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1284.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,787,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,787,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,787,2801.72,
LYSIS OF ADHESIONS ABDOMINAL,P991501367,CDM,521,RC,58740,HCPCS,Outpatient,,,1921,960.5,,1479.17,77,,,Percent of Total Billed Charges,77% of total billed charges,489.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,489.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,600.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1709.69,89,,,Percent of total Billed Charges,89% of total Billed charges,1709.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1709.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,783.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,783.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,783.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1479.17,77,,,Percent of total Billed charges,77% of total billed charges,1632.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,552.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,783.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,480.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.25,1709.69,
TUBOTUBAL/ANAST TUBL REVERS,P991501368,CDM,521,RC,58750,HCPCS,Outpatient,,,5393,2696.5,,4152.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1375.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1375.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1685.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1348.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4799.77,89,,,Percent of total Billed Charges,89% of total Billed charges,4799.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4799.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2200.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2200.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2200.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1348.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4152.61,77,,,Percent of total Billed charges,77% of total billed charges,4584.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1550.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2200.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1348.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1348.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1348.25,4799.77,
REVISE OVARIAN TUBE(S),P991501369,CDM,521,RC,58752,HCPCS,Outpatient,,,4943,2471.5,,3806.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1260.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1544.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1235.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4399.27,89,,,Percent of total Billed Charges,89% of total Billed charges,4399.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4399.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2016.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2016.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2016.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1235.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3806.11,77,,,Percent of total Billed charges,77% of total billed charges,4201.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1421.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2016.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1235.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1235.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1235.75,4399.27,
FIMBRIOPLASTY,P991501370,CDM,521,RC,58760,HCPCS,Outpatient,,,5171,2585.5,,3981.67,77,,,Percent of Total Billed Charges,77% of total billed charges,1318.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1318.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1615.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1292.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4602.19,89,,,Percent of total Billed Charges,89% of total Billed charges,4602.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4602.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2109.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2109.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2109.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1292.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3981.67,77,,,Percent of total Billed charges,77% of total billed charges,4395.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1486.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2109.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1292.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1292.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1292.75,4602.19,
SALPINGOSTOMY ABDOMINAL,P991501371,CDM,521,RC,58770,HCPCS,Outpatient,,,4719,2359.5,,3633.63,77,,,Percent of Total Billed Charges,77% of total billed charges,1203.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1203.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1474.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4199.91,89,,,Percent of total Billed Charges,89% of total Billed charges,4199.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4199.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3633.63,77,,,Percent of total Billed charges,77% of total billed charges,4011.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1356.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1925.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1179.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1179.75,4199.91,
I & D OVARIAN CYST ABDOMINAL,P991501372,CDM,521,RC,58805,HCPCS,Outpatient,,,839,419.5,,646.03,77,,,Percent of Total Billed Charges,77% of total billed charges,213.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.71,89,,,Percent of total Billed Charges,89% of total Billed charges,746.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,746.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.03,77,,,Percent of total Billed charges,77% of total billed charges,713.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,241.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.75,746.71,
DRAIN OVARIAN ABSCESS VAG APPR,P991501373,CDM,521,RC,58820,HCPCS,Outpatient,,,2092,1046,,1610.84,77,,,Percent of Total Billed Charges,77% of total billed charges,533.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,533.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,653.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1861.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1861.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1861.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1610.84,77,,,Percent of total Billed charges,77% of total billed charges,1778.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,601.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,853.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,523,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,523,1861.88,
DRAIN OVARIAN ABSCESS ABD APPR,P991501374,CDM,521,RC,58822,HCPCS,Outpatient,,,2298,1149,,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2045.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2045.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2045.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,937.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.5,2045.22,
OVARY BX ABD BI/UNI,P991501375,CDM,521,RC,58900,HCPCS,Outpatient,,,2484,1242,,1912.68,77,,,Percent of Total Billed Charges,77% of total billed charges,633.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,621,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2210.76,89,,,Percent of total Billed Charges,89% of total Billed charges,2210.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2210.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1013.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1013.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,621,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1912.68,77,,,Percent of total Billed charges,77% of total billed charges,2111.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,714.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1013.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,621,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,621,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,621,2210.76,
OVARIAN CYSTECTOMY,P991501376,CDM,521,RC,58925,HCPCS,Outpatient,,,2986,1493,,2299.22,77,,,Percent of Total Billed Charges,77% of total billed charges,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2657.54,89,,,Percent of total Billed Charges,89% of total Billed charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.22,77,,,Percent of total Billed charges,77% of total billed charges,2538.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,858.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1218.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.5,2657.54,
OOPHORECTOMY,P991501377,CDM,521,RC,58940,HCPCS,Outpatient,,,2986,1493,,2299.22,77,,,Percent of Total Billed Charges,77% of total billed charges,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2657.54,89,,,Percent of total Billed Charges,89% of total Billed charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.22,77,,,Percent of total Billed charges,77% of total billed charges,2538.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,858.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1218.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.5,2657.54,
OOPHORECTOMY MALIG WITH BX,P991501378,CDM,521,RC,58943,HCPCS,Outpatient,,,4917,2458.5,,3786.09,77,,,Percent of Total Billed Charges,77% of total billed charges,1253.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1253.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1536.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4376.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4376.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4376.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2006.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2006.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2006.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3786.09,77,,,Percent of total Billed charges,77% of total billed charges,4179.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1413.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2006.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1229.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1229.25,4376.13,
AMNIOCENTESIS,P991501379,CDM,521,RC,59000,HCPCS,Outpatient,,,390,195,,300.3,77,,,Percent of Total Billed Charges,77% of total billed charges,99.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,347.1,89,,,Percent of total Billed Charges,89% of total Billed charges,347.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,159.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.3,77,,,Percent of total Billed charges,77% of total billed charges,331.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.5,347.1,
FETAL CONTRACT STRESS TEST,P991501380,CDM,521,RC,59020,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.93,89,,,Percent of total Billed Charges,89% of total Billed charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.07,121.93,
NON-STRESS TEST FETAL,P991501381,CDM,521,RC,59025,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.1,89,,,Percent of total Billed Charges,89% of total Billed charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,80.1,
FETAL MONITOR/INTERPRET ONLY,P991501382,CDM,521,RC,59051,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,68.53,
ECTOPIC PREGNANCY RX W/BSO,P991501383,CDM,521,RC,59120,HCPCS,Outpatient,,,3454,1727,,2659.58,77,,,Percent of Total Billed Charges,77% of total billed charges,880.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,880.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1079.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,863.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3074.06,89,,,Percent of total Billed Charges,89% of total Billed charges,3074.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3074.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1409.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1409.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1409.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,863.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2659.58,77,,,Percent of total Billed charges,77% of total billed charges,2935.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,993.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1409.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,863.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,863.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,863.5,3074.06,
ECTOPIC PREGNANCY RX W/O BSO,P991501384,CDM,521,RC,59121,HCPCS,Outpatient,,,3361,1680.5,,2587.97,77,,,Percent of Total Billed Charges,77% of total billed charges,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2991.29,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.97,77,,,Percent of total Billed charges,77% of total billed charges,2856.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1371.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.25,2991.29,
LAP ECTOPIC PREGNANCY W/O BSO,P991501385,CDM,521,RC,59150,HCPCS,Outpatient,,,3361,1680.5,,2587.97,77,,,Percent of Total Billed Charges,77% of total billed charges,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2991.29,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.97,77,,,Percent of total Billed charges,77% of total billed charges,2856.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1371.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.25,2991.29,
LAP ECTOPIC PREGNANCY W/BSO,P991501386,CDM,521,RC,59151,HCPCS,Outpatient,,,3361,1680.5,,2587.97,77,,,Percent of Total Billed Charges,77% of total billed charges,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2991.29,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.97,77,,,Percent of total Billed charges,77% of total billed charges,2856.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1371.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,840.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.25,2991.29,
D & C PP HEMORRHAGE,P991501387,CDM,521,RC,59160,HCPCS,Outpatient,,,1200,600,,924,77,,,Percent of Total Billed Charges,77% of total billed charges,306,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,375,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1068,89,,,Percent of total Billed Charges,89% of total Billed charges,1068,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924,77,,,Percent of total Billed charges,77% of total billed charges,1020,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,345,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,489.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300,1068,
INSERTION OF CERVICAL DILATOR,P991501388,CDM,521,RC,59200,HCPCS,Outpatient,,,301,150.5,,231.77,77,,,Percent of Total Billed Charges,77% of total billed charges,76.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267.89,89,,,Percent of total Billed Charges,89% of total Billed charges,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.77,77,,,Percent of total Billed charges,77% of total billed charges,255.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.25,267.89,
EPISIOTOMY OR VAGINAL REPAIR,P991501389,CDM,521,RC,59300,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.5,364.9,
CERCLAGE OF CS VAG PREGNANCY,P991501390,CDM,521,RC,59320,HCPCS,Outpatient,,,1613,806.5,,1242.01,77,,,Percent of Total Billed Charges,77% of total billed charges,411.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,411.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,403.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1435.57,89,,,Percent of total Billed Charges,89% of total Billed charges,1435.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1435.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,658.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,658.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,658.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,77,,,Percent of total Billed charges,77% of total billed charges,1371.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,463.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,658.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,403.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.25,1435.57,
REPAIR OF UTERUS,P991501391,CDM,521,RC,59350,HCPCS,Outpatient,,,466,233,,358.82,77,,,Percent of Total Billed Charges,77% of total billed charges,118.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,414.74,89,,,Percent of total Billed Charges,89% of total Billed charges,414.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.82,77,,,Percent of total Billed charges,77% of total billed charges,396.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,414.74,
OBSTETRICAL CARE,P991501392,CDM,521,RC,59400,HCPCS,Outpatient,,,4532,2266,,3489.64,77,,,Percent of Total Billed Charges,77% of total billed charges,1155.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1155.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4033.48,89,,,Percent of total Billed Charges,89% of total Billed charges,4033.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4033.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1849.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1849.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1849.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3489.64,77,,,Percent of total Billed charges,77% of total billed charges,3852.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1302.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1849.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1133,4033.48,
VAGINAL DELIVERY ONLY,P991501393,CDM,521,RC,59409,HCPCS,Outpatient,,,2667,1333.5,,2053.59,77,,,Percent of Total Billed Charges,77% of total billed charges,680.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,833.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2373.63,89,,,Percent of total Billed Charges,89% of total Billed charges,2373.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2373.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1088.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1088.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1088.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.59,77,,,Percent of total Billed charges,77% of total billed charges,2266.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,766.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1088.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,666.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,666.75,2373.63,
VAGINAL DELIVERY W/PP CARE,P991501394,CDM,521,RC,59410,HCPCS,Outpatient,,,3177,1588.5,,2446.29,77,,,Percent of Total Billed Charges,77% of total billed charges,810.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,810.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,992.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,794.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2827.53,89,,,Percent of total Billed Charges,89% of total Billed charges,2827.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2827.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1296.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1296.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1296.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,794.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.29,77,,,Percent of total Billed charges,77% of total billed charges,2700.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,913.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1296.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,794.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,794.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,794.25,2827.53,
EXTERNAL CEPHALIC VERSION,P991501395,CDM,521,RC,59412,HCPCS,Outpatient,,,656,328,,505.12,77,,,Percent of Total Billed Charges,77% of total billed charges,167.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,583.84,89,,,Percent of total Billed Charges,89% of total Billed charges,583.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,505.12,77,,,Percent of total Billed charges,77% of total billed charges,557.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,267.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164,583.84,
DELIVER PLACENTA,P991501396,CDM,521,RC,59414,HCPCS,Outpatient,,,880,440,,677.6,77,,,Percent of Total Billed Charges,77% of total billed charges,224.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,783.2,89,,,Percent of total Billed Charges,89% of total Billed charges,783.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,783.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,359.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,359.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,359.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.6,77,,,Percent of total Billed charges,77% of total billed charges,748,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,253,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,359.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,220,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220,783.2,
ANTEPARTUM CARE ONLY,P991501397,CDM,521,RC,59425,HCPCS,Outpatient,,,937,468.5,,721.49,77,,,Percent of Total Billed Charges,77% of total billed charges,238.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,234.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,833.93,89,,,Percent of total Billed Charges,89% of total Billed charges,833.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,721.49,77,,,Percent of total Billed charges,77% of total billed charges,796.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,382.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,234.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.25,833.93,
ANTEPARTUM CARE ONLY;7+ VISITS,P991501398,CDM,521,RC,59426,HCPCS,Outpatient,,,1495,747.5,,1151.15,77,,,Percent of Total Billed Charges,77% of total billed charges,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,381.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,467.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1330.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1330.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,609.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.15,77,,,Percent of total Billed charges,77% of total billed charges,1270.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,609.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,373.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.75,1330.55,
POSTPARTUM CARE ONLY,P991501399,CDM,521,RC,59430,HCPCS,Outpatient,,,451,225.5,,347.27,77,,,Percent of Total Billed Charges,77% of total billed charges,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,401.39,89,,,Percent of total Billed Charges,89% of total Billed charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.27,77,,,Percent of total Billed charges,77% of total billed charges,383.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.75,401.39,
OB & ANTEPARTUM C-SECTION & PP,P991501400,CDM,521,RC,59510,HCPCS,Outpatient,,,5030,2515,,3873.1,77,,,Percent of Total Billed Charges,77% of total billed charges,1282.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1282.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1571.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1257.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4476.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4476.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4476.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2052.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2052.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2052.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1257.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3873.1,77,,,Percent of total Billed charges,77% of total billed charges,4275.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1446.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2052.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1257.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1257.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1257.5,4476.7,
C-SECTION DELIVERY ONLY,P991501401,CDM,521,RC,59514,HCPCS,Outpatient,,,2986,1493,,2299.22,77,,,Percent of Total Billed Charges,77% of total billed charges,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2657.54,89,,,Percent of total Billed Charges,89% of total Billed charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2657.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1218.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.22,77,,,Percent of total Billed charges,77% of total billed charges,2538.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,858.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1218.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,746.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.5,2657.54,
CESAREAN DELIVERY,P991501402,CDM,521,RC,59515,HCPCS,Outpatient,,,3659,1829.5,,2817.43,77,,,Percent of Total Billed Charges,77% of total billed charges,933.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,933.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1143.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,914.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3256.51,89,,,Percent of total Billed Charges,89% of total Billed charges,3256.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3256.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1492.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1492.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1492.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2817.43,77,,,Percent of total Billed charges,77% of total billed charges,3110.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1051.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1492.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,914.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,914.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,914.75,3256.51,
HYSTERECTOMY AT C-SECTION TIME,P991501403,CDM,521,RC,59525,HCPCS,Outpatient,,,1868,934,,1438.36,77,,,Percent of Total Billed Charges,77% of total billed charges,476.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,583.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1662.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1662.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1438.36,77,,,Percent of total Billed charges,77% of total billed charges,1587.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,762.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,467,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467,1662.52,
VBAC DELIVERY,P991501404,CDM,521,RC,59610,HCPCS,Outpatient,,,3958,1979,,3047.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1009.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1009.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1236.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3522.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3522.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3522.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3047.66,77,,,Percent of total Billed charges,77% of total billed charges,3364.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1137.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1614.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,989.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,989.5,3522.62,
VBAC DELIVERY ONLY,P991501405,CDM,521,RC,59612,HCPCS,Outpatient,,,2547,1273.5,,1961.19,77,,,Percent of Total Billed Charges,77% of total billed charges,649.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,649.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,795.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,636.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2266.83,89,,,Percent of total Billed Charges,89% of total Billed charges,2266.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2266.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1039.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1039.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,636.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1961.19,77,,,Percent of total Billed charges,77% of total billed charges,2164.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,732.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1039.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,636.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,636.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.75,2266.83,
ATTEMPTED VBAC DELIVERY,P991501406,CDM,521,RC,59618,HCPCS,Outpatient,,,4479,2239.5,,3448.83,77,,,Percent of Total Billed Charges,77% of total billed charges,1142.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1142.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3986.31,89,,,Percent of total Billed Charges,89% of total Billed charges,3986.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3986.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1827.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1827.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1827.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3448.83,77,,,Percent of total Billed charges,77% of total billed charges,3807.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1827.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.75,3986.31,
ATTEMPTED VBAC AFTER CARE,P991501407,CDM,521,RC,59622,HCPCS,Outpatient,,,4263,2131.5,,3282.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1087.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1087.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1332.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1065.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3794.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3794.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3794.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1739.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1739.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1739.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1065.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3282.51,77,,,Percent of total Billed charges,77% of total billed charges,3623.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1225.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1739.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1065.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1065.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.75,3794.07,
TREATMENT OF MISCARRIAGE,P991501408,CDM,521,RC,59812,HCPCS,Outpatient,,,1198,599,,922.46,77,,,Percent of Total Billed Charges,77% of total billed charges,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1066.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.46,77,,,Percent of total Billed charges,77% of total billed charges,1018.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,344.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.5,1066.22,
D&C MISSED ABORT SURGICAL,P991501409,CDM,521,RC,59820,HCPCS,Outpatient,,,828,414,,637.56,77,,,Percent of Total Billed Charges,77% of total billed charges,211.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,736.92,89,,,Percent of total Billed Charges,89% of total Billed charges,736.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,736.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.56,77,,,Percent of total Billed charges,77% of total billed charges,703.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,337.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,207,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207,736.92,
TREATMENT OF MISCARRIAGE,P991501410,CDM,521,RC,59821,HCPCS,Outpatient,,,832,416,,640.64,77,,,Percent of Total Billed Charges,77% of total billed charges,212.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,260,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,740.48,89,,,Percent of total Billed Charges,89% of total Billed charges,740.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,740.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.64,77,,,Percent of total Billed charges,77% of total billed charges,707.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,239.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208,740.48,
ABORTION,P991501411,CDM,521,RC,59855,HCPCS,Outpatient,,,455,227.5,,350.35,77,,,Percent of Total Billed Charges,77% of total billed charges,116.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.95,89,,,Percent of total Billed Charges,89% of total Billed charges,404.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.35,77,,,Percent of total Billed charges,77% of total billed charges,386.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.75,404.95,
EVACUATE MOLE OF UTERUS,P991501412,CDM,521,RC,59870,HCPCS,Outpatient,,,1042,521,,802.34,77,,,Percent of Total Billed Charges,77% of total billed charges,265.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,260.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,927.38,89,,,Percent of total Billed Charges,89% of total Billed charges,927.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,425.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,260.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,802.34,77,,,Percent of total Billed charges,77% of total billed charges,885.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,299.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,260.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.5,927.38,
REMOVE CERCLAGE SUTURE,P991501413,CDM,521,RC,59871,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,534,89,,,Percent of total Billed Charges,89% of total Billed charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,534,
NEEDLE BIOPSY OF THYROID,P991501414,CDM,521,RC,60100,HCPCS,Outpatient,,,233,116.5,,179.41,77,,,Percent of Total Billed Charges,77% of total billed charges,59.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.37,89,,,Percent of total Billed Charges,89% of total Billed charges,207.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,77,,,Percent of total Billed charges,77% of total billed charges,198.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.25,207.37,
EXC CYST OR ADENOMA OF THYROID,P991501415,CDM,521,RC,60200,HCPCS,Outpatient,,,1398,699,,1076.46,77,,,Percent of Total Billed Charges,77% of total billed charges,356.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,349.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1244.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.46,77,,,Percent of total Billed charges,77% of total billed charges,1188.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,570.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,349.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.5,1244.22,
PARTIAL THYROID EXCISION,P991501416,CDM,521,RC,60210,HCPCS,Outpatient,,,1507,753.5,,1160.39,77,,,Percent of Total Billed Charges,77% of total billed charges,384.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,470.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,376.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1341.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1341.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1341.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,614.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1160.39,77,,,Percent of total Billed charges,77% of total billed charges,1280.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,614.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,376.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,376.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.75,1341.23,
PARTIAL REMOVAL OF THYROID,P991501417,CDM,521,RC,60220,HCPCS,Outpatient,,,1506,753,,1159.62,77,,,Percent of Total Billed Charges,77% of total billed charges,384.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,470.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,376.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1340.34,89,,,Percent of total Billed Charges,89% of total Billed charges,1340.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1340.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,614.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,614.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,614.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,376.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1159.62,77,,,Percent of total Billed charges,77% of total billed charges,1280.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,432.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,614.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,376.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,376.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.5,1340.34,
PARTIAL REMOVAL OF THYROID,P991501418,CDM,521,RC,60225,HCPCS,Outpatient,,,1837,918.5,,1414.49,77,,,Percent of Total Billed Charges,77% of total billed charges,468.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,468.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,459.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1634.93,89,,,Percent of total Billed Charges,89% of total Billed charges,1634.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1634.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,749.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,749.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,749.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1414.49,77,,,Percent of total Billed charges,77% of total billed charges,1561.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,528.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,749.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,459.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,459.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,459.25,1634.93,
"THROIDECTOMY, TOTAL/COMPLETE",P991501419,CDM,521,RC,60240,HCPCS,Outpatient,,,1966,983,,1513.82,77,,,Percent of Total Billed Charges,77% of total billed charges,501.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,501.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,491.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1749.74,89,,,Percent of total Billed Charges,89% of total Billed charges,1749.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1749.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,802.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,802.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,802.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1513.82,77,,,Percent of total Billed charges,77% of total billed charges,1671.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,565.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,802.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,491.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,491.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.5,1749.74,
REPEAT THYROID SURGERY,P991501420,CDM,521,RC,60260,HCPCS,Outpatient,,,2343,1171.5,,1804.11,77,,,Percent of Total Billed Charges,77% of total billed charges,597.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,597.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,732.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,585.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2085.27,89,,,Percent of total Billed Charges,89% of total Billed charges,2085.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2085.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,955.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,955.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,955.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.11,77,,,Percent of total Billed charges,77% of total billed charges,1991.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,673.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,955.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,585.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,585.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.75,2085.27,
REMOVE THYROID DUCT LESION,P991501421,CDM,521,RC,60280,HCPCS,Outpatient,,,930,465,,716.1,77,,,Percent of Total Billed Charges,77% of total billed charges,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,827.7,89,,,Percent of total Billed Charges,89% of total Billed charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,716.1,77,,,Percent of total Billed charges,77% of total billed charges,790.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,232.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.5,827.7,
ASPIR/INJ THYROID CYST,P991501422,CDM,521,RC,60300,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204.7,89,,,Percent of total Billed Charges,89% of total Billed charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,204.7,
PARATHROIDECTOMY,P991501423,CDM,521,RC,60500,HCPCS,Outpatient,,,2062,1031,,1587.74,77,,,Percent of Total Billed Charges,77% of total billed charges,525.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,525.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,644.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1835.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1835.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,841.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,841.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,841.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1587.74,77,,,Percent of total Billed charges,77% of total billed charges,1752.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,592.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,841.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,515.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,515.5,1835.18,
"RE-EXPLORATION, HEAD/NECK",P991501424,CDM,521,RC,60502,HCPCS,Outpatient,,,2756,1378,,2122.12,77,,,Percent of Total Billed Charges,77% of total billed charges,702.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,702.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,861.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,689,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2452.84,89,,,Percent of total Billed Charges,89% of total Billed charges,2452.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2452.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2122.12,77,,,Percent of total Billed charges,77% of total billed charges,2342.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,792.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1124.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,689,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,689,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689,2452.84,
PARATHYROID AUTOTRANSPLANT,P991501425,CDM,521,RC,60512,HCPCS,Outpatient,,,528,264,,406.56,77,,,Percent of Total Billed Charges,77% of total billed charges,134.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,132,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,469.92,89,,,Percent of total Billed Charges,89% of total Billed charges,469.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,469.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.56,77,,,Percent of total Billed charges,77% of total billed charges,448.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,215.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,132,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132,469.92,
SCAN PROC CRANIAL EXTRA,P991501426,CDM,521,RC,61782,HCPCS,Outpatient,,,380,190,,292.6,77,,,Percent of Total Billed Charges,77% of total billed charges,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,338.2,89,,,Percent of total Billed Charges,89% of total Billed charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.6,77,,,Percent of total Billed charges,77% of total billed charges,323,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95,338.2,
RACZ,P991501427,CDM,521,RC,62264,HCPCS,Outpatient,,,520,260,,400.4,77,,,Percent of Total Billed Charges,77% of total billed charges,132.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,462.8,89,,,Percent of total Billed Charges,89% of total Billed charges,462.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,462.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.4,77,,,Percent of total Billed charges,77% of total billed charges,442,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,212.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130,462.8,
DX LMBR SPI PNXR,P991501428,CDM,521,RC,62270,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
BLOOD PATCH,P991501429,CDM,521,RC,62273,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,599.86,89,,,Percent of total Billed Charges,89% of total Billed charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.5,599.86,
TREAT SPINAL CORD LESION,P991501430,CDM,521,RC,62281,HCPCS,Outpatient,,,232,116,,178.64,77,,,Percent of Total Billed Charges,77% of total billed charges,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,206.48,89,,,Percent of total Billed Charges,89% of total Billed charges,206.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.64,77,,,Percent of total Billed charges,77% of total billed charges,197.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58,206.48,
TREAT SPINAL CANAL LESION,P991501431,CDM,521,RC,62282,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.5,364.9,
NJX INTERLAMINAR CRV/THRC,P991501432,CDM,521,RC,62320,HCPCS,Outpatient,,,219,109.5,,168.63,77,,,Percent of Total Billed Charges,77% of total billed charges,55.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194.91,89,,,Percent of total Billed Charges,89% of total Billed charges,194.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.63,77,,,Percent of total Billed charges,77% of total billed charges,186.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,89.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.75,194.91,
NJX INTERLAMINAR CRV/THRC,P991501433,CDM,521,RC,62321,HCPCS,Outpatient,,,236,118,,181.72,77,,,Percent of Total Billed Charges,77% of total billed charges,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.04,89,,,Percent of total Billed Charges,89% of total Billed charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.72,77,,,Percent of total Billed charges,77% of total billed charges,200.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59,210.04,
"INJ, DX OR THERAP SUB LMBR/SAC",P991501434,CDM,521,RC,62322,HCPCS,Outpatient,,,188,94,,144.76,77,,,Percent of Total Billed Charges,77% of total billed charges,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,167.32,89,,,Percent of total Billed Charges,89% of total Billed charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.76,77,,,Percent of total Billed charges,77% of total billed charges,159.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47,167.32,
NJX INTERLAMINAR LMBR/SAC,P991501435,CDM,521,RC,62323,HCPCS,Outpatient,,,180,90,,138.6,77,,,Percent of Total Billed Charges,77% of total billed charges,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.2,89,,,Percent of total Billed Charges,89% of total Billed charges,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.6,77,,,Percent of total Billed charges,77% of total billed charges,153,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45,160.2,
NJX INTERLAMINAR CRV/THRC,P991501436,CDM,521,RC,62324,HCPCS,Outpatient,,,203,101.5,,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180.67,89,,,Percent of total Billed Charges,89% of total Billed charges,180.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.75,180.67,
NJX INTERLAMINAR CRV/THRC,P991501437,CDM,521,RC,62325,HCPCS,Outpatient,,,198,99,,152.46,77,,,Percent of Total Billed Charges,77% of total billed charges,50.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,176.22,89,,,Percent of total Billed Charges,89% of total Billed charges,176.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.46,77,,,Percent of total Billed charges,77% of total billed charges,168.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.5,176.22,
NJX INTERLAMINAR LMBR/SAC,P991501438,CDM,521,RC,62326,HCPCS,Outpatient,,,198,99,,152.46,77,,,Percent of Total Billed Charges,77% of total billed charges,50.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,176.22,89,,,Percent of total Billed Charges,89% of total Billed charges,176.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.46,77,,,Percent of total Billed charges,77% of total billed charges,168.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.5,176.22,
NJX INTERLAMINAR LMBR/SAC,P991501439,CDM,521,RC,62327,HCPCS,Outpatient,,,211,105.5,,162.47,77,,,Percent of Total Billed Charges,77% of total billed charges,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,187.79,89,,,Percent of total Billed Charges,89% of total Billed charges,187.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.47,77,,,Percent of total Billed charges,77% of total billed charges,179.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.75,187.79,
REMOVE SPINE LAMINA 1/2 LMBR,P991501440,CDM,521,RC,63005,HCPCS,Outpatient,,,4091,2045.5,,3150.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1278.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1022.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3640.99,89,,,Percent of total Billed Charges,89% of total Billed charges,3640.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3640.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1022.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3150.07,77,,,Percent of total Billed charges,77% of total billed charges,3477.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1669.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1022.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1022.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.75,3640.99,
LAMINOTOMY ONE INTERSPACE,P991501441,CDM,521,RC,63030,HCPCS,Outpatient,,,3508,1754,,2701.16,77,,,Percent of Total Billed Charges,77% of total billed charges,894.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,894.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1096.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,877,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3122.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3122.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3122.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1431.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1431.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1431.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,877,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2701.16,77,,,Percent of total Billed charges,77% of total billed charges,2981.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1008.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1431.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,877,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,877,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877,3122.12,
NJX AA&/STRD GR OCPL NRV,P991501442,CDM,521,RC,64405,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.07,89,,,Percent of total Billed Charges,89% of total Billed charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
NJX AA&/STRD NTRCOST NRV 1,P991501443,CDM,521,RC,64420,HCPCS,Outpatient,,,205,102.5,,157.85,77,,,Percent of Total Billed Charges,77% of total billed charges,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,182.45,89,,,Percent of total Billed Charges,89% of total Billed charges,182.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.85,77,,,Percent of total Billed charges,77% of total billed charges,174.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.25,182.45,
"INJ, INTERCOSTAL NERVES, MULTI",P991501444,CDM,521,RC,64421,HCPCS,Outpatient,,,196,98,,150.92,77,,,Percent of Total Billed Charges,77% of total billed charges,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,174.44,89,,,Percent of total Billed Charges,89% of total Billed charges,174.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.92,77,,,Percent of total Billed charges,77% of total billed charges,166.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49,174.44,
INJECTION ILIOINGUINAL NERVE,P991501445,CDM,521,RC,64425,HCPCS,Outpatient,,,346,173,,266.42,77,,,Percent of Total Billed Charges,77% of total billed charges,88.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.94,89,,,Percent of total Billed Charges,89% of total Billed charges,307.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.42,77,,,Percent of total Billed charges,77% of total billed charges,294.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,307.94,
PUDENDAL NERVE BLOCK,P991501446,CDM,521,RC,64430,HCPCS,Outpatient,,,227,113.5,,174.79,77,,,Percent of Total Billed Charges,77% of total billed charges,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.03,89,,,Percent of total Billed Charges,89% of total Billed charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.79,77,,,Percent of total Billed charges,77% of total billed charges,192.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.75,202.03,
PARACX BLOCK UTERINE NERVE,P991501447,CDM,521,RC,64435,HCPCS,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.75,262.55,
"SCIATIC BLK, PIRIFORMIS",P991501448,CDM,521,RC,64445,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,146.85,89,,,Percent of total Billed Charges,89% of total Billed charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.85,
PERIPHERAL NERVE BLOCK,P991501449,CDM,521,RC,64450,HCPCS,Outpatient,,,98,49,,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.22,89,,,Percent of total Billed Charges,89% of total Billed charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,87.22,
NJX AA&/STRD TFRM EPI C/T 1,P991501450,CDM,521,RC,64479,HCPCS,Outpatient,,,393,196.5,,302.61,77,,,Percent of Total Billed Charges,77% of total billed charges,100.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,349.77,89,,,Percent of total Billed Charges,89% of total Billed charges,349.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.61,77,,,Percent of total Billed charges,77% of total billed charges,334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.25,349.77,
NJ AA&/STRD TFRM EPI L/S 1 BI,P991501451,CDM,521,RC,64483,HCPCS,Outpatient,,,480,240,50,369.6,77,,,Percent of Total Billed Charges,77% of total billed charges,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,427.2,89,,,Percent of total Billed Charges,89% of total Billed charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.6,77,,,Percent of total Billed charges,77% of total billed charges,408,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,138,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,195.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120,427.2,
NJX AA&/STRD TFRM EPI L/S 1,P991501452,CDM,521,RC,64483,HCPCS,Outpatient,,,240,120,,184.8,77,,,Percent of Total Billed Charges,77% of total billed charges,61.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.6,89,,,Percent of total Billed Charges,89% of total Billed charges,213.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.8,77,,,Percent of total Billed charges,77% of total billed charges,204,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60,213.6,
NJX AA&/STRD TFRM EPI L/S EA,P991501453,CDM,521,RC,64484,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
INJ PARAVERT F JNT C/T 1 LEV,P991501454,CDM,521,RC,64490,HCPCS,Outpatient,,,352,176,,271.04,77,,,Percent of Total Billed Charges,77% of total billed charges,89.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,313.28,89,,,Percent of total Billed Charges,89% of total Billed charges,313.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.04,77,,,Percent of total Billed charges,77% of total billed charges,299.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,143.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88,313.28,
INJ PARAVERT F JNT C/T 1 LEV,P991501455,CDM,510,RC,64490,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
INJ PARAVERT F JNT C/T 2 LEV,P991501456,CDM,521,RC,64491,HCPCS,Outpatient,,,180,90,,138.6,77,,,Percent of Total Billed Charges,77% of total billed charges,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160.2,89,,,Percent of total Billed Charges,89% of total Billed charges,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.6,77,,,Percent of total Billed charges,77% of total billed charges,153,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45,160.2,
INJ PARAVERT F JNT C/T 2 LEV,P991501457,CDM,510,RC,64491,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,132.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.25,235.85,
INJ PARAVERT F JNT C/T 3 LEV,P991501458,CDM,521,RC,64492,HCPCS,Outpatient,,,155,77.5,,119.35,77,,,Percent of Total Billed Charges,77% of total billed charges,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.95,89,,,Percent of total Billed Charges,89% of total Billed charges,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.35,77,,,Percent of total Billed charges,77% of total billed charges,131.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,137.95,
INJ PARAVERT F JNT L/S 1 BI,P991501459,CDM,521,RC,64493,HCPCS,Outpatient,,,454,227,50,349.58,77,,,Percent of Total Billed Charges,77% of total billed charges,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,404.06,89,,,Percent of total Billed Charges,89% of total Billed charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.58,77,,,Percent of total Billed charges,77% of total billed charges,385.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.5,404.06,
INJ PARAVERT F JNT L/S 1 LEV,P991501460,CDM,521,RC,64493,HCPCS,Outpatient,,,227,113.5,,174.79,77,,,Percent of Total Billed Charges,77% of total billed charges,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.03,89,,,Percent of total Billed Charges,89% of total Billed charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.79,77,,,Percent of total Billed charges,77% of total billed charges,192.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.75,202.03,
INJ PARAVERT F JNT L/S 2 BI,P991501461,CDM,521,RC,64494,HCPCS,Outpatient,,,268,134,50,206.36,77,,,Percent of Total Billed Charges,77% of total billed charges,68.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,238.52,89,,,Percent of total Billed Charges,89% of total Billed charges,238.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.36,77,,,Percent of total Billed charges,77% of total billed charges,227.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,109.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67,238.52,
INJ PARAVERT F JNT L/S 2 LEV,P991501462,CDM,521,RC,64494,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.26,89,,,Percent of total Billed Charges,89% of total Billed charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,119.26,
INJ PARAVERT F JNT L/S 3 BI,P991501463,CDM,521,RC,64495,HCPCS,Outpatient,,,268,134,50,206.36,77,,,Percent of Total Billed Charges,77% of total billed charges,68.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,238.52,89,,,Percent of total Billed Charges,89% of total Billed charges,238.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.36,77,,,Percent of total Billed charges,77% of total billed charges,227.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,109.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67,238.52,
INJ PARAVERT F JNT L/S 3 LEV,P991501464,CDM,521,RC,64495,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.26,89,,,Percent of total Billed Charges,89% of total Billed charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,119.26,
N BLOCK LUMBAR/THORACIC,P991501465,CDM,521,RC,64520,HCPCS,Outpatient,,,346,173,,266.42,77,,,Percent of Total Billed Charges,77% of total billed charges,88.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.94,89,,,Percent of total Billed Charges,89% of total Billed charges,307.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.42,77,,,Percent of total Billed charges,77% of total billed charges,294.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,307.94,
POSTERIOR TIB NEUROSTIMULATOR,P991501466,CDM,521,RC,64566,HCPCS,Outpatient,,,253,126.5,,194.81,77,,,Percent of Total Billed Charges,77% of total billed charges,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,225.17,89,,,Percent of total Billed Charges,89% of total Billed charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.81,77,,,Percent of total Billed charges,77% of total billed charges,215.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.25,225.17,
REVISE/REMOVE NEUROELECTRODE,P991501467,CDM,521,RC,64585,HCPCS,Outpatient,,,179,89.5,,137.83,77,,,Percent of Total Billed Charges,77% of total billed charges,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.31,89,,,Percent of total Billed Charges,89% of total Billed charges,159.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.83,77,,,Percent of total Billed charges,77% of total billed charges,152.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.75,159.31,
REVISE/RMV PN/GASTR STIMUL,P991501468,CDM,521,RC,64595,HCPCS,Outpatient,,,240,120,,184.8,77,,,Percent of Total Billed Charges,77% of total billed charges,61.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,213.6,89,,,Percent of total Billed Charges,89% of total Billed charges,213.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.8,77,,,Percent of total Billed charges,77% of total billed charges,204,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60,213.6,
DESTROY NERVE FACE MUSCLE,P991501469,CDM,521,RC,64612,HCPCS,Outpatient,,,242,121,,186.34,77,,,Percent of Total Billed Charges,77% of total billed charges,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,215.38,89,,,Percent of total Billed Charges,89% of total Billed charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.34,77,,,Percent of total Billed charges,77% of total billed charges,205.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,215.38,
CHEMODENERV MUSC MIGRAINE,P991501470,CDM,521,RC,64615,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,114.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,249.2,
DESTR C/T FACET JT,P991501471,CDM,521,RC,64633,HCPCS,Outpatient,,,530,265,,408.1,77,,,Percent of Total Billed Charges,77% of total billed charges,135.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,471.7,89,,,Percent of total Billed Charges,89% of total Billed charges,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.1,77,,,Percent of total Billed charges,77% of total billed charges,450.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,216.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.5,471.7,
DESTROY C/TH FACET JNT ADDL,P991501472,CDM,521,RC,64634,HCPCS,Outpatient,,,147,73.5,,113.19,77,,,Percent of Total Billed Charges,77% of total billed charges,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,130.83,89,,,Percent of total Billed Charges,89% of total Billed charges,130.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.19,77,,,Percent of total Billed charges,77% of total billed charges,124.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.75,130.83,
DESTROY LUMB/SAC FACET JNT,P991501473,CDM,521,RC,64635,HCPCS,Outpatient,,,476,238,,366.52,77,,,Percent of Total Billed Charges,77% of total billed charges,121.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,423.64,89,,,Percent of total Billed Charges,89% of total Billed charges,423.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,423.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.52,77,,,Percent of total Billed charges,77% of total billed charges,404.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,194.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119,423.64,
DESTROY L/S FACET JNT ADDL,P991501474,CDM,521,RC,64636,HCPCS,Outpatient,,,129,64.5,,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.81,89,,,Percent of total Billed Charges,89% of total Billed charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,114.81,
DEST PERIPHERAL NERVE,P991501475,CDM,521,RC,64640,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,599.86,89,,,Percent of total Billed Charges,89% of total Billed charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.5,599.86,
CHEMODENERV 1 EXTREMITY 1-4,P991501476,CDM,521,RC,64642,HCPCS,Outpatient,,,233,116.5,,179.41,77,,,Percent of Total Billed Charges,77% of total billed charges,59.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.37,89,,,Percent of total Billed Charges,89% of total Billed charges,207.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,77,,,Percent of total Billed charges,77% of total billed charges,198.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.25,207.37,
CHEMODENERV 1 EXTREM 1-4 EA,P991501477,CDM,521,RC,64643,HCPCS,Outpatient,,,156,78,,120.12,77,,,Percent of Total Billed Charges,77% of total billed charges,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,138.84,89,,,Percent of total Billed Charges,89% of total Billed charges,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.12,77,,,Percent of total Billed charges,77% of total billed charges,132.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39,138.84,
CHEMODENERV 1 EXTREM 5/> MUS,P991501478,CDM,521,RC,64644,HCPCS,Outpatient,,,255,127.5,,196.35,77,,,Percent of Total Billed Charges,77% of total billed charges,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,226.95,89,,,Percent of total Billed Charges,89% of total Billed charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.35,77,,,Percent of total Billed charges,77% of total billed charges,216.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.75,226.95,
REVISE ARM/LEG NERVE,P991501479,CDM,521,RC,64708,HCPCS,Outpatient,,,1702,851,,1310.54,77,,,Percent of Total Billed Charges,77% of total billed charges,434.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,434.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,425.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1514.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1514.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,694.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,694.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,694.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1310.54,77,,,Percent of total Billed charges,77% of total billed charges,1446.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,489.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,694.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,425.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,425.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.5,1514.78,
REVISE ULNAR NERVE AT ELBOW,P991501480,CDM,521,RC,64718,HCPCS,Outpatient,,,1224,612,,942.48,77,,,Percent of Total Billed Charges,77% of total billed charges,312.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,382.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,306,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1089.36,89,,,Percent of total Billed Charges,89% of total Billed charges,1089.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1089.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,499.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,499.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,499.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,942.48,77,,,Percent of total Billed charges,77% of total billed charges,1040.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,351.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,499.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,306,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306,1089.36,
REVISE ULNAR NERVE AT WRIST,P991501481,CDM,521,RC,64719,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,532.22,89,,,Percent of total Billed Charges,89% of total Billed charges,532.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,243.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,532.22,
CARPAL TUNNEL SURGERY,P991501482,CDM,521,RC,64721,HCPCS,Outpatient,,,884,442,,680.68,77,,,Percent of Total Billed Charges,77% of total billed charges,225.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,786.76,89,,,Percent of total Billed Charges,89% of total Billed charges,786.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.68,77,,,Percent of total Billed charges,77% of total billed charges,751.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,360.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221,786.76,
RELIEVE PRESSURE ON NERVE(S),P991501483,CDM,521,RC,64722,HCPCS,Outpatient,,,839,419.5,,646.03,77,,,Percent of Total Billed Charges,77% of total billed charges,213.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,746.71,89,,,Percent of total Billed Charges,89% of total Billed charges,746.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,746.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.03,77,,,Percent of total Billed charges,77% of total billed charges,713.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,241.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.75,746.71,
RELEASE FOOT/TOE NERVE,P991501484,CDM,521,RC,64726,HCPCS,Outpatient,,,564,282,,434.28,77,,,Percent of Total Billed Charges,77% of total billed charges,143.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,501.96,89,,,Percent of total Billed Charges,89% of total Billed charges,501.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.28,77,,,Percent of total Billed charges,77% of total billed charges,479.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,162.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,501.96,
REMOVE DIGIT NERVE LESION,P991501485,CDM,521,RC,64776,HCPCS,Outpatient,,,467,233.5,,359.59,77,,,Percent of Total Billed Charges,77% of total billed charges,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,415.63,89,,,Percent of total Billed Charges,89% of total Billed charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.59,77,,,Percent of total Billed charges,77% of total billed charges,396.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.75,415.63,
SYMPATHECTOMY CERVICAL,P991501486,CDM,521,RC,64802,HCPCS,Outpatient,,,2240,1120,,1724.8,77,,,Percent of Total Billed Charges,77% of total billed charges,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1993.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1993.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,913.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1724.8,77,,,Percent of total Billed charges,77% of total billed charges,1904,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,913.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,560,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560,1993.6,
REMOVAL OF FOREIGN BODY/EYE,P991501487,CDM,521,RC,65205,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.75,88.11,
DRAINAGE OF EYELID ABSCESS,P991501488,CDM,521,RC,67700,HCPCS,Outpatient,,,451,225.5,,347.27,77,,,Percent of Total Billed Charges,77% of total billed charges,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,401.39,89,,,Percent of total Billed Charges,89% of total Billed charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.27,77,,,Percent of total Billed charges,77% of total billed charges,383.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.75,401.39,
BIOPSY OF EYELID & LID MARGIN,P991501489,CDM,521,RC,67810,HCPCS,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.93,89,,,Percent of total Billed Charges,89% of total Billed charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.25,299.93,
EXCISION OF LESION OF EYELID,P991501490,CDM,521,RC,67840,HCPCS,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,221.61,89,,,Percent of total Billed Charges,89% of total Billed charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.25,221.61,
DRAIN EXTERNAL EAR LESION,P991501491,CDM,521,RC,69000,HCPCS,Outpatient,,,378,189,,291.06,77,,,Percent of Total Billed Charges,77% of total billed charges,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,336.42,89,,,Percent of total Billed Charges,89% of total Billed charges,336.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.06,77,,,Percent of total Billed charges,77% of total billed charges,321.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,154.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.5,336.42,
BIOPSY OF EXTERNAL EAR,P991501492,CDM,521,RC,69100,HCPCS,Outpatient,,,199,99.5,,153.23,77,,,Percent of Total Billed Charges,77% of total billed charges,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177.11,89,,,Percent of total Billed Charges,89% of total Billed charges,177.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.23,77,,,Percent of total Billed charges,77% of total billed charges,169.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.75,177.11,
BIOPSY OF EXTERNAL EAR CANAL,P991501493,CDM,521,RC,69105,HCPCS,Outpatient,,,277,138.5,,213.29,77,,,Percent of Total Billed Charges,77% of total billed charges,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,246.53,89,,,Percent of total Billed Charges,89% of total Billed charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.29,77,,,Percent of total Billed charges,77% of total billed charges,235.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.25,246.53,
REMOVE EXTERNAL EAR PARTIAL,P991501494,CDM,521,RC,69110,HCPCS,Outpatient,,,869,434.5,,669.13,77,,,Percent of Total Billed Charges,77% of total billed charges,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,773.41,89,,,Percent of total Billed Charges,89% of total Billed charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,773.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.13,77,,,Percent of total Billed charges,77% of total billed charges,738.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,354.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.25,773.41,
REMOVE EAR CANAL LESION(S),P991501495,CDM,521,RC,69145,HCPCS,Outpatient,,,513,256.5,,395.01,77,,,Percent of Total Billed Charges,77% of total billed charges,130.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,456.57,89,,,Percent of total Billed Charges,89% of total Billed charges,456.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,456.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.01,77,,,Percent of total Billed charges,77% of total billed charges,436.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.25,456.57,
REMOVAL FOREIGN BODY,P991501496,CDM,521,RC,69200,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
TUBE REMOVAL,P991501497,CDM,521,RC,69205,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.9,89,,,Percent of total Billed Charges,89% of total Billed charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.5,186.9,
REMOVE IMPACTED EAR WAX BILAT,P991501498,CDM,521,RC,69209,HCPCS,Outpatient,,,46,23,50,35.42,77,,,Percent of Total Billed Charges,77% of total billed charges,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.94,89,,,Percent of total Billed Charges,89% of total Billed charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.42,77,,,Percent of total Billed charges,77% of total billed charges,39.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,40.94,
REMOVE IMPACTED EAR WAX UNI,P991501499,CDM,521,RC,69209,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
REMOVE IMPACTED WAX INSTRMT,P991501500,CDM,521,RC,69210,HCPCS,Outpatient,,,106,53,,81.62,77,,,Percent of Total Billed Charges,77% of total billed charges,27.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.34,89,,,Percent of total Billed Charges,89% of total Billed charges,94.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.62,77,,,Percent of total Billed charges,77% of total billed charges,90.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,94.34,
REMOVE IMPCTD WAX INSTMT BI,P991501501,CDM,521,RC,69210,HCPCS,Outpatient,,,212,106,50,163.24,77,,,Percent of Total Billed Charges,77% of total billed charges,54.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,188.68,89,,,Percent of total Billed Charges,89% of total Billed charges,188.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.24,77,,,Percent of total Billed charges,77% of total billed charges,180.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53,188.68,
CLEAN OUT MASTOID CAVITY,P991501502,CDM,521,RC,69220,HCPCS,Outpatient,,,221,110.5,,170.17,77,,,Percent of Total Billed Charges,77% of total billed charges,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196.69,89,,,Percent of total Billed Charges,89% of total Billed charges,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.17,77,,,Percent of total Billed charges,77% of total billed charges,187.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,196.69,
OTOPLASTY,P991501503,CDM,521,RC,69300,HCPCS,Outpatient,,,1000,500,,770,77,,,Percent of Total Billed Charges,77% of total billed charges,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,890,89,,,Percent of total Billed Charges,89% of total Billed charges,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,77,,,Percent of total Billed charges,77% of total billed charges,850,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,408,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250,890,
INCISION OF EARDRUM,P991501504,CDM,521,RC,69420,HCPCS,Outpatient,,,382,191,,294.14,77,,,Percent of Total Billed Charges,77% of total billed charges,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,339.98,89,,,Percent of total Billed Charges,89% of total Billed charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.14,77,,,Percent of total Billed charges,77% of total billed charges,324.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,155.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.5,339.98,
INCISION OF EARDRUM,P991501505,CDM,521,RC,69421,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,274.12,89,,,Percent of total Billed Charges,89% of total Billed charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,274.12,
INCISION OF EARDRUM BILAT,P991501506,CDM,521,RC,69421,HCPCS,Outpatient,,,616,308,50,474.32,77,,,Percent of Total Billed Charges,77% of total billed charges,157.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,548.24,89,,,Percent of total Billed Charges,89% of total Billed charges,548.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,548.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,474.32,77,,,Percent of total Billed charges,77% of total billed charges,523.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,251.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,154,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,548.24,
REMOVE VENTILATING TUBE BILAT,P991501507,CDM,521,RC,69424,HCPCS,Outpatient,,,260,130,50,200.2,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,231.4,89,,,Percent of total Billed Charges,89% of total Billed charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.2,77,,,Percent of total Billed charges,77% of total billed charges,221,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.4,
TUBE REMOVAL W/ GEN ANESTHESIA,P991501508,CDM,521,RC,69424,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,115.7,
CREATE EARDRUM OPENING,P991501509,CDM,521,RC,69433,HCPCS,Outpatient,,,405,202.5,,311.85,77,,,Percent of Total Billed Charges,77% of total billed charges,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,360.45,89,,,Percent of total Billed Charges,89% of total Billed charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.85,77,,,Percent of total Billed charges,77% of total billed charges,344.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.25,360.45,
CREATE EARDRUM OPENING BILAT,P991501510,CDM,521,RC,69433,HCPCS,Outpatient,,,810,405,50,623.7,77,,,Percent of Total Billed Charges,77% of total billed charges,206.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,202.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,720.9,89,,,Percent of total Billed Charges,89% of total Billed charges,720.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,720.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,330.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,330.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623.7,77,,,Percent of total Billed charges,77% of total billed charges,688.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,330.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,202.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,202.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.5,720.9,
TYMPANOSTOMIES W/TUBE GEN ANES,P991501511,CDM,521,RC,69436,HCPCS,Outpatient,,,333,166.5,,256.41,77,,,Percent of Total Billed Charges,77% of total billed charges,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296.37,89,,,Percent of total Billed Charges,89% of total Billed charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.41,77,,,Percent of total Billed charges,77% of total billed charges,283.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,135.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.25,296.37,
TYMPANOSTOMY W/ ANES BILAT,P991501512,CDM,521,RC,69436,HCPCS,Outpatient,,,666,333,50,512.82,77,,,Percent of Total Billed Charges,77% of total billed charges,169.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,166.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,592.74,89,,,Percent of total Billed Charges,89% of total Billed charges,592.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,592.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,512.82,77,,,Percent of total Billed charges,77% of total billed charges,566.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,191.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,271.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,166.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,166.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.5,592.74,
REPAIR OF EARDRUM,P991501513,CDM,521,RC,69610,HCPCS,Outpatient,,,791,395.5,,609.07,77,,,Percent of Total Billed Charges,77% of total billed charges,201.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,703.99,89,,,Percent of total Billed Charges,89% of total Billed charges,703.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.07,77,,,Percent of total Billed charges,77% of total billed charges,672.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,227.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,322.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,197.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.75,703.99,
REPAIR OF EARDRUM BILAT,P991501514,CDM,521,RC,69610,HCPCS,Outpatient,,,1582,791,,1218.14,77,,,Percent of Total Billed Charges,77% of total billed charges,403.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,403.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,494.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,395.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1407.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1407.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1407.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,645.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1218.14,77,,,Percent of total Billed charges,77% of total billed charges,1344.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,454.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,645.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,395.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,395.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.5,1407.98,
FAT GRAFT MYRINGOPLASTY,P991501515,CDM,521,RC,69620,HCPCS,Outpatient,,,1016,508,,782.32,77,,,Percent of Total Billed Charges,77% of total billed charges,259.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,317.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,904.24,89,,,Percent of total Billed Charges,89% of total Billed charges,904.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,782.32,77,,,Percent of total Billed charges,77% of total billed charges,863.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,292.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,414.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254,904.24,
TYMPANOPLASTY W/OUT MASTOID,P991501516,CDM,521,RC,69631,HCPCS,Outpatient,,,1825,912.5,,1405.25,77,,,Percent of Total Billed Charges,77% of total billed charges,465.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,465.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,570.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,456.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1624.25,89,,,Percent of total Billed Charges,89% of total Billed charges,1624.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1624.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,744.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,744.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,744.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,456.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1405.25,77,,,Percent of total Billed charges,77% of total billed charges,1551.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,524.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,744.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,456.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,456.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.25,1624.25,
NPS SURG DILAT EUST TUBE UNI,P991501517,CDM,521,RC,69705,HCPCS,Outpatient,,,335,167.5,,257.95,77,,,Percent of Total Billed Charges,77% of total billed charges,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,298.15,89,,,Percent of total Billed Charges,89% of total Billed charges,298.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.95,77,,,Percent of total Billed charges,77% of total billed charges,284.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.75,298.15,
NPS SURG DILAT EUST TUBE BI,P991501518,CDM,521,RC,69706,HCPCS,Outpatient,,,467,233.5,,359.59,77,,,Percent of Total Billed Charges,77% of total billed charges,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,415.63,89,,,Percent of total Billed Charges,89% of total Billed charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.59,77,,,Percent of total Billed charges,77% of total billed charges,396.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.75,415.63,
UNLISTED PX MIDDLE EAR,P991501519,CDM,521,RC,69799,HCPCS,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,311.5,89,,,Percent of total Billed Charges,89% of total Billed charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.5,311.5,
UNLISTED PX MIDDLE EAR BILAT,P991501520,CDM,521,RC,69799,HCPCS,Outpatient,,,700,350,,539,77,,,Percent of Total Billed Charges,77% of total billed charges,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,623,89,,,Percent of total Billed Charges,89% of total Billed charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,623,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,285.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539,77,,,Percent of total Billed charges,77% of total billed charges,595,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,201.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175,623,
INCISE INNER EAR,P991501521,CDM,521,RC,69801,HCPCS,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
X-RAY EXAM OF JAW 4/> VIEWS,P991501522,CDM,521,RC,70110,HCPCS,Outpatient,,,27,13.5,26,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108,400,,,fee schedule,400% of healthlink fee schedule,101.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,108,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,108,
X-RAY EXAM OF MASTOIDS,P991501523,CDM,521,RC,70130,HCPCS,Outpatient,,,37,18.5,26,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148,400,,,fee schedule,400% of healthlink fee schedule,138.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,148,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,148,
X-RAY EXAM OF FACIAL BONES,P991501524,CDM,521,RC,70150,HCPCS,Outpatient,,,28,14,26,21.56,77,,,Percent of Total Billed Charges,77% of total billed charges,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112,400,,,fee schedule,400% of healthlink fee schedule,105,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,112,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.56,77,,,Percent of total Billed charges,77% of total billed charges,23.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7,112,
X-RAY EXAM OF NASAL BONES,P991501525,CDM,521,RC,70160,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,27.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
X-RAY EXAM OF EYE SOCKETS,P991501526,CDM,521,RC,70200,HCPCS,Outpatient,,,30,15,26,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120,400,,,fee schedule,400% of healthlink fee schedule,112.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,120,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,120,
X-RAY EXAM OF SINUSES,P991501527,CDM,521,RC,70210,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
X-RAY EXAM OF SINUSES,P991501528,CDM,521,RC,70220,HCPCS,Outpatient,,,27,13.5,26,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108,400,,,fee schedule,400% of healthlink fee schedule,101.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,108,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,24.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,108,
"XRAY, SELLA TURCICA",P991501529,CDM,521,RC,70240,HCPCS,Outpatient,,,21,10.5,26,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84,400,,,fee schedule,400% of healthlink fee schedule,78.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,84,
"XRAY SKULL, LESS THAN 4 VIEWS",P991501530,CDM,521,RC,70250,HCPCS,Outpatient,,,27,13.5,26,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108,400,,,fee schedule,400% of healthlink fee schedule,101.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,108,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,108,
X-RAY EXAM OF SKULL,P991501531,CDM,521,RC,70260,HCPCS,Outpatient,,,37,18.5,26,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148,400,,,fee schedule,400% of healthlink fee schedule,138.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,148,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,148,
"XRAY, BILAT, JAW OPEN & CLOSED",P991501532,CDM,521,RC,70330,HCPCS,Outpatient,,,26,13,26,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104,400,,,fee schedule,400% of healthlink fee schedule,97.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,38.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,104,
"MRI, TEMPOROMANDIBULAR JOINT",P991501533,CDM,521,RC,70336,HCPCS,Outpatient,,,158,79,26,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,632,400,,,fee schedule,400% of healthlink fee schedule,592.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,632,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,289.98,120,,,Fee Schedule,120% of MO Medicaid Rate,289.98,120,,,Fee Schedule,120% of MO Medicaid Rate,289.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,289.98,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,632,
"XRAY, NECK SOFT TISSUE",P991501534,CDM,521,RC,70360,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
X-RAY EXAM OF SALIVARY DUCT,P991501535,CDM,521,RC,70390,HCPCS,Outpatient,,,41,20.5,26,31.57,77,,,Percent of Total Billed Charges,77% of total billed charges,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164,400,,,fee schedule,400% of healthlink fee schedule,153.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,164,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,93.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.57,77,,,Percent of total Billed charges,77% of total billed charges,34.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,164,
"CT, HEAD OR BRAIN W/O CONTRAST",P991501536,CDM,521,RC,70450,HCPCS,Outpatient,,,91,45.5,26,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364,400,,,fee schedule,400% of healthlink fee schedule,341.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,364,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,364,
"CT, HEAD OR BRAIN W/ CONTRAST",P991501537,CDM,521,RC,70460,HCPCS,Outpatient,,,123,61.5,26,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,492,400,,,fee schedule,400% of healthlink fee schedule,461.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,492,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.75,492,
CT HEAD/BRAIN W/O & W/DYE,P991501538,CDM,521,RC,70470,HCPCS,Outpatient,,,137,68.5,26,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,548,400,,,fee schedule,400% of healthlink fee schedule,513.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,548,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,548,
"CT, ORBIT, EAR, FOSSA, W/O DYE",P991501539,CDM,521,RC,70480,HCPCS,Outpatient,,,138,69,26,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552,400,,,fee schedule,400% of healthlink fee schedule,517.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,552,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,552,
CT ORBIT/EAR/FOSSA W/DYE,P991501540,CDM,521,RC,70481,HCPCS,Outpatient,,,149,74.5,26,114.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,596,400,,,fee schedule,400% of healthlink fee schedule,558.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,596,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.73,77,,,Percent of total Billed charges,77% of total billed charges,126.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.25,596,
CT ORBIT/EAR/FOSSA W/O&W/DYE,P991501541,CDM,521,RC,70482,HCPCS,Outpatient,,,156,78,26,120.12,77,,,Percent of Total Billed Charges,77% of total billed charges,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,624,400,,,fee schedule,400% of healthlink fee schedule,585,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,624,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.12,77,,,Percent of total Billed charges,77% of total billed charges,132.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39,624,
CT MAXILLOFICIAL W/O CONTRAST,P991501542,CDM,521,RC,70486,HCPCS,Outpatient,,,92,46,26,70.84,77,,,Percent of Total Billed Charges,77% of total billed charges,23.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,368,400,,,fee schedule,400% of healthlink fee schedule,345,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,368,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.84,77,,,Percent of total Billed charges,77% of total billed charges,78.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23,368,
CT MAXILLOFICIAL WITH CONTRAST,P991501543,CDM,521,RC,70487,HCPCS,Outpatient,,,121,60.5,26,93.17,77,,,Percent of Total Billed Charges,77% of total billed charges,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,484,400,,,fee schedule,400% of healthlink fee schedule,453.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,484,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.17,77,,,Percent of total Billed charges,77% of total billed charges,102.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.25,484,
CT MAXILLOFACIAL W/O & W/DYE,P991501544,CDM,521,RC,70488,HCPCS,Outpatient,,,137,68.5,26,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,548,400,,,fee schedule,400% of healthlink fee schedule,513.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,548,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,548,
CT SOFT TISSUE NECK W/O DYE,P991501545,CDM,521,RC,70490,HCPCS,Outpatient,,,138,69,26,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,552,400,,,fee schedule,400% of healthlink fee schedule,517.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,552,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,552,
CT SOFT TISSUE NECK W/DYE,P991501546,CDM,521,RC,70491,HCPCS,Outpatient,,,149,74.5,26,114.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,596,400,,,fee schedule,400% of healthlink fee schedule,558.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,596,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.73,77,,,Percent of total Billed charges,77% of total billed charges,126.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.25,596,
CT SFT TSUE NCK W/O & W/DYE,P991501547,CDM,521,RC,70492,HCPCS,Outpatient,,,174,87,26,133.98,77,,,Percent of Total Billed Charges,77% of total billed charges,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,696,400,,,fee schedule,400% of healthlink fee schedule,652.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,696,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.98,77,,,Percent of total Billed charges,77% of total billed charges,147.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.5,696,
CT ANGIOGRAPHY HEAD,P991501548,CDM,521,RC,70496,HCPCS,Outpatient,,,189,94.5,26,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,756,400,,,fee schedule,400% of healthlink fee schedule,708.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,756,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,301.73,120,,,Fee Schedule,120% of MO Medicaid Rate,301.73,120,,,Fee Schedule,120% of MO Medicaid Rate,301.73,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,301.73,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.25,756,
CT ANGIOGRAPHY NECK,P991501549,CDM,521,RC,70498,HCPCS,Outpatient,,,189,94.5,26,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,756,400,,,fee schedule,400% of healthlink fee schedule,708.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,756,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,302.21,120,,,Fee Schedule,120% of MO Medicaid Rate,302.21,120,,,Fee Schedule,120% of MO Medicaid Rate,302.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,302.21,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.25,756,
MRI ORBIT/FACE/NECK W/O DYE,P991501550,CDM,521,RC,70540,HCPCS,Outpatient,,,145,72.5,26,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,580,400,,,fee schedule,400% of healthlink fee schedule,543.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,580,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,288.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.25,580,
MRI ORBIT/FACE/NECK W/DYE,P991501551,CDM,521,RC,70542,HCPCS,Outpatient,,,175,87.5,26,134.75,77,,,Percent of Total Billed Charges,77% of total billed charges,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,700,400,,,fee schedule,400% of healthlink fee schedule,656.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,700,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,335.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,77,,,Percent of total Billed charges,77% of total billed charges,148.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.75,700,
MRI ORBT/FAC/NCK W/O &W/DYE,P991501552,CDM,521,RC,70543,HCPCS,Outpatient,,,231,115.5,26,177.87,77,,,Percent of Total Billed Charges,77% of total billed charges,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,924,400,,,fee schedule,400% of healthlink fee schedule,866.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,924,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,568.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.87,77,,,Percent of total Billed charges,77% of total billed charges,196.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,924,
"MRA HEAD, W/O CONTRAST",P991501553,CDM,521,RC,70544,HCPCS,Outpatient,,,129,64.5,26,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516,400,,,fee schedule,400% of healthlink fee schedule,483.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,516,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,516,
"MRA HEAD, WITH CONTRAST",P991501554,CDM,521,RC,70545,HCPCS,Outpatient,,,129,64.5,26,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516,400,,,fee schedule,400% of healthlink fee schedule,483.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,516,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.58,120,,,Fee Schedule,120% of MO Medicaid Rate,306.58,120,,,Fee Schedule,120% of MO Medicaid Rate,306.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306.58,120,,,Fee Schedule,120% of MO Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,516,
MR ANGIOGRAPH HEAD W/O&W/DYE,P991501555,CDM,521,RC,70546,HCPCS,Outpatient,,,159,79.5,26,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,636,400,,,fee schedule,400% of healthlink fee schedule,596.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,636,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,549.29,120,,,Fee Schedule,120% of MO Medicaid Rate,549.29,120,,,Fee Schedule,120% of MO Medicaid Rate,549.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,549.29,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.75,636,
MRA NECK WITHOUT CONTRAST,P991501556,CDM,521,RC,70547,HCPCS,Outpatient,,,129,64.5,26,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516,400,,,fee schedule,400% of healthlink fee schedule,483.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,516,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,516,
MRA NECK WITH CONTRAST,P991501557,CDM,521,RC,70548,HCPCS,Outpatient,,,162,81,26,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,648,400,,,fee schedule,400% of healthlink fee schedule,607.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,648,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,311.68,120,,,Fee Schedule,120% of MO Medicaid Rate,311.68,120,,,Fee Schedule,120% of MO Medicaid Rate,311.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,311.68,120,,,Fee Schedule,120% of MO Medicaid Rate,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,648,
MRA NECK W/ & W/O CONTRAST,P991501558,CDM,521,RC,70549,HCPCS,Outpatient,,,194,97,26,149.38,77,,,Percent of Total Billed Charges,77% of total billed charges,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,776,400,,,fee schedule,400% of healthlink fee schedule,727.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,776,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,549.05,120,,,Fee Schedule,120% of MO Medicaid Rate,549.05,120,,,Fee Schedule,120% of MO Medicaid Rate,549.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,77,,,Percent of total Billed charges,77% of total billed charges,164.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,549.05,120,,,Fee Schedule,120% of MO Medicaid Rate,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.5,776,
"MRI BRAIN, W/O CONTRAST",P991501559,CDM,521,RC,70551,HCPCS,Outpatient,,,160,80,26,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,640,400,,,fee schedule,400% of healthlink fee schedule,600,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,640,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,640,
"MRI BRAIN, WITH CONTRAST",P991501560,CDM,521,RC,70552,HCPCS,Outpatient,,,192,96,26,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,768,400,,,fee schedule,400% of healthlink fee schedule,720,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,768,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,768,
"MRI BRAIN, W/ & W/O CONTRAST",P991501561,CDM,521,RC,70553,HCPCS,Outpatient,,,246,123,26,189.42,77,,,Percent of Total Billed Charges,77% of total billed charges,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,984,400,,,fee schedule,400% of healthlink fee schedule,922.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,984,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,575.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.42,77,,,Percent of total Billed charges,77% of total billed charges,209.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.5,984,
"XRAY, CHEST 1 VIEW",P991501562,CDM,521,RC,71045,HCPCS,Outpatient,,,19,9.5,26,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.91,89,,,Percent of total Billed Charges,89% of total Billed charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.91,
"XRAY, CHEST 2 VIEWS",P991501563,CDM,521,RC,71046,HCPCS,Outpatient,,,23,11.5,26,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.47,89,,,Percent of total Billed Charges,89% of total Billed charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,20.95,
"XRAY, CHEST 3 VIEWS",P991501564,CDM,521,RC,71047,HCPCS,Outpatient,,,30,15,26,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.7,89,,,Percent of total Billed Charges,89% of total Billed charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.72,120,,,Fee Schedule,120% of MO Medicaid Rate,26.72,120,,,Fee Schedule,120% of MO Medicaid Rate,26.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.72,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,26.72,
"XRAY, CHEST 4 OR MORE VIEWS",P991501565,CDM,521,RC,71048,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.26,89,,,Percent of total Billed Charges,89% of total Billed charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,30.26,
X-RAY EXAM RIBS UNI 2-VIEWS,P991501566,CDM,521,RC,71100,HCPCS,Outpatient,,,21,10.5,26,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84,400,,,fee schedule,400% of healthlink fee schedule,78.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,84,
X-RAY EXAM UNILAT RIBS/CHEST,P991501567,CDM,521,RC,71101,HCPCS,Outpatient,,,29,14.5,26,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116,400,,,fee schedule,400% of healthlink fee schedule,108.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,116,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,116,
X-RAY EXAM RIBS BIL 3 VIEWS,P991501568,CDM,521,RC,71110,HCPCS,Outpatient,,,27,13.5,26,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108,400,,,fee schedule,400% of healthlink fee schedule,101.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,108,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,108,
"XRAY RIBS, BILATERAL, 4 VIEWS",P991501569,CDM,521,RC,71111,HCPCS,Outpatient,,,35,17.5,26,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140,400,,,fee schedule,400% of healthlink fee schedule,131.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,140,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,140,
"XRAY STERNUM, 2 VIEWS",P991501570,CDM,521,RC,71120,HCPCS,Outpatient,,,21,10.5,26,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84,400,,,fee schedule,400% of healthlink fee schedule,78.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,84,
X-RAY STRENOCLAVIC JT 3/>VWS,P991501571,CDM,521,RC,71130,HCPCS,Outpatient,,,23,11.5,26,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92,400,,,fee schedule,400% of healthlink fee schedule,86.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,92,
"CT, THORAX, W/O CONTRAST",P991501572,CDM,521,RC,71250,HCPCS,Outpatient,,,126,63,26,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,504,400,,,fee schedule,400% of healthlink fee schedule,472.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,504,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,179.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,504,
"CT, THORAX, WTIH CONTRAST",P991501573,CDM,521,RC,71260,HCPCS,Outpatient,,,134,67,26,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,536,400,,,fee schedule,400% of healthlink fee schedule,502.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,536,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,258.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,536,
"CT, THORAX, W/&W/O CONTRAST",P991501574,CDM,521,RC,71270,HCPCS,Outpatient,,,149,74.5,26,114.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,596,400,,,fee schedule,400% of healthlink fee schedule,558.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,596,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,230.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.73,77,,,Percent of total Billed charges,77% of total billed charges,126.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.25,596,
CT THORAX LUNG CANCER SCR C-,P991501575,CDM,521,RC,71271,HCPCS,Outpatient,,,135,67.5,26,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120.15,89,,,Percent of total Billed Charges,89% of total Billed charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,136.48,
SPECIAL LUNG CA,P991501576,CDM,521,RC,71271,HCPCS,Outpatient,,,,,26,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,136.48,136.48,
CT ANGIOGRAPHY CHEST,P991501577,CDM,521,RC,71275,HCPCS,Outpatient,,,196,98,26,150.92,77,,,Percent of Total Billed Charges,77% of total billed charges,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,784,400,,,fee schedule,400% of healthlink fee schedule,735,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,784,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,298.48,120,,,Fee Schedule,120% of MO Medicaid Rate,298.48,120,,,Fee Schedule,120% of MO Medicaid Rate,298.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.92,77,,,Percent of total Billed charges,77% of total billed charges,166.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,298.48,120,,,Fee Schedule,120% of MO Medicaid Rate,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49,784,
MRI CHEST W/O CONTRAST,P991501578,CDM,521,RC,71550,HCPCS,Outpatient,,,157,78.5,26,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,628,400,,,fee schedule,400% of healthlink fee schedule,588.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,628,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,311.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,628,
MRI CHEST WITH CONTRAST,P991501579,CDM,521,RC,71551,HCPCS,Outpatient,,,186,93,26,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,744,400,,,fee schedule,400% of healthlink fee schedule,697.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,744,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,357.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.5,744,
MRI CHEST W/&W/O CONTRAST,P991501580,CDM,521,RC,71552,HCPCS,Outpatient,,,243,121.5,26,187.11,77,,,Percent of Total Billed Charges,77% of total billed charges,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,972,400,,,fee schedule,400% of healthlink fee schedule,911.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,972,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,594.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.11,77,,,Percent of total Billed charges,77% of total billed charges,206.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.75,972,
MRA CHEST WITH OR W/O CONTRAST,P991501581,CDM,521,RC,71555,HCPCS,Outpatient,,,193,96.5,26,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,772,400,,,fee schedule,400% of healthlink fee schedule,723.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,772,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,307.97,120,,,Fee Schedule,120% of MO Medicaid Rate,307.97,120,,,Fee Schedule,120% of MO Medicaid Rate,307.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.97,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,772,
"XRAY, SPINE 1 VIEW",P991501582,CDM,521,RC,72020,HCPCS,Outpatient,,,16,8,26,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64,400,,,fee schedule,400% of healthlink fee schedule,60,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,64,
XRAY SPINE CERVICAL 2-3 VIEWS,P991501583,CDM,521,RC,72040,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,96,
XRAY SPINE CERVICAL 4-5 VIEWS,P991501584,CDM,521,RC,72050,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136,400,,,fee schedule,400% of healthlink fee schedule,127.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,36.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,136,
X-RAY EXAM NECK SPINE 6/>VWS,P991501585,CDM,521,RC,72052,HCPCS,Outpatient,,,39,19.5,26,30.03,77,,,Percent of Total Billed Charges,77% of total billed charges,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,156,400,,,fee schedule,400% of healthlink fee schedule,146.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,156,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.03,77,,,Percent of total Billed charges,77% of total billed charges,33.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.75,156,
"XRAY SPINE, THORACIC 2 VIEWS",P991501586,CDM,521,RC,72070,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,96,
"XRAY SPINE, THORACIC 3 VIEWS",P991501587,CDM,521,RC,72072,HCPCS,Outpatient,,,23.54,11.77,26,18.13,77,,,Percent of Total Billed Charges,77% of total billed charges,6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.16,400,,,fee schedule,400% of healthlink fee schedule,88.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,94.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.13,77,,,Percent of total Billed charges,77% of total billed charges,20.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,5.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.89,94.16,
X-RAY EXAM THORACOLMB 2/> VW,P991501588,CDM,521,RC,72080,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,96,
X-RAY EXAM ENTIRE SPI 2/3 VW,P991501589,CDM,521,RC,72082,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.26,89,,,Percent of total Billed Charges,89% of total Billed charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,50.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,50.14,
X-RAY EXAM ENTIRE SPI 4/5 VW,P991501590,CDM,521,RC,72083,HCPCS,Outpatient,,,39,19.5,26,30.03,77,,,Percent of Total Billed Charges,77% of total billed charges,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.71,89,,,Percent of total Billed Charges,89% of total Billed charges,34.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,55.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.03,77,,,Percent of total Billed charges,77% of total billed charges,33.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.75,55.91,
X-RAY EXAM L-S SPINE 2/3 VWS,P991501591,CDM,521,RC,72100,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,96,
X-RAY EXAM L-2 SPINE 4/>VWS,P991501592,CDM,521,RC,72110,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136,400,,,fee schedule,400% of healthlink fee schedule,127.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,35.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,136,
X-RAY EXAM L-S SPINE BENDING,P991501593,CDM,521,RC,72114,HCPCS,Outpatient,,,35,17.5,26,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140,400,,,fee schedule,400% of healthlink fee schedule,131.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,140,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,43.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,140,
X-RAY BEND ONLY L-S SPINE,P991501594,CDM,521,RC,72120,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,27.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,96,
CT NECK SPINE W/O DYE,P991501595,CDM,521,RC,72125,HCPCS,Outpatient,,,115,57.5,26,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,460,400,,,fee schedule,400% of healthlink fee schedule,431.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,460,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.75,460,
CT NECK SPINE W/DYE,P991501596,CDM,521,RC,72126,HCPCS,Outpatient,,,132,66,26,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,528,400,,,fee schedule,400% of healthlink fee schedule,495,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,528,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33,528,
CT NECK SPINE W/O & W/DYE,P991501597,CDM,521,RC,72127,HCPCS,Outpatient,,,136,68,26,104.72,77,,,Percent of Total Billed Charges,77% of total billed charges,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,544,400,,,fee schedule,400% of healthlink fee schedule,510,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,544,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.72,77,,,Percent of total Billed charges,77% of total billed charges,115.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34,544,
CT CHEST SPINE W/O DYE,P991501598,CDM,521,RC,72128,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432,400,,,fee schedule,400% of healthlink fee schedule,405,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,432,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,432,
CT CHEST SPINE W/O & W/DYE,P991501599,CDM,521,RC,72130,HCPCS,Outpatient,,,117,58.5,26,90.09,77,,,Percent of Total Billed Charges,77% of total billed charges,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,468,400,,,fee schedule,400% of healthlink fee schedule,438.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,468,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.09,77,,,Percent of total Billed charges,77% of total billed charges,99.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,468,
CT LUMBAR SPINE W/O CONTRAST,P991501600,CDM,521,RC,72131,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432,400,,,fee schedule,400% of healthlink fee schedule,405,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,432,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,432,
CT LUMBAR SPINE W/O & W/DYE,P991501601,CDM,521,RC,72133,HCPCS,Outpatient,,,137,68.5,26,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,548,400,,,fee schedule,400% of healthlink fee schedule,513.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,548,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,548,
MRI NECK SPINE W/O DYE,P991501602,CDM,521,RC,72141,HCPCS,Outpatient,,,160,80,26,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,640,400,,,fee schedule,400% of healthlink fee schedule,600,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,640,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,282.67,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,640,
MRI NECK SPINE W/DYE,P991501603,CDM,521,RC,72142,HCPCS,Outpatient,,,193,96.5,26,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,772,400,,,fee schedule,400% of healthlink fee schedule,723.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,772,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,342.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,772,
MRI CHEST SPINE W/O DYE,P991501604,CDM,521,RC,72146,HCPCS,Outpatient,,,160,80,26,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,640,400,,,fee schedule,400% of healthlink fee schedule,600,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,640,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,640,
MRI CHEST SPINE W/DYE,P991501605,CDM,521,RC,72147,HCPCS,Outpatient,,,192,96,26,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,768,400,,,fee schedule,400% of healthlink fee schedule,720,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,768,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,330.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,768,
MRI LUMBAR SPINE W/O DYE,P991501606,CDM,521,RC,72148,HCPCS,Outpatient,,,160,80,26,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,640,400,,,fee schedule,400% of healthlink fee schedule,600,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,640,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,640,
MRI LUMBAR SPINE W/DYE,P991501607,CDM,521,RC,72149,HCPCS,Outpatient,,,193,96.5,26,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,772,400,,,fee schedule,400% of healthlink fee schedule,723.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,772,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,772,
MRI NECK SPINE W/O & W/DYE,P991501608,CDM,521,RC,72156,HCPCS,Outpatient,,,246,123,26,189.42,77,,,Percent of Total Billed Charges,77% of total billed charges,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,984,400,,,fee schedule,400% of healthlink fee schedule,922.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,984,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.42,77,,,Percent of total Billed charges,77% of total billed charges,209.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.5,984,
MRI CHEST SPINE W/O & W/DYE,P991501609,CDM,521,RC,72157,HCPCS,Outpatient,,,246,123,26,189.42,77,,,Percent of Total Billed Charges,77% of total billed charges,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,984,400,,,fee schedule,400% of healthlink fee schedule,922.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,984,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,563.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.42,77,,,Percent of total Billed charges,77% of total billed charges,209.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.5,984,
MRI LUMBAR SPINE W/O & W/DYE,P991501610,CDM,521,RC,72158,HCPCS,Outpatient,,,246,123,26,189.42,77,,,Percent of Total Billed Charges,77% of total billed charges,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,984,400,,,fee schedule,400% of healthlink fee schedule,922.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,984,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.42,77,,,Percent of total Billed charges,77% of total billed charges,209.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.5,984,
"XRAY, PELVIS 1-2 VIEWS",P991501611,CDM,521,RC,72170,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY PELVIS, COMPLETE, 3 VIEWS",P991501612,CDM,521,RC,72190,HCPCS,Outpatient,,,23,11.5,26,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92,400,,,fee schedule,400% of healthlink fee schedule,86.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,92,
CT ANGIOGRAPH PELV W/O&W/DYE,P991501613,CDM,521,RC,72191,HCPCS,Outpatient,,,194,97,26,149.38,77,,,Percent of Total Billed Charges,77% of total billed charges,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,776,400,,,fee schedule,400% of healthlink fee schedule,727.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,776,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,294.32,120,,,Fee Schedule,120% of MO Medicaid Rate,294.32,120,,,Fee Schedule,120% of MO Medicaid Rate,294.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,77,,,Percent of total Billed charges,77% of total billed charges,164.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.32,120,,,Fee Schedule,120% of MO Medicaid Rate,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.5,776,
CT PELVIS W/O CONTRAST,P991501614,CDM,521,RC,72192,HCPCS,Outpatient,,,117,58.5,26,90.09,77,,,Percent of Total Billed Charges,77% of total billed charges,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,468,400,,,fee schedule,400% of healthlink fee schedule,438.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,468,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,178.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.09,77,,,Percent of total Billed charges,77% of total billed charges,99.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,468,
CT PELVIS WITH CONTRAST,P991501615,CDM,320,RC,72193,HCPCS,Outpatient,,,126,63,26,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.24,74,,,Percent of Total Billed Charges,74% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,105.84,84,,,Percent of Total Billed Charges,84% of total billed charges,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,504,400,,,fee schedule,400% of healthlink fee schedule,472.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,504,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,504,
CT PELVIS W/&W/O CONTRAST,P991501616,CDM,521,RC,72194,HCPCS,Outpatient,,,131,65.5,26,100.87,77,,,Percent of Total Billed Charges,77% of total billed charges,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,524,400,,,fee schedule,400% of healthlink fee schedule,491.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,524,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.87,77,,,Percent of total Billed charges,77% of total billed charges,111.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.75,524,
MRI PELVIS W/O CONTRAST,P991501617,CDM,521,RC,72195,HCPCS,Outpatient,,,157,78.5,26,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,628,400,,,fee schedule,400% of healthlink fee schedule,588.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,628,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,295.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,628,
MRI PELVIS WITH CONTRAST,P991501618,CDM,521,RC,72196,HCPCS,Outpatient,,,187,93.5,26,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,748,400,,,fee schedule,400% of healthlink fee schedule,701.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,748,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,343.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.75,748,
MRI PELVIS W/ & W/O CONTRAST,P991501619,CDM,521,RC,72197,HCPCS,Outpatient,,,237,118.5,26,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,948,400,,,fee schedule,400% of healthlink fee schedule,888.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,948,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,571.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.25,948,
MRA PELVIS W/ OR W/O CONTRAST,P991501620,CDM,521,RC,72198,HCPCS,Outpatient,,,192,96,26,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,768,400,,,fee schedule,400% of healthlink fee schedule,720,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,768,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,305.76,120,,,Fee Schedule,120% of MO Medicaid Rate,305.76,120,,,Fee Schedule,120% of MO Medicaid Rate,305.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,305.76,120,,,Fee Schedule,120% of MO Medicaid Rate,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,768,
X-RAY EXAM SI JOINTS,P991501621,CDM,521,RC,72200,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
X-RAY EXAM SI JOINTS 3/> VWS,P991501622,CDM,521,RC,72202,HCPCS,Outpatient,,,20,10,26,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80,400,,,fee schedule,400% of healthlink fee schedule,75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,80,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,80,
XRAY SACRUM & COCCYX 2 VIEWS,P991501623,CDM,521,RC,72220,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"MYELOGRAPHY, CERVICAL",P991501624,CDM,521,RC,72240,HCPCS,Outpatient,,,98,49,26,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,392,400,,,fee schedule,400% of healthlink fee schedule,367.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,392,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,103.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,392,
CT MYELOGRAM,P991501625,CDM,521,RC,72265,HCPCS,Outpatient,,,88,44,26,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,352,400,,,fee schedule,400% of healthlink fee schedule,330,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,352,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,91.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,352,
"XRAY CLAVICLE, COMPLETE",P991501626,CDM,521,RC,73000,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, SCAPULA, COMPLETE",P991501627,CDM,521,RC,73010,HCPCS,Outpatient,,,19,9.5,26,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76,400,,,fee schedule,400% of healthlink fee schedule,71.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,76,
X-RAY EXAM OF SHOULDER,P991501628,CDM,521,RC,73030,HCPCS,Outpatient,,,20,10,26,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80,400,,,fee schedule,400% of healthlink fee schedule,75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,80,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,80,
"X-RAY SHOULDER,COMPLETE",P991501629,CDM,521,RC,73040,HCPCS,Outpatient,,,58,29,26,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232,400,,,fee schedule,400% of healthlink fee schedule,217.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,232,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,96.65,120,,,Fee Schedule,120% of MO Medicaid Rate,96.65,120,,,Fee Schedule,120% of MO Medicaid Rate,96.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,232,
X-RAY EXAM OF SHOULDERS,P991501630,CDM,521,RC,73050,HCPCS,Outpatient,,,22,11,26,16.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88,400,,,fee schedule,400% of healthlink fee schedule,82.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,77,,,Percent of total Billed charges,77% of total billed charges,18.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.5,88,
"XRAY, HUMERUS, 2 VIEWS",P991501631,CDM,521,RC,73060,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, ELBOW 2 VIEWS",P991501632,CDM,521,RC,73070,HCPCS,Outpatient,,,17,8.5,26,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,400,,,fee schedule,400% of healthlink fee schedule,63.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,68,
"XRAY, ELBOW COMPLETE, 3 VIEWS",P991501633,CDM,521,RC,73080,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, ELBOW, ARTHROGRAPHY",P991501634,CDM,521,RC,73085,HCPCS,Outpatient,,,61,30.5,26,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244,400,,,fee schedule,400% of healthlink fee schedule,228.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,244,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,78.71,120,,,Fee Schedule,120% of MO Medicaid Rate,78.71,120,,,Fee Schedule,120% of MO Medicaid Rate,78.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.71,120,,,Fee Schedule,120% of MO Medicaid Rate,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,244,
"XRAY, FOREARM, 2 VIEWS",P991501635,CDM,521,RC,73090,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, WRIST, 2 VIEWS",P991501636,CDM,521,RC,73100,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, WRIST, COMPLETE 3 VIEWS",P991501637,CDM,521,RC,73110,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, HAND, 2 VIEWS",P991501638,CDM,521,RC,73120,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, HAND, 3+ VIEWS",P991501639,CDM,521,RC,73130,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, FINGERS 2 VIEWS",P991501640,CDM,521,RC,73140,HCPCS,Outpatient,,,15,7.5,26,11.55,77,,,Percent of Total Billed Charges,77% of total billed charges,3.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60,400,,,fee schedule,400% of healthlink fee schedule,56.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,60,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,27.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,77,,,Percent of total Billed charges,77% of total billed charges,12.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.75,60,
CT UPPER EXTREMITY W/O DYE,P991501641,CDM,521,RC,73200,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432,400,,,fee schedule,400% of healthlink fee schedule,405,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,432,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,432,
CT UPPER EXTREMITY W/DYE,P991501642,CDM,320,RC,73201,HCPCS,Outpatient,,,126,63,26,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.24,74,,,Percent of Total Billed Charges,74% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,105.84,84,,,Percent of Total Billed Charges,84% of total billed charges,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,504,400,,,fee schedule,400% of healthlink fee schedule,472.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,504,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,504,
CT UPPR EXTREMITY W/O&W/DYE,P991501643,CDM,521,RC,73202,HCPCS,Outpatient,,,132,66,26,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,528,400,,,fee schedule,400% of healthlink fee schedule,495,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,528,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33,528,
CT ANGIO UPR EXTRM W/O&W/DYE,P991501644,CDM,521,RC,73206,HCPCS,Outpatient,,,193,96.5,26,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,772,400,,,fee schedule,400% of healthlink fee schedule,723.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,772,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,271.4,120,,,Fee Schedule,120% of MO Medicaid Rate,271.4,120,,,Fee Schedule,120% of MO Medicaid Rate,271.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,271.4,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,772,
MRI UPPER EXTREMITY W/O DYE,P991501645,CDM,521,RC,73218,HCPCS,Outpatient,,,146,73,26,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,584,400,,,fee schedule,400% of healthlink fee schedule,547.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,584,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,584,
MRI UPPER EXTREMITY W/DYE,P991501646,CDM,521,RC,73219,HCPCS,Outpatient,,,175,87.5,26,134.75,77,,,Percent of Total Billed Charges,77% of total billed charges,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,700,400,,,fee schedule,400% of healthlink fee schedule,656.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,700,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,346.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,77,,,Percent of total Billed charges,77% of total billed charges,148.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.75,700,
MRI UPPR EXTREMITY W/O&W/DYE,P991501647,CDM,521,RC,73220,HCPCS,Outpatient,,,231,115.5,26,177.87,77,,,Percent of Total Billed Charges,77% of total billed charges,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,924,400,,,fee schedule,400% of healthlink fee schedule,866.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,924,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,570.14,120,,,Fee Schedule,120% of MO Medicaid Rate,570.14,120,,,Fee Schedule,120% of MO Medicaid Rate,570.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.87,77,,,Percent of total Billed charges,77% of total billed charges,196.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,570.14,120,,,Fee Schedule,120% of MO Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,924,
MRI JOINT UPR EXTREM W/O DYE,P991501648,CDM,521,RC,73221,HCPCS,Outpatient,,,147,73.5,26,113.19,77,,,Percent of Total Billed Charges,77% of total billed charges,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,588,400,,,fee schedule,400% of healthlink fee schedule,551.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,588,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.19,77,,,Percent of total Billed charges,77% of total billed charges,124.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.75,588,
MRI JOINT UPR EXTREM W/DYE,P991501649,CDM,521,RC,73222,HCPCS,Outpatient,,,176,88,26,135.52,77,,,Percent of Total Billed Charges,77% of total billed charges,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,704,400,,,fee schedule,400% of healthlink fee schedule,660,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,704,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,335.54,120,,,Fee Schedule,120% of MO Medicaid Rate,335.54,120,,,Fee Schedule,120% of MO Medicaid Rate,335.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.52,77,,,Percent of total Billed charges,77% of total billed charges,149.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,335.54,120,,,Fee Schedule,120% of MO Medicaid Rate,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,704,
MRI JOINT UPR EXTR W/O&W/DYE,P991501650,CDM,521,RC,73223,HCPCS,Outpatient,,,232,116,26,178.64,77,,,Percent of Total Billed Charges,77% of total billed charges,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,928,400,,,fee schedule,400% of healthlink fee schedule,870,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,928,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,562.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.64,77,,,Percent of total Billed charges,77% of total billed charges,197.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58,928,
X-RAY EXAM HIP UNI 1 VIEW,P991501651,CDM,521,RC,73501,HCPCS,Outpatient,,,20,10,26,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.8,89,,,Percent of total Billed Charges,89% of total Billed charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,21.25,
X-RAY EXAM HIP UNI 2-3 VIEWS,P991501652,CDM,521,RC,73502,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.36,89,,,Percent of total Billed Charges,89% of total Billed charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,32.81,
X-RAY EXAM HIP UNI 4 VIEW,P991501653,CDM,521,RC,73503,HCPCS,Outpatient,,,27,13.5,26,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.03,89,,,Percent of total Billed Charges,89% of total Billed charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,120,,,Fee Schedule,120% of MO Medicaid Rate,41.62,120,,,Fee Schedule,120% of MO Medicaid Rate,41.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.62,120,,,Fee Schedule,120% of MO Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,41.62,
X-RAY EXAM HIPS BI 2 VIEWS,P991501654,CDM,521,RC,73521,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.36,89,,,Percent of total Billed Charges,89% of total Billed charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,27.64,
X-RAY EXAM HIPS BI 3-4 VIEW,P991501655,CDM,521,RC,73522,HCPCS,Outpatient,,,28,14,26,21.56,77,,,Percent of Total Billed Charges,77% of total billed charges,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.92,89,,,Percent of total Billed Charges,89% of total Billed charges,24.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.84,120,,,Fee Schedule,120% of MO Medicaid Rate,35.84,120,,,Fee Schedule,120% of MO Medicaid Rate,35.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.56,77,,,Percent of total Billed charges,77% of total billed charges,23.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7,35.84,
X-RAY EXAM HIPS BI 5/> VIEWS,P991501656,CDM,521,RC,73523,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.26,89,,,Percent of total Billed Charges,89% of total Billed charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,42.23,
"XRAY, HIP, ARTHROGRAPHY",P991501657,CDM,521,RC,73525,HCPCS,Outpatient,,,62,31,26,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248,400,,,fee schedule,400% of healthlink fee schedule,232.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,248,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,248,
XRAY FEMUR 1 VIEW,P991501658,CDM,521,RC,73551,HCPCS,Outpatient,,,16,8,26,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,19.13,
"XRAY, FEMUR 2 VIEW",P991501659,CDM,521,RC,73552,HCPCS,Outpatient,,,19,9.5,26,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.91,89,,,Percent of total Billed Charges,89% of total Billed charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,23.99,
"XRAY, KNEE 1-2 VIEW",P991501660,CDM,521,RC,73560,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"BILATERAL XRAY KNEE, 3 VIEWS",P991501661,CDM,521,RC,73562,HCPCS,Outpatient,,,40,20,26,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,118.4,
"XRAY KNEE, 3 VIEWS",P991501662,CDM,521,RC,73562,HCPCS,Outpatient,,,20,10,26,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80,400,,,fee schedule,400% of healthlink fee schedule,75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,80,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,80,
"XRAY, KNEE COMPLETE, 4+ VIEWS",P991501663,CDM,521,RC,73564,HCPCS,Outpatient,,,24,12,26,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,96,
X-RAY EXAM OF KNEES,P991501664,CDM,521,RC,73565,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, TIBIA AND FIBULA 2 VIEW",P991501665,CDM,521,RC,73590,HCPCS,Outpatient,,,17,8.5,26,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,400,,,fee schedule,400% of healthlink fee schedule,63.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,68,
"XRAY, ANKLE 2 VIEW",P991501666,CDM,521,RC,73600,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, ANKLE 3+ VIEW",P991501667,CDM,521,RC,73610,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, FOOT, 2 VIEWS",P991501668,CDM,521,RC,73620,HCPCS,Outpatient,,,16,8,26,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64,400,,,fee schedule,400% of healthlink fee schedule,60,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,64,
"XRAY, FOOT 3+ VIEWS",P991501669,CDM,521,RC,73630,HCPCS,Outpatient,,,18,9,26,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,72,400,,,fee schedule,400% of healthlink fee schedule,67.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,72,
"XRAY, CALCANEUS, 2 VIEWS",P991501670,CDM,521,RC,73650,HCPCS,Outpatient,,,17,8.5,26,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,400,,,fee schedule,400% of healthlink fee schedule,63.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,68,
"XRAY, TOES, 2 VIEWS",P991501671,CDM,521,RC,73660,HCPCS,Outpatient,,,14,7,26,10.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56,400,,,fee schedule,400% of healthlink fee schedule,52.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.78,77,,,Percent of total Billed charges,77% of total billed charges,11.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.5,56,
CT LOWER EXTREMITY W/O DYE,P991501672,CDM,521,RC,73700,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432,400,,,fee schedule,400% of healthlink fee schedule,405,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,432,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,432,
CT LOWER EXTREMITY W/DYE,P991501673,CDM,521,RC,73701,HCPCS,Outpatient,,,126,63,26,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,504,400,,,fee schedule,400% of healthlink fee schedule,472.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,504,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,504,
CT LWR EXTREMITY W/O&W/DYE,P991501674,CDM,521,RC,73702,HCPCS,Outpatient,,,131,65.5,26,100.87,77,,,Percent of Total Billed Charges,77% of total billed charges,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,524,400,,,fee schedule,400% of healthlink fee schedule,491.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,524,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.87,77,,,Percent of total Billed charges,77% of total billed charges,111.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.75,524,
CT ANGIO LWR EXTR W/O&W/DYE,P991501675,CDM,521,RC,73706,HCPCS,Outpatient,,,203,101.5,26,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,812,400,,,fee schedule,400% of healthlink fee schedule,761.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,812,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,280.04,120,,,Fee Schedule,120% of MO Medicaid Rate,280.04,120,,,Fee Schedule,120% of MO Medicaid Rate,280.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,280.04,120,,,Fee Schedule,120% of MO Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.75,812,
MRI LOWER EXTREMITY W/O DYE,P991501676,CDM,521,RC,73718,HCPCS,Outpatient,,,145,72.5,26,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,580,400,,,fee schedule,400% of healthlink fee schedule,543.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,580,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.25,580,
MRI LOWER EXTREMITY W/DYE,P991501677,CDM,521,RC,73719,HCPCS,Outpatient,,,175,87.5,26,134.75,77,,,Percent of Total Billed Charges,77% of total billed charges,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,700,400,,,fee schedule,400% of healthlink fee schedule,656.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,700,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,336.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,77,,,Percent of total Billed charges,77% of total billed charges,148.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.75,700,
MRI LWR EXTREMITY W/O&W/DYE,P991501678,CDM,521,RC,73720,HCPCS,Outpatient,,,231,115.5,26,177.87,77,,,Percent of Total Billed Charges,77% of total billed charges,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,924,400,,,fee schedule,400% of healthlink fee schedule,866.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,924,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,569.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.87,77,,,Percent of total Billed charges,77% of total billed charges,196.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,924,
MRI JNT OF LWR EXTRE W/O DYE,P991501679,CDM,521,RC,73721,HCPCS,Outpatient,,,147,73.5,26,113.19,77,,,Percent of Total Billed Charges,77% of total billed charges,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,588,400,,,fee schedule,400% of healthlink fee schedule,551.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,588,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.19,77,,,Percent of total Billed charges,77% of total billed charges,124.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.75,588,
MRI JOINT OF LWR EXTR W/DYE,P991501680,CDM,521,RC,73722,HCPCS,Outpatient,,,176,88,26,135.52,77,,,Percent of Total Billed Charges,77% of total billed charges,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,704,400,,,fee schedule,400% of healthlink fee schedule,660,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,704,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,337,120,,,Fee Schedule,120% of MO Medicaid Rate,337,120,,,Fee Schedule,120% of MO Medicaid Rate,337,120,,,Fee Schedule,120% of MO of Medicaid Rate,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.52,77,,,Percent of total Billed charges,77% of total billed charges,149.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,337,120,,,Fee Schedule,120% of MO Medicaid Rate,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,704,
MRI JOINT LWR EXTR W/O&W/DYE,P991501681,CDM,521,RC,73723,HCPCS,Outpatient,,,231,115.5,26,177.87,77,,,Percent of Total Billed Charges,77% of total billed charges,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,924,400,,,fee schedule,400% of healthlink fee schedule,866.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,924,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,561.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.87,77,,,Percent of total Billed charges,77% of total billed charges,196.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,924,
"XRAY, ABDOMEN 1 VIEW",P991501682,CDM,521,RC,74018,HCPCS,Outpatient,,,19,9.5,26,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.91,89,,,Percent of total Billed Charges,89% of total Billed charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,19.43,
"XRAY, ABDOMEN 2 VIEWS",P991501683,CDM,521,RC,74019,HCPCS,Outpatient,,,25,12.5,26,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,23.39,
"XRAY ABDOMEN, 3 VIEWS",P991501684,CDM,521,RC,74021,HCPCS,Outpatient,,,29,14.5,26,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.81,89,,,Percent of total Billed Charges,89% of total Billed charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,27.64,
X-RAY EXAM COMPLETE ABDOMEN,P991501685,CDM,521,RC,74022,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136,400,,,fee schedule,400% of healthlink fee schedule,127.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,136,
"CT, ABDOMEN W/O CONTRAST",P991501686,CDM,521,RC,74150,HCPCS,Outpatient,,,129,64.5,26,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,516,400,,,fee schedule,400% of healthlink fee schedule,483.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,516,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,516,
"CT, ABDOMEN WITH CONTRAST",P991501687,CDM,521,RC,74160,HCPCS,Outpatient,,,137,68.5,26,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,548,400,,,fee schedule,400% of healthlink fee schedule,513.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,548,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,548,
"CT, ABDOMEN W/&W/O CONTRAST",P991501688,CDM,521,RC,74170,HCPCS,Outpatient,,,151,75.5,26,116.27,77,,,Percent of Total Billed Charges,77% of total billed charges,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,604,400,,,fee schedule,400% of healthlink fee schedule,566.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,604,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,234.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,77,,,Percent of total Billed charges,77% of total billed charges,128.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.75,604,
CT ANGIO ABD&PELV W/O&W/DYE,P991501689,CDM,521,RC,74174,HCPCS,Outpatient,,,235,117.5,26,180.95,77,,,Percent of Total Billed Charges,77% of total billed charges,59.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,209.15,89,,,Percent of total Billed Charges,89% of total Billed charges,209.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.23,120,,,Fee Schedule,120% of MO Medicaid Rate,335.23,120,,,Fee Schedule,120% of MO Medicaid Rate,335.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.95,77,,,Percent of total Billed charges,77% of total billed charges,199.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,335.23,120,,,Fee Schedule,120% of MO Medicaid Rate,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.75,335.23,
CT ANGIO ABDOM W/O & W/DYE,P991501690,CDM,521,RC,74175,HCPCS,Outpatient,,,195,97.5,26,150.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,780,400,,,fee schedule,400% of healthlink fee schedule,731.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,780,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,299.5,120,,,Fee Schedule,120% of MO Medicaid Rate,299.5,120,,,Fee Schedule,120% of MO Medicaid Rate,299.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.15,77,,,Percent of total Billed charges,77% of total billed charges,165.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.5,120,,,Fee Schedule,120% of MO Medicaid Rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.75,780,
CT ABD & PELVIS W/O CONTRAST,P991501691,CDM,521,RC,74176,HCPCS,Outpatient,,,188,94,26,144.76,77,,,Percent of Total Billed Charges,77% of total billed charges,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,167.32,89,,,Percent of total Billed Charges,89% of total Billed charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.63,120,,,Fee Schedule,120% of MO Medicaid Rate,98.63,120,,,Fee Schedule,120% of MO Medicaid Rate,98.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.76,77,,,Percent of total Billed charges,77% of total billed charges,159.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.63,120,,,Fee Schedule,120% of MO Medicaid Rate,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47,167.32,
CT ABD & PELV W/CONTRAST,P991501692,CDM,521,RC,74177,HCPCS,Outpatient,,,197,98.5,26,151.69,77,,,Percent of Total Billed Charges,77% of total billed charges,50.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,175.33,89,,,Percent of total Billed Charges,89% of total Billed charges,175.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.56,120,,,Fee Schedule,120% of MO Medicaid Rate,214.56,120,,,Fee Schedule,120% of MO Medicaid Rate,214.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.69,77,,,Percent of total Billed charges,77% of total billed charges,167.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,214.56,120,,,Fee Schedule,120% of MO Medicaid Rate,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.25,214.56,
CT ABD & PELV 1/> REGNS,P991501693,CDM,521,RC,74178,HCPCS,Outpatient,,,184,92,26,141.68,77,,,Percent of Total Billed Charges,77% of total billed charges,46.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.76,89,,,Percent of total Billed Charges,89% of total Billed charges,163.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.57,120,,,Fee Schedule,120% of MO Medicaid Rate,248.57,120,,,Fee Schedule,120% of MO Medicaid Rate,248.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.68,77,,,Percent of total Billed charges,77% of total billed charges,156.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.57,120,,,Fee Schedule,120% of MO Medicaid Rate,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,248.57,
"MRI, ABDOMEN W/O CONTRAST",P991501694,CDM,521,RC,74181,HCPCS,Outpatient,,,157,78.5,26,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,628,400,,,fee schedule,400% of healthlink fee schedule,588.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,628,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,283.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,628,
MRI ABDOMEN WITH CONTRAST,P991501695,CDM,521,RC,74182,HCPCS,Outpatient,,,187,93.5,26,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,748,400,,,fee schedule,400% of healthlink fee schedule,701.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,748,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,353.95,120,,,Fee Schedule,120% of MO Medicaid Rate,353.95,120,,,Fee Schedule,120% of MO Medicaid Rate,353.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,353.95,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.75,748,
MRI ABDOMEN W/O & W/DYE,P991501696,CDM,521,RC,74183,HCPCS,Outpatient,,,237,118.5,26,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,948,400,,,fee schedule,400% of healthlink fee schedule,888.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,948,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.25,948,
MRI ANGIO ABDOM W ORW/O DYE,P991501697,CDM,521,RC,74185,HCPCS,Outpatient,,,193,96.5,26,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,772,400,,,fee schedule,400% of healthlink fee schedule,723.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,772,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306,120,,,Fee Schedule,120% of MO Medicaid Rate,306,120,,,Fee Schedule,120% of MO Medicaid Rate,306,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,306,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,772,
X-RAY XM ESOPHAGUS 1CNTRST,P991501698,CDM,521,RC,74220,HCPCS,Outpatient,,,72,36,26,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288,400,,,fee schedule,400% of healthlink fee schedule,270,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,288,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,65.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,288,
X-RAY XM ESOPHAGUS 2CNTRST,P991501699,CDM,521,RC,74221,HCPCS,Outpatient,,,72,36,26,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.08,89,,,Percent of total Billed Charges,89% of total Billed charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,72.92,
X-RAY XM SWLNG FUNCJ C+,P991501700,CDM,521,RC,74230,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212,400,,,fee schedule,400% of healthlink fee schedule,198.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,212,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,95.42,120,,,Fee Schedule,120% of MO Medicaid Rate,95.42,120,,,Fee Schedule,120% of MO Medicaid Rate,95.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.42,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,212,
X-RAY XM UPR GI TRC 1CNTRST,P991501701,CDM,521,RC,74240,HCPCS,Outpatient,,,74,37,26,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296,400,,,fee schedule,400% of healthlink fee schedule,277.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,296,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,80.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,296,
"XRAY, UPPER GI DOUBLE CONTRAST",P991501702,CDM,521,RC,74246,HCPCS,Outpatient,,,74,37,26,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296,400,,,fee schedule,400% of healthlink fee schedule,277.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,296,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,92.39,120,,,Fee Schedule,120% of MO Medicaid Rate,92.39,120,,,Fee Schedule,120% of MO Medicaid Rate,92.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.39,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,296,
XRAY SM INTESTINE F-THRU STUDY,P991501703,CDM,521,RC,74248,HCPCS,Outpatient,,,66,33,26,50.82,77,,,Percent of Total Billed Charges,77% of total billed charges,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.74,89,,,Percent of total Billed Charges,89% of total Billed charges,58.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,120,,,Fee Schedule,120% of MO Medicaid Rate,47.09,120,,,Fee Schedule,120% of MO Medicaid Rate,47.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.82,77,,,Percent of total Billed charges,77% of total billed charges,56.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.5,58.74,
X-RAY XM SM INT 1CNTRST STD,P991501704,CDM,521,RC,74250,HCPCS,Outpatient,,,50,25,26,38.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200,400,,,fee schedule,400% of healthlink fee schedule,187.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,200,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.62,120,,,Fee Schedule,120% of MO Medicaid Rate,79.62,120,,,Fee Schedule,120% of MO Medicaid Rate,79.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.5,77,,,Percent of total Billed charges,77% of total billed charges,42.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.62,120,,,Fee Schedule,120% of MO Medicaid Rate,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,200,
X-RAY XM SM INT 2CNTRST STD,P991501705,CDM,521,RC,74251,HCPCS,Outpatient,,,109,54.5,26,83.93,77,,,Percent of Total Billed Charges,77% of total billed charges,27.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,436,400,,,fee schedule,400% of healthlink fee schedule,408.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,436,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,160.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.93,77,,,Percent of total Billed charges,77% of total billed charges,92.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,436,
"CT, COLONOGRAPHY, SCREENING",P991501706,CDM,521,RC,74263,HCPCS,Outpatient,,,118,59,26,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.02,89,,,Percent of total Billed Charges,89% of total Billed charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.4,120,,,Fee Schedule,120% of MO Medicaid Rate,138.4,120,,,Fee Schedule,120% of MO Medicaid Rate,138.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.4,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,138.4,
X-RAY XM COLON 1CNTRST STD,P991501707,CDM,521,RC,74270,HCPCS,Outpatient,,,74,37,26,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296,400,,,fee schedule,400% of healthlink fee schedule,277.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,296,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,99.38,120,,,Fee Schedule,120% of MO Medicaid Rate,99.38,120,,,Fee Schedule,120% of MO Medicaid Rate,99.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.38,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,296,
X-RAY XM COLON 2CNTRST STD,P991501708,CDM,521,RC,74280,HCPCS,Outpatient,,,107,53.5,26,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,428,400,,,fee schedule,400% of healthlink fee schedule,401.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,428,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,153.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,428,
CONTRAST X-RAY GALLBLADDER,P991501709,CDM,521,RC,74290,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136,400,,,fee schedule,400% of healthlink fee schedule,127.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,136,
X-RAY BILE DUCTS/PANCREAS,P991501710,CDM,521,RC,74300,HCPCS,Outpatient,,,39,19.5,26,30.03,77,,,Percent of Total Billed Charges,77% of total billed charges,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,33.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.03,77,,,Percent of total Billed charges,77% of total billed charges,33.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.75,33.35,
UROGRAPHY IV +-KUB TOMOG,P991501711,CDM,521,RC,74400,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212,400,,,fee schedule,400% of healthlink fee schedule,198.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,212,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,104.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,212,
UROGRAPHY NFS DRIP&/BLS W/NF,P991501712,CDM,521,RC,74415,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212,400,,,fee schedule,400% of healthlink fee schedule,198.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,212,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,122.78,120,,,Fee Schedule,120% of MO Medicaid Rate,122.78,120,,,Fee Schedule,120% of MO Medicaid Rate,122.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.78,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,212,
UROGRAPHY RTRGR +-KUB,P991501713,CDM,521,RC,74420,HCPCS,Outpatient,,,169,84.5,26,130.13,77,,,Percent of Total Billed Charges,77% of total billed charges,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.13,77,,,Percent of total Billed charges,77% of total billed charges,143.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.25,143.65,
"CYSTOGRAPHY, 2 VIEWS",P991501714,CDM,521,RC,74430,HCPCS,Outpatient,,,34,17,26,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136,400,,,fee schedule,400% of healthlink fee schedule,127.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,40.78,120,,,Fee Schedule,120% of MO Medicaid Rate,40.78,120,,,Fee Schedule,120% of MO Medicaid Rate,40.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.78,120,,,Fee Schedule,120% of MO Medicaid Rate,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,136,
"URETHROCYSTOGRAPHY, RETROGRADE",P991501715,CDM,521,RC,74450,HCPCS,Outpatient,,,35,17.5,26,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,60.02,120,,,Fee Schedule,120% of MO Medicaid Rate,60.02,120,,,Fee Schedule,120% of MO Medicaid Rate,60.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.02,120,,,Fee Schedule,120% of MO Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,60.02,
"URETHROCYSTOGRAPHY, VOIDING",P991501716,CDM,521,RC,74455,HCPCS,Outpatient,,,35,17.5,26,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140,400,,,fee schedule,400% of healthlink fee schedule,131.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,140,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,82.97,120,,,Fee Schedule,120% of MO Medicaid Rate,82.97,120,,,Fee Schedule,120% of MO Medicaid Rate,82.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.97,120,,,Fee Schedule,120% of MO Medicaid Rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,140,
DIALTION OF URETERS OR URETHRA,P991501717,CDM,521,RC,74485,HCPCS,Outpatient,,,86,43,26,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,344,400,,,fee schedule,400% of healthlink fee schedule,322.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,344,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,77.44,120,,,Fee Schedule,120% of MO Medicaid Rate,77.44,120,,,Fee Schedule,120% of MO Medicaid Rate,77.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.44,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,344,
HYSTEROSALPINGOGRAPHY,P991501718,CDM,521,RC,74740,HCPCS,Outpatient,,,41,20.5,26,31.57,77,,,Percent of Total Billed Charges,77% of total billed charges,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164,400,,,fee schedule,400% of healthlink fee schedule,153.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,164,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.57,77,,,Percent of total Billed charges,77% of total billed charges,34.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,164,
CT HEART SCORE READING,P991501719,CDM,521,RC,75571,HCPCS,Outpatient,,,,,26,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,68.06,
SPECIAL HEART SCORE,P991501720,CDM,521,RC,75571,HCPCS,Outpatient,,,,,26,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,68.06,
"CT, HEART, W/ CONTRAST 3D",P991501721,CDM,521,RC,75572,HCPCS,Outpatient,,,187,93.5,26,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,139.42,120,,,Fee Schedule,120% of MO Medicaid Rate,139.42,120,,,Fee Schedule,120% of MO Medicaid Rate,139.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,139.42,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.75,158.95,
CT HRT C+ STRUX CGEN HRT DS,P991501722,CDM,521,RC,75573,HCPCS,Outpatient,,,272,136,26,209.44,77,,,Percent of Total Billed Charges,77% of total billed charges,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,181.22,120,,,Fee Schedule,120% of MO Medicaid Rate,181.22,120,,,Fee Schedule,120% of MO Medicaid Rate,181.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.44,77,,,Percent of total Billed charges,77% of total billed charges,231.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.22,120,,,Fee Schedule,120% of MO Medicaid Rate,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68,231.2,
CT ANGIO HRT W/3D IMAGE,P991501723,CDM,521,RC,75574,HCPCS,Outpatient,,,255,127.5,26,196.35,77,,,Percent of Total Billed Charges,77% of total billed charges,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,193.69,120,,,Fee Schedule,120% of MO Medicaid Rate,193.69,120,,,Fee Schedule,120% of MO Medicaid Rate,193.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.35,77,,,Percent of total Billed charges,77% of total billed charges,216.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,193.69,120,,,Fee Schedule,120% of MO Medicaid Rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.75,216.75,
CT ANGIO ABDOMINAL ARTERIES,P991501724,CDM,521,RC,75635,HCPCS,Outpatient,,,256,128,26,197.12,77,,,Percent of Total Billed Charges,77% of total billed charges,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1024,400,,,fee schedule,400% of healthlink fee schedule,960,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1024,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,367.88,120,,,Fee Schedule,120% of MO Medicaid Rate,367.88,120,,,Fee Schedule,120% of MO Medicaid Rate,367.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.12,77,,,Percent of total Billed charges,77% of total billed charges,217.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,367.88,120,,,Fee Schedule,120% of MO Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64,1024,
VEIN X-RAY ARM/LEG,P991501725,CDM,521,RC,75820,HCPCS,Outpatient,,,75,37.5,26,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300,400,,,fee schedule,400% of healthlink fee schedule,281.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,300,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,55.61,120,,,Fee Schedule,120% of MO Medicaid Rate,55.61,120,,,Fee Schedule,120% of MO Medicaid Rate,55.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.61,120,,,Fee Schedule,120% of MO Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,300,
VEIN XRAY LIVER w/ HEMODYNAM,P991501726,CDM,521,RC,75885,HCPCS,Outpatient,,,276,138,26,212.52,77,,,Percent of Total Billed Charges,77% of total billed charges,70.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,691.24,400,,,fee schedule,400% of healthlink fee schedule,648.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,691.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,256.09,120,,,Fee Schedule,120% of MO Medicaid Rate,256.09,120,,,Fee Schedule,120% of MO Medicaid Rate,256.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,77,,,Percent of total Billed charges,77% of total billed charges,234.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,256.09,120,,,Fee Schedule,120% of MO Medicaid Rate,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,691.24,
TRANS CATH RAD SUPER/INTERP,P991501727,CDM,521,RC,75894,HCPCS,Outpatient,,,563,281.5,,433.51,77,,,Percent of Total Billed Charges,77% of total billed charges,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,992.83,120,,,Fee Schedule,120% of MO Medicaid Rate,992.83,120,,,Fee Schedule,120% of MO Medicaid Rate,992.83,120,,,Fee Schedule,120% of MO of Medicaid Rate,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.51,77,,,Percent of total Billed charges,77% of total billed charges,478.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,992.83,120,,,Fee Schedule,120% of MO Medicaid Rate,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.75,992.83,
REMOVE CVA DEVICE OBSTRUCTION,P991501728,CDM,521,RC,75901,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,683.28,400,,,fee schedule,400% of healthlink fee schedule,640.58,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,683.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,197.53,120,,,Fee Schedule,120% of MO Medicaid Rate,197.53,120,,,Fee Schedule,120% of MO Medicaid Rate,197.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,197.53,120,,,Fee Schedule,120% of MO Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.25,683.28,
ABSCESS DRAINAGE UNDER X-RAY,P991501729,CDM,521,RC,75989,HCPCS,Outpatient,,,125,62.5,26,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,472.16,400,,,fee schedule,400% of healthlink fee schedule,442.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,472.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,86,120,,,Fee Schedule,120% of MO Medicaid Rate,86,120,,,Fee Schedule,120% of MO Medicaid Rate,86,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86,120,,,Fee Schedule,120% of MO Medicaid Rate,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,472.16,
FLUOROSCOPY <1 HR PHYS/QHP,P991501730,CDM,521,RC,76000,HCPCS,Outpatient,,,90,45,26,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.16,400,,,fee schedule,400% of healthlink fee schedule,335.78,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,56.15,120,,,Fee Schedule,120% of MO Medicaid Rate,56.15,120,,,Fee Schedule,120% of MO Medicaid Rate,56.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.15,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.5,358.16,
X-RAY EXAM OF FISTULA,P991501731,CDM,521,RC,76080,HCPCS,Outpatient,,,56,28,26,43.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,219.68,400,,,fee schedule,400% of healthlink fee schedule,205.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,219.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.12,77,,,Percent of total Billed charges,77% of total billed charges,47.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,219.68,
"XRAY, SURGICAL SPECIMEN",P991501732,CDM,521,RC,76098,HCPCS,Outpatient,,,17,8.5,26,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,65.28,
X-RAY EXAM OF BODY SECTION,P991501733,CDM,521,RC,76100,HCPCS,Outpatient,,,67,33.5,26,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,268,400,,,fee schedule,400% of healthlink fee schedule,251.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,268,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,56.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,268,
3D RENDER W/INTRP POSTPROCES,P991501734,CDM,521,RC,76376,HCPCS,Outpatient,,,21,10.5,26,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84,400,,,fee schedule,400% of healthlink fee schedule,78.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,84,
CAT SCAN FOLLOW-UP STUDY,P991501735,CDM,521,RC,76380,HCPCS,Outpatient,,,104,52,26,80.08,77,,,Percent of Total Billed Charges,77% of total billed charges,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416,400,,,fee schedule,400% of healthlink fee schedule,390,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,416,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,94.7,120,,,Fee Schedule,120% of MO Medicaid Rate,94.7,120,,,Fee Schedule,120% of MO Medicaid Rate,94.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.08,77,,,Percent of total Billed charges,77% of total billed charges,88.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,94.7,120,,,Fee Schedule,120% of MO Medicaid Rate,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,416,
ECHO EXAM OF THE HEAD,P991501736,CDM,521,RC,76506,HCPCS,Outpatient,,,69,34.5,26,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,276,400,,,fee schedule,400% of healthlink fee schedule,258.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,276,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,120,120,,,Fee Schedule,120% of MO Medicaid Rate,120,120,,,Fee Schedule,120% of MO Medicaid Rate,120,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,276,
"US, NECK/HEAD W/ REAL TIME IMG",P991501737,CDM,320,RC,76536,HCPCS,Outpatient,,,209,104.5,26,160.93,77,,,Percent of Total Billed Charges,77% of total billed charges,53.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.66,74,,,Percent of Total Billed Charges,74% of total billed charges,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,175.56,84,,,Percent of Total Billed Charges,84% of total billed charges,171.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,409.04,400,,,fee schedule,400% of healthlink fee schedule,383.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,409.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,77.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.93,77,,,Percent of total Billed charges,77% of total billed charges,177.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.25,409.04,
US EXAM CHEST,P991501738,CDM,521,RC,76604,HCPCS,Outpatient,,,116,58,26,89.32,77,,,Percent of Total Billed Charges,77% of total billed charges,29.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.04,400,,,fee schedule,400% of healthlink fee schedule,289.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,309.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,45.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.32,77,,,Percent of total Billed charges,77% of total billed charges,98.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29,309.04,
ULTRASOUND BREAST COMPLETE,P991501739,CDM,521,RC,76641,HCPCS,Outpatient,,,78,39,26,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,66.3,
ULTRASOUND BREAST LIMITED,P991501740,CDM,521,RC,76642,HCPCS,Outpatient,,,158,79,26,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,134.3,
"US, ABDOMINAL, COMPLETE",P991501741,CDM,521,RC,76700,HCPCS,Outpatient,,,87,43.5,26,66.99,77,,,Percent of Total Billed Charges,77% of total billed charges,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,348,400,,,fee schedule,400% of healthlink fee schedule,326.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,348,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,72.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.99,77,,,Percent of total Billed charges,77% of total billed charges,73.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.75,348,
"US, ABDOMINAL, LIMITED",P991501742,CDM,521,RC,76705,HCPCS,Outpatient,,,63,31.5,26,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,252,400,,,fee schedule,400% of healthlink fee schedule,236.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,252,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,252,
SPECIAL TRISCAN PAC,P991501743,CDM,521,RC,76706,HCPCS,Outpatient,,,,,26,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,81.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.71,81.71,
US ABDL AORTA SCREEN AAA,P991501744,CDM,521,RC,76706,HCPCS,Outpatient,,,59,29.5,26,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,81.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,81.71,
"US, RETROPERITONEAL, COMPLETE",P991501745,CDM,521,RC,76770,HCPCS,Outpatient,,,79,39.5,26,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,316,400,,,fee schedule,400% of healthlink fee schedule,296.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,316,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,67.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.75,316,
"US, RETROPERITONEAL, LIMITED",P991501746,CDM,521,RC,76775,HCPCS,Outpatient,,,62,31,26,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,248,400,,,fee schedule,400% of healthlink fee schedule,232.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,248,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,51.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,248,
"US, SPINAL CANAL AND CONTENTS",P991501747,CDM,521,RC,76800,HCPCS,Outpatient,,,127,63.5,26,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448.2,400,,,fee schedule,400% of healthlink fee schedule,420.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,448.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,448.2,
OB US < 14 WKS SINGLE FETUS,P991501748,CDM,521,RC,76801,HCPCS,Outpatient,,,107,53.5,26,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,428,400,,,fee schedule,400% of healthlink fee schedule,401.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,428,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,428,
"OB US <14 WKS, EA ADDTL FETUS",P991501749,CDM,521,RC,76802,HCPCS,Outpatient,,,91,45.5,26,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,258.8,400,,,fee schedule,400% of healthlink fee schedule,242.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,258.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,258.8,
OB US >/= 14 WKS SINGLE FETUS,P991501750,CDM,521,RC,76805,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432,400,,,fee schedule,400% of healthlink fee schedule,405,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,432,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,432,
OB US >= 14 WKS ADDL FETUS,P991501751,CDM,521,RC,76810,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,373,400,,,fee schedule,400% of healthlink fee schedule,349.69,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,373,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,373,
"OB US DETAILED, SINGLE FETUS",P991501752,CDM,521,RC,76811,HCPCS,Outpatient,,,210,105,26,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,707.76,400,,,fee schedule,400% of healthlink fee schedule,663.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,707.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,96.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.5,707.76,
"OB US, LIMITED, FETUS(S)",P991501753,CDM,521,RC,76815,HCPCS,Outpatient,,,61,30.5,26,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244,400,,,fee schedule,400% of healthlink fee schedule,228.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,244,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,244,
"OB US FOLLOW-UP, PER FETUS",P991501754,CDM,521,RC,76816,HCPCS,Outpatient,,,94,47,26,72.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,376,400,,,fee schedule,400% of healthlink fee schedule,352.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,376,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.38,77,,,Percent of total Billed charges,77% of total billed charges,79.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.5,376,
TRANSVAGINAL OB ULTRASOUND,P991501755,CDM,521,RC,76817,HCPCS,Outpatient,,,82,41,26,63.14,77,,,Percent of Total Billed Charges,77% of total billed charges,20.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,328,400,,,fee schedule,400% of healthlink fee schedule,307.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,328,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.14,77,,,Percent of total Billed charges,77% of total billed charges,69.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.5,328,
FETAL BIOPHYS PROFILE W/NST,P991501756,CDM,521,RC,76818,HCPCS,Outpatient,,,154,77,26,118.58,77,,,Percent of Total Billed Charges,77% of total billed charges,39.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,431.24,400,,,fee schedule,400% of healthlink fee schedule,404.29,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,431.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,58.62,120,,,Fee Schedule,120% of MO Medicaid Rate,58.62,120,,,Fee Schedule,120% of MO Medicaid Rate,58.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.58,77,,,Percent of total Billed charges,77% of total billed charges,130.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.62,120,,,Fee Schedule,120% of MO Medicaid Rate,38.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.5,431.24,
FETAL BIOPHYS PROFIL W/O NST,P991501757,CDM,521,RC,76819,HCPCS,Outpatient,,,85,42.5,26,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,320.44,
FETAL UMBILICAL ARTERY DOPPLER,P991501758,CDM,521,RC,76820,HCPCS,Outpatient,,,55,27.5,26,42.35,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160,400,,,fee schedule,400% of healthlink fee schedule,150,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,160,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,77,,,Percent of total Billed charges,77% of total billed charges,46.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,160,
MIDDLE CEREBRAL ARTERY ECHO,P991501759,CDM,521,RC,76821,HCPCS,Outpatient,,,78,39,26,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312,400,,,fee schedule,400% of healthlink fee schedule,292.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,312,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,50.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,312,
"ULTRASOUND, TRANSVAGINAL",P991501760,CDM,521,RC,76830,HCPCS,Outpatient,,,75,37.5,26,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300,400,,,fee schedule,400% of healthlink fee schedule,281.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,300,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,300,
ECHO EXAM UTERUS,P991501761,CDM,521,RC,76831,HCPCS,Outpatient,,,78,39,26,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,312,400,,,fee schedule,400% of healthlink fee schedule,292.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,312,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,75.36,120,,,Fee Schedule,120% of MO Medicaid Rate,75.36,120,,,Fee Schedule,120% of MO Medicaid Rate,75.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.36,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,312,
"US, PELVIC, COMPLETE",P991501762,CDM,521,RC,76856,HCPCS,Outpatient,,,74,37,26,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,296,400,,,fee schedule,400% of healthlink fee schedule,277.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,296,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,296,
"US, PELVIC, LIMITED OR W/U",P991501763,CDM,521,RC,76857,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,212,400,,,fee schedule,400% of healthlink fee schedule,198.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,212,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,45.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,212,
"ULTRASOUND, SCROTUM",P991501764,CDM,521,RC,76870,HCPCS,Outpatient,,,69,34.5,26,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,276,400,,,fee schedule,400% of healthlink fee schedule,258.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,276,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,276,
"ULTRASOUND, TRANSRECTAL",P991501765,CDM,521,RC,76872,HCPCS,Outpatient,,,72,36,26,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288,400,,,fee schedule,400% of healthlink fee schedule,270,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,288,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,288,
"US, JOINT, COMPLETE",P991501766,CDM,521,RC,76881,HCPCS,Outpatient,,,68,34,26,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,64.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,64.57,
US LMTD JT/FCL EVL NVASC XTR,P991501767,CDM,521,RC,76882,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,45.05,
"US, INFANT HIPS, DYNAMIC",P991501768,CDM,521,RC,76885,HCPCS,Outpatient,,,80,40,26,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,320,400,,,fee schedule,400% of healthlink fee schedule,300,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,320,
US GUIDE VASCULAR ACCESS,P991501769,CDM,521,RC,76937,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,135.4,400,,,fee schedule,400% of healthlink fee schedule,126.94,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,135.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.41,120,,,Fee Schedule,120% of MO Medicaid Rate,23.41,120,,,Fee Schedule,120% of MO Medicaid Rate,23.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.41,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,135.4,
ECHO GUIDE FOR BIOPSY,P991501770,CDM,521,RC,76942,HCPCS,Outpatient,,,69,34.5,26,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,276,400,,,fee schedule,400% of healthlink fee schedule,258.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,276,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,101.99,120,,,Fee Schedule,120% of MO Medicaid Rate,101.99,120,,,Fee Schedule,120% of MO Medicaid Rate,101.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,101.99,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,276,
ECHO GUIDED AMNIOCENTESIS,P991501771,CDM,521,RC,76946,HCPCS,Outpatient,,,41,20.5,26,31.57,77,,,Percent of Total Billed Charges,77% of total billed charges,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124.16,400,,,fee schedule,400% of healthlink fee schedule,116.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,124.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.04,120,,,Fee Schedule,120% of MO Medicaid Rate,27.04,120,,,Fee Schedule,120% of MO Medicaid Rate,27.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.57,77,,,Percent of total Billed charges,77% of total billed charges,34.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.04,120,,,Fee Schedule,120% of MO Medicaid Rate,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,124.16,
US GUIDE INTRAOP,P991501772,CDM,521,RC,76998,HCPCS,Outpatient,,,138,69,26,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,117.3,
FLUOROGUIDE FOR VEIN DEVICE,P991501773,CDM,521,RC,77001,HCPCS,Outpatient,,,40,20,26,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,160,400,,,fee schedule,400% of healthlink fee schedule,150,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,160,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,160,
FLOUROSCOPE GUIDANCE,P991501774,CDM,521,RC,77002,HCPCS,Outpatient,,,59,29.5,26,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236,400,,,fee schedule,400% of healthlink fee schedule,221.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,236,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,81.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,236,
FLUOROGUIDE FOR SPINE INJECT,P991501775,CDM,521,RC,77003,HCPCS,Outpatient,,,65,32.5,26,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.92,400,,,fee schedule,400% of healthlink fee schedule,178.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,190.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,70.19,120,,,Fee Schedule,120% of MO Medicaid Rate,70.19,120,,,Fee Schedule,120% of MO Medicaid Rate,70.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,190.92,
CT GUIDED NEEDLE PLACEMENT,P991501776,CDM,521,RC,77012,HCPCS,Outpatient,,,159,79.5,26,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,512.08,400,,,fee schedule,400% of healthlink fee schedule,480.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,512.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.75,512.08,
MRI GUIDED NEEDLE PLACEMENT,P991501777,CDM,521,RC,77021,HCPCS,Outpatient,,,158,79,26,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,632,400,,,fee schedule,400% of healthlink fee schedule,592.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,632,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,327.34,120,,,Fee Schedule,120% of MO Medicaid Rate,327.34,120,,,Fee Schedule,120% of MO Medicaid Rate,327.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327.34,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,632,
MRI GDN PARNCHYMA TISS ABLTJ,P991501778,CDM,320,RC,77022,HCPCS,Outpatient,,,466,233,26,358.82,77,,,Percent of Total Billed Charges,77% of total billed charges,118.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.84,74,,,Percent of Total Billed Charges,74% of total billed charges,321.54,69,,,Percent of Total Billed Charges,69% of total billed charges,321.54,69,,,Percent of Total Billed Charges,69% of total billed charges,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.54,69,,,Percent of Total Billed Charges,69% of total billed charges,321.54,69,,,Percent of Total Billed Charges,69% of total billed charges,391.44,84,,,Percent of Total Billed Charges,84% of total billed charges,382.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.82,77,,,Percent of total Billed charges,77% of total billed charges,396.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,116.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,396.1,
MRI BREAST C-+ W/CAD UNI,P991501779,CDM,521,RC,77048,HCPCS,Outpatient,,,226,113,26,174.02,77,,,Percent of Total Billed Charges,77% of total billed charges,57.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,233.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.02,77,,,Percent of total Billed charges,77% of total billed charges,192.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.5,233.1,
MRI BREAST C-+ W/CAD BI,P991501780,CDM,521,RC,77049,HCPCS,Outpatient,,,247,123.5,26,190.19,77,,,Percent of Total Billed Charges,77% of total billed charges,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,231.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.19,77,,,Percent of total Billed charges,77% of total billed charges,209.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.75,231.28,
XRAY MAMMARY DUCT,P991501781,CDM,521,RC,77053,HCPCS,Outpatient,,,38,19,26,29.26,77,,,Percent of Total Billed Charges,77% of total billed charges,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,152,400,,,fee schedule,400% of healthlink fee schedule,142.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,152,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,54.37,120,,,Fee Schedule,120% of MO Medicaid Rate,54.37,120,,,Fee Schedule,120% of MO Medicaid Rate,54.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.26,77,,,Percent of total Billed charges,77% of total billed charges,32.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.37,120,,,Fee Schedule,120% of MO Medicaid Rate,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.5,152,
XRAY MAMMARY DUCTS,P991501782,CDM,521,RC,77054,HCPCS,Outpatient,,,49,24.5,26,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196,400,,,fee schedule,400% of healthlink fee schedule,183.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,196,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,78.53,120,,,Fee Schedule,120% of MO Medicaid Rate,78.53,120,,,Fee Schedule,120% of MO Medicaid Rate,78.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,196,
BREAST TOMOSYNTHESIS BI,P991501783,CDM,521,RC,77063,HCPCS,Outpatient,,,64,32,26,49.28,77,,,Percent of Total Billed Charges,77% of total billed charges,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.28,77,,,Percent of total Billed charges,77% of total billed charges,54.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16,54.4,
UNILATERAL SCREENING MAMO,P991501784,CDM,521,RC,77065,HCPCS,Outpatient,,,88,44,26,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,88.1,
"DIAGNOSTIC MAMMOGRAPHY, BILAT",P991501785,CDM,521,RC,77066,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,112.33,
"XRAY, BONE AGE STUDIES",P991501787,CDM,521,RC,77072,HCPCS,Outpatient,,,20,10,26,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80,400,,,fee schedule,400% of healthlink fee schedule,75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,80,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,80,
"XRAY, BONE LENGTH STUDIES",P991501788,CDM,521,RC,77073,HCPCS,Outpatient,,,30,15,26,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120,400,,,fee schedule,400% of healthlink fee schedule,112.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,120,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,120,
"XRAY, OSSEOUS SURVEY, LIMITED",P991501789,CDM,521,RC,77074,HCPCS,Outpatient,,,49,24.5,26,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,196,400,,,fee schedule,400% of healthlink fee schedule,183.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,196,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,51.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,196,
"XRAY, OSSEOUS SURVEY, COMPLETE",P991501790,CDM,521,RC,77075,HCPCS,Outpatient,,,58,29,26,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,232,400,,,fee schedule,400% of healthlink fee schedule,217.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,232,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,74.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,232,
"XRAY, OSSEOUS SURVEY, INFANT",P991501791,CDM,521,RC,77076,HCPCS,Outpatient,,,75,37.5,26,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300,400,,,fee schedule,400% of healthlink fee schedule,281.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,300,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,300,
BONE MINERAL DENSITY,P991501792,CDM,521,RC,77080,HCPCS,Outpatient,,,21,10.5,26,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84,400,,,fee schedule,400% of healthlink fee schedule,78.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,84,
SPECIAL BONE DENSITY,P991501793,CDM,521,RC,77080,HCPCS,Outpatient,,,,,26,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.96,62.96,
"BONE DENSITY, APPENDICULAR",P991501794,CDM,521,RC,77081,HCPCS,Outpatient,,,21,10.5,26,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84,400,,,fee schedule,400% of healthlink fee schedule,78.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,20.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,84,
THRYOID IMAGING STUDY,P991501795,CDM,521,RC,78013,HCPCS,Outpatient,,,39,19.5,26,30.03,77,,,Percent of Total Billed Charges,77% of total billed charges,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,151.58,120,,,Fee Schedule,120% of MO Medicaid Rate,151.58,120,,,Fee Schedule,120% of MO Medicaid Rate,151.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.03,77,,,Percent of total Billed charges,77% of total billed charges,33.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.58,120,,,Fee Schedule,120% of MO Medicaid Rate,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.75,151.58,
THYROID IMAGING W/BLOOD FLOW,P991501796,CDM,521,RC,78014,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,184.1,120,,,Fee Schedule,120% of MO Medicaid Rate,184.1,120,,,Fee Schedule,120% of MO Medicaid Rate,184.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,184.1,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,184.1,
PARATHYROID PLANAR IMAGING,P991501797,CDM,521,RC,78070,HCPCS,Outpatient,,,84,42,26,64.68,77,,,Percent of Total Billed Charges,77% of total billed charges,21.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,336,400,,,fee schedule,400% of healthlink fee schedule,315,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,336,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,218.46,120,,,Fee Schedule,120% of MO Medicaid Rate,218.46,120,,,Fee Schedule,120% of MO Medicaid Rate,218.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.68,77,,,Percent of total Billed charges,77% of total billed charges,71.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218.46,120,,,Fee Schedule,120% of MO Medicaid Rate,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21,336,
LYMPH SYSTEM IMAGING,P991501798,CDM,521,RC,78195,HCPCS,Outpatient,,,127,63.5,26,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,508,400,,,fee schedule,400% of healthlink fee schedule,476.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,508,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.6,120,,,Fee Schedule,120% of MO Medicaid Rate,254.6,120,,,Fee Schedule,120% of MO Medicaid Rate,254.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254.6,120,,,Fee Schedule,120% of MO Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,508,
"LIVER IMAGING, STATIC ONLY",P991501799,CDM,521,RC,78201,HCPCS,Outpatient,,,45,22.5,26,34.65,77,,,Percent of Total Billed Charges,77% of total billed charges,11.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180,400,,,fee schedule,400% of healthlink fee schedule,168.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,180,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,146.11,120,,,Fee Schedule,120% of MO Medicaid Rate,146.11,120,,,Fee Schedule,120% of MO Medicaid Rate,146.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.65,77,,,Percent of total Billed charges,77% of total billed charges,38.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.11,120,,,Fee Schedule,120% of MO Medicaid Rate,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.25,180,
LIVER IMAGING WITH FLOW,P991501800,CDM,521,RC,78202,HCPCS,Outpatient,,,51,25.5,26,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,204,400,,,fee schedule,400% of healthlink fee schedule,191.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,204,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,161,120,,,Fee Schedule,120% of MO Medicaid Rate,161,120,,,Fee Schedule,120% of MO Medicaid Rate,161,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161,120,,,Fee Schedule,120% of MO Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.75,204,
LIVER AND SPLEEN IMAGING,P991501801,CDM,521,RC,78215,HCPCS,Outpatient,,,52,26,26,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,208,400,,,fee schedule,400% of healthlink fee schedule,195,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,208,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,148.54,120,,,Fee Schedule,120% of MO Medicaid Rate,148.54,120,,,Fee Schedule,120% of MO Medicaid Rate,148.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.54,120,,,Fee Schedule,120% of MO Medicaid Rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,208,
LIVER & SPLEEN IMAGE/FLOW,P991501802,CDM,521,RC,78216,HCPCS,Outpatient,,,59,29.5,26,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,236,400,,,fee schedule,400% of healthlink fee schedule,221.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,236,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,92,120,,,Fee Schedule,120% of MO Medicaid Rate,92,120,,,Fee Schedule,120% of MO Medicaid Rate,92,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92,120,,,Fee Schedule,120% of MO Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,236,
HEPATOBILIARY SYSTEM IMAGING,P991501803,CDM,521,RC,78226,HCPCS,Outpatient,,,79,39.5,26,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,248.52,120,,,Fee Schedule,120% of MO Medicaid Rate,248.52,120,,,Fee Schedule,120% of MO Medicaid Rate,248.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,248.52,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.75,248.52,
HEPATOBIL SYST IMAGE W/DRUG,P991501804,CDM,521,RC,78227,HCPCS,Outpatient,,,96,48,26,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,338.45,120,,,Fee Schedule,120% of MO Medicaid Rate,338.45,120,,,Fee Schedule,120% of MO Medicaid Rate,338.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,338.45,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24,338.45,
GASTRIC EMPTYING IMAGING STUDY,P991501805,CDM,521,RC,78264,HCPCS,Outpatient,,,83,41.5,26,63.91,77,,,Percent of Total Billed Charges,77% of total billed charges,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,332,400,,,fee schedule,400% of healthlink fee schedule,311.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,332,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,250.96,120,,,Fee Schedule,120% of MO Medicaid Rate,250.96,120,,,Fee Schedule,120% of MO Medicaid Rate,250.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.91,77,,,Percent of total Billed charges,77% of total billed charges,70.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,250.96,120,,,Fee Schedule,120% of MO Medicaid Rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.75,332,
ACUTE GI BLOOD LOSS IMAGING,P991501806,CDM,521,RC,78278,HCPCS,Outpatient,,,105,52.5,26,80.85,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,420,400,,,fee schedule,400% of healthlink fee schedule,393.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,420,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,257.94,120,,,Fee Schedule,120% of MO Medicaid Rate,257.94,120,,,Fee Schedule,120% of MO Medicaid Rate,257.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,77,,,Percent of total Billed charges,77% of total billed charges,89.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,257.94,120,,,Fee Schedule,120% of MO Medicaid Rate,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,420,
INTESTINE IMAGING,P991501807,CDM,521,RC,78290,HCPCS,Outpatient,,,72,36,26,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,288,400,,,fee schedule,400% of healthlink fee schedule,270,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,288,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,288,
BONE IMAGING LIMITED AREA,P991501808,CDM,521,RC,78300,HCPCS,Outpatient,,,66,33,26,50.82,77,,,Percent of Total Billed Charges,77% of total billed charges,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,264,400,,,fee schedule,400% of healthlink fee schedule,247.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,264,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,169.82,120,,,Fee Schedule,120% of MO Medicaid Rate,169.82,120,,,Fee Schedule,120% of MO Medicaid Rate,169.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.82,77,,,Percent of total Billed charges,77% of total billed charges,56.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.82,120,,,Fee Schedule,120% of MO Medicaid Rate,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.5,264,
BONE IMAGING WHOLE BODY,P991501809,CDM,521,RC,78306,HCPCS,Outpatient,,,91,45.5,26,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364,400,,,fee schedule,400% of healthlink fee schedule,341.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,364,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,219.06,120,,,Fee Schedule,120% of MO Medicaid Rate,219.06,120,,,Fee Schedule,120% of MO Medicaid Rate,219.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,219.06,120,,,Fee Schedule,120% of MO Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,364,
BONE IMAGING 3 PHASE,P991501810,CDM,521,RC,78315,HCPCS,Outpatient,,,108,54,26,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,432,400,,,fee schedule,400% of healthlink fee schedule,405,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,432,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27,432,
HT MUSCLE IMAGE SPECT MULT,P991501811,CDM,521,RC,78452,HCPCS,Outpatient,,,156,78,26,120.12,77,,,Percent of Total Billed Charges,77% of total billed charges,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.12,77,,,Percent of total Billed charges,77% of total billed charges,132.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39,339.32,
HT MUSC IMAGE PLANAR MULT,P991501812,CDM,521,RC,78454,HCPCS,Outpatient,,,143,71.5,26,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,316.25,120,,,Fee Schedule,120% of MO Medicaid Rate,316.25,120,,,Fee Schedule,120% of MO Medicaid Rate,316.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,316.25,120,,,Fee Schedule,120% of MO Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.75,316.25,
HEART INFARCT IMAGE,P991501813,CDM,521,RC,78466,HCPCS,Outpatient,,,75,37.5,26,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300,400,,,fee schedule,400% of healthlink fee schedule,281.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,300,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,137.59,120,,,Fee Schedule,120% of MO Medicaid Rate,137.59,120,,,Fee Schedule,120% of MO Medicaid Rate,137.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.59,120,,,Fee Schedule,120% of MO Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,300,
"HEART INFARCT AVID, SPECT, 3D",P991501814,CDM,521,RC,78469,HCPCS,Outpatient,,,97,48.5,26,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,388,400,,,fee schedule,400% of healthlink fee schedule,363.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,388,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,263.8,120,,,Fee Schedule,120% of MO Medicaid Rate,263.8,120,,,Fee Schedule,120% of MO Medicaid Rate,263.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,263.8,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,388,
CARDIAC BLOOD POOLING IMAGING,P991501815,CDM,521,RC,78472,HCPCS,Outpatient,,,104,52,26,80.08,77,,,Percent of Total Billed Charges,77% of total billed charges,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,416,400,,,fee schedule,400% of healthlink fee schedule,390,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,416,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,188.89,120,,,Fee Schedule,120% of MO Medicaid Rate,188.89,120,,,Fee Schedule,120% of MO Medicaid Rate,188.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.08,77,,,Percent of total Billed charges,77% of total billed charges,88.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.89,120,,,Fee Schedule,120% of MO Medicaid Rate,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,416,
PULMONARY PERFUSION IMAGING,P991501816,CDM,521,RC,78580,HCPCS,Outpatient,,,79,39.5,26,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,316,400,,,fee schedule,400% of healthlink fee schedule,296.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,316,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,172.25,120,,,Fee Schedule,120% of MO Medicaid Rate,172.25,120,,,Fee Schedule,120% of MO Medicaid Rate,172.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.75,316,
LUNG VENTILAT&PERFUS IMAGING,P991501817,CDM,521,RC,78582,HCPCS,Outpatient,,,114,57,26,87.78,77,,,Percent of Total Billed Charges,77% of total billed charges,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,241.22,120,,,Fee Schedule,120% of MO Medicaid Rate,241.22,120,,,Fee Schedule,120% of MO Medicaid Rate,241.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.78,77,,,Percent of total Billed charges,77% of total billed charges,96.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.22,120,,,Fee Schedule,120% of MO Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.5,241.22,
LUNG PERF&VENTILAT DIFERENTL,P991501818,CDM,521,RC,78598,HCPCS,Outpatient,,,89,44.5,26,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,226.06,120,,,Fee Schedule,120% of MO Medicaid Rate,226.06,120,,,Fee Schedule,120% of MO Medicaid Rate,226.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,226.06,120,,,Fee Schedule,120% of MO Medicaid Rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,226.06,
"BRAIN IMAGING, 4 STATIC VIEWS",P991501819,CDM,521,RC,78605,HCPCS,Outpatient,,,57,28.5,26,43.89,77,,,Percent of Total Billed Charges,77% of total billed charges,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,228,400,,,fee schedule,400% of healthlink fee schedule,213.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,228,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,150.06,120,,,Fee Schedule,120% of MO Medicaid Rate,150.06,120,,,Fee Schedule,120% of MO Medicaid Rate,150.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.89,77,,,Percent of total Billed charges,77% of total billed charges,48.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150.06,120,,,Fee Schedule,120% of MO Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,228,
BRAIN IMAGE W/FLOW 4 + VIEWS,P991501820,CDM,521,RC,78606,HCPCS,Outpatient,,,67,33.5,26,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,268,400,,,fee schedule,400% of healthlink fee schedule,251.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,268,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,268,
KIDNEY IMAGING MORPHOLOGY,P991501821,CDM,521,RC,78700,HCPCS,Outpatient,,,47,23.5,26,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,188,400,,,fee schedule,400% of healthlink fee schedule,176.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,188,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,128.47,120,,,Fee Schedule,120% of MO Medicaid Rate,128.47,120,,,Fee Schedule,120% of MO Medicaid Rate,128.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.47,120,,,Fee Schedule,120% of MO Medicaid Rate,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,188,
K FLOW/FUNCT IMAGE W/O DRUG,P991501822,CDM,521,RC,78707,HCPCS,Outpatient,,,100,50,26,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,400,400,,,fee schedule,400% of healthlink fee schedule,375,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,400,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,160.4,120,,,Fee Schedule,120% of MO Medicaid Rate,160.4,120,,,Fee Schedule,120% of MO Medicaid Rate,160.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,160.4,120,,,Fee Schedule,120% of MO Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,400,
K FLOW/FUNCT IMAGE W/DRUG,P991501823,CDM,521,RC,78708,HCPCS,Outpatient,,,127,63.5,26,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,508,400,,,fee schedule,400% of healthlink fee schedule,476.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,508,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,111.12,120,,,Fee Schedule,120% of MO Medicaid Rate,111.12,120,,,Fee Schedule,120% of MO Medicaid Rate,111.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,111.12,120,,,Fee Schedule,120% of MO Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,508,
K FLOW/FUNCT IMAGE MULTIPLE,P991501824,CDM,521,RC,78709,HCPCS,Outpatient,,,147,73.5,26,113.19,77,,,Percent of Total Billed Charges,77% of total billed charges,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,588,400,,,fee schedule,400% of healthlink fee schedule,551.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,588,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,259.16,120,,,Fee Schedule,120% of MO Medicaid Rate,259.16,120,,,Fee Schedule,120% of MO Medicaid Rate,259.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.19,77,,,Percent of total Billed charges,77% of total billed charges,124.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,259.16,120,,,Fee Schedule,120% of MO Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.75,588,
TESTICULAR IMAGING W/FLOW,P991501825,CDM,521,RC,78761,HCPCS,Outpatient,,,76,38,26,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,304,400,,,fee schedule,400% of healthlink fee schedule,285,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,304,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,152.48,120,,,Fee Schedule,120% of MO Medicaid Rate,152.48,120,,,Fee Schedule,120% of MO Medicaid Rate,152.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.48,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19,304,
RP LOCLZJ TUM 2+AREA 1+D IMG,P991501826,CDM,521,RC,78801,HCPCS,Outpatient,,,85,42.5,26,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340,400,,,fee schedule,400% of healthlink fee schedule,318.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,340,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,206.59,120,,,Fee Schedule,120% of MO Medicaid Rate,206.59,120,,,Fee Schedule,120% of MO Medicaid Rate,206.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,206.59,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,340,
"TUMOR IMAGING, WHOLE BODY",P991501827,CDM,521,RC,78802,HCPCS,Outpatient,,,89,44.5,26,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,356,400,,,fee schedule,400% of healthlink fee schedule,333.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,356,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,233.65,120,,,Fee Schedule,120% of MO Medicaid Rate,233.65,120,,,Fee Schedule,120% of MO Medicaid Rate,233.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,233.65,120,,,Fee Schedule,120% of MO Medicaid Rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,356,
RP LOCLZJ TUM SPECT 1 AREA,P991501828,CDM,521,RC,78803,HCPCS,Outpatient,,,112,56,26,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,448,400,,,fee schedule,400% of healthlink fee schedule,420,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,448,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,448,
PET IMAGE W/CT SKULL-THIGH,P991501829,CDM,521,RC,78815,HCPCS,Outpatient,,,257,128.5,26,197.89,77,,,Percent of Total Billed Charges,77% of total billed charges,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.89,77,,,Percent of total Billed charges,77% of total billed charges,218.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.25,1513.87,
PET W/ CT WHOLE BODY,P991501830,CDM,521,RC,78816,HCPCS,Outpatient,,,260,130,26,200.2,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.2,77,,,Percent of total Billed charges,77% of total billed charges,221,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,1513.87,
HEP A ADULT VACCINE,P991501831,CDM,521,RC,90632,HCPCS,Outpatient,,,50,25,,38.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.5,77,,,Percent of total Billed charges,77% of total billed charges,42.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,42.5,
HEPATITIS A AND B VACCINE,P991501832,CDM,521,RC,90636,HCPCS,Outpatient,,,101,50.5,,77.77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,41.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.77,77,,,Percent of total Billed charges,77% of total billed charges,85.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.25,85.85,
"HIB, PRP-OMP, 3 DOSE SCHEDULE",P991501833,CDM,521,RC,90647,HCPCS,Outpatient,,,11,5.5,,8.47,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.47,77,,,Percent of total Billed charges,77% of total billed charges,9.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.35,
HIB PRP-T VACCINE 4 DOSE IM,P991501834,CDM,521,RC,90648,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,21.25,
GARDASIL INJECTION,P991501835,CDM,521,RC,90649,HCPCS,Outpatient,,,315,157.5,,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.75,267.75,
GARDASIL 9,P991501836,CDM,521,RC,90651,HCPCS,Outpatient,,,315,157.5,,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.75,267.75,
IIV3 VACC NO PRSV 0.25 ML IM,P991501837,CDM,521,RC,90655,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,65.45,
IIV3 VACCINE SPLT 0.25 ML IM,P991501839,CDM,521,RC,90657,HCPCS,Outpatient,,,18,9,,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,7.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,15.3,
FLU VACCINE,P991501840,CDM,521,RC,90658,HCPCS,Outpatient,,,17,8.5,,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,14.45,
FLU MIST,P991501841,CDM,521,RC,90660,HCPCS,Outpatient,,,34,17,,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,13.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,28.9,
"FLU VACCINE, PRESERVATIVE FREE",P991501842,CDM,521,RC,90661,HCPCS,Outpatient,,,31,15.5,,23.87,77,,,Percent of Total Billed Charges,77% of total billed charges,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.87,77,,,Percent of total Billed charges,77% of total billed charges,26.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,26.35,
"FLU MIST, INTRANASAL",P991501843,CDM,521,RC,90672,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,34,
PREVNAR 20,P991501844,CDM,521,RC,90677,HCPCS,Outpatient,,,420,210,,323.4,77,,,Percent of Total Billed Charges,77% of total billed charges,107.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.4,77,,,Percent of total Billed charges,77% of total billed charges,357,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,171.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105,357,
PREFUSION F (RSV) VACCINE,P991501845,CDM,521,RC,90679,HCPCS,Outpatient,,,600,300,,462,77,,,Percent of Total Billed Charges,77% of total billed charges,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462,77,,,Percent of total Billed charges,77% of total billed charges,510,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,244.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,150,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150,510,
ROTOVIRUS VACCINE,P991501846,CDM,521,RC,90680,HCPCS,Outpatient,,,136,68,,104.72,77,,,Percent of Total Billed Charges,77% of total billed charges,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.72,77,,,Percent of total Billed charges,77% of total billed charges,115.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34,115.6,
IIV4 VACC NO PRSV 0.25 ML IM,P991501847,CDM,521,RC,90685,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,65.45,
IIV4 VACCINE SPLT 0.5 ML IM,P991501848,CDM,521,RC,90688,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,34,
"TYPHOID VACCINE, VI CAPSULAR",P991501849,CDM,521,RC,90691,HCPCS,Outpatient,,,41,20.5,,31.57,77,,,Percent of Total Billed Charges,77% of total billed charges,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.57,77,,,Percent of total Billed charges,77% of total billed charges,34.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,34.85,
DTaP-IPV AGE 4-6,P991501850,CDM,521,RC,90696,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,63.75,
DTaP-Hib-IPV INTRAMUSCULAR,P991501851,CDM,521,RC,90698,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,116.45,
DTAP VACCINE < 7 YRS IM,P991501853,CDM,521,RC,90700,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,34,
MMR VACCINE SC,P991501854,CDM,521,RC,90707,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.75,80.75,
MMRV VACCINE SC,P991501855,CDM,521,RC,90710,HCPCS,Outpatient,,,320,160,,246.4,77,,,Percent of Total Billed Charges,77% of total billed charges,81.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.4,77,,,Percent of total Billed charges,77% of total billed charges,272,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,272,
POLIO IMMUNIZATION,P991501856,CDM,521,RC,90713,HCPCS,Outpatient,,,48,24,,36.96,77,,,Percent of Total Billed Charges,77% of total billed charges,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.96,77,,,Percent of total Billed charges,77% of total billed charges,40.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,40.8,
TD VACC NO PRESV 7 YRS+ IM,P991501857,CDM,521,RC,90714,HCPCS,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,51,
TD VACC NO PRESV 7 YRS+ IM,P991501857,CDM,521,RC,90714,HCPCS,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,51,
TDAP IMMUNIZ OVER 7 YEARS OLD,P991501858,CDM,521,RC,90715,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,72.25,
DTAP HEPB IPV,P991501859,CDM,521,RC,90723,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,106.25,
MENINGOCOCCAL CONJUGATE,P991501860,CDM,521,RC,90734,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,170,
HZV VACCINE LIVE SUBQ,P991501861,CDM,521,RC,90736,HCPCS,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.5,297.5,
HEPB VACC 3 DOSE ADOLESCENT,P991501862,CDM,521,RC,90740,HCPCS,Outpatient,,,253,126.5,,194.81,77,,,Percent of Total Billed Charges,77% of total billed charges,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.81,77,,,Percent of total Billed charges,77% of total billed charges,215.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.25,215.05,
PSYTX COMPLEX INTERACTIVE,P991501863,CDM,521,RC,90785,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,22.1,
PSYTX COMPLEX INTERACTIVE,P991501864,CDM,521,RC,90785,HCPCS,Outpatient,,,35,17.5,95,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,29.75,
PSYCH DIAGNOSTIC EVALUATION,P991501865,CDM,521,RC,90791,HCPCS,Outpatient,,,215,107.5,,165.55,77,,,Percent of Total Billed Charges,77% of total billed charges,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.55,77,,,Percent of total Billed charges,77% of total billed charges,182.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.75,182.75,
PSYCH DIAGNOSTIC EVALUATION,P991501866,CDM,521,RC,90791,HCPCS,Outpatient,,,215,107.5,95,165.55,77,,,Percent of Total Billed Charges,77% of total billed charges,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.55,77,,,Percent of total Billed charges,77% of total billed charges,182.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.75,182.75,
PSYCH DIAG EVAL W/MED SRVCS,P991501867,CDM,521,RC,90792,HCPCS,Outpatient,,,340,170,,261.8,77,,,Percent of Total Billed Charges,77% of total billed charges,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.8,77,,,Percent of total Billed charges,77% of total billed charges,289,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,138.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85,289,
PSYTX W PT 30 MINUTES,P991501868,CDM,521,RC,90832,HCPCS,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,114.75,
PSYTX W PT 30 MINUTES,P991501869,CDM,521,RC,90832,HCPCS,Outpatient,,,135,67.5,95,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,114.75,
PSYCH PT 30 MIN,P991501870,CDM,521,RC,90833,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,105.4,
PSYTX W PT 45 MINUTES,P991501871,CDM,521,RC,90834,HCPCS,Outpatient,,,178,89,,137.06,77,,,Percent of Total Billed Charges,77% of total billed charges,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.06,77,,,Percent of total Billed charges,77% of total billed charges,151.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.5,151.3,
PSYTX W PT 45 MINUTES,P991501872,CDM,521,RC,90834,HCPCS,Outpatient,,,178,89,95,137.06,77,,,Percent of Total Billed Charges,77% of total billed charges,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.06,77,,,Percent of total Billed charges,77% of total billed charges,151.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.5,151.3,
PSYTX W PT 60 MINUTES,P991501873,CDM,521,RC,90837,HCPCS,Outpatient,,,215,107.5,,165.55,77,,,Percent of Total Billed Charges,77% of total billed charges,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.55,77,,,Percent of total Billed charges,77% of total billed charges,182.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.75,182.75,
PSYTX W PT 60 MINUTES,P991501874,CDM,521,RC,90837,HCPCS,Outpatient,,,215,107.5,,165.55,77,,,Percent of Total Billed Charges,77% of total billed charges,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.55,77,,,Percent of total Billed charges,77% of total billed charges,182.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.75,182.75,
PSYTX CRISIS INITIAL 60 MIN,P991501875,CDM,521,RC,90839,HCPCS,Outpatient,,,171,85.5,,131.67,77,,,Percent of Total Billed Charges,77% of total billed charges,43.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.67,77,,,Percent of total Billed charges,77% of total billed charges,145.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.75,145.35,
PSYTX CRISIS INITIAL 60 MIN,P991501876,CDM,521,RC,90839,HCPCS,Outpatient,,,171,85.5,,131.67,77,,,Percent of Total Billed Charges,77% of total billed charges,43.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.67,77,,,Percent of total Billed charges,77% of total billed charges,145.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.75,145.35,
PSYCHOANALYSIS,P991501877,CDM,521,RC,90845,HCPCS,Outpatient,,,196,98,,150.92,77,,,Percent of Total Billed Charges,77% of total billed charges,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.92,77,,,Percent of total Billed charges,77% of total billed charges,166.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49,166.6,
FAMILY PSYTX W/O PT 50 MIN,P991501878,CDM,521,RC,90846,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33,112.2,
FAMILY PSYTX W/O PT 50 MIN,P991501879,CDM,521,RC,90846,HCPCS,Outpatient,,,132,66,95,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33,112.2,
FAMILY THERAPY CONJOIN W PT,P991501880,CDM,521,RC,90847,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,140.25,
FAMILY THERAPY CONJOIN W PT,P991501881,CDM,521,RC,90847,HCPCS,Outpatient,,,165,82.5,95,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,140.25,
MULTI-FAMILY GROUP THERAPY,P991501882,CDM,521,RC,90849,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.5,175.1,
MULTI-FAMILY GROUP THERAPY,P991501883,CDM,521,RC,90849,HCPCS,Outpatient,,,206,103,95,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.5,175.1,
GROUP THERAPY,P991501884,CDM,521,RC,90853,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.5,175.1,
BIOFEED TRAIN W/PSYTX 30 MIN,P991501885,CDM,521,RC,90875,HCPCS,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,119,
BIOFEEDBACK TRAIN ANY METH,P991501886,CDM,521,RC,90901,HCPCS,Outpatient,,,78,39,,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,66.3,
ESOPHAGEAL MOTILITY STUDY,P991501887,CDM,521,RC,91010,HCPCS,Outpatient,,,412,206,,317.24,77,,,Percent of Total Billed Charges,77% of total billed charges,105.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,147.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.24,77,,,Percent of total Billed charges,77% of total billed charges,350.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,350.2,
ESOPHAGUS MOTILITY STUDY,P991501888,CDM,510,RC,91010,HCPCS,Outpatient,,,122,61,26,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,147.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.5,147.68,
GASTROESOPHAGEAL REFLUX TEST,P991501889,CDM,510,RC,91034,HCPCS,Outpatient,,,96,48,26,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,132.5,120,,,Fee Schedule,120% of MO Medicaid Rate,132.5,120,,,Fee Schedule,120% of MO Medicaid Rate,132.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,132.5,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24,132.5,
G-ESOPH REFLX TST W/ ELECTROD,P991501890,CDM,510,RC,91035,HCPCS,Outpatient,,,155,77.5,26,119.35,77,,,Percent of Total Billed Charges,77% of total billed charges,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,364.14,120,,,Fee Schedule,120% of MO Medicaid Rate,364.14,120,,,Fee Schedule,120% of MO Medicaid Rate,364.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.35,77,,,Percent of total Billed charges,77% of total billed charges,131.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.14,120,,,Fee Schedule,120% of MO Medicaid Rate,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,364.14,
ESOPH IMPED FUNCTION TEST,P991501891,CDM,510,RC,91037,HCPCS,Outpatient,,,93,46.5,26,71.61,77,,,Percent of Total Billed Charges,77% of total billed charges,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,112.45,120,,,Fee Schedule,120% of MO Medicaid Rate,112.45,120,,,Fee Schedule,120% of MO Medicaid Rate,112.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.61,77,,,Percent of total Billed charges,77% of total billed charges,79.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.45,120,,,Fee Schedule,120% of MO Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.25,112.45,
ESOPH IMPED FUNCT TEST > 1HR,P991501892,CDM,510,RC,91038,HCPCS,Outpatient,,,105,52.5,26,80.85,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,336.76,120,,,Fee Schedule,120% of MO Medicaid Rate,336.76,120,,,Fee Schedule,120% of MO Medicaid Rate,336.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,77,,,Percent of total Billed charges,77% of total billed charges,89.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,336.76,
PILLCAM ENDOSCOPY,P991501893,CDM,521,RC,91110,HCPCS,Outpatient,,,1800,900,,1386,77,,,Percent of Total Billed Charges,77% of total billed charges,459,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,562.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,450,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,607.93,120,,,Fee Schedule,120% of MO Medicaid Rate,607.93,120,,,Fee Schedule,120% of MO Medicaid Rate,607.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,450,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1386,77,,,Percent of total Billed charges,77% of total billed charges,1530,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,517.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,607.93,120,,,Fee Schedule,120% of MO Medicaid Rate,450,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,450,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450,1530,
GI TRC IMG INTRAL COLON I&R,P991501894,CDM,510,RC,91113,HCPCS,Outpatient,,,230,115,26,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,949.2,120,,,Fee Schedule,120% of MO Medicaid Rate,949.2,120,,,Fee Schedule,120% of MO Medicaid Rate,949.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,115,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,949.2,120,,,Fee Schedule,120% of MO Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,949.2,
COLON MOTILITY 6HR STUDY,P991501895,CDM,521,RC,91117,HCPCS,Outpatient,,,260.5,130.25,,200.59,77,,,Percent of Total Billed Charges,77% of total billed charges,66.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,65.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,106.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.59,77,,,Percent of total Billed charges,77% of total billed charges,221.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,106.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.13,221.43,
ANAL PRESSURE RECORD,P991501896,CDM,510,RC,91122,HCPCS,Outpatient,,,167,83.5,26,128.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,172.31,120,,,Fee Schedule,120% of MO Medicaid Rate,172.31,120,,,Fee Schedule,120% of MO Medicaid Rate,172.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.59,77,,,Percent of total Billed charges,77% of total billed charges,141.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.31,120,,,Fee Schedule,120% of MO Medicaid Rate,41.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,172.31,
LIVER ELASTOGRAPHY W/O IMAGING,P991501897,CDM,521,RC,91200,HCPCS,Outpatient,,,30,15,,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.22,120,,,Fee Schedule,120% of MO Medicaid Rate,18.22,120,,,Fee Schedule,120% of MO Medicaid Rate,18.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.22,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,25.5,
FLUORESCEIN ANGIOGRAPHY,P991501899,CDM,521,RC,92235,HCPCS,Outpatient,,,225,112.5,,173.25,77,,,Percent of Total Billed Charges,77% of total billed charges,57.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,75.06,120,,,Fee Schedule,120% of MO Medicaid Rate,75.06,120,,,Fee Schedule,120% of MO Medicaid Rate,75.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.25,77,,,Percent of total Billed charges,77% of total billed charges,191.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.06,120,,,Fee Schedule,120% of MO Medicaid Rate,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.25,191.25,
EAR AND THROAT EXAMINATION,P991501900,CDM,521,RC,92502,HCPCS,Outpatient,,,180,90,,138.6,77,,,Percent of Total Billed Charges,77% of total billed charges,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.6,77,,,Percent of total Billed charges,77% of total billed charges,153,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45,153,
EAR MICROSCOPY EXAMINATION,P991501901,CDM,521,RC,92504,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,49.3,
NASOPHARYNGOSCOPY,P991501902,CDM,521,RC,92511,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,185.3,
NASOPHARYNGOSCOPY BILAT,P991501903,CDM,521,RC,92511,HCPCS,Outpatient,,,436,218,,335.72,77,,,Percent of Total Billed Charges,77% of total billed charges,111.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,109,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,177.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.72,77,,,Percent of total Billed charges,77% of total billed charges,370.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,109,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109,370.6,
SCREENING TEST PURE TONE,P991501904,CDM,521,RC,92551,HCPCS,Outpatient,,,11,5.5,,8.47,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.47,77,,,Percent of total Billed charges,77% of total billed charges,9.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.35,
TYMPANOMETRY,P991501905,CDM,521,RC,92567,HCPCS,Outpatient,,,57,28.5,,43.89,77,,,Percent of Total Billed Charges,77% of total billed charges,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.24,120,,,Fee Schedule,120% of MO Medicaid Rate,16.24,120,,,Fee Schedule,120% of MO Medicaid Rate,16.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.89,77,,,Percent of total Billed charges,77% of total billed charges,48.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.24,120,,,Fee Schedule,120% of MO Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,48.45,
TYMPANOMETRY,P991501906,CDM,521,RC,92568,HCPCS,Outpatient,,,57,28.5,,43.89,77,,,Percent of Total Billed Charges,77% of total billed charges,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,15.49,120,,,Fee Schedule,120% of MO Medicaid Rate,15.49,120,,,Fee Schedule,120% of MO Medicaid Rate,15.49,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.89,77,,,Percent of total Billed charges,77% of total billed charges,48.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.49,120,,,Fee Schedule,120% of MO Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,48.45,
"HEARING SCREENING, LIMITED",P991501907,CDM,521,RC,92587,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,37.4,
EVOKED AUDITORY TST COMPLETE,P991501908,CDM,521,RC,92588,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,51.85,
MOTION FLUOROSCOPY/SWALLOW,P991501909,CDM,521,RC,92611,HCPCS,Outpatient,,,188,94,,144.76,77,,,Percent of Total Billed Charges,77% of total billed charges,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.76,77,,,Percent of total Billed charges,77% of total billed charges,159.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47,159.8,
CARDIOVERSION ELECTRIC EXT,P991501910,CDM,521,RC,92960,HCPCS,Outpatient,,,310,155,,238.7,77,,,Percent of Total Billed Charges,77% of total billed charges,79.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,126.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.7,77,,,Percent of total Billed charges,77% of total billed charges,263.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.5,263.5,
EKG MONITORING,P991501911,CDM,521,RC,93005,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,12.43,
ELECTROCARDIOGRAM REPORT,P991501912,CDM,730,RC,93010,HCPCS,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,296,
CARDIOVASCULAR STRESS TEST,P991501913,CDM,521,RC,93015,HCPCS,Outpatient,,,151,75.5,,116.27,77,,,Percent of Total Billed Charges,77% of total billed charges,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,77,,,Percent of total Billed charges,77% of total billed charges,128.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.75,128.35,
STRESS TEST SUPERVISION,P991501914,CDM,521,RC,93016,HCPCS,Outpatient,,,42,21,,32.34,77,,,Percent of Total Billed Charges,77% of total billed charges,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.34,77,,,Percent of total Billed charges,77% of total billed charges,35.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.5,35.7,
CARDIOVASCULAR STRESS TEST,P991501915,CDM,521,RC,93017,HCPCS,Outpatient,,,65,32.5,26,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.29,120,,,Fee Schedule,120% of MO Medicaid Rate,62.29,120,,,Fee Schedule,120% of MO Medicaid Rate,62.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.29,120,,,Fee Schedule,120% of MO Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,62.29,
STRESS TEST INT,P991501916,CDM,521,RC,93018,HCPCS,Outpatient,,,30,15,,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,25.5,
RHYTHM ECG WITH REPORT,P991501917,CDM,521,RC,93040,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,34,
ECG MONIT/REPRT UP TO 48 HRS,P991501918,CDM,521,RC,93224,HCPCS,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,114.75,
ECG MONIT/REPRT UP TO 48 HRS,P991501919,CDM,521,RC,93227,HCPCS,Outpatient,,,36,18,,27.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.72,77,,,Percent of total Billed charges,77% of total billed charges,30.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9,30.6,
REMOTE 30 DAY ECG REV/REPORT,P991501920,CDM,521,RC,93228,HCPCS,Outpatient,,,50,25,,38.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.5,77,,,Percent of total Billed charges,77% of total billed charges,42.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,42.5,
EXT ECG>48HR<7D REV & INTERP,P991501921,CDM,521,RC,93244,HCPCS,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,39.95,
EXT ECG>7D<15D REVIEW & INTERP,P991501922,CDM,521,RC,93248,HCPCS,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,44.2,
HEART MONITOR/PORTABLE,P991501923,CDM,521,RC,93268,HCPCS,Outpatient,,,327,163.5,,251.79,77,,,Percent of Total Billed Charges,77% of total billed charges,83.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,133.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,77,,,Percent of total Billed charges,77% of total billed charges,277.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.75,277.95,
INTERPRETATION EVENT MONITOR,P991501924,CDM,521,RC,93272,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,73.1,
PRGRMG DEV EVAL PM/LDLS PM,P991501925,CDM,521,RC,93279,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,105.4,
PRGRMG DEV EVAL PM/LDLS PM,P991501926,CDM,521,RC,93279,HCPCS,Outpatient,,,66,33,26,50.82,77,,,Percent of Total Billed Charges,77% of total billed charges,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.82,77,,,Percent of total Billed charges,77% of total billed charges,56.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.5,56.1,
PM DEVICE PROGR EVAL DUAL,P991501927,CDM,521,RC,93280,HCPCS,Outpatient,,,147,73.5,,113.19,77,,,Percent of Total Billed Charges,77% of total billed charges,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,40.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.19,77,,,Percent of total Billed charges,77% of total billed charges,124.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.75,124.95,
PM DEVICE PROGR EVAL DUAL,P991501928,CDM,521,RC,93280,HCPCS,Outpatient,,,80,40,26,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,40.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,68,
PM DEVICE PROG EVAL MULTI,P991501929,CDM,521,RC,93281,HCPCS,Outpatient,,,157,78.5,,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.7,120,,,Fee Schedule,120% of MO Medicaid Rate,40.7,120,,,Fee Schedule,120% of MO Medicaid Rate,40.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.7,120,,,Fee Schedule,120% of MO Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,133.45,
PM DEVICE PROGR EVAL MULTI,P991501930,CDM,521,RC,93281,HCPCS,Outpatient,,,88,44,26,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.7,120,,,Fee Schedule,120% of MO Medicaid Rate,40.7,120,,,Fee Schedule,120% of MO Medicaid Rate,40.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.7,120,,,Fee Schedule,120% of MO Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,74.8,
PRGRMG EVAL IMPLANTABLE DFB,P991501931,CDM,521,RC,93282,HCPCS,Outpatient,,,150,75,,115.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,77,,,Percent of total Billed charges,77% of total billed charges,127.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,127.5,
PRGRMG EVAL IMPLANTABLE DFB,P991501932,CDM,521,RC,93282,HCPCS,Outpatient,,,88,44,26,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,74.8,
PRGRMG EVAL IMPLANTABLE DFB,P991501933,CDM,521,RC,93283,HCPCS,Outpatient,,,188,94,,144.76,77,,,Percent of Total Billed Charges,77% of total billed charges,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.4,120,,,Fee Schedule,120% of MO Medicaid Rate,40.4,120,,,Fee Schedule,120% of MO Medicaid Rate,40.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.76,77,,,Percent of total Billed charges,77% of total billed charges,159.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.4,120,,,Fee Schedule,120% of MO Medicaid Rate,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.4,159.8,
PRGRMG EVAL IMPLANTABLE DFB,P991501934,CDM,521,RC,93283,HCPCS,Outpatient,,,120,60,26,92.4,77,,,Percent of Total Billed Charges,77% of total billed charges,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.4,120,,,Fee Schedule,120% of MO Medicaid Rate,40.4,120,,,Fee Schedule,120% of MO Medicaid Rate,40.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.4,77,,,Percent of total Billed charges,77% of total billed charges,102,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.4,120,,,Fee Schedule,120% of MO Medicaid Rate,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30,102,
PERI-PX EVAL PM/LDLS PM IP,P991501935,CDM,521,RC,93286,HCPCS,Outpatient,,,82,41,,63.14,77,,,Percent of Total Billed Charges,77% of total billed charges,20.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.76,120,,,Fee Schedule,120% of MO Medicaid Rate,29.76,120,,,Fee Schedule,120% of MO Medicaid Rate,29.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.14,77,,,Percent of total Billed charges,77% of total billed charges,69.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.76,120,,,Fee Schedule,120% of MO Medicaid Rate,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.5,69.7,
PERI-PX EVAL PM/LDLS PM IP,P991501936,CDM,521,RC,93286,HCPCS,Outpatient,,,32,16,26,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.76,120,,,Fee Schedule,120% of MO Medicaid Rate,29.76,120,,,Fee Schedule,120% of MO Medicaid Rate,29.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.76,120,,,Fee Schedule,120% of MO Medicaid Rate,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,29.76,
INTERROG EVL PM/LDLS PM IP,P991501937,CDM,521,RC,93288,HCPCS,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,77.35,
INTERROG EVL PM/LDLS PM IP,P991501938,CDM,521,RC,93288,HCPCS,Outpatient,,,46,23,26,35.42,77,,,Percent of Total Billed Charges,77% of total billed charges,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.42,77,,,Percent of total Billed charges,77% of total billed charges,39.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,39.1,
INTERROG DEVICE ELVAL HEART,P991501939,CDM,521,RC,93289,HCPCS,Outpatient,,,136,68,,104.72,77,,,Percent of Total Billed Charges,77% of total billed charges,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.72,77,,,Percent of total Billed charges,77% of total billed charges,115.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34,115.6,
INTERROG DEVICE EVAL HEART,P991501940,CDM,521,RC,93289,HCPCS,Outpatient,,,79,39.5,26,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,34.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.33,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.75,67.15,
PM PHONE R-STRIP DEVICE EVAL,P991501941,CDM,521,RC,93293,HCPCS,Outpatient,,,106,53,,81.62,77,,,Percent of Total Billed Charges,77% of total billed charges,27.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.32,120,,,Fee Schedule,120% of MO Medicaid Rate,31.32,120,,,Fee Schedule,120% of MO Medicaid Rate,31.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.62,77,,,Percent of total Billed charges,77% of total billed charges,90.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.32,120,,,Fee Schedule,120% of MO Medicaid Rate,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,90.1,
PM PHONE R-STRIP DEVICE EVAL,P991501942,CDM,521,RC,93293,HCPCS,Outpatient,,,31,15.5,26,23.87,77,,,Percent of Total Billed Charges,77% of total billed charges,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.32,120,,,Fee Schedule,120% of MO Medicaid Rate,31.32,120,,,Fee Schedule,120% of MO Medicaid Rate,31.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.87,77,,,Percent of total Billed charges,77% of total billed charges,26.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.32,120,,,Fee Schedule,120% of MO Medicaid Rate,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,31.32,
REM INTERROG EVL PM/LDLS PM,P991501943,CDM,521,RC,93294,HCPCS,Outpatient,,,64,32,,49.28,77,,,Percent of Total Billed Charges,77% of total billed charges,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.28,77,,,Percent of total Billed charges,77% of total billed charges,54.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16,54.4,
REM INTERROG EVL PM/IDS,P991501944,CDM,521,RC,93296,HCPCS,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,44.2,
"ECHO, TRANSTHORACIC, COMPLETE",P991501945,CDM,521,RC,93304,HCPCS,Outpatient,,,79,39.5,26,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,110.9,120,,,Fee Schedule,120% of MO Medicaid Rate,110.9,120,,,Fee Schedule,120% of MO Medicaid Rate,110.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.9,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.75,110.9,
ECHO W/COLOR DOPPLER,P991501946,CDM,521,RC,93306,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,142.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,142.21,
ECHOCARDIOGRAM,P991501947,CDM,521,RC,93307,HCPCS,Outpatient,,,534,267,,411.18,77,,,Percent of Total Billed Charges,77% of total billed charges,136.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,105.84,120,,,Fee Schedule,120% of MO Medicaid Rate,105.84,120,,,Fee Schedule,120% of MO Medicaid Rate,105.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,133.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.18,77,,,Percent of total Billed charges,77% of total billed charges,453.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,153.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.84,120,,,Fee Schedule,120% of MO Medicaid Rate,133.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.84,453.9,
TTE F-UP OR LMTD,P991501948,CDM,521,RC,93308,HCPCS,Outpatient,,,55,27.5,26,42.35,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,85.03,120,,,Fee Schedule,120% of MO Medicaid Rate,85.03,120,,,Fee Schedule,120% of MO Medicaid Rate,85.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,77,,,Percent of total Billed charges,77% of total billed charges,46.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.03,120,,,Fee Schedule,120% of MO Medicaid Rate,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,85.03,
ECHO TRANSESOPHAGEAL,P991501949,CDM,521,RC,93312,HCPCS,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,178.63,120,,,Fee Schedule,120% of MO Medicaid Rate,178.63,120,,,Fee Schedule,120% of MO Medicaid Rate,178.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,178.63,120,,,Fee Schedule,120% of MO Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,178.63,
DOPPLER ECHO EXAM HEART,P991501950,CDM,521,RC,93320,HCPCS,Outpatient,,,107,53.5,,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,59.58,120,,,Fee Schedule,120% of MO Medicaid Rate,59.58,120,,,Fee Schedule,120% of MO Medicaid Rate,59.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.58,120,,,Fee Schedule,120% of MO Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,90.95,
DOPPLER ECHO EXAM HEART,P991501951,CDM,521,RC,93321,HCPCS,Outpatient,,,16,8,26,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,27.28,120,,,Fee Schedule,120% of MO Medicaid Rate,27.28,120,,,Fee Schedule,120% of MO Medicaid Rate,27.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.28,120,,,Fee Schedule,120% of MO Medicaid Rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,27.28,
DOPPLER COLOR FLOW ADD-ON,P991501952,CDM,521,RC,93325,HCPCS,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,51.58,120,,,Fee Schedule,120% of MO Medicaid Rate,51.58,120,,,Fee Schedule,120% of MO Medicaid Rate,51.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.58,120,,,Fee Schedule,120% of MO Medicaid Rate,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,51.58,
STRESS TTE ONLY,P991501953,CDM,521,RC,93350,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,134.72,120,,,Fee Schedule,120% of MO Medicaid Rate,134.72,120,,,Fee Schedule,120% of MO Medicaid Rate,134.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.72,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,272.85,
STRESS TTE COMPLETE,P991501954,CDM,521,RC,93351,HCPCS,Outpatient,,,483,241.5,,371.91,77,,,Percent of Total Billed Charges,77% of total billed charges,123.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,120.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,137.9,120,,,Fee Schedule,120% of MO Medicaid Rate,137.9,120,,,Fee Schedule,120% of MO Medicaid Rate,137.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,120.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,371.91,77,,,Percent of total Billed charges,77% of total billed charges,410.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,138.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.9,120,,,Fee Schedule,120% of MO Medicaid Rate,120.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,120.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.75,410.55,
ADMIN ECG CONTRAST AGENT,P991501955,CDM,521,RC,93352,HCPCS,Outpatient,,,45,22.5,,34.65,77,,,Percent of Total Billed Charges,77% of total billed charges,11.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.65,77,,,Percent of total Billed charges,77% of total billed charges,38.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.25,38.25,
TILT TABLE EVALUATION,P991501956,CDM,521,RC,93660,HCPCS,Outpatient,,,202,101,26,155.54,77,,,Percent of Total Billed Charges,77% of total billed charges,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,60.68,120,,,Fee Schedule,120% of MO Medicaid Rate,60.68,120,,,Fee Schedule,120% of MO Medicaid Rate,60.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.54,77,,,Percent of total Billed charges,77% of total billed charges,171.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.68,120,,,Fee Schedule,120% of MO Medicaid Rate,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.5,171.7,
INTERROGATION VAD IN PERSON,P991501957,CDM,521,RC,93750,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,95.2,
AMBL BP MNTR W/SOFTWARE,P991501958,CDM,521,RC,93784,HCPCS,Outpatient,,,151,75.5,,116.27,77,,,Percent of Total Billed Charges,77% of total billed charges,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,77,,,Percent of total Billed charges,77% of total billed charges,128.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.75,128.35,
AMBL BP MNTR W/SW I&R,P991501959,CDM,521,RC,93790,HCPCS,Outpatient,,,42,21,,32.34,77,,,Percent of Total Billed Charges,77% of total billed charges,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.34,77,,,Percent of total Billed charges,77% of total billed charges,35.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.5,35.7,
PT/CAREGIVER TRAINING HOME INR,P991501960,CDM,521,RC,93792,HCPCS,Outpatient,,,122,61,,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,57.05,120,,,Fee Schedule,120% of MO Medicaid Rate,57.05,120,,,Fee Schedule,120% of MO Medicaid Rate,57.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.05,120,,,Fee Schedule,120% of MO Medicaid Rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.5,103.7,
ANTICOAG MGMT PT WARFARIN,P991501961,CDM,521,RC,93793,HCPCS,Outpatient,,,22,11,,16.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,10.14,120,,,Fee Schedule,120% of MO Medicaid Rate,10.14,120,,,Fee Schedule,120% of MO Medicaid Rate,10.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,77,,,Percent of total Billed charges,77% of total billed charges,18.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.14,120,,,Fee Schedule,120% of MO Medicaid Rate,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.5,18.7,
CARDIAC REHAB,P991501962,CDM,521,RC,93797,HCPCS,Outpatient,,,18,9,,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,18.88,
CARDIAC REHAB/MONITOR,P991501963,CDM,521,RC,93798,HCPCS,Outpatient,,,28,14,,21.56,77,,,Percent of Total Billed Charges,77% of total billed charges,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.56,77,,,Percent of total Billed charges,77% of total billed charges,23.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7,23.8,
UNLISTED CV SVC/PROCEDURE,P991501964,CDM,521,RC,93799,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,49.3,
EXTRACRANIAL BILAT STUDY,P991501965,CDM,521,RC,93880,HCPCS,Outpatient,,,86,43,26,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,181.34,120,,,Fee Schedule,120% of MO Medicaid Rate,181.34,120,,,Fee Schedule,120% of MO Medicaid Rate,181.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,181.34,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,181.34,
EXTRACRANIAL UNI/LTD STUDY,P991501966,CDM,521,RC,93882,HCPCS,Outpatient,,,47,23.5,26,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,108.89,120,,,Fee Schedule,120% of MO Medicaid Rate,108.89,120,,,Fee Schedule,120% of MO Medicaid Rate,108.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,108.89,
UPR/L XTREMITY ART 2 LEVELS,P991501967,CDM,521,RC,93922,HCPCS,Outpatient,,,27,13.5,,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,82.09,120,,,Fee Schedule,120% of MO Medicaid Rate,82.09,120,,,Fee Schedule,120% of MO Medicaid Rate,82.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.09,120,,,Fee Schedule,120% of MO Medicaid Rate,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,82.09,
UPR/LXTR ART STDY 3+ LVLS,P991501968,CDM,521,RC,93923,HCPCS,Outpatient,,,48,24,26,36.96,77,,,Percent of Total Billed Charges,77% of total billed charges,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,123.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.96,77,,,Percent of total Billed charges,77% of total billed charges,40.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,123.31,
LWR XTR VASC STDY BILAT,P991501969,CDM,521,RC,93924,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,151.39,120,,,Fee Schedule,120% of MO Medicaid Rate,151.39,120,,,Fee Schedule,120% of MO Medicaid Rate,151.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,151.39,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,151.39,
LOWER EXTREMITY STUDY,P991501970,CDM,521,RC,93925,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,187.45,120,,,Fee Schedule,120% of MO Medicaid Rate,187.45,120,,,Fee Schedule,120% of MO Medicaid Rate,187.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,187.45,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,187.45,
LOWER EXTREMITY STUDY,P991501971,CDM,521,RC,93926,HCPCS,Outpatient,,,52,26,26,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,108.47,120,,,Fee Schedule,120% of MO Medicaid Rate,108.47,120,,,Fee Schedule,120% of MO Medicaid Rate,108.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,108.47,120,,,Fee Schedule,120% of MO Medicaid Rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,108.47,
UPPER EXTREMITY STUDY,P991501972,CDM,521,RC,93930,HCPCS,Outpatient,,,86,43,26,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,145.2,120,,,Fee Schedule,120% of MO Medicaid Rate,145.2,120,,,Fee Schedule,120% of MO Medicaid Rate,145.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,145.2,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,145.2,
UPPER EXTREMITY STUDY,P991501973,CDM,521,RC,93931,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92.93,120,,,Fee Schedule,120% of MO Medicaid Rate,92.93,120,,,Fee Schedule,120% of MO Medicaid Rate,92.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,92.93,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,92.93,
EXTREMITY STUDY,P991501974,CDM,521,RC,93970,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,141.9,
EXTREMITY STUDY,P991501975,CDM,521,RC,93971,HCPCS,Outpatient,,,48,24,26,36.96,77,,,Percent of Total Billed Charges,77% of total billed charges,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.96,77,,,Percent of total Billed charges,77% of total billed charges,40.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,93.16,
VASCULAR STUDY,P991501976,CDM,521,RC,93975,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,193.52,120,,,Fee Schedule,120% of MO Medicaid Rate,193.52,120,,,Fee Schedule,120% of MO Medicaid Rate,193.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,193.52,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,193.52,
VASCULAR STUDY,P991501977,CDM,521,RC,93976,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,110.94,120,,,Fee Schedule,120% of MO Medicaid Rate,110.94,120,,,Fee Schedule,120% of MO Medicaid Rate,110.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.94,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,110.94,
VASCULAR STUDY,P991501978,CDM,521,RC,93978,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,131.21,120,,,Fee Schedule,120% of MO Medicaid Rate,131.21,120,,,Fee Schedule,120% of MO Medicaid Rate,131.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,131.21,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,131.21,
VASCULAR STUDY,P991501979,CDM,521,RC,93979,HCPCS,Outpatient,,,53,26.5,26,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,87.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,87.26,
BREATHING CAPACITY TEST,P991501980,CDM,521,RC,94010,HCPCS,Outpatient,,,18,9,,13.86,77,,,Percent of Total Billed Charges,77% of total billed charges,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.86,77,,,Percent of total Billed charges,77% of total billed charges,15.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,18.9,
PULMONARY FUNCTION TEST,P991501981,CDM,521,RC,94010,HCPCS,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,45.05,
PULMONARY FUNCTION PRE/POST,P991501982,CDM,521,RC,94060,HCPCS,Outpatient,,,83,41.5,,63.91,77,,,Percent of Total Billed Charges,77% of total billed charges,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.91,77,,,Percent of total Billed charges,77% of total billed charges,70.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.75,70.55,
VITAL CAPACITY PEAK FLOW,P991501983,CDM,521,RC,94150,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,2.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2.47,2.47,
LUNG FUNCTION TEST (MBC/MVV),P991501984,CDM,521,RC,94200,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,12.82,120,,,Fee Schedule,120% of MO Medicaid Rate,12.82,120,,,Fee Schedule,120% of MO Medicaid Rate,12.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.82,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.82,100.3,
RESPIRATORY FLOW VOLUME LOOP,P991501985,CDM,521,RC,94375,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,62.9,
EXERCISE TEST FOR BRONCHOSPASM,P991501986,CDM,521,RC,94617,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50.41,120,,,Fee Schedule,120% of MO Medicaid Rate,50.41,120,,,Fee Schedule,120% of MO Medicaid Rate,50.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.41,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.25,160.65,
PULMONARY STRESS TESTING,P991501987,CDM,521,RC,94618,HCPCS,Outpatient,,,70,35,,53.9,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,47.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,77,,,Percent of total Billed charges,77% of total billed charges,59.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,59.5,
PHY/QHP OP PULM RHB W/O MNTR,P991501988,CDM,521,RC,94625,HCPCS,Outpatient,,,36,18,,27.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.72,77,,,Percent of total Billed charges,77% of total billed charges,30.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9,30.6,
PHY/QHP OP PULM RHB W/ MNTR,P991501989,CDM,521,RC,94626,HCPCS,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,44.2,
Nebulizer Tx Acute Episode,P991501990,CDM,521,RC,94640,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.02,65.45,
INHALATION EVALUATION,P991501991,CDM,521,RC,94664,HCPCS,Outpatient,,,87,43.5,,66.99,77,,,Percent of Total Billed Charges,77% of total billed charges,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.99,77,,,Percent of total Billed charges,77% of total billed charges,73.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.75,73.95,
O2 SATURATION,P991501992,CDM,521,RC,94760,HCPCS,Outpatient,,,4,2,,3.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,3.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,77,,,Percent of total Billed charges,77% of total billed charges,3.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1,3.4,
MEASURE BLOOD OXYGEN LEVEL,P991501993,CDM,521,RC,94761,HCPCS,Outpatient,,,21,10.5,,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,17.85,
MEASURE BLOOD OXYGEN LEVEL,P991501994,CDM,521,RC,94762,HCPCS,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,27.2,
ALLERGY INJECTION,P991501995,CDM,924,RC,95115,HCPCS,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108,100,,,Case Rate,Pays based on per visit rate,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94,100,,,Case Rate,Pays based on per visit rate,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,108,
ALLERGY INJECTION X2 OR MORE,P991501996,CDM,924,RC,95117,HCPCS,Outpatient,,,20,10,,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.8,74,,,Percent of Total Billed Charges,74% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16.8,84,,,Percent of Total Billed Charges,84% of total billed charges,16.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108,100,,,Case Rate,Pays based on per visit rate,8.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94,100,,,Case Rate,Pays based on per visit rate,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,108,
CONT GLUC MNTR PT PROV EQP,P991501997,CDM,521,RC,95249,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,85,
CONT GLUC MNTR PHYS/QHP EQP,P991501998,CDM,521,RC,95250,HCPCS,Outpatient,,,259,129.5,,199.43,77,,,Percent of Total Billed Charges,77% of total billed charges,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,133.04,120,,,Fee Schedule,120% of MO Medicaid Rate,133.04,120,,,Fee Schedule,120% of MO Medicaid Rate,133.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,77,,,Percent of total Billed charges,77% of total billed charges,220.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.04,120,,,Fee Schedule,120% of MO Medicaid Rate,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.75,220.15,
CONT GLUC MNTR ANALYSIS I&R,P991501999,CDM,521,RC,95251,HCPCS,Outpatient,,,68,34,,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,57.8,
SLP STDY UNATTENDED,P991502000,CDM,521,RC,95800,HCPCS,Outpatient,,,80,40,26,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,107.59,120,,,Fee Schedule,120% of MO Medicaid Rate,107.59,120,,,Fee Schedule,120% of MO Medicaid Rate,107.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,107.59,120,,,Fee Schedule,120% of MO Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,107.59,
SLP STDY UNATND W/ANLYS,P991502002,CDM,521,RC,95801,HCPCS,Outpatient,,,80,40,26,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,44.96,120,,,Fee Schedule,120% of MO Medicaid Rate,44.96,120,,,Fee Schedule,120% of MO Medicaid Rate,44.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.96,120,,,Fee Schedule,120% of MO Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,68,
SLEEP STUDY UNATT&RESP EFFT,P991502004,CDM,521,RC,95806,HCPCS,Outpatient,,,184,92,,141.68,77,,,Percent of Total Billed Charges,77% of total billed charges,46.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.68,77,,,Percent of total Billed charges,77% of total billed charges,156.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,156.4,
SLEEP STUDY UNATT&RESP EFFT,P991502005,CDM,521,RC,95806,HCPCS,Outpatient,,,87,43.5,26,66.99,77,,,Percent of Total Billed Charges,77% of total billed charges,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.99,77,,,Percent of total Billed charges,77% of total billed charges,73.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.75,73.95,
SLEEP STUDY,P991502006,CDM,521,RC,95807,HCPCS,Outpatient,,,763,381.5,,587.51,77,,,Percent of Total Billed Charges,77% of total billed charges,194.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,329.63,120,,,Fee Schedule,120% of MO Medicaid Rate,329.63,120,,,Fee Schedule,120% of MO Medicaid Rate,329.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,190.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.51,77,,,Percent of total Billed charges,77% of total billed charges,648.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,329.63,120,,,Fee Schedule,120% of MO Medicaid Rate,190.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,190.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.75,648.55,
POLYSOM 6/> YRS 4/> PARAM,P991502007,CDM,521,RC,95810,HCPCS,Outpatient,,,709,354.5,26,545.93,77,,,Percent of Total Billed Charges,77% of total billed charges,180.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,464.96,120,,,Fee Schedule,120% of MO Medicaid Rate,464.96,120,,,Fee Schedule,120% of MO Medicaid Rate,464.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.93,77,,,Percent of total Billed charges,77% of total billed charges,602.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,464.96,120,,,Fee Schedule,120% of MO Medicaid Rate,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.25,602.65,
SLEEP STUDY W/CPAP,P991502008,CDM,521,RC,95811,HCPCS,Outpatient,,,745,372.5,,573.65,77,,,Percent of Total Billed Charges,77% of total billed charges,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,521.62,120,,,Fee Schedule,120% of MO Medicaid Rate,521.62,120,,,Fee Schedule,120% of MO Medicaid Rate,521.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.65,77,,,Percent of total Billed charges,77% of total billed charges,633.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,214.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,521.62,120,,,Fee Schedule,120% of MO Medicaid Rate,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,186.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.25,633.25,
ELECTROENCEPHALOGRAM,P991502009,CDM,521,RC,95816,HCPCS,Outpatient,,,111,55.5,,85.47,77,,,Percent of Total Billed Charges,77% of total billed charges,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.47,77,,,Percent of total Billed charges,77% of total billed charges,94.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,294.14,
MUSCLE TEST ONE LIMB,P991502010,CDM,521,RC,95860,HCPCS,Outpatient,,,243,121.5,,187.11,77,,,Percent of Total Billed Charges,77% of total billed charges,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,57.73,120,,,Fee Schedule,120% of MO Medicaid Rate,57.73,120,,,Fee Schedule,120% of MO Medicaid Rate,57.73,120,,,Fee Schedule,120% of MO of Medicaid Rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.11,77,,,Percent of total Billed charges,77% of total billed charges,206.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.73,120,,,Fee Schedule,120% of MO Medicaid Rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.73,206.55,
MUSCLE TEST 2 LIMBS,P991502011,CDM,521,RC,95861,HCPCS,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.27,120,,,Fee Schedule,120% of MO Medicaid Rate,76.27,120,,,Fee Schedule,120% of MO Medicaid Rate,76.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.27,120,,,Fee Schedule,120% of MO Medicaid Rate,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.27,297.5,
MUSCLE TEST 4 LIMBS,P991502012,CDM,521,RC,95864,HCPCS,Outpatient,,,234,117,,180.18,77,,,Percent of Total Billed Charges,77% of total billed charges,59.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,123.08,120,,,Fee Schedule,120% of MO Medicaid Rate,123.08,120,,,Fee Schedule,120% of MO Medicaid Rate,123.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.18,77,,,Percent of total Billed charges,77% of total billed charges,198.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.08,120,,,Fee Schedule,120% of MO Medicaid Rate,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.5,198.9,
MUSC TST DONE W/NERV TST LIM,P991502013,CDM,521,RC,95885,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,41.95,120,,,Fee Schedule,120% of MO Medicaid Rate,41.95,120,,,Fee Schedule,120% of MO Medicaid Rate,41.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.95,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,72.25,
MUSC TEST DONE W/N TEST BILAT,P991502014,CDM,521,RC,95886,HCPCS,Outpatient,,,279,139.5,,214.83,77,,,Percent of Total Billed Charges,77% of total billed charges,71.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50.16,120,,,Fee Schedule,120% of MO Medicaid Rate,50.16,120,,,Fee Schedule,120% of MO Medicaid Rate,50.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.83,77,,,Percent of total Billed charges,77% of total billed charges,237.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.16,120,,,Fee Schedule,120% of MO Medicaid Rate,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.16,237.15,
MUSC TEST DONE W/N TEST COMP,P991502015,CDM,521,RC,95886,HCPCS,Outpatient,,,186,93,50,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50.16,120,,,Fee Schedule,120% of MO Medicaid Rate,50.16,120,,,Fee Schedule,120% of MO Medicaid Rate,50.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.16,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.5,158.1,
MOTOR &/SENS NRVE CNDJ TEST,P991502016,CDM,521,RC,95905,HCPCS,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.26,120,,,Fee Schedule,120% of MO Medicaid Rate,40.26,120,,,Fee Schedule,120% of MO Medicaid Rate,40.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.26,120,,,Fee Schedule,120% of MO Medicaid Rate,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,51,
NVR CNDJ TST 1-2 STUDIES,P991502017,CDM,521,RC,95907,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,35.54,120,,,Fee Schedule,120% of MO Medicaid Rate,35.54,120,,,Fee Schedule,120% of MO Medicaid Rate,35.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.54,120,,,Fee Schedule,120% of MO Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,95.2,
NRV CNDJ TST 3-4 STUDIES,P991502018,CDM,521,RC,95908,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,44.05,120,,,Fee Schedule,120% of MO Medicaid Rate,44.05,120,,,Fee Schedule,120% of MO Medicaid Rate,44.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.05,120,,,Fee Schedule,120% of MO Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.75,118.15,
NERVE CONDUCTION 5-6 STUDIES,P991502019,CDM,521,RC,95909,HCPCS,Outpatient,,,302,151,,232.54,77,,,Percent of Total Billed Charges,77% of total billed charges,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,52.87,120,,,Fee Schedule,120% of MO Medicaid Rate,52.87,120,,,Fee Schedule,120% of MO Medicaid Rate,52.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.54,77,,,Percent of total Billed charges,77% of total billed charges,256.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.87,120,,,Fee Schedule,120% of MO Medicaid Rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.87,256.7,
NRV CNDJ TEST 7-8 STUDIES,P991502020,CDM,521,RC,95910,HCPCS,Outpatient,,,397,198.5,,305.69,77,,,Percent of Total Billed Charges,77% of total billed charges,101.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.69,77,,,Percent of total Billed charges,77% of total billed charges,337.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,114.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,337.45,
NRV CNDJ TEST 7-8 STUDY BILAT,P991502021,CDM,521,RC,95910,HCPCS,Outpatient,,,440,220,50,338.8,77,,,Percent of Total Billed Charges,77% of total billed charges,112.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.8,77,,,Percent of total Billed charges,77% of total billed charges,374,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,374,
NRV CNDJ TEST 9-10 STUDIES,P991502022,CDM,521,RC,95911,HCPCS,Outpatient,,,478,239,,368.06,77,,,Percent of Total Billed Charges,77% of total billed charges,121.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.06,77,,,Percent of total Billed charges,77% of total billed charges,406.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.18,406.3,
NRV CNDJ TEST 9-10 STUDY BILAT,P991502023,CDM,521,RC,95911,HCPCS,Outpatient,,,536,268,50,412.72,77,,,Percent of Total Billed Charges,77% of total billed charges,136.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412.72,77,,,Percent of total Billed charges,77% of total billed charges,455.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.18,120,,,Fee Schedule,120% of MO Medicaid Rate,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.18,455.6,
NRV CNDJ TEST 11-12 STUDIES,P991502024,CDM,521,RC,95912,HCPCS,Outpatient,,,539,269.5,,415.03,77,,,Percent of Total Billed Charges,77% of total billed charges,137.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,86.58,120,,,Fee Schedule,120% of MO Medicaid Rate,86.58,120,,,Fee Schedule,120% of MO Medicaid Rate,86.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.03,77,,,Percent of total Billed charges,77% of total billed charges,458.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.58,120,,,Fee Schedule,120% of MO Medicaid Rate,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.58,458.15,
ALYS NPGT W/O PRGRMG,P991502025,CDM,521,RC,95970,HCPCS,Outpatient,,,41,20.5,,31.57,77,,,Percent of Total Billed Charges,77% of total billed charges,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.57,77,,,Percent of total Billed charges,77% of total billed charges,34.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,34.85,
ALYS SMPL SP/PN NPGT W/PRGRM,P991502026,CDM,521,RC,95971,HCPCS,Outpatient,,,98,49,,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,83.3,
ALYS CPLX SP/PN NPGT W/PRGRM,P991502027,CDM,521,RC,95972,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.75,104.55,
ALYS BRN NPGT PRGRMG 15MIN,P991502028,CDM,521,RC,95983,HCPCS,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,93.5,
ALYS BRN NPGT PRGRMG ADDL 15,P991502029,CDM,521,RC,95984,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,82.45,
GENETIC COUNSELING 30+ MIN,P991502030,CDM,521,RC,96040,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,39.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24,81.6,
DEVELOPMENTAL SCREEN W/SCORE,P991502031,CDM,521,RC,96110,HCPCS,Outpatient,,,27,13.5,,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.03,89,,,Percent of total Billed Charges,89% of total Billed charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,24.03,
BRIEF EMOTIONAL/BEHAV ASSMT,P991502032,CDM,521,RC,96127,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
HYDRATION IV INFUSION INIT,P991502033,CDM,521,RC,96360,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.55,89,,,Percent of total Billed Charges,89% of total Billed charges,84.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.75,84.55,
THER/PROPH/DIAG IV INF INIT,P991502034,CDM,521,RC,96365,HCPCS,Outpatient,,,122.3,61.15,,94.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.85,89,,,Percent of total Billed Charges,89% of total Billed charges,108.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,77,,,Percent of total Billed charges,77% of total billed charges,103.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.58,108.85,
THER/PROPH/DIAG INJ SC/IM,P991502035,CDM,521,RC,96372,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
ULTRAVIOLET LIGHT THERAPY,P991502036,CDM,521,RC,96900,HCPCS,Outpatient,,,35,17.5,,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.15,89,,,Percent of total Billed Charges,89% of total Billed charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,31.15,
HEAT THERAPY/COLD THERAPY,P991502037,CDM,521,RC,97010,HCPCS,Outpatient,,,27,13.5,,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.03,89,,,Percent of total Billed Charges,89% of total Billed charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,24.03,
ELECTRIC STIMULATION THERAPY,P991502038,CDM,521,RC,97014,HCPCS,Outpatient,,,41,20.5,,31.57,77,,,Percent of Total Billed Charges,77% of total billed charges,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.49,89,,,Percent of total Billed Charges,89% of total Billed charges,36.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.57,77,,,Percent of total Billed charges,77% of total billed charges,34.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,36.49,
ULTRASOUND EACH 15 MINUTES,P991502039,CDM,521,RC,97035,HCPCS,Outpatient,,,36,18,,27.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.72,77,,,Percent of total Billed charges,77% of total billed charges,30.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9,32.04,
MASSAGE,P991502040,CDM,521,RC,97124,HCPCS,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,57.85,
MYOFASCIAL TRIGGER POINT,P991502041,CDM,521,RC,97140,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67.64,89,,,Percent of total Billed Charges,89% of total Billed charges,67.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19,67.64,
THERAPEUTIC ACTIVITIES,P991502042,CDM,521,RC,97530,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
RMVL DEVITAL TIS 20 CM/<,P991502043,CDM,510,RC,97597,HCPCS,Outpatient,,,182,91,,140.14,77,,,Percent of Total Billed Charges,77% of total billed charges,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.14,77,,,Percent of total Billed charges,77% of total billed charges,154.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.5,161.98,
RMVL DEVITAL TIS ADDL 20CM/<,P991502044,CDM,521,RC,97598,HCPCS,Outpatient,,,14,7,,10.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.46,89,,,Percent of total Billed Charges,89% of total Billed charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.78,77,,,Percent of total Billed charges,77% of total billed charges,11.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.5,12.46,
WOUND(S) CARE NON-SELECTIVE,P991502045,CDM,510,RC,97602,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
NEG PRESS WOUND TX <=50 CM,P991502046,CDM,521,RC,97605,HCPCS,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.48,89,,,Percent of total Billed Charges,89% of total Billed charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,28.48,
NEG PRESS WOUND TX >50 CM,P991502047,CDM,521,RC,97606,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.6,89,,,Percent of total Billed Charges,89% of total Billed charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,35.6,
NEG PRESS WND TX <=50 SQCM,P991502048,CDM,521,RC,97607,HCPCS,Outpatient,,,592,296,,455.84,77,,,Percent of Total Billed Charges,77% of total billed charges,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,526.88,89,,,Percent of total Billed Charges,89% of total Billed charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.84,77,,,Percent of total Billed charges,77% of total billed charges,503.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,241.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148,526.88,
NEG PRESS WND TX >50 SQCM,P991502049,CDM,521,RC,97608,HCPCS,Outpatient,,,595,297.5,,458.15,77,,,Percent of Total Billed Charges,77% of total billed charges,151.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,529.55,89,,,Percent of total Billed Charges,89% of total Billed charges,529.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,529.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.15,77,,,Percent of total Billed charges,77% of total billed charges,505.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,242.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,148.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.75,529.55,
MEDICAL NUTRITION INDIV IN,P991502050,CDM,521,RC,97802,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.41,89,,,Percent of total Billed Charges,89% of total Billed charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,61.41,
MED NUTRITION INDIV SUBSEQ,P991502051,CDM,521,RC,97803,HCPCS,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.4,89,,,Percent of total Billed Charges,89% of total Billed charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,53.4,
MEDICAL NUTRITION GROUP,P991502052,CDM,521,RC,97804,HCPCS,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.48,89,,,Percent of total Billed Charges,89% of total Billed charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,28.48,
OSTEOPATH MANJ 1-2 REGIONS,P991502053,CDM,521,RC,98925,HCPCS,Outpatient,,,89,44.5,,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,79.21,89,,,Percent of total Billed Charges,89% of total Billed charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,79.21,
OSTEOPATH MANJ 3-4 REGIONS,P991502054,CDM,521,RC,98926,HCPCS,Outpatient,,,122,61,,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,108.58,89,,,Percent of total Billed Charges,89% of total Billed charges,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.5,108.58,
OSTEOPATH MANJ 5-6 REGIONS,P991502055,CDM,521,RC,98927,HCPCS,Outpatient,,,150,75,,115.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.5,89,,,Percent of total Billed Charges,89% of total Billed charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,77,,,Percent of total Billed charges,77% of total billed charges,127.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.5,133.5,
OSTEOPATH MANJ 7-8 REGIONS,P991502056,CDM,521,RC,98928,HCPCS,Outpatient,,,179,89.5,,137.83,77,,,Percent of Total Billed Charges,77% of total billed charges,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,159.31,89,,,Percent of total Billed Charges,89% of total Billed charges,159.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.83,77,,,Percent of total Billed charges,77% of total billed charges,152.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,73.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.75,159.31,
OSTEOPATH MANJ 9-10 REGIONS,P991502057,CDM,521,RC,98929,HCPCS,Outpatient,,,209,104.5,,160.93,77,,,Percent of Total Billed Charges,77% of total billed charges,53.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,186.01,89,,,Percent of total Billed Charges,89% of total Billed charges,186.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.93,77,,,Percent of total Billed charges,77% of total billed charges,177.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.25,186.01,
CHIROPRACT MANJ 1-2 REGIONS,P991502058,CDM,521,RC,98940,HCPCS,Outpatient,,,68,34,,52.36,77,,,Percent of Total Billed Charges,77% of total billed charges,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.52,89,,,Percent of total Billed Charges,89% of total Billed charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.36,77,,,Percent of total Billed charges,77% of total billed charges,57.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,60.52,
CHIROPRACT MANJ 3-4 REGIONS,P991502059,CDM,521,RC,98941,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
MANIPULATION 5 REGIONS,P991502060,CDM,521,RC,98942,HCPCS,Outpatient,,,145,72.5,,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.05,89,,,Percent of total Billed Charges,89% of total Billed charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.25,129.05,
EXTRASPINAL ONE OR MORE,P991502061,CDM,521,RC,98943,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
SELF-MNGMT EDUCATION 30 MIN,P991502062,CDM,510,RC,98960,HCPCS,Outpatient,,,38,19,,29.26,77,,,Percent of Total Billed Charges,77% of total billed charges,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.26,77,,,Percent of total Billed charges,77% of total billed charges,32.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.5,33.82,
MEDICAL SERVICES AFTER HRS,P991502065,CDM,521,RC,99050,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
EXTENDED HOURS,P991502066,CDM,521,RC,99051,HCPCS,Outpatient,,,24,12,,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.36,89,,,Percent of total Billed Charges,89% of total Billed charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,21.36,
OFFICE EMERGENCY CARE,P991502067,CDM,521,RC,99058,HCPCS,Outpatient,,,111,55.5,,85.47,77,,,Percent of Total Billed Charges,77% of total billed charges,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,98.79,89,,,Percent of total Billed Charges,89% of total Billed charges,98.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.47,77,,,Percent of total Billed charges,77% of total billed charges,94.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,98.79,
ADDL SUPL MATRL&STAF TM PHE,P991502068,CDM,521,RC,99072,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
REPORTS/MEDICAL RECORDS,P991502069,CDM,521,RC,99080,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
COLLJ & INTERPJ DATA EA 30 D,P991502070,CDM,521,RC,99091,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,119.26,89,,,Percent of total Billed Charges,89% of total Billed charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,119.26,
OCULAR INSTRUMNT SCREEN BIL,P991502071,CDM,521,RC,99177,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
OFFICE O/P NEW SF 15-29 MIN,P991502072,CDM,521,RC,99202,HCPCS,Outpatient,,,142,71,,109.34,77,,,Percent of Total Billed Charges,77% of total billed charges,36.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.38,89,,,Percent of total Billed Charges,89% of total Billed charges,126.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.34,77,,,Percent of total Billed charges,77% of total billed charges,120.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.5,126.38,
OFFICE O/P NEW LOW 30-44 MIN,P991502074,CDM,521,RC,99203,HCPCS,Outpatient,,,203,101.5,,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180.67,89,,,Percent of total Billed Charges,89% of total Billed charges,180.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.75,180.67,
OFFICE O/P NEW MOD 45-59 MIN,P991502076,CDM,521,RC,99204,HCPCS,Outpatient,,,312,156,,240.24,77,,,Percent of Total Billed Charges,77% of total billed charges,79.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,277.68,89,,,Percent of total Billed Charges,89% of total Billed charges,277.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.24,77,,,Percent of total Billed charges,77% of total billed charges,265.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78,277.68,
OFFICE O/P NEW HI 60-74 MIN,P991502078,CDM,521,RC,99205,HCPCS,Outpatient,,,396,198,,304.92,77,,,Percent of Total Billed Charges,77% of total billed charges,100.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,352.44,89,,,Percent of total Billed Charges,89% of total Billed charges,352.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,352.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.92,77,,,Percent of total Billed charges,77% of total billed charges,336.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,161.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99,352.44,
OFFICE O/P EST SF 10-19 MIN,P991502082,CDM,521,RC,99212,HCPCS,Outpatient,,,84,42,,64.68,77,,,Percent of Total Billed Charges,77% of total billed charges,21.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.76,89,,,Percent of total Billed Charges,89% of total Billed charges,74.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.68,77,,,Percent of total Billed charges,77% of total billed charges,71.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21,74.76,
OFFICE O/P EST LOW 20-29 MIN,P991502086,CDM,521,RC,99213,HCPCS,Outpatient,,,141,70.5,,108.57,77,,,Percent of Total Billed Charges,77% of total billed charges,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,125.49,89,,,Percent of total Billed Charges,89% of total Billed charges,125.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.57,77,,,Percent of total Billed charges,77% of total billed charges,119.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.25,125.49,
OFFICE O/P EST MOD 30-39 MIN,P991502088,CDM,521,RC,99214,HCPCS,Outpatient,,,205,102.5,,157.85,77,,,Percent of Total Billed Charges,77% of total billed charges,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,182.45,89,,,Percent of total Billed Charges,89% of total Billed charges,182.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.85,77,,,Percent of total Billed charges,77% of total billed charges,174.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.25,182.45,
OFFICE O/P EST HI 40-54 MIN,P991502090,CDM,521,RC,99215,HCPCS,Outpatient,,,277,138.5,,213.29,77,,,Percent of Total Billed Charges,77% of total billed charges,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,246.53,89,,,Percent of total Billed Charges,89% of total Billed charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.29,77,,,Percent of total Billed charges,77% of total billed charges,235.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.25,246.53,
HOSPITAL ADMISSION FOCUSED,P991502092,CDM,521,RC,99221,HCPCS,Outpatient,,,203,101.5,,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,180.67,89,,,Percent of total Billed Charges,89% of total Billed charges,180.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.75,180.67,
HOSPITAL ADMISSION DETAILED,P991502093,CDM,521,RC,99222,HCPCS,Outpatient,,,415,207.5,,319.55,77,,,Percent of Total Billed Charges,77% of total billed charges,105.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,369.35,89,,,Percent of total Billed Charges,89% of total Billed charges,369.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,369.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.55,77,,,Percent of total Billed charges,77% of total billed charges,352.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,169.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.75,369.35,
1ST HOSP IP/OBS HIGH 75,P991502094,CDM,521,RC,99223,HCPCS,Outpatient,,,493,246.5,,379.61,77,,,Percent of Total Billed Charges,77% of total billed charges,125.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,438.77,89,,,Percent of total Billed Charges,89% of total Billed charges,438.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,438.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.61,77,,,Percent of total Billed charges,77% of total billed charges,419.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,201.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.25,438.77,
SBSQ HOSP IP/OBS SF/LOW 25,P991502095,CDM,521,RC,99231,HCPCS,Outpatient,,,129,64.5,,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.81,89,,,Percent of total Billed Charges,89% of total Billed charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,114.81,
SBSQ HOSP IP/OBS MODERATE 35,P991502096,CDM,521,RC,99232,HCPCS,Outpatient,,,223,111.5,,171.71,77,,,Percent of Total Billed Charges,77% of total billed charges,56.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.47,89,,,Percent of total Billed Charges,89% of total Billed charges,198.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.71,77,,,Percent of total Billed charges,77% of total billed charges,189.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,198.47,
SBSQ HOSP IP/OBS HIGH 50,P991502097,CDM,521,RC,99233,HCPCS,Outpatient,,,196,98,,150.92,77,,,Percent of Total Billed Charges,77% of total billed charges,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,174.44,89,,,Percent of total Billed Charges,89% of total Billed charges,174.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.92,77,,,Percent of total Billed charges,77% of total billed charges,166.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49,174.44,
HOSP IP/OBS SM DT SF/LOW 45,P991502098,CDM,521,RC,99234,HCPCS,Outpatient,,,403,201.5,,310.31,77,,,Percent of Total Billed Charges,77% of total billed charges,102.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,358.67,89,,,Percent of total Billed Charges,89% of total Billed charges,358.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.31,77,,,Percent of total Billed charges,77% of total billed charges,342.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,164.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,100.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.75,358.67,
HOSP IP/OBS SAME DATE MOD 70,P991502099,CDM,521,RC,99235,HCPCS,Outpatient,,,532,266,,409.64,77,,,Percent of Total Billed Charges,77% of total billed charges,135.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,473.48,89,,,Percent of total Billed Charges,89% of total Billed charges,473.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,409.64,77,,,Percent of total Billed charges,77% of total billed charges,452.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,217.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133,473.48,
HOSP IP/OBS SAME DATE HI 85,P991502100,CDM,521,RC,99236,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.5,364.9,
HOSPITAL DISCHARGE <30 MINUTES,P991502101,CDM,521,RC,99238,HCPCS,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124.6,89,,,Percent of total Billed Charges,89% of total Billed charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,124.6,
HOSPITAL DISCHARGE >30 MINUTES,P991502102,CDM,521,RC,99239,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,178,
OFF/OP CONSLTJ NEW/EST SF 20,P991502103,CDM,521,RC,99242,HCPCS,Outpatient,,,242,121,,186.34,77,,,Percent of Total Billed Charges,77% of total billed charges,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,215.38,89,,,Percent of total Billed Charges,89% of total Billed charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.34,77,,,Percent of total Billed charges,77% of total billed charges,205.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,98.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,215.38,
OFF/OP CNSLTJ NEW/EST LOW 30,P991502104,CDM,521,RC,99243,HCPCS,Outpatient,,,278,139,,214.06,77,,,Percent of Total Billed Charges,77% of total billed charges,70.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,69.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,247.42,89,,,Percent of total Billed Charges,89% of total Billed charges,247.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,247.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.06,77,,,Percent of total Billed charges,77% of total billed charges,236.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,113.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.5,247.42,
OFF/OP CNSLTJ NEW/EST MOD 40,P991502105,CDM,521,RC,99244,HCPCS,Outpatient,,,413,206.5,,318.01,77,,,Percent of Total Billed Charges,77% of total billed charges,105.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,103.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,367.57,89,,,Percent of total Billed Charges,89% of total Billed charges,367.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,367.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.01,77,,,Percent of total Billed charges,77% of total billed charges,351.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,168.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,103.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.25,367.57,
OFF/OP CONSLTJ NEW/EST HI 55,P991502106,CDM,521,RC,99245,HCPCS,Outpatient,,,546,273,,420.42,77,,,Percent of Total Billed Charges,77% of total billed charges,139.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,485.94,89,,,Percent of total Billed Charges,89% of total Billed charges,485.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,485.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.42,77,,,Percent of total Billed charges,77% of total billed charges,464.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,156.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,222.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.5,485.94,
IP/OBS CONSLTJ NEW/EST SF 35,P991502107,CDM,521,RC,99252,HCPCS,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164.65,89,,,Percent of total Billed Charges,89% of total Billed charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,164.65,
IP/OBS CNSLTJ NEW/EST LOW 45,P991502108,CDM,521,RC,99253,HCPCS,Outpatient,,,252,126,,194.04,77,,,Percent of Total Billed Charges,77% of total billed charges,64.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.28,89,,,Percent of total Billed Charges,89% of total Billed charges,224.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.04,77,,,Percent of total Billed charges,77% of total billed charges,214.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63,224.28,
IP/OBS CNSLTJ NEW/EST MOD 60,P991502109,CDM,521,RC,99254,HCPCS,Outpatient,,,375,187.5,,288.75,77,,,Percent of Total Billed Charges,77% of total billed charges,95.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,333.75,89,,,Percent of total Billed Charges,89% of total Billed charges,333.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.75,77,,,Percent of total Billed charges,77% of total billed charges,318.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.75,333.75,
IP/OBS CONSLTJ NEW/EST HI 80,P991502110,CDM,521,RC,99255,HCPCS,Outpatient,,,498,249,,383.46,77,,,Percent of Total Billed Charges,77% of total billed charges,126.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,443.22,89,,,Percent of total Billed Charges,89% of total Billed charges,443.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,443.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.46,77,,,Percent of total Billed charges,77% of total billed charges,423.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,203.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.5,443.22,
EMR DPT VST MAYX REQ PHY/QHP,P991502111,CDM,521,RC,99281,HCPCS,Outpatient,,,62,31,,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.18,89,,,Percent of total Billed Charges,89% of total Billed charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,55.18,
EMERGENCY DEPT VISIT SF MDM,P991502112,CDM,521,RC,99282,HCPCS,Outpatient,,,84,42,,64.68,77,,,Percent of Total Billed Charges,77% of total billed charges,21.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.76,89,,,Percent of total Billed Charges,89% of total Billed charges,74.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.68,77,,,Percent of total Billed charges,77% of total billed charges,71.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21,74.76,
EMERGENCY DEPT VISIT LOW MDM,P991502113,CDM,521,RC,99283,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,166.43,89,,,Percent of total Billed Charges,89% of total Billed charges,166.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.75,166.43,
EMERGENCY DEPT VISIT MOD MDM,P991502114,CDM,521,RC,99284,HCPCS,Outpatient,,,449,224.5,,345.73,77,,,Percent of Total Billed Charges,77% of total billed charges,114.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,112.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,399.61,89,,,Percent of total Billed Charges,89% of total Billed charges,399.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,399.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.73,77,,,Percent of total Billed charges,77% of total billed charges,381.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,183.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.25,399.61,
EMERGENCY DEPT VISIT HI MDM,P991502115,CDM,521,RC,99285,HCPCS,Outpatient,,,345,172.5,,265.65,77,,,Percent of Total Billed Charges,77% of total billed charges,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,307.05,89,,,Percent of total Billed Charges,89% of total Billed charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,77,,,Percent of total Billed charges,77% of total billed charges,293.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,140.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,307.05,
CRITICAL CARE FIRST HOUR,P991502116,CDM,521,RC,99291,HCPCS,Outpatient,,,612,306,,471.24,77,,,Percent of Total Billed Charges,77% of total billed charges,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,544.68,89,,,Percent of total Billed Charges,89% of total Billed charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,471.24,77,,,Percent of total Billed charges,77% of total billed charges,520.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,153,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,544.68,
CRITICAL CARE ADDL 30 MIN,P991502117,CDM,521,RC,99292,HCPCS,Outpatient,,,307,153.5,,236.39,77,,,Percent of Total Billed Charges,77% of total billed charges,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,273.23,89,,,Percent of total Billed Charges,89% of total Billed charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.39,77,,,Percent of total Billed charges,77% of total billed charges,260.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,125.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.75,273.23,
NURSING HOME-INITIAL,P991502118,CDM,524,RC,99304,HCPCS,Outpatient,,,190,95,,146.3,77,,,Percent of Total Billed Charges,77% of total billed charges,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,169.1,89,,,Percent of total Billed Charges,89% of total Billed charges,169.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.3,77,,,Percent of total Billed charges,77% of total billed charges,161.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,77.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.5,169.1,
NURSING HOME - INITIAL,P991502119,CDM,521,RC,99305,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,222.5,89,,,Percent of total Billed Charges,89% of total Billed charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.5,222.5,
NURSING HOME - INITIAL,P991502120,CDM,524,RC,99306,HCPCS,Outpatient,,,354,177,,272.58,77,,,Percent of Total Billed Charges,77% of total billed charges,90.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,315.06,89,,,Percent of total Billed Charges,89% of total Billed charges,315.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.58,77,,,Percent of total Billed charges,77% of total billed charges,300.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,144.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.5,315.06,
NHV/SNF VISIT,P991502121,CDM,524,RC,99307,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99.68,89,,,Percent of total Billed Charges,89% of total Billed charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,99.68,
NH VISIT/SNF VISIT,P991502122,CDM,524,RC,99308,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.62,89,,,Percent of total Billed Charges,89% of total Billed charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,140.62,
NH VISIT/SNF VISIT,P991502123,CDM,524,RC,99309,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
NH VISIT/SNF VISIT,P991502124,CDM,524,RC,99310,HCPCS,Outpatient,,,286,143,,220.22,77,,,Percent of Total Billed Charges,77% of total billed charges,72.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,254.54,89,,,Percent of total Billed Charges,89% of total Billed charges,254.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.22,77,,,Percent of total Billed charges,77% of total billed charges,243.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,116.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.5,254.54,
NF DSCHRG MGMT 30 MIN/LESS,P991502125,CDM,522,RC,99315,HCPCS,Outpatient,,,155,77.5,,119.35,77,,,Percent of Total Billed Charges,77% of total billed charges,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.95,89,,,Percent of total Billed Charges,89% of total Billed charges,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.35,77,,,Percent of total Billed charges,77% of total billed charges,131.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,38.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,137.95,
NF DSCHRG MGMT 30 MIN+,P991502126,CDM,522,RC,99316,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
HOME VISIT NEW PATIENT LVL1,P991502127,CDM,522,RC,99341,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
HOME VISIT NEW PATIENT LVL2,P991502128,CDM,522,RC,99342,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,129.94,
HOME VISIT NEW PT LVL4,P991502129,CDM,522,RC,99344,HCPCS,Outpatient,,,343,171.5,,264.11,77,,,Percent of Total Billed Charges,77% of total billed charges,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,305.27,89,,,Percent of total Billed Charges,89% of total Billed charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.11,77,,,Percent of total Billed charges,77% of total billed charges,291.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,139.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.75,305.27,
HOME VISIT NEW PATIENT LVL 5,P991502130,CDM,522,RC,99345,HCPCS,Outpatient,,,418,209,,321.86,77,,,Percent of Total Billed Charges,77% of total billed charges,106.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,372.02,89,,,Percent of total Billed Charges,89% of total Billed charges,372.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.86,77,,,Percent of total Billed charges,77% of total billed charges,355.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.5,372.02,
HOME VISIT EST PATIENT LVL1,P991502131,CDM,522,RC,99347,HCPCS,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.65,89,,,Percent of total Billed Charges,89% of total Billed charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,75.65,
HOME VISIT,P991502132,CDM,521,RC,99348,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,141.51,89,,,Percent of total Billed Charges,89% of total Billed charges,141.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.75,141.51,
HOME VISIT EST PATIENT LVL 3,P991502133,CDM,522,RC,99349,HCPCS,Outpatient,,,244,122,,187.88,77,,,Percent of Total Billed Charges,77% of total billed charges,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,217.16,89,,,Percent of total Billed Charges,89% of total Billed charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.88,77,,,Percent of total Billed charges,77% of total billed charges,207.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,99.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,217.16,
"HOME VISIT, EST PT, COMPLEX",P991502134,CDM,522,RC,99350,HCPCS,Outpatient,,,338,169,,260.26,77,,,Percent of Total Billed Charges,77% of total billed charges,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,300.82,89,,,Percent of total Billed Charges,89% of total Billed charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.26,77,,,Percent of total Billed charges,77% of total billed charges,287.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.5,300.82,
PHYSICIAN STANDBY SERVICES,P991502135,CDM,521,RC,99360,HCPCS,Outpatient,,,195,97.5,,150.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,173.55,89,,,Percent of total Billed Charges,89% of total Billed charges,173.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.15,77,,,Percent of total Billed charges,77% of total billed charges,165.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.75,173.55,
NEW PATIENT WELL CHILD 0-1 YR,P991502136,CDM,521,RC,99381,HCPCS,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,164.65,89,,,Percent of total Billed Charges,89% of total Billed charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,164.65,
NEW PT WELL CHILD 1-4,P991502137,CDM,521,RC,99382,HCPCS,Outpatient,,,208,104,,160.16,77,,,Percent of Total Billed Charges,77% of total billed charges,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185.12,89,,,Percent of total Billed Charges,89% of total Billed charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.16,77,,,Percent of total Billed charges,77% of total billed charges,176.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52,185.12,
NEW PT WELL CHILD 5-11,P991502138,CDM,521,RC,99383,HCPCS,Outpatient,,,223,111.5,,171.71,77,,,Percent of Total Billed Charges,77% of total billed charges,56.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.47,89,,,Percent of total Billed Charges,89% of total Billed charges,198.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.71,77,,,Percent of total Billed charges,77% of total billed charges,189.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,198.47,
PREV VISIT NEW AGE 12-17,P991502139,CDM,521,RC,99384,HCPCS,Outpatient,,,234,117,,180.18,77,,,Percent of Total Billed Charges,77% of total billed charges,59.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,208.26,89,,,Percent of total Billed Charges,89% of total Billed charges,208.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.18,77,,,Percent of total Billed charges,77% of total billed charges,198.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.5,208.26,
PREV VISIT NEW AGE 18-39,P991502140,CDM,521,RC,99385,HCPCS,Outpatient,,,303,151.5,,233.31,77,,,Percent of Total Billed Charges,77% of total billed charges,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,269.67,89,,,Percent of total Billed Charges,89% of total Billed charges,269.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.31,77,,,Percent of total Billed charges,77% of total billed charges,257.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.75,269.67,
PREV VISIT NEW AGE 40-64,P991502141,CDM,521,RC,99386,HCPCS,Outpatient,,,330,165,,254.1,77,,,Percent of Total Billed Charges,77% of total billed charges,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,293.7,89,,,Percent of total Billed Charges,89% of total Billed charges,293.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.1,77,,,Percent of total Billed charges,77% of total billed charges,280.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,134.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.5,293.7,
INIT PM E/M NEW PAT 65+ YRS,P991502142,CDM,521,RC,99387,HCPCS,Outpatient,,,373,186.5,,287.21,77,,,Percent of Total Billed Charges,77% of total billed charges,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,331.97,89,,,Percent of total Billed Charges,89% of total Billed charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.21,77,,,Percent of total Billed charges,77% of total billed charges,317.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.25,331.97,
PER PM REEVAL EST PAT INFANT,P991502143,CDM,521,RC,99391,HCPCS,Outpatient,,,151,75.5,,116.27,77,,,Percent of Total Billed Charges,77% of total billed charges,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,134.39,89,,,Percent of total Billed Charges,89% of total Billed charges,134.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,77,,,Percent of total Billed charges,77% of total billed charges,128.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.75,134.39,
PREV VISIT EST AGE 1-4,P991502144,CDM,521,RC,99392,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,140.62,89,,,Percent of total Billed Charges,89% of total Billed charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,64.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.5,140.62,
PREV VISIT EST AGE 5-11,P991502145,CDM,521,RC,99393,HCPCS,Outpatient,,,173,86.5,,133.21,77,,,Percent of Total Billed Charges,77% of total billed charges,44.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.97,89,,,Percent of total Billed Charges,89% of total Billed charges,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.21,77,,,Percent of total Billed charges,77% of total billed charges,147.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.25,153.97,
PREV VISIT EST AGE 12-17,P991502146,CDM,521,RC,99394,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,165.54,89,,,Percent of total Billed Charges,89% of total Billed charges,165.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.5,165.54,
PREV VISIT EST AGE 18-39,P991502147,CDM,521,RC,99395,HCPCS,Outpatient,,,252,126,,194.04,77,,,Percent of Total Billed Charges,77% of total billed charges,64.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,224.28,89,,,Percent of total Billed Charges,89% of total Billed charges,224.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.04,77,,,Percent of total Billed charges,77% of total billed charges,214.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,102.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63,224.28,
PREV VISIT EST AGE 40-64,P991502148,CDM,521,RC,99396,HCPCS,Outpatient,,,275,137.5,,211.75,77,,,Percent of Total Billed Charges,77% of total billed charges,70.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.75,89,,,Percent of total Billed Charges,89% of total Billed charges,244.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.75,77,,,Percent of total Billed charges,77% of total billed charges,233.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.75,244.75,
PREV VISIT EST AGE 40-64,P991502148,CDM,521,RC,G0439,HCPCS,Outpatient,,,275,137.5,,211.75,77,,,Percent of Total Billed Charges,77% of total billed charges,70.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,244.75,89,,,Percent of total Billed Charges,89% of total Billed charges,244.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.75,77,,,Percent of total Billed charges,77% of total billed charges,233.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,112.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.75,244.75,
PER PM REEVAL EST PAT 65+ YR,P991502149,CDM,521,RC,99397,HCPCS,Outpatient,,,313,156.5,,241.01,77,,,Percent of Total Billed Charges,77% of total billed charges,79.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,278.57,89,,,Percent of total Billed Charges,89% of total Billed charges,278.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.01,77,,,Percent of total Billed charges,77% of total billed charges,266.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.25,278.57,
PER PM REEVAL EST PAT 65+ YR,P991502149,CDM,521,RC,G0439,HCPCS,Outpatient,,,313,156.5,,241.01,77,,,Percent of Total Billed Charges,77% of total billed charges,79.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,278.57,89,,,Percent of total Billed Charges,89% of total Billed charges,278.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.01,77,,,Percent of total Billed charges,77% of total billed charges,266.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,127.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.25,278.57,
PREV MED CSL&/RISK 15 MIN,P991502150,CDM,521,RC,99401,HCPCS,Outpatient,,,104,52,,80.08,77,,,Percent of Total Billed Charges,77% of total billed charges,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,92.56,89,,,Percent of total Billed Charges,89% of total Billed charges,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.08,77,,,Percent of total Billed charges,77% of total billed charges,88.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,92.56,
PREVENTIVE COUNSELING INDIV,P991502151,CDM,521,RC,99402,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
PREV MED CSL&/RISK 45 MIN,P991502152,CDM,521,RC,99403,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,88.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,194.02,
PREV MED CSL&/RISK 60 MIN,P991502153,CDM,521,RC,99404,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,234.96,89,,,Percent of total Billed Charges,89% of total Billed charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,107.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66,234.96,
SMOKING CESSATION > 10 MINUTES,P991502154,CDM,521,RC,99407,HCPCS,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.17,89,,,Percent of total Billed Charges,89% of total Billed charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.17,
OL DIG E/M SVC 5-10 MIN,P991502155,CDM,521,RC,99421,HCPCS,Outpatient,,,31,15.5,,23.87,77,,,Percent of Total Billed Charges,77% of total billed charges,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.59,89,,,Percent of total Billed Charges,89% of total Billed charges,27.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.87,77,,,Percent of total Billed charges,77% of total billed charges,26.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.59,
OL DIG E/M SVC 11-20 MIN,P991502156,CDM,521,RC,99422,HCPCS,Outpatient,,,64,32,,49.28,77,,,Percent of Total Billed Charges,77% of total billed charges,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.96,89,,,Percent of total Billed Charges,89% of total Billed charges,56.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.28,77,,,Percent of total Billed charges,77% of total billed charges,54.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16,56.96,
OL DIG E/M SVC 21+ MIN,P991502157,CDM,521,RC,99423,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
CHRONIC CARE MGMT 30 MIN (PHY),P991502158,CDM,521,RC,99424,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,147.74,89,,,Percent of total Billed Charges,89% of total Billed charges,147.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.5,147.74,
PRIN CARE MGMT PHYS EA ADDL,P991502159,CDM,521,RC,99425,HCPCS,Outpatient,,,121,60.5,,93.17,77,,,Percent of Total Billed Charges,77% of total billed charges,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,107.69,89,,,Percent of total Billed Charges,89% of total Billed charges,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.17,77,,,Percent of total Billed charges,77% of total billed charges,102.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.25,107.69,
CHRONIC CARE MGMT 30 MIN,P991502160,CDM,521,RC,99426,HCPCS,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.9,89,,,Percent of total Billed Charges,89% of total Billed charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,97.9,
CHRONIC CARE MGMT ADDL 30 MIN,P991502161,CDM,521,RC,99427,HCPCS,Outpatient,,,80,40,,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,71.2,89,,,Percent of total Billed Charges,89% of total Billed charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,71.2,
CHRONIC CARE MGMT ADDL 30,P991502162,CDM,521,RC,99437,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,102.35,89,,,Percent of total Billed Charges,89% of total Billed charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.75,102.35,
CHRONIC CARE MGMT +20MIN,P991502163,CDM,521,RC,99439,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.63,89,,,Percent of total Billed Charges,89% of total Billed charges,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.63,
PHONE VISIT 5-10 MIN,P991502164,CDM,521,RC,99441,HCPCS,Outpatient,,,31,15.5,,23.87,77,,,Percent of Total Billed Charges,77% of total billed charges,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.59,89,,,Percent of total Billed Charges,89% of total Billed charges,27.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.87,77,,,Percent of total Billed charges,77% of total billed charges,26.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.59,
PHONE VISIT 11-20 MIN,P991502165,CDM,521,RC,99442,HCPCS,Outpatient,,,64,32,,49.28,77,,,Percent of Total Billed Charges,77% of total billed charges,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.96,89,,,Percent of total Billed Charges,89% of total Billed charges,56.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.28,77,,,Percent of total Billed charges,77% of total billed charges,54.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16,56.96,
PHONE VISIT 21-30 MIN,P991502166,CDM,521,RC,99443,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
WORK RELATED DISABILITY EXAM,P991502167,CDM,521,RC,99455,HCPCS,Outpatient,,,650,325,,500.5,77,,,Percent of Total Billed Charges,77% of total billed charges,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,578.5,89,,,Percent of total Billed Charges,89% of total Billed charges,578.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,500.5,77,,,Percent of total Billed charges,77% of total billed charges,552.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,265.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.5,578.5,
INITIAL NEWBORN CARE,P991502168,CDM,521,RC,99460,HCPCS,Outpatient,,,419,209.5,,322.63,77,,,Percent of Total Billed Charges,77% of total billed charges,106.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,372.91,89,,,Percent of total Billed Charges,89% of total Billed charges,372.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.63,77,,,Percent of total Billed charges,77% of total billed charges,356.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,170.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.75,372.91,
SBSQ NB EM PER DAY HOSP,P991502169,CDM,521,RC,99462,HCPCS,Outpatient,,,236,118,,181.72,77,,,Percent of Total Billed Charges,77% of total billed charges,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.04,89,,,Percent of total Billed Charges,89% of total Billed charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.72,77,,,Percent of total Billed charges,77% of total billed charges,200.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59,210.04,
SAME DAY NB DISCHARGE,P991502170,CDM,521,RC,99463,HCPCS,Outpatient,,,208,104,,160.16,77,,,Percent of Total Billed Charges,77% of total billed charges,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185.12,89,,,Percent of total Billed Charges,89% of total Billed charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.16,77,,,Percent of total Billed charges,77% of total billed charges,176.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52,185.12,
ATTENDANCE AT DELIVERY,P991502171,CDM,521,RC,99464,HCPCS,Outpatient,,,348,174,,267.96,77,,,Percent of Total Billed Charges,77% of total billed charges,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,309.72,89,,,Percent of total Billed Charges,89% of total Billed charges,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.96,77,,,Percent of total Billed charges,77% of total billed charges,295.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,141.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87,309.72,
NB RESUSCITATION,P991502172,CDM,521,RC,99465,HCPCS,Outpatient,,,272,136,,209.44,77,,,Percent of Total Billed Charges,77% of total billed charges,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,242.08,89,,,Percent of total Billed Charges,89% of total Billed charges,242.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.44,77,,,Percent of total Billed charges,77% of total billed charges,231.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68,242.08,
SELF-MEAS BP PT EDU/TRAIN,P991502173,CDM,521,RC,99473,HCPCS,Outpatient,,,20,10,,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.8,89,,,Percent of total Billed Charges,89% of total Billed charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,17.8,
SELF-MEAS BP READG BID 30D,P991502174,CDM,521,RC,99474,HCPCS,Outpatient,,,27,13.5,,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.03,89,,,Percent of total Billed Charges,89% of total Billed charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,24.03,
CPLX CHRNC CARE 1ST 60 MIN,P991502175,CDM,521,RC,99487,HCPCS,Outpatient,,,212,106,,163.24,77,,,Percent of Total Billed Charges,77% of total billed charges,54.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,188.68,89,,,Percent of total Billed Charges,89% of total Billed charges,188.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.24,77,,,Percent of total Billed charges,77% of total billed charges,180.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,86.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53,188.68,
CHRONIC CARE MGMT ADDL 30MIN,P991502176,CDM,521,RC,99489,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,99.68,89,,,Percent of total Billed Charges,89% of total Billed charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,99.68,
CHRNC CARE MGMT STAFF 1ST 20,P991502177,CDM,521,RC,99490,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,85.44,89,,,Percent of total Billed Charges,89% of total Billed charges,85.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24,85.44,
CHRNC CARE MGMT PHYS 1ST 30,P991502178,CDM,521,RC,99491,HCPCS,Outpatient,,,175,87.5,,134.75,77,,,Percent of Total Billed Charges,77% of total billed charges,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,155.75,89,,,Percent of total Billed Charges,89% of total Billed charges,155.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,77,,,Percent of total Billed charges,77% of total billed charges,148.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,71.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.75,155.75,
TRANS CARE MGMT 14 DAY DISCH,P991502179,CDM,522,RC,99495,HCPCS,Outpatient,,,383,191.5,,294.91,77,,,Percent of Total Billed Charges,77% of total billed charges,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.87,89,,,Percent of total Billed Charges,89% of total Billed charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.91,77,,,Percent of total Billed charges,77% of total billed charges,325.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.75,340.87,
TRANS CARE MGMT 7 DAY DISCH,P991502180,CDM,522,RC,99496,HCPCS,Outpatient,,,519,259.5,,399.63,77,,,Percent of Total Billed Charges,77% of total billed charges,132.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,461.91,89,,,Percent of total Billed Charges,89% of total Billed charges,461.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.63,77,,,Percent of total Billed charges,77% of total billed charges,441.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,211.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.75,461.91,
ADVNCD CARE PLAN 30 MIN,P991502181,CDM,521,RC,99497,HCPCS,Outpatient,,,162,81,,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144.18,89,,,Percent of total Billed Charges,89% of total Billed charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,144.18,
ADVNCD CARE PLAN ADDL 30 MIN,P991502182,CDM,521,RC,99498,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.93,89,,,Percent of total Billed Charges,89% of total Billed charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,121.93,
EAP VISIT,P991502188,CDM,521,RC,,,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,57.85,
OFF-SITE LAB COLLECTION,P991502190,CDM,521,RC,,,Outpatient,,,10,5,,7.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.7,77,,,Percent of total Billed charges,77% of total billed charges,8.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.5,8.9,
PREVENT MED COUNSEL 45 MIN TWC,P991502194,CDM,521,RC,99403,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.75,88.11,
SPORTS/SCHOOL OR WORK PHYSICAL,P991502198,CDM,521,RC,,,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
TWC - INITIAL,P991502199,CDM,521,RC,,,Outpatient,,,150,75,,115.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.5,89,,,Percent of total Billed Charges,89% of total Billed charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,77,,,Percent of total Billed charges,77% of total billed charges,127.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.5,133.5,
TWC - QUARTERLY,P991502200,CDM,521,RC,,,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.75,88.11,
TWC - REACTIVATION,P991502201,CDM,521,RC,,,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.75,88.11,
TWC - REACTIVATION - *NO RVU*,P991502202,CDM,521,RC,,,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.75,88.11,
TWC MED COUNSEL ADDTL 60 MIN,P991502206,CDM,521,RC,99404,HCPCS,Outpatient,,,299,149.5,,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,121.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,266.11,
TWC MED COUNSELING 60 MIN,P991502207,CDM,521,RC,,,Outpatient,,,199,99.5,,153.23,77,,,Percent of Total Billed Charges,77% of total billed charges,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,177.11,89,,,Percent of total Billed Charges,89% of total Billed charges,177.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.23,77,,,Percent of total Billed charges,77% of total billed charges,169.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,81.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.75,177.11,
TWC PRODUCT PAYMENT PLAN,P991502208,CDM,521,RC,,,Outpatient,,,1,0.5,,0.77,77,,,Percent of Total Billed Charges,77% of total billed charges,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,0.89,89,,,Percent of total Billed Charges,89% of total Billed charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.77,77,,,Percent of total Billed charges,77% of total billed charges,0.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,0.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.25,0.89,
NJX PLATELET PLASMA,P991502219,CDM,521,RC,0232T,HCPCS,Outpatient,,,585,292.5,,450.45,77,,,Percent of Total Billed Charges,77% of total billed charges,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,520.65,89,,,Percent of total Billed Charges,89% of total Billed charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.45,77,,,Percent of total Billed charges,77% of total billed charges,497.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,238.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.25,520.65,
PNEUMONIA VACCINE ADMIN,P991502228,CDM,521,RC,G0009,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
PNEUMONIA VACCINE ADMIN,P991502228,CDM,521,RC,G0009,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
PNEUMONIA VACCINE ADMIN,P991502228,CDM,521,RC,G0009,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
HOSPICE CPO,P991502229,CDM,521,RC,G0065,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,121.93,89,,,Percent of total Billed Charges,89% of total Billed charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,55.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,121.93,
"REMOTE COMUN OR EVALUATION,RHC",P991502230,CDM,521,RC,G0071,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.75,
PELVIC AND BREAST HEALTH EXAM,P991502231,CDM,521,RC,G0101,HCPCS,Outpatient,,,129,64.5,,99.33,77,,,Percent of Total Billed Charges,77% of total billed charges,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,114.81,89,,,Percent of total Billed Charges,89% of total Billed charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.33,77,,,Percent of total Billed charges,77% of total billed charges,109.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,52.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.25,114.81,
DIGITAL RECTAL EXAMINATION,P991502233,CDM,521,RC,G0102,HCPCS,Outpatient,,,42,21,,32.34,77,,,Percent of Total Billed Charges,77% of total billed charges,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.38,89,,,Percent of total Billed Charges,89% of total Billed charges,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.34,77,,,Percent of total Billed charges,77% of total billed charges,35.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.5,37.38,
COLAN CX SCREEN FLEX SIGMOID,P991502234,CDM,521,RC,G0104,HCPCS,Outpatient,,,171,85.5,,131.67,77,,,Percent of Total Billed Charges,77% of total billed charges,43.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,152.19,89,,,Percent of total Billed Charges,89% of total Billed charges,152.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.67,77,,,Percent of total Billed charges,77% of total billed charges,145.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,69.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,42.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.75,152.19,
"COLAN CX SCREEN,HIGH RISK",P991502235,CDM,521,RC,G0105,HCPCS,Outpatient,,,1198,599,,922.46,77,,,Percent of Total Billed Charges,77% of total billed charges,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,374.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1066.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,488.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.46,77,,,Percent of total Billed charges,77% of total billed charges,1018.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,344.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,488.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,299.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.5,1066.22,
MEDICARE COLONOSCOPY SCREENING,P991502236,CDM,521,RC,G0121,HCPCS,Outpatient,,,1295,647.5,,997.15,77,,,Percent of Total Billed Charges,77% of total billed charges,330.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,330.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,404.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1152.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1152.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1152.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,528.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,997.15,77,,,Percent of total Billed charges,77% of total billed charges,1100.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,372.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,528.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,323.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.75,1152.55,
RECERT OF HOME HEALTH SERVICES,P991502237,CDM,521,RC,G0179,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,67.64,89,,,Percent of total Billed Charges,89% of total Billed charges,67.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19,67.64,
CERT OF HOME HEALTH SERVICES,P991502238,CDM,521,RC,G0180,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
CARE PLAN OVERSIGHT 30 MIN+,P991502239,CDM,521,RC,G0181,HCPCS,Outpatient,,,196,98,,150.92,77,,,Percent of Total Billed Charges,77% of total billed charges,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,174.44,89,,,Percent of total Billed Charges,89% of total Billed charges,174.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.92,77,,,Percent of total Billed charges,77% of total billed charges,166.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,79.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49,174.44,
ROUTINE DIABETIC FOOT CARE,P991502240,CDM,521,RC,G0247,HCPCS,Outpatient,,,150,75,,115.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,133.5,89,,,Percent of total Billed Charges,89% of total Billed charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,77,,,Percent of total Billed charges,77% of total billed charges,127.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.5,133.5,
MNT SUBS TX FOR CHANGE DX,P991502241,CDM,510,RC,G0270,HCPCS,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,53.4,
DX BREAST TOMOSYNTHESIS,P991502242,CDM,521,RC,G0279,HCPCS,Outpatient,,,98,49,26,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,87.22,89,,,Percent of total Billed Charges,89% of total Billed charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.28,87.22,
"ARTHROSCOPY,KNEE,REMOVAL OF FB",P991502243,CDM,521,RC,G0289,HCPCS,Outpatient,,,162,81,,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,144.18,89,,,Percent of total Billed Charges,89% of total Billed charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,144.18,
"VISIT, LDCT ELIG LUNG CANCER",P991502244,CDM,521,RC,G0296,HCPCS,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
MD SERVICE REQUIRED FOR PMD,P991502245,CDM,521,RC,G0372,HCPCS,Outpatient,,,17,8.5,,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.13,89,,,Percent of total Billed Charges,89% of total Billed charges,15.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.13,
ALCOHOL/SUBSCTANCE ABUSE BRIEF,P991502246,CDM,521,RC,G0396,HCPCS,Outpatient,,,66,33,,50.82,77,,,Percent of Total Billed Charges,77% of total billed charges,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,58.74,89,,,Percent of total Billed Charges,89% of total Billed charges,58.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.82,77,,,Percent of total Billed charges,77% of total billed charges,56.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.5,58.74,
ALCOHOL/SUBSTANCE ABUSE 30MIN+,P991502247,CDM,521,RC,G0397,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,115.7,
SLEEP STUDY - UNATTENDED,P991502248,CDM,521,RC,G0398,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,267,89,,,Percent of total Billed Charges,89% of total Billed charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75,267,
SLEEP STUDY UNATT w/ ANALYSIS,P991502249,CDM,521,RC,G0399,HCPCS,Outpatient,,,164,82,,126.28,77,,,Percent of Total Billed Charges,77% of total billed charges,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.96,89,,,Percent of total Billed Charges,89% of total Billed charges,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.28,77,,,Percent of total Billed charges,77% of total billed charges,139.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41,145.96,
PHYSICAL W/IN 12 MON OF MCARE,P991502250,CDM,521,RC,G0402,HCPCS,Outpatient,,,173,86.5,,133.21,77,,,Percent of Total Billed Charges,77% of total billed charges,44.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,153.97,89,,,Percent of total Billed Charges,89% of total Billed charges,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.21,77,,,Percent of total Billed charges,77% of total billed charges,147.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.25,153.97,
CARDIAC REHAB W/EXERCISE,P991502251,CDM,521,RC,G0422,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.25,89,,,Percent of total Billed Charges,89% of total Billed charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,111.25,
CARDIAC REHAB W/O EXERCISE,P991502252,CDM,521,RC,G0423,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,111.25,89,,,Percent of total Billed Charges,89% of total Billed charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,111.25,
"ANNUAL WELL VISIT, INITIAL",P991502253,CDM,521,RC,G0438,HCPCS,Outpatient,,,163,81.5,,125.51,77,,,Percent of Total Billed Charges,77% of total billed charges,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,145.07,89,,,Percent of total Billed Charges,89% of total Billed charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.51,77,,,Percent of total Billed charges,77% of total billed charges,138.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.75,145.07,
ANNUAL WELL VISIT/SUBQ VISIT,P991502255,CDM,521,RC,G0439,HCPCS,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.9,89,,,Percent of total Billed Charges,89% of total Billed charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,44.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,97.9,
ANNUAL ALCOHOL SCRN 15 MIN,P991502257,CDM,521,RC,G0442,HCPCS,Outpatient,,,36,18,,27.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.72,77,,,Percent of total Billed charges,77% of total billed charges,30.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9,32.04,
BH COUNSEL ALCOHOL 15 MIN,P991502258,CDM,521,RC,G0443,HCPCS,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
SEMIANNL F2F STD COUNSELING,P991502260,CDM,521,RC,G0445,HCPCS,Outpatient,,,50,25,,38.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.5,89,,,Percent of total Billed Charges,89% of total Billed charges,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.5,77,,,Percent of total Billed charges,77% of total billed charges,42.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.5,
INTENSIVE BH THERAPY,P991502261,CDM,521,RC,G0446,HCPCS,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
"F2F BH COUNSEL OBESITY, 15 MIN",P991502262,CDM,521,RC,G0447,HCPCS,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
SELFPAY PREP/INST FECAL MICROB,P991502263,CDM,521,RC,G0455,HCPCS,Outpatient,,,2500,1250,,1925,77,,,Percent of Total Billed Charges,77% of total billed charges,637.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,637.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2225,500,,,fee schedule,500% of healthlink,2225,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2225,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1020,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1020,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1020,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925,77,,,Percent of total Billed charges,77% of total billed charges,2125,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,718.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1020,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,625,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,625,2225,
GROUP BEHAVIOR COUNSELING 2-10,P991502264,CDM,510,RC,G0473,HCPCS,Outpatient,,,24,12,,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,21.36,
COMP ASSESS & PLANNING (PHY),P991502265,CDM,521,RC,G0506,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,90.78,89,,,Percent of total Billed Charges,89% of total Billed charges,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.5,90.78,
CHRONIC CARE MANAGEMENT,P991502266,CDM,521,RC,G0511,HCPCS,Outpatient,,,88,44,,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,78.32,89,,,Percent of total Billed Charges,89% of total Billed charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,78.32,
REMOTE EVALW/VIDEO STORE/FWD,P991502267,CDM,521,RC,G2010,HCPCS,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
BRIEF COMM VIRTUAL CHECK-IN,P991502268,CDM,521,RC,G2012,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
AUDIO/AUDIOVIDEO VISIT 5MIN,P991502270,CDM,521,RC,G2025,HCPCS,Outpatient,,,138,69,,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,122.82,89,,,Percent of total Billed Charges,89% of total Billed charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,122.82,
Obtaining Screen PAP Smear,P991502271,CDM,521,RC,Q0091,HCPCS,Outpatient,,,23,11.5,,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,20.47,89,,,Percent of total Billed Charges,89% of total Billed charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,9.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,20.47,
TELEHEALTH ORIG SITE FEE,P991502272,CDM,780,RC,Q3014,HCPCS,Outpatient,,,46,23,,35.42,77,,,Percent of Total Billed Charges,77% of total billed charges,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.04,74,,,Percent of Total Billed Charges,74% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,84,,,Percent of Total Billed Charges,84% of total billed charges,37.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.94,89,,,Percent of total Billed Charges,89% of total Billed charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.42,77,,,Percent of total Billed charges,77% of total billed charges,39.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,40.94,
GENETIC COUNSEL 15 MIN,P991502273,CDM,521,RC,S0265,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,61.41,89,,,Percent of total Billed Charges,89% of total Billed charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,61.41,
ANNUAL GYN EXAM,P991502274,CDM,521,RC,S0612,HCPCS,Outpatient,,,64,32,,49.28,77,,,Percent of Total Billed Charges,77% of total billed charges,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,56.96,89,,,Percent of total Billed Charges,89% of total Billed charges,56.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.28,77,,,Percent of total Billed charges,77% of total billed charges,54.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16,56.96,
Application Of Long Arm Cast,P991502277,CDM,510,RC,29065,HCPCS,Outpatient,,,214,107,,164.78,77,,,Percent of Total Billed Charges,77% of total billed charges,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.78,77,,,Percent of total Billed charges,77% of total billed charges,181.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.5,190.46,
Application Short Arm Cast,P991502278,CDM,510,RC,29075,HCPCS,Outpatient,,,177,88.5,,136.29,77,,,Percent of Total Billed Charges,77% of total billed charges,45.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.29,77,,,Percent of total Billed charges,77% of total billed charges,150.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.25,157.53,
Apply Hand/Wrist Cast,P991502279,CDM,510,RC,29085,HCPCS,Outpatient,,,174,87,,133.98,77,,,Percent of Total Billed Charges,77% of total billed charges,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.98,77,,,Percent of total Billed charges,77% of total billed charges,147.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.5,154.86,
Apply Forearm Splint,P991502280,CDM,510,RC,29125,HCPCS,Outpatient,,,120,60,,92.4,77,,,Percent of Total Billed Charges,77% of total billed charges,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.4,77,,,Percent of total Billed charges,77% of total billed charges,102,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30,106.8,
Application Of Long Leg Cast,P991502281,CDM,510,RC,29345,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,154,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,274.12,
Application Of Short Leg Cast,P991502282,CDM,510,RC,29405,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.5,186.9,
Application Lower Leg Splint,P991502283,CDM,510,RC,29515,HCPCS,Outpatient,,,151,75.5,,116.27,77,,,Percent of Total Billed Charges,77% of total billed charges,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,77,,,Percent of total Billed charges,77% of total billed charges,128.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.75,134.39,
Cystoscopy And Treatment,P991502284,CDM,510,RC,52260,HCPCS,Outpatient,,,464,232,,357.28,77,,,Percent of Total Billed Charges,77% of total billed charges,118.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,189.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.28,77,,,Percent of total Billed charges,77% of total billed charges,394.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116,412.96,
Ht Muscle Image Spect Sing,P991502285,CDM,521,RC,78451,HCPCS,Outpatient,,,127.92,63.96,26,98.5,77,,,Percent of Total Billed Charges,77% of total billed charges,32.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,113.85,89,,,Percent of total Billed Charges,89% of total Billed charges,113.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.85,120,,,Fee Schedule,120% of MO Medicaid Rate,234.85,120,,,Fee Schedule,120% of MO Medicaid Rate,234.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.5,77,,,Percent of total Billed charges,77% of total billed charges,108.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,234.85,120,,,Fee Schedule,120% of MO Medicaid Rate,31.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.98,234.85,
Mult Sleep Latency Test,P991502286,CDM,521,RC,95805,HCPCS,Outpatient,,,113.36,56.68,26,87.29,77,,,Percent of Total Billed Charges,77% of total billed charges,28.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,100.89,89,,,Percent of total Billed Charges,89% of total Billed charges,100.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.2,120,,,Fee Schedule,120% of MO Medicaid Rate,344.2,120,,,Fee Schedule,120% of MO Medicaid Rate,344.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.29,77,,,Percent of total Billed charges,77% of total billed charges,96.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,344.2,120,,,Fee Schedule,120% of MO Medicaid Rate,28.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,28.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.34,344.2,
Rhythm Ecg Report,P991502287,CDM,521,RC,93042,HCPCS,Outpatient,,,13.52,6.76,26,10.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,12.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.41,77,,,Percent of total Billed charges,77% of total billed charges,11.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,3.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.38,12.03,
Change Percu Tube/Drain Cath,P991502288,CDM,320,RC,75984,HCPCS,Outpatient,,,75.5,37.75,26,58.14,77,,,Percent of Total Billed Charges,77% of total billed charges,19.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.87,74,,,Percent of Total Billed Charges,74% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,63.42,84,,,Percent of Total Billed Charges,84% of total billed charges,61.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,302,400,,,fee schedule,400% of healthlink fee schedule,283.13,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,302,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,170.52,120,,,Fee Schedule,120% of MO Medicaid Rate,170.52,120,,,Fee Schedule,120% of MO Medicaid Rate,170.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.14,77,,,Percent of total Billed charges,77% of total billed charges,64.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,170.52,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,302,
"Unlisted Musculoskeletal, Head",P991502289,CDM,521,RC,21499,HCPCS,Outpatient,,,873.6,436.8,,672.67,77,,,Percent of Total Billed Charges,77% of total billed charges,222.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,218.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,777.5,89,,,Percent of total Billed Charges,89% of total Billed charges,777.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,356.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,356.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.67,77,,,Percent of total Billed charges,77% of total billed charges,742.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,251.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,356.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,218.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.4,777.5,
Pneu 15 Valent Conj Vac,P991502290,CDM,636,RC,90671,HCPCS,Outpatient,,,267.28,133.64,,205.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.42,69,,,Percent of Total Billed Charges,69% of total billed charges,184.42,69,,,Percent of Total Billed Charges,69% of total billed charges,184.42,69,,,Percent of Total Billed Charges,69% of total billed charges,66.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.42,69,,,Percent of Total Billed Charges,69% of total billed charges,184.42,69,,,Percent of Total Billed Charges,69% of total billed charges,184.42,69,,,Percent of Total Billed Charges,69% of total billed charges,120.28,45,,,Percent of Total Billed Charges,45% of total billed charges,237.88,89,,,Percent of total Billed Charges,89% of total Billed charges,237.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.81,77,,,Percent of total Billed charges,77% of total billed charges,227.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,109.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,66.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.82,237.88,
Urethra &Bladder Transurethral,P991502292,CDM,521,RC,52300,HCPCS,Outpatient,,,550.16,275.08,,423.62,77,,,Percent of Total Billed Charges,77% of total billed charges,140.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,137.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,489.64,89,,,Percent of total Billed Charges,89% of total Billed charges,489.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,489.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,423.62,77,,,Percent of total Billed charges,77% of total billed charges,467.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,158.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,137.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.54,489.64,
Lapidus Bunionectomy/Fusion,P991502293,CDM,521,RC,28297,HCPCS,Outpatient,,,1947.92,973.96,,1499.9,77,,,Percent of Total Billed Charges,77% of total billed charges,496.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,608.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1733.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1733.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1733.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,794.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,794.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,794.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1499.9,77,,,Percent of total Billed charges,77% of total billed charges,1655.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,560.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,794.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.98,1733.65,
"Correction, (Bunionectomy)",P991502295,CDM,521,RC,28299,HCPCS,Outpatient,,,1976,988,,1521.52,77,,,Percent of Total Billed Charges,77% of total billed charges,503.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,503.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,617.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,494,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1758.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1758.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1758.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,806.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,806.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,806.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1521.52,77,,,Percent of total Billed charges,77% of total billed charges,1679.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,568.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,806.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,494,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,494,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,494,1758.64,
Shoulder Prosthesis Rmv W/Dbrd,P991502296,CDM,521,RC,23335,HCPCS,Outpatient,,,2490.8,1245.4,,1917.92,77,,,Percent of Total Billed Charges,77% of total billed charges,635.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,778.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,622.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2216.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2216.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2216.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1016.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1016.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1016.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,622.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1917.92,77,,,Percent of total Billed charges,77% of total billed charges,2117.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,716.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1016.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,622.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,622.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,622.7,2216.81,
Lapidus Bunionectomy/ Fusion,P991502297,CDM,521,RC,28297,HCPCS,Outpatient,,,1947.92,973.96,,1499.9,77,,,Percent of Total Billed Charges,77% of total billed charges,496.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,608.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1733.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1733.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1733.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,794.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,794.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,794.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1499.9,77,,,Percent of total Billed charges,77% of total billed charges,1655.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,560.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,794.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,486.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.98,1733.65,
Ex Lesion Of Tongue W/Closure,P991502298,CDM,521,RC,41113,HCPCS,Outpatient,,,696,348,,535.92,77,,,Percent of Total Billed Charges,77% of total billed charges,177.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,619.44,89,,,Percent of total Billed Charges,89% of total Billed charges,619.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,619.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.92,77,,,Percent of total Billed charges,77% of total billed charges,591.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,200.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,283.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174,619.44,
Excision Of Nasal Polyp(S),P991502299,CDM,521,RC,30110,HCPCS,Outpatient,,,514,257,,395.78,77,,,Percent of Total Billed Charges,77% of total billed charges,131.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,128.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,457.46,89,,,Percent of total Billed Charges,89% of total Billed charges,457.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,457.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.78,77,,,Percent of total Billed charges,77% of total billed charges,436.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,209.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,128.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.5,457.46,
Treat Sesamoid Bone Fracture,P991502300,CDM,521,RC,28530,HCPCS,Outpatient,,,214,107,,164.78,77,,,Percent of Total Billed Charges,77% of total billed charges,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,190.46,89,,,Percent of total Billed Charges,89% of total Billed charges,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.78,77,,,Percent of total Billed charges,77% of total billed charges,181.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,87.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.5,190.46,
Autochondrocyte Implant Knee,P991502301,CDM,521,RC,27412,HCPCS,Outpatient,,,3112,1556,,2396.24,77,,,Percent of Total Billed Charges,77% of total billed charges,793.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,793.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,972.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,778,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2769.68,89,,,Percent of total Billed Charges,89% of total Billed charges,2769.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2769.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2396.24,77,,,Percent of total Billed charges,77% of total billed charges,2645.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,894.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1269.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,778,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,778,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778,2769.68,
Fecal Microbiota Transplant,P991502302,CDM,521,RC,44705,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,127.27,89,,,Percent of total Billed Charges,89% of total Billed charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,58.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.75,127.27,
Autfrift Implnt Knww W/Scope,P991502303,CDM,521,RC,29866,HCPCS,Outpatient,,,1951,975.5,,1502.27,77,,,Percent of Total Billed Charges,77% of total billed charges,497.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,609.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1736.39,89,,,Percent of total Billed Charges,89% of total Billed charges,1736.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1736.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,796.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,796.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,796.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.27,77,,,Percent of total Billed charges,77% of total billed charges,1658.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,560.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,796.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,487.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,487.75,1736.39,
Complex E/M Visit Add On,P991502304,CDM,521,RC,G2211,HCPCS,Outpatient,,,31,15.5,,23.87,77,,,Percent of Total Billed Charges,77% of total billed charges,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,27.59,89,,,Percent of total Billed Charges,89% of total Billed charges,27.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.87,77,,,Percent of total Billed charges,77% of total billed charges,26.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,12.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.59,
Bil Manip Under Anes/Jt Shldr,P991502305,CDM,521,RC,23700,HCPCS,Outpatient,,,740,370,50,569.8,77,,,Percent of Total Billed Charges,77% of total billed charges,188.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,658.6,89,,,Percent of total Billed Charges,89% of total Billed charges,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.8,77,,,Percent of total Billed charges,77% of total billed charges,629,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,212.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,301.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185,658.6,
Ablate Inf Turbinate Superf,P991502306,CDM,521,RC,30801,HCPCS,Outpatient,,,383,191.5,,294.91,77,,,Percent of Total Billed Charges,77% of total billed charges,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,340.87,89,,,Percent of total Billed Charges,89% of total Billed charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.91,77,,,Percent of total Billed charges,77% of total billed charges,325.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,156.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.75,340.87,
Nsl Sinus Ndscrf Abltj Pnn,P991502307,CDM,521,RC,31242,HCPCS,Outpatient,,,4251,2125.5,,3273.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1084.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1084.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1062.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3783.39,89,,,Percent of total Billed Charges,89% of total Billed charges,3783.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3783.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1734.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1734.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1734.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1062.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3273.27,77,,,Percent of total Billed charges,77% of total billed charges,3613.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1222.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1734.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1062.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1062.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1062.75,3783.39,
Rpr Aa Hrn >10Ncr Strn,P991502308,CDM,521,RC,49618,HCPCS,Outpatient,,,2337,1168.5,,1799.49,77,,,Percent of Total Billed Charges,77% of total billed charges,595.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,730.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2079.93,89,,,Percent of total Billed Charges,89% of total Billed charges,2079.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2079.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,953.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,953.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,953.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1799.49,77,,,Percent of total Billed charges,77% of total billed charges,1986.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,671.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,953.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,584.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,584.25,2079.93,
Loop recorder interrogation,P991502310,CDM,521,RC,93298,HCPCS,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
Drain External Ear Leasion,P991502313,CDM,521,RC,69005,HCPCS,Outpatient,,,302,151,,232.54,77,,,Percent of Total Billed Charges,77% of total billed charges,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,268.78,89,,,Percent of total Billed Charges,89% of total Billed charges,268.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.54,77,,,Percent of total Billed charges,77% of total billed charges,256.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,123.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.5,268.78,
LAP Colectonmy part w/ileum,P991502314,CDM,521,RC,44205,HCPCS,Outpatient,,,3789,1894.5,,2917.53,77,,,Percent of Total Billed Charges,77% of total billed charges,966.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,966.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1184.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,947.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3372.21,89,,,Percent of total Billed Charges,89% of total Billed charges,3372.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3372.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1545.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1545.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1545.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,947.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2917.53,77,,,Percent of total Billed charges,77% of total billed charges,3220.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1089.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1545.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,947.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,947.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,947.25,3372.21,
Remove Forearem foreign body,P991502315,CDM,521,RC,25248,HCPCS,Outpatient,,,803,401.5,,618.31,77,,,Percent of Total Billed Charges,77% of total billed charges,204.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,200.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,714.67,89,,,Percent of total Billed Charges,89% of total Billed charges,714.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,714.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,327.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,327.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,618.31,77,,,Percent of total Billed charges,77% of total billed charges,682.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,327.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,200.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.75,714.67,
Colonoscopy submucous NJX,P991502316,CDM,521,RC,45381,HCPCS,Outpatient,,,617,308.5,,475.09,77,,,Percent of Total Billed Charges,77% of total billed charges,157.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,549.13,89,,,Percent of total Billed Charges,89% of total Billed charges,549.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.09,77,,,Percent of total Billed charges,77% of total billed charges,524.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,251.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,154.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.25,549.13,
N block inj common digit,P991502318,CDM,521,RC,64632,HCPCS,Outpatient,,,184,92,,141.68,77,,,Percent of Total Billed Charges,77% of total billed charges,46.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,163.76,89,,,Percent of total Billed Charges,89% of total Billed charges,163.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.68,77,,,Percent of total Billed charges,77% of total billed charges,156.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,163.76,
Electrogastrography Interpret,P991502319,CDM,521,RC,91132,HCPCS,Outpatient,,,55,27.5,26,42.35,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,48.95,89,,,Percent of total Billed Charges,89% of total Billed charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,77,,,Percent of total Billed charges,77% of total billed charges,46.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.95,
Nerve condt test 13/> studies,P991502320,CDM,521,RC,95913,HCPCS,Outpatient,,,571,285.5,,439.67,77,,,Percent of Total Billed Charges,77% of total billed charges,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,508.19,89,,,Percent of total Billed Charges,89% of total Billed charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96,120,,,Fee Schedule,120% of MO Medicaid Rate,96,120,,,Fee Schedule,120% of MO Medicaid Rate,96,120,,,Fee Schedule,120% of MO of Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439.67,77,,,Percent of total Billed charges,77% of total billed charges,485.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,164.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,96,120,,,Fee Schedule,120% of MO Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,508.19,
Drainage of pelvis bursa,P991502321,CDM,521,RC,26991,HCPCS,Outpatient,,,1305,652.5,,1004.85,77,,,Percent of Total Billed Charges,77% of total billed charges,332.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,407.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1161.45,89,,,Percent of total Billed Charges,89% of total Billed charges,1161.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1161.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1004.85,77,,,Percent of total Billed charges,77% of total billed charges,1109.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,375.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,532.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,326.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.25,1161.45,
Rmvl FB upperarm/elbow deep,P991502322,CDM,521,RC,24201,HCPCS,Outpatient,,,754,377,,580.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,188.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,671.06,89,,,Percent of total Billed Charges,89% of total Billed charges,671.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.58,77,,,Percent of total Billed charges,77% of total billed charges,640.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,307.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,188.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.5,671.06,
Ex Arm/Elbow TUM dep 5 CM,P991502323,CDM,521,RC,24073,HCPCS,Outpatient,,,1312,656,,1010.24,77,,,Percent of Total Billed Charges,77% of total billed charges,334.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,334.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,410,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,328,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1167.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1167.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1167.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,535.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,535.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.24,77,,,Percent of total Billed charges,77% of total billed charges,1115.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,377.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,535.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,328,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,328,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328,1167.68,
EXC Leg/Ankle TUM DEP 5 CM,P991502324,CDM,521,RC,27634,HCPCS,Outpatient,,,1274,637,,980.98,77,,,Percent of Total Billed Charges,77% of total billed charges,324.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,318.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1133.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1133.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1133.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,519.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,519.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,519.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,980.98,77,,,Percent of total Billed charges,77% of total billed charges,1082.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,366.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,519.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,318.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.5,1133.86,
Exc forearm tum deep 3 cm/>,P991502325,CDM,521,RC,25073,HCPCS,Outpatient,,,1012,506,,779.24,77,,,Percent of Total Billed Charges,77% of total billed charges,258.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,316.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,253,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,900.68,89,,,Percent of total Billed Charges,89% of total Billed charges,900.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,900.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,412.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,779.24,77,,,Percent of total Billed charges,77% of total billed charges,860.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,290.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,412.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,253,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,253,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253,900.68,
Ligation Sphenopalatine artery,P991502328,CDM,521,RC,31241,HCPCS,Outpatient,,,843,421.5,,649.11,77,,,Percent of Total Billed Charges,77% of total billed charges,214.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,210.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,750.27,89,,,Percent of total Billed Charges,89% of total Billed charges,750.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,750.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,343.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.11,77,,,Percent of total Billed charges,77% of total billed charges,716.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,343.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,210.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.75,750.27,
Colectomy/coloproctostomy,P991502345,CDM,521,RC,44207,HCPCS,Outpatient,,,3428,1714,,2639.56,77,,,Percent of Total Billed Charges,77% of total billed charges,874.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,874.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1071.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,857,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,3050.92,89,,,Percent of total Billed Charges,89% of total Billed charges,3050.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3050.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1398.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,857,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2639.56,77,,,Percent of total Billed charges,77% of total billed charges,2913.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,985.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1398.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,857,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,857,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,857,3050.92,
MAM NEEDLE HOMER 6.4,S300450001,CDM,270,RC,,,Outpatient,,,174.5,87.25,,134.37,77,,,Percent of Total Billed Charges,77% of total billed charges,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.13,74,,,Percent of Total Billed Charges,74% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,146.58,84,,,Percent of Total Billed Charges,84% of total billed charges,143.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.31,89,,,Percent of total Billed Charges,89% of total Billed charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.37,77,,,Percent of total Billed charges,77% of total billed charges,148.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.63,155.31,
"Prevention Mattress, per day",S990010000,CDM,270,RC,,,Outpatient,,,245,122.5,,188.65,77,,,Percent of Total Billed Charges,77% of total billed charges,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.3,74,,,Percent of Total Billed Charges,74% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,205.8,84,,,Percent of Total Billed Charges,84% of total billed charges,200.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.05,89,,,Percent of total Billed Charges,89% of total Billed charges,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.65,77,,,Percent of total Billed charges,77% of total billed charges,208.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.05,
BUCK'S TRACTION PROCEDURE,S990010001,CDM,270,RC,,,Outpatient,,,393.5,196.75,,303,77,,,Percent of Total Billed Charges,77% of total billed charges,100.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,291.19,74,,,Percent of Total Billed Charges,74% of total billed charges,271.52,69,,,Percent of Total Billed Charges,69% of total billed charges,271.52,69,,,Percent of Total Billed Charges,69% of total billed charges,98.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.52,69,,,Percent of Total Billed Charges,69% of total billed charges,271.52,69,,,Percent of Total Billed Charges,69% of total billed charges,330.54,84,,,Percent of Total Billed Charges,84% of total billed charges,322.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,350.22,89,,,Percent of total Billed Charges,89% of total Billed charges,350.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303,77,,,Percent of total Billed charges,77% of total billed charges,334.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,196.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,160.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.38,350.22,
O2 PER HOUR 1ST HR,S990010002,CDM,270,RC,,,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.77,89,,,Percent of total Billed Charges,89% of total Billed charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.77,
O2 SUBS HR(s),S990010003,CDM,270,RC,,,Outpatient,,,46,23,,35.42,77,,,Percent of Total Billed Charges,77% of total billed charges,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.04,74,,,Percent of Total Billed Charges,74% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,84,,,Percent of Total Billed Charges,84% of total billed charges,37.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.94,89,,,Percent of total Billed Charges,89% of total Billed charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.42,77,,,Percent of total Billed charges,77% of total billed charges,39.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,40.94,
DELEE SUCTION,S990100001,CDM,270,RC,,,Outpatient,,,38.5,19.25,,29.65,77,,,Percent of Total Billed Charges,77% of total billed charges,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.49,74,,,Percent of Total Billed Charges,74% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,32.34,84,,,Percent of Total Billed Charges,84% of total billed charges,31.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.27,89,,,Percent of total Billed Charges,89% of total Billed charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.65,77,,,Percent of total Billed charges,77% of total billed charges,32.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,34.27,
FHR EVAL,S990100002,CDM,270,RC,,,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.54,89,,,Percent of total Billed Charges,89% of total Billed charges,76.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,76.54,
NITRAZINE TEST,S990100003,CDM,270,RC,,,Outpatient,,,56,28,,43.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.44,74,,,Percent of Total Billed Charges,74% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,84,,,Percent of Total Billed Charges,84% of total billed charges,45.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.84,89,,,Percent of total Billed Charges,89% of total Billed charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.12,77,,,Percent of total Billed charges,77% of total billed charges,47.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,49.84,
IMMUNIZATION INJ ADM,S990140001,CDM,771,RC,90471,HCPCS,Outpatient,,,94.5,47.25,,72.77,77,,,Percent of Total Billed Charges,77% of total billed charges,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.93,74,,,Percent of Total Billed Charges,74% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,84,,,Percent of Total Billed Charges,84% of total billed charges,77.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.11,89,,,Percent of total Billed Charges,89% of total Billed charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.77,77,,,Percent of total Billed charges,77% of total billed charges,80.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,38.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.63,84.11,
BLOOD GLUCOSE CHECK PROC,S990140002,CDM,270,RC,,,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.4,74,,,Percent of Total Billed Charges,74% of total billed charges,41.4,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,69,,,Percent of Total Billed Charges,69% of total billed charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.4,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,69,,,Percent of Total Billed Charges,69% of total billed charges,50.4,84,,,Percent of Total Billed Charges,84% of total billed charges,49.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.4,89,,,Percent of total Billed Charges,89% of total Billed charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,53.4,
NURSERY 02 PER HR/1ST HOUR,S990140003,CDM,270,RC,,,Outpatient,,,96.5,48.25,,74.31,77,,,Percent of Total Billed Charges,77% of total billed charges,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.41,74,,,Percent of Total Billed Charges,74% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,81.06,84,,,Percent of Total Billed Charges,84% of total billed charges,79.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.89,89,,,Percent of total Billed Charges,89% of total Billed charges,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.31,77,,,Percent of total Billed charges,77% of total billed charges,82.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.13,85.89,
NURSERY O2 PER HR/SUBS,S990140004,CDM,270,RC,,,Outpatient,,,38.5,19.25,,29.65,77,,,Percent of Total Billed Charges,77% of total billed charges,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.49,74,,,Percent of Total Billed Charges,74% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,32.34,84,,,Percent of Total Billed Charges,84% of total billed charges,31.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.27,89,,,Percent of total Billed Charges,89% of total Billed charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.65,77,,,Percent of total Billed charges,77% of total billed charges,32.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,34.27,
OXYHOOD-O2 1ST HOUR,S990140005,CDM,270,RC,,,Outpatient,,,96.5,48.25,,74.31,77,,,Percent of Total Billed Charges,77% of total billed charges,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.41,74,,,Percent of Total Billed Charges,74% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,81.06,84,,,Percent of Total Billed Charges,84% of total billed charges,79.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.89,89,,,Percent of total Billed Charges,89% of total Billed charges,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.31,77,,,Percent of total Billed charges,77% of total billed charges,82.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.13,85.89,
OXYHOOD-O2 SUBS,S990140006,CDM,270,RC,,,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.26,74,,,Percent of Total Billed Charges,74% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.16,84,,,Percent of Total Billed Charges,84% of total billed charges,40.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
PHOTOTHERAPY PROC 1ST HR,S990140007,CDM,270,RC,,,Outpatient,,,273,136.5,,210.21,77,,,Percent of Total Billed Charges,77% of total billed charges,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,202.02,74,,,Percent of Total Billed Charges,74% of total billed charges,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,229.32,84,,,Percent of Total Billed Charges,84% of total billed charges,223.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,242.97,89,,,Percent of total Billed Charges,89% of total Billed charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.21,77,,,Percent of total Billed charges,77% of total billed charges,232.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,242.97,
PHOTOTHERAPY PROC SUBS HR,S990140008,CDM,270,RC,,,Outpatient,,,29,14.5,,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.46,74,,,Percent of Total Billed Charges,74% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24.36,84,,,Percent of Total Billed Charges,84% of total billed charges,23.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.81,89,,,Percent of total Billed Charges,89% of total Billed charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,25.81,
THERMAL SUPPORT (EA HOUR),S990140009,CDM,270,RC,,,Outpatient,,,58.5,29.25,,45.05,77,,,Percent of Total Billed Charges,77% of total billed charges,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.29,74,,,Percent of Total Billed Charges,74% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,49.14,84,,,Percent of Total Billed Charges,84% of total billed charges,47.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.07,89,,,Percent of total Billed Charges,89% of total Billed charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,77,,,Percent of total Billed charges,77% of total billed charges,49.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,52.07,
5MM SHARP HOOK,S990220001,CDM,272,RC,,,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.72,74,,,Percent of Total Billed Charges,74% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,113.92,
ADVINCULAR DELINEATOR,S990220002,CDM,272,RC,,,Outpatient,,,335.5,167.75,,258.34,77,,,Percent of Total Billed Charges,77% of total billed charges,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,248.27,74,,,Percent of Total Billed Charges,74% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,281.82,84,,,Percent of Total Billed Charges,84% of total billed charges,275.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,298.6,89,,,Percent of total Billed Charges,89% of total Billed charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.34,77,,,Percent of total Billed charges,77% of total billed charges,285.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,167.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.88,298.6,
ALEXIS CONTAINMENT SYSTEM,S990220003,CDM,272,RC,,,Outpatient,,,566,283,,435.82,77,,,Percent of Total Billed Charges,77% of total billed charges,144.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,418.84,74,,,Percent of Total Billed Charges,74% of total billed charges,390.54,69,,,Percent of Total Billed Charges,69% of total billed charges,390.54,69,,,Percent of Total Billed Charges,69% of total billed charges,141.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.54,69,,,Percent of Total Billed Charges,69% of total billed charges,390.54,69,,,Percent of Total Billed Charges,69% of total billed charges,475.44,84,,,Percent of Total Billed Charges,84% of total billed charges,464.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,503.74,89,,,Percent of total Billed Charges,89% of total Billed charges,503.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,503.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.82,77,,,Percent of total Billed charges,77% of total billed charges,481.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,162.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,283,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,230.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.5,503.74,
ALEXIS RETRACTOR C8401,S990220004,CDM,272,RC,,,Outpatient,,,94.5,47.25,,72.77,77,,,Percent of Total Billed Charges,77% of total billed charges,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.93,74,,,Percent of Total Billed Charges,74% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,84,,,Percent of Total Billed Charges,84% of total billed charges,77.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.11,89,,,Percent of total Billed Charges,89% of total Billed charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.77,77,,,Percent of total Billed charges,77% of total billed charges,80.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.63,84.11,
ALTRUS THERMAL TIS FUSION SYS,S990220005,CDM,272,RC,,,Outpatient,,,1668.5,834.25,,1284.75,77,,,Percent of Total Billed Charges,77% of total billed charges,425.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,425.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1234.69,74,,,Percent of Total Billed Charges,74% of total billed charges,1151.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1151.27,69,,,Percent of Total Billed Charges,69% of total billed charges,417.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1151.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1151.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1401.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1368.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,1484.97,89,,,Percent of total Billed Charges,89% of total Billed charges,1484.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1484.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,417.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1284.75,77,,,Percent of total Billed charges,77% of total billed charges,1418.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,479.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,834.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,680.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,417.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1484.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,417.13,1484.97,
AMPLATZ RENAL DIALTOR,S990220006,CDM,272,RC,,,Outpatient,,,739,369.5,,569.03,77,,,Percent of Total Billed Charges,77% of total billed charges,188.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,546.86,74,,,Percent of Total Billed Charges,74% of total billed charges,509.91,69,,,Percent of Total Billed Charges,69% of total billed charges,509.91,69,,,Percent of Total Billed Charges,69% of total billed charges,184.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,509.91,69,,,Percent of Total Billed Charges,69% of total billed charges,509.91,69,,,Percent of Total Billed Charges,69% of total billed charges,620.76,84,,,Percent of Total Billed Charges,84% of total billed charges,605.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,657.71,89,,,Percent of total Billed Charges,89% of total Billed charges,657.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,657.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.03,77,,,Percent of total Billed charges,77% of total billed charges,628.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,212.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,369.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,301.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,184.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.75,657.71,
ANKLE DISTRACTOR,S990220007,CDM,279,RC,,,Outpatient,,,72.5,36.25,,55.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.65,74,,,Percent of Total Billed Charges,74% of total billed charges,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,60.9,84,,,Percent of Total Billed Charges,84% of total billed charges,59.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.53,89,,,Percent of total Billed Charges,89% of total Billed charges,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.83,77,,,Percent of total Billed charges,77% of total billed charges,61.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.13,64.53,
AQUACEL 3X14,S990220008,CDM,272,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
AQUACEL 3X4,S990220009,CDM,272,RC,,,Outpatient,,,58.5,29.25,,45.05,77,,,Percent of Total Billed Charges,77% of total billed charges,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.29,74,,,Percent of Total Billed Charges,74% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,49.14,84,,,Percent of Total Billed Charges,84% of total billed charges,47.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.07,89,,,Percent of total Billed Charges,89% of total Billed charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,77,,,Percent of total Billed charges,77% of total billed charges,49.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,52.07,
AQUACEL 3X9,S990220010,CDM,272,RC,,,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.75,74,,,Percent of Total Billed Charges,74% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,84,,,Percent of Total Billed Charges,84% of total billed charges,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.88,89,,,Percent of total Billed Charges,89% of total Billed charges,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.88,77.88,
AQUACEL 9X15 AG SILV,S990220011,CDM,272,RC,,,Outpatient,,,58.5,29.25,,45.05,77,,,Percent of Total Billed Charges,77% of total billed charges,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.29,74,,,Percent of Total Billed Charges,74% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,49.14,84,,,Percent of Total Billed Charges,84% of total billed charges,47.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.07,89,,,Percent of total Billed Charges,89% of total Billed charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,77,,,Percent of total Billed charges,77% of total billed charges,49.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,52.07,
AR-3638DS FiberTak Kit,S990220012,CDM,272,RC,,,Outpatient,,,928.5,464.25,,714.95,77,,,Percent of Total Billed Charges,77% of total billed charges,236.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,687.09,74,,,Percent of Total Billed Charges,74% of total billed charges,640.67,69,,,Percent of Total Billed Charges,69% of total billed charges,640.67,69,,,Percent of Total Billed Charges,69% of total billed charges,232.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.67,69,,,Percent of Total Billed Charges,69% of total billed charges,640.67,69,,,Percent of Total Billed Charges,69% of total billed charges,779.94,84,,,Percent of Total Billed Charges,84% of total billed charges,761.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,826.37,89,,,Percent of total Billed Charges,89% of total Billed charges,826.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,378.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,378.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,714.95,77,,,Percent of total Billed charges,77% of total billed charges,789.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,266.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,464.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,378.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,826.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.13,826.37,
AR-4068-05SD Suture Wire,S990220013,CDM,272,RC,,,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.14,89,,,Percent of total Billed Charges,89% of total Billed charges,108.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.38,108.14,
AR-6068-45L Deg Lasso,S990220014,CDM,272,RC,,,Outpatient,,,693,346.5,,533.61,77,,,Percent of Total Billed Charges,77% of total billed charges,176.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,512.82,74,,,Percent of Total Billed Charges,74% of total billed charges,478.17,69,,,Percent of Total Billed Charges,69% of total billed charges,478.17,69,,,Percent of Total Billed Charges,69% of total billed charges,173.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.17,69,,,Percent of Total Billed Charges,69% of total billed charges,478.17,69,,,Percent of Total Billed Charges,69% of total billed charges,582.12,84,,,Percent of Total Billed Charges,84% of total billed charges,568.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,616.77,89,,,Percent of total Billed Charges,89% of total Billed charges,616.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,616.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,282.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.61,77,,,Percent of total Billed charges,77% of total billed charges,589.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,199.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,346.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,282.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,173.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.25,616.77,
AR-6570 Cannula,S990220015,CDM,272,RC,,,Outpatient,,,182,91,,140.14,77,,,Percent of Total Billed Charges,77% of total billed charges,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.68,74,,,Percent of Total Billed Charges,74% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,152.88,84,,,Percent of Total Billed Charges,84% of total billed charges,149.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.98,89,,,Percent of total Billed Charges,89% of total Billed charges,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.14,77,,,Percent of total Billed charges,77% of total billed charges,154.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.5,161.98,
AR-FIBERTAK RC KIT,S990220016,CDM,272,RC,,,Outpatient,,,844,422,,649.88,77,,,Percent of Total Billed Charges,77% of total billed charges,215.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,624.56,74,,,Percent of Total Billed Charges,74% of total billed charges,582.36,69,,,Percent of Total Billed Charges,69% of total billed charges,582.36,69,,,Percent of Total Billed Charges,69% of total billed charges,211,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.36,69,,,Percent of Total Billed Charges,69% of total billed charges,582.36,69,,,Percent of Total Billed Charges,69% of total billed charges,708.96,84,,,Percent of Total Billed Charges,84% of total billed charges,692.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,751.16,89,,,Percent of total Billed Charges,89% of total Billed charges,751.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,751.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.88,77,,,Percent of total Billed charges,77% of total billed charges,717.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,422,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,344.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,211,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,751.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211,751.16,
ARM PROTECTOR TRENDEL,S990220017,CDM,270,RC,,,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.22,74,,,Percent of Total Billed Charges,74% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,44.52,84,,,Percent of Total Billed Charges,84% of total billed charges,43.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.17,89,,,Percent of total Billed Charges,89% of total Billed charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.17,
ARTHOCARE SPEED STITCH NEEDLE,S990220018,CDM,272,RC,,,Outpatient,,,107,53.5,,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.18,74,,,Percent of Total Billed Charges,74% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,89.88,84,,,Percent of Total Billed Charges,84% of total billed charges,87.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.23,89,,,Percent of total Billed Charges,89% of total Billed charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,95.23,
ARTHREX AR-8850 C-Line Endo In,S990220019,CDM,272,RC,,,Outpatient,,,348,174,,267.96,77,,,Percent of Total Billed Charges,77% of total billed charges,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,257.52,74,,,Percent of Total Billed Charges,74% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,292.32,84,,,Percent of Total Billed Charges,84% of total billed charges,285.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.72,89,,,Percent of total Billed Charges,89% of total Billed charges,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.96,77,,,Percent of total Billed charges,77% of total billed charges,295.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87,309.72,
ARTHREX Biceps Tend Graft Size,S990220020,CDM,272,RC,,,Outpatient,,,479,239.5,,368.83,77,,,Percent of Total Billed Charges,77% of total billed charges,122.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.46,74,,,Percent of Total Billed Charges,74% of total billed charges,330.51,69,,,Percent of Total Billed Charges,69% of total billed charges,330.51,69,,,Percent of Total Billed Charges,69% of total billed charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.51,69,,,Percent of Total Billed Charges,69% of total billed charges,330.51,69,,,Percent of Total Billed Charges,69% of total billed charges,402.36,84,,,Percent of Total Billed Charges,84% of total billed charges,392.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.31,89,,,Percent of total Billed Charges,89% of total Billed charges,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.83,77,,,Percent of total Billed charges,77% of total billed charges,407.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.75,426.31,
ARTHREX Biceps Tendon Reamer,S990220021,CDM,272,RC,,,Outpatient,,,320,160,,246.4,77,,,Percent of Total Billed Charges,77% of total billed charges,81.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.8,74,,,Percent of Total Billed Charges,74% of total billed charges,220.8,69,,,Percent of Total Billed Charges,69% of total billed charges,220.8,69,,,Percent of Total Billed Charges,69% of total billed charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.8,69,,,Percent of Total Billed Charges,69% of total billed charges,220.8,69,,,Percent of Total Billed Charges,69% of total billed charges,268.8,84,,,Percent of Total Billed Charges,84% of total billed charges,262.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.8,89,,,Percent of total Billed Charges,89% of total Billed charges,284.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.4,77,,,Percent of total Billed charges,77% of total billed charges,272,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,160,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,284.8,
ARTHREX CHONDRAL DART KIT,S990220022,CDM,272,RC,,,Outpatient,,,941,470.5,,724.57,77,,,Percent of Total Billed Charges,77% of total billed charges,239.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,294.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,696.34,74,,,Percent of Total Billed Charges,74% of total billed charges,649.29,69,,,Percent of Total Billed Charges,69% of total billed charges,649.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,649.29,69,,,Percent of Total Billed Charges,69% of total billed charges,649.29,69,,,Percent of Total Billed Charges,69% of total billed charges,790.44,84,,,Percent of Total Billed Charges,84% of total billed charges,771.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,837.49,89,,,Percent of total Billed Charges,89% of total Billed charges,837.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,837.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.57,77,,,Percent of total Billed charges,77% of total billed charges,799.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,470.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,235.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,837.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.25,837.49,
"ARTHREX Fibertape 17""w/STR NDL",S990220023,CDM,272,RC,,,Outpatient,,,342,171,,263.34,77,,,Percent of Total Billed Charges,77% of total billed charges,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,253.08,74,,,Percent of Total Billed Charges,74% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,287.28,84,,,Percent of Total Billed Charges,84% of total billed charges,280.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,304.38,89,,,Percent of total Billed Charges,89% of total Billed charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.34,77,,,Percent of total Billed charges,77% of total billed charges,290.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,171,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.5,304.38,
ARTHREX HIP ARTHRO KIT W/BLADE,S990220024,CDM,272,RC,,,Outpatient,,,909,454.5,,699.93,77,,,Percent of Total Billed Charges,77% of total billed charges,231.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,672.66,74,,,Percent of Total Billed Charges,74% of total billed charges,627.21,69,,,Percent of Total Billed Charges,69% of total billed charges,627.21,69,,,Percent of Total Billed Charges,69% of total billed charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,627.21,69,,,Percent of Total Billed Charges,69% of total billed charges,627.21,69,,,Percent of Total Billed Charges,69% of total billed charges,763.56,84,,,Percent of Total Billed Charges,84% of total billed charges,745.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,809.01,89,,,Percent of total Billed Charges,89% of total Billed charges,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,699.93,77,,,Percent of total Billed charges,77% of total billed charges,772.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,261.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,454.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,370.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,809.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.25,809.01,
ARTHREX ORTHO DISP KIT,S990220025,CDM,272,RC,,,Outpatient,,,570,285,,438.9,77,,,Percent of Total Billed Charges,77% of total billed charges,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,421.8,74,,,Percent of Total Billed Charges,74% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,478.8,84,,,Percent of Total Billed Charges,84% of total billed charges,467.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,507.3,89,,,Percent of total Billed Charges,89% of total Billed charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.9,77,,,Percent of total Billed charges,77% of total billed charges,484.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,285,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.5,507.3,
ARTHREX PRP KIT,S990220026,CDM,272,RC,,,Outpatient,,,2012,1006,,1549.24,77,,,Percent of Total Billed Charges,77% of total billed charges,513.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,513.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,628.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1488.88,74,,,Percent of Total Billed Charges,74% of total billed charges,1388.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.28,69,,,Percent of Total Billed Charges,69% of total billed charges,503,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1690.08,84,,,Percent of Total Billed Charges,84% of total billed charges,1649.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1790.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1790.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,503,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1549.24,77,,,Percent of total Billed charges,77% of total billed charges,1710.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,578.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1006,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,820.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,503,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,503,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503,1790.68,
ARTHREX REAMER,S990220027,CDM,272,RC,,,Outpatient,,,587.5,293.75,,452.38,77,,,Percent of Total Billed Charges,77% of total billed charges,149.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,434.75,74,,,Percent of Total Billed Charges,74% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,493.5,84,,,Percent of Total Billed Charges,84% of total billed charges,481.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,522.88,89,,,Percent of total Billed Charges,89% of total Billed charges,522.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,522.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,239.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.38,77,,,Percent of total Billed charges,77% of total billed charges,499.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,293.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,239.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.88,522.88,
"ARTHREX SUTURE PASSER, TRANSOS",S990220028,CDM,272,RC,,,Outpatient,,,108.5,54.25,,83.55,77,,,Percent of Total Billed Charges,77% of total billed charges,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.29,74,,,Percent of Total Billed Charges,74% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,91.14,84,,,Percent of Total Billed Charges,84% of total billed charges,88.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.57,89,,,Percent of total Billed Charges,89% of total Billed charges,96.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.55,77,,,Percent of total Billed charges,77% of total billed charges,92.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.13,96.57,
ARTHREX TIBIAL ACL W/SAWBLADE,S990220029,CDM,272,RC,,,Outpatient,,,456,228,,351.12,77,,,Percent of Total Billed Charges,77% of total billed charges,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,337.44,74,,,Percent of Total Billed Charges,74% of total billed charges,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,383.04,84,,,Percent of Total Billed Charges,84% of total billed charges,373.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,405.84,89,,,Percent of total Billed Charges,89% of total Billed charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.12,77,,,Percent of total Billed charges,77% of total billed charges,387.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,228,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114,405.84,
ARTHREX TIGER STICK AR-7209T,S990220030,CDM,272,RC,,,Outpatient,,,107,53.5,,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.18,74,,,Percent of Total Billed Charges,74% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,89.88,84,,,Percent of Total Billed Charges,84% of total billed charges,87.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.23,89,,,Percent of total Billed Charges,89% of total Billed charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,95.23,
ARTHREX TIGER TAPE AR-7237-7T,S990220031,CDM,272,RC,,,Outpatient,,,150.5,75.25,,115.89,77,,,Percent of Total Billed Charges,77% of total billed charges,38.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.37,74,,,Percent of Total Billed Charges,74% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,126.42,84,,,Percent of Total Billed Charges,84% of total billed charges,123.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.95,89,,,Percent of total Billed Charges,89% of total Billed charges,133.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.89,77,,,Percent of total Billed charges,77% of total billed charges,127.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.63,133.95,
ASTRIN GYN,S990220032,CDM,272,RC,,,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.26,74,,,Percent of Total Billed Charges,74% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.16,84,,,Percent of Total Billed Charges,84% of total billed charges,40.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
BASKET ZERO TIP,S990220033,CDM,270,RC,,,Outpatient,,,576,288,,443.52,77,,,Percent of Total Billed Charges,77% of total billed charges,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,426.24,74,,,Percent of Total Billed Charges,74% of total billed charges,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,483.84,84,,,Percent of Total Billed Charges,84% of total billed charges,472.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,512.64,89,,,Percent of total Billed Charges,89% of total Billed charges,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443.52,77,,,Percent of total Billed charges,77% of total billed charges,489.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,288,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,512.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144,512.64,
BIO PREP BONE KIT,S990220034,CDM,272,RC,,,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.38,74,,,Percent of Total Billed Charges,74% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,283.08,84,,,Percent of Total Billed Charges,84% of total billed charges,276.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.93,89,,,Percent of total Billed Charges,89% of total Billed charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.25,299.93,
BIOMET CALIBRATED DRILL,S990220035,CDM,272,RC,,,Outpatient,,,506,253,,389.62,77,,,Percent of Total Billed Charges,77% of total billed charges,129.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,374.44,74,,,Percent of Total Billed Charges,74% of total billed charges,349.14,69,,,Percent of Total Billed Charges,69% of total billed charges,349.14,69,,,Percent of Total Billed Charges,69% of total billed charges,126.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.14,69,,,Percent of Total Billed Charges,69% of total billed charges,349.14,69,,,Percent of Total Billed Charges,69% of total billed charges,425.04,84,,,Percent of Total Billed Charges,84% of total billed charges,414.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,450.34,89,,,Percent of total Billed Charges,89% of total Billed charges,450.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,389.62,77,,,Percent of total Billed charges,77% of total billed charges,430.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,253,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,206.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.5,450.34,
BIOMET ONE STEP REAMER,S990220036,CDM,272,RC,,,Outpatient,,,1889.5,944.75,,1454.92,77,,,Percent of Total Billed Charges,77% of total billed charges,481.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,590.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1398.23,74,,,Percent of Total Billed Charges,74% of total billed charges,1303.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1303.76,69,,,Percent of Total Billed Charges,69% of total billed charges,472.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1303.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1303.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1587.18,84,,,Percent of Total Billed Charges,84% of total billed charges,1549.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,1681.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1681.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1681.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,770.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,770.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,770.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,472.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1454.92,77,,,Percent of total Billed charges,77% of total billed charges,1606.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,543.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,944.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,770.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,472.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1681.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,472.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.38,1681.66,
BIOMET QUATTRO SUTURE PASSER,S990220037,CDM,272,RC,,,Outpatient,,,322.5,161.25,,248.33,77,,,Percent of Total Billed Charges,77% of total billed charges,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,238.65,74,,,Percent of Total Billed Charges,74% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,270.9,84,,,Percent of Total Billed Charges,84% of total billed charges,264.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.03,89,,,Percent of total Billed Charges,89% of total Billed charges,287.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.33,77,,,Percent of total Billed charges,77% of total billed charges,274.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.63,287.03,
BIOPATCH BLUE DISK,S990220038,CDM,272,RC,,,Outpatient,,,33,16.5,,25.41,77,,,Percent of Total Billed Charges,77% of total billed charges,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.42,74,,,Percent of Total Billed Charges,74% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,27.72,84,,,Percent of Total Billed Charges,84% of total billed charges,27.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.37,89,,,Percent of total Billed Charges,89% of total Billed charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.41,77,,,Percent of total Billed charges,77% of total billed charges,28.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,29.37,
BIOPSY PORT SEAL ADJUSTER,S990220039,CDM,272,RC,,,Outpatient,,,37,18.5,,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.38,74,,,Percent of Total Billed Charges,74% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,31.08,84,,,Percent of Total Billed Charges,84% of total billed charges,30.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.93,89,,,Percent of total Billed Charges,89% of total Billed charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,32.93,
"BLADE, SAGITTAL 13mm",S990220040,CDM,272,RC,,,Outpatient,,,89.5,44.75,,68.92,77,,,Percent of Total Billed Charges,77% of total billed charges,22.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.23,74,,,Percent of Total Billed Charges,74% of total billed charges,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,75.18,84,,,Percent of Total Billed Charges,84% of total billed charges,73.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.66,89,,,Percent of total Billed Charges,89% of total Billed charges,79.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.92,77,,,Percent of total Billed charges,77% of total billed charges,76.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.38,79.66,
BME DRILL TRAY,S990220041,CDM,272,RC,,,Outpatient,,,855.5,427.75,,658.74,77,,,Percent of Total Billed Charges,77% of total billed charges,218.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,633.07,74,,,Percent of Total Billed Charges,74% of total billed charges,590.3,69,,,Percent of Total Billed Charges,69% of total billed charges,590.3,69,,,Percent of Total Billed Charges,69% of total billed charges,213.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.3,69,,,Percent of Total Billed Charges,69% of total billed charges,590.3,69,,,Percent of Total Billed Charges,69% of total billed charges,718.62,84,,,Percent of Total Billed Charges,84% of total billed charges,701.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,761.4,89,,,Percent of total Billed Charges,89% of total Billed charges,761.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,761.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,658.74,77,,,Percent of total Billed charges,77% of total billed charges,727.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,427.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,349.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.88,761.4,
BONE CEMENT MIXING SYSTEM,S990220042,CDM,272,RC,,,Outpatient,,,301,150.5,,231.77,77,,,Percent of Total Billed Charges,77% of total billed charges,76.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,222.74,74,,,Percent of Total Billed Charges,74% of total billed charges,207.69,69,,,Percent of Total Billed Charges,69% of total billed charges,207.69,69,,,Percent of Total Billed Charges,69% of total billed charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.69,69,,,Percent of Total Billed Charges,69% of total billed charges,207.69,69,,,Percent of Total Billed Charges,69% of total billed charges,252.84,84,,,Percent of Total Billed Charges,84% of total billed charges,246.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,267.89,89,,,Percent of total Billed Charges,89% of total Billed charges,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.77,77,,,Percent of total Billed charges,77% of total billed charges,255.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.25,267.89,
BONE CEMENT REFOBACIN,S990220043,CDM,272,RC,,,Outpatient,,,446.5,223.25,,343.81,77,,,Percent of Total Billed Charges,77% of total billed charges,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.41,74,,,Percent of Total Billed Charges,74% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,375.06,84,,,Percent of Total Billed Charges,84% of total billed charges,366.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.39,89,,,Percent of total Billed Charges,89% of total Billed charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.81,77,,,Percent of total Billed charges,77% of total billed charges,379.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.63,397.39,
BONE DOWEL REVISION KIT,S990220044,CDM,272,RC,,,Outpatient,,,4236,2118,,3261.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1080.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1080.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1323.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3134.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2922.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2922.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1059,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2922.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2922.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3558.24,84,,,Percent of Total Billed Charges,84% of total billed charges,3473.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3770.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3770.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3770.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1728.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1728.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1728.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1059,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3261.72,77,,,Percent of total Billed charges,77% of total billed charges,3600.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1217.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2118,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1728.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1059,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3770.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1059,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1059,3770.04,
BURR GREAT WHITE 4.8MM,S990220045,CDM,272,RC,,,Outpatient,,,142.5,71.25,,109.73,77,,,Percent of Total Billed Charges,77% of total billed charges,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.45,74,,,Percent of Total Billed Charges,74% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,119.7,84,,,Percent of Total Billed Charges,84% of total billed charges,116.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.83,89,,,Percent of total Billed Charges,89% of total Billed charges,126.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.73,77,,,Percent of total Billed charges,77% of total billed charges,121.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.63,126.83,
CALCIUM ALGINATE 4X4,S990220046,CDM,272,RC,,,Outpatient,,,30,15,,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.2,74,,,Percent of Total Billed Charges,74% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,25.2,84,,,Percent of Total Billed Charges,84% of total billed charges,24.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.7,89,,,Percent of total Billed Charges,89% of total Billed charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,26.7,
CALIBRATED REAMER,S990220047,CDM,272,RC,,,Outpatient,,,388,194,,298.76,77,,,Percent of Total Billed Charges,77% of total billed charges,98.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,287.12,74,,,Percent of Total Billed Charges,74% of total billed charges,267.72,69,,,Percent of Total Billed Charges,69% of total billed charges,267.72,69,,,Percent of Total Billed Charges,69% of total billed charges,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.72,69,,,Percent of Total Billed Charges,69% of total billed charges,267.72,69,,,Percent of Total Billed Charges,69% of total billed charges,325.92,84,,,Percent of Total Billed Charges,84% of total billed charges,318.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,345.32,89,,,Percent of total Billed Charges,89% of total Billed charges,345.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.76,77,,,Percent of total Billed charges,77% of total billed charges,329.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,194,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,158.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97,345.32,
CANNULA ARTHREX 8.25,S990220048,CDM,272,RC,,,Outpatient,,,85,42.5,,65.45,77,,,Percent of Total Billed Charges,77% of total billed charges,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.9,74,,,Percent of Total Billed Charges,74% of total billed charges,58.65,69,,,Percent of Total Billed Charges,69% of total billed charges,58.65,69,,,Percent of Total Billed Charges,69% of total billed charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.65,69,,,Percent of Total Billed Charges,69% of total billed charges,58.65,69,,,Percent of Total Billed Charges,69% of total billed charges,71.4,84,,,Percent of Total Billed Charges,84% of total billed charges,69.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.65,89,,,Percent of total Billed Charges,89% of total Billed charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.45,77,,,Percent of total Billed charges,77% of total billed charges,72.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,75.65,
CANNULA SET GREEN L/F,S990220049,CDM,270,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
CANNULA TERRY SQUEEGEE 27GA,S990220050,CDM,272,RC,,,Outpatient,,,28.5,14.25,,21.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,23.94,84,,,Percent of Total Billed Charges,84% of total billed charges,23.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.37,89,,,Percent of total Billed Charges,89% of total Billed charges,25.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.95,77,,,Percent of total Billed charges,77% of total billed charges,24.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.13,25.37,
CANULATED COUNTER SINK,S990220051,CDM,272,RC,,,Outpatient,,,1190,595,,916.3,77,,,Percent of Total Billed Charges,77% of total billed charges,303.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,371.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,880.6,74,,,Percent of Total Billed Charges,74% of total billed charges,821.1,69,,,Percent of Total Billed Charges,69% of total billed charges,821.1,69,,,Percent of Total Billed Charges,69% of total billed charges,297.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,821.1,69,,,Percent of Total Billed Charges,69% of total billed charges,821.1,69,,,Percent of Total Billed Charges,69% of total billed charges,999.6,84,,,Percent of Total Billed Charges,84% of total billed charges,975.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,1059.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1059.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1059.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,485.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,485.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,297.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,916.3,77,,,Percent of total Billed charges,77% of total billed charges,1011.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,342.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,595,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,485.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,297.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1059.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,297.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.5,1059.1,
CANULATED SCREW DRIVER,S990220052,CDM,272,RC,,,Outpatient,,,574.5,287.25,,442.37,77,,,Percent of Total Billed Charges,77% of total billed charges,146.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,425.13,74,,,Percent of Total Billed Charges,74% of total billed charges,396.41,69,,,Percent of Total Billed Charges,69% of total billed charges,396.41,69,,,Percent of Total Billed Charges,69% of total billed charges,143.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.41,69,,,Percent of Total Billed Charges,69% of total billed charges,396.41,69,,,Percent of Total Billed Charges,69% of total billed charges,482.58,84,,,Percent of Total Billed Charges,84% of total billed charges,471.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,511.31,89,,,Percent of total Billed Charges,89% of total Billed charges,511.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.37,77,,,Percent of total Billed charges,77% of total billed charges,488.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,287.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,234.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,143.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.63,511.31,
CARTER CLOSURE CTI-1015P,S990220053,CDM,272,RC,,,Outpatient,,,303.5,151.75,,233.7,77,,,Percent of Total Billed Charges,77% of total billed charges,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.59,74,,,Percent of Total Billed Charges,74% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,254.94,84,,,Percent of Total Billed Charges,84% of total billed charges,248.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.12,89,,,Percent of total Billed Charges,89% of total Billed charges,270.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.7,77,,,Percent of total Billed charges,77% of total billed charges,257.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.88,270.12,
CATH 5 FR 70 CM RETROGRADE,S990220054,CDM,272,RC,,,Outpatient,,,47.5,23.75,,36.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.15,74,,,Percent of Total Billed Charges,74% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.9,84,,,Percent of Total Billed Charges,84% of total billed charges,38.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.28,89,,,Percent of total Billed Charges,89% of total Billed charges,42.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.58,77,,,Percent of total Billed charges,77% of total billed charges,40.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,42.28,
CATH ANORECTAL EXPULSION,S990220055,CDM,272,RC,,,Outpatient,,,55.5,27.75,,42.74,77,,,Percent of Total Billed Charges,77% of total billed charges,14.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.07,74,,,Percent of Total Billed Charges,74% of total billed charges,38.3,69,,,Percent of Total Billed Charges,69% of total billed charges,38.3,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.3,69,,,Percent of Total Billed Charges,69% of total billed charges,38.3,69,,,Percent of Total Billed Charges,69% of total billed charges,46.62,84,,,Percent of Total Billed Charges,84% of total billed charges,45.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.4,89,,,Percent of total Billed Charges,89% of total Billed charges,49.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.74,77,,,Percent of total Billed charges,77% of total billed charges,47.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,49.4,
CATH BALLOON UROMAX,S990220056,CDM,272,RC,,,Outpatient,,,726.5,363.25,,559.41,77,,,Percent of Total Billed Charges,77% of total billed charges,185.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,537.61,74,,,Percent of Total Billed Charges,74% of total billed charges,501.29,69,,,Percent of Total Billed Charges,69% of total billed charges,501.29,69,,,Percent of Total Billed Charges,69% of total billed charges,181.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.29,69,,,Percent of Total Billed Charges,69% of total billed charges,501.29,69,,,Percent of Total Billed Charges,69% of total billed charges,610.26,84,,,Percent of Total Billed Charges,84% of total billed charges,595.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,646.59,89,,,Percent of total Billed Charges,89% of total Billed charges,646.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.41,77,,,Percent of total Billed charges,77% of total billed charges,617.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,363.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,296.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.63,646.59,
CATH BLADDER SMARTFLOW,S990220057,CDM,272,RC,,,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.82,74,,,Percent of Total Billed Charges,74% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.27,89,,,Percent of total Billed Charges,89% of total Billed charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.75,127.27,
CATH CERVIX RIPENING,S990220058,CDM,272,RC,,,Outpatient,,,79.5,39.75,,61.22,77,,,Percent of Total Billed Charges,77% of total billed charges,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.83,74,,,Percent of Total Billed Charges,74% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,66.78,84,,,Percent of Total Billed Charges,84% of total billed charges,65.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.76,89,,,Percent of total Billed Charges,89% of total Billed charges,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,77,,,Percent of total Billed charges,77% of total billed charges,67.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.88,70.76,
CATH CHOLANGIOGRAM 4.5,S990220059,CDM,272,RC,,,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.4,74,,,Percent of Total Billed Charges,74% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,92.4,84,,,Percent of Total Billed Charges,84% of total billed charges,90.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.9,89,,,Percent of total Billed Charges,89% of total Billed charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,97.9,
CATH URETHAL CONE TIP 5 FR,S990220060,CDM,272,RC,,,Outpatient,,,38.5,19.25,,29.65,77,,,Percent of Total Billed Charges,77% of total billed charges,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.49,74,,,Percent of Total Billed Charges,74% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,32.34,84,,,Percent of Total Billed Charges,84% of total billed charges,31.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.27,89,,,Percent of total Billed Charges,89% of total Billed charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.65,77,,,Percent of total Billed charges,77% of total billed charges,32.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,34.27,
CATH UTERINE BALLOON,S990220061,CDM,272,RC,,,Outpatient,,,1442.5,721.25,,1110.73,77,,,Percent of Total Billed Charges,77% of total billed charges,367.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,450.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1067.45,74,,,Percent of Total Billed Charges,74% of total billed charges,995.33,69,,,Percent of Total Billed Charges,69% of total billed charges,995.33,69,,,Percent of Total Billed Charges,69% of total billed charges,360.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,995.33,69,,,Percent of Total Billed Charges,69% of total billed charges,995.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1211.7,84,,,Percent of Total Billed Charges,84% of total billed charges,1182.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1283.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1283.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1283.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,588.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,588.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,588.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,360.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1110.73,77,,,Percent of total Billed charges,77% of total billed charges,1226.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,414.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,721.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,588.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,360.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1283.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,360.63,1283.83,
"CATH, FOLEY",S990220062,CDM,272,RC,,,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.14,74,,,Percent of Total Billed Charges,74% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,51.24,84,,,Percent of Total Billed Charges,84% of total billed charges,50.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.29,89,,,Percent of total Billed Charges,89% of total Billed charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,54.29,
CAUTERY TIP EXT BLADE,S990220063,CDM,272,RC,,,Outpatient,,,30,15,,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.2,74,,,Percent of Total Billed Charges,74% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,25.2,84,,,Percent of Total Billed Charges,84% of total billed charges,24.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.7,89,,,Percent of total Billed Charges,89% of total Billed charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,26.7,
C-LINE ENDO SOFT TISSUE REL,S990220064,CDM,272,RC,,,Outpatient,,,529,264.5,,407.33,77,,,Percent of Total Billed Charges,77% of total billed charges,134.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,391.46,74,,,Percent of Total Billed Charges,74% of total billed charges,365.01,69,,,Percent of Total Billed Charges,69% of total billed charges,365.01,69,,,Percent of Total Billed Charges,69% of total billed charges,132.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.01,69,,,Percent of Total Billed Charges,69% of total billed charges,365.01,69,,,Percent of Total Billed Charges,69% of total billed charges,444.36,84,,,Percent of Total Billed Charges,84% of total billed charges,433.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.81,89,,,Percent of total Billed Charges,89% of total Billed charges,470.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.33,77,,,Percent of total Billed charges,77% of total billed charges,449.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.25,470.81,
COLD THERAPY PAD,S990220066,CDM,270,RC,,,Outpatient,,,146.5,73.25,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.41,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.06,84,,,Percent of Total Billed Charges,84% of total billed charges,120.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
COLLATOR WAND EVEAC ENT,S990220067,CDM,270,RC,,,Outpatient,,,489,244.5,,376.53,77,,,Percent of Total Billed Charges,77% of total billed charges,124.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.86,74,,,Percent of Total Billed Charges,74% of total billed charges,337.41,69,,,Percent of Total Billed Charges,69% of total billed charges,337.41,69,,,Percent of Total Billed Charges,69% of total billed charges,122.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.41,69,,,Percent of Total Billed Charges,69% of total billed charges,337.41,69,,,Percent of Total Billed Charges,69% of total billed charges,410.76,84,,,Percent of Total Billed Charges,84% of total billed charges,400.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,435.21,89,,,Percent of total Billed Charges,89% of total Billed charges,435.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.53,77,,,Percent of total Billed charges,77% of total billed charges,415.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.25,435.21,
CROSSFIX PROCEDURE,S990220069,CDM,270,RC,,,Outpatient,,,921.5,460.75,,709.56,77,,,Percent of Total Billed Charges,77% of total billed charges,234.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.91,74,,,Percent of Total Billed Charges,74% of total billed charges,635.84,69,,,Percent of Total Billed Charges,69% of total billed charges,635.84,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.84,69,,,Percent of Total Billed Charges,69% of total billed charges,635.84,69,,,Percent of Total Billed Charges,69% of total billed charges,774.06,84,,,Percent of Total Billed Charges,84% of total billed charges,755.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.14,89,,,Percent of total Billed Charges,89% of total Billed charges,820.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.56,77,,,Percent of total Billed charges,77% of total billed charges,783.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.14,
CUDA SHAVER BLADE,S990220070,CDM,272,RC,,,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.31,74,,,Percent of Total Billed Charges,74% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,84,,,Percent of Total Billed Charges,84% of total billed charges,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,117.04,
DEVICE LAP PLUME FILT,S990220071,CDM,272,RC,,,Outpatient,,,56,28,,43.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.44,74,,,Percent of Total Billed Charges,74% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,84,,,Percent of Total Billed Charges,84% of total billed charges,45.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.84,89,,,Percent of total Billed Charges,89% of total Billed charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.12,77,,,Percent of total Billed charges,77% of total billed charges,47.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,49.84,
DILATOR SHEATH SET 8x10,S990220072,CDM,272,RC,,,Outpatient,,,146.5,73.25,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.41,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.06,84,,,Percent of Total Billed Charges,84% of total billed charges,120.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
DISSECTOR EXACT LIGASURE,S990220073,CDM,272,RC,,,Outpatient,,,1194,597,,919.38,77,,,Percent of Total Billed Charges,77% of total billed charges,304.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,883.56,74,,,Percent of Total Billed Charges,74% of total billed charges,823.86,69,,,Percent of Total Billed Charges,69% of total billed charges,823.86,69,,,Percent of Total Billed Charges,69% of total billed charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,823.86,69,,,Percent of Total Billed Charges,69% of total billed charges,823.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1002.96,84,,,Percent of Total Billed Charges,84% of total billed charges,979.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,1062.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1062.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1062.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,919.38,77,,,Percent of total Billed charges,77% of total billed charges,1014.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1062.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.5,1062.66,
DRAIN BLAKE 10FR HUBLESS,S990220074,CDM,272,RC,,,Outpatient,,,89,44.5,,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.86,74,,,Percent of Total Billed Charges,74% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,74.76,84,,,Percent of Total Billed Charges,84% of total billed charges,72.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.21,89,,,Percent of total Billed Charges,89% of total Billed charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,79.21,
DRILL BIT/TAP,S990220075,CDM,272,RC,,,Outpatient,,,576.5,288.25,,443.91,77,,,Percent of Total Billed Charges,77% of total billed charges,147.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,426.61,74,,,Percent of Total Billed Charges,74% of total billed charges,397.79,69,,,Percent of Total Billed Charges,69% of total billed charges,397.79,69,,,Percent of Total Billed Charges,69% of total billed charges,144.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.79,69,,,Percent of Total Billed Charges,69% of total billed charges,397.79,69,,,Percent of Total Billed Charges,69% of total billed charges,484.26,84,,,Percent of Total Billed Charges,84% of total billed charges,472.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,513.09,89,,,Percent of total Billed Charges,89% of total Billed charges,513.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,513.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443.91,77,,,Percent of total Billed charges,77% of total billed charges,490.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,288.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.13,513.09,
DRILL CANNULATED/STD,S990220076,CDM,272,RC,,,Outpatient,,,1030.5,515.25,,793.49,77,,,Percent of Total Billed Charges,77% of total billed charges,262.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,762.57,74,,,Percent of Total Billed Charges,74% of total billed charges,711.05,69,,,Percent of Total Billed Charges,69% of total billed charges,711.05,69,,,Percent of Total Billed Charges,69% of total billed charges,257.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.05,69,,,Percent of Total Billed Charges,69% of total billed charges,711.05,69,,,Percent of Total Billed Charges,69% of total billed charges,865.62,84,,,Percent of Total Billed Charges,84% of total billed charges,845.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,917.15,89,,,Percent of total Billed Charges,89% of total Billed charges,917.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,917.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,793.49,77,,,Percent of total Billed charges,77% of total billed charges,875.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,296.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,515.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,420.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,257.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,917.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.63,917.15,
DRSING TEGDERM TRANS 3 STERILE,S990220077,CDM,272,RC,,,Outpatient,,,10,5,,7.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.4,74,,,Percent of Total Billed Charges,74% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8.4,84,,,Percent of Total Billed Charges,84% of total billed charges,8.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.7,77,,,Percent of total Billed charges,77% of total billed charges,8.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.5,8.9,
DW Tonier Reversed Guide,S990220078,CDM,272,RC,,,Outpatient,,,2367.5,1183.75,,1822.98,77,,,Percent of Total Billed Charges,77% of total billed charges,603.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,603.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,739.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1751.95,74,,,Percent of Total Billed Charges,74% of total billed charges,1633.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.58,69,,,Percent of Total Billed Charges,69% of total billed charges,591.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1633.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1988.7,84,,,Percent of Total Billed Charges,84% of total billed charges,1941.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,2107.08,89,,,Percent of total Billed Charges,89% of total Billed charges,2107.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,965.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,965.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,965.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1822.98,77,,,Percent of total Billed charges,77% of total billed charges,2012.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,680.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1183.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,965.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,591.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,591.88,2107.08,
EGIA 4 HANDLE STANDARD,S990220079,CDM,272,RC,,,Outpatient,,,696,348,,535.92,77,,,Percent of Total Billed Charges,77% of total billed charges,177.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,515.04,74,,,Percent of Total Billed Charges,74% of total billed charges,480.24,69,,,Percent of Total Billed Charges,69% of total billed charges,480.24,69,,,Percent of Total Billed Charges,69% of total billed charges,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.24,69,,,Percent of Total Billed Charges,69% of total billed charges,480.24,69,,,Percent of Total Billed Charges,69% of total billed charges,584.64,84,,,Percent of Total Billed Charges,84% of total billed charges,570.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,619.44,89,,,Percent of total Billed Charges,89% of total Billed charges,619.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,619.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.92,77,,,Percent of total Billed charges,77% of total billed charges,591.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,200.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,348,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,283.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,619.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174,619.44,
EGIA RT ARTIC VAS MED CVD,S990220080,CDM,272,RC,,,Outpatient,,,2074,1037,,1596.98,77,,,Percent of Total Billed Charges,77% of total billed charges,528.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,648.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1534.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1431.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1431.06,69,,,Percent of Total Billed Charges,69% of total billed charges,518.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1431.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1431.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1742.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1700.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1845.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1845.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1845.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,846.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,846.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,846.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1596.98,77,,,Percent of total Billed charges,77% of total billed charges,1762.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,596.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1037,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,846.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,518.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1845.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.5,1845.86,
ELECTRODE BALL,S990220081,CDM,272,RC,,,Outpatient,,,50.5,25.25,,38.89,77,,,Percent of Total Billed Charges,77% of total billed charges,12.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.37,74,,,Percent of Total Billed Charges,74% of total billed charges,34.85,69,,,Percent of Total Billed Charges,69% of total billed charges,34.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,69,,,Percent of Total Billed Charges,69% of total billed charges,34.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,84,,,Percent of Total Billed Charges,84% of total billed charges,41.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.95,89,,,Percent of total Billed Charges,89% of total Billed charges,44.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.89,77,,,Percent of total Billed charges,77% of total billed charges,42.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.95,
ELECTRODE L HOOK,S990220082,CDM,272,RC,,,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.43,89,,,Percent of total Billed Charges,89% of total Billed charges,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,73.43,
ELECTRODE LOOP,S990220083,CDM,272,RC,,,Outpatient,,,80.5,40.25,,61.99,77,,,Percent of Total Billed Charges,77% of total billed charges,20.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.57,74,,,Percent of Total Billed Charges,74% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,84,,,Percent of Total Billed Charges,84% of total billed charges,66.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.65,89,,,Percent of total Billed Charges,89% of total Billed charges,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.99,77,,,Percent of total Billed charges,77% of total billed charges,68.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.13,71.65,
ENDO RETRACT 10 MM,S990220084,CDM,272,RC,,,Outpatient,,,495.5,247.75,,381.54,77,,,Percent of Total Billed Charges,77% of total billed charges,126.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,366.67,74,,,Percent of Total Billed Charges,74% of total billed charges,341.9,69,,,Percent of Total Billed Charges,69% of total billed charges,341.9,69,,,Percent of Total Billed Charges,69% of total billed charges,123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.9,69,,,Percent of Total Billed Charges,69% of total billed charges,341.9,69,,,Percent of Total Billed Charges,69% of total billed charges,416.22,84,,,Percent of Total Billed Charges,84% of total billed charges,406.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,441,89,,,Percent of total Billed Charges,89% of total Billed charges,441,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,381.54,77,,,Percent of total Billed charges,77% of total billed charges,421.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,142.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,247.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,202.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,441,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.88,441,
ENDOCATH GOLD 10MM,S990220085,CDM,272,RC,,,Outpatient,,,268.5,134.25,,206.75,77,,,Percent of Total Billed Charges,77% of total billed charges,68.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.69,74,,,Percent of Total Billed Charges,74% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,225.54,84,,,Percent of Total Billed Charges,84% of total billed charges,220.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,238.97,89,,,Percent of total Billed Charges,89% of total Billed charges,238.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.75,77,,,Percent of total Billed charges,77% of total billed charges,228.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.13,238.97,
ENDOCLIP 5MM,S990220086,CDM,272,RC,,,Outpatient,,,970.5,485.25,,747.29,77,,,Percent of Total Billed Charges,77% of total billed charges,247.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,303.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,718.17,74,,,Percent of Total Billed Charges,74% of total billed charges,669.65,69,,,Percent of Total Billed Charges,69% of total billed charges,669.65,69,,,Percent of Total Billed Charges,69% of total billed charges,242.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.65,69,,,Percent of Total Billed Charges,69% of total billed charges,669.65,69,,,Percent of Total Billed Charges,69% of total billed charges,815.22,84,,,Percent of Total Billed Charges,84% of total billed charges,795.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,863.75,89,,,Percent of total Billed Charges,89% of total Billed charges,863.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,863.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,395.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,747.29,77,,,Percent of total Billed charges,77% of total billed charges,824.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,279.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,485.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,395.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,242.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,863.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.63,863.75,
ENDOLOOP LIG VICRYL 18in,S990220087,CDM,272,RC,,,Outpatient,,,265.5,132.75,,204.44,77,,,Percent of Total Billed Charges,77% of total billed charges,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,74,,,Percent of Total Billed Charges,74% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,223.02,84,,,Percent of Total Billed Charges,84% of total billed charges,217.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,236.3,89,,,Percent of total Billed Charges,89% of total Billed charges,236.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.44,77,,,Percent of total Billed charges,77% of total billed charges,225.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,132.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.38,236.3,
ENSEAL G2 SUPER JAW,S990220088,CDM,272,RC,,,Outpatient,,,1513.5,756.75,,1165.4,77,,,Percent of Total Billed Charges,77% of total billed charges,385.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,385.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,472.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1119.99,74,,,Percent of Total Billed Charges,74% of total billed charges,1044.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1044.32,69,,,Percent of Total Billed Charges,69% of total billed charges,378.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1044.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1044.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1271.34,84,,,Percent of Total Billed Charges,84% of total billed charges,1241.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1347.02,89,,,Percent of total Billed Charges,89% of total Billed charges,1347.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1347.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,378.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1165.4,77,,,Percent of total Billed charges,77% of total billed charges,1286.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,435.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,756.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,617.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,378.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1347.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.38,1347.02,
ENSEAL G2 TISSUE SEALER,S990220089,CDM,272,RC,,,Outpatient,,,1106,553,,851.62,77,,,Percent of Total Billed Charges,77% of total billed charges,282.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,282.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,818.44,74,,,Percent of Total Billed Charges,74% of total billed charges,763.14,69,,,Percent of Total Billed Charges,69% of total billed charges,763.14,69,,,Percent of Total Billed Charges,69% of total billed charges,276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,763.14,69,,,Percent of Total Billed Charges,69% of total billed charges,763.14,69,,,Percent of Total Billed Charges,69% of total billed charges,929.04,84,,,Percent of Total Billed Charges,84% of total billed charges,906.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,984.34,89,,,Percent of total Billed Charges,89% of total Billed charges,984.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,984.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,451.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,451.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,451.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,851.62,77,,,Percent of total Billed charges,77% of total billed charges,940.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,317.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,553,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,451.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,984.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,276.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.5,984.34,
ESOPHAGEAL DILATOR,S990220090,CDM,272,RC,,,Outpatient,,,743.5,371.75,,572.5,77,,,Percent of Total Billed Charges,77% of total billed charges,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,550.19,74,,,Percent of Total Billed Charges,74% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,624.54,84,,,Percent of Total Billed Charges,84% of total billed charges,609.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,661.72,89,,,Percent of total Billed Charges,89% of total Billed charges,661.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,661.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.5,77,,,Percent of total Billed charges,77% of total billed charges,631.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,371.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,303.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,661.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.88,661.72,
ET Tube Dilation Tray,S990220091,CDM,272,RC,,,Outpatient,,,3760.5,1880.25,,2895.59,77,,,Percent of Total Billed Charges,77% of total billed charges,958.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1175.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2782.77,74,,,Percent of Total Billed Charges,74% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2594.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3158.82,84,,,Percent of Total Billed Charges,84% of total billed charges,3083.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,3346.85,89,,,Percent of total Billed Charges,89% of total Billed charges,3346.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3346.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2895.59,77,,,Percent of total Billed charges,77% of total billed charges,3196.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1081.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1880.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1534.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3346.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,940.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,940.13,3346.85,
FEMORAL CANAL TIP,S990220092,CDM,272,RC,,,Outpatient,,,37.5,18.75,,28.88,77,,,Percent of Total Billed Charges,77% of total billed charges,9.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,84,,,Percent of Total Billed Charges,84% of total billed charges,30.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,33.38,89,,,Percent of total Billed Charges,89% of total Billed charges,33.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.88,77,,,Percent of total Billed charges,77% of total billed charges,31.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.38,33.38,
FIBER TAPE 2MM ARTHREX,S990220093,CDM,272,RC,,,Outpatient,,,142.5,71.25,,109.73,77,,,Percent of Total Billed Charges,77% of total billed charges,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.45,74,,,Percent of Total Billed Charges,74% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,119.7,84,,,Percent of Total Billed Charges,84% of total billed charges,116.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.83,89,,,Percent of total Billed Charges,89% of total Billed charges,126.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.73,77,,,Percent of total Billed charges,77% of total billed charges,121.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.63,126.83,
FOOT SCD EXP,S990220094,CDM,270,RC,,,Outpatient,,,98.5,49.25,,75.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.89,74,,,Percent of Total Billed Charges,74% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,82.74,84,,,Percent of Total Billed Charges,84% of total billed charges,80.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.67,89,,,Percent of total Billed Charges,89% of total Billed charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,77,,,Percent of total Billed charges,77% of total billed charges,83.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.63,87.67,
FORCEP CURVED OPEN 25 CM GYRUS,S990220095,CDM,272,RC,,,Outpatient,,,479.5,239.75,,369.22,77,,,Percent of Total Billed Charges,77% of total billed charges,122.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.83,74,,,Percent of Total Billed Charges,74% of total billed charges,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,402.78,84,,,Percent of Total Billed Charges,84% of total billed charges,393.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.76,89,,,Percent of total Billed Charges,89% of total Billed charges,426.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.22,77,,,Percent of total Billed charges,77% of total billed charges,407.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.88,426.76,
FORCEP RADIAL JAW W/NEEDLE,S990220096,CDM,272,RC,,,Outpatient,,,185.5,92.75,,142.84,77,,,Percent of Total Billed Charges,77% of total billed charges,47.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.27,74,,,Percent of Total Billed Charges,74% of total billed charges,128,69,,,Percent of Total Billed Charges,69% of total billed charges,128,69,,,Percent of Total Billed Charges,69% of total billed charges,46.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128,69,,,Percent of Total Billed Charges,69% of total billed charges,128,69,,,Percent of Total Billed Charges,69% of total billed charges,155.82,84,,,Percent of Total Billed Charges,84% of total billed charges,152.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.1,89,,,Percent of total Billed Charges,89% of total Billed charges,165.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.84,77,,,Percent of total Billed charges,77% of total billed charges,157.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.38,165.1,
FS DEVICE CERVICAL CUP,S990220097,CDM,272,RC,,,Outpatient,,,299,149.5,,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.26,74,,,Percent of Total Billed Charges,74% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,84,,,Percent of Total Billed Charges,84% of total billed charges,245.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,266.11,
GEL GRATFON BDM SYRNG .5CC,S990220098,CDM,272,RC,,,Outpatient,,,252.5,126.25,,194.43,77,,,Percent of Total Billed Charges,77% of total billed charges,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.85,74,,,Percent of Total Billed Charges,74% of total billed charges,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,212.1,84,,,Percent of Total Billed Charges,84% of total billed charges,207.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.73,89,,,Percent of total Billed Charges,89% of total Billed charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.43,77,,,Percent of total Billed charges,77% of total billed charges,214.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,126.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.13,224.73,
GRAFT PERIGEE,S990220099,CDM,272,RC,,,Outpatient,,,5218,2609,,4017.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1330.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1330.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1630.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3861.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3600.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3600.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3600.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3600.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4383.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4278.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,4644.02,89,,,Percent of total Billed Charges,89% of total Billed charges,4644.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4644.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4017.86,77,,,Percent of total Billed charges,77% of total billed charges,4435.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1500.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2609,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2128.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4644.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1304.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1304.5,4644.02,
GRASPER 5 MM W/RATCH,S990220100,CDM,272,RC,,,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.82,74,,,Percent of Total Billed Charges,74% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
GREAT WHITE 4.2,S990220101,CDM,272,RC,,,Outpatient,,,273,136.5,,210.21,77,,,Percent of Total Billed Charges,77% of total billed charges,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,202.02,74,,,Percent of Total Billed Charges,74% of total billed charges,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,188.37,69,,,Percent of Total Billed Charges,69% of total billed charges,229.32,84,,,Percent of Total Billed Charges,84% of total billed charges,223.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,242.97,89,,,Percent of total Billed Charges,89% of total Billed charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.21,77,,,Percent of total Billed charges,77% of total billed charges,232.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,111.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,242.97,
GUIDEWIRE URO EZ GLIDR STR TIP,S990220102,CDM,272,RC,,,Outpatient,,,88,44,,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.12,74,,,Percent of Total Billed Charges,74% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,73.92,84,,,Percent of Total Billed Charges,84% of total billed charges,72.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.32,89,,,Percent of total Billed Charges,89% of total Billed charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,78.32,
HALO OLYMPUS,S990220103,CDM,272,RC,,,Outpatient,,,999.5,499.75,,769.62,77,,,Percent of Total Billed Charges,77% of total billed charges,254.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,739.63,74,,,Percent of Total Billed Charges,74% of total billed charges,689.66,69,,,Percent of Total Billed Charges,69% of total billed charges,689.66,69,,,Percent of Total Billed Charges,69% of total billed charges,249.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.66,69,,,Percent of Total Billed Charges,69% of total billed charges,689.66,69,,,Percent of Total Billed Charges,69% of total billed charges,839.58,84,,,Percent of Total Billed Charges,84% of total billed charges,819.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,889.56,89,,,Percent of total Billed Charges,89% of total Billed charges,889.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,889.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,769.62,77,,,Percent of total Billed charges,77% of total billed charges,849.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,499.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,407.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,249.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,889.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.88,889.56,
HAND PENCIL - COOPER,S990220104,CDM,272,RC,,,Outpatient,,,27,13.5,,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.98,74,,,Percent of Total Billed Charges,74% of total billed charges,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,22.68,84,,,Percent of Total Billed Charges,84% of total billed charges,22.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.03,89,,,Percent of total Billed Charges,89% of total Billed charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,24.03,
HEMOSTATIC POWDER 3 GR,S990220105,CDM,270,RC,,,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,375.92,74,,,Percent of Total Billed Charges,74% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,426.72,84,,,Percent of Total Billed Charges,84% of total billed charges,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127,452.12,
I O NEEDLE,S990220106,CDM,272,RC,,,Outpatient,,,229.5,114.75,,176.72,77,,,Percent of Total Billed Charges,77% of total billed charges,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,169.83,74,,,Percent of Total Billed Charges,74% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,192.78,84,,,Percent of Total Billed Charges,84% of total billed charges,188.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,204.26,89,,,Percent of total Billed Charges,89% of total Billed charges,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.72,77,,,Percent of total Billed charges,77% of total billed charges,195.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,114.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.38,204.26,
IMPLANT SILICON SHEETING 2X3,S990220107,CDM,272,RC,,,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.63,89,,,Percent of total Billed Charges,89% of total Billed charges,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.63,
INFLATION/DEFLATION DEVICE,S990220108,CDM,272,RC,,,Outpatient,,,191.5,95.75,,147.46,77,,,Percent of Total Billed Charges,77% of total billed charges,48.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.71,74,,,Percent of Total Billed Charges,74% of total billed charges,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,160.86,84,,,Percent of Total Billed Charges,84% of total billed charges,157.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.44,89,,,Percent of total Billed Charges,89% of total Billed charges,170.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.46,77,,,Percent of total Billed charges,77% of total billed charges,162.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.88,170.44,
INFLOW TUBE SET HYSTER,S990220109,CDM,272,RC,,,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.26,74,,,Percent of Total Billed Charges,74% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,84,,,Percent of Total Billed Charges,84% of total billed charges,204.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,221.61,89,,,Percent of total Billed Charges,89% of total Billed charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,124.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.25,221.61,
INJETAK NEEDLE 70cm,S990220110,CDM,272,RC,,,Outpatient,,,114.5,57.25,,88.17,77,,,Percent of Total Billed Charges,77% of total billed charges,29.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.73,74,,,Percent of Total Billed Charges,74% of total billed charges,79.01,69,,,Percent of Total Billed Charges,69% of total billed charges,79.01,69,,,Percent of Total Billed Charges,69% of total billed charges,28.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.01,69,,,Percent of Total Billed Charges,69% of total billed charges,79.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.18,84,,,Percent of Total Billed Charges,84% of total billed charges,93.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.91,89,,,Percent of total Billed Charges,89% of total Billed charges,101.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.17,77,,,Percent of total Billed charges,77% of total billed charges,97.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.63,101.91,
INSTURMENT TENO SCREW KIT,S990220111,CDM,272,RC,,,Outpatient,,,361,180.5,,277.97,77,,,Percent of Total Billed Charges,77% of total billed charges,92.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,267.14,74,,,Percent of Total Billed Charges,74% of total billed charges,249.09,69,,,Percent of Total Billed Charges,69% of total billed charges,249.09,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.09,69,,,Percent of Total Billed Charges,69% of total billed charges,249.09,69,,,Percent of Total Billed Charges,69% of total billed charges,303.24,84,,,Percent of Total Billed Charges,84% of total billed charges,296.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,321.29,89,,,Percent of total Billed Charges,89% of total Billed charges,321.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,321.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.97,77,,,Percent of total Billed charges,77% of total billed charges,306.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,180.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,147.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.25,321.29,
INTERCEED ADH BARRIER,S990220112,CDM,272,RC,,,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,460.28,74,,,Percent of Total Billed Charges,74% of total billed charges,429.18,69,,,Percent of Total Billed Charges,69% of total billed charges,429.18,69,,,Percent of Total Billed Charges,69% of total billed charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,429.18,69,,,Percent of Total Billed Charges,69% of total billed charges,429.18,69,,,Percent of Total Billed Charges,69% of total billed charges,522.48,84,,,Percent of Total Billed Charges,84% of total billed charges,510.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,311,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
INTERDRY SILVER AG,S990220113,CDM,270,RC,,,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.88,74,,,Percent of Total Billed Charges,74% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,10.08,84,,,Percent of Total Billed Charges,84% of total billed charges,9.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
INTERPULSE HANDPIECE,S990220114,CDM,270,RC,,,Outpatient,,,360,180,,277.2,77,,,Percent of Total Billed Charges,77% of total billed charges,91.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,266.4,74,,,Percent of Total Billed Charges,74% of total billed charges,248.4,69,,,Percent of Total Billed Charges,69% of total billed charges,248.4,69,,,Percent of Total Billed Charges,69% of total billed charges,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.4,69,,,Percent of Total Billed Charges,69% of total billed charges,248.4,69,,,Percent of Total Billed Charges,69% of total billed charges,302.4,84,,,Percent of Total Billed Charges,84% of total billed charges,295.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.4,89,,,Percent of total Billed Charges,89% of total Billed charges,320.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,320.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.2,77,,,Percent of total Billed charges,77% of total billed charges,306,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,180,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,146.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90,320.4,
INTRODUCER KIT 10 FR TEARAWAY,S990220115,CDM,272,RC,,,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.36,89,,,Percent of total Billed Charges,89% of total Billed charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,110.36,
IRIS RETRACTOR,S990220116,CDM,272,RC,,,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,68.53,
IUR NON STERILE KIT,S990220117,CDM,270,RC,,,Outpatient,,,57,28.5,,43.89,77,,,Percent of Total Billed Charges,77% of total billed charges,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.18,74,,,Percent of Total Billed Charges,74% of total billed charges,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,47.88,84,,,Percent of Total Billed Charges,84% of total billed charges,46.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.73,89,,,Percent of total Billed Charges,89% of total Billed charges,50.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.89,77,,,Percent of total Billed charges,77% of total billed charges,48.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,50.73,
JADA HEMORRAGE CONTROL SYSTEM,S990220118,CDM,272,RC,,,Outpatient,,,2652,1326,,2042.04,77,,,Percent of Total Billed Charges,77% of total billed charges,676.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.88,69,,,Percent of Total Billed Charges,69% of total billed charges,663,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.68,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,2360.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2360.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2360.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1082.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1082.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1082.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,663,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.04,77,,,Percent of total Billed charges,77% of total billed charges,2254.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1326,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1082.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,663,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2360.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,663,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663,2360.28,
KNEE UNIV POSITION STERILE KIT,S990220120,CDM,272,RC,,,Outpatient,,,89,44.5,,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.86,74,,,Percent of Total Billed Charges,74% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,74.76,84,,,Percent of Total Billed Charges,84% of total billed charges,72.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.21,89,,,Percent of total Billed Charges,89% of total Billed charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,79.21,
LACERATION TRAY,S990220121,CDM,272,RC,,,Outpatient,,,35,17.5,,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.9,74,,,Percent of Total Billed Charges,74% of total billed charges,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,29.4,84,,,Percent of Total Billed Charges,84% of total billed charges,28.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,89,,,Percent of total Billed Charges,89% of total Billed charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,31.15,
LAP CHOLE KIT,S990220122,CDM,272,RC,,,Outpatient,,,1349,674.5,,1038.73,77,,,Percent of Total Billed Charges,77% of total billed charges,344,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,421.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,998.26,74,,,Percent of Total Billed Charges,74% of total billed charges,930.81,69,,,Percent of Total Billed Charges,69% of total billed charges,930.81,69,,,Percent of Total Billed Charges,69% of total billed charges,337.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,930.81,69,,,Percent of Total Billed Charges,69% of total billed charges,930.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1133.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1106.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,1200.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1200.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1200.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,550.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,550.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,550.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1038.73,77,,,Percent of total Billed charges,77% of total billed charges,1146.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,387.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,674.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,550.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1200.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,1200.61,
LATERAL ARM SLEEVE,S990220123,CDM,272,RC,,,Outpatient,,,112.5,56.25,,86.63,77,,,Percent of Total Billed Charges,77% of total billed charges,28.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.25,74,,,Percent of Total Billed Charges,74% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,94.5,84,,,Percent of Total Billed Charges,84% of total billed charges,92.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.13,89,,,Percent of total Billed Charges,89% of total Billed charges,100.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.63,77,,,Percent of total Billed charges,77% of total billed charges,95.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.13,100.13,
LIGASURE JAW SEALER/DRIVER,S990220124,CDM,272,RC,,,Outpatient,,,1151,575.5,,886.27,77,,,Percent of Total Billed Charges,77% of total billed charges,293.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,359.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,851.74,74,,,Percent of Total Billed Charges,74% of total billed charges,794.19,69,,,Percent of Total Billed Charges,69% of total billed charges,794.19,69,,,Percent of Total Billed Charges,69% of total billed charges,287.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,794.19,69,,,Percent of Total Billed Charges,69% of total billed charges,794.19,69,,,Percent of Total Billed Charges,69% of total billed charges,966.84,84,,,Percent of Total Billed Charges,84% of total billed charges,943.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1024.39,89,,,Percent of total Billed Charges,89% of total Billed charges,1024.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1024.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,469.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,469.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,469.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,287.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,886.27,77,,,Percent of total Billed charges,77% of total billed charges,978.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,330.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,575.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,469.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,287.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1024.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.75,1024.39,
LIGASURE MARYLAND 23CM,S990220125,CDM,272,RC,,,Outpatient,,,1453,726.5,,1118.81,77,,,Percent of Total Billed Charges,77% of total billed charges,370.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,454.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1075.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1002.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1002.57,69,,,Percent of Total Billed Charges,69% of total billed charges,363.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1002.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1220.52,84,,,Percent of Total Billed Charges,84% of total billed charges,1191.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,1293.17,89,,,Percent of total Billed Charges,89% of total Billed charges,1293.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1293.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,592.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,592.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,592.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1118.81,77,,,Percent of total Billed charges,77% of total billed charges,1235.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,726.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,592.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,363.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.25,1293.17,
LIGASURE RETRACT 37cm,S990220126,CDM,272,RC,,,Outpatient,,,1564,782,,1204.28,77,,,Percent of Total Billed Charges,77% of total billed charges,398.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.36,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.16,69,,,Percent of Total Billed Charges,69% of total billed charges,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1313.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,1391.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1391.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1391.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.28,77,,,Percent of total Billed charges,77% of total billed charges,1329.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1391.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391,1391.96,
LIGASURE SMALL JAW,S990220127,CDM,272,RC,,,Outpatient,,,968,484,,745.36,77,,,Percent of Total Billed Charges,77% of total billed charges,246.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,246.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,716.32,74,,,Percent of Total Billed Charges,74% of total billed charges,667.92,69,,,Percent of Total Billed Charges,69% of total billed charges,667.92,69,,,Percent of Total Billed Charges,69% of total billed charges,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,667.92,69,,,Percent of Total Billed Charges,69% of total billed charges,667.92,69,,,Percent of Total Billed Charges,69% of total billed charges,813.12,84,,,Percent of Total Billed Charges,84% of total billed charges,793.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,861.52,89,,,Percent of total Billed Charges,89% of total Billed charges,861.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,745.36,77,,,Percent of total Billed charges,77% of total billed charges,822.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,278.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,484,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,394.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,242,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242,861.52,
LIGATING LOOP O CHROMIC,S990220128,CDM,272,RC,,,Outpatient,,,72.5,36.25,,55.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.65,74,,,Percent of Total Billed Charges,74% of total billed charges,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,50.03,69,,,Percent of Total Billed Charges,69% of total billed charges,60.9,84,,,Percent of Total Billed Charges,84% of total billed charges,59.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.53,89,,,Percent of total Billed Charges,89% of total Billed charges,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.83,77,,,Percent of total Billed charges,77% of total billed charges,61.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.13,64.53,
LIGHTWAVE SUCTION ABLATION,S990220129,CDM,272,RC,,,Outpatient,,,380.5,190.25,,292.99,77,,,Percent of Total Billed Charges,77% of total billed charges,97.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,281.57,74,,,Percent of Total Billed Charges,74% of total billed charges,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,319.62,84,,,Percent of Total Billed Charges,84% of total billed charges,312.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,338.65,89,,,Percent of total Billed Charges,89% of total Billed charges,338.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.99,77,,,Percent of total Billed charges,77% of total billed charges,323.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,190.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.13,338.65,
LOAD UNIT TA 3.5 SINGLE,S990220130,CDM,272,RC,,,Outpatient,,,294,147,,226.38,77,,,Percent of Total Billed Charges,77% of total billed charges,74.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.56,74,,,Percent of Total Billed Charges,74% of total billed charges,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,246.96,84,,,Percent of Total Billed Charges,84% of total billed charges,241.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.66,89,,,Percent of total Billed Charges,89% of total Billed charges,261.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.38,77,,,Percent of total Billed charges,77% of total billed charges,249.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.5,261.66,
Lugols Iodine 2%,S990220131,CDM,270,RC,,,Outpatient,,,33,16.5,,25.41,77,,,Percent of Total Billed Charges,77% of total billed charges,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.42,74,,,Percent of Total Billed Charges,74% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,27.72,84,,,Percent of Total Billed Charges,84% of total billed charges,27.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.37,89,,,Percent of total Billed Charges,89% of total Billed charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.41,77,,,Percent of total Billed charges,77% of total billed charges,28.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,29.37,
MARKER FIDUCIAL GOLD,S990220132,CDM,272,RC,,,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,103.6,74,,,Percent of Total Billed Charges,74% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,117.6,84,,,Percent of Total Billed Charges,84% of total billed charges,114.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.6,89,,,Percent of total Billed Charges,89% of total Billed charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,124.6,
MENISCAL ROOT REPAIR,S990220133,CDM,272,RC,,,Outpatient,,,10870.5,5435.25,,8370.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2771.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2771.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3397.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8044.17,74,,,Percent of Total Billed Charges,74% of total billed charges,7500.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7500.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2717.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7500.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7500.65,69,,,Percent of Total Billed Charges,69% of total billed charges,9131.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8913.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,9674.75,89,,,Percent of total Billed Charges,89% of total Billed charges,9674.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9674.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4435.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4435.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4435.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2717.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8370.29,77,,,Percent of total Billed charges,77% of total billed charges,9239.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3125.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5435.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4435.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2717.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9674.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2717.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2717.63,9674.75,
Mepliex border 4x12,S990220134,CDM,272,RC,,,Outpatient,,,107,53.5,,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.18,74,,,Percent of Total Billed Charges,74% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,89.88,84,,,Percent of Total Billed Charges,84% of total billed charges,87.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.23,89,,,Percent of total Billed Charges,89% of total Billed charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,95.23,
MEPILEX SACRUM,S990220135,CDM,272,RC,,,Outpatient,,,36.5,18.25,,28.11,77,,,Percent of Total Billed Charges,77% of total billed charges,9.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.01,74,,,Percent of Total Billed Charges,74% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30.66,84,,,Percent of Total Billed Charges,84% of total billed charges,29.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.49,89,,,Percent of total Billed Charges,89% of total Billed charges,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.11,77,,,Percent of total Billed charges,77% of total billed charges,31.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,32.49,
MERCOGEL NASAL DRESSING,S990220136,CDM,272,RC,,,Outpatient,,,221,110.5,,170.17,77,,,Percent of Total Billed Charges,77% of total billed charges,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.54,74,,,Percent of Total Billed Charges,74% of total billed charges,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,185.64,84,,,Percent of Total Billed Charges,84% of total billed charges,181.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.69,89,,,Percent of total Billed Charges,89% of total Billed charges,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.17,77,,,Percent of total Billed charges,77% of total billed charges,187.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,196.69,
MINERVA SURGICAL HANDPIECE,S990220137,CDM,272,RC,,,Outpatient,,,2340,1170,,1801.8,77,,,Percent of Total Billed Charges,77% of total billed charges,596.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,731.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1731.6,74,,,Percent of Total Billed Charges,74% of total billed charges,1614.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1614.6,69,,,Percent of Total Billed Charges,69% of total billed charges,585,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1614.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1614.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1965.6,84,,,Percent of Total Billed Charges,84% of total billed charges,1918.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,2082.6,89,,,Percent of total Billed Charges,89% of total Billed charges,2082.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2082.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,954.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,954.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,954.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1801.8,77,,,Percent of total Billed charges,77% of total billed charges,1989,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,672.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1170,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,954.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,585,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2082.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585,2082.6,
Multiple Clip Applier 10 mm,S990220139,CDM,272,RC,,,Outpatient,,,297.5,148.75,,229.08,77,,,Percent of Total Billed Charges,77% of total billed charges,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.15,74,,,Percent of Total Billed Charges,74% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,249.9,84,,,Percent of Total Billed Charges,84% of total billed charges,243.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.78,89,,,Percent of total Billed Charges,89% of total Billed charges,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,77,,,Percent of total Billed charges,77% of total billed charges,252.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.38,264.78,
MYRINGOTOMY TUBE BEVELED,S990220140,CDM,272,RC,,,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.22,74,,,Percent of Total Billed Charges,74% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,44.52,84,,,Percent of Total Billed Charges,84% of total billed charges,43.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.17,89,,,Percent of total Billed Charges,89% of total Billed charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.17,
NASAL ANTISEPTIC PRE OP,S990220141,CDM,272,RC,,,Outpatient,,,39,19.5,,30.03,77,,,Percent of Total Billed Charges,77% of total billed charges,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.86,74,,,Percent of Total Billed Charges,74% of total billed charges,26.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,69,,,Percent of Total Billed Charges,69% of total billed charges,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.76,84,,,Percent of Total Billed Charges,84% of total billed charges,31.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.71,89,,,Percent of total Billed Charges,89% of total Billed charges,34.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.03,77,,,Percent of total Billed charges,77% of total billed charges,33.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.75,34.71,
NASAL PACKING,S990220142,CDM,272,RC,,,Outpatient,,,47.5,23.75,,36.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.15,74,,,Percent of Total Billed Charges,74% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.9,84,,,Percent of Total Billed Charges,84% of total billed charges,38.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.28,89,,,Percent of total Billed Charges,89% of total Billed charges,42.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.58,77,,,Percent of total Billed charges,77% of total billed charges,40.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,42.28,
NASAL SEPTAL 2 PART BUTTON,S990220143,CDM,272,RC,,,Outpatient,,,530,265,,408.1,77,,,Percent of Total Billed Charges,77% of total billed charges,135.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,392.2,74,,,Percent of Total Billed Charges,74% of total billed charges,365.7,69,,,Percent of Total Billed Charges,69% of total billed charges,365.7,69,,,Percent of Total Billed Charges,69% of total billed charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.7,69,,,Percent of Total Billed Charges,69% of total billed charges,365.7,69,,,Percent of Total Billed Charges,69% of total billed charges,445.2,84,,,Percent of Total Billed Charges,84% of total billed charges,434.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,471.7,89,,,Percent of total Billed Charges,89% of total Billed charges,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.1,77,,,Percent of total Billed charges,77% of total billed charges,450.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,265,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,216.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,471.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.5,471.7,
NASAL SPLINT AQUAPLAST,S990220144,CDM,272,RC,,,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
NAVIGATOR 11 TO 13 FR 35CM,S990220145,CDM,272,RC,,,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,285.69,89,,,Percent of total Billed Charges,89% of total Billed charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,160.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,285.69,
NEEDLE & SUTURE CAPTURE,S990220146,CDM,272,RC,,,Outpatient,,,434.5,217.25,,334.57,77,,,Percent of Total Billed Charges,77% of total billed charges,110.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.53,74,,,Percent of Total Billed Charges,74% of total billed charges,299.81,69,,,Percent of Total Billed Charges,69% of total billed charges,299.81,69,,,Percent of Total Billed Charges,69% of total billed charges,108.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.81,69,,,Percent of Total Billed Charges,69% of total billed charges,299.81,69,,,Percent of Total Billed Charges,69% of total billed charges,364.98,84,,,Percent of Total Billed Charges,84% of total billed charges,356.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,386.71,89,,,Percent of total Billed Charges,89% of total Billed charges,386.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,386.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.57,77,,,Percent of total Billed charges,77% of total billed charges,369.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,386.71,
NEEDLE BIOPSY BARD MAX-CORE,S990220147,CDM,272,RC,,,Outpatient,,,88,44,,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.12,74,,,Percent of Total Billed Charges,74% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,73.92,84,,,Percent of Total Billed Charges,84% of total billed charges,72.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.32,89,,,Percent of total Billed Charges,89% of total Billed charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,78.32,
NEEDLE COAPTATE,S990220148,CDM,270,RC,,,Outpatient,,,100.5,50.25,,77.39,77,,,Percent of Total Billed Charges,77% of total billed charges,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.37,74,,,Percent of Total Billed Charges,74% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.42,84,,,Percent of Total Billed Charges,84% of total billed charges,82.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.45,89,,,Percent of total Billed Charges,89% of total Billed charges,89.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.39,77,,,Percent of total Billed charges,77% of total billed charges,85.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.13,89.45,
NEEDLE INSUFFLATION,S990220149,CDM,272,RC,,,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.26,74,,,Percent of Total Billed Charges,74% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.16,84,,,Percent of Total Billed Charges,84% of total billed charges,40.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
NEEDLE SCORPION SUREFIRE,S990220150,CDM,272,RC,,,Outpatient,,,456,228,,351.12,77,,,Percent of Total Billed Charges,77% of total billed charges,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,337.44,74,,,Percent of Total Billed Charges,74% of total billed charges,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,314.64,69,,,Percent of Total Billed Charges,69% of total billed charges,383.04,84,,,Percent of Total Billed Charges,84% of total billed charges,373.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,405.84,89,,,Percent of total Billed Charges,89% of total Billed charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.12,77,,,Percent of total Billed charges,77% of total billed charges,387.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,228,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114,405.84,
NERVE STIMULATOR IOMED,S990220151,CDM,270,RC,,,Outpatient,,,237,118.5,,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.38,74,,,Percent of Total Billed Charges,74% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,199.08,84,,,Percent of Total Billed Charges,84% of total billed charges,194.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.93,89,,,Percent of total Billed Charges,89% of total Billed charges,210.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.25,210.93,
OBLATOR ASPIRATING,S990220152,CDM,270,RC,,,Outpatient,,,875.5,437.75,,674.14,77,,,Percent of Total Billed Charges,77% of total billed charges,223.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,647.87,74,,,Percent of Total Billed Charges,74% of total billed charges,604.1,69,,,Percent of Total Billed Charges,69% of total billed charges,604.1,69,,,Percent of Total Billed Charges,69% of total billed charges,218.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.1,69,,,Percent of Total Billed Charges,69% of total billed charges,604.1,69,,,Percent of Total Billed Charges,69% of total billed charges,735.42,84,,,Percent of Total Billed Charges,84% of total billed charges,717.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,779.2,89,,,Percent of total Billed Charges,89% of total Billed charges,779.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,779.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,357.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,357.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,357.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.14,77,,,Percent of total Billed charges,77% of total billed charges,744.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,251.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,437.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,357.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,779.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.88,779.2,
OPHTHALMIC SOLN 5%,S990220153,CDM,272,RC,,,Outpatient,,,34,17,,26.18,77,,,Percent of Total Billed Charges,77% of total billed charges,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.16,74,,,Percent of Total Billed Charges,74% of total billed charges,23.46,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,69,,,Percent of Total Billed Charges,69% of total billed charges,28.56,84,,,Percent of Total Billed Charges,84% of total billed charges,27.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.26,89,,,Percent of total Billed Charges,89% of total Billed charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.18,77,,,Percent of total Billed charges,77% of total billed charges,28.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,30.26,
OPSITE DRESSING 30X10cm,S990220154,CDM,272,RC,,,Outpatient,,,19.5,9.75,,15.02,77,,,Percent of Total Billed Charges,77% of total billed charges,4.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.43,74,,,Percent of Total Billed Charges,74% of total billed charges,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,16.38,84,,,Percent of Total Billed Charges,84% of total billed charges,15.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.36,89,,,Percent of total Billed Charges,89% of total Billed charges,17.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.02,77,,,Percent of total Billed charges,77% of total billed charges,16.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.88,17.36,
"OSTEO-DRILL, MINI ACUTRAK 2",S990220155,CDM,272,RC,,,Outpatient,,,1778.5,889.25,,1369.45,77,,,Percent of Total Billed Charges,77% of total billed charges,453.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1316.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1227.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1227.17,69,,,Percent of Total Billed Charges,69% of total billed charges,444.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1227.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1493.94,84,,,Percent of Total Billed Charges,84% of total billed charges,1458.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1582.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1582.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1582.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,725.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,725.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,725.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.45,77,,,Percent of total Billed charges,77% of total billed charges,1511.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,511.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,725.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1582.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.63,1582.87,
OTO RHINO FOREIGN BODY REMOVER,S990220156,CDM,272,RC,,,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.13,117.93,
OUTFLOW TUBE SET HYSTER,S990220157,CDM,272,RC,,,Outpatient,,,209,104.5,,160.93,77,,,Percent of Total Billed Charges,77% of total billed charges,53.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.66,74,,,Percent of Total Billed Charges,74% of total billed charges,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,144.21,69,,,Percent of Total Billed Charges,69% of total billed charges,175.56,84,,,Percent of Total Billed Charges,84% of total billed charges,171.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.01,89,,,Percent of total Billed Charges,89% of total Billed charges,186.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.93,77,,,Percent of total Billed charges,77% of total billed charges,177.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.25,186.01,
PACK SINUS SLIM,S990220158,CDM,272,RC,,,Outpatient,,,37,18.5,,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.38,74,,,Percent of Total Billed Charges,74% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,31.08,84,,,Percent of Total Billed Charges,84% of total billed charges,30.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.93,89,,,Percent of total Billed Charges,89% of total Billed charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,32.93,
PAD PATIENT POSITIONING,S990220159,CDM,270,RC,,,Outpatient,,,153,76.5,,117.81,77,,,Percent of Total Billed Charges,77% of total billed charges,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.22,74,,,Percent of Total Billed Charges,74% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,128.52,84,,,Percent of Total Billed Charges,84% of total billed charges,125.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.17,89,,,Percent of total Billed Charges,89% of total Billed charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.81,77,,,Percent of total Billed charges,77% of total billed charges,130.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.25,136.17,
PASSPORT CANNULA 10 X 3,S990220160,CDM,272,RC,,,Outpatient,,,102.5,51.25,,78.93,77,,,Percent of Total Billed Charges,77% of total billed charges,26.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.85,74,,,Percent of Total Billed Charges,74% of total billed charges,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.1,84,,,Percent of Total Billed Charges,84% of total billed charges,84.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.23,89,,,Percent of total Billed Charges,89% of total Billed charges,91.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.93,77,,,Percent of total Billed charges,77% of total billed charges,87.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.63,91.23,
PATCH GEL ADHESIVE 4X2.8,S990220161,CDM,272,RC,,,Outpatient,,,14,7,,10.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.36,74,,,Percent of Total Billed Charges,74% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,11.76,84,,,Percent of Total Billed Charges,84% of total billed charges,11.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.46,89,,,Percent of total Billed Charges,89% of total Billed charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.78,77,,,Percent of total Billed charges,77% of total billed charges,11.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.5,12.46,
PENCIL CAUTERY GOLDEVAC,S990220162,CDM,272,RC,,,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.63,89,,,Percent of total Billed Charges,89% of total Billed charges,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.63,
PENCIL W/HOLSTER ASP,S990220163,CDM,270,RC,,,Outpatient,,,19,9.5,,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.06,74,,,Percent of Total Billed Charges,74% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,15.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.91,89,,,Percent of total Billed Charges,89% of total Billed charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.91,
PHACOEMULSIFICATION,S990220164,CDM,270,RC,,,Outpatient,,,5282.5,2641.25,,4067.53,77,,,Percent of Total Billed Charges,77% of total billed charges,1347.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1650.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3909.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3644.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3644.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1320.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3644.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3644.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4437.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4331.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,4701.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4701.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2155.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2155.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2155.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1320.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4067.53,77,,,Percent of total Billed charges,77% of total billed charges,4490.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1518.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2641.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2155.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1320.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1320.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1320.63,4701.43,
PHOTONBLADE W/EVAC,S990220165,CDM,272,RC,,,Outpatient,,,620,310,,477.4,77,,,Percent of Total Billed Charges,77% of total billed charges,158.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,458.8,74,,,Percent of Total Billed Charges,74% of total billed charges,427.8,69,,,Percent of Total Billed Charges,69% of total billed charges,427.8,69,,,Percent of Total Billed Charges,69% of total billed charges,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,427.8,69,,,Percent of Total Billed Charges,69% of total billed charges,427.8,69,,,Percent of Total Billed Charges,69% of total billed charges,520.8,84,,,Percent of Total Billed Charges,84% of total billed charges,508.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,551.8,89,,,Percent of total Billed Charges,89% of total Billed charges,551.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,477.4,77,,,Percent of total Billed charges,77% of total billed charges,527,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,310,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,252.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155,551.8,
PICO 7 DRESSING,S990220166,CDM,272,RC,,,Outpatient,,,449.5,224.75,,346.12,77,,,Percent of Total Billed Charges,77% of total billed charges,114.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,332.63,74,,,Percent of Total Billed Charges,74% of total billed charges,310.16,69,,,Percent of Total Billed Charges,69% of total billed charges,310.16,69,,,Percent of Total Billed Charges,69% of total billed charges,112.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.16,69,,,Percent of Total Billed Charges,69% of total billed charges,310.16,69,,,Percent of Total Billed Charges,69% of total billed charges,377.58,84,,,Percent of Total Billed Charges,84% of total billed charges,368.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.06,89,,,Percent of total Billed Charges,89% of total Billed charges,400.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.12,77,,,Percent of total Billed charges,77% of total billed charges,382.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,224.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.38,400.06,
PICO WOUND NEG PRES 20X20,S990220167,CDM,272,RC,,,Outpatient,,,406,203,,312.62,77,,,Percent of Total Billed Charges,77% of total billed charges,103.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,300.44,74,,,Percent of Total Billed Charges,74% of total billed charges,280.14,69,,,Percent of Total Billed Charges,69% of total billed charges,280.14,69,,,Percent of Total Billed Charges,69% of total billed charges,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.14,69,,,Percent of Total Billed Charges,69% of total billed charges,280.14,69,,,Percent of Total Billed Charges,69% of total billed charges,341.04,84,,,Percent of Total Billed Charges,84% of total billed charges,332.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,361.34,89,,,Percent of total Billed Charges,89% of total Billed charges,361.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,312.62,77,,,Percent of total Billed charges,77% of total billed charges,345.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,203,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.5,361.34,
PICO WOUND PACK 20X20,S990220168,CDM,272,RC,,,Outpatient,,,389.5,194.75,,299.92,77,,,Percent of Total Billed Charges,77% of total billed charges,99.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,288.23,74,,,Percent of Total Billed Charges,74% of total billed charges,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,327.18,84,,,Percent of Total Billed Charges,84% of total billed charges,319.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,346.66,89,,,Percent of total Billed Charges,89% of total Billed charges,346.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.92,77,,,Percent of total Billed charges,77% of total billed charges,331.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,194.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.38,346.66,
PICO WOUND THERAPY 4X8,S990220169,CDM,272,RC,,,Outpatient,,,665,332.5,,512.05,77,,,Percent of Total Billed Charges,77% of total billed charges,169.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,492.1,74,,,Percent of Total Billed Charges,74% of total billed charges,458.85,69,,,Percent of Total Billed Charges,69% of total billed charges,458.85,69,,,Percent of Total Billed Charges,69% of total billed charges,166.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.85,69,,,Percent of Total Billed Charges,69% of total billed charges,458.85,69,,,Percent of Total Billed Charges,69% of total billed charges,558.6,84,,,Percent of Total Billed Charges,84% of total billed charges,545.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,591.85,89,,,Percent of total Billed Charges,89% of total Billed charges,591.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,512.05,77,,,Percent of total Billed charges,77% of total billed charges,565.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,191.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,332.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,271.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,166.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,591.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.25,591.85,
PIN PACK ODYSSEY STERILE,S990220170,CDM,272,RC,,,Outpatient,,,1359,679.5,,1046.43,77,,,Percent of Total Billed Charges,77% of total billed charges,346.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1005.66,74,,,Percent of Total Billed Charges,74% of total billed charges,937.71,69,,,Percent of Total Billed Charges,69% of total billed charges,937.71,69,,,Percent of Total Billed Charges,69% of total billed charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,937.71,69,,,Percent of Total Billed Charges,69% of total billed charges,937.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1141.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1114.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1209.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1046.43,77,,,Percent of total Billed charges,77% of total billed charges,1155.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,390.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,679.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,554.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1209.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.75,1209.51,
PLASMASPATULA OLYMPUS,S990220171,CDM,272,RC,,,Outpatient,,,779.5,389.75,,600.22,77,,,Percent of Total Billed Charges,77% of total billed charges,198.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,576.83,74,,,Percent of Total Billed Charges,74% of total billed charges,537.86,69,,,Percent of Total Billed Charges,69% of total billed charges,537.86,69,,,Percent of Total Billed Charges,69% of total billed charges,194.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.86,69,,,Percent of Total Billed Charges,69% of total billed charges,537.86,69,,,Percent of Total Billed Charges,69% of total billed charges,654.78,84,,,Percent of Total Billed Charges,84% of total billed charges,639.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,693.76,89,,,Percent of total Billed Charges,89% of total Billed charges,693.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,693.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,318.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.22,77,,,Percent of total Billed charges,77% of total billed charges,662.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,224.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,318.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,693.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.88,693.76,
POLYPECTOMY LOOP,S990220172,CDM,272,RC,,,Outpatient,,,345,172.5,,265.65,77,,,Percent of Total Billed Charges,77% of total billed charges,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.3,74,,,Percent of Total Billed Charges,74% of total billed charges,238.05,69,,,Percent of Total Billed Charges,69% of total billed charges,238.05,69,,,Percent of Total Billed Charges,69% of total billed charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.05,69,,,Percent of Total Billed Charges,69% of total billed charges,238.05,69,,,Percent of Total Billed Charges,69% of total billed charges,289.8,84,,,Percent of Total Billed Charges,84% of total billed charges,282.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,307.05,89,,,Percent of total Billed Charges,89% of total Billed charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,77,,,Percent of total Billed charges,77% of total billed charges,293.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,307.05,
POSISEPX NASAL PACKING,S990220173,CDM,272,RC,,,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.76,74,,,Percent of Total Billed Charges,74% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
POYLP TRAP STERIS,S990220174,CDM,272,RC,,,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.24,74,,,Percent of Total Billed Charges,74% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,21.84,84,,,Percent of Total Billed Charges,84% of total billed charges,21.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,23.14,
PROCERA PROCEDURE,S990220175,CDM,270,RC,,,Outpatient,,,2700,1350,,2079,77,,,Percent of Total Billed Charges,77% of total billed charges,688.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1998,74,,,Percent of Total Billed Charges,74% of total billed charges,1863,69,,,Percent of Total Billed Charges,69% of total billed charges,1863,69,,,Percent of Total Billed Charges,69% of total billed charges,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1863,69,,,Percent of Total Billed Charges,69% of total billed charges,1863,69,,,Percent of Total Billed Charges,69% of total billed charges,2268,84,,,Percent of Total Billed Charges,84% of total billed charges,2214,82,,,Percent of Total Billed Charges,82% of total billed charges ,2403,89,,,Percent of total Billed Charges,89% of total Billed charges,2403,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2403,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2079,77,,,Percent of total Billed charges,77% of total billed charges,2295,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1350,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2403,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,675,2403,
PROLARYN PLUS 1.0 cc KIT,S990220176,CDM,272,RC,,,Outpatient,,,1087.5,543.75,,837.38,77,,,Percent of Total Billed Charges,77% of total billed charges,277.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,804.75,74,,,Percent of Total Billed Charges,74% of total billed charges,750.38,69,,,Percent of Total Billed Charges,69% of total billed charges,750.38,69,,,Percent of Total Billed Charges,69% of total billed charges,271.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,750.38,69,,,Percent of Total Billed Charges,69% of total billed charges,750.38,69,,,Percent of Total Billed Charges,69% of total billed charges,913.5,84,,,Percent of Total Billed Charges,84% of total billed charges,891.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,967.88,89,,,Percent of total Billed Charges,89% of total Billed charges,967.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,967.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,443.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,443.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,837.38,77,,,Percent of total Billed charges,77% of total billed charges,924.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,312.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,543.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,443.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,967.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.88,967.88,
PROMOGRAN MATRIX,S990220177,CDM,272,RC,,,Outpatient,,,30,15,,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.2,74,,,Percent of Total Billed Charges,74% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,25.2,84,,,Percent of Total Billed Charges,84% of total billed charges,24.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.7,89,,,Percent of total Billed Charges,89% of total Billed charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,26.7,
PUPIL EXPANSION DEVICE VANTAGE,S990220178,CDM,272,RC,,,Outpatient,,,570,285,,438.9,77,,,Percent of Total Billed Charges,77% of total billed charges,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,421.8,74,,,Percent of Total Billed Charges,74% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,478.8,84,,,Percent of Total Billed Charges,84% of total billed charges,467.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,507.3,89,,,Percent of total Billed Charges,89% of total Billed charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.9,77,,,Percent of total Billed charges,77% of total billed charges,484.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,285,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.5,507.3,
RADIOFREQ VEIN ALATION TRAY,S990220179,CDM,272,RC,,,Outpatient,,,1264.5,632.25,,973.67,77,,,Percent of Total Billed Charges,77% of total billed charges,322.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,395.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,935.73,74,,,Percent of Total Billed Charges,74% of total billed charges,872.51,69,,,Percent of Total Billed Charges,69% of total billed charges,872.51,69,,,Percent of Total Billed Charges,69% of total billed charges,316.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,872.51,69,,,Percent of Total Billed Charges,69% of total billed charges,872.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1062.18,84,,,Percent of Total Billed Charges,84% of total billed charges,1036.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,1125.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1125.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1125.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,515.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.67,77,,,Percent of total Billed charges,77% of total billed charges,1074.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,363.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,632.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,515.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,316.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.13,1125.41,
RENASYS F MED W/SOFT PORT,S990220180,CDM,272,RC,,,Outpatient,,,131,65.5,,100.87,77,,,Percent of Total Billed Charges,77% of total billed charges,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.94,74,,,Percent of Total Billed Charges,74% of total billed charges,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,110.04,84,,,Percent of Total Billed Charges,84% of total billed charges,107.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.59,89,,,Percent of total Billed Charges,89% of total Billed charges,116.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.87,77,,,Percent of total Billed charges,77% of total billed charges,111.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.75,116.59,
RENASYS TECH 800 CANNISTER,S990220181,CDM,272,RC,,,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.2,74,,,Percent of Total Billed Charges,74% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,109.2,84,,,Percent of Total Billed Charges,84% of total billed charges,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,115.7,
RENASYS TRANSPARENT FILM,S990220182,CDM,272,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
REPRO GREAT WHITE 1.2,S990220183,CDM,270,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
RETRIEVAL SYSTEM BAG,S990220184,CDM,272,RC,,,Outpatient,,,372.5,186.25,,286.83,77,,,Percent of Total Billed Charges,77% of total billed charges,94.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,275.65,74,,,Percent of Total Billed Charges,74% of total billed charges,257.03,69,,,Percent of Total Billed Charges,69% of total billed charges,257.03,69,,,Percent of Total Billed Charges,69% of total billed charges,93.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.03,69,,,Percent of Total Billed Charges,69% of total billed charges,257.03,69,,,Percent of Total Billed Charges,69% of total billed charges,312.9,84,,,Percent of Total Billed Charges,84% of total billed charges,305.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,331.53,89,,,Percent of total Billed Charges,89% of total Billed charges,331.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.83,77,,,Percent of total Billed charges,77% of total billed charges,316.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,186.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.13,331.53,
RhinAer Stylus,S990220185,CDM,272,RC,,,Outpatient,,,8653,4326.5,,6662.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2206.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2206.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2704.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6403.22,74,,,Percent of Total Billed Charges,74% of total billed charges,5970.57,69,,,Percent of Total Billed Charges,69% of total billed charges,5970.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5970.57,69,,,Percent of Total Billed Charges,69% of total billed charges,5970.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7268.52,84,,,Percent of Total Billed Charges,84% of total billed charges,7095.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,7701.17,89,,,Percent of total Billed Charges,89% of total Billed charges,7701.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7701.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3530.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3530.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3530.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6662.81,77,,,Percent of total Billed charges,77% of total billed charges,7355.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2487.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4326.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3530.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2163.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2163.25,7701.17,
RIGIDFIX BIOCRYL DEPUY,S990220186,CDM,270,RC,,,Outpatient,,,932,466,,717.64,77,,,Percent of Total Billed Charges,77% of total billed charges,237.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.68,74,,,Percent of Total Billed Charges,74% of total billed charges,643.08,69,,,Percent of Total Billed Charges,69% of total billed charges,643.08,69,,,Percent of Total Billed Charges,69% of total billed charges,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.08,69,,,Percent of Total Billed Charges,69% of total billed charges,643.08,69,,,Percent of Total Billed Charges,69% of total billed charges,782.88,84,,,Percent of Total Billed Charges,84% of total billed charges,764.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.48,89,,,Percent of total Billed Charges,89% of total Billed charges,829.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.64,77,,,Percent of total Billed charges,77% of total billed charges,792.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,466,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,233,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233,829.48,
SCD FOOT STOCKING,S990220187,CDM,272,RC,,,Outpatient,,,211.5,105.75,,162.86,77,,,Percent of Total Billed Charges,77% of total billed charges,53.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.51,74,,,Percent of Total Billed Charges,74% of total billed charges,145.94,69,,,Percent of Total Billed Charges,69% of total billed charges,145.94,69,,,Percent of Total Billed Charges,69% of total billed charges,52.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.94,69,,,Percent of Total Billed Charges,69% of total billed charges,145.94,69,,,Percent of Total Billed Charges,69% of total billed charges,177.66,84,,,Percent of Total Billed Charges,84% of total billed charges,173.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.24,89,,,Percent of total Billed Charges,89% of total Billed charges,188.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.86,77,,,Percent of total Billed charges,77% of total billed charges,179.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.88,188.24,
SCISSORS LAP CURVED 5MMX32CM,S990220188,CDM,272,RC,,,Outpatient,,,201.5,100.75,,155.16,77,,,Percent of Total Billed Charges,77% of total billed charges,51.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.11,74,,,Percent of Total Billed Charges,74% of total billed charges,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.26,84,,,Percent of Total Billed Charges,84% of total billed charges,165.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.34,89,,,Percent of total Billed Charges,89% of total Billed charges,179.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.16,77,,,Percent of total Billed charges,77% of total billed charges,171.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.38,179.34,
SE Inflation Device,S990220189,CDM,272,RC,,,Outpatient,,,131,65.5,,100.87,77,,,Percent of Total Billed Charges,77% of total billed charges,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.94,74,,,Percent of Total Billed Charges,74% of total billed charges,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,90.39,69,,,Percent of Total Billed Charges,69% of total billed charges,110.04,84,,,Percent of Total Billed Charges,84% of total billed charges,107.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.59,89,,,Percent of total Billed Charges,89% of total Billed charges,116.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.87,77,,,Percent of total Billed charges,77% of total billed charges,111.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.75,116.59,
SEALER AQUAMANTYS,S990220190,CDM,272,RC,,,Outpatient,,,1236,618,,951.72,77,,,Percent of Total Billed Charges,77% of total billed charges,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,914.64,74,,,Percent of Total Billed Charges,74% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,852.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1038.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1013.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1100.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.72,77,,,Percent of total Billed charges,77% of total billed charges,1050.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,355.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,618,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,504.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1100.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309,1100.04,
SHEATH BIO-INTRA DEPUY,S990220191,CDM,270,RC,,,Outpatient,,,613,306.5,,472.01,77,,,Percent of Total Billed Charges,77% of total billed charges,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,453.62,74,,,Percent of Total Billed Charges,74% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,514.92,84,,,Percent of Total Billed Charges,84% of total billed charges,502.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,545.57,89,,,Percent of total Billed Charges,89% of total Billed charges,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.01,77,,,Percent of total Billed charges,77% of total billed charges,521.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,306.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,250.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.25,545.57,
SILVERCEL 4X4,S990220192,CDM,272,RC,,,Outpatient,,,33,16.5,,25.41,77,,,Percent of Total Billed Charges,77% of total billed charges,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.42,74,,,Percent of Total Billed Charges,74% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,27.72,84,,,Percent of Total Billed Charges,84% of total billed charges,27.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.37,89,,,Percent of total Billed Charges,89% of total Billed charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.41,77,,,Percent of total Billed charges,77% of total billed charges,28.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,29.37,
SINUS BALLOON DILAT TRAY,S990220193,CDM,272,RC,,,Outpatient,,,4715,2357.5,,3630.55,77,,,Percent of Total Billed Charges,77% of total billed charges,1202.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1202.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3489.1,74,,,Percent of Total Billed Charges,74% of total billed charges,3253.35,69,,,Percent of Total Billed Charges,69% of total billed charges,3253.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3253.35,69,,,Percent of Total Billed Charges,69% of total billed charges,3253.35,69,,,Percent of Total Billed Charges,69% of total billed charges,3960.6,84,,,Percent of Total Billed Charges,84% of total billed charges,3866.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,4196.35,89,,,Percent of total Billed Charges,89% of total Billed charges,4196.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4196.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1923.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1923.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1923.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3630.55,77,,,Percent of total Billed charges,77% of total billed charges,4007.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2357.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1923.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4196.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.75,4196.35,
SKIN CLOSURE ZIP 24,S990220194,CDM,272,RC,,,Outpatient,,,220.5,110.25,,169.79,77,,,Percent of Total Billed Charges,77% of total billed charges,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.17,74,,,Percent of Total Billed Charges,74% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,185.22,84,,,Percent of Total Billed Charges,84% of total billed charges,180.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.25,89,,,Percent of total Billed Charges,89% of total Billed charges,196.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.79,77,,,Percent of total Billed charges,77% of total billed charges,187.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.13,196.25,
SNARE CAPI 2 STIFF 20mm,S990220195,CDM,272,RC,,,Outpatient,,,46,23,,35.42,77,,,Percent of Total Billed Charges,77% of total billed charges,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.04,74,,,Percent of Total Billed Charges,74% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,84,,,Percent of Total Billed Charges,84% of total billed charges,37.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.94,89,,,Percent of total Billed Charges,89% of total Billed charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.42,77,,,Percent of total Billed charges,77% of total billed charges,39.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,40.94,
SPLINT BOXER,S990220198,CDM,274,RC,,,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,44.1,70,,,Percent of Total Billed Charges,70% total billed charges,43.47,69,,,Percent of total Billed Charges,69% of total Billed charges,43.47,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,43.47,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,53.55,
SPLINT DOYLE II NASAL SEPTAL,S990220199,CDM,272,RC,,,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.46,89,,,Percent of total Billed Charges,89% of total Billed charges,97.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.38,97.46,
STAPLER TA 3.5 RELOAD,S990220200,CDM,272,RC,,,Outpatient,,,597.5,298.75,,460.08,77,,,Percent of Total Billed Charges,77% of total billed charges,152.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,442.15,74,,,Percent of Total Billed Charges,74% of total billed charges,412.28,69,,,Percent of Total Billed Charges,69% of total billed charges,412.28,69,,,Percent of Total Billed Charges,69% of total billed charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,412.28,69,,,Percent of Total Billed Charges,69% of total billed charges,412.28,69,,,Percent of Total Billed Charges,69% of total billed charges,501.9,84,,,Percent of Total Billed Charges,84% of total billed charges,489.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,531.78,89,,,Percent of total Billed Charges,89% of total Billed charges,531.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,531.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.08,77,,,Percent of total Billed charges,77% of total billed charges,507.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,298.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,531.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,531.78,
Storz ENT SHAVER BLADE,S990220201,CDM,272,RC,,,Outpatient,,,269,134.5,,207.13,77,,,Percent of Total Billed Charges,77% of total billed charges,68.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.06,74,,,Percent of Total Billed Charges,74% of total billed charges,185.61,69,,,Percent of Total Billed Charges,69% of total billed charges,185.61,69,,,Percent of Total Billed Charges,69% of total billed charges,67.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.61,69,,,Percent of Total Billed Charges,69% of total billed charges,185.61,69,,,Percent of Total Billed Charges,69% of total billed charges,225.96,84,,,Percent of Total Billed Charges,84% of total billed charges,220.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.41,89,,,Percent of total Billed Charges,89% of total Billed charges,239.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.13,77,,,Percent of total Billed charges,77% of total billed charges,228.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.25,239.41,
Storz ENT TUBE SET,S990220202,CDM,272,RC,,,Outpatient,,,62,31,,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.88,74,,,Percent of Total Billed Charges,74% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.08,84,,,Percent of Total Billed Charges,84% of total billed charges,50.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.18,89,,,Percent of total Billed Charges,89% of total Billed charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,55.18,
STRAIGHT COLD KNIFE,S990220203,CDM,270,RC,,,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.96,89,,,Percent of total Billed Charges,89% of total Billed charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,132,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66,234.96,
"STRATAFIX PADS PLUS 18""",S990220204,CDM,272,RC,,,Outpatient,,,48,24,,36.96,77,,,Percent of Total Billed Charges,77% of total billed charges,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.52,74,,,Percent of Total Billed Charges,74% of total billed charges,33.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.12,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,84,,,Percent of Total Billed Charges,84% of total billed charges,39.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.72,89,,,Percent of total Billed Charges,89% of total Billed charges,42.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.96,77,,,Percent of total Billed charges,77% of total billed charges,40.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.72,
Stryker ASSY RP360 Sut Pas Ref,S990220205,CDM,272,RC,,,Outpatient,,,736,368,,566.72,77,,,Percent of Total Billed Charges,77% of total billed charges,187.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,544.64,74,,,Percent of Total Billed Charges,74% of total billed charges,507.84,69,,,Percent of Total Billed Charges,69% of total billed charges,507.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.84,69,,,Percent of Total Billed Charges,69% of total billed charges,507.84,69,,,Percent of Total Billed Charges,69% of total billed charges,618.24,84,,,Percent of Total Billed Charges,84% of total billed charges,603.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,655.04,89,,,Percent of total Billed Charges,89% of total Billed charges,655.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,655.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.72,77,,,Percent of total Billed charges,77% of total billed charges,625.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,368,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,300.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184,655.04,
STRYKER FIXATION PIN,S990220206,CDM,272,RC,,,Outpatient,,,918.5,459.25,,707.25,77,,,Percent of Total Billed Charges,77% of total billed charges,234.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,679.69,74,,,Percent of Total Billed Charges,74% of total billed charges,633.77,69,,,Percent of Total Billed Charges,69% of total billed charges,633.77,69,,,Percent of Total Billed Charges,69% of total billed charges,229.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,633.77,69,,,Percent of Total Billed Charges,69% of total billed charges,633.77,69,,,Percent of Total Billed Charges,69% of total billed charges,771.54,84,,,Percent of Total Billed Charges,84% of total billed charges,753.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.47,89,,,Percent of total Billed Charges,89% of total Billed charges,817.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.25,77,,,Percent of total Billed charges,77% of total billed charges,780.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.63,817.47,
SUCTION COAGULATOR-CONMED,S990220207,CDM,272,RC,,,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.6,74,,,Percent of Total Billed Charges,74% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,33.6,84,,,Percent of Total Billed Charges,84% of total billed charges,32.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.6,89,,,Percent of total Billed Charges,89% of total Billed charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,35.6,
SUCTION IRRIGATOR,S990220208,CDM,270,RC,,,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,129.94,
SUCTION SHAVER BLADE 40,S990220209,CDM,272,RC,,,Outpatient,,,227,113.5,,174.79,77,,,Percent of Total Billed Charges,77% of total billed charges,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.98,74,,,Percent of Total Billed Charges,74% of total billed charges,156.63,69,,,Percent of Total Billed Charges,69% of total billed charges,156.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.63,69,,,Percent of Total Billed Charges,69% of total billed charges,156.63,69,,,Percent of Total Billed Charges,69% of total billed charges,190.68,84,,,Percent of Total Billed Charges,84% of total billed charges,186.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.03,89,,,Percent of total Billed Charges,89% of total Billed charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.79,77,,,Percent of total Billed charges,77% of total billed charges,192.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.75,202.03,
SUCTION SHAVER BLADE 65,S990220210,CDM,272,RC,,,Outpatient,,,323,161.5,,248.71,77,,,Percent of Total Billed Charges,77% of total billed charges,82.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.02,74,,,Percent of Total Billed Charges,74% of total billed charges,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,271.32,84,,,Percent of Total Billed Charges,84% of total billed charges,264.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.47,89,,,Percent of total Billed Charges,89% of total Billed charges,287.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.71,77,,,Percent of total Billed charges,77% of total billed charges,274.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.75,287.47,
SUPRAPUBIC CATH KIT VSCS,S990220211,CDM,272,RC,,,Outpatient,,,177,88.5,,136.29,77,,,Percent of Total Billed Charges,77% of total billed charges,45.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.98,74,,,Percent of Total Billed Charges,74% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,69,,,Percent of Total Billed Charges,69% of total billed charges,148.68,84,,,Percent of Total Billed Charges,84% of total billed charges,145.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.53,89,,,Percent of total Billed Charges,89% of total Billed charges,157.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.29,77,,,Percent of total Billed charges,77% of total billed charges,150.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.25,157.53,
SURGICAL PATTIES,S990220212,CDM,272,RC,,,Outpatient,,,11,5.5,,8.47,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.14,74,,,Percent of Total Billed Charges,74% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,9.24,84,,,Percent of Total Billed Charges,84% of total billed charges,9.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.79,89,,,Percent of total Billed Charges,89% of total Billed charges,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.47,77,,,Percent of total Billed charges,77% of total billed charges,9.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.79,
"SURGICEL, LARGE",S990220213,CDM,272,RC,,,Outpatient,,,477,238.5,,367.29,77,,,Percent of Total Billed Charges,77% of total billed charges,121.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,352.98,74,,,Percent of Total Billed Charges,74% of total billed charges,329.13,69,,,Percent of Total Billed Charges,69% of total billed charges,329.13,69,,,Percent of Total Billed Charges,69% of total billed charges,119.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.13,69,,,Percent of Total Billed Charges,69% of total billed charges,329.13,69,,,Percent of Total Billed Charges,69% of total billed charges,400.68,84,,,Percent of Total Billed Charges,84% of total billed charges,391.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,424.53,89,,,Percent of total Billed Charges,89% of total Billed charges,424.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,367.29,77,,,Percent of total Billed charges,77% of total billed charges,405.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,238.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,194.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.25,424.53,
SUTURE V-LOC ABS CLOSE DEVICE,S990220214,CDM,272,RC,,,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,189.13,89,,,Percent of total Billed Charges,89% of total Billed charges,189.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,106.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,189.13,
"SUTURE, EYE",S990220215,CDM,272,RC,,,Outpatient,,,120.5,60.25,,92.79,77,,,Percent of Total Billed Charges,77% of total billed charges,30.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.17,74,,,Percent of Total Billed Charges,74% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,101.22,84,,,Percent of Total Billed Charges,84% of total billed charges,98.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.25,89,,,Percent of total Billed Charges,89% of total Billed charges,107.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.79,77,,,Percent of total Billed charges,77% of total billed charges,102.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.13,107.25,
Synthes 4.2 Drill Bit,S990220216,CDM,272,RC,,,Outpatient,,,1272.5,636.25,,979.83,77,,,Percent of Total Billed Charges,77% of total billed charges,324.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,941.65,74,,,Percent of Total Billed Charges,74% of total billed charges,878.03,69,,,Percent of Total Billed Charges,69% of total billed charges,878.03,69,,,Percent of Total Billed Charges,69% of total billed charges,318.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,878.03,69,,,Percent of Total Billed Charges,69% of total billed charges,878.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.9,84,,,Percent of Total Billed Charges,84% of total billed charges,1043.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,1132.53,89,,,Percent of total Billed Charges,89% of total Billed charges,1132.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1132.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,519.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,519.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,519.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,318.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.83,77,,,Percent of total Billed charges,77% of total billed charges,1081.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,636.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,519.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,318.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1132.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,318.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.13,1132.53,
Synthes TEN Fen Helical Blade,S990220217,CDM,272,RC,,,Outpatient,,,5192,2596,,3997.84,77,,,Percent of Total Billed Charges,77% of total billed charges,1323.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1323.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3842.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3582.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3582.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3582.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3582.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4361.28,84,,,Percent of Total Billed Charges,84% of total billed charges,4257.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,4620.88,89,,,Percent of total Billed Charges,89% of total Billed charges,4620.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4620.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2118.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2118.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2118.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3997.84,77,,,Percent of total Billed charges,77% of total billed charges,4413.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1492.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2596,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2118.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4620.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1298,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1298,4620.88,
TIELLE PLUS ADHESIVE,S990220218,CDM,272,RC,,,Outpatient,,,19,9.5,,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.06,74,,,Percent of Total Billed Charges,74% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,15.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.91,89,,,Percent of total Billed Charges,89% of total Billed charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.91,
TRACH CLEAN-UP TRAY 4682A,S990220219,CDM,272,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.57,
TRACHEAL DILATION DEVICE,S990220220,CDM,272,RC,,,Outpatient,,,4121,2060.5,,3173.17,77,,,Percent of Total Billed Charges,77% of total billed charges,1050.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1287.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3049.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2843.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2843.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1030.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2843.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2843.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3461.64,84,,,Percent of Total Billed Charges,84% of total billed charges,3379.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,3667.69,89,,,Percent of total Billed Charges,89% of total Billed charges,3667.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3667.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1681.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1681.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1681.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1030.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3173.17,77,,,Percent of total Billed charges,77% of total billed charges,3502.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1184.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2060.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1681.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1030.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3667.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1030.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1030.25,3667.69,
TRANS-OBTURATOR URETHRAL SYSTM,S990220221,CDM,270,RC,,,Outpatient,,,2230,1115,,1717.1,77,,,Percent of Total Billed Charges,77% of total billed charges,568.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,568.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,696.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1650.2,74,,,Percent of Total Billed Charges,74% of total billed charges,1538.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1538.7,69,,,Percent of Total Billed Charges,69% of total billed charges,557.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1538.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1538.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1873.2,84,,,Percent of Total Billed Charges,84% of total billed charges,1828.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1984.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1984.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,909.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,909.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,909.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,557.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1717.1,77,,,Percent of total Billed charges,77% of total billed charges,1895.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,641.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1115,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,909.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,557.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,557.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.5,1984.7,
TRAXI PANNICULUS RETRACTOR,S990220222,CDM,272,RC,,,Outpatient,,,94,47,,72.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.56,74,,,Percent of Total Billed Charges,74% of total billed charges,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,84,,,Percent of Total Billed Charges,84% of total billed charges,77.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.66,89,,,Percent of total Billed Charges,89% of total Billed charges,83.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.38,77,,,Percent of total Billed charges,77% of total billed charges,79.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.5,83.66,
TRILLIANT CONCAVE REAMER,S990220223,CDM,272,RC,,,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,218.3,74,,,Percent of Total Billed Charges,74% of total billed charges,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,247.8,84,,,Percent of Total Billed Charges,84% of total billed charges,241.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.75,262.55,
TROCAR 11MM,S990220224,CDM,272,RC,,,Outpatient,,,236.5,118.25,,182.11,77,,,Percent of Total Billed Charges,77% of total billed charges,60.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.01,74,,,Percent of Total Billed Charges,74% of total billed charges,163.19,69,,,Percent of Total Billed Charges,69% of total billed charges,163.19,69,,,Percent of Total Billed Charges,69% of total billed charges,59.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.19,69,,,Percent of Total Billed Charges,69% of total billed charges,163.19,69,,,Percent of Total Billed Charges,69% of total billed charges,198.66,84,,,Percent of Total Billed Charges,84% of total billed charges,193.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.49,89,,,Percent of total Billed Charges,89% of total Billed charges,210.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,77,,,Percent of total Billed charges,77% of total billed charges,201.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.13,210.49,
TROCAR 5MM,S990220225,CDM,270,RC,,,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.82,74,,,Percent of Total Billed Charges,74% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
TROCAR DISPOS W/O 8mm,S990220226,CDM,272,RC,,,Outpatient,,,488.5,244.25,,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.77,89,,,Percent of total Billed Charges,89% of total Billed charges,434.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.13,434.77,
TROCAR Z THREAD 12X100,S990220227,CDM,272,RC,,,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.22,74,,,Percent of Total Billed Charges,74% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,86.52,84,,,Percent of Total Billed Charges,84% of total billed charges,84.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,91.67,
TRUCLEAR INCISOR DEVICE,S990220228,CDM,272,RC,,,Outpatient,,,1291,645.5,,994.07,77,,,Percent of Total Billed Charges,77% of total billed charges,329.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,329.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,403.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,955.34,74,,,Percent of Total Billed Charges,74% of total billed charges,890.79,69,,,Percent of Total Billed Charges,69% of total billed charges,890.79,69,,,Percent of Total Billed Charges,69% of total billed charges,322.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.79,69,,,Percent of Total Billed Charges,69% of total billed charges,890.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1084.44,84,,,Percent of Total Billed Charges,84% of total billed charges,1058.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,1148.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1148.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,526.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,526.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,526.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,994.07,77,,,Percent of total Billed charges,77% of total billed charges,1097.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,371.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,645.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,526.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,322.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.75,1148.99,
TRUCLEAR ULTARA PLUS DEVICE,S990220229,CDM,272,RC,,,Outpatient,,,1761,880.5,,1355.97,77,,,Percent of Total Billed Charges,77% of total billed charges,449.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,449.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,550.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1303.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1215.09,69,,,Percent of Total Billed Charges,69% of total billed charges,1215.09,69,,,Percent of Total Billed Charges,69% of total billed charges,440.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1215.09,69,,,Percent of Total Billed Charges,69% of total billed charges,1215.09,69,,,Percent of Total Billed Charges,69% of total billed charges,1479.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1444.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1567.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1567.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1567.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,718.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,718.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,718.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,440.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1355.97,77,,,Percent of total Billed charges,77% of total billed charges,1496.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,506.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,880.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,718.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,440.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1567.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,440.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,440.25,1567.29,
TRUCLEAR ULTRA MINI,S990220230,CDM,272,RC,,,Outpatient,,,2147.5,1073.75,,1653.58,77,,,Percent of Total Billed Charges,77% of total billed charges,547.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,547.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,671.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1589.15,74,,,Percent of Total Billed Charges,74% of total billed charges,1481.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1481.78,69,,,Percent of Total Billed Charges,69% of total billed charges,536.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1481.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1481.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1803.9,84,,,Percent of Total Billed Charges,84% of total billed charges,1760.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,1911.28,89,,,Percent of total Billed Charges,89% of total Billed charges,1911.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1911.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,876.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,876.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,876.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,536.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1653.58,77,,,Percent of total Billed charges,77% of total billed charges,1825.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,617.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1073.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,876.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,536.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1911.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,536.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,536.88,1911.28,
UNA BOOT,S990220231,CDM,270,RC,,,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.82,89,,,Percent of total Billed Charges,89% of total Billed charges,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.38,29.82,
UTEM RUMI KOH-EFFICIENT,S990220232,CDM,272,RC,,,Outpatient,,,222.5,111.25,,171.33,77,,,Percent of Total Billed Charges,77% of total billed charges,56.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,164.65,74,,,Percent of Total Billed Charges,74% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,186.9,84,,,Percent of Total Billed Charges,84% of total billed charges,182.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.03,89,,,Percent of total Billed Charges,89% of total Billed charges,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.33,77,,,Percent of total Billed charges,77% of total billed charges,189.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.63,198.03,
UTERINE MANIPULATOR RUMI,S990220233,CDM,272,RC,,,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.46,89,,,Percent of total Billed Charges,89% of total Billed charges,97.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.38,97.46,
UTERINE MANIPULATOR STD V-CARE,S990220234,CDM,270,RC,,,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,177.56,89,,,Percent of total Billed Charges,89% of total Billed charges,177.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.88,177.56,
VESSEL SEALER SALIENT TECH,S990220235,CDM,272,RC,,,Outpatient,,,344.5,172.25,,265.27,77,,,Percent of Total Billed Charges,77% of total billed charges,87.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.93,74,,,Percent of Total Billed Charges,74% of total billed charges,237.71,69,,,Percent of Total Billed Charges,69% of total billed charges,237.71,69,,,Percent of Total Billed Charges,69% of total billed charges,86.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.71,69,,,Percent of Total Billed Charges,69% of total billed charges,237.71,69,,,Percent of Total Billed Charges,69% of total billed charges,289.38,84,,,Percent of Total Billed Charges,84% of total billed charges,282.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.61,89,,,Percent of total Billed Charges,89% of total Billed charges,306.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.27,77,,,Percent of total Billed charges,77% of total billed charges,292.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.13,306.61,
VISCOAT/ANIKAVISC,S990220236,CDM,272,RC,,,Outpatient,,,277,138.5,,213.29,77,,,Percent of Total Billed Charges,77% of total billed charges,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.98,74,,,Percent of Total Billed Charges,74% of total billed charges,191.13,69,,,Percent of Total Billed Charges,69% of total billed charges,191.13,69,,,Percent of Total Billed Charges,69% of total billed charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.13,69,,,Percent of Total Billed Charges,69% of total billed charges,191.13,69,,,Percent of Total Billed Charges,69% of total billed charges,232.68,84,,,Percent of Total Billed Charges,84% of total billed charges,227.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,246.53,89,,,Percent of total Billed Charges,89% of total Billed charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.29,77,,,Percent of total Billed charges,77% of total billed charges,235.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.25,246.53,
VISION BLUE,S990220237,CDM,270,RC,,,Outpatient,,,211,105.5,,162.47,77,,,Percent of Total Billed Charges,77% of total billed charges,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.14,74,,,Percent of Total Billed Charges,74% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,177.24,84,,,Percent of Total Billed Charges,84% of total billed charges,173.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.79,89,,,Percent of total Billed Charges,89% of total Billed charges,187.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.47,77,,,Percent of total Billed charges,77% of total billed charges,179.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.75,187.79,
VITOSS TRAUMA FOAM 2.5 cc,S990220238,CDM,272,RC,,,Outpatient,,,3060.5,1530.25,,2356.59,77,,,Percent of Total Billed Charges,77% of total billed charges,780.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,780.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,956.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2264.77,74,,,Percent of Total Billed Charges,74% of total billed charges,2111.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2111.75,69,,,Percent of Total Billed Charges,69% of total billed charges,765.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2111.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2111.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2570.82,84,,,Percent of Total Billed Charges,84% of total billed charges,2509.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,2723.85,89,,,Percent of total Billed Charges,89% of total Billed charges,2723.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2723.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1248.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1248.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1248.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2356.59,77,,,Percent of total Billed charges,77% of total billed charges,2601.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,879.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1530.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1248.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,765.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2723.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.13,2723.85,
VITRECTOMY KIT,S990220239,CDM,272,RC,,,Outpatient,,,289,144.5,,222.53,77,,,Percent of Total Billed Charges,77% of total billed charges,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,213.86,74,,,Percent of Total Billed Charges,74% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,242.76,84,,,Percent of Total Billed Charges,84% of total billed charges,236.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,257.21,89,,,Percent of total Billed Charges,89% of total Billed charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,77,,,Percent of total Billed charges,77% of total billed charges,245.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,144.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.25,257.21,
WIRE SENSOR 0.35 3CM,S990220240,CDM,272,RC,C1713,HCPCS,Outpatient,,,120.5,60.25,,92.79,77,,,Percent of Total Billed Charges,77% of total billed charges,30.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.17,74,,,Percent of Total Billed Charges,74% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,101.22,84,,,Percent of Total Billed Charges,84% of total billed charges,98.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.25,89,,,Percent of total Billed Charges,89% of total Billed charges,107.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.79,77,,,Percent of total Billed charges,77% of total billed charges,102.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.13,107.25,
Wound Vac-IP only,S990220241,CDM,270,RC,,,Outpatient,,,183.5,91.75,,141.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.79,74,,,Percent of Total Billed Charges,74% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.14,84,,,Percent of Total Billed Charges,84% of total billed charges,150.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.32,89,,,Percent of total Billed Charges,89% of total Billed charges,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.3,77,,,Percent of total Billed charges,77% of total billed charges,155.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.88,163.32,
"Zimmer Suction Cup, sterile",S990220242,CDM,272,RC,,,Outpatient,,,436.5,218.25,,336.11,77,,,Percent of Total Billed Charges,77% of total billed charges,111.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.01,74,,,Percent of Total Billed Charges,74% of total billed charges,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,366.66,84,,,Percent of Total Billed Charges,84% of total billed charges,357.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,388.49,89,,,Percent of total Billed Charges,89% of total Billed charges,388.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.11,77,,,Percent of total Billed charges,77% of total billed charges,371.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,218.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.13,388.49,
0.9NS IRR 3000 ML BAG,S990220244,CDM,272,RC,,,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,103.6,74,,,Percent of Total Billed Charges,74% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,117.6,84,,,Percent of Total Billed Charges,84% of total billed charges,114.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.6,89,,,Percent of total Billed Charges,89% of total Billed charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,124.6,
1/2 STERI SKIN CLOSE,S990220245,CDM,272,RC,,,Outpatient,,,23,11.5,,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.02,74,,,Percent of Total Billed Charges,74% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,19.32,84,,,Percent of Total Billed Charges,84% of total billed charges,18.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.47,89,,,Percent of total Billed Charges,89% of total Billed charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,20.47,
1/4 STERI SKIN CLOSE,S990220246,CDM,272,RC,,,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,14.24,
ADAPTIC DRESSING 3X3,S990220247,CDM,272,RC,,,Outpatient,,,12.5,6.25,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.25,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.5,84,,,Percent of Total Billed Charges,84% of total billed charges,10.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
ADAPTIC DRESSING 3X8,S990220248,CDM,272,RC,,,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,14.24,
BARIUM CUP,S990220249,CDM,270,RC,,,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.68,74,,,Percent of Total Billed Charges,74% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,26.88,84,,,Percent of Total Billed Charges,84% of total billed charges,26.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.48,89,,,Percent of total Billed Charges,89% of total Billed charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,28.48,
BARIUM ENEMA KIT,S990220250,CDM,270,RC,,,Outpatient,,,62.5,31.25,,48.13,77,,,Percent of Total Billed Charges,77% of total billed charges,15.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.25,74,,,Percent of Total Billed Charges,74% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,84,,,Percent of Total Billed Charges,84% of total billed charges,51.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.63,89,,,Percent of total Billed Charges,89% of total Billed charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.13,77,,,Percent of total Billed charges,77% of total billed charges,53.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.63,55.63,
BASIC SURGERY TRAY,S990220251,CDM,272,RC,,,Outpatient,,,162.5,81.25,,125.13,77,,,Percent of Total Billed Charges,77% of total billed charges,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.25,74,,,Percent of Total Billed Charges,74% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,136.5,84,,,Percent of Total Billed Charges,84% of total billed charges,133.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.63,89,,,Percent of total Billed Charges,89% of total Billed charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.13,77,,,Percent of total Billed charges,77% of total billed charges,138.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.63,144.63,
BIOPSY FORCEPS DISP,S990220252,CDM,272,RC,,,Outpatient,,,287.5,143.75,,221.38,77,,,Percent of Total Billed Charges,77% of total billed charges,73.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,212.75,74,,,Percent of Total Billed Charges,74% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,84,,,Percent of Total Billed Charges,84% of total billed charges,235.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,255.88,89,,,Percent of total Billed Charges,89% of total Billed charges,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.38,77,,,Percent of total Billed charges,77% of total billed charges,244.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,117.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.88,255.88,
BIOPSY NEEDLE,S990220253,CDM,270,RC,,,Outpatient,,,173,86.5,,133.21,77,,,Percent of Total Billed Charges,77% of total billed charges,44.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,119.37,69,,,Percent of Total Billed Charges,69% of total billed charges,119.37,69,,,Percent of Total Billed Charges,69% of total billed charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.37,69,,,Percent of Total Billed Charges,69% of total billed charges,119.37,69,,,Percent of Total Billed Charges,69% of total billed charges,145.32,84,,,Percent of Total Billed Charges,84% of total billed charges,141.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.97,89,,,Percent of total Billed Charges,89% of total Billed charges,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.21,77,,,Percent of total Billed charges,77% of total billed charges,147.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.25,153.97,
BOVIE NEEDLE TIP,S990220254,CDM,272,RC,,,Outpatient,,,20,10,,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.8,74,,,Percent of Total Billed Charges,74% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16.8,84,,,Percent of Total Billed Charges,84% of total billed charges,16.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.8,89,,,Percent of total Billed Charges,89% of total Billed charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,17.8,
BURR 4.0MM,S990220255,CDM,272,RC,,,Outpatient,,,122,61,,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.28,74,,,Percent of Total Billed Charges,74% of total billed charges,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,84,,,Percent of Total Billed Charges,84% of total billed charges,100.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.58,89,,,Percent of total Billed Charges,89% of total Billed charges,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.5,108.58,
"CAST, ARM",S990220256,CDM,270,RC,,,Outpatient,,,305,152.5,,234.85,77,,,Percent of Total Billed Charges,77% of total billed charges,77.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.7,74,,,Percent of Total Billed Charges,74% of total billed charges,210.45,69,,,Percent of Total Billed Charges,69% of total billed charges,210.45,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.45,69,,,Percent of Total Billed Charges,69% of total billed charges,210.45,69,,,Percent of Total Billed Charges,69% of total billed charges,256.2,84,,,Percent of Total Billed Charges,84% of total billed charges,250.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,271.45,89,,,Percent of total Billed Charges,89% of total Billed charges,271.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.85,77,,,Percent of total Billed charges,77% of total billed charges,259.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.25,271.45,
"CAST, LEG",S990220257,CDM,270,RC,,,Outpatient,,,358,179,,275.66,77,,,Percent of Total Billed Charges,77% of total billed charges,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.92,74,,,Percent of Total Billed Charges,74% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,300.72,84,,,Percent of Total Billed Charges,84% of total billed charges,293.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,318.62,89,,,Percent of total Billed Charges,89% of total Billed charges,318.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,318.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.66,77,,,Percent of total Billed charges,77% of total billed charges,304.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,179,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,146.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.5,318.62,
CATH COUDE,S990220258,CDM,272,RC,,,Outpatient,,,116,58,,89.32,77,,,Percent of Total Billed Charges,77% of total billed charges,29.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.84,74,,,Percent of Total Billed Charges,74% of total billed charges,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,97.44,84,,,Percent of Total Billed Charges,84% of total billed charges,95.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.24,89,,,Percent of total Billed Charges,89% of total Billed charges,103.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.32,77,,,Percent of total Billed charges,77% of total billed charges,98.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29,103.24,
CATH FOLEY TRAY,S990220259,CDM,272,RC,,,Outpatient,,,89,44.5,,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.86,74,,,Percent of Total Billed Charges,74% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,74.76,84,,,Percent of Total Billed Charges,84% of total billed charges,72.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.21,89,,,Percent of total Billed Charges,89% of total Billed charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,79.21,
CATH TROCAR,S990220260,CDM,450,RC,,,Outpatient,,,54,27,,41.58,77,,,Percent of Total Billed Charges,77% of total billed charges,13.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.86,59,,,Percent of Total Billed Charges,59% of total billed charges,31.86,100,,,case rate,pays based on per visit,31.86,59,,,case rate,pays based on per visit,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.86,59,,,Percent of Total Billed Charges,59% of total billed charges,31.86,59,,,Percent of Total Billed Charges,59% of total billed charges,45.36,84,,,Percent of Total Billed Charges,84% of total billed charges,44.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.06,89,,,Percent of total Billed Charges,89% of total Billed charges,45.36,84,,,Percent of Total Billed Charges,84% of Total Billed charges,48.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.58,77,,,Percent of total Billed charges,77% of total billed charges,45.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4232,100,,,Case Rate,Pays based on per visit rate,22.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3662,100,,,Case Rate,Pays based on per visit rate,13.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.5,4232,
"CATH, URINE",S990220261,CDM,272,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
"CAUTERY, HIGH TEMP",S990220262,CDM,270,RC,,,Outpatient,,,36.5,18.25,,28.11,77,,,Percent of Total Billed Charges,77% of total billed charges,9.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.01,74,,,Percent of Total Billed Charges,74% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30.66,84,,,Percent of Total Billed Charges,84% of total billed charges,29.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.49,89,,,Percent of total Billed Charges,89% of total Billed charges,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.11,77,,,Percent of total Billed charges,77% of total billed charges,31.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,32.49,
CEMENT GUN CARTRIDGE,S990220263,CDM,272,RC,,,Outpatient,,,144.5,72.25,,111.27,77,,,Percent of Total Billed Charges,77% of total billed charges,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.93,74,,,Percent of Total Billed Charges,74% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,121.38,84,,,Percent of Total Billed Charges,84% of total billed charges,118.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.61,89,,,Percent of total Billed Charges,89% of total Billed charges,128.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,77,,,Percent of total Billed charges,77% of total billed charges,122.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.13,128.61,
CEMENT RESTRICTOR,S990220264,CDM,272,RC,,,Outpatient,,,342,171,,263.34,77,,,Percent of Total Billed Charges,77% of total billed charges,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,253.08,74,,,Percent of Total Billed Charges,74% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,287.28,84,,,Percent of Total Billed Charges,84% of total billed charges,280.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,304.38,89,,,Percent of total Billed Charges,89% of total Billed charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.34,77,,,Percent of total Billed charges,77% of total billed charges,290.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,171,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,139.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.5,304.38,
CENTRAL LINE TRIPLE LUMEN TRAY,S990220265,CDM,272,RC,,,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,192.69,89,,,Percent of total Billed Charges,89% of total Billed charges,192.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,192.69,
CIRCUMCISION TRAY,S990220266,CDM,270,RC,,,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.1,89,,,Percent of total Billed Charges,89% of total Billed charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.5,80.1,
COTTON SHEETING 12 INCH,S990220267,CDM,270,RC,,,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.88,74,,,Percent of Total Billed Charges,74% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,10.08,84,,,Percent of Total Billed Charges,84% of total billed charges,9.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,10.68,
CT BARIUM,S990220268,CDM,270,RC,,,Outpatient,,,33,16.5,,25.41,77,,,Percent of Total Billed Charges,77% of total billed charges,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.42,74,,,Percent of Total Billed Charges,74% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22.77,69,,,Percent of Total Billed Charges,69% of total billed charges,27.72,84,,,Percent of Total Billed Charges,84% of total billed charges,27.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.37,89,,,Percent of total Billed Charges,89% of total Billed charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.41,77,,,Percent of total Billed charges,77% of total billed charges,28.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,29.37,
DOBBHOFF FEED TUBE,S990220269,CDM,270,RC,,,Outpatient,,,182,91,,140.14,77,,,Percent of Total Billed Charges,77% of total billed charges,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.68,74,,,Percent of Total Billed Charges,74% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,152.88,84,,,Percent of Total Billed Charges,84% of total billed charges,149.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.98,89,,,Percent of total Billed Charges,89% of total Billed charges,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.14,77,,,Percent of total Billed charges,77% of total billed charges,154.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.5,161.98,
ELASTIC BANDAGE (ACE WRAP),S990220270,CDM,270,RC,,,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.82,89,,,Percent of total Billed Charges,89% of total Billed charges,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.38,29.82,
ENEMA FLEET PHOSPHATE,S990220271,CDM,270,RC,,,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,14.24,
EYE IRRIG LENS/MORGAN,S990220272,CDM,272,RC,,,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.1,89,,,Percent of total Billed Charges,89% of total Billed charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.5,80.1,
EYE TRAY,S990220273,CDM,270,RC,,,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.72,74,,,Percent of Total Billed Charges,74% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,113.92,
FINGER SPLINT,S990220274,CDM,270,RC,,,Outpatient,,,29,14.5,,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.46,74,,,Percent of Total Billed Charges,74% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24.36,84,,,Percent of Total Billed Charges,84% of total billed charges,23.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.81,89,,,Percent of total Billed Charges,89% of total Billed charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,25.81,
GASTROSTOMY TUBE,S990220275,CDM,270,RC,,,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,177.56,89,,,Percent of total Billed Charges,89% of total Billed charges,177.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.88,177.56,
GIA STAPLES,S990220276,CDM,272,RC,,,Outpatient,,,981.5,490.75,,755.76,77,,,Percent of Total Billed Charges,77% of total billed charges,250.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,726.31,74,,,Percent of Total Billed Charges,74% of total billed charges,677.24,69,,,Percent of Total Billed Charges,69% of total billed charges,677.24,69,,,Percent of Total Billed Charges,69% of total billed charges,245.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.24,69,,,Percent of Total Billed Charges,69% of total billed charges,677.24,69,,,Percent of Total Billed Charges,69% of total billed charges,824.46,84,,,Percent of Total Billed Charges,84% of total billed charges,804.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,873.54,89,,,Percent of total Billed Charges,89% of total Billed charges,873.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,873.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.76,77,,,Percent of total Billed charges,77% of total billed charges,834.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,490.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,400.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,245.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,873.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.38,873.54,
HEEL & ELBOW PROTECT,S990220277,CDM,270,RC,,,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.76,74,,,Percent of Total Billed Charges,74% of total billed charges,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,62.16,84,,,Percent of Total Billed Charges,84% of total billed charges,60.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.86,89,,,Percent of total Billed Charges,89% of total Billed charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,65.86,
J/P DRAIN,S990220278,CDM,272,RC,,,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
J/P SUCT RESERVIOR,S990220279,CDM,272,RC,,,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.02,89,,,Percent of total Billed Charges,89% of total Billed charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,105.02,
KNEE SUPPORT PATELLA,S990220280,CDM,274,RC,,,Outpatient,,,64.5,32.25,,49.67,77,,,Percent of Total Billed Charges,77% of total billed charges,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,45.15,70,,,Percent of Total Billed Charges,70% total billed charges,44.51,69,,,Percent of total Billed Charges,69% of total Billed charges,44.51,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,44.51,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,26.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.67,77,,,Percent of total Billed charges,77% of total billed charges,54.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,54.83,
K-PAD,S990220281,CDM,270,RC,,,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.31,89,,,Percent of total Billed Charges,89% of total Billed charges,70.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.75,70.31,
K-WIRE,S990220282,CDM,272,RC,,,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,48.1,74,,,Percent of Total Billed Charges,74% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,84,,,Percent of Total Billed Charges,84% of total billed charges,53.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,57.85,
LUMBAR TRAY ADULT,S990220283,CDM,272,RC,,,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.39,74,,,Percent of Total Billed Charges,74% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,103.74,84,,,Percent of Total Billed Charges,84% of total billed charges,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,109.92,
LUMBAR TRAY INFANT,S990220284,CDM,272,RC,,,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.39,74,,,Percent of Total Billed Charges,74% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,103.74,84,,,Percent of Total Billed Charges,84% of total billed charges,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,109.92,
MALECOT DRAIN,S990220285,CDM,272,RC,,,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.21,89,,,Percent of total Billed Charges,89% of total Billed charges,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.25,168.21,
MYRINGOTOMY TUBE,S990220286,CDM,272,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.57,
MYRINGOTOMY TUBE MODIFIED,S990220287,CDM,272,RC,,,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.02,89,,,Percent of total Billed Charges,89% of total Billed charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,105.02,
OCL SPLINT,S990220288,CDM,270,RC,,,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.12,74,,,Percent of Total Billed Charges,74% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,211.82,
PLAIN IODOFORM GAUZE,S990220289,CDM,272,RC,,,Outpatient,,,49,24.5,,37.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.26,74,,,Percent of Total Billed Charges,74% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.16,84,,,Percent of Total Billed Charges,84% of total billed charges,40.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.61,89,,,Percent of total Billed Charges,89% of total Billed charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.73,77,,,Percent of total Billed charges,77% of total billed charges,41.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.25,43.61,
PLASTIC C-COLLAR,S990220290,CDM,270,RC,,,Outpatient,,,80,40,,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.2,74,,,Percent of Total Billed Charges,74% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,67.2,84,,,Percent of Total Billed Charges,84% of total billed charges,65.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.2,89,,,Percent of total Billed Charges,89% of total Billed charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,71.2,
PLEUR/EVAC W STAND,S990220291,CDM,272,RC,,,Outpatient,,,511,255.5,,393.47,77,,,Percent of Total Billed Charges,77% of total billed charges,130.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.14,74,,,Percent of Total Billed Charges,74% of total billed charges,352.59,69,,,Percent of Total Billed Charges,69% of total billed charges,352.59,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.59,69,,,Percent of Total Billed Charges,69% of total billed charges,352.59,69,,,Percent of Total Billed Charges,69% of total billed charges,429.24,84,,,Percent of Total Billed Charges,84% of total billed charges,419.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.79,89,,,Percent of total Billed Charges,89% of total Billed charges,454.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.47,77,,,Percent of total Billed charges,77% of total billed charges,434.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.75,454.79,
POLYMEM DRESSING,S990220292,CDM,272,RC,,,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.68,74,,,Percent of Total Billed Charges,74% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,26.88,84,,,Percent of Total Billed Charges,84% of total billed charges,26.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.48,89,,,Percent of total Billed Charges,89% of total Billed charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,28.48,
POLYPECTOMY SNARE,S990220293,CDM,272,RC,,,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
POST-OP SURGICAL SHOE,S990220294,CDM,270,RC,,,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,48.1,74,,,Percent of Total Billed Charges,74% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,84,,,Percent of Total Billed Charges,84% of total billed charges,53.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,57.85,
PVC TUBING,S990220295,CDM,272,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
QUIK CON SPIRAL ELECTRODE,S990220296,CDM,270,RC,,,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,39.16,
QUIK CONNECT PADS,S990220297,CDM,270,RC,,,Outpatient,,,15,7.5,,11.55,77,,,Percent of Total Billed Charges,77% of total billed charges,3.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.1,74,,,Percent of Total Billed Charges,74% of total billed charges,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,12.6,84,,,Percent of Total Billed Charges,84% of total billed charges,12.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.35,89,,,Percent of total Billed Charges,89% of total Billed charges,13.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,77,,,Percent of total Billed charges,77% of total billed charges,12.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.75,13.35,
"SALEM SUMP TUBE, ALL SIZES",S990220298,CDM,270,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
SAW BLADE,S990220299,CDM,272,RC,,,Outpatient,,,246,123,,189.42,77,,,Percent of Total Billed Charges,77% of total billed charges,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.04,74,,,Percent of Total Billed Charges,74% of total billed charges,169.74,69,,,Percent of Total Billed Charges,69% of total billed charges,169.74,69,,,Percent of Total Billed Charges,69% of total billed charges,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.74,69,,,Percent of Total Billed Charges,69% of total billed charges,169.74,69,,,Percent of Total Billed Charges,69% of total billed charges,206.64,84,,,Percent of Total Billed Charges,84% of total billed charges,201.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.94,89,,,Percent of total Billed Charges,89% of total Billed charges,218.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.42,77,,,Percent of total Billed charges,77% of total billed charges,209.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,123,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.5,218.94,
SCD SLEEVE EXL THIGH,S990220300,CDM,270,RC,,,Outpatient,,,324.5,162.25,,249.87,77,,,Percent of Total Billed Charges,77% of total billed charges,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,240.13,74,,,Percent of Total Billed Charges,74% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,272.58,84,,,Percent of Total Billed Charges,84% of total billed charges,266.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,288.81,89,,,Percent of total Billed Charges,89% of total Billed charges,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.87,77,,,Percent of total Billed charges,77% of total billed charges,275.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,162.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.13,288.81,
SCD SLEEVE KNEE,S990220301,CDM,270,RC,,,Outpatient,,,202.5,101.25,,155.93,77,,,Percent of Total Billed Charges,77% of total billed charges,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.85,74,,,Percent of Total Billed Charges,74% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,170.1,84,,,Percent of Total Billed Charges,84% of total billed charges,166.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,180.23,89,,,Percent of total Billed Charges,89% of total Billed charges,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.93,77,,,Percent of total Billed charges,77% of total billed charges,172.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.63,180.23,
SCD SLEEVE THIGH,S990220302,CDM,270,RC,,,Outpatient,,,297.5,148.75,,229.08,77,,,Percent of Total Billed Charges,77% of total billed charges,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.15,74,,,Percent of Total Billed Charges,74% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,249.9,84,,,Percent of Total Billed Charges,84% of total billed charges,243.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.78,89,,,Percent of total Billed Charges,89% of total Billed charges,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,77,,,Percent of total Billed charges,77% of total billed charges,252.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.38,264.78,
SCROTAL SUPPORT,S990220303,CDM,270,RC,,,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.43,89,,,Percent of total Billed Charges,89% of total Billed charges,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,73.43,
SILVER NITRATE APPL,S990220304,CDM,270,RC,,,Outpatient,,,12.5,6.25,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.25,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.5,84,,,Percent of Total Billed Charges,84% of total billed charges,10.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
SKIN STAPLER PROX,S990220305,CDM,272,RC,,,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.85,89,,,Percent of total Billed Charges,89% of total Billed charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.85,
SURGICEL,S990220306,CDM,272,RC,,,Outpatient,,,96.5,48.25,,74.31,77,,,Percent of Total Billed Charges,77% of total billed charges,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.41,74,,,Percent of Total Billed Charges,74% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,81.06,84,,,Percent of Total Billed Charges,84% of total billed charges,79.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.89,89,,,Percent of total Billed Charges,89% of total Billed charges,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.31,77,,,Percent of total Billed charges,77% of total billed charges,82.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.13,85.89,
SURGICLIP APPLIER,S990220307,CDM,272,RC,,,Outpatient,,,615,307.5,,473.55,77,,,Percent of Total Billed Charges,77% of total billed charges,156.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,455.1,74,,,Percent of Total Billed Charges,74% of total billed charges,424.35,69,,,Percent of Total Billed Charges,69% of total billed charges,424.35,69,,,Percent of Total Billed Charges,69% of total billed charges,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.35,69,,,Percent of Total Billed Charges,69% of total billed charges,424.35,69,,,Percent of Total Billed Charges,69% of total billed charges,516.6,84,,,Percent of Total Billed Charges,84% of total billed charges,504.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,547.35,89,,,Percent of total Billed Charges,89% of total Billed charges,547.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,547.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473.55,77,,,Percent of total Billed charges,77% of total billed charges,522.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,307.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,250.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.75,547.35,
SUTURE,S990220308,CDM,272,RC,,,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.34,74,,,Percent of Total Billed Charges,74% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,76.44,84,,,Percent of Total Billed Charges,84% of total billed charges,74.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.99,89,,,Percent of total Billed Charges,89% of total Billed charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.99,
TA 55 STAPLES,S990220309,CDM,272,RC,,,Outpatient,,,477.5,238.75,,367.68,77,,,Percent of Total Billed Charges,77% of total billed charges,121.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,353.35,74,,,Percent of Total Billed Charges,74% of total billed charges,329.48,69,,,Percent of Total Billed Charges,69% of total billed charges,329.48,69,,,Percent of Total Billed Charges,69% of total billed charges,119.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.48,69,,,Percent of Total Billed Charges,69% of total billed charges,329.48,69,,,Percent of Total Billed Charges,69% of total billed charges,401.1,84,,,Percent of Total Billed Charges,84% of total billed charges,391.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,424.98,89,,,Percent of total Billed Charges,89% of total Billed charges,424.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,367.68,77,,,Percent of total Billed charges,77% of total billed charges,405.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,238.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,194.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.38,424.98,
TRACHEOSTOMY TUBE,S990220310,CDM,270,RC,,,Outpatient,,,242.5,121.25,,186.73,77,,,Percent of Total Billed Charges,77% of total billed charges,61.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.45,74,,,Percent of Total Billed Charges,74% of total billed charges,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,203.7,84,,,Percent of Total Billed Charges,84% of total billed charges,198.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,215.83,89,,,Percent of total Billed Charges,89% of total Billed charges,215.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,77,,,Percent of total Billed charges,77% of total billed charges,206.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.63,215.83,
TROCAR-HASAN,S990220311,CDM,272,RC,,,Outpatient,,,570,285,,438.9,77,,,Percent of Total Billed Charges,77% of total billed charges,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,421.8,74,,,Percent of Total Billed Charges,74% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,393.3,69,,,Percent of Total Billed Charges,69% of total billed charges,478.8,84,,,Percent of Total Billed Charges,84% of total billed charges,467.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,507.3,89,,,Percent of total Billed Charges,89% of total Billed charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.9,77,,,Percent of total Billed charges,77% of total billed charges,484.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,285,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,232.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.5,507.3,
VACUUM CURETTE,S990220312,CDM,272,RC,,,Outpatient,,,31.5,15.75,,24.26,77,,,Percent of Total Billed Charges,77% of total billed charges,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.31,74,,,Percent of Total Billed Charges,74% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,26.46,84,,,Percent of Total Billed Charges,84% of total billed charges,25.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.04,89,,,Percent of total Billed Charges,89% of total Billed charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.26,77,,,Percent of total Billed charges,77% of total billed charges,26.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,28.04,
VASELINE GAUZE,S990220313,CDM,272,RC,,,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,14.24,
XEROFOAM GAUZE DRESSING,S990220314,CDM,272,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.57,
"PROBE, CRYOABLATION",S990220319,CDM,272,RC,C2618,HCPCS,Outpatient,,,6499,3249.5,,5004.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1657.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1657.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2030.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4809.26,74,,,Percent of Total Billed Charges,74% of total billed charges,4484.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4484.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1624.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4484.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4484.31,69,,,Percent of Total Billed Charges,69% of total billed charges,5459.16,84,,,Percent of Total Billed Charges,84% of total billed charges,5329.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,5784.11,89,,,Percent of total Billed Charges,89% of total Billed charges,5784.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5784.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2651.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2651.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2651.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1624.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5004.23,77,,,Percent of total Billed charges,77% of total billed charges,5524.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1868.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3249.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2651.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1624.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5784.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1624.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1624.75,5784.11,
FOAM COLLAR UNIVERSAL,S990220320,CDM,274,RC,L0120,HCPCS,Outpatient,,,21,10.5,,16.17,77,,,Percent of Total Billed Charges,77% of total billed charges,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.49,69,,,Percent of Total Billed Charges,69% of total billed charges,14.49,69,,,Percent of Total Billed Charges,69% of total billed charges,14.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.49,69,,,Percent of Total Billed Charges,69% of total billed charges,14.49,69,,,Percent of Total Billed Charges,69% of total billed charges,14.49,69,,,Percent of Total Billed Charges,69% of total billed charges,14.7,70,,,Percent of Total Billed Charges,70% total billed charges,14.49,69,,,Percent of total Billed Charges,69% of total Billed charges,14.49,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,14.49,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,8.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,77,,,Percent of total Billed charges,77% of total billed charges,17.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,8.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,5.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.25,17.85,
TLSO PRIPLANAR CONTROL MODULAR,S990220321,CDM,274,RC,L0462,HCPCS,Outpatient,,,1461.5,730.75,,1125.36,77,,,Percent of Total Billed Charges,77% of total billed charges,372.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,372.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,456.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1008.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.44,69,,,Percent of Total Billed Charges,69% of total billed charges,365.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.05,70,,,Percent of Total Billed Charges,70% total billed charges,1008.44,69,,,Percent of total Billed Charges,69% of total Billed charges,1008.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1008.44,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,596.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,596.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,596.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,365.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.36,77,,,Percent of total Billed charges,77% of total billed charges,1242.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,420.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,596.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,365.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,365.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.38,1242.28,
BACK BRACE-TLSO BACK BRACE,S990220322,CDM,274,RC,L0472,HCPCS,Outpatient,,,897,448.5,,690.69,77,,,Percent of Total Billed Charges,77% of total billed charges,228.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.93,69,,,Percent of Total Billed Charges,69% of total billed charges,618.93,69,,,Percent of Total Billed Charges,69% of total billed charges,618.93,69,,,Percent of Total Billed Charges,69% of total billed charges,224.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,618.93,69,,,Percent of Total Billed Charges,69% of total billed charges,618.93,69,,,Percent of Total Billed Charges,69% of total billed charges,618.93,69,,,Percent of Total Billed Charges,69% of total billed charges,627.9,70,,,Percent of Total Billed Charges,70% total billed charges,618.93,69,,,Percent of total Billed Charges,69% of total Billed charges,618.93,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,618.93,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,365.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,365.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,365.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,224.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.69,77,,,Percent of total Billed charges,77% of total billed charges,762.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,365.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,224.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,224.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.25,762.45,
KNEE IMMOBILIZER,S990220323,CDM,274,RC,L1830,HCPCS,Outpatient,,,62,31,,47.74,77,,,Percent of Total Billed Charges,77% of total billed charges,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,69,,,Percent of Total Billed Charges,69% of total billed charges,43.4,70,,,Percent of Total Billed Charges,70% total billed charges,42.78,69,,,Percent of total Billed Charges,69% of total Billed charges,42.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,42.78,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.74,77,,,Percent of total Billed charges,77% of total billed charges,52.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,25.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.5,52.7,
EXTENDER PLUS,S990220324,CDM,274,RC,L1832,HCPCS,Outpatient,,,289,144.5,,222.53,77,,,Percent of Total Billed Charges,77% of total billed charges,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,202.3,70,,,Percent of Total Billed Charges,70% total billed charges,199.41,69,,,Percent of total Billed Charges,69% of total Billed charges,199.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,199.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,77,,,Percent of total Billed charges,77% of total billed charges,245.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.25,245.65,
KNEE BRACE EXTENDER PLUS,S990220325,CDM,274,RC,L1832,HCPCS,Outpatient,,,289,144.5,,222.53,77,,,Percent of Total Billed Charges,77% of total billed charges,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,202.3,70,,,Percent of Total Billed Charges,70% total billed charges,199.41,69,,,Percent of total Billed Charges,69% of total Billed charges,199.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,199.41,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,77,,,Percent of total Billed charges,77% of total billed charges,245.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.25,245.65,
KNEE BRACE EXTENDER+UNIVERSAL,S990220326,CDM,274,RC,L1832,HCPCS,Outpatient,,,283.5,141.75,,218.3,77,,,Percent of Total Billed Charges,77% of total billed charges,72.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.62,69,,,Percent of Total Billed Charges,69% of total billed charges,198.45,70,,,Percent of Total Billed Charges,70% total billed charges,195.62,69,,,Percent of total Billed Charges,69% of total Billed charges,195.62,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,195.62,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,115.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.3,77,,,Percent of total Billed charges,77% of total billed charges,240.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,115.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.88,240.98,
"ORTHOTIC, ANKLE/FOOT",S990220327,CDM,274,RC,L1906,HCPCS,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,129.5,70,,,Percent of Total Billed Charges,70% total billed charges,127.65,69,,,Percent of total Billed Charges,69% of total Billed charges,127.65,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,127.65,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,157.25,
SHOULDER IMMOBILIZER,S990220328,CDM,274,RC,L3650,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,88.2,70,,,Percent of Total Billed Charges,70% total billed charges,86.94,69,,,Percent of total Billed Charges,69% of total Billed charges,86.94,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,86.94,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,107.1,
SHOULDER IMMOBILIZER SLINGSHOT,S990220330,CDM,274,RC,L3670,HCPCS,Outpatient,,,150.5,75.25,,115.89,77,,,Percent of Total Billed Charges,77% of total billed charges,38.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,105.35,70,,,Percent of Total Billed Charges,70% total billed charges,103.85,69,,,Percent of total Billed Charges,69% of total Billed charges,103.85,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,103.85,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.89,77,,,Percent of total Billed charges,77% of total billed charges,127.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.63,127.93,
J WALKER BOOT,S990220331,CDM,274,RC,L4386,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.6,70,,,Percent of Total Billed Charges,70% total billed charges,40.02,69,,,Percent of total Billed Charges,69% of total Billed charges,40.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,40.02,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,49.3,
PODUS BOOT STAND,S990220332,CDM,274,RC,L4398,HCPCS,Outpatient,,,119.5,59.75,,92.02,77,,,Percent of Total Billed Charges,77% of total billed charges,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,83.65,70,,,Percent of Total Billed Charges,70% total billed charges,82.46,69,,,Percent of total Billed Charges,69% of total Billed charges,82.46,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,82.46,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,48.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.02,77,,,Percent of total Billed charges,77% of total billed charges,101.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.88,101.58,
COAPTATE 1 CC SYRINGE,S990220333,CDM,274,RC,L8606,HCPCS,Outpatient,,,705.5,352.75,,543.24,77,,,Percent of Total Billed Charges,77% of total billed charges,179.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,486.8,69,,,Percent of Total Billed Charges,69% of total billed charges,486.8,69,,,Percent of Total Billed Charges,69% of total billed charges,486.8,69,,,Percent of Total Billed Charges,69% of total billed charges,176.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.8,69,,,Percent of Total Billed Charges,69% of total billed charges,486.8,69,,,Percent of Total Billed Charges,69% of total billed charges,486.8,69,,,Percent of Total Billed Charges,69% of total billed charges,493.85,70,,,Percent of Total Billed Charges,70% total billed charges,486.8,69,,,Percent of total Billed Charges,69% of total Billed charges,486.8,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,486.8,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,287.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,287.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,287.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,543.24,77,,,Percent of total Billed charges,77% of total billed charges,599.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,202.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,287.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,176.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,176.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.38,599.68,
URETHERAL BULKING SYSTEM,S990220334,CDM,272,RC,,,Outpatient,,,1638,819,,1261.26,77,,,Percent of Total Billed Charges,77% of total billed charges,417.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,511.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1212.12,74,,,Percent of Total Billed Charges,74% of total billed charges,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1375.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1343.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,1457.82,89,,,Percent of total Billed Charges,89% of total Billed charges,1457.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1457.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.26,77,,,Percent of total Billed charges,77% of total billed charges,1392.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,470.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,819,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1457.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,409.5,1457.82,
STAPLER CIRCULAR,S990220335,CDM,272,RC,,,Outpatient,,,1752.5,876.25,,1349.43,77,,,Percent of Total Billed Charges,77% of total billed charges,446.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,446.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,547.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1296.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1209.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1209.23,69,,,Percent of Total Billed Charges,69% of total billed charges,438.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1209.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1209.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1472.1,84,,,Percent of Total Billed Charges,84% of total billed charges,1437.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1559.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1559.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1559.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,715.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,715.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,715.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1349.43,77,,,Percent of total Billed charges,77% of total billed charges,1489.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,503.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,876.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,715.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,438.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,438.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.13,1559.73,
CATH CHOLONGIOGRAPHY,S990220336,CDM,272,RC,,,Outpatient,,,156,78,,120.12,77,,,Percent of Total Billed Charges,77% of total billed charges,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.44,74,,,Percent of Total Billed Charges,74% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,131.04,84,,,Percent of Total Billed Charges,84% of total billed charges,127.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.84,89,,,Percent of total Billed Charges,89% of total Billed charges,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.12,77,,,Percent of total Billed charges,77% of total billed charges,132.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39,138.84,
CENTURION VITRECTOMY PACK,S990220337,CDM,272,RC,,,Outpatient,,,1032,516,,794.64,77,,,Percent of Total Billed Charges,77% of total billed charges,263.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,763.68,74,,,Percent of Total Billed Charges,74% of total billed charges,712.08,69,,,Percent of Total Billed Charges,69% of total billed charges,712.08,69,,,Percent of Total Billed Charges,69% of total billed charges,258,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,712.08,69,,,Percent of Total Billed Charges,69% of total billed charges,712.08,69,,,Percent of Total Billed Charges,69% of total billed charges,866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,846.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,918.48,89,,,Percent of total Billed Charges,89% of total Billed charges,918.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,918.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,421.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,421.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,258,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,794.64,77,,,Percent of total Billed charges,77% of total billed charges,877.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,296.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,516,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,421.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,258,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,918.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258,918.48,
PARAGUARD IUD,S990221216,CDM,636,RC,J7300,HCPCS,Outpatient,,,1991,995.5,,1533.07,77,,,Percent of Total Billed Charges,77% of total billed charges,507.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,507.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,622.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1373.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1373.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1373.79,69,,,Percent of Total Billed Charges,69% of total billed charges,497.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1373.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1373.79,69,,,Percent of Total Billed Charges,69% of total billed charges,895.95,45,,,Percent of Total Billed Charges,45% of total billed charges,1771.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1771.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1771.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,812.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,812.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,497.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.07,77,,,Percent of total Billed charges,77% of total billed charges,1692.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,572.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,812.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,497.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,497.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,497.75,1771.99,
Etonogestrel Implant Sys,S990221217,CDM,636,RC,J7307,HCPCS,Outpatient,,,1175,587.5,,904.75,77,,,Percent of Total Billed Charges,77% of total billed charges,299.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,528.75,45,,,Percent of Total Billed Charges,45% of total billed charges,1045.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1045.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1045.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.75,77,,,Percent of total Billed charges,77% of total billed charges,998.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,337.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,479.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.75,1045.75,
Etonogestrel Implant Sys,S990221217,CDM,636,RC,J7307,HCPCS,Outpatient,,,1175,587.5,,904.75,77,,,Percent of Total Billed Charges,77% of total billed charges,299.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,810.75,69,,,Percent of Total Billed Charges,69% of total billed charges,528.75,45,,,Percent of Total Billed Charges,45% of total billed charges,1045.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1045.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1045.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,479.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.75,77,,,Percent of total Billed charges,77% of total billed charges,998.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,337.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,479.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,293.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.75,1045.75,
Levonorgestrel-Releasing Iud,S990221218,CDM,521,RC,J7297,HCPCS,Outpatient,,,950,475,,731.5,77,,,Percent of Total Billed Charges,77% of total billed charges,242.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,845.5,89,,,Percent of total Billed Charges,89% of total Billed charges,845.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,845.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,731.5,77,,,Percent of total Billed charges,77% of total billed charges,807.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,387.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.5,845.5,
Levonorgestrel-Releasing Iud,S990221218,CDM,521,RC,J7297,HCPCS,Outpatient,,,950,475,,731.5,77,,,Percent of Total Billed Charges,77% of total billed charges,242.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,845.5,89,,,Percent of total Billed Charges,89% of total Billed charges,845.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,845.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,731.5,77,,,Percent of total Billed charges,77% of total billed charges,807.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,273.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,387.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,237.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.5,845.5,
Levonorgestrel 52 Mg,S990221219,CDM,521,RC,J7298,HCPCS,Outpatient,,,1258,629,,968.66,77,,,Percent of Total Billed Charges,77% of total billed charges,320.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,320.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1119.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1119.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,968.66,77,,,Percent of total Billed charges,77% of total billed charges,1069.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,361.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,513.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.5,1119.62,
Levonorgestrel 52 Mg,S990221219,CDM,521,RC,J7298,HCPCS,Outpatient,,,1258,629,,968.66,77,,,Percent of Total Billed Charges,77% of total billed charges,320.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,320.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1119.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1119.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,513.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,968.66,77,,,Percent of total Billed charges,77% of total billed charges,1069.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,361.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,513.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.5,1119.62,
Intrauterine Contraceptive,S990221220,CDM,521,RC,J7300,HCPCS,Outpatient,,,1067,533.5,,821.59,77,,,Percent of Total Billed Charges,77% of total billed charges,272.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,949.63,89,,,Percent of total Billed Charges,89% of total Billed charges,949.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,821.59,77,,,Percent of total Billed charges,77% of total billed charges,906.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,306.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,435.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.75,949.63,
Intrauterine Contraceptive,S990221220,CDM,521,RC,J7300,HCPCS,Outpatient,,,1067,533.5,,821.59,77,,,Percent of Total Billed Charges,77% of total billed charges,272.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,949.63,89,,,Percent of total Billed Charges,89% of total Billed charges,949.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,821.59,77,,,Percent of total Billed charges,77% of total billed charges,906.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,306.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,435.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,266.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.75,949.63,
Levonorgestrel-Iud Skyla,S990221221,CDM,521,RC,J7301,HCPCS,Outpatient,,,1048,524,,806.96,77,,,Percent of Total Billed Charges,77% of total billed charges,267.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,932.72,89,,,Percent of total Billed Charges,89% of total Billed charges,932.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,932.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.96,77,,,Percent of total Billed charges,77% of total billed charges,890.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262,932.72,
Levonorgestrel-Iud Skyla,S990221221,CDM,521,RC,J7301,HCPCS,Outpatient,,,1048,524,,806.96,77,,,Percent of Total Billed Charges,77% of total billed charges,267.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,932.72,89,,,Percent of total Billed Charges,89% of total Billed charges,932.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,932.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.96,77,,,Percent of total Billed charges,77% of total billed charges,890.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,427.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,262,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262,932.72,
Uretheral Bulking System,S990221222,CDM,272,RC,,,Outpatient,,,1638,819,,1261.26,77,,,Percent of Total Billed Charges,77% of total billed charges,417.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,511.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1212.12,74,,,Percent of Total Billed Charges,74% of total billed charges,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1130.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1375.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1343.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,1457.82,89,,,Percent of total Billed Charges,89% of total Billed charges,1457.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1457.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.26,77,,,Percent of total Billed charges,77% of total billed charges,1392.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,470.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,819,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,668.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1457.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,409.5,1457.82,
Stapler Circular,S990221223,CDM,272,RC,,,Outpatient,,,1752.4,876.2,,1349.35,77,,,Percent of Total Billed Charges,77% of total billed charges,446.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,446.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,547.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1296.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,438.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1472.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1436.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,1559.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1559.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1559.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,714.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,714.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,714.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,438.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1349.35,77,,,Percent of total Billed charges,77% of total billed charges,1489.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,503.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,876.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,714.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,438.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,438.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,438.1,1559.64,
Centurion Vitrect Pack,S990221224,CDM,272,RC,,,Outpatient,,,1031.68,515.84,,794.39,77,,,Percent of Total Billed Charges,77% of total billed charges,263.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,322.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,763.44,74,,,Percent of Total Billed Charges,74% of total billed charges,711.86,69,,,Percent of Total Billed Charges,69% of total billed charges,711.86,69,,,Percent of Total Billed Charges,69% of total billed charges,257.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.86,69,,,Percent of Total Billed Charges,69% of total billed charges,711.86,69,,,Percent of Total Billed Charges,69% of total billed charges,866.61,84,,,Percent of Total Billed Charges,84% of total billed charges,845.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,918.2,89,,,Percent of total Billed Charges,89% of total Billed charges,918.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,918.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,420.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,257.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,794.39,77,,,Percent of total Billed charges,77% of total billed charges,876.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,296.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,515.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,420.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,257.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,918.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.92,918.2,
Cath Cholangiography,S990221225,CDM,272,RC,,,Outpatient,,,156,78,,120.12,77,,,Percent of Total Billed Charges,77% of total billed charges,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.44,74,,,Percent of Total Billed Charges,74% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,131.04,84,,,Percent of Total Billed Charges,84% of total billed charges,127.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.84,89,,,Percent of total Billed Charges,89% of total Billed charges,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.12,77,,,Percent of total Billed charges,77% of total billed charges,132.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39,138.84,
Absorbatack Devise,S990221229,CDM,272,RC,C1781,HCPCS,Outpatient,,,1353.3,676.65,,1042.04,77,,,Percent of Total Billed Charges,77% of total billed charges,345.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.44,74,,,Percent of Total Billed Charges,74% of total billed charges,933.78,69,,,Percent of Total Billed Charges,69% of total billed charges,933.78,69,,,Percent of Total Billed Charges,69% of total billed charges,338.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.78,69,,,Percent of Total Billed Charges,69% of total billed charges,933.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1136.77,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.04,77,,,Percent of total Billed charges,77% of total billed charges,1150.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.33,1204.44,
Symbotex 20X30,S990221230,CDM,278,RC,,,Outpatient,,,4130.88,2065.44,,3180.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1053.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1053.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1290.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2850.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1032.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2850.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2891.62,70,,,Percent of Total Billed Charges,70% total billed charges,2850.31,69,,,Percent of total Billed Charges,69% of total Billed charges,2850.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,2850.31,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1685.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1685.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1685.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1032.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3180.78,77,,,Percent of total Billed charges,77% of total billed charges,3511.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1187.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2065.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1685.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1032.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2065.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1032.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1032.72,3511.25,
Symbotex 20X15,S990221231,CDM,278,RC,,,Outpatient,,,1893.32,946.66,,1457.86,77,,,Percent of Total Billed Charges,77% of total billed charges,482.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,591.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1306.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.39,69,,,Percent of Total Billed Charges,69% of total billed charges,473.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1306.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1325.32,70,,,Percent of Total Billed Charges,70% total billed charges,1306.39,69,,,Percent of total Billed Charges,69% of total Billed charges,1306.39,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1306.39,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,772.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,772.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,772.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,473.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1457.86,77,,,Percent of total Billed charges,77% of total billed charges,1609.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,544.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,772.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,473.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,473.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473.33,1609.32,
Symbotex 15 Round,S990221232,CDM,278,RC,C1781,HCPCS,Outpatient,,,1699.36,849.68,,1308.51,77,,,Percent of Total Billed Charges,77% of total billed charges,433.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,433.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1172.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.56,69,,,Percent of Total Billed Charges,69% of total billed charges,424.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1172.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1189.55,70,,,Percent of Total Billed Charges,70% total billed charges,1172.56,69,,,Percent of total Billed Charges,69% of total Billed charges,1172.56,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,1172.56,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,693.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,693.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,693.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1308.51,77,,,Percent of total Billed charges,77% of total billed charges,1444.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,488.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,693.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,424.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,424.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.84,1444.46,
"Mini Acutrak Drill, Long",S990221236,CDM,272,RC,,,Outpatient,,,104,52,,80.08,77,,,Percent of Total Billed Charges,77% of total billed charges,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.96,74,,,Percent of Total Billed Charges,74% of total billed charges,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,84,,,Percent of Total Billed Charges,84% of total billed charges,85.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.56,89,,,Percent of total Billed Charges,89% of total Billed charges,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.08,77,,,Percent of total Billed charges,77% of total billed charges,88.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,92.56,
.045X6 Guide Wire,S990221237,CDM,272,RC,,,Outpatient,,,2783.04,1391.52,,2142.94,77,,,Percent of Total Billed Charges,77% of total billed charges,709.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,709.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,869.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2059.45,74,,,Percent of Total Billed Charges,74% of total billed charges,1920.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1920.3,69,,,Percent of Total Billed Charges,69% of total billed charges,695.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1920.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1920.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2337.75,84,,,Percent of Total Billed Charges,84% of total billed charges,2282.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,2476.91,89,,,Percent of total Billed Charges,89% of total Billed charges,2476.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2476.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1135.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1135.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1135.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,695.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2142.94,77,,,Percent of total Billed charges,77% of total billed charges,2365.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,800.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1391.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1135.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,695.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,695.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,695.76,2476.91,
"Alexis Retractor, Small",S990221238,CDM,272,RC,,,Outpatient,,,104,52,,80.08,77,,,Percent of Total Billed Charges,77% of total billed charges,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.96,74,,,Percent of Total Billed Charges,74% of total billed charges,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,71.76,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,84,,,Percent of Total Billed Charges,84% of total billed charges,85.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.56,89,,,Percent of total Billed Charges,89% of total Billed charges,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.08,77,,,Percent of total Billed charges,77% of total billed charges,88.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,92.56,
Closure System Carter,S990221239,CDM,272,RC,,,Outpatient,,,227.76,113.88,,175.38,77,,,Percent of Total Billed Charges,77% of total billed charges,58.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.54,74,,,Percent of Total Billed Charges,74% of total billed charges,157.15,69,,,Percent of Total Billed Charges,69% of total billed charges,157.15,69,,,Percent of Total Billed Charges,69% of total billed charges,56.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.15,69,,,Percent of Total Billed Charges,69% of total billed charges,157.15,69,,,Percent of Total Billed Charges,69% of total billed charges,191.32,84,,,Percent of Total Billed Charges,84% of total billed charges,186.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.71,89,,,Percent of total Billed Charges,89% of total Billed charges,202.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.38,77,,,Percent of total Billed charges,77% of total billed charges,193.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.94,202.71,
Perform Reverse Insert Size ?,S990221240,CDM,278,RC,,,Outpatient,,,10650,5325,,8200.5,77,,,Percent of Total Billed Charges,77% of total billed charges,2715.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2715.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3328.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7348.5,69,,,Percent of Total Billed Charges,69% of total billed charges,7348.5,69,,,Percent of Total Billed Charges,69% of total billed charges,7348.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2662.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7348.5,69,,,Percent of Total Billed Charges,69% of total billed charges,7348.5,69,,,Percent of Total Billed Charges,69% of total billed charges,7348.5,69,,,Percent of Total Billed Charges,69% of total billed charges,7455,70,,,Percent of Total Billed Charges,70% total billed charges,7348.5,69,,,Percent of total Billed Charges,69% of total Billed charges,7348.5,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7348.5,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4345.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4345.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4345.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2662.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8200.5,77,,,Percent of total Billed charges,77% of total billed charges,9052.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3061.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5325,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4345.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2662.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5325,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2662.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2662.5,9052.5,
Perform Reverse Insert Size ?,S990221241,CDM,278,RC,,,Outpatient,,,11482,5741,,8841.14,77,,,Percent of Total Billed Charges,77% of total billed charges,2927.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2927.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3588.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7922.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7922.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7922.58,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7922.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7922.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7922.58,69,,,Percent of Total Billed Charges,69% of total billed charges,8037.4,70,,,Percent of Total Billed Charges,70% total billed charges,7922.58,69,,,Percent of total Billed Charges,69% of total Billed charges,7922.58,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7922.58,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,4684.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4684.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4684.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2870.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8841.14,77,,,Percent of total Billed charges,77% of total billed charges,9759.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3301.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5741,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4684.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2870.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5741,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2870.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2870.5,9759.7,
Perform Humeral Stem,S990221243,CDM,278,RC,,,Outpatient,,,17206,8603,,13248.62,77,,,Percent of Total Billed Charges,77% of total billed charges,4387.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4387.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5376.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11872.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11872.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11872.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11872.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11872.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11872.14,69,,,Percent of Total Billed Charges,69% of total billed charges,12044.2,70,,,Percent of Total Billed Charges,70% total billed charges,11872.14,69,,,Percent of total Billed Charges,69% of total Billed charges,11872.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,11872.14,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7020.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7020.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7020.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13248.62,77,,,Percent of total Billed charges,77% of total billed charges,14625.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4946.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8603,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7020.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8603,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4301.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4301.5,14625.1,
Bactisure Wound Lavage,S990221244,CDM,272,RC,,,Outpatient,,,3276,1638,,2522.52,77,,,Percent of Total Billed Charges,77% of total billed charges,835.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,835.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1023.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2424.24,74,,,Percent of Total Billed Charges,74% of total billed charges,2260.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2260.44,69,,,Percent of Total Billed Charges,69% of total billed charges,819,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2260.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2260.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2751.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2686.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2915.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2915.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2915.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,819,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2522.52,77,,,Percent of total Billed charges,77% of total billed charges,2784.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,941.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1638,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1336.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,819,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2915.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,819,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,819,2915.64,
Zb Orif Tibia,S990221245,CDM,278,RC,,,Outpatient,,,17938,8969,,13812.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4574.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4574.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5605.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12377.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12377.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12377.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4484.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12377.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12377.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12377.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12556.6,70,,,Percent of Total Billed Charges,70% total billed charges,12377.22,69,,,Percent of total Billed Charges,69% of total Billed charges,12377.22,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,12377.22,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,7318.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7318.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7318.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4484.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13812.26,77,,,Percent of total Billed charges,77% of total billed charges,15247.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5157.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8969,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7318.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4484.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8969,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4484.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4484.5,15247.3,
Reload Rti-Staple 2.0 EX Thick,S990221246,CDM,272,RC,,,Outpatient,,,1609,804.5,,1238.93,77,,,Percent of Total Billed Charges,77% of total billed charges,410.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,410.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,502.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1190.66,74,,,Percent of Total Billed Charges,74% of total billed charges,1110.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1110.21,69,,,Percent of Total Billed Charges,69% of total billed charges,402.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1110.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1110.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1351.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1319.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1432.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1432.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1432.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,656.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,656.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,656.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,402.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1238.93,77,,,Percent of total Billed charges,77% of total billed charges,1367.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,462.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,804.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,656.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,402.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1432.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,402.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,402.25,1432.01,
Pmma Bone Cement,S990221247,CDM,272,RC,,,Outpatient,,,468,234,,360.36,77,,,Percent of Total Billed Charges,77% of total billed charges,119.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,346.32,74,,,Percent of Total Billed Charges,74% of total billed charges,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,393.12,84,,,Percent of Total Billed Charges,84% of total billed charges,383.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,416.52,89,,,Percent of total Billed Charges,89% of total Billed charges,416.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,416.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,360.36,77,,,Percent of total Billed charges,77% of total billed charges,397.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,234,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,416.52,
Osseoflex SB,S990221248,CDM,272,RC,,,Outpatient,,,3588,1794,,2762.76,77,,,Percent of Total Billed Charges,77% of total billed charges,914.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,914.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1121.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2655.12,74,,,Percent of Total Billed Charges,74% of total billed charges,2475.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2475.72,69,,,Percent of Total Billed Charges,69% of total billed charges,897,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2475.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2475.72,69,,,Percent of Total Billed Charges,69% of total billed charges,3013.92,84,,,Percent of Total Billed Charges,84% of total billed charges,2942.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3193.32,89,,,Percent of total Billed Charges,89% of total Billed charges,3193.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3193.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,897,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2762.76,77,,,Percent of total Billed charges,77% of total billed charges,3049.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1031.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1794,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1463.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,897,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,897,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897,3193.32,
Wound Paste Triad,S990221249,CDM,272,RC,,,Outpatient,,,22,11,,16.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.28,74,,,Percent of Total Billed Charges,74% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,18.48,84,,,Percent of Total Billed Charges,84% of total billed charges,18.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.58,89,,,Percent of total Billed Charges,89% of total Billed charges,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,77,,,Percent of total Billed charges,77% of total billed charges,18.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.5,19.58,
Harmonic Shears 36Cm,S990221250,CDM,272,RC,,,Outpatient,,,2381,1190.5,,1833.37,77,,,Percent of Total Billed Charges,77% of total billed charges,607.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,744.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1761.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1642.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1642.89,69,,,Percent of Total Billed Charges,69% of total billed charges,595.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1642.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2000.04,84,,,Percent of Total Billed Charges,84% of total billed charges,1952.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,2119.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2119.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2119.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,971.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,971.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,971.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,595.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1833.37,77,,,Percent of total Billed charges,77% of total billed charges,2023.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,684.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1190.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,971.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,595.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2119.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,595.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,595.25,2119.09,
Tissell Sealant 4ml,S990221251,CDM,272,RC,,,Outpatient,,,444,222,,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.56,74,,,Percent of Total Billed Charges,74% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,372.96,84,,,Percent of Total Billed Charges,84% of total billed charges,364.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.16,89,,,Percent of total Billed Charges,89% of total Billed charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111,395.16,
"Endoloop 18"" Ligature",S990221252,CDM,272,RC,,,Outpatient,,,702,351,,540.54,77,,,Percent of Total Billed Charges,77% of total billed charges,179.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,519.48,74,,,Percent of Total Billed Charges,74% of total billed charges,484.38,69,,,Percent of Total Billed Charges,69% of total billed charges,484.38,69,,,Percent of Total Billed Charges,69% of total billed charges,175.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,484.38,69,,,Percent of Total Billed Charges,69% of total billed charges,484.38,69,,,Percent of Total Billed Charges,69% of total billed charges,589.68,84,,,Percent of Total Billed Charges,84% of total billed charges,575.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,624.78,89,,,Percent of total Billed Charges,89% of total Billed charges,624.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,624.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,286.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,286.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,286.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.54,77,,,Percent of total Billed charges,77% of total billed charges,596.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,201.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,351,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,286.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,175.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,624.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.5,624.78,
Clip Resolution 360,S990221260,CDM,272,RC,,,Outpatient,,,398,199,,306.46,77,,,Percent of Total Billed Charges,77% of total billed charges,101.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,294.52,74,,,Percent of Total Billed Charges,74% of total billed charges,274.62,69,,,Percent of Total Billed Charges,69% of total billed charges,274.62,69,,,Percent of Total Billed Charges,69% of total billed charges,99.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.62,69,,,Percent of Total Billed Charges,69% of total billed charges,274.62,69,,,Percent of Total Billed Charges,69% of total billed charges,334.32,84,,,Percent of Total Billed Charges,84% of total billed charges,326.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,354.22,89,,,Percent of total Billed Charges,89% of total Billed charges,354.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.46,77,,,Percent of total Billed charges,77% of total billed charges,338.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,114.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,199,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,162.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.5,354.22,
Ligator Speedband Superview 7,S990221261,CDM,272,RC,,,Outpatient,,,225,112.5,,173.25,77,,,Percent of Total Billed Charges,77% of total billed charges,57.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.5,74,,,Percent of Total Billed Charges,74% of total billed charges,155.25,69,,,Percent of Total Billed Charges,69% of total billed charges,155.25,69,,,Percent of Total Billed Charges,69% of total billed charges,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.25,69,,,Percent of Total Billed Charges,69% of total billed charges,155.25,69,,,Percent of Total Billed Charges,69% of total billed charges,189,84,,,Percent of Total Billed Charges,84% of total billed charges,184.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,200.25,89,,,Percent of total Billed Charges,89% of total Billed charges,200.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.25,77,,,Percent of total Billed charges,77% of total billed charges,191.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.25,200.25,
Syringe 5ml Endolink,S990221262,CDM,272,RC,,,Outpatient,,,70,35,,53.9,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.8,74,,,Percent of Total Billed Charges,74% of total billed charges,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,58.8,84,,,Percent of Total Billed Charges,84% of total billed charges,57.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.3,89,,,Percent of total Billed Charges,89% of total Billed charges,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,77,,,Percent of total Billed charges,77% of total billed charges,59.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.3,
Alliance Inflat Syringe,S990221263,CDM,272,RC,,,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.22,74,,,Percent of Total Billed Charges,74% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,44.52,84,,,Percent of Total Billed Charges,84% of total billed charges,43.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.17,89,,,Percent of total Billed Charges,89% of total Billed charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.17,
Dilation Ballon,S990221264,CDM,272,RC,,,Outpatient,,,274,137,,210.98,77,,,Percent of Total Billed Charges,77% of total billed charges,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,202.76,74,,,Percent of Total Billed Charges,74% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,230.16,84,,,Percent of Total Billed Charges,84% of total billed charges,224.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,243.86,89,,,Percent of total Billed Charges,89% of total Billed charges,243.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.98,77,,,Percent of total Billed charges,77% of total billed charges,232.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,137,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,111.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.5,243.86,
Needle Interject,S990221265,CDM,272,RC,,,Outpatient,,,53,26.5,,40.81,77,,,Percent of Total Billed Charges,77% of total billed charges,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.22,74,,,Percent of Total Billed Charges,74% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,69,,,Percent of Total Billed Charges,69% of total billed charges,44.52,84,,,Percent of Total Billed Charges,84% of total billed charges,43.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.17,89,,,Percent of total Billed Charges,89% of total Billed charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.81,77,,,Percent of total Billed charges,77% of total billed charges,45.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.17,
Gastro Scope Ambu Sterile,S990221266,CDM,272,RC,,,Outpatient,,,998,499,,768.46,77,,,Percent of Total Billed Charges,77% of total billed charges,254.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,311.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,738.52,74,,,Percent of Total Billed Charges,74% of total billed charges,688.62,69,,,Percent of Total Billed Charges,69% of total billed charges,688.62,69,,,Percent of Total Billed Charges,69% of total billed charges,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.62,69,,,Percent of Total Billed Charges,69% of total billed charges,688.62,69,,,Percent of Total Billed Charges,69% of total billed charges,838.32,84,,,Percent of Total Billed Charges,84% of total billed charges,818.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,888.22,89,,,Percent of total Billed Charges,89% of total Billed charges,888.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,768.46,77,,,Percent of total Billed charges,77% of total billed charges,848.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,499,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,407.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,888.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.5,888.22,
Endoink Endoscopic Marker,S990221267,CDM,272,RC,,,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,103.6,74,,,Percent of Total Billed Charges,74% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,117.6,84,,,Percent of Total Billed Charges,84% of total billed charges,114.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.6,89,,,Percent of total Billed Charges,89% of total Billed charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,124.6,
Fetal Pillow,S990221268,CDM,272,RC,,,Outpatient,,,1200,600,,924,77,,,Percent of Total Billed Charges,77% of total billed charges,306,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,375,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,888,74,,,Percent of Total Billed Charges,74% of total billed charges,828,69,,,Percent of Total Billed Charges,69% of total billed charges,828,69,,,Percent of Total Billed Charges,69% of total billed charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,828,69,,,Percent of Total Billed Charges,69% of total billed charges,828,69,,,Percent of Total Billed Charges,69% of total billed charges,1008,84,,,Percent of Total Billed Charges,84% of total billed charges,984,82,,,Percent of Total Billed Charges,82% of total billed charges ,1068,89,,,Percent of total Billed Charges,89% of total Billed charges,1068,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924,77,,,Percent of total Billed charges,77% of total billed charges,1020,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,345,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,600,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,489.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300,1068,
Kii Dissecting Balloon Oval,S990221269,CDM,272,RC,,,Outpatient,,,820,410,,631.4,77,,,Percent of Total Billed Charges,77% of total billed charges,209.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,606.8,74,,,Percent of Total Billed Charges,74% of total billed charges,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,688.8,84,,,Percent of Total Billed Charges,84% of total billed charges,672.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,729.8,89,,,Percent of total Billed Charges,89% of total Billed charges,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,631.4,77,,,Percent of total Billed charges,77% of total billed charges,697,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,410,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205,729.8,
Kii Dissecting Balloon Round,S990221270,CDM,272,RC,,,Outpatient,,,820,410,,631.4,77,,,Percent of Total Billed Charges,77% of total billed charges,209.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,256.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,606.8,74,,,Percent of Total Billed Charges,74% of total billed charges,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,565.8,69,,,Percent of Total Billed Charges,69% of total billed charges,688.8,84,,,Percent of Total Billed Charges,84% of total billed charges,672.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,729.8,89,,,Percent of total Billed Charges,89% of total Billed charges,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,631.4,77,,,Percent of total Billed charges,77% of total billed charges,697,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,410,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,334.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205,729.8,
Kii Low Profile Optic Trocar,S990221271,CDM,272,RC,,,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
"Captivator Cold Single, Snare",S990221272,CDM,278,RC,C1889,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,81.55,70,,,Percent of Total Billed Charges,70% total billed charges,80.39,69,,,Percent of total Billed Charges,69% of total Billed charges,80.39,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,80.39,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,99.03,
Valve Hemostasis LG Bore Cysto,S990221273,CDM,272,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,46.28,
Trocar 15x100 Kii OPT ZTHER,S990221274,CDM,272,RC,,,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,178,
Suture V-Loc M2145,S990221275,CDM,272,RC,,,Outpatient,,,191,95.5,,147.07,77,,,Percent of Total Billed Charges,77% of total billed charges,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.34,74,,,Percent of Total Billed Charges,74% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,160.44,84,,,Percent of Total Billed Charges,84% of total billed charges,156.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.99,89,,,Percent of total Billed Charges,89% of total Billed charges,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.07,77,,,Percent of total Billed charges,77% of total billed charges,162.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.75,169.99,
Suture V-Loc N2145,S990221276,CDM,272,RC,,,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.26,74,,,Percent of Total Billed Charges,74% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,84,,,Percent of Total Billed Charges,84% of total billed charges,204.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,221.61,89,,,Percent of total Billed Charges,89% of total Billed charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,124.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,101.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.25,221.61,
Stryker Sag Blade 6113-119-090,S990221277,CDM,272,RC,,,Outpatient,,,261,130.5,,200.97,77,,,Percent of Total Billed Charges,77% of total billed charges,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.14,74,,,Percent of Total Billed Charges,74% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,219.24,84,,,Percent of Total Billed Charges,84% of total billed charges,214.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,232.29,89,,,Percent of total Billed Charges,89% of total Billed charges,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.97,77,,,Percent of total Billed charges,77% of total billed charges,221.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,232.29,
EndoGia Staples,S990221278,CDM,272,RC,,,Outpatient,,,1980,990,,1524.6,77,,,Percent of Total Billed Charges,77% of total billed charges,504.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.2,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.2,69,,,Percent of Total Billed Charges,69% of total billed charges,495,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.2,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.6,77,,,Percent of total Billed charges,77% of total billed charges,1683,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495,1762.2,
EPIDURAL TRAY,S990230001,CDM,270,RC,,,Outpatient,,,374,187,,287.98,77,,,Percent of Total Billed Charges,77% of total billed charges,95.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,314.16,84,,,Percent of Total Billed Charges,84% of total billed charges,306.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,332.86,89,,,Percent of total Billed Charges,89% of total Billed charges,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.98,77,,,Percent of total Billed charges,77% of total billed charges,317.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,332.86,
SPINAL/EPIDURAL TRAY,S990230002,CDM,270,RC,,,Outpatient,,,621,310.5,,478.17,77,,,Percent of Total Billed Charges,77% of total billed charges,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,459.54,74,,,Percent of Total Billed Charges,74% of total billed charges,428.49,69,,,Percent of Total Billed Charges,69% of total billed charges,428.49,69,,,Percent of Total Billed Charges,69% of total billed charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.49,69,,,Percent of Total Billed Charges,69% of total billed charges,428.49,69,,,Percent of Total Billed Charges,69% of total billed charges,521.64,84,,,Percent of Total Billed Charges,84% of total billed charges,509.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,552.69,89,,,Percent of total Billed Charges,89% of total Billed charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.17,77,,,Percent of total Billed charges,77% of total billed charges,527.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,310.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,253.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,552.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.25,552.69,
SPINE ANESTH TRAY,S990230003,CDM,270,RC,,,Outpatient,,,354,177,,272.58,77,,,Percent of Total Billed Charges,77% of total billed charges,90.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,261.96,74,,,Percent of Total Billed Charges,74% of total billed charges,244.26,69,,,Percent of Total Billed Charges,69% of total billed charges,244.26,69,,,Percent of Total Billed Charges,69% of total billed charges,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.26,69,,,Percent of Total Billed Charges,69% of total billed charges,244.26,69,,,Percent of Total Billed Charges,69% of total billed charges,297.36,84,,,Percent of Total Billed Charges,84% of total billed charges,290.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.06,89,,,Percent of total Billed Charges,89% of total Billed charges,315.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.58,77,,,Percent of total Billed charges,77% of total billed charges,300.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.5,315.06,
CHEST TUBE INST/SUPPLY TRAY,S990300001,CDM,270,RC,,,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
SUCTION,S990300002,CDM,270,RC,,,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.12,74,,,Percent of Total Billed Charges,74% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,211.82,
SUTURE (EACH PACK),S990300003,CDM,270,RC,,,Outpatient,,,51.5,25.75,,39.66,77,,,Percent of Total Billed Charges,77% of total billed charges,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.11,74,,,Percent of Total Billed Charges,74% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,43.26,84,,,Percent of Total Billed Charges,84% of total billed charges,42.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.84,89,,,Percent of total Billed Charges,89% of total Billed charges,45.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.66,77,,,Percent of total Billed charges,77% of total billed charges,43.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.88,45.84,
ENTITLE CO2 SPOT CHECK,S990300009,CDM,270,RC,,,Outpatient,,,73.5,36.75,,56.6,77,,,Percent of Total Billed Charges,77% of total billed charges,18.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.39,74,,,Percent of Total Billed Charges,74% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,61.74,84,,,Percent of Total Billed Charges,84% of total billed charges,60.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.42,89,,,Percent of total Billed Charges,89% of total Billed charges,65.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.6,77,,,Percent of total Billed charges,77% of total billed charges,62.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.38,65.42,
BIOPSY TRAY,S990400001,CDM,270,RC,,,Outpatient,,,187.5,93.75,,144.38,77,,,Percent of Total Billed Charges,77% of total billed charges,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.75,74,,,Percent of Total Billed Charges,74% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,157.5,84,,,Percent of Total Billed Charges,84% of total billed charges,153.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,166.88,89,,,Percent of total Billed Charges,89% of total Billed charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.38,77,,,Percent of total Billed charges,77% of total billed charges,159.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,93.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.88,166.88,
TRAY CHARGE,S990400002,CDM,270,RC,,,Outpatient,,,98,49,,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.52,74,,,Percent of Total Billed Charges,74% of total billed charges,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,82.32,84,,,Percent of Total Billed Charges,84% of total billed charges,80.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.22,89,,,Percent of total Billed Charges,89% of total Billed charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,87.22,
ECHO CONTRAST,S990440001,CDM,250,RC,Q9956,HCPCS,Outpatient,,,280.5,140.25,,215.99,77,,,Percent of Total Billed Charges,77% of total billed charges,71.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,207.57,74,,,Percent of Total Billed Charges,74% of total billed charges,193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,235.62,84,,,Percent of Total Billed Charges,84% of total billed charges,230.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,249.65,89,,,Percent of total Billed Charges,89% of total Billed charges,249.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.99,77,,,Percent of total Billed charges,77% of total billed charges,238.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.13,249.65,
AEROCHAMBER W/MASK,S990600001,CDM,270,RC,,,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.9,74,,,Percent of Total Billed Charges,74% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,155.4,84,,,Percent of Total Billed Charges,84% of total billed charges,151.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.65,89,,,Percent of total Billed Charges,89% of total Billed charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,164.65,
"INCENTIVE SPIRO, INITIAL",S990600002,CDM,270,RC,,,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.48,89,,,Percent of total Billed Charges,89% of total Billed charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33,117.48,
"INCENTIVE SPIRO, SUB",S990600003,CDM,270,RC,,,Outpatient,,,103.5,51.75,,79.7,77,,,Percent of Total Billed Charges,77% of total billed charges,26.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.59,74,,,Percent of Total Billed Charges,74% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,84,,,Percent of Total Billed Charges,84% of total billed charges,84.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.12,89,,,Percent of total Billed Charges,89% of total Billed charges,92.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.7,77,,,Percent of total Billed charges,77% of total billed charges,87.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.88,92.12,
O2 24 HR FIRST DAY,S990600004,CDM,270,RC,,,Outpatient,,,978,489,,753.06,77,,,Percent of Total Billed Charges,77% of total billed charges,249.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,723.72,74,,,Percent of Total Billed Charges,74% of total billed charges,674.82,69,,,Percent of Total Billed Charges,69% of total billed charges,674.82,69,,,Percent of Total Billed Charges,69% of total billed charges,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.82,69,,,Percent of Total Billed Charges,69% of total billed charges,674.82,69,,,Percent of Total Billed Charges,69% of total billed charges,821.52,84,,,Percent of Total Billed Charges,84% of total billed charges,801.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,870.42,89,,,Percent of total Billed Charges,89% of total Billed charges,870.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,753.06,77,,,Percent of total Billed charges,77% of total billed charges,831.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,489,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,399.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,870.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.5,870.42,
O2 SUB DAY,S990600005,CDM,270,RC,,,Outpatient,,,749,374.5,,576.73,77,,,Percent of Total Billed Charges,77% of total billed charges,191,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,554.26,74,,,Percent of Total Billed Charges,74% of total billed charges,516.81,69,,,Percent of Total Billed Charges,69% of total billed charges,516.81,69,,,Percent of Total Billed Charges,69% of total billed charges,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.81,69,,,Percent of Total Billed Charges,69% of total billed charges,516.81,69,,,Percent of Total Billed Charges,69% of total billed charges,629.16,84,,,Percent of Total Billed Charges,84% of total billed charges,614.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,666.61,89,,,Percent of total Billed Charges,89% of total Billed charges,666.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,666.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.73,77,,,Percent of total Billed charges,77% of total billed charges,636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,374.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,666.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.25,666.61,
SUCTION IST DAY,S990600006,CDM,270,RC,,,Outpatient,,,373,186.5,,287.21,77,,,Percent of Total Billed Charges,77% of total billed charges,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,276.02,74,,,Percent of Total Billed Charges,74% of total billed charges,257.37,69,,,Percent of Total Billed Charges,69% of total billed charges,257.37,69,,,Percent of Total Billed Charges,69% of total billed charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.37,69,,,Percent of Total Billed Charges,69% of total billed charges,257.37,69,,,Percent of Total Billed Charges,69% of total billed charges,313.32,84,,,Percent of Total Billed Charges,84% of total billed charges,305.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,331.97,89,,,Percent of total Billed Charges,89% of total Billed charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.21,77,,,Percent of total Billed charges,77% of total billed charges,317.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,186.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,152.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.25,331.97,
SUCTION SUB DAY,S990600007,CDM,270,RC,,,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.78,89,,,Percent of total Billed Charges,89% of total Billed charges,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.5,90.78,
O2 1ST 15 MINUTES,S990650001,CDM,270,RC,,,Outpatient,,,38,19,,29.26,77,,,Percent of Total Billed Charges,77% of total billed charges,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.12,74,,,Percent of Total Billed Charges,74% of total billed charges,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,31.92,84,,,Percent of Total Billed Charges,84% of total billed charges,31.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,33.82,89,,,Percent of total Billed Charges,89% of total Billed charges,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.26,77,,,Percent of total Billed charges,77% of total billed charges,32.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.5,33.82,
O2 PER EACH ADD'L 15 MIN,S990650002,CDM,270,RC,,,Outpatient,,,11,5.5,,8.47,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.14,74,,,Percent of Total Billed Charges,74% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,9.24,84,,,Percent of Total Billed Charges,84% of total billed charges,9.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.79,89,,,Percent of total Billed Charges,89% of total Billed charges,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.47,77,,,Percent of total Billed charges,77% of total billed charges,9.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.79,
CPM KIT - ARM,S990700002,CDM,270,RC,,,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.36,89,,,Percent of total Billed Charges,89% of total Billed charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,110.36,
CPM KIT - LEG,S990700003,CDM,270,RC,,,Outpatient,,,251.5,125.75,,193.66,77,,,Percent of Total Billed Charges,77% of total billed charges,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.11,74,,,Percent of Total Billed Charges,74% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,211.26,84,,,Percent of Total Billed Charges,84% of total billed charges,206.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.84,89,,,Percent of total Billed Charges,89% of total Billed charges,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.66,77,,,Percent of total Billed charges,77% of total billed charges,213.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.88,223.84,
FOOT INSERT ORTHOTIC,S990700004,CDM,274,RC,L3010,HCPCS,Outpatient,,,422.5,211.25,,325.33,77,,,Percent of Total Billed Charges,77% of total billed charges,107.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,291.53,69,,,Percent of Total Billed Charges,69% of total billed charges,291.53,69,,,Percent of Total Billed Charges,69% of total billed charges,291.53,69,,,Percent of Total Billed Charges,69% of total billed charges,105.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.53,69,,,Percent of Total Billed Charges,69% of total billed charges,291.53,69,,,Percent of Total Billed Charges,69% of total billed charges,291.53,69,,,Percent of Total Billed Charges,69% of total billed charges,295.75,70,,,Percent of Total Billed Charges,70% total billed charges,291.53,69,,,Percent of total Billed Charges,69% of total Billed charges,291.53,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,291.53,69,,,Percent of Total Billed Charges,69% of Total Billed Charges,172.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.33,77,,,Percent of total Billed charges,77% of total billed charges,359.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,172.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,105.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.63,359.13,
HOT PACK,S990710001,CDM,270,RC,,,Outpatient,,,37,18.5,,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.38,74,,,Percent of Total Billed Charges,74% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,31.08,84,,,Percent of Total Billed Charges,84% of total billed charges,30.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.93,89,,,Percent of total Billed Charges,89% of total Billed charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,32.93,
IMMUNIZATION ADM,S990750001,CDM,771,RC,90471,HCPCS,Outpatient,,,94.5,47.25,,72.77,77,,,Percent of Total Billed Charges,77% of total billed charges,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.93,74,,,Percent of Total Billed Charges,74% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,84,,,Percent of Total Billed Charges,84% of total billed charges,77.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.11,89,,,Percent of total Billed Charges,89% of total Billed charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.77,77,,,Percent of total Billed charges,77% of total billed charges,80.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,38.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.63,84.11,
IMMUNIZATIO ADM EA ADD VACCINE,S990750002,CDM,771,RC,90472,HCPCS,Outpatient,,,98.5,49.25,,75.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.89,74,,,Percent of Total Billed Charges,74% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,82.74,84,,,Percent of Total Billed Charges,84% of total billed charges,80.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.67,89,,,Percent of total Billed Charges,89% of total Billed charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,77,,,Percent of total Billed charges,77% of total billed charges,83.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,40.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.63,87.67,
ANTI FLOW VALVE,S990750005,CDM,270,RC,,,Outpatient,,,20,10,,15.4,77,,,Percent of Total Billed Charges,77% of total billed charges,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.8,74,,,Percent of Total Billed Charges,74% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16.8,84,,,Percent of Total Billed Charges,84% of total billed charges,16.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.8,89,,,Percent of total Billed Charges,89% of total Billed charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.4,77,,,Percent of total Billed charges,77% of total billed charges,17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,17.8,
"4"" KERLIX BULKY",S990760002,CDM,272,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.57,
ABD PAD 8X10,S990760003,CDM,272,RC,,,Outpatient,,,8.5,4.25,,6.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.29,74,,,Percent of Total Billed Charges,74% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,7.14,84,,,Percent of Total Billed Charges,84% of total billed charges,6.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.57,89,,,Percent of total Billed Charges,89% of total Billed charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.55,77,,,Percent of total Billed charges,77% of total billed charges,7.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.13,7.57,
ACE WRAP 4in,S990760004,CDM,272,RC,,,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.82,89,,,Percent of total Billed Charges,89% of total Billed charges,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.38,29.82,
ADAPTIC NON-ADH,S990760005,CDM,272,RC,,,Outpatient,,,14,7,,10.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.36,74,,,Percent of Total Billed Charges,74% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,11.76,84,,,Percent of Total Billed Charges,84% of total billed charges,11.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.46,89,,,Percent of total Billed Charges,89% of total Billed charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.78,77,,,Percent of total Billed charges,77% of total billed charges,11.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.5,12.46,
Amniofix 2x3 cm,S990760007,CDM,272,RC,,,Outpatient,,,4543,2271.5,,3498.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1158.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1158.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1419.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3361.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3134.67,69,,,Percent of Total Billed Charges,69% of total billed charges,3134.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.67,69,,,Percent of Total Billed Charges,69% of total billed charges,3134.67,69,,,Percent of Total Billed Charges,69% of total billed charges,3816.12,84,,,Percent of Total Billed Charges,84% of total billed charges,3725.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,4043.27,89,,,Percent of total Billed Charges,89% of total Billed charges,4043.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4043.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1853.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1135.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.11,77,,,Percent of total Billed charges,77% of total billed charges,3861.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1306.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2271.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1853.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1135.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4043.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1135.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1135.75,4043.27,
Amniofix 4x10cm,S990760008,CDM,272,RC,,,Outpatient,,,13239.5,6619.75,,10194.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3376.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3376.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4137.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9797.23,74,,,Percent of Total Billed Charges,74% of total billed charges,9135.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9135.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3309.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9135.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9135.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11121.18,84,,,Percent of Total Billed Charges,84% of total billed charges,10856.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,11783.16,89,,,Percent of total Billed Charges,89% of total Billed charges,11783.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11783.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5401.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5401.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5401.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3309.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10194.42,77,,,Percent of total Billed charges,77% of total billed charges,11253.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3806.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6619.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5401.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3309.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11783.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3309.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3309.88,11783.16,
Amniofix 6x10cm,S990760009,CDM,272,RC,,,Outpatient,,,19837,9918.5,,15274.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5058.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5058.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6199.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14679.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13687.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13687.53,69,,,Percent of Total Billed Charges,69% of total billed charges,4959.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13687.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13687.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16663.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17654.93,89,,,Percent of total Billed Charges,89% of total Billed charges,17654.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17654.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8093.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8093.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8093.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4959.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15274.49,77,,,Percent of total Billed charges,77% of total billed charges,16861.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5703.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9918.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8093.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4959.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17654.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4959.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4959.25,17654.93,
AQUACEL AG ROPE 3/4X18,S990760012,CDM,272,RC,,,Outpatient,,,36.5,18.25,,28.11,77,,,Percent of Total Billed Charges,77% of total billed charges,9.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.01,74,,,Percent of Total Billed Charges,74% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30.66,84,,,Percent of Total Billed Charges,84% of total billed charges,29.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.49,89,,,Percent of total Billed Charges,89% of total Billed charges,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.11,77,,,Percent of total Billed charges,77% of total billed charges,31.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,32.49,
"AQUACEL ROPE, CONVATEC 4X5",S990760013,CDM,272,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
BANDAGE WRAP COHESIVE GAUZE 1,S990760014,CDM,272,RC,,,Outpatient,,,8.5,4.25,,6.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.29,74,,,Percent of Total Billed Charges,74% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,7.14,84,,,Percent of Total Billed Charges,84% of total billed charges,6.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.57,89,,,Percent of total Billed Charges,89% of total Billed charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.55,77,,,Percent of total Billed charges,77% of total billed charges,7.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.13,7.57,
CALCIUM ALGINATE,S990760016,CDM,272,RC,,,Outpatient,,,27,13.5,,20.79,77,,,Percent of Total Billed Charges,77% of total billed charges,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.98,74,,,Percent of Total Billed Charges,74% of total billed charges,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,69,,,Percent of Total Billed Charges,69% of total billed charges,22.68,84,,,Percent of Total Billed Charges,84% of total billed charges,22.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.03,89,,,Percent of total Billed Charges,89% of total Billed charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.79,77,,,Percent of total Billed charges,77% of total billed charges,22.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.75,24.03,
COBAN 3in,S990760018,CDM,272,RC,,,Outpatient,,,14,7,,10.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.36,74,,,Percent of Total Billed Charges,74% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,69,,,Percent of Total Billed Charges,69% of total billed charges,11.76,84,,,Percent of Total Billed Charges,84% of total billed charges,11.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.46,89,,,Percent of total Billed Charges,89% of total Billed charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.78,77,,,Percent of total Billed charges,77% of total billed charges,11.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.5,12.46,
"COBAN 6""",S990760019,CDM,272,RC,,,Outpatient,,,19.5,9.75,,15.02,77,,,Percent of Total Billed Charges,77% of total billed charges,4.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.43,74,,,Percent of Total Billed Charges,74% of total billed charges,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,13.46,69,,,Percent of Total Billed Charges,69% of total billed charges,16.38,84,,,Percent of Total Billed Charges,84% of total billed charges,15.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.36,89,,,Percent of total Billed Charges,89% of total Billed charges,17.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.02,77,,,Percent of total Billed charges,77% of total billed charges,16.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.88,17.36,
COFLEX 2 LAYER,S990760020,CDM,272,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
EXTRASORB 4X5,S990760023,CDM,272,RC,,,Outpatient,,,10,5,,7.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.4,74,,,Percent of Total Billed Charges,74% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8.4,84,,,Percent of Total Billed Charges,84% of total billed charges,8.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.7,77,,,Percent of total Billed charges,77% of total billed charges,8.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.5,8.9,
Exu-Dry,S990760024,CDM,272,RC,,,Outpatient,,,22,11,,16.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.28,74,,,Percent of Total Billed Charges,74% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,18.48,84,,,Percent of Total Billed Charges,84% of total billed charges,18.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.58,89,,,Percent of total Billed Charges,89% of total Billed charges,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,77,,,Percent of total Billed charges,77% of total billed charges,18.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.5,19.58,
HYDROFERA BLUE 4X4,S990760025,CDM,272,RC,,,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.71,89,,,Percent of total Billed Charges,89% of total Billed charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,30.71,
MAXSORB Ag ROPE 1X12,S990760033,CDM,272,RC,,,Outpatient,,,32.5,16.25,,25.03,77,,,Percent of Total Billed Charges,77% of total billed charges,8.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.05,74,,,Percent of Total Billed Charges,74% of total billed charges,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,27.3,84,,,Percent of Total Billed Charges,84% of total billed charges,26.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.93,89,,,Percent of total Billed Charges,89% of total Billed charges,28.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,77,,,Percent of total Billed charges,77% of total billed charges,27.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,28.93,
MEDIHONEY SHEET 4.3X4.3,S990760034,CDM,272,RC,,,Outpatient,,,38.5,19.25,,29.65,77,,,Percent of Total Billed Charges,77% of total billed charges,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.49,74,,,Percent of Total Billed Charges,74% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,32.34,84,,,Percent of Total Billed Charges,84% of total billed charges,31.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.27,89,,,Percent of total Billed Charges,89% of total Billed charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.65,77,,,Percent of total Billed charges,77% of total billed charges,32.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,34.27,
Mepilex Flex Border 4x4,S990760035,CDM,272,RC,,,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,14.24,
MEPILEX Ag 4X4,S990760036,CDM,272,RC,,,Outpatient,,,16,8,,12.32,77,,,Percent of Total Billed Charges,77% of total billed charges,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.84,74,,,Percent of Total Billed Charges,74% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,11.04,69,,,Percent of Total Billed Charges,69% of total billed charges,13.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.24,89,,,Percent of total Billed Charges,89% of total Billed charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,77,,,Percent of total Billed charges,77% of total billed charges,13.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4,14.24,
Mepilex Ag 4x4,S990760037,CDM,272,RC,,,Outpatient,,,110.5,55.25,,85.09,77,,,Percent of Total Billed Charges,77% of total billed charges,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.77,74,,,Percent of Total Billed Charges,74% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,92.82,84,,,Percent of Total Billed Charges,84% of total billed charges,90.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.35,89,,,Percent of total Billed Charges,89% of total Billed charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.09,77,,,Percent of total Billed charges,77% of total billed charges,93.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.63,98.35,
MEPILEX BORDER,S990760038,CDM,272,RC,,,Outpatient,,,13,6.5,,10.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.62,74,,,Percent of Total Billed Charges,74% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10.92,84,,,Percent of Total Billed Charges,84% of total billed charges,10.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.01,77,,,Percent of total Billed charges,77% of total billed charges,11.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.57,
MEPILEX BORDER SACRU,S990760039,CDM,272,RC,,,Outpatient,,,22,11,,16.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.28,74,,,Percent of Total Billed Charges,74% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,15.18,69,,,Percent of Total Billed Charges,69% of total billed charges,18.48,84,,,Percent of Total Billed Charges,84% of total billed charges,18.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.58,89,,,Percent of total Billed Charges,89% of total Billed charges,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,77,,,Percent of total Billed charges,77% of total billed charges,18.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.5,19.58,
POLYMEN 4X4,S990760042,CDM,272,RC,,,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.68,74,,,Percent of Total Billed Charges,74% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,26.88,84,,,Percent of Total Billed Charges,84% of total billed charges,26.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.48,89,,,Percent of total Billed Charges,89% of total Billed charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,28.48,
PROMOGRAN,S990760043,CDM,272,RC,,,Outpatient,,,30.5,15.25,,23.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.57,74,,,Percent of Total Billed Charges,74% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,25.62,84,,,Percent of Total Billed Charges,84% of total billed charges,25.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.15,89,,,Percent of total Billed Charges,89% of total Billed charges,27.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.49,77,,,Percent of total Billed charges,77% of total billed charges,25.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.15,
Promogran Matrix Prisma,S990760044,CDM,272,RC,,,Outpatient,,,32.5,16.25,,25.03,77,,,Percent of Total Billed Charges,77% of total billed charges,8.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.05,74,,,Percent of Total Billed Charges,74% of total billed charges,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,22.43,69,,,Percent of Total Billed Charges,69% of total billed charges,27.3,84,,,Percent of Total Billed Charges,84% of total billed charges,26.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.93,89,,,Percent of total Billed Charges,89% of total Billed charges,28.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,77,,,Percent of total Billed charges,77% of total billed charges,27.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,28.93,
PURAPLY MICRONIZED 100mg,S990760045,CDM,272,RC,,,Outpatient,,,1061,530.5,,816.97,77,,,Percent of Total Billed Charges,77% of total billed charges,270.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.14,74,,,Percent of Total Billed Charges,74% of total billed charges,732.09,69,,,Percent of Total Billed Charges,69% of total billed charges,732.09,69,,,Percent of Total Billed Charges,69% of total billed charges,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.09,69,,,Percent of Total Billed Charges,69% of total billed charges,732.09,69,,,Percent of Total Billed Charges,69% of total billed charges,891.24,84,,,Percent of Total Billed Charges,84% of total billed charges,870.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,944.29,89,,,Percent of total Billed Charges,89% of total Billed charges,944.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,944.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,816.97,77,,,Percent of total Billed charges,77% of total billed charges,901.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,530.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,432.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.25,944.29,
REMEDY PHYTOPLX MOISTURIZR-2OZ,S990760046,CDM,272,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
SILVERCEL 4.5X4.5,S990760048,CDM,272,RC,,,Outpatient,,,28.5,14.25,,21.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,23.94,84,,,Percent of Total Billed Charges,84% of total billed charges,23.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.37,89,,,Percent of total Billed Charges,89% of total Billed charges,25.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.95,77,,,Percent of total Billed charges,77% of total billed charges,24.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.13,25.37,
SKIN PREP,S990760049,CDM,270,RC,,,Outpatient,,,11,5.5,,8.47,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.14,74,,,Percent of Total Billed Charges,74% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,69,,,Percent of Total Billed Charges,69% of total billed charges,9.24,84,,,Percent of Total Billed Charges,84% of total billed charges,9.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.79,89,,,Percent of total Billed Charges,89% of total Billed charges,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.47,77,,,Percent of total Billed charges,77% of total billed charges,9.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.79,
STERILE COTTON TIP APPL(2PK),S990760051,CDM,272,RC,,,Outpatient,,,11.5,5.75,,8.86,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.51,74,,,Percent of Total Billed Charges,74% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.24,89,,,Percent of total Billed Charges,89% of total Billed charges,10.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.86,77,,,Percent of total Billed charges,77% of total billed charges,9.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.88,10.24,
TELFA 8X3,S990760052,CDM,272,RC,,,Outpatient,,,11.5,5.75,,8.86,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.51,74,,,Percent of Total Billed Charges,74% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7.94,69,,,Percent of Total Billed Charges,69% of total billed charges,9.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.24,89,,,Percent of total Billed Charges,89% of total Billed charges,10.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.86,77,,,Percent of total Billed charges,77% of total billed charges,9.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.88,10.24,
TELFA ISLAND 4X10,S990760053,CDM,272,RC,,,Outpatient,,,10.5,5.25,,8.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7.25,69,,,Percent of Total Billed Charges,69% of total billed charges,7.25,69,,,Percent of Total Billed Charges,69% of total billed charges,2.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,69,,,Percent of Total Billed Charges,69% of total billed charges,7.25,69,,,Percent of Total Billed Charges,69% of total billed charges,8.82,84,,,Percent of Total Billed Charges,84% of total billed charges,8.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.35,89,,,Percent of total Billed Charges,89% of total Billed charges,9.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.09,77,,,Percent of total Billed charges,77% of total billed charges,8.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.63,9.35,
APLIGRAF - PER SQ CM,S990760061,CDM,636,RC,Q4101,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,45,,,Percent of Total Billed Charges,45% of total billed charges,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,80.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.38,175.78,
Affinity 2.5x2.5,S990760069,CDM,636,RC,Q4159,HCPCS,Outpatient,,,10600,5300,,8162,77,,,Percent of Total Billed Charges,77% of total billed charges,2703,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2703,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3312.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7314,69,,,Percent of Total Billed Charges,69% of total billed charges,7314,69,,,Percent of Total Billed Charges,69% of total billed charges,7314,69,,,Percent of Total Billed Charges,69% of total billed charges,2650,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7314,69,,,Percent of Total Billed Charges,69% of total billed charges,7314,69,,,Percent of Total Billed Charges,69% of total billed charges,7314,69,,,Percent of Total Billed Charges,69% of total billed charges,4770,45,,,Percent of Total Billed Charges,45% of total billed charges,9434,89,,,Percent of total Billed Charges,89% of total Billed charges,9434,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9434,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4324.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4324.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4324.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2650,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8162,77,,,Percent of total Billed charges,77% of total billed charges,9010,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3047.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4346,41,,,Percent of Total Billed Charges,41% of Total Billed Charges,4324.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2650,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4346,41,,,Percent of Total Billed Charges,41% of Total Billed Charges,2650,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2650,9434,
NUSHIELD Per SQ cm,S990760070,CDM,636,RC,Q4160,HCPCS,Outpatient,,,338,169,,260.26,77,,,Percent of Total Billed Charges,77% of total billed charges,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.22,69,,,Percent of Total Billed Charges,69% of total billed charges,233.22,69,,,Percent of Total Billed Charges,69% of total billed charges,233.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.22,69,,,Percent of Total Billed Charges,69% of total billed charges,233.22,69,,,Percent of Total Billed Charges,69% of total billed charges,233.22,69,,,Percent of Total Billed Charges,69% of total billed charges,152.1,45,,,Percent of Total Billed Charges,45% of total billed charges,300.82,89,,,Percent of total Billed Charges,89% of total Billed charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.26,77,,,Percent of total Billed charges,77% of total billed charges,287.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,137.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,84.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.5,300.82,
"EPIFIX, PER SQ CM",S990760071,CDM,636,RC,Q4186,HCPCS,Outpatient,,,990,495,,762.3,77,,,Percent of Total Billed Charges,77% of total billed charges,252.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,683.1,69,,,Percent of Total Billed Charges,69% of total billed charges,683.1,69,,,Percent of Total Billed Charges,69% of total billed charges,683.1,69,,,Percent of Total Billed Charges,69% of total billed charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,683.1,69,,,Percent of Total Billed Charges,69% of total billed charges,683.1,69,,,Percent of Total Billed Charges,69% of total billed charges,683.1,69,,,Percent of Total Billed Charges,69% of total billed charges,445.5,45,,,Percent of Total Billed Charges,45% of total billed charges,881.1,89,,,Percent of total Billed Charges,89% of total Billed charges,881.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,881.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,403.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,762.3,77,,,Percent of total Billed charges,77% of total billed charges,841.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,403.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,247.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.5,881.1,
"EPICORD, PER SQ CM",S990760072,CDM,636,RC,Q4187,HCPCS,Outpatient,,,1116,558,,859.32,77,,,Percent of Total Billed Charges,77% of total billed charges,284.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,284.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,770.04,69,,,Percent of Total Billed Charges,69% of total billed charges,770.04,69,,,Percent of Total Billed Charges,69% of total billed charges,770.04,69,,,Percent of Total Billed Charges,69% of total billed charges,279,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.04,69,,,Percent of Total Billed Charges,69% of total billed charges,770.04,69,,,Percent of Total Billed Charges,69% of total billed charges,770.04,69,,,Percent of Total Billed Charges,69% of total billed charges,502.2,45,,,Percent of Total Billed Charges,45% of total billed charges,993.24,89,,,Percent of total Billed Charges,89% of total Billed charges,993.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,993.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,455.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,455.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,279,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,859.32,77,,,Percent of total Billed charges,77% of total billed charges,948.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,320.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,455.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,279,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,279,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279,993.24,
"PURAPLY AM, PER SQ CM",S990760073,CDM,636,RC,Q4196,HCPCS,Outpatient,,,471,235.5,,362.67,77,,,Percent of Total Billed Charges,77% of total billed charges,120.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.99,69,,,Percent of Total Billed Charges,69% of total billed charges,324.99,69,,,Percent of Total Billed Charges,69% of total billed charges,324.99,69,,,Percent of Total Billed Charges,69% of total billed charges,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.99,69,,,Percent of Total Billed Charges,69% of total billed charges,324.99,69,,,Percent of Total Billed Charges,69% of total billed charges,324.99,69,,,Percent of Total Billed Charges,69% of total billed charges,211.95,45,,,Percent of Total Billed Charges,45% of total billed charges,419.19,89,,,Percent of total Billed Charges,89% of total Billed charges,419.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.67,77,,,Percent of total Billed charges,77% of total billed charges,400.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,192.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.75,419.19,
"PURAPLY XT, PER SQ CM",S990760074,CDM,636,RC,Q4197,HCPCS,Outpatient,,,741,370.5,,570.57,77,,,Percent of Total Billed Charges,77% of total billed charges,188.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,511.29,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,69,,,Percent of Total Billed Charges,69% of total billed charges,185.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,69,,,Percent of Total Billed Charges,69% of total billed charges,333.45,45,,,Percent of Total Billed Charges,45% of total billed charges,659.49,89,,,Percent of total Billed Charges,89% of total Billed charges,659.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,302.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,302.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,302.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,570.57,77,,,Percent of total Billed charges,77% of total billed charges,629.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,302.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,185.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.25,659.49,
Acticoat Flex 4X8,S990760075,CDM,272,RC,,,Outpatient,,,88,44,,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.12,74,,,Percent of Total Billed Charges,74% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,73.92,84,,,Percent of Total Billed Charges,84% of total billed charges,72.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.32,89,,,Percent of total Billed Charges,89% of total Billed charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,78.32,
Adaptic 3X3,S990760076,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Adaptic 3X8,S990760077,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Aquacell Ag Advantage 4X5,S990760078,CDM,272,RC,,,Outpatient,,,42,21,,32.34,77,,,Percent of Total Billed Charges,77% of total billed charges,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.08,74,,,Percent of Total Billed Charges,74% of total billed charges,28.98,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,69,,,Percent of Total Billed Charges,69% of total billed charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.98,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,69,,,Percent of Total Billed Charges,69% of total billed charges,35.28,84,,,Percent of Total Billed Charges,84% of total billed charges,34.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.38,89,,,Percent of total Billed Charges,89% of total Billed charges,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.34,77,,,Percent of total Billed charges,77% of total billed charges,35.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.5,37.38,
Durafiber 4X4,S990760079,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Gentac Island Dressing 2X2,S990760080,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Gentac Island Dressing 4X4,S990760081,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Gentac Island Dressing 6X6,S990760082,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Iodopher 2X2,S990760083,CDM,272,RC,,,Outpatient,,,38,19,,29.26,77,,,Percent of Total Billed Charges,77% of total billed charges,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.12,74,,,Percent of Total Billed Charges,74% of total billed charges,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,26.22,69,,,Percent of Total Billed Charges,69% of total billed charges,31.92,84,,,Percent of Total Billed Charges,84% of total billed charges,31.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,33.82,89,,,Percent of total Billed Charges,89% of total Billed charges,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.26,77,,,Percent of total Billed charges,77% of total billed charges,32.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.5,33.82,
Iodopher 4X5,S990760084,CDM,272,RC,,,Outpatient,,,80,40,,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.2,74,,,Percent of Total Billed Charges,74% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,67.2,84,,,Percent of Total Billed Charges,84% of total billed charges,65.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.2,89,,,Percent of total Billed Charges,89% of total Billed charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20,71.2,
Kerlex Super Sponges,S990760085,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Max Orb 4X4 Cal Alginate,S990760086,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Mepilex Flex Border 6X6,S990760087,CDM,272,RC,,,Outpatient,,,24,12,,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.76,74,,,Percent of Total Billed Charges,74% of total billed charges,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,20.16,84,,,Percent of Total Billed Charges,84% of total billed charges,19.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.36,89,,,Percent of total Billed Charges,89% of total Billed charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,21.36,
Mepilex Ag 6X6,S990760088,CDM,272,RC,,,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.5,74,,,Percent of Total Billed Charges,74% of total billed charges,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,105,84,,,Percent of Total Billed Charges,84% of total billed charges,102.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.25,89,,,Percent of total Billed Charges,89% of total Billed charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.25,111.25,
Renasys Get Patch 4X4,S990760089,CDM,272,RC,,,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.62,74,,,Percent of Total Billed Charges,74% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,84,,,Percent of Total Billed Charges,84% of total billed charges,51.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.07,89,,,Percent of total Billed Charges,89% of total Billed charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,56.07,
Vashe 2 Oz,S990760090,CDM,272,RC,,,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,5.34,
Unna-Z Wrap,S990760091,CDM,272,RC,,,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
"Cygnus Dual, per sq cm",S990760092,CDM,636,RC,Q4282,HCPCS,Outpatient,,,2468,1234,,1900.36,77,,,Percent of Total Billed Charges,77% of total billed charges,629.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,629.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1702.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1702.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1702.92,69,,,Percent of Total Billed Charges,69% of total billed charges,617,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1702.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1702.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1702.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1110.6,45,,,Percent of Total Billed Charges,45% of total billed charges,2196.52,89,,,Percent of total Billed Charges,89% of total Billed charges,2196.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2196.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1006.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1006.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1006.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1900.36,77,,,Percent of total Billed charges,77% of total billed charges,2097.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,709.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,1006.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,617,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617,2196.52,
Kerecis-MariGen per sq cm,S990760093,CDM,636,RC,Q4158,HCPCS,Outpatient,,,374,187,,287.98,77,,,Percent of Total Billed Charges,77% of total billed charges,95.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,258.06,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,45,,,Percent of Total Billed Charges,45% of total billed charges,332.86,89,,,Percent of total Billed Charges,89% of total Billed charges,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,332.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.98,77,,,Percent of total Billed charges,77% of total billed charges,317.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,152.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,93.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,332.86,
Kerecis-MariGen Fenstrated,S990760094,CDM,636,RC,Q4158,HCPCS,Outpatient,,,270,135,,207.9,77,,,Percent of Total Billed Charges,77% of total billed charges,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,45,,,Percent of Total Billed Charges,45% of total billed charges,240.3,89,,,Percent of total Billed Charges,89% of total Billed charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.9,77,,,Percent of total Billed charges,77% of total billed charges,229.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,110.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.5,240.3,
Kerecis-MeriGen Expanse per cm,S990760095,CDM,636,RC,Q4158,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,100.8,45,,,Percent of Total Billed Charges,45% of total billed charges,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
Kerecis-MeriGen Micro per sq c,S990760096,CDM,636,RC,Q4158,HCPCS,Outpatient,,,334,167,,257.18,77,,,Percent of Total Billed Charges,77% of total billed charges,85.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.46,69,,,Percent of Total Billed Charges,69% of total billed charges,230.46,69,,,Percent of Total Billed Charges,69% of total billed charges,230.46,69,,,Percent of Total Billed Charges,69% of total billed charges,83.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.46,69,,,Percent of Total Billed Charges,69% of total billed charges,230.46,69,,,Percent of Total Billed Charges,69% of total billed charges,230.46,69,,,Percent of Total Billed Charges,69% of total billed charges,150.3,45,,,Percent of Total Billed Charges,45% of total billed charges,297.26,89,,,Percent of total Billed Charges,89% of total Billed charges,297.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,297.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.18,77,,,Percent of total Billed charges,77% of total billed charges,283.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,136.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,297.26,
Urgo Clean AG 4x5,S990760097,CDM,270,RC,,,Outpatient,,,50,25,,38.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37,74,,,Percent of Total Billed Charges,74% of total billed charges,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,42,84,,,Percent of Total Billed Charges,84% of total billed charges,41,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.5,89,,,Percent of total Billed Charges,89% of total Billed charges,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.5,77,,,Percent of total Billed charges,77% of total billed charges,42.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.5,
GLUCERNA 1.5,S990810003,CDM,270,RC,,,Outpatient,,,51,25.5,,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.74,74,,,Percent of Total Billed Charges,74% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,84,,,Percent of Total Billed Charges,84% of total billed charges,41.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.39,89,,,Percent of total Billed Charges,89% of total Billed charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.75,45.39,
JEVITY 1.5,S990810005,CDM,270,RC,,,Outpatient,,,36,18,,27.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.64,74,,,Percent of Total Billed Charges,74% of total billed charges,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.24,84,,,Percent of Total Billed Charges,84% of total billed charges,29.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.72,77,,,Percent of total Billed charges,77% of total billed charges,30.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9,32.04,
TwoCal HN,S990810008,CDM,270,RC,,,Outpatient,,,29,14.5,,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.46,74,,,Percent of Total Billed Charges,74% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24.36,84,,,Percent of Total Billed Charges,84% of total billed charges,23.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.81,89,,,Percent of total Billed Charges,89% of total Billed charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,25.81,
Osmolite 1.2,S990810009,CDM,270,RC,,,Outpatient,,,23,11.5,,17.71,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.02,74,,,Percent of Total Billed Charges,74% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,15.87,69,,,Percent of Total Billed Charges,69% of total billed charges,19.32,84,,,Percent of Total Billed Charges,84% of total billed charges,18.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.47,89,,,Percent of total Billed Charges,89% of total Billed charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.71,77,,,Percent of total Billed charges,77% of total billed charges,19.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,20.47,
Kates Farm Standard 1.4 Van,S990810010,CDM,270,RC,,,Outpatient,,,294,147,,226.38,77,,,Percent of Total Billed Charges,77% of total billed charges,74.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.56,74,,,Percent of Total Billed Charges,74% of total billed charges,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,202.86,69,,,Percent of Total Billed Charges,69% of total billed charges,246.96,84,,,Percent of Total Billed Charges,84% of total billed charges,241.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.66,89,,,Percent of total Billed Charges,89% of total Billed charges,261.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.38,77,,,Percent of total Billed charges,77% of total billed charges,249.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.5,261.66,
DXA BNDSTY AXIL SKEL; W/ASSESS,T300400078,CDM,320,RC,77085,HCPCS,Outpatient,,,589,294.5,,453.53,77,,,Percent of Total Billed Charges,77% of total billed charges,150.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.86,74,,,Percent of Total Billed Charges,74% of total billed charges,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,494.76,84,,,Percent of Total Billed Charges,84% of total billed charges,482.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.21,89,,,Percent of total Billed Charges,89% of total Billed charges,524.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.3,120,,,Fee Schedule,120% of MO Medicaid Rate,36.3,120,,,Fee Schedule,120% of MO Medicaid Rate,36.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.53,77,,,Percent of total Billed charges,77% of total billed charges,500.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,36.3,120,,,Fee Schedule,120% of MO Medicaid Rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.3,524.21,
DXA BNDSTY AXIL SKEL; W/ASSESS,T300400078,CDM,320,RC,77085,HCPCS,Outpatient,,,589,294.5,TC,453.53,77,,,Percent of Total Billed Charges,77% of total billed charges,150.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.86,74,,,Percent of Total Billed Charges,74% of total billed charges,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,406.41,69,,,Percent of Total Billed Charges,69% of total billed charges,494.76,84,,,Percent of Total Billed Charges,84% of total billed charges,482.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.21,89,,,Percent of total Billed Charges,89% of total Billed charges,524.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.3,120,,,Fee Schedule,120% of MO Medicaid Rate,36.3,120,,,Fee Schedule,120% of MO Medicaid Rate,36.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.53,77,,,Percent of total Billed charges,77% of total billed charges,500.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,36.3,120,,,Fee Schedule,120% of MO Medicaid Rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.3,524.21,
BREAST NEEDLE LOCALIZATION,T300440002,CDM,320,RC,19281,HCPCS,Outpatient,,,878.5,439.25,,676.45,77,,,Percent of Total Billed Charges,77% of total billed charges,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,650.09,74,,,Percent of Total Billed Charges,74% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,737.94,84,,,Percent of Total Billed Charges,84% of total billed charges,720.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,781.87,89,,,Percent of total Billed Charges,89% of total Billed charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.45,77,,,Percent of total Billed charges,77% of total billed charges,746.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,358.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.63,781.87,
BREAST NEEDLE LOCALIZATION,T300440002,CDM,320,RC,19281,HCPCS,Outpatient,,,878.5,439.25,TC,676.45,77,,,Percent of Total Billed Charges,77% of total billed charges,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,650.09,74,,,Percent of Total Billed Charges,74% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,737.94,84,,,Percent of Total Billed Charges,84% of total billed charges,720.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,781.87,89,,,Percent of total Billed Charges,89% of total Billed charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.45,77,,,Percent of total Billed charges,77% of total billed charges,746.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,358.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.63,781.87,
BREAST SURGICAL SPECIMEN,T300440003,CDM,320,RC,76098,HCPCS,Outpatient,,,488.5,244.25,,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,415.23,
BREAST SURGICAL SPECIMEN,T300440003,CDM,320,RC,76098,HCPCS,Outpatient,,,488.5,244.25,TC,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,415.23,
3D RECONS; US,T300440004,CDM,483,RC,76376,HCPCS,Outpatient,,,743.5,371.75,,572.5,77,,,Percent of Total Billed Charges,77% of total billed charges,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,550.19,74,,,Percent of Total Billed Charges,74% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,624.54,84,,,Percent of Total Billed Charges,84% of total billed charges,609.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.84,400,,,fee schedule,400% of healthlink fee schedule,194.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,207.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.5,77,,,Percent of total Billed charges,77% of total billed charges,631.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,498,100,,,Case Rate,Pays based on per visit rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431,100,,,Case Rate,Pays based on per visit rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.08,631.98,
3D RECONS; US,T300440004,CDM,483,RC,76376,HCPCS,Outpatient,,,743.5,371.75,TC,572.5,77,,,Percent of Total Billed Charges,77% of total billed charges,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,550.19,74,,,Percent of Total Billed Charges,74% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,513.02,69,,,Percent of Total Billed Charges,69% of total billed charges,624.54,84,,,Percent of Total Billed Charges,84% of total billed charges,609.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.84,400,,,fee schedule,400% of healthlink fee schedule,194.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,207.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.5,77,,,Percent of total Billed charges,77% of total billed charges,631.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,498,100,,,Case Rate,Pays based on per visit rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431,100,,,Case Rate,Pays based on per visit rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.08,631.98,
BREAST W/AXIL; BILATERAL,T300440008,CDM,402,RC,76641,HCPCS,Outpatient,,,1656.5,828.25,50,1275.51,77,,,Percent of Total Billed Charges,77% of total billed charges,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.51,77,,,Percent of total Billed charges,77% of total billed charges,1408.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,1474.29,
BREAST W/AXIL; BILATERAL,T300440008,CDM,402,RC,76641,HCPCS,Outpatient,,,1656.5,828.25,TC,1275.51,77,,,Percent of Total Billed Charges,77% of total billed charges,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.51,77,,,Percent of total Billed charges,77% of total billed charges,1408.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,1474.29,
"BREAST W/AXILL, RT",T300440009,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,TC,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,767.18,89,,,Percent of total Billed Charges,89% of total Billed charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,767.18,
"BREAST W/AXILL, RT",T300440009,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,RT,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,767.18,89,,,Percent of total Billed Charges,89% of total Billed charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,767.18,
"BREAST W/AXILLA, LT",T300440010,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,LT,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,767.18,89,,,Percent of total Billed Charges,89% of total Billed charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,767.18,
"BREAST W/AXILLA, LT",T300440010,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,TC,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,767.18,89,,,Percent of total Billed Charges,89% of total Billed charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,767.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,767.18,
SHOW ME BREAST US UNIL/BILAT,T300440011,CDM,402,RC,76641,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.25,446,
SHOW ME PF-US BRST W/AX UNILAT,T300440012,CDM,972,RC,76641,HCPCS,Outpatient,,,37,18.5,26,,,,,other,not seperately reimbusable,42.55,115,,,fee schedule,115% of cms physician fee schedule,43.4,117.3,,,fee schedule,117.3% of cms physician fee schedule,53.19,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.55,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.25,100,,,fee schedule,100% of cigna fee schedule,37,100,,,fee schedule,100% of healthlink fee schedule,37,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,37,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,33.3,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,33.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,65.95,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,48.93,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,102.45,100,,,Fee Schedule,100% of UHC Fee Schedule,33.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,115,,,Fee Schedule,115% of CMS OPPS Rate,114.49,100,,,Fee Schedule,100% of UMR Fee Schedule,42.55,115,,,Fee Schedule,115% of CMS OPPS Rate,33.3,114.49,
"BREAST US, LT",T300440013,CDM,402,RC,76642,HCPCS,Outpatient,,,646.5,323.25,LT,497.81,77,,,Percent of Total Billed Charges,77% of total billed charges,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,478.41,74,,,Percent of Total Billed Charges,74% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,543.06,84,,,Percent of Total Billed Charges,84% of total billed charges,530.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,575.39,89,,,Percent of total Billed Charges,89% of total Billed charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,497.81,77,,,Percent of total Billed charges,77% of total billed charges,549.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.01,575.39,
"BREAST US, LT",T300440013,CDM,402,RC,76642,HCPCS,Outpatient,,,646.5,323.25,TC,497.81,77,,,Percent of Total Billed Charges,77% of total billed charges,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,478.41,74,,,Percent of Total Billed Charges,74% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,543.06,84,,,Percent of Total Billed Charges,84% of total billed charges,530.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,575.39,89,,,Percent of total Billed Charges,89% of total Billed charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,497.81,77,,,Percent of total Billed charges,77% of total billed charges,549.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.01,575.39,
"BREAST US, RT",T300440014,CDM,402,RC,76642,HCPCS,Outpatient,,,646.5,323.25,RT,497.81,77,,,Percent of Total Billed Charges,77% of total billed charges,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,478.41,74,,,Percent of Total Billed Charges,74% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,543.06,84,,,Percent of Total Billed Charges,84% of total billed charges,530.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,575.39,89,,,Percent of total Billed Charges,89% of total Billed charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,497.81,77,,,Percent of total Billed charges,77% of total billed charges,549.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.01,575.39,
"BREAST US, RT",T300440014,CDM,402,RC,76642,HCPCS,Outpatient,,,646.5,323.25,TC,497.81,77,,,Percent of Total Billed Charges,77% of total billed charges,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,478.41,74,,,Percent of Total Billed Charges,74% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,446.09,69,,,Percent of Total Billed Charges,69% of total billed charges,543.06,84,,,Percent of Total Billed Charges,84% of total billed charges,530.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,575.39,89,,,Percent of total Billed Charges,89% of total Billed charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,575.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,497.81,77,,,Percent of total Billed charges,77% of total billed charges,549.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,161.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.01,575.39,
SHOW ME BRST US UNL LMT W/AX,T300440015,CDM,402,RC,76642,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.1,89,,,Percent of total Billed Charges,89% of total Billed charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.5,446,
SHOW ME PF BRST US UNL LMT W/A,T300440016,CDM,972,RC,76642,HCPCS,Outpatient,,,34.5,17.25,26,106.06,135,,,fee schedule,135% of aetna fee schedule,39.68,115,,,fee schedule,115% of cms physician fee schedule,40.47,117.3,,,fee schedule,117.3% of cms physician fee schedule,49.59,143.75,,,fee schedule,143.75% of cms fee schedule ,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,39.68,115,,,fee schedule,115% of cms fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,79.98,100,,,fee schedule,100% of cigna fee schedule,34.5,100,,,fee schedule,100% of healthlink fee schedule,34.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,34.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,31.05,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,31.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.68,115,,,fee schedule,115% of cms fee schedule,106.06,135,,,Fee Schedule,135% of CMS Fee Schedule ,61.5,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,45.63,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,83.94,100,,,Fee Schedule,100% of UHC Fee Schedule,31.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.68,115,,,Fee Schedule,115% of CMS OPPS Rate,93.81,100,,,Fee Schedule,100% of UMR Fee Schedule,39.68,115,,,Fee Schedule,115% of CMS OPPS Rate,31.05,106.06,
HI-RISK OB 1ST TRIMESTER,T300440023,CDM,402,RC,76801,HCPCS,Outpatient,,,778.5,389.25,,599.45,77,,,Percent of Total Billed Charges,77% of total billed charges,198.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,576.09,74,,,Percent of Total Billed Charges,74% of total billed charges,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,653.94,84,,,Percent of Total Billed Charges,84% of total billed charges,638.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,457.2,400,,,fee schedule,400% of healthlink fee schedule,428.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,457.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.45,77,,,Percent of total Billed charges,77% of total billed charges,661.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.72,661.73,
HI-RISK OB 1ST TRIMESTER,T300440023,CDM,402,RC,76801,HCPCS,Outpatient,,,778.5,389.25,TC,599.45,77,,,Percent of Total Billed Charges,77% of total billed charges,198.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,576.09,74,,,Percent of Total Billed Charges,74% of total billed charges,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,537.17,69,,,Percent of Total Billed Charges,69% of total billed charges,653.94,84,,,Percent of Total Billed Charges,84% of total billed charges,638.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,457.2,400,,,fee schedule,400% of healthlink fee schedule,428.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,457.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.45,77,,,Percent of total Billed charges,77% of total billed charges,661.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,194.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.72,661.73,
HI-RISK OB 1ST TRI EA ADD GEST,T300440025,CDM,402,RC,76802,HCPCS,Outpatient,,,624,312,TC,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,461.76,74,,,Percent of Total Billed Charges,74% of total billed charges,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,524.16,84,,,Percent of Total Billed Charges,84% of total billed charges,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.8,400,,,fee schedule,400% of healthlink fee schedule,242.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,258.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.54,530.4,
HI-RISK OB 1ST TRI EA ADD GEST,T300440025,CDM,402,RC,76802,HCPCS,Outpatient,,,624,312,,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,461.76,74,,,Percent of Total Billed Charges,74% of total billed charges,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,430.56,69,,,Percent of Total Billed Charges,69% of total billed charges,524.16,84,,,Percent of Total Billed Charges,84% of total billed charges,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.8,400,,,fee schedule,400% of healthlink fee schedule,242.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,258.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.54,530.4,
HI-RISK OB AFTER 1ST TRIMESTER,T300440027,CDM,402,RC,76805,HCPCS,Outpatient,,,923,461.5,,710.71,77,,,Percent of Total Billed Charges,77% of total billed charges,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,683.02,74,,,Percent of Total Billed Charges,74% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,775.32,84,,,Percent of Total Billed Charges,84% of total billed charges,756.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,522.32,400,,,fee schedule,400% of healthlink fee schedule,489.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,522.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,710.71,77,,,Percent of total Billed charges,77% of total billed charges,784.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.53,784.55,
HI-RISK OB AFTER 1ST TRIMESTER,T300440027,CDM,402,RC,76805,HCPCS,Outpatient,,,923,461.5,TC,710.71,77,,,Percent of Total Billed Charges,77% of total billed charges,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,683.02,74,,,Percent of Total Billed Charges,74% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,775.32,84,,,Percent of Total Billed Charges,84% of total billed charges,756.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,522.32,400,,,fee schedule,400% of healthlink fee schedule,489.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,522.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,710.71,77,,,Percent of total Billed charges,77% of total billed charges,784.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.53,784.55,
HI-RISK OB AFTER 1 TRI EA GEST,T300440029,CDM,402,RC,76810,HCPCS,Outpatient,,,923,461.5,TC,710.71,77,,,Percent of Total Billed Charges,77% of total billed charges,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,683.02,74,,,Percent of Total Billed Charges,74% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,775.32,84,,,Percent of Total Billed Charges,84% of total billed charges,756.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,373,400,,,fee schedule,400% of healthlink fee schedule,349.69,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,373,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,710.71,77,,,Percent of total Billed charges,77% of total billed charges,784.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.78,784.55,
HI-RISK OB AFTER 1 TRI EA GEST,T300440029,CDM,402,RC,76810,HCPCS,Outpatient,,,923,461.5,,710.71,77,,,Percent of Total Billed Charges,77% of total billed charges,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,288.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,683.02,74,,,Percent of Total Billed Charges,74% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,636.87,69,,,Percent of Total Billed Charges,69% of total billed charges,775.32,84,,,Percent of Total Billed Charges,84% of total billed charges,756.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,373,400,,,fee schedule,400% of healthlink fee schedule,349.69,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,373,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,710.71,77,,,Percent of total Billed charges,77% of total billed charges,784.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,230.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.78,784.55,
"HI-RISK OB US, LIMITED",T300440031,CDM,402,RC,76815,HCPCS,Outpatient,,,472,236,,363.44,77,,,Percent of Total Billed Charges,77% of total billed charges,120.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.28,74,,,Percent of Total Billed Charges,74% of total billed charges,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,396.48,84,,,Percent of Total Billed Charges,84% of total billed charges,387.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,321.6,400,,,fee schedule,400% of healthlink fee schedule,301.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,321.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.44,77,,,Percent of total Billed charges,77% of total billed charges,401.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.18,446,
"HI-RISK OB US, LIMITED",T300440031,CDM,402,RC,76815,HCPCS,Outpatient,,,472,236,TC,363.44,77,,,Percent of Total Billed Charges,77% of total billed charges,120.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.28,74,,,Percent of Total Billed Charges,74% of total billed charges,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,325.68,69,,,Percent of Total Billed Charges,69% of total billed charges,396.48,84,,,Percent of Total Billed Charges,84% of total billed charges,387.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,321.6,400,,,fee schedule,400% of healthlink fee schedule,301.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,321.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.44,77,,,Percent of total Billed charges,77% of total billed charges,401.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.18,446,
ESSURE TVU,T300440041,CDM,402,RC,76830,HCPCS,Outpatient,,,586.5,293.25,,451.61,77,,,Percent of Total Billed Charges,77% of total billed charges,149.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,434.01,74,,,Percent of Total Billed Charges,74% of total billed charges,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,492.66,84,,,Percent of Total Billed Charges,84% of total billed charges,480.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,441.56,400,,,fee schedule,400% of healthlink fee schedule,413.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,441.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,451.61,77,,,Percent of total Billed charges,77% of total billed charges,498.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.92,498.53,
ESSURE TVU,T300440041,CDM,402,RC,76830,HCPCS,Outpatient,,,586.5,293.25,TC,451.61,77,,,Percent of Total Billed Charges,77% of total billed charges,149.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,434.01,74,,,Percent of Total Billed Charges,74% of total billed charges,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,404.69,69,,,Percent of Total Billed Charges,69% of total billed charges,492.66,84,,,Percent of Total Billed Charges,84% of total billed charges,480.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,441.56,400,,,fee schedule,400% of healthlink fee schedule,413.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,441.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,451.61,77,,,Percent of total Billed charges,77% of total billed charges,498.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,146.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.92,498.53,
DUPLEX DOPPLER LIMITED,T300440066,CDM,921,RC,93979,HCPCS,Outpatient,,,618,309,,475.86,77,,,Percent of Total Billed Charges,77% of total billed charges,157.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,457.32,74,,,Percent of Total Billed Charges,74% of total billed charges,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,519.12,84,,,Percent of Total Billed Charges,84% of total billed charges,506.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,550.02,89,,,Percent of total Billed Charges,89% of total Billed charges,550.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,550.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,87.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.86,77,,,Percent of total Billed charges,77% of total billed charges,525.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.26,728,
DUPLEX DOPPLER LIMITED,T300440066,CDM,921,RC,93979,HCPCS,Outpatient,,,618,309,TC,475.86,77,,,Percent of Total Billed Charges,77% of total billed charges,157.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,193.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,457.32,74,,,Percent of Total Billed Charges,74% of total billed charges,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,426.42,69,,,Percent of Total Billed Charges,69% of total billed charges,519.12,84,,,Percent of Total Billed Charges,84% of total billed charges,506.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,550.02,89,,,Percent of total Billed Charges,89% of total Billed charges,550.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,550.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,87.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.86,77,,,Percent of total Billed charges,77% of total billed charges,525.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,87.26,120,,,Fee Schedule,120% of MO Medicaid Rate,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,154.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.26,728,
HI RISK OB TRANVAG EA ADD GEST,T300440067,CDM,402,RC,,,Outpatient,,,716.5,358.25,,551.71,77,,,Percent of Total Billed Charges,77% of total billed charges,182.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,530.21,74,,,Percent of Total Billed Charges,74% of total billed charges,494.39,69,,,Percent of Total Billed Charges,69% of total billed charges,494.39,69,,,Percent of Total Billed Charges,69% of total billed charges,179.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,494.39,69,,,Percent of Total Billed Charges,69% of total billed charges,494.39,69,,,Percent of Total Billed Charges,69% of total billed charges,601.86,84,,,Percent of Total Billed Charges,84% of total billed charges,587.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,637.69,89,,,Percent of total Billed Charges,89% of total Billed charges,637.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,637.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551.71,77,,,Percent of total Billed charges,77% of total billed charges,609.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,205.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,292.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,179.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.13,637.69,
"Bilateral Breast us, limited",T300440068,CDM,402,RC,76642,HCPCS,Outpatient,,,1293,646.5,50,995.61,77,,,Percent of Total Billed Charges,77% of total billed charges,329.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,329.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,404.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,956.82,74,,,Percent of Total Billed Charges,74% of total billed charges,892.17,69,,,Percent of Total Billed Charges,69% of total billed charges,892.17,69,,,Percent of Total Billed Charges,69% of total billed charges,323.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,892.17,69,,,Percent of Total Billed Charges,69% of total billed charges,892.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1086.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1060.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1150.77,89,,,Percent of total Billed Charges,89% of total Billed charges,1150.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1150.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,48.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,323.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,995.61,77,,,Percent of total Billed charges,77% of total billed charges,1099.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,371.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,48.01,120,,,Fee Schedule,120% of MO Medicaid Rate,323.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,323.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.01,1150.77,
"BREAST NEEDLE LOC , MAMM",T300450001,CDM,401,RC,19281,HCPCS,Outpatient,,,878.5,439.25,,676.45,77,,,Percent of Total Billed Charges,77% of total billed charges,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,650.09,74,,,Percent of Total Billed Charges,74% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,737.94,84,,,Percent of Total Billed Charges,84% of total billed charges,720.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,781.87,89,,,Percent of total Billed Charges,89% of total Billed charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.45,77,,,Percent of total Billed charges,77% of total billed charges,746.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,358.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,781.87,
"BREAST NEEDLE LOC , MAMM",T300450001,CDM,401,RC,19281,HCPCS,Outpatient,,,878.5,439.25,TC,676.45,77,,,Percent of Total Billed Charges,77% of total billed charges,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,650.09,74,,,Percent of Total Billed Charges,74% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,606.17,69,,,Percent of Total Billed Charges,69% of total billed charges,737.94,84,,,Percent of Total Billed Charges,84% of total billed charges,720.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,781.87,89,,,Percent of total Billed Charges,89% of total Billed charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.45,77,,,Percent of total Billed charges,77% of total billed charges,746.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,358.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,219.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,781.87,
BREAST SURGICAL SPECIMEN,T300450002,CDM,320,RC,76098,HCPCS,Outpatient,,,488.5,244.25,,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,415.23,
BREAST SURGICAL SPECIMEN,T300450002,CDM,320,RC,76098,HCPCS,Outpatient,,,488.5,244.25,TC,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,415.23,
SHOW ME MAM SURG SPECIMEN,T300450003,CDM,401,RC,76098,HCPCS,Outpatient,,,28.5,14.25,,21.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,23.94,84,,,Percent of Total Billed Charges,84% of total billed charges,23.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.95,77,,,Percent of total Billed charges,77% of total billed charges,24.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.13,177,
SHOW ME PF-MAM SURG SPECIMEN,T300450004,CDM,972,RC,76098,HCPCS,Outpatient,,,17.5,8.75,26,22.03,175,,,fee schedule,175% of aetna fee schedule,20.13,115,,,fee schedule,115% of cms physician fee schedule,20.53,117.3,,,fee schedule,117.3% of cms physician fee schedule,25.16,143.75,,,fee schedule,143.75% of cms fee schedule ,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,20.13,115,,,fee schedule,115% of cms fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,39.08,100,,,fee schedule,100% of cigna fee schedule,17.5,100,,,fee schedule,100% of healthlink fee schedule,17.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,17.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,15.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.13,115,,,fee schedule,115% of cms fee schedule,22.03,135,,,Fee Schedule,135% of CMS Fee Schedule ,31.19,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,23.14,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,16.05,100,,,Fee Schedule,100% of UHC Fee Schedule,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.13,115,,,Fee Schedule,115% of CMS OPPS Rate,17.18,100,,,Fee Schedule,100% of UMR Fee Schedule,20.13,115,,,Fee Schedule,115% of CMS OPPS Rate,15.5,39.08,
3D SCRN BILAT/UNILAT MAMM,T300450005,CDM,403,RC,77063,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
3D SCRN BILAT/UNILAT MAMM,T300450005,CDM,403,RC,77063,HCPCS,Outpatient,,,77,38.5,TC,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
3D SCRN UNILATERAL,T300450006,CDM,403,RC,77063,HCPCS,Outpatient,,,77,38.5,TC,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
3D SCRN UNILATERAL,T300450006,CDM,403,RC,77063,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
3D SCRN UNILATERAL,T300450006,CDM,403,RC,G0279,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
3D SCRN UNILATERAL,T300450006,CDM,403,RC,G0279,HCPCS,Outpatient,,,77,38.5,TC,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
SHOW ME 3D SCRN B/U ADD ON,T300450007,CDM,403,RC,77063,HCPCS,Outpatient,,,29.5,14.75,,22.72,77,,,Percent of Total Billed Charges,77% of total billed charges,7.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.83,74,,,Percent of Total Billed Charges,74% of total billed charges,20.36,69,,,Percent of Total Billed Charges,69% of total billed charges,20.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.36,69,,,Percent of Total Billed Charges,69% of total billed charges,20.36,69,,,Percent of Total Billed Charges,69% of total billed charges,24.78,84,,,Percent of Total Billed Charges,84% of total billed charges,24.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.26,89,,,Percent of total Billed Charges,89% of total Billed charges,26.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,23.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.72,77,,,Percent of total Billed charges,77% of total billed charges,25.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.54,120,,,Fee Schedule,120% of MO Medicaid Rate,7.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,7.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.38,177,
"2D MAM, DIAG UNILATERAL",T300450008,CDM,401,RC,77065,HCPCS,Outpatient,,,539.5,269.75,,415.42,77,,,Percent of Total Billed Charges,77% of total billed charges,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,399.23,74,,,Percent of Total Billed Charges,74% of total billed charges,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,453.18,84,,,Percent of Total Billed Charges,84% of total billed charges,442.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,480.16,89,,,Percent of total Billed Charges,89% of total Billed charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.42,77,,,Percent of total Billed charges,77% of total billed charges,458.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,480.16,
"2D MAM, DIAG UNILATERAL",T300450008,CDM,401,RC,77065,HCPCS,Outpatient,,,539.5,269.75,TC,415.42,77,,,Percent of Total Billed Charges,77% of total billed charges,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,399.23,74,,,Percent of Total Billed Charges,74% of total billed charges,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.26,69,,,Percent of Total Billed Charges,69% of total billed charges,453.18,84,,,Percent of Total Billed Charges,84% of total billed charges,442.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,480.16,89,,,Percent of total Billed Charges,89% of total Billed charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.42,77,,,Percent of total Billed charges,77% of total billed charges,458.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,480.16,
SHOW ME DIAG 2D UNILAT MAMM,T300450009,CDM,401,RC,77065,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.04,74,,,Percent of Total Billed Charges,74% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,80.64,84,,,Percent of Total Billed Charges,84% of total billed charges,78.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.44,89,,,Percent of total Billed Charges,89% of total Billed charges,85.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24,177,
"2D MAM BILAT, DIAGNOSTIC",T300450011,CDM,401,RC,77066,HCPCS,Outpatient,,,653.5,326.75,,503.2,77,,,Percent of Total Billed Charges,77% of total billed charges,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,483.59,74,,,Percent of Total Billed Charges,74% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,548.94,84,,,Percent of Total Billed Charges,84% of total billed charges,535.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,581.62,89,,,Percent of total Billed Charges,89% of total Billed charges,581.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.2,77,,,Percent of total Billed charges,77% of total billed charges,555.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.33,581.62,
"2D MAM BILAT, DIAGNOSTIC",T300450011,CDM,401,RC,77066,HCPCS,Outpatient,,,653.5,326.75,TC,503.2,77,,,Percent of Total Billed Charges,77% of total billed charges,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,483.59,74,,,Percent of Total Billed Charges,74% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,548.94,84,,,Percent of Total Billed Charges,84% of total billed charges,535.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,581.62,89,,,Percent of total Billed Charges,89% of total Billed charges,581.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.2,77,,,Percent of total Billed charges,77% of total billed charges,555.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.33,581.62,
SHOW ME DIAG 2D BILAT MAMM,T300450012,CDM,401,RC,77066,HCPCS,Outpatient,,,122.5,61.25,,94.33,77,,,Percent of Total Billed Charges,77% of total billed charges,31.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.65,74,,,Percent of Total Billed Charges,74% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,102.9,84,,,Percent of Total Billed Charges,84% of total billed charges,100.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.03,89,,,Percent of total Billed Charges,89% of total Billed charges,109.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.33,77,,,Percent of total Billed charges,77% of total billed charges,104.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.63,177,
"2D MAM BILAT, SCREEN",T300450013,CDM,403,RC,77067,HCPCS,Outpatient,,,578.5,289.25,,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.87,89,,,Percent of total Billed Charges,89% of total Billed charges,514.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,514.87,
"2D MAM BILAT, SCREEN",T300450013,CDM,403,RC,77067,HCPCS,Outpatient,,,578.5,289.25,TC,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.87,89,,,Percent of total Billed Charges,89% of total Billed charges,514.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,514.87,
SHOW ME SCRN BILAT 2D MAMM,T300450014,CDM,403,RC,77067,HCPCS,Outpatient,,,122.5,61.25,,94.33,77,,,Percent of Total Billed Charges,77% of total billed charges,31.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.65,74,,,Percent of Total Billed Charges,74% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,102.9,84,,,Percent of Total Billed Charges,84% of total billed charges,100.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.03,89,,,Percent of total Billed Charges,89% of total Billed charges,109.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.33,77,,,Percent of total Billed charges,77% of total billed charges,104.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.63,177,
UNILAT SCRN MAMMOGRAM,T300450015,CDM,403,RC,77067,HCPCS,Outpatient,,,524.5,262.25,,403.87,77,,,Percent of Total Billed Charges,77% of total billed charges,133.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.13,74,,,Percent of Total Billed Charges,74% of total billed charges,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,440.58,84,,,Percent of Total Billed Charges,84% of total billed charges,430.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.81,89,,,Percent of total Billed Charges,89% of total Billed charges,466.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.87,77,,,Percent of total Billed charges,77% of total billed charges,445.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,466.81,
UNILAT SCRN MAMMOGRAM,T300450015,CDM,403,RC,77067,HCPCS,Outpatient,,,524.5,262.25,TC,403.87,77,,,Percent of Total Billed Charges,77% of total billed charges,133.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.13,74,,,Percent of Total Billed Charges,74% of total billed charges,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,361.91,69,,,Percent of Total Billed Charges,69% of total billed charges,440.58,84,,,Percent of Total Billed Charges,84% of total billed charges,430.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.81,89,,,Percent of total Billed Charges,89% of total Billed charges,466.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.87,77,,,Percent of total Billed charges,77% of total billed charges,445.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,131.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,466.81,
3D DIAG BILAT/UNILAT,T300450017,CDM,401,RC,G0279,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
3D DIAG BILAT/UNILAT,T300450017,CDM,401,RC,G0279,HCPCS,Outpatient,,,77,38.5,TC,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,177,
SHOW ME 3D DIAG B/U ADD ON,T300450018,CDM,401,RC,G0279,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.24,74,,,Percent of Total Billed Charges,74% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,21.84,84,,,Percent of Total Billed Charges,84% of total billed charges,21.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,177,
2D Unilat Diag Mammo w/Implant,T300450019,CDM,401,RC,77065,HCPCS,Outpatient,,,809,404.5,,622.93,77,,,Percent of Total Billed Charges,77% of total billed charges,206.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,598.66,74,,,Percent of Total Billed Charges,74% of total billed charges,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,679.56,84,,,Percent of Total Billed Charges,84% of total billed charges,663.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,720.01,89,,,Percent of total Billed Charges,89% of total Billed charges,720.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,720.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,622.93,77,,,Percent of total Billed charges,77% of total billed charges,687.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,720.01,
2D Unilat Diag Mammo w/Implant,T300450019,CDM,401,RC,77065,HCPCS,Outpatient,,,809,404.5,TC,622.93,77,,,Percent of Total Billed Charges,77% of total billed charges,206.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,598.66,74,,,Percent of Total Billed Charges,74% of total billed charges,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,558.21,69,,,Percent of Total Billed Charges,69% of total billed charges,679.56,84,,,Percent of Total Billed Charges,84% of total billed charges,663.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,720.01,89,,,Percent of total Billed Charges,89% of total Billed charges,720.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,720.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,622.93,77,,,Percent of total Billed charges,77% of total billed charges,687.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,202.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,720.01,
2D Bilat Diag Mammo w/Implant,T300450020,CDM,401,RC,77066,HCPCS,Outpatient,,,980,490,,754.6,77,,,Percent of Total Billed Charges,77% of total billed charges,249.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,725.2,74,,,Percent of Total Billed Charges,74% of total billed charges,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,823.2,84,,,Percent of Total Billed Charges,84% of total billed charges,803.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,872.2,89,,,Percent of total Billed Charges,89% of total Billed charges,872.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,872.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,754.6,77,,,Percent of total Billed charges,77% of total billed charges,833,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.33,872.2,
2D Bilat Diag Mammo w/Implant,T300450020,CDM,401,RC,77066,HCPCS,Outpatient,,,980,490,TC,754.6,77,,,Percent of Total Billed Charges,77% of total billed charges,249.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,725.2,74,,,Percent of Total Billed Charges,74% of total billed charges,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,676.2,69,,,Percent of Total Billed Charges,69% of total billed charges,823.2,84,,,Percent of Total Billed Charges,84% of total billed charges,803.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,872.2,89,,,Percent of total Billed Charges,89% of total Billed charges,872.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,872.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,754.6,77,,,Percent of total Billed charges,77% of total billed charges,833,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,245,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.33,872.2,
2D Unilat Screen w/Implant,T300450021,CDM,403,RC,77067,HCPCS,Outpatient,,,785,392.5,,604.45,77,,,Percent of Total Billed Charges,77% of total billed charges,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,580.9,74,,,Percent of Total Billed Charges,74% of total billed charges,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,659.4,84,,,Percent of Total Billed Charges,84% of total billed charges,643.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,698.65,89,,,Percent of total Billed Charges,89% of total Billed charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.45,77,,,Percent of total Billed charges,77% of total billed charges,667.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,698.65,
2D Unilat Screen w/Implant,T300450021,CDM,403,RC,77067,HCPCS,Outpatient,,,785,392.5,TC,604.45,77,,,Percent of Total Billed Charges,77% of total billed charges,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,580.9,74,,,Percent of Total Billed Charges,74% of total billed charges,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,541.65,69,,,Percent of Total Billed Charges,69% of total billed charges,659.4,84,,,Percent of Total Billed Charges,84% of total billed charges,643.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,698.65,89,,,Percent of total Billed Charges,89% of total Billed charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.45,77,,,Percent of total Billed charges,77% of total billed charges,667.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,196.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,698.65,
2D Bilat Screen w/Implant,T300450022,CDM,403,RC,77067,HCPCS,Outpatient,,,868,434,,668.36,77,,,Percent of Total Billed Charges,77% of total billed charges,221.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.32,74,,,Percent of Total Billed Charges,74% of total billed charges,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,84,,,Percent of Total Billed Charges,84% of total billed charges,711.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.52,89,,,Percent of total Billed Charges,89% of total Billed charges,772.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.36,77,,,Percent of total Billed charges,77% of total billed charges,737.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,772.52,
2D Bilat Screen w/Implant,T300450022,CDM,403,RC,77067,HCPCS,Outpatient,,,868,434,TC,668.36,77,,,Percent of Total Billed Charges,77% of total billed charges,221.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.32,74,,,Percent of Total Billed Charges,74% of total billed charges,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,598.92,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,84,,,Percent of Total Billed Charges,84% of total billed charges,711.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.52,89,,,Percent of total Billed Charges,89% of total Billed charges,772.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,92.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.36,77,,,Percent of total Billed charges,77% of total billed charges,737.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,92.82,120,,,Fee Schedule,120% of MO Medicaid Rate,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,217,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.82,772.52,
BONE DENSITY SPINE/HIP,T300460001,CDM,320,RC,77080,HCPCS,Outpatient,,,613,306.5,,472.01,77,,,Percent of Total Billed Charges,77% of total billed charges,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,453.62,74,,,Percent of Total Billed Charges,74% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,514.92,84,,,Percent of Total Billed Charges,84% of total billed charges,502.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.84,400,,,fee schedule,400% of healthlink fee schedule,172.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,183.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.01,77,,,Percent of total Billed charges,77% of total billed charges,521.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,521.05,
BONE DENSITY SPINE/HIP,T300460001,CDM,320,RC,77080,HCPCS,Outpatient,,,613,306.5,TC,472.01,77,,,Percent of Total Billed Charges,77% of total billed charges,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,453.62,74,,,Percent of Total Billed Charges,74% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,514.92,84,,,Percent of Total Billed Charges,84% of total billed charges,502.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.84,400,,,fee schedule,400% of healthlink fee schedule,172.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,183.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,62.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.01,77,,,Percent of total Billed charges,77% of total billed charges,521.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,62.96,120,,,Fee Schedule,120% of MO Medicaid Rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,521.05,
BONE DENSITY WRIST,T300460002,CDM,320,RC,77081,HCPCS,Outpatient,,,376.5,188.25,,289.91,77,,,Percent of Total Billed Charges,77% of total billed charges,96.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,278.61,74,,,Percent of Total Billed Charges,74% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,316.26,84,,,Percent of Total Billed Charges,84% of total billed charges,308.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,20.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.91,77,,,Percent of total Billed charges,77% of total billed charges,320.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.46,320.03,
BONE DENSITY WRIST,T300460002,CDM,320,RC,77081,HCPCS,Outpatient,,,376.5,188.25,TC,289.91,77,,,Percent of Total Billed Charges,77% of total billed charges,96.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,278.61,74,,,Percent of Total Billed Charges,74% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,316.26,84,,,Percent of Total Billed Charges,84% of total billed charges,308.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,96,400,,,fee schedule,400% of healthlink fee schedule,90,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,20.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.91,77,,,Percent of total Billed charges,77% of total billed charges,320.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.46,120,,,Fee Schedule,120% of MO Medicaid Rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.46,320.03,
DXA; VERTERBRAL FX ASSESSMENT,T300460003,CDM,320,RC,77086,HCPCS,Outpatient,,,480.5,240.25,,369.99,77,,,Percent of Total Billed Charges,77% of total billed charges,122.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,355.57,74,,,Percent of Total Billed Charges,74% of total billed charges,331.55,69,,,Percent of Total Billed Charges,69% of total billed charges,331.55,69,,,Percent of Total Billed Charges,69% of total billed charges,120.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.55,69,,,Percent of Total Billed Charges,69% of total billed charges,331.55,69,,,Percent of Total Billed Charges,69% of total billed charges,403.62,84,,,Percent of Total Billed Charges,84% of total billed charges,394.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,427.65,89,,,Percent of total Billed Charges,89% of total Billed charges,427.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,120.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.99,77,,,Percent of total Billed charges,77% of total billed charges,408.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,138.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,120.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,120.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,427.65,
Health Fair Bone Density Scrn,T300460004,CDM,320,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,271,
HEALTHE FAIR BONE DENSITY SCRN,T300460005,CDM,320,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,271,
STEREOTACTIC MAMMOGRAM,T300470001,CDM,401,RC,77065,HCPCS,Outpatient,,,1332,666,TC,1025.64,77,,,Percent of Total Billed Charges,77% of total billed charges,339.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,985.68,74,,,Percent of Total Billed Charges,74% of total billed charges,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,1118.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1092.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1185.48,89,,,Percent of total Billed Charges,89% of total Billed charges,1185.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1185.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1025.64,77,,,Percent of total Billed charges,77% of total billed charges,1132.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,382.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,1185.48,
STEREOTACTIC MAMMOGRAM,T300470001,CDM,401,RC,77065,HCPCS,Outpatient,,,1332,666,,1025.64,77,,,Percent of Total Billed Charges,77% of total billed charges,339.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,339.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,985.68,74,,,Percent of Total Billed Charges,74% of total billed charges,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,919.08,69,,,Percent of Total Billed Charges,69% of total billed charges,1118.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1092.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1185.48,89,,,Percent of total Billed Charges,89% of total Billed charges,1185.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1185.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,88.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1025.64,77,,,Percent of total Billed charges,77% of total billed charges,1132.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,382.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,88.1,120,,,Fee Schedule,120% of MO Medicaid Rate,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,333,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,1185.48,
CHEST TUBE INSERT W/WATERSEAL,T990010004,CDM,761,RC,32551,HCPCS,Outpatient,,,836.5,418.25,,644.11,77,,,Percent of Total Billed Charges,77% of total billed charges,213.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,619.01,74,,,Percent of Total Billed Charges,74% of total billed charges,577.19,69,,,Percent of Total Billed Charges,69% of total billed charges,577.19,69,,,Percent of Total Billed Charges,69% of total billed charges,209.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.19,69,,,Percent of Total Billed Charges,69% of total billed charges,577.19,69,,,Percent of Total Billed Charges,69% of total billed charges,702.66,84,,,Percent of Total Billed Charges,84% of total billed charges,685.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,744.49,89,,,Percent of total Billed Charges,89% of total Billed charges,744.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,744.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,341.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.11,77,,,Percent of total Billed charges,77% of total billed charges,711.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,418.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,341.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,744.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.13,744.49,
CENTRAL LINE < 5 YEARS OF AGE,T990010014,CDM,761,RC,36555,HCPCS,Outpatient,,,446,223,,343.42,77,,,Percent of Total Billed Charges,77% of total billed charges,113.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.04,74,,,Percent of Total Billed Charges,74% of total billed charges,307.74,69,,,Percent of Total Billed Charges,69% of total billed charges,307.74,69,,,Percent of Total Billed Charges,69% of total billed charges,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.74,69,,,Percent of Total Billed Charges,69% of total billed charges,307.74,69,,,Percent of Total Billed Charges,69% of total billed charges,374.64,84,,,Percent of Total Billed Charges,84% of total billed charges,365.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.94,89,,,Percent of total Billed Charges,89% of total Billed charges,396.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.42,77,,,Percent of total Billed charges,77% of total billed charges,379.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,396.94,
INSERTION NON-DWELLING CATH,T990010019,CDM,761,RC,51701,HCPCS,Outpatient,,,162.5,81.25,,125.13,77,,,Percent of Total Billed Charges,77% of total billed charges,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.25,74,,,Percent of Total Billed Charges,74% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,136.5,84,,,Percent of Total Billed Charges,84% of total billed charges,133.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.63,89,,,Percent of total Billed Charges,89% of total Billed charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.13,77,,,Percent of total Billed charges,77% of total billed charges,138.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.63,144.63,
"INSERTION FOLEY, SIMPLE",T990010020,CDM,761,RC,51702,HCPCS,Outpatient,,,124.5,62.25,,95.87,77,,,Percent of Total Billed Charges,77% of total billed charges,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.13,74,,,Percent of Total Billed Charges,74% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,104.58,84,,,Percent of Total Billed Charges,84% of total billed charges,102.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.81,89,,,Percent of total Billed Charges,89% of total Billed charges,110.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.87,77,,,Percent of total Billed charges,77% of total billed charges,105.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.13,110.81,
"INSERTION FOLEY,COMPLICATED",T990010021,CDM,761,RC,51703,HCPCS,Outpatient,,,236,118,,181.72,77,,,Percent of Total Billed Charges,77% of total billed charges,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.64,74,,,Percent of Total Billed Charges,74% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,198.24,84,,,Percent of Total Billed Charges,84% of total billed charges,193.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.04,89,,,Percent of total Billed Charges,89% of total Billed charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.72,77,,,Percent of total Billed charges,77% of total billed charges,200.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59,210.04,
BLOOD GLUCOSE CHK PROCEDURE,T990010022,CDM,300,RC,82947,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,75.23,
HYDRATION IV INFUSION INIT,T990010023,CDM,940,RC,96360,HCPCS,Outpatient,,,1035.5,517.75,,797.34,77,,,Percent of Total Billed Charges,77% of total billed charges,264.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,264.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,766.27,74,,,Percent of Total Billed Charges,74% of total billed charges,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,869.82,84,,,Percent of Total Billed Charges,84% of total billed charges,849.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,921.6,89,,,Percent of total Billed Charges,89% of total Billed charges,921.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,921.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,797.34,77,,,Percent of total Billed charges,77% of total billed charges,880.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,297.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,422.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,921.6,
INF-HYDRATIN EA ADD HR UP T 8,T990010024,CDM,940,RC,96361,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,54.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.13,136,
"INFUSION, TPD, INITIAL",T990010025,CDM,940,RC,96365,HCPCS,Outpatient,,,1014,507,,780.78,77,,,Percent of Total Billed Charges,77% of total billed charges,258.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,316.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,750.36,74,,,Percent of Total Billed Charges,74% of total billed charges,699.66,69,,,Percent of Total Billed Charges,69% of total billed charges,699.66,69,,,Percent of Total Billed Charges,69% of total billed charges,253.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,699.66,69,,,Percent of Total Billed Charges,69% of total billed charges,699.66,69,,,Percent of Total Billed Charges,69% of total billed charges,851.76,84,,,Percent of Total Billed Charges,84% of total billed charges,831.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,902.46,89,,,Percent of total Billed Charges,89% of total Billed charges,902.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,413.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,413.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,413.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,780.78,77,,,Percent of total Billed charges,77% of total billed charges,861.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,291.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,413.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,253.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,253.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,902.46,
INF-TPD EA ADD HR UP TO 8,T990010026,CDM,940,RC,96366,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.31,74,,,Percent of Total Billed Charges,74% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,84,,,Percent of Total Billed Charges,84% of total billed charges,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,136,
INF-TPD ADD SEQUENT DRUG 1 HR,T990010027,CDM,940,RC,96367,HCPCS,Outpatient,,,247,123.5,,190.19,77,,,Percent of Total Billed Charges,77% of total billed charges,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.78,74,,,Percent of Total Billed Charges,74% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,207.48,84,,,Percent of Total Billed Charges,84% of total billed charges,202.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.83,89,,,Percent of total Billed Charges,89% of total Billed charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.19,77,,,Percent of total Billed charges,77% of total billed charges,209.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,100.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.75,219.83,
INF-TPD CONCURRENT DRUG,T990010028,CDM,940,RC,96368,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.12,74,,,Percent of Total Billed Charges,74% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,211.82,
INJECTION IM/SQ (MUE=5),T990010029,CDM,940,RC,96372,HCPCS,Outpatient,,,389.5,194.75,,299.92,77,,,Percent of Total Billed Charges,77% of total billed charges,99.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,288.23,74,,,Percent of Total Billed Charges,74% of total billed charges,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,268.76,69,,,Percent of Total Billed Charges,69% of total billed charges,327.18,84,,,Percent of Total Billed Charges,84% of total billed charges,319.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,346.66,89,,,Percent of total Billed Charges,89% of total Billed charges,346.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.92,77,,,Percent of total Billed charges,77% of total billed charges,331.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,158.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,97.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.38,346.66,
"IV PUSH, INITIAL",T990010030,CDM,940,RC,96374,HCPCS,Outpatient,,,293.5,146.75,,226,77,,,Percent of Total Billed Charges,77% of total billed charges,74.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.19,74,,,Percent of Total Billed Charges,74% of total billed charges,202.52,69,,,Percent of Total Billed Charges,69% of total billed charges,202.52,69,,,Percent of Total Billed Charges,69% of total billed charges,73.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.52,69,,,Percent of Total Billed Charges,69% of total billed charges,202.52,69,,,Percent of Total Billed Charges,69% of total billed charges,246.54,84,,,Percent of Total Billed Charges,84% of total billed charges,240.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.22,89,,,Percent of total Billed Charges,89% of total Billed charges,261.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226,77,,,Percent of total Billed charges,77% of total billed charges,249.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,119.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,73.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.38,261.22,
IV PUSH EA NEW SEQ DRUG,T990010031,CDM,940,RC,96375,HCPCS,Outpatient,,,231.5,115.75,,178.26,77,,,Percent of Total Billed Charges,77% of total billed charges,59.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,171.31,74,,,Percent of Total Billed Charges,74% of total billed charges,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,194.46,84,,,Percent of Total Billed Charges,84% of total billed charges,189.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,206.04,89,,,Percent of total Billed Charges,89% of total Billed charges,206.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.26,77,,,Percent of total Billed charges,77% of total billed charges,196.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,94.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.88,206.04,
IV PUSH EA ADD SAME SEQ DRUG,T990010032,CDM,940,RC,96376,HCPCS,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.72,74,,,Percent of Total Billed Charges,74% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,136,
ACUTE ROOM,T990010034,CDM,120,RC,,,Inpatient,,,970,485,,746.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,746.9,77,,,Percent of total Billed charges,77% of total billed charges,824.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,746.9,3445,
ACUTE/BEHAVIORAL HEALTH ROOM,T990010035,CDM,120,RC,,,Inpatient,,,1275.5,637.75,,982.14,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,982.14,77,,,Percent of total Billed charges,77% of total billed charges,1084.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,982.14,3445,
ANC ROOM,T990010036,CDM,202,RC,,,Inpatient,,,1328.5,664.25,,1022.95,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,2472,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pay based on per day,2350,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,2350,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pays based on per day rate,2547,100,,,per diem,pays based on per day rate,2440,100,,,per diem,pays based on per day rate,3323,100,,,per diem,pays based on per day rate,2947,100,,,Per Diem,Pays based on per day rate,3323,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1022.95,77,,,Percent of total Billed charges,77% of total billed charges,1129.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,3045,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,2636,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,1022.95,3445,
ANC/BEHAVIORAL HEALTH BED,T990010037,CDM,120,RC,,,Inpatient,,,1636,818,,1259.72,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1259.72,77,,,Percent of total Billed charges,77% of total billed charges,1390.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,1259.72,3445,
ANC/ISO/BEHAVIORAL HEALTH BED,T990010038,CDM,164,RC,,,Inpatient,,,1722,861,,1325.94,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1325.94,77,,,Percent of total Billed charges,77% of total billed charges,1463.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,1325.94,3445,
ANC/ISOLATION ROOM,T990010039,CDM,202,RC,,,Inpatient,,,1512.5,756.25,,1164.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,2472,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pay based on per day,2350,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,2350,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pays based on per day rate,2547,100,,,per diem,pays based on per day rate,2440,100,,,per diem,pays based on per day rate,3323,100,,,per diem,pays based on per day rate,2947,100,,,Per Diem,Pays based on per day rate,3323,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1164.63,77,,,Percent of total Billed charges,77% of total billed charges,1285.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,3045,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,2636,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,1164.63,3445,
INV ROOM,T990010040,CDM,120,RC,,,Inpatient,,,1948,974,,1499.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1499.96,77,,,Percent of total Billed charges,77% of total billed charges,1655.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,1499.96,3445,
ISO/BEHAVIORAL HEALTH ROOM,T990010041,CDM,164,RC,,,Inpatient,,,1397,698.5,,1075.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1075.69,77,,,Percent of total Billed charges,77% of total billed charges,1187.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,1075.69,3445,
ISOLATION ROOM,T990010042,CDM,164,RC,,,Inpatient,,,1107.5,553.75,,852.78,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,852.78,77,,,Percent of total Billed charges,77% of total billed charges,941.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,852.78,3445,
M/S NO CHARGE ROOM RATE,T990010043,CDM,120,RC,,,Inpatient,,,,,,,,,,other,not seperately reimbusable,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,2494.66,3445,
M/S Per Hour Non-OBSV package,T990010044,CDM,762,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2285,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1978,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1978,2285,
OP ROOM CHARGE,T990010045,CDM,120,RC,,,Inpatient,,,,,,,,,,other,not seperately reimbusable,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,2494.66,3445,
TELE/ISO/BEHAVIORAL HEALTH BED,T990010046,CDM,164,RC,,,Inpatient,,,1433.5,716.75,,1103.8,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1103.8,77,,,Percent of total Billed charges,77% of total billed charges,1218.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,1103.8,3445,
TELE/ISOLATION ROOM,T990010047,CDM,210,RC,,,Inpatient,,,1320,660,,1016.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,2472,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pay based on per day,2350,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,2350,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pays based on per day rate,2547,100,,,per diem,pays based on per day rate,2440,100,,,per diem,pays based on per day rate,3323,100,,,per diem,pays based on per day rate,2947,100,,,Per Diem,Pays based on per day rate,3323,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1016.4,77,,,Percent of total Billed charges,77% of total billed charges,1122,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,3045,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,2636,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,1016.4,3445,
TELEMETRY ROOM,T990010048,CDM,210,RC,,,Inpatient,,,1163,581.5,,895.51,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,2472,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pay based on per day,2350,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,2350,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pays based on per day rate,2547,100,,,per diem,pays based on per day rate,2440,100,,,per diem,pays based on per day rate,3323,100,,,per diem,pays based on per day rate,2947,100,,,Per Diem,Pays based on per day rate,3323,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,895.51,77,,,Percent of total Billed charges,77% of total billed charges,988.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,3045,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,2636,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,895.51,3445,
WOUND VAC-ACUTE ROOM,T990010049,CDM,120,RC,,,Inpatient,,,1981.5,990.75,,1525.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,1525.76,77,,,Percent of total Billed charges,77% of total billed charges,1684.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,1525.76,3445,
AMBULATORY CARE 1ST HOUR,T990010057,CDM,490,RC,,,Outpatient,,,453,226.5,,348.81,77,,,Percent of Total Billed Charges,77% of total billed charges,115.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,371.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,403.17,89,,,Percent of total Billed Charges,89% of total Billed charges,380.52,84,,,Percent of Total Billed Charges,84% of Total Billed charges,403.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.81,77,,,Percent of total Billed charges,77% of total billed charges,385.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,226.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,184.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.25,2278,
AMBULATORY CARE ADD'L HRS,T990010058,CDM,490,RC,,,Outpatient,,,297.5,148.75,,229.08,77,,,Percent of Total Billed Charges,77% of total billed charges,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,243.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.78,89,,,Percent of total Billed Charges,89% of total Billed charges,249.9,84,,,Percent of Total Billed Charges,84% of Total Billed charges,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,77,,,Percent of total Billed charges,77% of total billed charges,252.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.38,2278,
PFIZER VACCINE ADM DOSE 1,T990010059,CDM,771,RC,0001A,HCPCS,Outpatient,,,192,96,,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.08,74,,,Percent of Total Billed Charges,74% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,161.28,84,,,Percent of Total Billed Charges,84% of total billed charges,157.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.88,89,,,Percent of total Billed Charges,89% of total Billed charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,78.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,170.88,
PFIZER VACCINE ADM 2,T990010060,CDM,771,RC,0002A,HCPCS,Outpatient,,,192,96,,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.08,74,,,Percent of Total Billed Charges,74% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,161.28,84,,,Percent of Total Billed Charges,84% of total billed charges,157.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.88,89,,,Percent of total Billed Charges,89% of total Billed charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,78.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,170.88,
MODERNA VACCINE ADM 1,T990010061,CDM,771,RC,0011A,HCPCS,Outpatient,,,192,96,,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.08,74,,,Percent of Total Billed Charges,74% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,161.28,84,,,Percent of Total Billed Charges,84% of total billed charges,157.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.88,89,,,Percent of total Billed Charges,89% of total Billed charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,78.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,170.88,
MODERNA VACCINE ADM 2,T990010062,CDM,771,RC,0012A,HCPCS,Outpatient,,,192,96,,147.84,77,,,Percent of Total Billed Charges,77% of total billed charges,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.08,74,,,Percent of Total Billed Charges,74% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,132.48,69,,,Percent of Total Billed Charges,69% of total billed charges,161.28,84,,,Percent of Total Billed Charges,84% of total billed charges,157.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.88,89,,,Percent of total Billed Charges,89% of total Billed charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.84,77,,,Percent of total Billed charges,77% of total billed charges,163.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,78.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48,170.88,
MODERNA VACCINE ADM 3,T990010063,CDM,771,RC,0013A,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.21,89,,,Percent of total Billed Charges,89% of total Billed charges,164.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,75.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.13,164.21,
OBSERVATION (EA ADDL HOUR),T990010064,CDM,762,RC,G0378,HCPCS,Outpatient,,,60.5,30.25,,46.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,100,,,case rate,pays based on per visit,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,50.82,84,,,Percent of Total Billed Charges,84% of total billed charges,49.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.85,89,,,Percent of total Billed Charges,89% of total Billed charges,50.82,84,,,Percent of Total Billed Charges,84% of Total Billed charges,53.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.59,77,,,Percent of total Billed charges,77% of total billed charges,51.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2285,100,,,Case Rate,Pays based on per visit rate,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978,100,,,Case Rate,Pays based on per visit rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.13,2285,
OBSERVATION (INITIAL HOUR),T990010065,CDM,762,RC,G0378,HCPCS,Outpatient,,,260,130,,200.2,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,179.4,100,,,case rate,pays based on per visit,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,218.4,84,,,Percent of Total Billed Charges,84% of total billed charges,213.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.4,89,,,Percent of total Billed Charges,89% of total Billed charges,218.4,84,,,Percent of Total Billed Charges,84% of Total Billed charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.2,77,,,Percent of total Billed charges,77% of total billed charges,221,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2285,100,,,Case Rate,Pays based on per visit rate,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978,100,,,Case Rate,Pays based on per visit rate,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,2285,
OBS DIRECT ADMIT 1st HOUR,T990010066,CDM,762,RC,G0379,HCPCS,Outpatient,,,60.5,30.25,,46.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,100,,,case rate,pays based on per visit,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,50.82,84,,,Percent of Total Billed Charges,84% of total billed charges,49.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.85,89,,,Percent of total Billed Charges,89% of total Billed charges,50.82,84,,,Percent of Total Billed Charges,84% of Total Billed charges,53.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.59,77,,,Percent of total Billed charges,77% of total billed charges,51.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2285,100,,,Case Rate,Pays based on per visit rate,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978,100,,,Case Rate,Pays based on per visit rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.13,2285,
STRAIGHT CATH FOR URINE COLL,T990010068,CDM,300,RC,P9612,HCPCS,Outpatient,,,124.5,62.25,,95.87,77,,,Percent of Total Billed Charges,77% of total billed charges,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.13,74,,,Percent of Total Billed Charges,74% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,104.58,84,,,Percent of Total Billed Charges,84% of total billed charges,102.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,15,500,,,fee schedule,500% of healthlink,15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.23,120,,,Fee Schedule,120% of MO Medicaid Rate,8.23,120,,,Fee Schedule,120% of MO Medicaid Rate,8.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.87,77,,,Percent of total Billed charges,77% of total billed charges,105.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.23,120,,,Fee Schedule,120% of MO Medicaid Rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.23,105.83,
TELEHEALTH ORIG SITE FEE,T990010069,CDM,780,RC,Q3014,HCPCS,Outpatient,,,121,60.5,,93.17,77,,,Percent of Total Billed Charges,77% of total billed charges,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.54,74,,,Percent of Total Billed Charges,74% of total billed charges,83.49,69,,,Percent of Total Billed Charges,69% of total billed charges,83.49,69,,,Percent of Total Billed Charges,69% of total billed charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.49,69,,,Percent of Total Billed Charges,69% of total billed charges,83.49,69,,,Percent of Total Billed Charges,69% of total billed charges,101.64,84,,,Percent of Total Billed Charges,84% of total billed charges,99.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.69,89,,,Percent of total Billed Charges,89% of total Billed charges,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.17,77,,,Percent of total Billed charges,77% of total billed charges,102.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.25,107.69,
No Charge Room Rate,T990010070,CDM,120,RC,,,Inpatient,,,,,,,,,,other,not seperately reimbusable,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,2494.66,3445,
BH Telementry Room & Board,T990010071,CDM,120,RC,,,Inpatient,,,1250,625,,962.5,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,962.5,77,,,Percent of total Billed charges,77% of total billed charges,1062.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,962.5,3445,
COVID Vaccine Administration,T990010072,CDM,771,RC,90480,HCPCS,Outpatient,,,70,35,,53.9,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.8,74,,,Percent of Total Billed Charges,74% of total billed charges,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,48.3,69,,,Percent of Total Billed Charges,69% of total billed charges,58.8,84,,,Percent of Total Billed Charges,84% of total billed charges,57.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.3,89,,,Percent of total Billed Charges,89% of total Billed charges,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,77,,,Percent of total Billed charges,77% of total billed charges,59.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,
SWB ROOM,T990030001,CDM,190,RC,,,Inpatient,,,440.5,220.25,,339.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pay based on per day,593,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,639,100,,,per diem,pays based on per day rate,640,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,339.19,77,,,Percent of total Billed charges,77% of total billed charges,374.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,1101,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,953,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,339.19,3445,
SWB/ISO/MATTRESS ROOM,T990030002,CDM,190,RC,,,Inpatient,,,703.5,351.75,,541.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pay based on per day,593,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,639,100,,,per diem,pays based on per day rate,640,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,541.7,77,,,Percent of total Billed charges,77% of total billed charges,597.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,1101,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,953,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,541.7,3445,
SWB/ISOLATION ROOM,T990030003,CDM,190,RC,,,Inpatient,,,621.5,310.75,,478.56,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pay based on per day,593,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,639,100,,,per diem,pays based on per day rate,640,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,478.56,77,,,Percent of total Billed charges,77% of total billed charges,528.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,1101,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,953,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,478.56,3445,
SWB/PREVENTION MATTRESS ROOM,T990030004,CDM,190,RC,,,Inpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pay based on per day,593,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,593,100,,,per diem,pays based on per day rate,593,100,,,per diem,pays based on per day rate,639,100,,,per diem,pays based on per day rate,640,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,1101,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,953,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day rate,404.25,3445,
OCYTOCIN CHALLENGE TEST,T990100010,CDM,920,RC,59020,HCPCS,Outpatient,,,590.5,295.25,,454.69,77,,,Percent of Total Billed Charges,77% of total billed charges,150.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,436.97,74,,,Percent of Total Billed Charges,74% of total billed charges,407.45,69,,,Percent of Total Billed Charges,69% of total billed charges,407.45,69,,,Percent of Total Billed Charges,69% of total billed charges,147.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.45,69,,,Percent of Total Billed Charges,69% of total billed charges,407.45,69,,,Percent of Total Billed Charges,69% of total billed charges,496.02,84,,,Percent of Total Billed Charges,84% of total billed charges,484.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,525.55,89,,,Percent of total Billed Charges,89% of total Billed charges,525.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,525.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,147.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.69,77,,,Percent of total Billed charges,77% of total billed charges,501.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,147.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,147.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.07,525.55,
FHR MONITORING/INTERP 1ST HOUR,T990100011,CDM,920,RC,59025,HCPCS,Outpatient,,,287.5,143.75,,221.38,77,,,Percent of Total Billed Charges,77% of total billed charges,73.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,212.75,74,,,Percent of Total Billed Charges,74% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,84,,,Percent of Total Billed Charges,84% of total billed charges,235.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,255.88,89,,,Percent of total Billed Charges,89% of total Billed charges,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.38,77,,,Percent of total Billed charges,77% of total billed charges,244.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,255.88,
FHR MONT/INTERP 1HR ADD'L,T990100012,CDM,920,RC,59025,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.1,89,,,Percent of total Billed Charges,89% of total Billed charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,119,
NON STRESS TEST,T990100013,CDM,920,RC,59025,HCPCS,Outpatient,,,357,178.5,,274.89,77,,,Percent of Total Billed Charges,77% of total billed charges,91.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.18,74,,,Percent of Total Billed Charges,74% of total billed charges,246.33,69,,,Percent of Total Billed Charges,69% of total billed charges,246.33,69,,,Percent of Total Billed Charges,69% of total billed charges,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.33,69,,,Percent of Total Billed Charges,69% of total billed charges,246.33,69,,,Percent of Total Billed Charges,69% of total billed charges,299.88,84,,,Percent of Total Billed Charges,84% of total billed charges,292.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,317.73,89,,,Percent of total Billed Charges,89% of total Billed charges,317.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.89,77,,,Percent of total Billed charges,77% of total billed charges,303.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,89.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,317.73,
AMNEO-INFUSION,T990100014,CDM,920,RC,59899,HCPCS,Outpatient,,,709,354.5,,545.93,77,,,Percent of Total Billed Charges,77% of total billed charges,180.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.66,74,,,Percent of Total Billed Charges,74% of total billed charges,489.21,69,,,Percent of Total Billed Charges,69% of total billed charges,489.21,69,,,Percent of Total Billed Charges,69% of total billed charges,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.21,69,,,Percent of Total Billed Charges,69% of total billed charges,489.21,69,,,Percent of Total Billed Charges,69% of total billed charges,595.56,84,,,Percent of Total Billed Charges,84% of total billed charges,581.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,631.01,89,,,Percent of total Billed Charges,89% of total Billed charges,631.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,631.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.93,77,,,Percent of total Billed charges,77% of total billed charges,602.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,289.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,177.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,631.01,
NEWBORN HEARING SCREENING,T990100017,CDM,471,RC,92551,HCPCS,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.39,74,,,Percent of Total Billed Charges,74% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,103.74,84,,,Percent of Total Billed Charges,84% of total billed charges,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,195,100,,,Case Rate,Pays based on per visit rate,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,100,,,Case Rate,Pays based on per visit rate,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,195,
CCHD,T990100018,CDM,460,RC,94761,HCPCS,Outpatient,,,36,18,,27.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.64,74,,,Percent of Total Billed Charges,74% of total billed charges,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,24.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.24,84,,,Percent of Total Billed Charges,84% of total billed charges,29.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.72,77,,,Percent of total Billed charges,77% of total billed charges,30.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.23,650,
NEW PATIENT 2-LIMITED OP,T990100029,CDM,510,RC,99202,HCPCS,Outpatient,,,310.5,155.25,,239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,79.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,126.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.09,77,,,Percent of total Billed charges,77% of total billed charges,263.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,126.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.63,276.35,
NEW PATIENT 2-LIMITED OP,T990100029,CDM,510,RC,G0463,HCPCS,Outpatient,,,310.5,155.25,,239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,79.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,126.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.09,77,,,Percent of total Billed charges,77% of total billed charges,263.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,126.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.63,276.35,
NP 3-INTERMEDIATE OP,T990100031,CDM,510,RC,G0463,HCPCS,Outpatient,,,462,231,,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,231,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,411.18,
NP 3-INTERMEDIATE OP,T990100031,CDM,510,RC,99203,HCPCS,Outpatient,,,462,231,,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,231,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.5,411.18,
NP 4-EXTENDED OP,T990100032,CDM,510,RC,99204,HCPCS,Outpatient,,,628.5,314.25,,483.95,77,,,Percent of Total Billed Charges,77% of total billed charges,160.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,256.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,483.95,77,,,Percent of total Billed charges,77% of total billed charges,534.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,314.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,256.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.13,559.37,
NP 4-EXTENDED OP,T990100032,CDM,510,RC,G0463,HCPCS,Outpatient,,,628.5,314.25,,483.95,77,,,Percent of Total Billed Charges,77% of total billed charges,160.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,256.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,483.95,77,,,Percent of total Billed charges,77% of total billed charges,534.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,314.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,256.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.13,559.37,
NP 5-COMPREHENSIVE OP,T990100033,CDM,510,RC,G0463,HCPCS,Outpatient,,,795.5,397.75,,612.54,77,,,Percent of Total Billed Charges,77% of total billed charges,202.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,324.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,612.54,77,,,Percent of total Billed charges,77% of total billed charges,676.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,228.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,397.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,324.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,708,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.88,708,
NP 5-COMPREHENSIVE OP,T990100033,CDM,510,RC,99205,HCPCS,Outpatient,,,795.5,397.75,,612.54,77,,,Percent of Total Billed Charges,77% of total billed charges,202.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,324.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,612.54,77,,,Percent of total Billed charges,77% of total billed charges,676.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,228.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,397.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,324.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,708,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.88,708,
DELIVERY ROOM 1ST HOUR,T990100039,CDM,722,RC,,,Outpatient,,,1177.5,588.75,,906.68,77,,,Percent of Total Billed Charges,77% of total billed charges,300.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,871.35,74,,,Percent of Total Billed Charges,74% of total billed charges,812.48,69,,,Percent of Total Billed Charges,69% of total billed charges,812.48,69,,,Percent of Total Billed Charges,69% of total billed charges,294.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.48,69,,,Percent of Total Billed Charges,69% of total billed charges,812.48,69,,,Percent of Total Billed Charges,69% of total billed charges,989.1,84,,,Percent of Total Billed Charges,84% of total billed charges,965.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1047.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1047.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1047.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,480.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,480.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,480.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,906.68,77,,,Percent of total Billed charges,77% of total billed charges,1000.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,338.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,480.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,294.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,294.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.38,1047.98,
DELIVERY ROOM EA ADD'L 30 MIN,T990100040,CDM,722,RC,,,Outpatient,,,488,244,,375.76,77,,,Percent of Total Billed Charges,77% of total billed charges,124.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.12,74,,,Percent of Total Billed Charges,74% of total billed charges,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,409.92,84,,,Percent of Total Billed Charges,84% of total billed charges,400.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.32,89,,,Percent of total Billed Charges,89% of total Billed charges,434.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.76,77,,,Percent of total Billed charges,77% of total billed charges,414.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,199.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122,761,
FORCEPS ASSISTED DELIVERY,T990100041,CDM,722,RC,,,Outpatient,,,150.5,75.25,,115.89,77,,,Percent of Total Billed Charges,77% of total billed charges,38.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.37,74,,,Percent of Total Billed Charges,74% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,103.85,69,,,Percent of Total Billed Charges,69% of total billed charges,126.42,84,,,Percent of Total Billed Charges,84% of total billed charges,123.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.95,89,,,Percent of total Billed Charges,89% of total Billed charges,133.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.89,77,,,Percent of total Billed charges,77% of total billed charges,127.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,61.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,37.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.63,761,
INT CONTRACT MONIT/INTRP SUB,T990100042,CDM,920,RC,,,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,100,,,case rate,pays based on per visit,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,103.74,84,,,Percent of Total Billed Charges,84% of total billed charges,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,119,
INT CONTRACT MONT/INTRP 1ST HR,T990100043,CDM,920,RC,,,Outpatient,,,238.5,119.25,,183.65,77,,,Percent of Total Billed Charges,77% of total billed charges,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,100,,,case rate,pays based on per visit,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,200.34,84,,,Percent of Total Billed Charges,84% of total billed charges,195.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.27,89,,,Percent of total Billed Charges,89% of total Billed charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.65,77,,,Percent of total Billed charges,77% of total billed charges,202.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,97.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.63,212.27,
INT FETAL MONT/INTURP 1ST HR,T990100044,CDM,920,RC,,,Outpatient,,,238.5,119.25,,183.65,77,,,Percent of Total Billed Charges,77% of total billed charges,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,100,,,case rate,pays based on per visit,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,200.34,84,,,Percent of Total Billed Charges,84% of total billed charges,195.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.27,89,,,Percent of total Billed Charges,89% of total Billed charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.65,77,,,Percent of total Billed charges,77% of total billed charges,202.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,97.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.63,212.27,
INT FETAL MONT/INTURP SUBSQU,T990100045,CDM,920,RC,,,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,100,,,case rate,pays based on per visit,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,103.74,84,,,Percent of Total Billed Charges,84% of total billed charges,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,119,
LABOR ROOM EACH HOUR,T990100046,CDM,721,RC,,,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.77,89,,,Percent of total Billed Charges,89% of total Billed charges,167.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,76.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,761,
"LABOR ROOM, LEVEL II (per hr)",T990100047,CDM,721,RC,,,Outpatient,,,233.5,116.75,,179.8,77,,,Percent of Total Billed Charges,77% of total billed charges,59.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.79,74,,,Percent of Total Billed Charges,74% of total billed charges,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,196.14,84,,,Percent of Total Billed Charges,84% of total billed charges,191.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.82,89,,,Percent of total Billed Charges,89% of total Billed charges,207.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.8,77,,,Percent of total Billed charges,77% of total billed charges,198.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,95.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.38,761,
NO CHARGE ROOM RATE,T990100048,CDM,120,RC,,,Inpatient,,,,,,,,,,other,not seperately reimbusable,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,2494.66,3445,
O/B Per Hour Non-OBSV package,T990100049,CDM,762,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2285,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1978,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1978,2285,
POSITIVE PRESSURE ASST RESP,T990100050,CDM,940,RC,,,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.82,74,,,Percent of Total Billed Charges,74% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
RECOVERY ROOM HOURLY,T990100051,CDM,721,RC,,,Outpatient,,,751.5,375.75,,578.66,77,,,Percent of Total Billed Charges,77% of total billed charges,191.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,556.11,74,,,Percent of Total Billed Charges,74% of total billed charges,518.54,69,,,Percent of Total Billed Charges,69% of total billed charges,518.54,69,,,Percent of Total Billed Charges,69% of total billed charges,187.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.54,69,,,Percent of Total Billed Charges,69% of total billed charges,518.54,69,,,Percent of Total Billed Charges,69% of total billed charges,631.26,84,,,Percent of Total Billed Charges,84% of total billed charges,616.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,668.84,89,,,Percent of total Billed Charges,89% of total Billed charges,668.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,668.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,306.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,578.66,77,,,Percent of total Billed charges,77% of total billed charges,638.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,306.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,187.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.88,761,
VACCUM ASSISTED DELIVERY,T990100052,CDM,722,RC,,,Outpatient,,,195,97.5,,150.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.3,74,,,Percent of Total Billed Charges,74% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,163.8,84,,,Percent of Total Billed Charges,84% of total billed charges,159.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.55,89,,,Percent of total Billed Charges,89% of total Billed charges,173.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.15,77,,,Percent of total Billed charges,77% of total billed charges,165.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,79.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.75,761,
OB Acute Room Rate,T990100053,CDM,122,RC,,,Inpatient,,,1029,514.5,,792.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,792.33,77,,,Percent of total Billed charges,77% of total billed charges,874.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,792.33,3445,
OB Isolation Room Rate,T990100054,CDM,122,RC,,,Inpatient,,,1100,550,,847,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,847,77,,,Percent of total Billed charges,77% of total billed charges,935,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,847,3445,
OB Telemetry Room Rate,T990100055,CDM,122,RC,,,Inpatient,,,1160,580,,893.2,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,2756,100,,,per diem,pays based on per day,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,893.2,77,,,Percent of total Billed charges,77% of total billed charges,986,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,893.2,3445,
NB HEARING SCREENING,T990140001,CDM,470,RC,92551,HCPCS,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.39,74,,,Percent of Total Billed Charges,74% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,85.22,69,,,Percent of Total Billed Charges,69% of total billed charges,103.74,84,,,Percent of Total Billed Charges,84% of total billed charges,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,195,100,,,Case Rate,Pays based on per visit rate,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,100,,,Case Rate,Pays based on per visit rate,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,195,
CIRCUMCISION PROCEDURE,T990140002,CDM,270,RC,,,Outpatient,,,298.5,149.25,,229.85,77,,,Percent of Total Billed Charges,77% of total billed charges,76.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.89,74,,,Percent of Total Billed Charges,74% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,250.74,84,,,Percent of Total Billed Charges,84% of total billed charges,244.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.67,89,,,Percent of total Billed Charges,89% of total Billed charges,265.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,77,,,Percent of total Billed charges,77% of total billed charges,253.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.63,265.67,
NURSERY,T990140003,CDM,171,RC,,,Inpatient,,,514,257,,395.78,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,586,100,,,per diem,pays based on per day rate,557,100,,,per diem,pay based on per day,557,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,557,100,,,per diem,pays based on per day rate,557,100,,,per diem,pays based on per day rate,604,100,,,per diem,pays based on per day rate,425,100,,,per diem,pays based on per day rate,545,100,,,per diem,pays based on per day rate,529,100,,,Per Diem,Pays based on per day rate,545,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,395.78,77,,,Percent of total Billed charges,77% of total billed charges,436.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,395.78,3445,
NURSERY LEVEL 4,T990140004,CDM,174,RC,,,Inpatient,,,1076.5,538.25,,828.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,2472,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pay based on per day,2350,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,2350,100,,,per diem,pays based on per day rate,2350,100,,,per diem,pays based on per day rate,2547,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,828.91,77,,,Percent of total Billed charges,77% of total billed charges,915.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,828.91,3445,
NURSERY LEVEL II,T990140005,CDM,172,RC,,,Inpatient,,,705,352.5,,542.85,77,,,Percent of Total Billed Charges,77% of total billed charges,2811.12,100,,,per diem,pays based on per day rate,2811.12,100,,,per diem,pays based on per day rate,3445,100,,,per diem,pays based on per day rate,586,100,,,per diem,pays based on per day rate,557,100,,,per diem,pay based on per day,557,100,,,per diem,pays based on per day,2756,100,,,per diem,pays based on per day,557,100,,,per diem,pays based on per day rate,557,100,,,per diem,pays based on per day rate,604,100,,,per diem,pays based on per day rate,721,100,,,per diem,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,per diem,pays based on per day,542.85,77,,,Percent of total Billed charges,77% of total billed charges,599.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3169.4,100,,,Per Diem,Pays based on per day rate,,,,,Other,Not Seperately Reimbusable,2494.66,100,,,Per Diem,Pays based on per day rate,2756,100,,,Per Diem,Pays based on per day Rate,,,,,Other,Not Seperately Reimbusable,2756,100,,,Per Diem,Pays based on per day rate,542.85,3445,
"PREP W/INSTALL FMT, recurrent",T990200001,CDM,999,RC,G0455,HCPCS,Outpatient,,,1996,998,,1536.92,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1477.04,74,,,Percent of Total Billed Charges,74% of total billed charges,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,76.13,115,,,fee schedule,115% of cms fee schedule,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1676.64,84,,,Percent of Total Billed Charges,84% of total billed charges,1636.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,1776.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1776.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1776.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,814.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,814.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,814.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.13,115,,,fee schedule,115% of cms fee schedule,1536.92,77,,,Percent of total Billed charges,77% of total billed charges,1696.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,814.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.11,115,,,Fee Schedule,115% of CMS OPPS Rate,76.11,1776.44,
"PREP W/INSTALL FMT, recurrent",T990200001,CDM,999,RC,44705,HCPCS,Outpatient,,,1996,998,,1536.92,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,1477.04,74,,,Percent of Total Billed Charges,74% of total billed charges,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,77.56,115,,,fee schedule,115% of cms fee schedule,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1377.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1676.64,84,,,Percent of Total Billed Charges,84% of total billed charges,1636.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,1776.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1776.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1776.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,814.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,814.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,814.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.56,115,,,fee schedule,115% of cms fee schedule,1536.92,77,,,Percent of total Billed charges,77% of total billed charges,1696.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,814.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,77.53,115,,,Fee Schedule,115% of CMS OPPS Rate,77.53,1776.44,
"LITHOLAPAXY, BLADDER",T990200002,CDM,360,RC,52317,HCPCS,Outpatient,,,6089,3044.5,,4688.53,77,,,Percent of Total Billed Charges,77% of total billed charges,1552.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1552.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1902.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1614,69,,,Percent of Total Billed Charges,69% of total billed charges,1606,100,,,case rate,pays based on per visit,1606,69,,,Percent of Total Billed Charges,69% of total billed charges,1522.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1606,69,,,Percent of Total Billed Charges,69% of total billed charges,1606,69,,,Percent of Total Billed Charges,69% of total billed charges,1606,84,,,Percent of Total Billed Charges,84% of total billed charges,4992.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4592,89,,,Percent of total Billed Charges,89% of total Billed charges,4458,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4592,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2484.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2484.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1522.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4688.53,77,,,Percent of total Billed charges,77% of total billed charges,5175.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1750.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2647,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,2484.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1522.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2291,100,,,Fee Schedule,100% of UMR Fee Schedule,1522.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1522.25,5175.65,
Prostate Saturation Sampling,T990200006,CDM,360,RC,52648,HCPCS,Outpatient,,,3000,1500,,2310,77,,,Percent of Total Billed Charges,77% of total billed charges,765,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,765,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,937.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,750,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,2460,82,,,Percent of Total Billed Charges,82% of total billed charges ,2670,89,,,Percent of total Billed Charges,89% of total Billed charges,2520,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2670,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1224,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1224,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1224,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,750,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2310,77,,,Percent of total Billed charges,77% of total billed charges,2550,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,862.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3481,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,1224,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,750,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3013,100,,,Fee Schedule,100% of UMR Fee Schedule,750,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,750,3481,
FIDUCIAL MARKER PLACEMENT,T990200008,CDM,360,RC,55876,HCPCS,Outpatient,,,4250,2125,,3272.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1083.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1083.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1062.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3485,82,,,Percent of Total Billed Charges,82% of total billed charges ,3782.5,89,,,Percent of total Billed Charges,89% of total Billed charges,3570,84,,,Percent of Total Billed Charges,84% of Total Billed charges,3782.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1734,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1734,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1734,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1062.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3272.5,77,,,Percent of total Billed charges,77% of total billed charges,3612.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1221.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2350,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,1734,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1062.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2034,100,,,Fee Schedule,100% of UMR Fee Schedule,1062.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1062.5,3782.5,
IRIDOCAPSULOTOMY BY LASER,T990200011,CDM,490,RC,66821,HCPCS,Outpatient,,,1574.5,787.25,,1212.37,77,,,Percent of Total Billed Charges,77% of total billed charges,401.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,928.96,59,,,Percent of Total Billed Charges,59% of total billed charges,928.96,100,,,case rate,pays based on per visit,928.96,59,,,case rate,pays based on per visit,393.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,928.96,59,,,Percent of Total Billed Charges,59% of total billed charges,928.96,59,,,Percent of Total Billed Charges,59% of total billed charges,1322.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1291.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,1401.31,89,,,Percent of total Billed Charges,89% of total Billed charges,1322.58,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1401.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1212.37,77,,,Percent of total Billed charges,77% of total billed charges,1338.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,452.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1261,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,642.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1092,100,,,Fee Schedule,100% of UMR Fee Schedule,393.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.63,1401.31,
Esophageal Manometry,T990200013,CDM,360,RC,91010,HCPCS,Outpatient,,,2080,1040,,1601.6,77,,,Percent of Total Billed Charges,77% of total billed charges,530.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,530.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1539.2,74,,,Percent of Total Billed Charges,74% of total billed charges,1435.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1435.2,69,,,Percent of Total Billed Charges,69% of total billed charges,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1435.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1435.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1747.2,84,,,Percent of Total Billed Charges,84% of total billed charges,1705.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1851.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1747.2,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1851.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,147.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1601.6,77,,,Percent of total Billed charges,77% of total billed charges,1768,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,147.68,120,,,Fee Schedule,120% of MO Medicaid Rate,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.68,1851.2,
EGD w/ Bravo Reflux,T990200014,CDM,360,RC,91035,HCPCS,Outpatient,,,3895,1947.5,,2999.15,77,,,Percent of Total Billed Charges,77% of total billed charges,993.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.3,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.55,69,,,Percent of Total Billed Charges,69% of total billed charges,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.8,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3271.8,84,,,Percent of Total Billed Charges,84% of Total Billed charges,3466.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.14,120,,,Fee Schedule,120% of MO Medicaid Rate,364.14,120,,,Fee Schedule,120% of MO Medicaid Rate,364.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.15,77,,,Percent of total Billed charges,77% of total billed charges,3310.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,364.14,120,,,Fee Schedule,120% of MO Medicaid Rate,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.14,3466.55,
Anorectal Manometry,T990200015,CDM,360,RC,91122,HCPCS,Outpatient,,,1248,624,,960.96,77,,,Percent of Total Billed Charges,77% of total billed charges,318.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,390,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,923.52,74,,,Percent of Total Billed Charges,74% of total billed charges,861.12,69,,,Percent of Total Billed Charges,69% of total billed charges,861.12,69,,,Percent of Total Billed Charges,69% of total billed charges,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.12,69,,,Percent of Total Billed Charges,69% of total billed charges,861.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1048.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1023.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1110.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1048.32,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1110.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.31,120,,,Fee Schedule,120% of MO Medicaid Rate,172.31,120,,,Fee Schedule,120% of MO Medicaid Rate,172.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.96,77,,,Percent of total Billed charges,77% of total billed charges,1060.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,358.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,172.31,120,,,Fee Schedule,120% of MO Medicaid Rate,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,312,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.31,1110.72,
"Capsulized FMT, preparation",T990200016,CDM,360,RC,,,Outpatient,,,8869.5,4434.75,,6829.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2261.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2261.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2771.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,2217.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,7272.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,4592,89,,,Percent of total Billed Charges,89% of total Billed charges,4458,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4592,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3618.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3618.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3618.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2217.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6829.52,77,,,Percent of total Billed charges,77% of total billed charges,7539.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2549.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4434.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3618.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2217.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7893.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2217.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,7893.86,
"COMPLEX CYSTO,W/URETH PRESSURE",T990200017,CDM,490,RC,,,Outpatient,,,900.5,450.25,,693.39,77,,,Percent of Total Billed Charges,77% of total billed charges,229.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,281.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,738.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,801.45,89,,,Percent of total Billed Charges,89% of total Billed charges,756.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,801.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,693.39,77,,,Percent of total Billed charges,77% of total billed charges,765.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,450.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,801.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.13,2278,
"CYSTO, W/VOID-URETHR PRESSURE",T990200018,CDM,490,RC,,,Outpatient,,,1125.5,562.75,,866.64,77,,,Percent of Total Billed Charges,77% of total billed charges,287,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,281.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,922.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1001.7,89,,,Percent of total Billed Charges,89% of total Billed charges,945.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1001.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,866.64,77,,,Percent of total Billed charges,77% of total billed charges,956.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,562.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.38,2278,
"CYSTOMETROGRAM, ANY TECH",T990200019,CDM,490,RC,,,Outpatient,,,900.5,450.25,,693.39,77,,,Percent of Total Billed Charges,77% of total billed charges,229.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,281.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,738.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,801.45,89,,,Percent of total Billed Charges,89% of total Billed charges,756.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,801.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,693.39,77,,,Percent of total Billed charges,77% of total billed charges,765.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,258.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,450.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,367.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,801.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,225.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.13,2278,
CYSTOSCOPY W/Holmium Laser,T990200020,CDM,790,RC,,,Outpatient,,,4571.5,2285.75,,3520.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1165.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1165.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1428.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5961,100,,,Case rate,pays based on per visit rate,5961,100,,,case rate,pays based on per visit,5961,100,,,case rate,pays based on per visit,1142.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5961,100,,,case rate,pays based on per visit,5961,100,,,case rate,pays based on per day rate,6140,100,,,case rate,pays based on per day rate,3748.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,5833,100,,,Case rate,Pays based on per visit rate,5495,84,,,Percent of Total Billed Charges,84% of Total Billed charges,5833,100,,,Case Rate,Pays based on per visit rate,1865.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1865.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1865.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1142.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3520.06,77,,,Percent of total Billed charges,77% of total billed charges,3885.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1314.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2285.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1865.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1142.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4068.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1142.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.88,6140,
Cystoscopy W/Thulium Laser,T990200021,CDM,790,RC,,,Outpatient,,,9449,4724.5,,7275.73,77,,,Percent of Total Billed Charges,77% of total billed charges,2409.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2952.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5961,100,,,Case rate,pays based on per visit rate,5961,100,,,case rate,pays based on per visit,5961,100,,,case rate,pays based on per visit,2362.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5961,100,,,case rate,pays based on per visit,5961,100,,,case rate,pays based on per day rate,6140,100,,,case rate,pays based on per day rate,7748.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,5833,100,,,Case rate,Pays based on per visit rate,5495,84,,,Percent of Total Billed Charges,84% of Total Billed charges,5833,100,,,Case Rate,Pays based on per visit rate,3855.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3855.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3855.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2362.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7275.73,77,,,Percent of total Billed charges,77% of total billed charges,8031.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2716.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4724.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3855.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2362.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8409.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2362.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2362.25,8409.61,
Digitrapper pHz,T990200022,CDM,360,RC,,,Outpatient,,,2080,1040,,1601.6,77,,,Percent of Total Billed Charges,77% of total billed charges,530.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,530.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,1705.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1851.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1747.2,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1851.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1601.6,77,,,Percent of total Billed charges,77% of total billed charges,1768,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1040,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,848.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1851.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520,2278,
"ELECTROMYOGRAPHY STY, ANY TECH",T990200023,CDM,490,RC,,,Outpatient,,,360.5,180.25,,277.59,77,,,Percent of Total Billed Charges,77% of total billed charges,91.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,295.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.85,89,,,Percent of total Billed Charges,89% of total Billed charges,302.82,84,,,Percent of Total Billed Charges,84% of Total Billed charges,320.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.59,77,,,Percent of total Billed charges,77% of total billed charges,306.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,180.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,147.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.13,2278,
ENDOSCOPY II,T990200024,CDM,360,RC,,,Outpatient,,,2722,1361,,2095.94,77,,,Percent of Total Billed Charges,77% of total billed charges,694.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,680.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,2232.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2422.58,89,,,Percent of total Billed Charges,89% of total Billed charges,2286.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2422.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2095.94,77,,,Percent of total Billed charges,77% of total billed charges,2313.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2422.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.5,2422.58,
"ENDOSCOPY II, EA ADD 15 MIN",T990200025,CDM,360,RC,,,Outpatient,,,683.5,341.75,,526.3,77,,,Percent of Total Billed Charges,77% of total billed charges,174.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,170.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,560.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,608.32,89,,,Percent of total Billed Charges,89% of total Billed charges,574.14,84,,,Percent of Total Billed Charges,84% of Total Billed charges,608.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,278.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,278.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,526.3,77,,,Percent of total Billed charges,77% of total billed charges,580.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,341.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,278.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,170.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,608.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.88,2278,
ESI FACILITY FEE,T990200026,CDM,360,RC,,,Outpatient,,,790.5,395.25,,608.69,77,,,Percent of Total Billed Charges,77% of total billed charges,201.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,247.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,197.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,703.55,89,,,Percent of total Billed Charges,89% of total Billed charges,664.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,703.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,322.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,197.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,608.69,77,,,Percent of total Billed charges,77% of total billed charges,671.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,227.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,395.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,322.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,197.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,197.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.63,2278,
ESO Manometry w/Impedance Cath,T990200027,CDM,360,RC,,,Outpatient,,,1098.5,549.25,,845.85,77,,,Percent of Total Billed Charges,77% of total billed charges,280.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,343.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,274.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,900.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,977.67,89,,,Percent of total Billed Charges,89% of total Billed charges,922.74,84,,,Percent of Total Billed Charges,84% of Total Billed charges,977.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,448.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,845.85,77,,,Percent of total Billed charges,77% of total billed charges,933.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,315.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,549.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,448.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,274.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,977.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.63,2278,
INSERTION NON-DWELLING CATH,T990200028,CDM,361,RC,,,Outpatient,,,162.5,81.25,,125.13,77,,,Percent of Total Billed Charges,77% of total billed charges,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.88,59,,,Percent of Total Billed Charges,59% of total billed charges,95.88,100,,,case rate,pays based on per visit,95.88,59,,,case rate,pays based on per visit,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.88,59,,,Percent of Total Billed Charges,59% of total billed charges,95.88,59,,,Percent of Total Billed Charges,59% of total billed charges,136.5,84,,,Percent of Total Billed Charges,84% of total billed charges,133.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.63,89,,,Percent of total Billed Charges,89% of total Billed charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.13,77,,,Percent of total Billed charges,77% of total billed charges,138.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.63,144.63,
LITHOTRIPSY,T990200029,CDM,790,RC,,,Outpatient,,,14758.5,7379.25,,11364.05,77,,,Percent of Total Billed Charges,77% of total billed charges,3763.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3763.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4612.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5961,100,,,Case rate,pays based on per visit rate,5961,100,,,case rate,pays based on per visit,5961,100,,,case rate,pays based on per visit,3689.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5961,100,,,case rate,pays based on per visit,5961,100,,,case rate,pays based on per day rate,6140,100,,,case rate,pays based on per day rate,12101.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,5833,100,,,Case rate,Pays based on per visit rate,5495,84,,,Percent of Total Billed Charges,84% of Total Billed charges,5833,100,,,Case Rate,Pays based on per visit rate,6021.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6021.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6021.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3689.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11364.05,77,,,Percent of total Billed charges,77% of total billed charges,12544.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4243.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7379.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6021.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3689.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13135.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3689.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3689.63,13135.07,
MEAS POST VOID URIN/BLAD BY US,T990200030,CDM,490,RC,,,Outpatient,,,281.5,140.75,,216.76,77,,,Percent of Total Billed Charges,77% of total billed charges,71.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,230.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.54,89,,,Percent of total Billed Charges,89% of total Billed charges,236.46,84,,,Percent of Total Billed Charges,84% of Total Billed charges,250.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.76,77,,,Percent of total Billed charges,77% of total billed charges,239.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,2278,
OP LOCAL-Goff,T990200031,CDM,490,RC,,,Outpatient,,,3245,1622.5,,2498.65,77,,,Percent of Total Billed Charges,77% of total billed charges,827.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,827.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1014.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,811.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,2660.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,2888.05,89,,,Percent of total Billed Charges,89% of total Billed charges,2725.8,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2888.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1323.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1323.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1323.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,811.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2498.65,77,,,Percent of total Billed charges,77% of total billed charges,2758.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,932.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1622.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1323.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,811.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2888.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,811.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,811.25,2888.05,
OR LEVEL 1 0-30 MIN,T990200032,CDM,360,RC,,,Outpatient,,,2404.5,1202.25,,1851.47,77,,,Percent of Total Billed Charges,77% of total billed charges,613.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,751.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,601.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,1971.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2140.01,89,,,Percent of total Billed Charges,89% of total Billed charges,2019.78,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2140.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1851.47,77,,,Percent of total Billed charges,77% of total billed charges,2043.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1202.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.13,2278,
"OR LEVEL 1, EA ADD 15 MIN",T990200033,CDM,360,RC,,,Outpatient,,,604,302,,465.08,77,,,Percent of Total Billed Charges,77% of total billed charges,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,495.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,537.56,89,,,Percent of total Billed Charges,89% of total Billed charges,507.36,84,,,Percent of Total Billed Charges,84% of Total Billed charges,537.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.08,77,,,Percent of total Billed charges,77% of total billed charges,513.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,302,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,246.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151,2278,
OR LEVEL 2 0-30 MIN,T990200034,CDM,360,RC,,,Outpatient,,,3046.5,1523.25,,2345.81,77,,,Percent of Total Billed Charges,77% of total billed charges,776.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,952.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,761.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,2498.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,2711.39,89,,,Percent of total Billed Charges,89% of total Billed charges,2559.06,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2711.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1242.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1242.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,761.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2345.81,77,,,Percent of total Billed charges,77% of total billed charges,2589.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,875.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1523.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1242.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,761.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,761.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.63,2711.39,
"OR LEVEL 2, EA ADD 15 MIN",T990200035,CDM,360,RC,,,Outpatient,,,765,382.5,,589.05,77,,,Percent of Total Billed Charges,77% of total billed charges,195.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,627.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,680.85,89,,,Percent of total Billed Charges,89% of total Billed charges,642.6,84,,,Percent of Total Billed Charges,84% of Total Billed charges,680.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,589.05,77,,,Percent of total Billed charges,77% of total billed charges,650.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,382.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,312.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.25,2278,
OR LEVEL 3 0-60 MIN,T990200036,CDM,360,RC,,,Outpatient,,,3685.5,1842.75,,2837.84,77,,,Percent of Total Billed Charges,77% of total billed charges,939.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,939.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1151.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,921.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3022.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,3280.1,89,,,Percent of total Billed Charges,89% of total Billed charges,3095.82,84,,,Percent of Total Billed Charges,84% of Total Billed charges,3280.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1503.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1503.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1503.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,921.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2837.84,77,,,Percent of total Billed charges,77% of total billed charges,3132.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1059.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1842.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1503.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,921.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3280.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,921.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,921.38,3280.1,
"OR LEVEL 3, EA ADD 15 MIN",T990200037,CDM,360,RC,,,Outpatient,,,925,462.5,,712.25,77,,,Percent of Total Billed Charges,77% of total billed charges,235.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,231.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,758.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,823.25,89,,,Percent of total Billed Charges,89% of total Billed charges,777,84,,,Percent of Total Billed Charges,84% of Total Billed charges,823.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,712.25,77,,,Percent of total Billed charges,77% of total billed charges,786.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,265.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,462.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,377.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,231.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,823.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.25,2278,
OR LEVEL 4 0-60 MIN,T990200038,CDM,360,RC,,,Outpatient,,,4166.5,2083.25,,3208.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1062.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1062.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1302.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1041.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3416.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,3708.19,89,,,Percent of total Billed Charges,89% of total Billed charges,3499.86,84,,,Percent of Total Billed Charges,84% of Total Billed charges,3708.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1699.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1699.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1699.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1041.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3208.21,77,,,Percent of total Billed charges,77% of total billed charges,3541.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1197.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2083.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1699.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1041.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3708.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1041.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.63,3708.19,
"OR LEVEL 4, EA ADD 15 MIN",T990200039,CDM,360,RC,,,Outpatient,,,1044,522,,803.88,77,,,Percent of Total Billed Charges,77% of total billed charges,266.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,326.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,856.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,929.16,89,,,Percent of total Billed Charges,89% of total Billed charges,876.96,84,,,Percent of Total Billed Charges,84% of Total Billed charges,929.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,803.88,77,,,Percent of total Billed charges,77% of total billed charges,887.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,522,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,425.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,929.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261,2278,
OR LEVEL 5 0-60 MIN,T990200040,CDM,360,RC,,,Outpatient,,,4806.5,2403.25,,3701.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1225.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1225.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1502.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1201.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3941.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4277.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4037.46,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4277.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1961.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1961.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1961.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1201.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3701.01,77,,,Percent of total Billed charges,77% of total billed charges,4085.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1381.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2403.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1961.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1201.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4277.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1201.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1201.63,4277.79,
"OR LEVEL 5, EA ADD 15 MIN",T990200041,CDM,360,RC,,,Outpatient,,,1203.5,601.75,,926.7,77,,,Percent of Total Billed Charges,77% of total billed charges,306.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,300.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,986.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.12,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.94,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1071.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.7,77,,,Percent of total Billed charges,77% of total billed charges,1022.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.88,2278,
Outpatient LOCAL,T990200042,CDM,360,RC,,,Outpatient,,,1194,597,,919.38,77,,,Percent of Total Billed Charges,77% of total billed charges,304.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,979.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,1062.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.96,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1062.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,919.38,77,,,Percent of total Billed charges,77% of total billed charges,1014.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1062.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.5,2278,
"Prep w/Install FMT, fulminant",T990200043,CDM,360,RC,,,Outpatient,,,7334,3667,,5647.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1870.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1870.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2291.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1833.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,6013.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4592,89,,,Percent of total Billed Charges,89% of total Billed charges,4458,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4592,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2992.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2992.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2992.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1833.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.18,77,,,Percent of total Billed charges,77% of total billed charges,6233.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2108.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3667,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2992.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1833.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6527.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1833.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1833.5,6527.26,
"UROFLOWMETRY, COMPLEX",T990200044,CDM,490,RC,,,Outpatient,,,653.5,326.75,,503.2,77,,,Percent of Total Billed Charges,77% of total billed charges,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,535.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,581.62,89,,,Percent of total Billed Charges,89% of total Billed charges,548.94,84,,,Percent of Total Billed Charges,84% of Total Billed charges,581.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,266.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.2,77,,,Percent of total Billed charges,77% of total billed charges,555.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,326.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,266.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.38,2278,
"VOIDING PRESS STUDY, INTRA ABD",T990200045,CDM,490,RC,,,Outpatient,,,405.5,202.75,,312.24,77,,,Percent of Total Billed Charges,77% of total billed charges,103.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,101.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,332.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,360.9,89,,,Percent of total Billed Charges,89% of total Billed charges,340.62,84,,,Percent of Total Billed Charges,84% of Total Billed charges,360.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,312.24,77,,,Percent of total Billed charges,77% of total billed charges,344.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,202.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,165.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,360.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.38,2278,
EGD/EGD with Dilation,T990200064,CDM,360,RC,,,Outpatient,,,1815.5,907.75,,1397.94,77,,,Percent of Total Billed Charges,77% of total billed charges,462.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,462.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,567.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,453.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,1488.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,1615.8,89,,,Percent of total Billed Charges,89% of total Billed charges,1525.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1615.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,740.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,740.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,740.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,453.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.94,77,,,Percent of total Billed charges,77% of total billed charges,1543.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,521.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,907.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,740.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,453.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1615.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,453.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.88,2278,
EGD/EGD w/ Dilation ea+ 15 min,T990200065,CDM,360,RC,,,Outpatient,,,456,228,,351.12,77,,,Percent of Total Billed Charges,77% of total billed charges,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,373.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,405.84,89,,,Percent of total Billed Charges,89% of total Billed charges,383.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.12,77,,,Percent of total Billed charges,77% of total billed charges,387.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,228,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114,2278,
IRIDOTOMY BY LASER,T990200066,CDM,490,RC,,,Outpatient,,,1260,630,,970.2,77,,,Percent of Total Billed Charges,77% of total billed charges,321.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,321.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,315,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,1033.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1121.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1058.4,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1121.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,514.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,514.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,315,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,970.2,77,,,Percent of total Billed charges,77% of total billed charges,1071,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,362.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,630,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,514.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,315,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1121.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315,2278,
ENDO III - EGD & COLONOSCOPY,T990200070,CDM,360,RC,,,Outpatient,,,2720,1360,,2094.4,77,,,Percent of Total Billed Charges,77% of total billed charges,693.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,693.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,680,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,2230.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2420.8,89,,,Percent of total Billed Charges,89% of total Billed charges,2284.8,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2420.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1109.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1109.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1109.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2094.4,77,,,Percent of total Billed charges,77% of total billed charges,2312,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1360,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1109.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680,2420.8,
ENDO III-EGD&COLON EA ADD'L 15,T990200071,CDM,360,RC,,,Outpatient,,,850,425,,654.5,77,,,Percent of Total Billed Charges,77% of total billed charges,216.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,697,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.5,89,,,Percent of total Billed Charges,89% of total Billed charges,714,84,,,Percent of Total Billed Charges,84% of Total Billed charges,756.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.5,77,,,Percent of total Billed charges,77% of total billed charges,722.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.5,2278,
ENDO IV -EGD&COLON W/ POLYP,T990200072,CDM,360,RC,,,Outpatient,,,3170,1585,,2440.9,77,,,Percent of Total Billed Charges,77% of total billed charges,808.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,990.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,792.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,2599.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2821.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2662.8,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2821.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1293.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1293.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1293.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,792.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2440.9,77,,,Percent of total Billed charges,77% of total billed charges,2694.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,911.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1585,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1293.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,792.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2821.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.5,2821.3,
ENDO IV-EGD&COLON POLYP EA ADD,T990200073,CDM,360,RC,,,Outpatient,,,1050,525,,808.5,77,,,Percent of Total Billed Charges,77% of total billed charges,267.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,861,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.5,89,,,Percent of total Billed Charges,89% of total Billed charges,882,84,,,Percent of Total Billed Charges,84% of Total Billed charges,934.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.5,77,,,Percent of total Billed charges,77% of total billed charges,892.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.5,2278,
"Cataract, Phaco Implantation",T990200075,CDM,360,RC,,,Outpatient,,,4700,2350,,3619,77,,,Percent of Total Billed Charges,77% of total billed charges,1198.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1198.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1468.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3854,82,,,Percent of Total Billed Charges,82% of total billed charges ,4183,89,,,Percent of total Billed Charges,89% of total Billed charges,3948,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4183,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1917.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1917.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1917.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3619,77,,,Percent of total Billed charges,77% of total billed charges,3995,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1351.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2350,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1917.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4183,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1175,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1175,4183,
Excision Lesion w/CO2 Laser,T990200076,CDM,360,RC,,,Outpatient,,,4100,2050,,3157,77,,,Percent of Total Billed Charges,77% of total billed charges,1045.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1045.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1281.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1025,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3362,82,,,Percent of Total Billed Charges,82% of total billed charges ,3649,89,,,Percent of total Billed Charges,89% of total Billed charges,3444,84,,,Percent of Total Billed Charges,84% of Total Billed charges,3649,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1672.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1672.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1672.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1025,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3157,77,,,Percent of total Billed charges,77% of total billed charges,3485,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1178.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2050,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1672.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1025,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3649,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1025,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1025,3649,
Thyroidectomy w/ IONN,T990200077,CDM,360,RC,,,Outpatient,,,8350,4175,,6429.5,77,,,Percent of Total Billed Charges,77% of total billed charges,2129.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2129.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2609.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,6847,82,,,Percent of Total Billed Charges,82% of total billed charges ,4592,89,,,Percent of total Billed Charges,89% of total Billed charges,4458,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4592,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6429.5,77,,,Percent of total Billed charges,77% of total billed charges,7097.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2400.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4175,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7431.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.5,7431.5,
EGD w/Manometry,T990200078,CDM,360,RC,,,Outpatient,,,3895,1947.5,,2999.15,77,,,Percent of Total Billed Charges,77% of total billed charges,993.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,3193.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3271.8,84,,,Percent of Total Billed Charges,84% of Total Billed charges,3466.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.15,77,,,Percent of total Billed charges,77% of total billed charges,3310.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.75,3466.55,
"Inj platelet plasma, w/image",T990200079,CDM,940,RC,0232T,HCPCS,Outpatient,,,1624.5,812.25,,1250.87,77,,,Percent of Total Billed Charges,77% of total billed charges,414.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,414.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,507.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1202.13,74,,,Percent of Total Billed Charges,74% of total billed charges,1120.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.91,69,,,Percent of Total Billed Charges,69% of total billed charges,406.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1120.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1364.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1332.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,1445.81,89,,,Percent of total Billed Charges,89% of total Billed charges,1445.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1445.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,406.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1250.87,77,,,Percent of total Billed charges,77% of total billed charges,1380.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,467.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,662.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,406.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,406.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,1445.81,
Green Light Laser Procedure,T990200080,CDM,360,RC,,,Outpatient,,,7500,3750,,5775,77,,,Percent of Total Billed Charges,77% of total billed charges,1912.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1912.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2343.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,1875,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,6150,82,,,Percent of Total Billed Charges,82% of total billed charges ,4592,500,,,fee schedule,500% of healthlink,4458,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4592,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3060,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3060,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3060,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1875,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5775,77,,,Percent of total Billed charges,77% of total billed charges,6375,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2156.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3750,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3060,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1875,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6675,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1875,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875,6675,
Parotidectomy w/ IONM,T990200081,CDM,360,RC,,,Outpatient,,,8350,4175,,6429.5,77,,,Percent of Total Billed Charges,77% of total billed charges,2129.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2129.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2609.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,6847,82,,,Percent of Total Billed Charges,82% of total billed charges ,4592,89,,,Percent of total Billed Charges,89% of total Billed charges,4458,84,,,Percent of Total Billed Charges,84% of Total Billed charges,4592,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6429.5,77,,,Percent of total Billed charges,77% of total billed charges,7097.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2400.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4175,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3406.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7431.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2087.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.5,7431.5,
RECOVERY 0-30 MINS,T990210003,CDM,710,RC,,,Outpatient,,,1342.5,671.25,,1033.73,77,,,Percent of Total Billed Charges,77% of total billed charges,342.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,342.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,419.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,993.45,74,,,Percent of Total Billed Charges,74% of total billed charges,926.33,69,,,Percent of Total Billed Charges,69% of total billed charges,926.33,69,,,Percent of Total Billed Charges,69% of total billed charges,335.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.33,69,,,Percent of Total Billed Charges,69% of total billed charges,926.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1127.7,84,,,Percent of Total Billed Charges,84% of total billed charges,1100.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1194.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1194.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1194.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,547.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,547.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,547.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,335.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1033.73,77,,,Percent of total Billed charges,77% of total billed charges,1141.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,385.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,671.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,547.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,335.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1194.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.63,1194.83,
RECOVERY EACH ADD 15 MIN,T990210004,CDM,710,RC,,,Outpatient,,,411,205.5,,316.47,77,,,Percent of Total Billed Charges,77% of total billed charges,104.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.14,74,,,Percent of Total Billed Charges,74% of total billed charges,283.59,69,,,Percent of Total Billed Charges,69% of total billed charges,283.59,69,,,Percent of Total Billed Charges,69% of total billed charges,102.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.59,69,,,Percent of Total Billed Charges,69% of total billed charges,283.59,69,,,Percent of Total Billed Charges,69% of total billed charges,345.24,84,,,Percent of Total Billed Charges,84% of total billed charges,337.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,365.79,89,,,Percent of total Billed Charges,89% of total Billed charges,365.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,365.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.47,77,,,Percent of total Billed charges,77% of total billed charges,349.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,205.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,167.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.75,365.79,
INTUBATION,T990230001,CDM,370,RC,31500,HCPCS,Outpatient,,,949,474.5,,730.73,77,,,Percent of Total Billed Charges,77% of total billed charges,242,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,702.26,74,,,Percent of Total Billed Charges,74% of total billed charges,654.81,69,,,Percent of Total Billed Charges,69% of total billed charges,654.81,69,,,Percent of Total Billed Charges,69% of total billed charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.81,69,,,Percent of Total Billed Charges,69% of total billed charges,654.81,69,,,Percent of Total Billed Charges,69% of total billed charges,797.16,84,,,Percent of Total Billed Charges,84% of total billed charges,778.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,844.61,89,,,Percent of total Billed Charges,89% of total Billed charges,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,730.73,77,,,Percent of total Billed charges,77% of total billed charges,806.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,272.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,474.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,844.61,
ARTERIAL PUNCTURE ANESTHESIA,T990230003,CDM,300,RC,36600,HCPCS,Outpatient,,,135.5,67.75,,104.34,77,,,Percent of Total Billed Charges,77% of total billed charges,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.27,74,,,Percent of Total Billed Charges,74% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,113.82,84,,,Percent of Total Billed Charges,84% of total billed charges,111.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.6,89,,,Percent of total Billed Charges,89% of total Billed charges,120.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.34,77,,,Percent of total Billed charges,77% of total billed charges,115.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,55.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,120.6,
EMERGENCY ANESTHESIA,T990230004,CDM,370,RC,,,Outpatient,,,330.5,165.25,,254.49,77,,,Percent of Total Billed Charges,77% of total billed charges,84.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,244.57,74,,,Percent of Total Billed Charges,74% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,277.62,84,,,Percent of Total Billed Charges,84% of total billed charges,271.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,294.15,89,,,Percent of total Billed Charges,89% of total Billed charges,294.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.49,77,,,Percent of total Billed charges,77% of total billed charges,280.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,165.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.63,294.15,
IV THERAPY ANESTHESIA,T990230009,CDM,260,RC,,,Outpatient,,,120,60,,92.4,77,,,Percent of Total Billed Charges,77% of total billed charges,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.8,74,,,Percent of Total Billed Charges,74% of total billed charges,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,100.8,84,,,Percent of Total Billed Charges,84% of total billed charges,98.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.8,89,,,Percent of total Billed Charges,89% of total Billed charges,106.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.4,77,,,Percent of total Billed charges,77% of total billed charges,102,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,144,100,,,Case Rate,Pays based on per visit rate,48.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30,144,
Ultrasound Guided (Anesthesia),T990230010,CDM,370,RC,,,Outpatient,,,370.5,185.25,,285.29,77,,,Percent of Total Billed Charges,77% of total billed charges,94.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.17,74,,,Percent of Total Billed Charges,74% of total billed charges,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,311.22,84,,,Percent of Total Billed Charges,84% of total billed charges,303.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.75,89,,,Percent of total Billed Charges,89% of total Billed charges,329.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.29,77,,,Percent of total Billed charges,77% of total billed charges,314.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.63,329.75,
Gen anes w/IV Sed First 15 Min,T990230011,CDM,370,RC,,,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296,74,,,Percent of Total Billed Charges,74% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,336,84,,,Percent of Total Billed Charges,84% of total billed charges,328,82,,,Percent of Total Billed Charges,82% of total billed charges ,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
Gen anes w/IV Sed ea addt'l 15,T990230012,CDM,370,RC,,,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,178,
Gen anes w/LMA First 15 min,T990230013,CDM,370,RC,,,Outpatient,,,775,387.5,,596.75,77,,,Percent of Total Billed Charges,77% of total billed charges,197.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,573.5,74,,,Percent of Total Billed Charges,74% of total billed charges,534.75,69,,,Percent of Total Billed Charges,69% of total billed charges,534.75,69,,,Percent of Total Billed Charges,69% of total billed charges,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,534.75,69,,,Percent of Total Billed Charges,69% of total billed charges,534.75,69,,,Percent of Total Billed Charges,69% of total billed charges,651,84,,,Percent of Total Billed Charges,84% of total billed charges,635.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,689.75,89,,,Percent of total Billed Charges,89% of total Billed charges,689.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,596.75,77,,,Percent of total Billed charges,77% of total billed charges,658.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,222.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,387.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,316.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.75,689.75,
Gen anes w/LMA ea addtl 15 min,T990230014,CDM,370,RC,,,Outpatient,,,387.5,193.75,,298.38,77,,,Percent of Total Billed Charges,77% of total billed charges,98.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,286.75,74,,,Percent of Total Billed Charges,74% of total billed charges,267.38,69,,,Percent of Total Billed Charges,69% of total billed charges,267.38,69,,,Percent of Total Billed Charges,69% of total billed charges,96.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.38,69,,,Percent of Total Billed Charges,69% of total billed charges,267.38,69,,,Percent of Total Billed Charges,69% of total billed charges,325.5,84,,,Percent of Total Billed Charges,84% of total billed charges,317.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,344.88,89,,,Percent of total Billed Charges,89% of total Billed charges,344.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,158.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.38,77,,,Percent of total Billed charges,77% of total billed charges,329.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,158.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.88,344.88,
Gen endotrach anes First 15min,T990230015,CDM,370,RC,,,Outpatient,,,1000,500,,770,77,,,Percent of Total Billed Charges,77% of total billed charges,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740,74,,,Percent of Total Billed Charges,74% of total billed charges,690,69,,,Percent of Total Billed Charges,69% of total billed charges,690,69,,,Percent of Total Billed Charges,69% of total billed charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690,69,,,Percent of Total Billed Charges,69% of total billed charges,690,69,,,Percent of Total Billed Charges,69% of total billed charges,840,84,,,Percent of Total Billed Charges,84% of total billed charges,820,82,,,Percent of Total Billed Charges,82% of total billed charges ,890,89,,,Percent of total Billed Charges,89% of total Billed charges,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,77,,,Percent of total Billed charges,77% of total billed charges,850,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250,890,
Gen endotrach anes add't 15min,T990230016,CDM,370,RC,,,Outpatient,,,500,250,,385,77,,,Percent of Total Billed Charges,77% of total billed charges,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,370,74,,,Percent of Total Billed Charges,74% of total billed charges,345,69,,,Percent of Total Billed Charges,69% of total billed charges,345,69,,,Percent of Total Billed Charges,69% of total billed charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345,69,,,Percent of Total Billed Charges,69% of total billed charges,345,69,,,Percent of Total Billed Charges,69% of total billed charges,420,84,,,Percent of Total Billed Charges,84% of total billed charges,410,82,,,Percent of Total Billed Charges,82% of total billed charges ,445,500,,,fee schedule,500% of healthlink,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385,77,,,Percent of total Billed charges,77% of total billed charges,425,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125,445,
General Mask anes first 15 min,T990230017,CDM,370,RC,,,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296,74,,,Percent of Total Billed Charges,74% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,336,84,,,Percent of Total Billed Charges,84% of total billed charges,328,82,,,Percent of Total Billed Charges,82% of total billed charges ,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
General Mask anes ea addt'l 15,T990230018,CDM,370,RC,,,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,178,
IV Regional anes first 15 min,T990230019,CDM,370,RC,,,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,259,74,,,Percent of Total Billed Charges,74% of total billed charges,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,294,84,,,Percent of Total Billed Charges,84% of total billed charges,287,82,,,Percent of Total Billed Charges,82% of total billed charges ,311.5,89,,,Percent of total Billed Charges,89% of total Billed charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,175,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.5,311.5,
IV Regional anes ea addt'l 15,T990230020,CDM,370,RC,,,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.9,74,,,Percent of Total Billed Charges,74% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,155.4,84,,,Percent of Total Billed Charges,84% of total billed charges,151.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.65,89,,,Percent of total Billed Charges,89% of total Billed charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,164.65,
Spinal anesthesia first 15 min,T990230021,CDM,370,RC,,,Outpatient,,,1000,500,,770,77,,,Percent of Total Billed Charges,77% of total billed charges,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740,74,,,Percent of Total Billed Charges,74% of total billed charges,690,69,,,Percent of Total Billed Charges,69% of total billed charges,690,69,,,Percent of Total Billed Charges,69% of total billed charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690,69,,,Percent of Total Billed Charges,69% of total billed charges,690,69,,,Percent of Total Billed Charges,69% of total billed charges,840,84,,,Percent of Total Billed Charges,84% of total billed charges,820,82,,,Percent of Total Billed Charges,82% of total billed charges ,890,89,,,Percent of total Billed Charges,89% of total Billed charges,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,77,,,Percent of total Billed charges,77% of total billed charges,850,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250,890,
Spinal each addt'l 15 min,T990230022,CDM,370,RC,,,Outpatient,,,500,250,,385,77,,,Percent of Total Billed Charges,77% of total billed charges,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,370,74,,,Percent of Total Billed Charges,74% of total billed charges,345,69,,,Percent of Total Billed Charges,69% of total billed charges,345,69,,,Percent of Total Billed Charges,69% of total billed charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345,69,,,Percent of Total Billed Charges,69% of total billed charges,345,69,,,Percent of Total Billed Charges,69% of total billed charges,420,84,,,Percent of Total Billed Charges,84% of total billed charges,410,82,,,Percent of Total Billed Charges,82% of total billed charges ,445,500,,,fee schedule,500% of healthlink,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385,77,,,Percent of total Billed charges,77% of total billed charges,425,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125,445,
MAC anesthesia first 15 min,T990230023,CDM,370,RC,,,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,259,74,,,Percent of Total Billed Charges,74% of total billed charges,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,69,,,Percent of Total Billed Charges,69% of total billed charges,294,84,,,Percent of Total Billed Charges,84% of total billed charges,287,82,,,Percent of Total Billed Charges,82% of total billed charges ,311.5,89,,,Percent of total Billed Charges,89% of total Billed charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,175,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.5,311.5,
MAC anesthesia each addt'l 15,T990230024,CDM,370,RC,,,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.9,74,,,Percent of Total Billed Charges,74% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,155.4,84,,,Percent of Total Billed Charges,84% of total billed charges,151.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.65,89,,,Percent of total Billed Charges,89% of total Billed charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.25,164.65,
"Epidural for c-section, 1st hr",T990230025,CDM,370,RC,,,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296,74,,,Percent of Total Billed Charges,74% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,336,84,,,Percent of Total Billed Charges,84% of total billed charges,328,82,,,Percent of Total Billed Charges,82% of total billed charges ,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
"Epidural for c-section, ea 15m",T990230026,CDM,370,RC,,,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
I&D SIMPLE SQ CYST ABSCESS,T990300001,CDM,450,RC,10060,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,100,,,case rate,pays based on per visit,132.16,59,,,case rate,pays based on per visit,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,188.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
I & D COMPLEX SQ/CYST/ABC,T990300002,CDM,450,RC,10061,HCPCS,Outpatient,,,343,171.5,,264.11,77,,,Percent of Total Billed Charges,77% of total billed charges,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,202.37,59,,,Percent of Total Billed Charges,59% of total billed charges,202.37,100,,,case rate,pays based on per visit,202.37,59,,,case rate,pays based on per visit,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.37,59,,,Percent of Total Billed Charges,59% of total billed charges,202.37,59,,,Percent of Total Billed Charges,59% of total billed charges,288.12,84,,,Percent of Total Billed Charges,84% of total billed charges,281.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,305.27,89,,,Percent of total Billed Charges,89% of total Billed charges,288.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.11,77,,,Percent of total Billed charges,77% of total billed charges,291.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,171.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.75,305.27,
"I&D PILONIDAL CYST, SIMPLE",T990300003,CDM,450,RC,10080,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.87,59,,,Percent of Total Billed Charges,59% of total billed charges,113.87,100,,,case rate,pays based on per visit,113.87,59,,,case rate,pays based on per visit,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.87,59,,,Percent of Total Billed Charges,59% of total billed charges,113.87,59,,,Percent of Total Billed Charges,59% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.77,89,,,Percent of total Billed Charges,89% of total Billed charges,162.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.25,171.77,
"SQ RFB, SIMPLE",T990300004,CDM,450,RC,10120,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.51,59,,,Percent of Total Billed Charges,59% of total billed charges,111.51,100,,,case rate,pays based on per visit,111.51,59,,,case rate,pays based on per visit,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.51,59,,,Percent of Total Billed Charges,59% of total billed charges,111.51,59,,,Percent of Total Billed Charges,59% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.76,84,,,Percent of Total Billed Charges,84% of Total Billed charges,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.25,168.21,
SQ RFB COMPLICATED,T990300005,CDM,450,RC,10121,HCPCS,Outpatient,,,323,161.5,,248.71,77,,,Percent of Total Billed Charges,77% of total billed charges,82.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.57,59,,,Percent of Total Billed Charges,59% of total billed charges,190.57,100,,,case rate,pays based on per visit,190.57,59,,,case rate,pays based on per visit,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.57,59,,,Percent of Total Billed Charges,59% of total billed charges,190.57,59,,,Percent of Total Billed Charges,59% of total billed charges,271.32,84,,,Percent of Total Billed Charges,84% of total billed charges,264.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.47,89,,,Percent of total Billed Charges,89% of total Billed charges,271.32,84,,,Percent of Total Billed Charges,84% of Total Billed charges,287.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.71,77,,,Percent of total Billed charges,77% of total billed charges,274.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.75,287.47,
"I&D HEMATOMA, SIMPLE",T990300006,CDM,450,RC,10140,HCPCS,Outpatient,,,224.5,112.25,,172.87,77,,,Percent of Total Billed Charges,77% of total billed charges,57.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.46,59,,,Percent of Total Billed Charges,59% of total billed charges,132.46,100,,,case rate,pays based on per visit,132.46,59,,,case rate,pays based on per visit,56.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.46,59,,,Percent of Total Billed Charges,59% of total billed charges,132.46,59,,,Percent of Total Billed Charges,59% of total billed charges,188.58,84,,,Percent of Total Billed Charges,84% of total billed charges,184.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.81,89,,,Percent of total Billed Charges,89% of total Billed charges,188.58,84,,,Percent of Total Billed Charges,84% of Total Billed charges,199.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.87,77,,,Percent of total Billed charges,77% of total billed charges,190.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,199.81,
PUNCTURE ASPIRATION CYST ABCES,T990300007,CDM,450,RC,10160,HCPCS,Outpatient,,,179.5,89.75,,138.22,77,,,Percent of Total Billed Charges,77% of total billed charges,45.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.91,59,,,Percent of Total Billed Charges,59% of total billed charges,105.91,100,,,case rate,pays based on per visit,105.91,59,,,case rate,pays based on per visit,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.91,59,,,Percent of Total Billed Charges,59% of total billed charges,105.91,59,,,Percent of Total Billed Charges,59% of total billed charges,150.78,84,,,Percent of Total Billed Charges,84% of total billed charges,147.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.76,89,,,Percent of total Billed Charges,89% of total Billed charges,150.78,84,,,Percent of Total Billed Charges,84% of Total Billed charges,159.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.22,77,,,Percent of total Billed charges,77% of total billed charges,152.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.88,159.76,
DEBRIDE INF SKIN<10%BSA,T990300008,CDM,450,RC,11000,HCPCS,Outpatient,,,252.5,126.25,,194.43,77,,,Percent of Total Billed Charges,77% of total billed charges,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.98,59,,,Percent of Total Billed Charges,59% of total billed charges,148.98,100,,,case rate,pays based on per visit,148.98,59,,,case rate,pays based on per visit,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.98,59,,,Percent of Total Billed Charges,59% of total billed charges,148.98,59,,,Percent of Total Billed Charges,59% of total billed charges,212.1,84,,,Percent of Total Billed Charges,84% of total billed charges,207.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.73,89,,,Percent of total Billed Charges,89% of total Billed charges,212.1,84,,,Percent of Total Billed Charges,84% of Total Billed charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.43,77,,,Percent of total Billed charges,77% of total billed charges,214.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,126.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.13,224.73,
AVULSION NAIL,T990300009,CDM,450,RC,11730,HCPCS,Outpatient,,,239.5,119.75,,184.42,77,,,Percent of Total Billed Charges,77% of total billed charges,61.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.31,59,,,Percent of Total Billed Charges,59% of total billed charges,141.31,100,,,case rate,pays based on per visit,141.31,59,,,case rate,pays based on per visit,59.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.31,59,,,Percent of Total Billed Charges,59% of total billed charges,141.31,59,,,Percent of Total Billed Charges,59% of total billed charges,201.18,84,,,Percent of Total Billed Charges,84% of total billed charges,196.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.16,89,,,Percent of total Billed Charges,89% of total Billed charges,201.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,213.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.42,77,,,Percent of total Billed charges,77% of total billed charges,203.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.88,213.16,
SUBUNGUAL HEMATOMA,T990300010,CDM,450,RC,11740,HCPCS,Outpatient,,,162,81,,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.58,59,,,Percent of Total Billed Charges,59% of total billed charges,95.58,100,,,case rate,pays based on per visit,95.58,59,,,case rate,pays based on per visit,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.58,59,,,Percent of Total Billed Charges,59% of total billed charges,95.58,59,,,Percent of Total Billed Charges,59% of total billed charges,136.08,84,,,Percent of Total Billed Charges,84% of total billed charges,132.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.18,89,,,Percent of total Billed Charges,89% of total Billed charges,136.08,84,,,Percent of Total Billed Charges,84% of Total Billed charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,144.18,
NAIL EX PARTIAL/COMPLETE,T990300011,CDM,450,RC,11750,HCPCS,Outpatient,,,201.5,100.75,,155.16,77,,,Percent of Total Billed Charges,77% of total billed charges,51.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.89,59,,,Percent of Total Billed Charges,59% of total billed charges,118.89,100,,,case rate,pays based on per visit,118.89,59,,,case rate,pays based on per visit,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.89,59,,,Percent of Total Billed Charges,59% of total billed charges,118.89,59,,,Percent of Total Billed Charges,59% of total billed charges,169.26,84,,,Percent of Total Billed Charges,84% of total billed charges,165.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.34,89,,,Percent of total Billed Charges,89% of total Billed charges,169.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,179.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.16,77,,,Percent of total Billed charges,77% of total billed charges,171.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.38,179.34,
"LACERATIN SIMPLE, 0-2.5CM",T990300012,CDM,450,RC,12001,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LACERATION, SIMPLE 2.6-7.5 CM",T990300013,CDM,450,RC,12002,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
LACERATION SIMPLE 7.6-12.5 CM,T990300014,CDM,450,RC,12004,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,297.36,59,,,Percent of Total Billed Charges,59% of total billed charges,297.36,100,,,case rate,pays based on per visit,297.36,59,,,case rate,pays based on per visit,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.36,59,,,Percent of Total Billed Charges,59% of total billed charges,297.36,59,,,Percent of Total Billed Charges,59% of total billed charges,423.36,84,,,Percent of Total Billed Charges,84% of total billed charges,413.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,448.56,89,,,Percent of total Billed Charges,89% of total Billed charges,423.36,84,,,Percent of Total Billed Charges,84% of Total Billed charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,252,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126,448.56,
SIMPLE REPAIR 12.6-20CM,T990300015,CDM,450,RC,12005,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
"LAC, SIMPLE FACE 0-2.5 CM",T990300016,CDM,450,RC,12011,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, SIMPLE FACE 2.6-5.0CM",T990300017,CDM,450,RC,12013,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,299.72,59,,,Percent of Total Billed Charges,59% of total billed charges,299.72,100,,,case rate,pays based on per visit,299.72,59,,,case rate,pays based on per visit,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,59,,,Percent of Total Billed Charges,59% of total billed charges,299.72,59,,,Percent of Total Billed Charges,59% of total billed charges,426.72,84,,,Percent of Total Billed Charges,84% of total billed charges,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,426.72,84,,,Percent of Total Billed Charges,84% of Total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127,452.12,
"LAC, SIMPLE FACE 5.1-7.6 CM",T990300018,CDM,450,RC,12014,HCPCS,Outpatient,,,522,261,,401.94,77,,,Percent of Total Billed Charges,77% of total billed charges,133.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,307.98,59,,,Percent of Total Billed Charges,59% of total billed charges,307.98,100,,,case rate,pays based on per visit,307.98,59,,,case rate,pays based on per visit,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.98,59,,,Percent of Total Billed Charges,59% of total billed charges,307.98,59,,,Percent of Total Billed Charges,59% of total billed charges,438.48,84,,,Percent of Total Billed Charges,84% of total billed charges,428.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,464.58,89,,,Percent of total Billed Charges,89% of total Billed charges,438.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,464.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.94,77,,,Percent of total Billed charges,77% of total billed charges,443.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,261,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,212.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,464.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,464.58,
"LAC, SIMPLE FACE 7.7-12.5 CM",T990300019,CDM,450,RC,12015,HCPCS,Outpatient,,,512.5,256.25,,394.63,77,,,Percent of Total Billed Charges,77% of total billed charges,130.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.38,59,,,Percent of Total Billed Charges,59% of total billed charges,302.38,100,,,case rate,pays based on per visit,302.38,59,,,case rate,pays based on per visit,128.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.38,59,,,Percent of Total Billed Charges,59% of total billed charges,302.38,59,,,Percent of Total Billed Charges,59% of total billed charges,430.5,84,,,Percent of Total Billed Charges,84% of total billed charges,420.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,456.13,89,,,Percent of total Billed Charges,89% of total Billed charges,430.5,84,,,Percent of Total Billed Charges,84% of Total Billed charges,456.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,394.63,77,,,Percent of total Billed charges,77% of total billed charges,435.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,256.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,209.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,128.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.13,456.13,
SIMPLE REPAIR 12.6-20 CM,T990300020,CDM,450,RC,12016,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
SUPERFICICAL WOUND DEHIS,T990300021,CDM,450,RC,12020,HCPCS,Outpatient,,,247,123.5,,190.19,77,,,Percent of Total Billed Charges,77% of total billed charges,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.73,59,,,Percent of Total Billed Charges,59% of total billed charges,145.73,100,,,case rate,pays based on per visit,145.73,59,,,case rate,pays based on per visit,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.73,59,,,Percent of Total Billed Charges,59% of total billed charges,145.73,59,,,Percent of Total Billed Charges,59% of total billed charges,207.48,84,,,Percent of Total Billed Charges,84% of total billed charges,202.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.83,89,,,Percent of total Billed Charges,89% of total Billed charges,207.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.19,77,,,Percent of total Billed charges,77% of total billed charges,209.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,123.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,100.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.75,219.83,
WOUND DEHIS W PACKING,T990300022,CDM,450,RC,12021,HCPCS,Outpatient,,,280.5,140.25,,215.99,77,,,Percent of Total Billed Charges,77% of total billed charges,71.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.5,59,,,Percent of Total Billed Charges,59% of total billed charges,165.5,100,,,case rate,pays based on per visit,165.5,59,,,case rate,pays based on per visit,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.5,59,,,Percent of Total Billed Charges,59% of total billed charges,165.5,59,,,Percent of Total Billed Charges,59% of total billed charges,235.62,84,,,Percent of Total Billed Charges,84% of total billed charges,230.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,249.65,89,,,Percent of total Billed Charges,89% of total Billed charges,235.62,84,,,Percent of Total Billed Charges,84% of Total Billed charges,249.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.99,77,,,Percent of total Billed charges,77% of total billed charges,238.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.13,249.65,
"LAC, INTERMEDIATE 0-2.5 CM",T990300023,CDM,450,RC,12031,HCPCS,Outpatient,,,519,259.5,,399.63,77,,,Percent of Total Billed Charges,77% of total billed charges,132.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,306.21,59,,,Percent of Total Billed Charges,59% of total billed charges,306.21,100,,,case rate,pays based on per visit,306.21,59,,,case rate,pays based on per visit,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.21,59,,,Percent of Total Billed Charges,59% of total billed charges,306.21,59,,,Percent of Total Billed Charges,59% of total billed charges,435.96,84,,,Percent of Total Billed Charges,84% of total billed charges,425.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.91,89,,,Percent of total Billed Charges,89% of total Billed charges,435.96,84,,,Percent of Total Billed Charges,84% of Total Billed charges,461.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.63,77,,,Percent of total Billed charges,77% of total billed charges,441.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.75,461.91,
"LAC, INTERMEDIATE 2.6-7.5CM",T990300024,CDM,450,RC,12032,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
"LAC, INTERMEDIATE 7.6-12.5 CM",T990300025,CDM,450,RC,12034,HCPCS,Outpatient,,,556,278,,428.12,77,,,Percent of Total Billed Charges,77% of total billed charges,141.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.04,59,,,Percent of Total Billed Charges,59% of total billed charges,328.04,100,,,case rate,pays based on per visit,328.04,59,,,case rate,pays based on per visit,139,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.04,59,,,Percent of Total Billed Charges,59% of total billed charges,328.04,59,,,Percent of Total Billed Charges,59% of total billed charges,467.04,84,,,Percent of Total Billed Charges,84% of total billed charges,455.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,494.84,89,,,Percent of total Billed Charges,89% of total Billed charges,467.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,494.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,226.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.12,77,,,Percent of total Billed charges,77% of total billed charges,472.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,159.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,226.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,494.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139,494.84,
LAC REPR INTERM 12.6CM-20.0CM,T990300026,CDM,450,RC,12035,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, INTERMEDIATE 0-2.5CM",T990300027,CDM,450,RC,12041,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
"LAC, INTERMEDIATE 2.6-7.5CM",T990300028,CDM,450,RC,12042,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
"LAC, INTERMEDIATE 7.6-12.5CM",T990300029,CDM,450,RC,12044,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
INTERMED REPAIR 12.6-20 CM,T990300030,CDM,450,RC,12045,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
INTERMED REPAIR: 20.1-30.0 CM,T990300031,CDM,450,RC,12046,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, INTERMEDIATE 0-2.5CM",T990300032,CDM,450,RC,12051,HCPCS,Outpatient,,,547.5,273.75,,421.58,77,,,Percent of Total Billed Charges,77% of total billed charges,139.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.03,59,,,Percent of Total Billed Charges,59% of total billed charges,323.03,100,,,case rate,pays based on per visit,323.03,59,,,case rate,pays based on per visit,136.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.03,59,,,Percent of Total Billed Charges,59% of total billed charges,323.03,59,,,Percent of Total Billed Charges,59% of total billed charges,459.9,84,,,Percent of Total Billed Charges,84% of total billed charges,448.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,487.28,89,,,Percent of total Billed Charges,89% of total Billed charges,459.9,84,,,Percent of Total Billed Charges,84% of Total Billed charges,487.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.58,77,,,Percent of total Billed charges,77% of total billed charges,465.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,273.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,223.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,487.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,487.28,
"LAC, INTERMEDIATE 2.6-5 CM",T990300033,CDM,450,RC,12052,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
"LAC, INTERMEDIATE 5.1-7.5 CM",T990300034,CDM,450,RC,12053,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
INTERMED REPAIR 7.6-12.5 CM,T990300035,CDM,450,RC,12054,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
INTERMED REPAIR 12.6-20 CM,T990300036,CDM,450,RC,12055,HCPCS,Outpatient,,,581,290.5,,447.37,77,,,Percent of Total Billed Charges,77% of total billed charges,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,100,,,case rate,pays based on per visit,342.79,59,,,case rate,pays based on per visit,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,342.79,59,,,Percent of Total Billed Charges,59% of total billed charges,488.04,84,,,Percent of Total Billed Charges,84% of total billed charges,476.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.09,89,,,Percent of total Billed Charges,89% of total Billed charges,488.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.37,77,,,Percent of total Billed charges,77% of total billed charges,493.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,290.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,237.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,517.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,517.09,
"LAC, COMPLEX 1.1-2.5CM",T990300037,CDM,450,RC,13100,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 2.6-7.5CM",T990300038,CDM,450,RC,13101,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 1.1-2.5CM",T990300039,CDM,450,RC,13120,HCPCS,Outpatient,,,714.5,357.25,,550.17,77,,,Percent of Total Billed Charges,77% of total billed charges,182.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,421.56,59,,,Percent of Total Billed Charges,59% of total billed charges,421.56,100,,,case rate,pays based on per visit,421.56,59,,,case rate,pays based on per visit,178.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.56,59,,,Percent of Total Billed Charges,59% of total billed charges,421.56,59,,,Percent of Total Billed Charges,59% of total billed charges,600.18,84,,,Percent of Total Billed Charges,84% of total billed charges,585.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,635.91,89,,,Percent of total Billed Charges,89% of total Billed charges,600.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,635.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.17,77,,,Percent of total Billed charges,77% of total billed charges,607.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,205.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,357.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,291.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.63,635.91,
"LAC, COMPLEX 2.6-7.5CM",T990300040,CDM,450,RC,13121,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 1.1-2.5CM",T990300041,CDM,450,RC,13131,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 2.6-7.5CM",T990300042,CDM,450,RC,13132,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 0-1.0 CM",T990300043,CDM,450,RC,13133,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 1.1-2.5CM",T990300044,CDM,450,RC,13151,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
"LAC, COMPLEX 2.6-7.5CM",T990300045,CDM,450,RC,13152,HCPCS,Outpatient,,,465.5,232.75,,358.44,77,,,Percent of Total Billed Charges,77% of total billed charges,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,100,,,case rate,pays based on per visit,274.65,59,,,case rate,pays based on per visit,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,274.65,59,,,Percent of Total Billed Charges,59% of total billed charges,391.02,84,,,Percent of Total Billed Charges,84% of total billed charges,381.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.3,89,,,Percent of total Billed Charges,89% of total Billed charges,391.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.44,77,,,Percent of total Billed charges,77% of total billed charges,395.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.38,414.3,
1ST DEGREE BURN LOCAL TX,T990300046,CDM,450,RC,16000,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,84.37,100,,,case rate,pays based on per visit,84.37,59,,,case rate,pays based on per visit,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.27,89,,,Percent of total Billed Charges,89% of total Billed charges,120.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.75,127.27,
"DRESSINGS/DEBRIDE, SMALL BURN",T990300047,CDM,450,RC,16020,HCPCS,Outpatient,,,228.5,114.25,,175.95,77,,,Percent of Total Billed Charges,77% of total billed charges,58.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.82,59,,,Percent of Total Billed Charges,59% of total billed charges,134.82,100,,,case rate,pays based on per visit,134.82,59,,,case rate,pays based on per visit,57.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.82,59,,,Percent of Total Billed Charges,59% of total billed charges,134.82,59,,,Percent of Total Billed Charges,59% of total billed charges,191.94,84,,,Percent of Total Billed Charges,84% of total billed charges,187.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,203.37,89,,,Percent of total Billed Charges,89% of total Billed charges,191.94,84,,,Percent of Total Billed Charges,84% of Total Billed charges,203.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.95,77,,,Percent of total Billed charges,77% of total billed charges,194.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,114.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,93.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.13,203.37,
MEDIUM FACE/WHOLE EXT BURN,T990300048,CDM,450,RC,16025,HCPCS,Outpatient,,,251.5,125.75,,193.66,77,,,Percent of Total Billed Charges,77% of total billed charges,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,148.39,100,,,case rate,pays based on per visit,148.39,59,,,case rate,pays based on per visit,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,211.26,84,,,Percent of Total Billed Charges,84% of total billed charges,206.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.84,89,,,Percent of total Billed Charges,89% of total Billed charges,211.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.66,77,,,Percent of total Billed charges,77% of total billed charges,213.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.88,223.84,
LARGE BURN (>1 EXTREMITY),T990300049,CDM,450,RC,16030,HCPCS,Outpatient,,,289,144.5,,222.53,77,,,Percent of Total Billed Charges,77% of total billed charges,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,170.51,59,,,Percent of Total Billed Charges,59% of total billed charges,170.51,100,,,case rate,pays based on per visit,170.51,59,,,case rate,pays based on per visit,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.51,59,,,Percent of Total Billed Charges,59% of total billed charges,170.51,59,,,Percent of Total Billed Charges,59% of total billed charges,242.76,84,,,Percent of Total Billed Charges,84% of total billed charges,236.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,257.21,89,,,Percent of total Billed Charges,89% of total Billed charges,242.76,84,,,Percent of Total Billed Charges,84% of Total Billed charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,77,,,Percent of total Billed charges,77% of total billed charges,245.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,144.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.25,257.21,
"DESTRUC PREMALIG LESIONS, 1ST",T990300050,CDM,450,RC,17000,HCPCS,Outpatient,,,202,101,,155.54,77,,,Percent of Total Billed Charges,77% of total billed charges,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.18,59,,,Percent of Total Billed Charges,59% of total billed charges,119.18,100,,,case rate,pays based on per visit,119.18,59,,,case rate,pays based on per visit,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.18,59,,,Percent of Total Billed Charges,59% of total billed charges,119.18,59,,,Percent of Total Billed Charges,59% of total billed charges,169.68,84,,,Percent of Total Billed Charges,84% of total billed charges,165.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.78,89,,,Percent of total Billed Charges,89% of total Billed charges,169.68,84,,,Percent of Total Billed Charges,84% of Total Billed charges,179.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.54,77,,,Percent of total Billed charges,77% of total billed charges,171.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.5,179.78,
EXP PENETRATE WOUND/EXTREMITY,T990300051,CDM,450,RC,20103,HCPCS,Outpatient,,,776.5,388.25,,597.91,77,,,Percent of Total Billed Charges,77% of total billed charges,198.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,458.14,100,,,case rate,pays based on per visit,458.14,59,,,case rate,pays based on per visit,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,652.26,84,,,Percent of Total Billed Charges,84% of total billed charges,636.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,691.09,89,,,Percent of total Billed Charges,89% of total Billed charges,652.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,691.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.91,77,,,Percent of total Billed charges,77% of total billed charges,660.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,388.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.13,691.09,
"RFB MUSCLE, SIMPLE",T990300052,CDM,450,RC,20520,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,100,,,case rate,pays based on per visit,132.16,59,,,case rate,pays based on per visit,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,188.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
RFB MUSCLE DEEP/COMPLEX,T990300053,CDM,450,RC,20525,HCPCS,Outpatient,,,376,188,,289.52,77,,,Percent of Total Billed Charges,77% of total billed charges,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.84,59,,,Percent of Total Billed Charges,59% of total billed charges,221.84,100,,,case rate,pays based on per visit,221.84,59,,,case rate,pays based on per visit,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.84,59,,,Percent of Total Billed Charges,59% of total billed charges,221.84,59,,,Percent of Total Billed Charges,59% of total billed charges,315.84,84,,,Percent of Total Billed Charges,84% of total billed charges,308.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,334.64,89,,,Percent of total Billed Charges,89% of total Billed charges,315.84,84,,,Percent of Total Billed Charges,84% of Total Billed charges,334.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.52,77,,,Percent of total Billed charges,77% of total billed charges,319.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94,334.64,
SM JOINT ARTHROCENT/INJ BURSA,T990300054,CDM,450,RC,20600,HCPCS,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.65,59,,,Percent of Total Billed Charges,59% of total billed charges,79.65,100,,,case rate,pays based on per visit,79.65,59,,,case rate,pays based on per visit,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.65,59,,,Percent of Total Billed Charges,59% of total billed charges,79.65,59,,,Percent of Total Billed Charges,59% of total billed charges,113.4,84,,,Percent of Total Billed Charges,84% of total billed charges,110.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.15,89,,,Percent of total Billed Charges,89% of total Billed charges,113.4,84,,,Percent of Total Billed Charges,84% of Total Billed charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,120.15,
INTERMED JNT ARTHRO/INJ BURSA,T990300055,CDM,450,RC,20605,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.68,59,,,Percent of Total Billed Charges,59% of total billed charges,89.68,100,,,case rate,pays based on per visit,89.68,59,,,case rate,pays based on per visit,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.68,59,,,Percent of Total Billed Charges,59% of total billed charges,89.68,59,,,Percent of Total Billed Charges,59% of total billed charges,127.68,84,,,Percent of Total Billed Charges,84% of total billed charges,124.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.28,89,,,Percent of total Billed Charges,89% of total Billed charges,127.68,84,,,Percent of Total Billed Charges,84% of Total Billed charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38,135.28,
MAJOR JOINT ARTHROCE/INJ BURSA,T990300056,CDM,450,RC,20610,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,100,,,case rate,pays based on per visit,132.16,59,,,case rate,pays based on per visit,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,188.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
"FX, ORBIT",T990300057,CDM,450,RC,21400,HCPCS,Outpatient,,,295.5,147.75,,227.54,77,,,Percent of Total Billed Charges,77% of total billed charges,75.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.35,59,,,Percent of Total Billed Charges,59% of total billed charges,174.35,100,,,case rate,pays based on per visit,174.35,59,,,case rate,pays based on per visit,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.35,59,,,Percent of Total Billed Charges,59% of total billed charges,174.35,59,,,Percent of Total Billed Charges,59% of total billed charges,248.22,84,,,Percent of Total Billed Charges,84% of total billed charges,242.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,263,89,,,Percent of total Billed Charges,89% of total Billed charges,248.22,84,,,Percent of Total Billed Charges,84% of Total Billed charges,263,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.54,77,,,Percent of total Billed charges,77% of total billed charges,251.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,120.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.88,263,
"FX, MANDIBLE",T990300058,CDM,450,RC,21450,HCPCS,Outpatient,,,333,166.5,,256.41,77,,,Percent of Total Billed Charges,77% of total billed charges,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,196.47,100,,,case rate,pays based on per visit,196.47,59,,,case rate,pays based on per visit,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,279.72,84,,,Percent of Total Billed Charges,84% of total billed charges,273.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,296.37,89,,,Percent of total Billed Charges,89% of total Billed charges,279.72,84,,,Percent of Total Billed Charges,84% of Total Billed charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.41,77,,,Percent of total Billed charges,77% of total billed charges,283.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.25,296.37,
TMJ DISLOCATION,T990300059,CDM,450,RC,21480,HCPCS,Outpatient,,,259,129.5,,199.43,77,,,Percent of Total Billed Charges,77% of total billed charges,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.81,59,,,Percent of Total Billed Charges,59% of total billed charges,152.81,100,,,case rate,pays based on per visit,152.81,59,,,case rate,pays based on per visit,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.81,59,,,Percent of Total Billed Charges,59% of total billed charges,152.81,59,,,Percent of Total Billed Charges,59% of total billed charges,217.56,84,,,Percent of Total Billed Charges,84% of total billed charges,212.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.51,89,,,Percent of total Billed Charges,89% of total Billed charges,217.56,84,,,Percent of Total Billed Charges,84% of Total Billed charges,230.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,77,,,Percent of total Billed charges,77% of total billed charges,220.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.75,230.51,
"FX, STERNUM, CLOSED",T990300060,CDM,450,RC,21820,HCPCS,Outpatient,,,309,154.5,,237.93,77,,,Percent of Total Billed Charges,77% of total billed charges,78.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.31,59,,,Percent of Total Billed Charges,59% of total billed charges,182.31,100,,,case rate,pays based on per visit,182.31,59,,,case rate,pays based on per visit,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.31,59,,,Percent of Total Billed Charges,59% of total billed charges,182.31,59,,,Percent of Total Billed Charges,59% of total billed charges,259.56,84,,,Percent of Total Billed Charges,84% of total billed charges,253.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,275.01,89,,,Percent of total Billed Charges,89% of total Billed charges,259.56,84,,,Percent of Total Billed Charges,84% of Total Billed charges,275.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.93,77,,,Percent of total Billed charges,77% of total billed charges,262.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,154.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.25,275.01,
"FX, CERVICAL SPINE",T990300061,CDM,450,RC,22310,HCPCS,Outpatient,,,380.5,190.25,,292.99,77,,,Percent of Total Billed Charges,77% of total billed charges,97.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.5,59,,,Percent of Total Billed Charges,59% of total billed charges,224.5,100,,,case rate,pays based on per visit,224.5,59,,,case rate,pays based on per visit,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.5,59,,,Percent of Total Billed Charges,59% of total billed charges,224.5,59,,,Percent of Total Billed Charges,59% of total billed charges,319.62,84,,,Percent of Total Billed Charges,84% of total billed charges,312.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,338.65,89,,,Percent of total Billed Charges,89% of total Billed charges,319.62,84,,,Percent of Total Billed Charges,84% of Total Billed charges,338.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.99,77,,,Percent of total Billed charges,77% of total billed charges,323.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,190.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,155.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.13,338.65,
"FX, CLAVICLE W/O MANIP",T990300062,CDM,450,RC,23500,HCPCS,Outpatient,,,375,187.5,,288.75,77,,,Percent of Total Billed Charges,77% of total billed charges,95.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.25,59,,,Percent of Total Billed Charges,59% of total billed charges,221.25,100,,,case rate,pays based on per visit,221.25,59,,,case rate,pays based on per visit,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.25,59,,,Percent of Total Billed Charges,59% of total billed charges,221.25,59,,,Percent of Total Billed Charges,59% of total billed charges,315,84,,,Percent of Total Billed Charges,84% of total billed charges,307.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.75,89,,,Percent of total Billed Charges,89% of total Billed charges,315,84,,,Percent of Total Billed Charges,84% of Total Billed charges,333.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.75,77,,,Percent of total Billed charges,77% of total billed charges,318.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.75,333.75,
"FX, CLAVICLE W/MANIPULATION",T990300063,CDM,450,RC,23505,HCPCS,Outpatient,,,526.5,263.25,,405.41,77,,,Percent of Total Billed Charges,77% of total billed charges,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,310.64,59,,,Percent of Total Billed Charges,59% of total billed charges,310.64,100,,,case rate,pays based on per visit,310.64,59,,,case rate,pays based on per visit,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.64,59,,,Percent of Total Billed Charges,59% of total billed charges,310.64,59,,,Percent of Total Billed Charges,59% of total billed charges,442.26,84,,,Percent of Total Billed Charges,84% of total billed charges,431.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,468.59,89,,,Percent of total Billed Charges,89% of total Billed charges,442.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,468.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.41,77,,,Percent of total Billed charges,77% of total billed charges,447.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,263.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.63,468.59,
FX ACROMIOCLAVICULAR,T990300064,CDM,450,RC,23540,HCPCS,Outpatient,,,368,184,,283.36,77,,,Percent of Total Billed Charges,77% of total billed charges,93.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.12,59,,,Percent of Total Billed Charges,59% of total billed charges,217.12,100,,,case rate,pays based on per visit,217.12,59,,,case rate,pays based on per visit,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.12,59,,,Percent of Total Billed Charges,59% of total billed charges,217.12,59,,,Percent of Total Billed Charges,59% of total billed charges,309.12,84,,,Percent of Total Billed Charges,84% of total billed charges,301.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,327.52,89,,,Percent of total Billed Charges,89% of total Billed charges,309.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,327.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.36,77,,,Percent of total Billed charges,77% of total billed charges,312.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92,327.52,
"FX, SCAPULAR W/O MANIP",T990300065,CDM,450,RC,23570,HCPCS,Outpatient,,,326,163,,251.02,77,,,Percent of Total Billed Charges,77% of total billed charges,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.34,59,,,Percent of Total Billed Charges,59% of total billed charges,192.34,100,,,case rate,pays based on per visit,192.34,59,,,case rate,pays based on per visit,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.34,59,,,Percent of Total Billed Charges,59% of total billed charges,192.34,59,,,Percent of Total Billed Charges,59% of total billed charges,273.84,84,,,Percent of Total Billed Charges,84% of total billed charges,267.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,290.14,89,,,Percent of total Billed Charges,89% of total Billed charges,273.84,84,,,Percent of Total Billed Charges,84% of Total Billed charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.02,77,,,Percent of total Billed charges,77% of total billed charges,277.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.5,290.14,
"FX, HUMORAL NECK W/O MANIP",T990300066,CDM,450,RC,23600,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, HUMERAL TUBERSITY W/O MANP",T990300067,CDM,450,RC,23620,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
SHLDER DISLOC W/MANIP W/O ANES,T990300068,CDM,450,RC,23650,HCPCS,Outpatient,,,607.5,303.75,,467.78,77,,,Percent of Total Billed Charges,77% of total billed charges,154.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,358.43,59,,,Percent of Total Billed Charges,59% of total billed charges,358.43,100,,,case rate,pays based on per visit,358.43,59,,,case rate,pays based on per visit,151.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.43,59,,,Percent of Total Billed Charges,59% of total billed charges,358.43,59,,,Percent of Total Billed Charges,59% of total billed charges,510.3,84,,,Percent of Total Billed Charges,84% of total billed charges,498.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,540.68,89,,,Percent of total Billed Charges,89% of total Billed charges,510.3,84,,,Percent of Total Billed Charges,84% of Total Billed charges,540.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,247.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,247.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.78,77,,,Percent of total Billed charges,77% of total billed charges,516.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,174.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,303.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,247.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,151.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.88,540.68,
SHOULDER DISLOC W/MANIP W/ANES,T990300069,CDM,450,RC,23655,HCPCS,Outpatient,,,713.5,356.75,,549.4,77,,,Percent of Total Billed Charges,77% of total billed charges,181.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,420.97,59,,,Percent of Total Billed Charges,59% of total billed charges,420.97,100,,,case rate,pays based on per visit,420.97,59,,,case rate,pays based on per visit,178.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.97,59,,,Percent of Total Billed Charges,59% of total billed charges,420.97,59,,,Percent of Total Billed Charges,59% of total billed charges,599.34,84,,,Percent of Total Billed Charges,84% of total billed charges,585.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,635.02,89,,,Percent of total Billed Charges,89% of total Billed charges,599.34,84,,,Percent of Total Billed Charges,84% of Total Billed charges,635.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.4,77,,,Percent of total Billed charges,77% of total billed charges,606.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,205.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,356.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,291.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,178.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.38,635.02,
"RFB, SQ UPPER ARM",T990300070,CDM,450,RC,24200,HCPCS,Outpatient,,,293,146.5,,225.61,77,,,Percent of Total Billed Charges,77% of total billed charges,74.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.87,59,,,Percent of Total Billed Charges,59% of total billed charges,172.87,100,,,case rate,pays based on per visit,172.87,59,,,case rate,pays based on per visit,73.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.87,59,,,Percent of Total Billed Charges,59% of total billed charges,172.87,59,,,Percent of Total Billed Charges,59% of total billed charges,246.12,84,,,Percent of Total Billed Charges,84% of total billed charges,240.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,260.77,89,,,Percent of total Billed Charges,89% of total Billed charges,246.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,260.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.61,77,,,Percent of total Billed charges,77% of total billed charges,249.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.25,260.77,
"FX, HUMORAL SHAFT W/0 MANIP",T990300071,CDM,450,RC,24500,HCPCS,Outpatient,,,375,187.5,,288.75,77,,,Percent of Total Billed Charges,77% of total billed charges,95.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.25,59,,,Percent of Total Billed Charges,59% of total billed charges,221.25,100,,,case rate,pays based on per visit,221.25,59,,,case rate,pays based on per visit,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.25,59,,,Percent of Total Billed Charges,59% of total billed charges,221.25,59,,,Percent of Total Billed Charges,59% of total billed charges,315,84,,,Percent of Total Billed Charges,84% of total billed charges,307.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.75,89,,,Percent of total Billed Charges,89% of total Billed charges,315,84,,,Percent of Total Billed Charges,84% of Total Billed charges,333.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.75,77,,,Percent of total Billed charges,77% of total billed charges,318.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.75,333.75,
FX SUPRA/TRANSCONDYL W/O MANIP,T990300072,CDM,450,RC,24530,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, HUM EPICONDYLAR, W/O MANIP",T990300073,CDM,450,RC,24560,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
ELBOW DISLOCATION W/O ANES,T990300074,CDM,450,RC,24600,HCPCS,Outpatient,,,539.5,269.75,,415.42,77,,,Percent of Total Billed Charges,77% of total billed charges,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,318.31,100,,,case rate,pays based on per visit,318.31,59,,,case rate,pays based on per visit,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,453.18,84,,,Percent of Total Billed Charges,84% of total billed charges,442.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,480.16,89,,,Percent of total Billed Charges,89% of total Billed charges,453.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.42,77,,,Percent of total Billed charges,77% of total billed charges,458.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,269.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.88,480.16,
ELBOW DISLOCATION W/ANES,T990300075,CDM,450,RC,24605,HCPCS,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,100,,,case rate,pays based on per visit,366.98,59,,,case rate,pays based on per visit,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,522.48,84,,,Percent of Total Billed Charges,84% of total billed charges,510.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,522.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,311,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
CLSD TX MONTEGA FX DISLOC ELBO,T990300076,CDM,450,RC,24620,HCPCS,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,100,,,case rate,pays based on per visit,366.98,59,,,case rate,pays based on per visit,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,522.48,84,,,Percent of Total Billed Charges,84% of total billed charges,510.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,522.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,311,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
NURSMAIDS ELBOW W/MANIP,T990300077,CDM,450,RC,24640,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX RADIAL HEAD/NECK W/O MANIP,T990300078,CDM,450,RC,24650,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
Radial Head Fx w/Manipulation,T990300079,CDM,450,RC,24655,HCPCS,Outpatient,,,526.5,263.25,,405.41,77,,,Percent of Total Billed Charges,77% of total billed charges,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,310.64,59,,,Percent of Total Billed Charges,59% of total billed charges,310.64,100,,,case rate,pays based on per visit,310.64,59,,,case rate,pays based on per visit,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.64,59,,,Percent of Total Billed Charges,59% of total billed charges,310.64,59,,,Percent of Total Billed Charges,59% of total billed charges,442.26,84,,,Percent of Total Billed Charges,84% of total billed charges,431.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,468.59,89,,,Percent of total Billed Charges,89% of total Billed charges,442.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,468.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.41,77,,,Percent of total Billed charges,77% of total billed charges,447.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,263.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,214.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.63,468.59,
FX ULNA PROXIMA W/O MANIP,T990300080,CDM,450,RC,24670,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, CLSD RADIAL SHAFT W/O MANI",T990300081,CDM,450,RC,25500,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, ULNA SHAFT W/O MANIP",T990300082,CDM,450,RC,25530,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, RADIAL&ULNA SHFT W/O MANIP",T990300083,CDM,450,RC,25560,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, RADIAL&ULNA SHFT W/MANIP",T990300084,CDM,450,RC,25565,HCPCS,Outpatient,,,1071,535.5,,824.67,77,,,Percent of Total Billed Charges,77% of total billed charges,273.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,334.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.89,59,,,Percent of Total Billed Charges,59% of total billed charges,631.89,100,,,case rate,pays based on per visit,631.89,59,,,case rate,pays based on per visit,267.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,631.89,59,,,Percent of Total Billed Charges,59% of total billed charges,631.89,59,,,Percent of Total Billed Charges,59% of total billed charges,899.64,84,,,Percent of Total Billed Charges,84% of total billed charges,878.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,953.19,89,,,Percent of total Billed Charges,89% of total Billed charges,899.64,84,,,Percent of Total Billed Charges,84% of Total Billed charges,953.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,436.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,436.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.67,77,,,Percent of total Billed charges,77% of total billed charges,910.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,535.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,436.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.75,953.19,
"FX, RADIAL DISTAL W/O MANIP",T990300085,CDM,450,RC,25600,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX CARPEL/SCAPHOID W/O MANIP,T990300086,CDM,450,RC,25622,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, CARPAL W/O MANIP EA BONE",T990300087,CDM,450,RC,25630,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,100,,,case rate,pays based on per visit,99.12,59,,,case rate,pays based on per visit,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,141.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
"FX,RADI/INER CARP DISLOC W/MAN",T990300088,CDM,450,RC,25660,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,189.39,100,,,case rate,pays based on per visit,189.39,59,,,case rate,pays based on per visit,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,285.69,89,,,Percent of total Billed Charges,89% of total Billed charges,269.64,84,,,Percent of Total Billed Charges,84% of Total Billed charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,160.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,285.69,
"DRAINAGE FINGER ABSC, SIMPLE",T990300089,CDM,450,RC,26010,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,100,,,case rate,pays based on per visit,132.16,59,,,case rate,pays based on per visit,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,132.16,59,,,Percent of Total Billed Charges,59% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,188.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56,199.36,
"FX METACARPAL W/O MANIP, EACH",T990300091,CDM,450,RC,26600,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,100,,,case rate,pays based on per visit,99.12,59,,,case rate,pays based on per visit,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,141.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
"FX, METACARPAL W/MANIP EA BONE",T990300092,CDM,450,RC,26605,HCPCS,Outpatient,,,400.5,200.25,,308.39,77,,,Percent of Total Billed Charges,77% of total billed charges,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,100,,,case rate,pays based on per visit,236.3,59,,,case rate,pays based on per visit,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,336.42,84,,,Percent of Total Billed Charges,84% of total billed charges,328.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.45,89,,,Percent of total Billed Charges,89% of total Billed charges,336.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.39,77,,,Percent of total Billed charges,77% of total billed charges,340.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.13,356.45,
"DISLOCATION THUMB, W/MANIP",T990300093,CDM,450,RC,26641,HCPCS,Outpatient,,,333,166.5,,256.41,77,,,Percent of Total Billed Charges,77% of total billed charges,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,196.47,100,,,case rate,pays based on per visit,196.47,59,,,case rate,pays based on per visit,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,279.72,84,,,Percent of Total Billed Charges,84% of total billed charges,273.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,296.37,89,,,Percent of total Billed Charges,89% of total Billed charges,279.72,84,,,Percent of Total Billed Charges,84% of Total Billed charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.41,77,,,Percent of total Billed charges,77% of total billed charges,283.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.25,296.37,
FX & DISLOC THUMB W MANIP,T990300094,CDM,450,RC,26645,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
MCP DISLOC W/MANIP W/O ANES,T990300095,CDM,450,RC,26700,HCPCS,Outpatient,,,333,166.5,,256.41,77,,,Percent of Total Billed Charges,77% of total billed charges,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,196.47,100,,,case rate,pays based on per visit,196.47,59,,,case rate,pays based on per visit,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,196.47,59,,,Percent of Total Billed Charges,59% of total billed charges,279.72,84,,,Percent of Total Billed Charges,84% of total billed charges,273.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,296.37,89,,,Percent of total Billed Charges,89% of total Billed charges,279.72,84,,,Percent of Total Billed Charges,84% of Total Billed charges,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.41,77,,,Percent of total Billed charges,77% of total billed charges,283.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.25,296.37,
FX PROX/MIDPHALNX W/O MANIP EA,T990300096,CDM,450,RC,26720,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.9,59,,,Percent of Total Billed Charges,59% of total billed charges,123.9,100,,,case rate,pays based on per visit,123.9,59,,,case rate,pays based on per visit,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.9,59,,,Percent of Total Billed Charges,59% of total billed charges,123.9,59,,,Percent of Total Billed Charges,59% of total billed charges,176.4,84,,,Percent of Total Billed Charges,84% of total billed charges,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.9,89,,,Percent of total Billed Charges,89% of total Billed charges,176.4,84,,,Percent of Total Billed Charges,84% of Total Billed charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.5,186.9,
"FX, PHALANGEAL PROX W/MANIP EA",T990300097,CDM,450,RC,26725,HCPCS,Outpatient,,,314.5,157.25,,242.17,77,,,Percent of Total Billed Charges,77% of total billed charges,80.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.56,59,,,Percent of Total Billed Charges,59% of total billed charges,185.56,100,,,case rate,pays based on per visit,185.56,59,,,case rate,pays based on per visit,78.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.56,59,,,Percent of Total Billed Charges,59% of total billed charges,185.56,59,,,Percent of Total Billed Charges,59% of total billed charges,264.18,84,,,Percent of Total Billed Charges,84% of total billed charges,257.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,279.91,89,,,Percent of total Billed Charges,89% of total Billed charges,264.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,279.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.17,77,,,Percent of total Billed charges,77% of total billed charges,267.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.63,279.91,
FX DISTAL PHALANG W/O MANIP EA,T990300098,CDM,450,RC,26750,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,100,,,case rate,pays based on per visit,99.12,59,,,case rate,pays based on per visit,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,141.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
FX DISTAL PHALANG W/MANIP EA,T990300099,CDM,450,RC,26755,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.42,59,,,Percent of Total Billed Charges,59% of total billed charges,140.42,100,,,case rate,pays based on per visit,140.42,59,,,case rate,pays based on per visit,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,59,,,Percent of Total Billed Charges,59% of total billed charges,140.42,59,,,Percent of Total Billed Charges,59% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,199.92,84,,,Percent of Total Billed Charges,84% of Total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,211.82,
DIP/PIP DISLO W/MP W/O ANES EA,T990300100,CDM,450,RC,26770,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,241.9,59,,,Percent of Total Billed Charges,59% of total billed charges,241.9,100,,,case rate,pays based on per visit,241.9,59,,,case rate,pays based on per visit,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.9,59,,,Percent of Total Billed Charges,59% of total billed charges,241.9,59,,,Percent of Total Billed Charges,59% of total billed charges,344.4,84,,,Percent of Total Billed Charges,84% of total billed charges,336.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,344.4,84,,,Percent of Total Billed Charges,84% of Total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,205,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.5,364.9,
"FX, PELVIC RING W/0 MANIP",T990300101,CDM,450,RC,27197,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX COCCYX/SACRAL,T990300102,CDM,450,RC,27200,HCPCS,Outpatient,,,317,158.5,,244.09,77,,,Percent of Total Billed Charges,77% of total billed charges,80.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.03,59,,,Percent of Total Billed Charges,59% of total billed charges,187.03,100,,,case rate,pays based on per visit,187.03,59,,,case rate,pays based on per visit,79.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.03,59,,,Percent of Total Billed Charges,59% of total billed charges,187.03,59,,,Percent of Total Billed Charges,59% of total billed charges,266.28,84,,,Percent of Total Billed Charges,84% of total billed charges,259.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.13,89,,,Percent of total Billed Charges,89% of total Billed charges,266.28,84,,,Percent of Total Billed Charges,84% of Total Billed charges,282.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.09,77,,,Percent of total Billed charges,77% of total billed charges,269.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.25,282.13,
"FX, FEMUR-PROX, NECK W/O MANIP",T990300103,CDM,450,RC,27230,HCPCS,Outpatient,,,396.5,198.25,,305.31,77,,,Percent of Total Billed Charges,77% of total billed charges,101.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.94,59,,,Percent of Total Billed Charges,59% of total billed charges,233.94,100,,,case rate,pays based on per visit,233.94,59,,,case rate,pays based on per visit,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.94,59,,,Percent of Total Billed Charges,59% of total billed charges,233.94,59,,,Percent of Total Billed Charges,59% of total billed charges,333.06,84,,,Percent of Total Billed Charges,84% of total billed charges,325.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,352.89,89,,,Percent of total Billed Charges,89% of total Billed charges,333.06,84,,,Percent of Total Billed Charges,84% of Total Billed charges,352.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.31,77,,,Percent of total Billed charges,77% of total billed charges,337.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,198.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,352.89,
"FX,CLSD TX FEMORAL W/O MANIP",T990300104,CDM,450,RC,27238,HCPCS,Outpatient,,,396.5,198.25,,305.31,77,,,Percent of Total Billed Charges,77% of total billed charges,101.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.94,59,,,Percent of Total Billed Charges,59% of total billed charges,233.94,100,,,case rate,pays based on per visit,233.94,59,,,case rate,pays based on per visit,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.94,59,,,Percent of Total Billed Charges,59% of total billed charges,233.94,59,,,Percent of Total Billed Charges,59% of total billed charges,333.06,84,,,Percent of Total Billed Charges,84% of total billed charges,325.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,352.89,89,,,Percent of total Billed Charges,89% of total Billed charges,333.06,84,,,Percent of Total Billed Charges,84% of Total Billed charges,352.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.31,77,,,Percent of total Billed charges,77% of total billed charges,337.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,198.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,352.89,
DISLOCATION HIP W/O ANES,T990300105,CDM,450,RC,27250,HCPCS,Outpatient,,,776.5,388.25,,597.91,77,,,Percent of Total Billed Charges,77% of total billed charges,198.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,458.14,100,,,case rate,pays based on per visit,458.14,59,,,case rate,pays based on per visit,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,652.26,84,,,Percent of Total Billed Charges,84% of total billed charges,636.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,691.09,89,,,Percent of total Billed Charges,89% of total Billed charges,652.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,691.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.91,77,,,Percent of total Billed charges,77% of total billed charges,660.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,388.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.13,691.09,
DISLOCATION HIP W/ANES,T990300106,CDM,450,RC,27252,HCPCS,Outpatient,,,776.5,388.25,,597.91,77,,,Percent of Total Billed Charges,77% of total billed charges,198.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,458.14,100,,,case rate,pays based on per visit,458.14,59,,,case rate,pays based on per visit,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,458.14,59,,,Percent of Total Billed Charges,59% of total billed charges,652.26,84,,,Percent of Total Billed Charges,84% of total billed charges,636.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,691.09,89,,,Percent of total Billed Charges,89% of total Billed charges,652.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,691.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.91,77,,,Percent of total Billed charges,77% of total billed charges,660.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,388.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,316.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.13,691.09,
"FX, FEMUR SHAFT W/O MANIP",T990300107,CDM,450,RC,27500,HCPCS,Outpatient,,,799,399.5,,615.23,77,,,Percent of Total Billed Charges,77% of total billed charges,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,471.41,59,,,Percent of Total Billed Charges,59% of total billed charges,471.41,100,,,case rate,pays based on per visit,471.41,59,,,case rate,pays based on per visit,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,471.41,59,,,Percent of Total Billed Charges,59% of total billed charges,471.41,59,,,Percent of Total Billed Charges,59% of total billed charges,671.16,84,,,Percent of Total Billed Charges,84% of total billed charges,655.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,711.11,89,,,Percent of total Billed Charges,89% of total Billed charges,671.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,711.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,615.23,77,,,Percent of total Billed charges,77% of total billed charges,679.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,399.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.75,711.11,
FX PATELLA CLOSED W/O MANIP,T990300108,CDM,450,RC,27520,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX TIBIAL PLATEAU W/O MANIP,T990300109,CDM,450,RC,27530,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX INTERCON SPINE W OR W/O MAN,T990300110,CDM,450,RC,27538,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
DISLOCATED KNEE W/O ANES,T990300111,CDM,450,RC,27550,HCPCS,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,100,,,case rate,pays based on per visit,366.98,59,,,case rate,pays based on per visit,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,522.48,84,,,Percent of Total Billed Charges,84% of total billed charges,510.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,522.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,311,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
CLSD TX OF KNEE W/ANES,T990300112,CDM,450,RC,27552,HCPCS,Outpatient,,,828.5,414.25,,637.95,77,,,Percent of Total Billed Charges,77% of total billed charges,211.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,488.82,59,,,Percent of Total Billed Charges,59% of total billed charges,488.82,100,,,case rate,pays based on per visit,488.82,59,,,case rate,pays based on per visit,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.82,59,,,Percent of Total Billed Charges,59% of total billed charges,488.82,59,,,Percent of Total Billed Charges,59% of total billed charges,695.94,84,,,Percent of Total Billed Charges,84% of total billed charges,679.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,737.37,89,,,Percent of total Billed Charges,89% of total Billed charges,695.94,84,,,Percent of Total Billed Charges,84% of Total Billed charges,737.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.95,77,,,Percent of total Billed charges,77% of total billed charges,704.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,414.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,338.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,737.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.13,737.37,
DISLOCATED PATELLA W/O ANES,T990300113,CDM,450,RC,27560,HCPCS,Outpatient,,,438.5,219.25,,337.65,77,,,Percent of Total Billed Charges,77% of total billed charges,111.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.72,59,,,Percent of Total Billed Charges,59% of total billed charges,258.72,100,,,case rate,pays based on per visit,258.72,59,,,case rate,pays based on per visit,109.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.72,59,,,Percent of Total Billed Charges,59% of total billed charges,258.72,59,,,Percent of Total Billed Charges,59% of total billed charges,368.34,84,,,Percent of Total Billed Charges,84% of total billed charges,359.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.27,89,,,Percent of total Billed Charges,89% of total Billed charges,368.34,84,,,Percent of Total Billed Charges,84% of Total Billed charges,390.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.65,77,,,Percent of total Billed charges,77% of total billed charges,372.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.63,390.27,
FX TIB &/OR FIB SHAFT W/O MANI,T990300114,CDM,450,RC,27750,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX MEDIAL MALLEOLUS W/O MANIP,T990300115,CDM,450,RC,27760,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX POSTERIOR MALLEOL W/O MANIP,T990300116,CDM,450,RC,27767,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX PROX FIBULA/SHAFT W/O MANIP,T990300117,CDM,450,RC,27780,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX DISTAL FIBULA W/O MANIP,T990300118,CDM,450,RC,27786,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX BIMALLEOLAR ANKLE W/O MANIP,T990300119,CDM,450,RC,27808,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX TRIMALLEOLAR W/O MANIP,T990300120,CDM,450,RC,27816,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
"FX, TIBIA DISTAL W/O MANIP",T990300121,CDM,450,RC,27824,HCPCS,Outpatient,,,658.5,329.25,,507.05,77,,,Percent of Total Billed Charges,77% of total billed charges,167.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.52,59,,,Percent of Total Billed Charges,59% of total billed charges,388.52,100,,,case rate,pays based on per visit,388.52,59,,,case rate,pays based on per visit,164.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.52,59,,,Percent of Total Billed Charges,59% of total billed charges,388.52,59,,,Percent of Total Billed Charges,59% of total billed charges,553.14,84,,,Percent of Total Billed Charges,84% of total billed charges,539.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,586.07,89,,,Percent of total Billed Charges,89% of total Billed charges,553.14,84,,,Percent of Total Billed Charges,84% of Total Billed charges,586.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,268.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.05,77,,,Percent of total Billed charges,77% of total billed charges,559.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,189.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,329.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,268.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,164.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.63,586.07,
DISLOCATION ANKLE W/0 ANES,T990300122,CDM,450,RC,27840,HCPCS,Outpatient,,,622,311,,478.94,77,,,Percent of Total Billed Charges,77% of total billed charges,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,100,,,case rate,pays based on per visit,366.98,59,,,case rate,pays based on per visit,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,366.98,59,,,Percent of Total Billed Charges,59% of total billed charges,522.48,84,,,Percent of Total Billed Charges,84% of total billed charges,510.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,553.58,89,,,Percent of total Billed Charges,89% of total Billed charges,522.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.94,77,,,Percent of total Billed charges,77% of total billed charges,528.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,178.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,311,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,253.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.5,553.58,
"RFB, FOOT SQ",T990300123,CDM,450,RC,28190,HCPCS,Outpatient,,,309,154.5,,237.93,77,,,Percent of Total Billed Charges,77% of total billed charges,78.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.31,59,,,Percent of Total Billed Charges,59% of total billed charges,182.31,100,,,case rate,pays based on per visit,182.31,59,,,case rate,pays based on per visit,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.31,59,,,Percent of Total Billed Charges,59% of total billed charges,182.31,59,,,Percent of Total Billed Charges,59% of total billed charges,259.56,84,,,Percent of Total Billed Charges,84% of total billed charges,253.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,275.01,89,,,Percent of total Billed Charges,89% of total Billed charges,259.56,84,,,Percent of Total Billed Charges,84% of Total Billed charges,275.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.93,77,,,Percent of total Billed charges,77% of total billed charges,262.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,154.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,126.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.25,275.01,
"RFB, FOOT DEEP SQ",T990300124,CDM,450,RC,28192,HCPCS,Outpatient,,,722,361,,555.94,77,,,Percent of Total Billed Charges,77% of total billed charges,184.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,425.98,59,,,Percent of Total Billed Charges,59% of total billed charges,425.98,100,,,case rate,pays based on per visit,425.98,59,,,case rate,pays based on per visit,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,425.98,59,,,Percent of Total Billed Charges,59% of total billed charges,425.98,59,,,Percent of Total Billed Charges,59% of total billed charges,606.48,84,,,Percent of Total Billed Charges,84% of total billed charges,592.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,642.58,89,,,Percent of total Billed Charges,89% of total Billed charges,606.48,84,,,Percent of Total Billed Charges,84% of Total Billed charges,642.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.94,77,,,Percent of total Billed charges,77% of total billed charges,613.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,361,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,294.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.5,642.58,
"RFB, FOOT COMPLEX SQ",T990300125,CDM,450,RC,28193,HCPCS,Outpatient,,,800,400,,616,77,,,Percent of Total Billed Charges,77% of total billed charges,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,472,59,,,Percent of Total Billed Charges,59% of total billed charges,472,100,,,case rate,pays based on per visit,472,59,,,case rate,pays based on per visit,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472,59,,,Percent of Total Billed Charges,59% of total billed charges,472,59,,,Percent of Total Billed Charges,59% of total billed charges,672,84,,,Percent of Total Billed Charges,84% of total billed charges,656,82,,,Percent of Total Billed Charges,82% of total billed charges ,712,89,,,Percent of total Billed Charges,89% of total Billed charges,672,84,,,Percent of Total Billed Charges,84% of Total Billed charges,712,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616,77,,,Percent of total Billed charges,77% of total billed charges,680,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,400,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,326.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,712,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,712,
FX CALCANEAL W/O MANIP,T990300126,CDM,450,RC,28400,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX TALUS W/O MANIP,T990300127,CDM,450,RC,28430,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,100,,,case rate,pays based on per visit,245.44,59,,,case rate,pays based on per visit,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,245.44,59,,,Percent of Total Billed Charges,59% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,349.44,84,,,Percent of Total Billed Charges,84% of Total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
FX TARSAL EACH W/0 MANIP,T990300128,CDM,450,RC,28450,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,100,,,case rate,pays based on per visit,99.12,59,,,case rate,pays based on per visit,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,141.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
"FX METATARSAL, EACH W/O MANIP",T990300129,CDM,450,RC,28470,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,100,,,case rate,pays based on per visit,99.12,59,,,case rate,pays based on per visit,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,141.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
FX GREAT TOE W/O MANIP,T990300130,CDM,450,RC,28490,HCPCS,Outpatient,,,209.5,104.75,,161.32,77,,,Percent of Total Billed Charges,77% of total billed charges,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.61,59,,,Percent of Total Billed Charges,59% of total billed charges,123.61,100,,,case rate,pays based on per visit,123.61,59,,,case rate,pays based on per visit,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.61,59,,,Percent of Total Billed Charges,59% of total billed charges,123.61,59,,,Percent of Total Billed Charges,59% of total billed charges,175.98,84,,,Percent of Total Billed Charges,84% of total billed charges,171.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.46,89,,,Percent of total Billed Charges,89% of total Billed charges,175.98,84,,,Percent of Total Billed Charges,84% of Total Billed charges,186.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.32,77,,,Percent of total Billed charges,77% of total billed charges,178.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.38,186.46,
FX PHALANGES-TOE EA W/O MANIP,T990300131,CDM,450,RC,28510,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,100,,,case rate,pays based on per visit,99.12,59,,,case rate,pays based on per visit,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,99.12,59,,,Percent of Total Billed Charges,59% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,141.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
FX PHALANGES-TOE EACH W/MANIP,T990300132,CDM,450,RC,28515,HCPCS,Outpatient,,,251.5,125.75,,193.66,77,,,Percent of Total Billed Charges,77% of total billed charges,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,148.39,100,,,case rate,pays based on per visit,148.39,59,,,case rate,pays based on per visit,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,211.26,84,,,Percent of Total Billed Charges,84% of total billed charges,206.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.84,89,,,Percent of total Billed Charges,89% of total Billed charges,211.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.66,77,,,Percent of total Billed charges,77% of total billed charges,213.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.88,223.84,
TOE DISLOC W/O ANES W/MANIP,T990300133,CDM,450,RC,28630,HCPCS,Outpatient,,,303.5,151.75,,233.7,77,,,Percent of Total Billed Charges,77% of total billed charges,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.07,59,,,Percent of Total Billed Charges,59% of total billed charges,179.07,100,,,case rate,pays based on per visit,179.07,59,,,case rate,pays based on per visit,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,59,,,Percent of Total Billed Charges,59% of total billed charges,179.07,59,,,Percent of Total Billed Charges,59% of total billed charges,254.94,84,,,Percent of Total Billed Charges,84% of total billed charges,248.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.12,89,,,Percent of total Billed Charges,89% of total Billed charges,254.94,84,,,Percent of Total Billed Charges,84% of Total Billed charges,270.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.7,77,,,Percent of total Billed charges,77% of total billed charges,257.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.88,270.12,
PIP/DIP DISLOC W/O ANES W/MANI,T990300134,CDM,450,RC,28660,HCPCS,Outpatient,,,415.5,207.75,,319.94,77,,,Percent of Total Billed Charges,77% of total billed charges,105.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.15,59,,,Percent of Total Billed Charges,59% of total billed charges,245.15,100,,,case rate,pays based on per visit,245.15,59,,,case rate,pays based on per visit,103.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.15,59,,,Percent of Total Billed Charges,59% of total billed charges,245.15,59,,,Percent of Total Billed Charges,59% of total billed charges,349.02,84,,,Percent of Total Billed Charges,84% of total billed charges,340.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,369.8,89,,,Percent of total Billed Charges,89% of total Billed charges,349.02,84,,,Percent of Total Billed Charges,84% of Total Billed charges,369.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.94,77,,,Percent of total Billed charges,77% of total billed charges,353.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,207.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.88,369.8,
REMOVAL OR BIVALVING CAST,T990300135,CDM,450,RC,29700,HCPCS,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.52,59,,,Percent of Total Billed Charges,59% of total billed charges,75.52,100,,,case rate,pays based on per visit,75.52,59,,,case rate,pays based on per visit,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.52,59,,,Percent of Total Billed Charges,59% of total billed charges,75.52,59,,,Percent of Total Billed Charges,59% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,107.52,84,,,Percent of Total Billed Charges,84% of Total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,113.92,
REMOVE/BIVALV FULL ARM OR LEG,T990300136,CDM,450,RC,29705,HCPCS,Outpatient,,,160,80,,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.4,59,,,Percent of Total Billed Charges,59% of total billed charges,94.4,100,,,case rate,pays based on per visit,94.4,59,,,case rate,pays based on per visit,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.4,59,,,Percent of Total Billed Charges,59% of total billed charges,94.4,59,,,Percent of Total Billed Charges,59% of total billed charges,134.4,84,,,Percent of Total Billed Charges,84% of total billed charges,131.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.4,89,,,Percent of total Billed Charges,89% of total Billed charges,134.4,84,,,Percent of Total Billed Charges,84% of Total Billed charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,142.4,
WINDOWING OF CAST,T990300137,CDM,450,RC,29730,HCPCS,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.52,59,,,Percent of Total Billed Charges,59% of total billed charges,75.52,100,,,case rate,pays based on per visit,75.52,59,,,case rate,pays based on per visit,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.52,59,,,Percent of Total Billed Charges,59% of total billed charges,75.52,59,,,Percent of Total Billed Charges,59% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,107.52,84,,,Percent of Total Billed Charges,84% of Total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,113.92,
I & D SEPTAL HEMATOMA/ABSCESS,T990300138,CDM,450,RC,30020,HCPCS,Outpatient,,,288,144,,221.76,77,,,Percent of Total Billed Charges,77% of total billed charges,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,169.92,59,,,Percent of Total Billed Charges,59% of total billed charges,169.92,100,,,case rate,pays based on per visit,169.92,59,,,case rate,pays based on per visit,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.92,59,,,Percent of Total Billed Charges,59% of total billed charges,169.92,59,,,Percent of Total Billed Charges,59% of total billed charges,241.92,84,,,Percent of Total Billed Charges,84% of total billed charges,236.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.32,89,,,Percent of total Billed Charges,89% of total Billed charges,241.92,84,,,Percent of Total Billed Charges,84% of Total Billed charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.76,77,,,Percent of total Billed charges,77% of total billed charges,244.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,144,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72,256.32,
RFB INTRANASAL,T990300139,CDM,450,RC,30300,HCPCS,Outpatient,,,146.5,73.25,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.44,59,,,Percent of Total Billed Charges,59% of total billed charges,86.44,100,,,case rate,pays based on per visit,86.44,59,,,case rate,pays based on per visit,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.44,59,,,Percent of Total Billed Charges,59% of total billed charges,86.44,59,,,Percent of Total Billed Charges,59% of total billed charges,123.06,84,,,Percent of Total Billed Charges,84% of total billed charges,120.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,123.06,84,,,Percent of Total Billed Charges,84% of Total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
"ANT NOSE BLEED, SIMPLE",T990300140,CDM,450,RC,30901,HCPCS,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.05,59,,,Percent of Total Billed Charges,59% of total billed charges,174.05,100,,,case rate,pays based on per visit,174.05,59,,,case rate,pays based on per visit,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.05,59,,,Percent of Total Billed Charges,59% of total billed charges,174.05,59,,,Percent of Total Billed Charges,59% of total billed charges,247.8,84,,,Percent of Total Billed Charges,84% of total billed charges,241.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,247.8,84,,,Percent of Total Billed Charges,84% of Total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.75,262.55,
"ANT NOSE BLEED, COMPLEX",T990300141,CDM,450,RC,30903,HCPCS,Outpatient,,,301.5,150.75,,232.16,77,,,Percent of Total Billed Charges,77% of total billed charges,76.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,177.89,100,,,case rate,pays based on per visit,177.89,59,,,case rate,pays based on per visit,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,253.26,84,,,Percent of Total Billed Charges,84% of total billed charges,247.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.34,89,,,Percent of total Billed Charges,89% of total Billed charges,253.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,268.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.16,77,,,Percent of total Billed charges,77% of total billed charges,256.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,268.34,
POSTERIOR NOSE BLEED,T990300142,CDM,450,RC,30905,HCPCS,Outpatient,,,539.5,269.75,,415.42,77,,,Percent of Total Billed Charges,77% of total billed charges,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,318.31,100,,,case rate,pays based on per visit,318.31,59,,,case rate,pays based on per visit,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,453.18,84,,,Percent of Total Billed Charges,84% of total billed charges,442.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,480.16,89,,,Percent of total Billed Charges,89% of total Billed charges,453.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.42,77,,,Percent of total Billed charges,77% of total billed charges,458.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,269.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.88,480.16,
INTUBATION-ENDOTRACHEAL,T990300143,CDM,450,RC,31500,HCPCS,Outpatient,,,949,474.5,,730.73,77,,,Percent of Total Billed Charges,77% of total billed charges,242,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.91,59,,,Percent of Total Billed Charges,59% of total billed charges,559.91,100,,,case rate,pays based on per visit,559.91,59,,,case rate,pays based on per visit,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.91,59,,,Percent of Total Billed Charges,59% of total billed charges,559.91,59,,,Percent of Total Billed Charges,59% of total billed charges,797.16,84,,,Percent of Total Billed Charges,84% of total billed charges,778.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,844.61,89,,,Percent of total Billed Charges,89% of total Billed charges,797.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,730.73,77,,,Percent of total Billed charges,77% of total billed charges,806.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,272.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,474.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,387.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,844.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,844.61,
"LARYNGOSCOPY, DIRECT W/RFB",T990300144,CDM,450,RC,31530,HCPCS,Outpatient,,,664.5,332.25,,511.67,77,,,Percent of Total Billed Charges,77% of total billed charges,169.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,392.06,59,,,Percent of Total Billed Charges,59% of total billed charges,392.06,100,,,case rate,pays based on per visit,392.06,59,,,case rate,pays based on per visit,166.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.06,59,,,Percent of Total Billed Charges,59% of total billed charges,392.06,59,,,Percent of Total Billed Charges,59% of total billed charges,558.18,84,,,Percent of Total Billed Charges,84% of total billed charges,544.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,591.41,89,,,Percent of total Billed Charges,89% of total Billed charges,558.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,591.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.67,77,,,Percent of total Billed charges,77% of total billed charges,564.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,191.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,332.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,271.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,166.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,591.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.13,591.41,
TRACHEOSTOMY,T990300145,CDM,450,RC,31603,HCPCS,Outpatient,,,1242,621,,956.34,77,,,Percent of Total Billed Charges,77% of total billed charges,316.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,316.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,388.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,732.78,59,,,Percent of Total Billed Charges,59% of total billed charges,732.78,100,,,case rate,pays based on per visit,732.78,59,,,case rate,pays based on per visit,310.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.78,59,,,Percent of Total Billed Charges,59% of total billed charges,732.78,59,,,Percent of Total Billed Charges,59% of total billed charges,1043.28,84,,,Percent of Total Billed Charges,84% of total billed charges,1018.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,1105.38,89,,,Percent of total Billed Charges,89% of total Billed charges,1043.28,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1105.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,310.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,956.34,77,,,Percent of total Billed charges,77% of total billed charges,1055.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,357.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,621,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,506.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,310.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.5,1105.38,
CRICOTHYROTOMY,T990300146,CDM,450,RC,31605,HCPCS,Outpatient,,,994,497,,765.38,77,,,Percent of Total Billed Charges,77% of total billed charges,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,586.46,100,,,case rate,pays based on per visit,586.46,59,,,case rate,pays based on per visit,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,834.96,84,,,Percent of Total Billed Charges,84% of total billed charges,815.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,884.66,89,,,Percent of total Billed Charges,89% of total Billed charges,834.96,84,,,Percent of Total Billed Charges,84% of Total Billed charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.38,77,,,Percent of total Billed charges,77% of total billed charges,844.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,497,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.5,884.66,
CHEST TUBE INSERT W/WATERSEAL,T990300147,CDM,450,RC,32551,HCPCS,Outpatient,,,811,405.5,,624.47,77,,,Percent of Total Billed Charges,77% of total billed charges,206.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,478.49,59,,,Percent of Total Billed Charges,59% of total billed charges,478.49,100,,,case rate,pays based on per visit,478.49,59,,,case rate,pays based on per visit,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.49,59,,,Percent of Total Billed Charges,59% of total billed charges,478.49,59,,,Percent of Total Billed Charges,59% of total billed charges,681.24,84,,,Percent of Total Billed Charges,84% of total billed charges,665.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,721.79,89,,,Percent of total Billed Charges,89% of total Billed charges,681.24,84,,,Percent of Total Billed Charges,84% of Total Billed charges,721.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,330.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,330.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,624.47,77,,,Percent of total Billed charges,77% of total billed charges,689.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,233.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,405.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,330.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,721.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.75,721.79,
PERICARDIOCENTESIS,T990300148,CDM,450,RC,33018,HCPCS,Outpatient,,,994,497,,765.38,77,,,Percent of Total Billed Charges,77% of total billed charges,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,586.46,100,,,case rate,pays based on per visit,586.46,59,,,case rate,pays based on per visit,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,834.96,84,,,Percent of Total Billed Charges,84% of total billed charges,815.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,884.66,89,,,Percent of total Billed Charges,89% of total Billed charges,834.96,84,,,Percent of Total Billed Charges,84% of Total Billed charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.38,77,,,Percent of total Billed charges,77% of total billed charges,844.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,497,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.5,884.66,
TRANSVENOUS PACEMAKER,T990300149,CDM,450,RC,33210,HCPCS,Outpatient,,,1475.5,737.75,,1136.14,77,,,Percent of Total Billed Charges,77% of total billed charges,376.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,461.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,870.55,59,,,Percent of Total Billed Charges,59% of total billed charges,870.55,100,,,case rate,pays based on per visit,870.55,59,,,case rate,pays based on per visit,368.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,870.55,59,,,Percent of Total Billed Charges,59% of total billed charges,870.55,59,,,Percent of Total Billed Charges,59% of total billed charges,1239.42,84,,,Percent of Total Billed Charges,84% of total billed charges,1209.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1313.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1239.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1313.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,368.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1136.14,77,,,Percent of total Billed charges,77% of total billed charges,1254.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,424.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,737.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,602,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,368.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1313.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,368.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.88,1313.2,
CENTRAL LINE < 5 YEARS OF AGE,T990300155,CDM,450,RC,36555,HCPCS,Outpatient,,,432.5,216.25,,333.03,77,,,Percent of Total Billed Charges,77% of total billed charges,110.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.18,59,,,Percent of Total Billed Charges,59% of total billed charges,255.18,100,,,case rate,pays based on per visit,255.18,59,,,case rate,pays based on per visit,108.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.18,59,,,Percent of Total Billed Charges,59% of total billed charges,255.18,59,,,Percent of Total Billed Charges,59% of total billed charges,363.3,84,,,Percent of Total Billed Charges,84% of total billed charges,354.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,384.93,89,,,Percent of total Billed Charges,89% of total Billed charges,363.3,84,,,Percent of Total Billed Charges,84% of Total Billed charges,384.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.03,77,,,Percent of total Billed charges,77% of total billed charges,367.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.13,384.93,
CENTRAL LINE > 5 YEARS OF AGE,T990300156,CDM,450,RC,36569,HCPCS,Outpatient,,,539.5,269.75,,415.42,77,,,Percent of Total Billed Charges,77% of total billed charges,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,318.31,100,,,case rate,pays based on per visit,318.31,59,,,case rate,pays based on per visit,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,318.31,59,,,Percent of Total Billed Charges,59% of total billed charges,453.18,84,,,Percent of Total Billed Charges,84% of total billed charges,442.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,480.16,89,,,Percent of total Billed Charges,89% of total Billed charges,453.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.42,77,,,Percent of total Billed charges,77% of total billed charges,458.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,269.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,220.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.88,480.16,
ER RN ARTERIAL PUNCTURE,T990300158,CDM,450,RC,36600,HCPCS,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.17,59,,,Percent of Total Billed Charges,59% of total billed charges,37.17,100,,,case rate,pays based on per visit,37.17,59,,,case rate,pays based on per visit,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.17,59,,,Percent of Total Billed Charges,59% of total billed charges,37.17,59,,,Percent of Total Billed Charges,59% of total billed charges,52.92,84,,,Percent of Total Billed Charges,84% of total billed charges,51.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.07,89,,,Percent of total Billed Charges,89% of total Billed charges,52.92,84,,,Percent of Total Billed Charges,84% of Total Billed charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,56.07,
I/O NEEDLE PLACEMENT,T990300159,CDM,450,RC,36680,HCPCS,Outpatient,,,479.5,239.75,,369.22,77,,,Percent of Total Billed Charges,77% of total billed charges,122.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,282.91,59,,,Percent of Total Billed Charges,59% of total billed charges,282.91,100,,,case rate,pays based on per visit,282.91,59,,,case rate,pays based on per visit,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.91,59,,,Percent of Total Billed Charges,59% of total billed charges,282.91,59,,,Percent of Total Billed Charges,59% of total billed charges,402.78,84,,,Percent of Total Billed Charges,84% of total billed charges,393.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.76,89,,,Percent of total Billed Charges,89% of total Billed charges,402.78,84,,,Percent of Total Billed Charges,84% of Total Billed charges,426.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.22,77,,,Percent of total Billed charges,77% of total billed charges,407.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.88,426.76,
REPAIR TONGUE <2.5 CM,T990300160,CDM,450,RC,41250,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,218.01,59,,,Percent of Total Billed Charges,59% of total billed charges,218.01,100,,,case rate,pays based on per visit,218.01,59,,,case rate,pays based on per visit,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.01,59,,,Percent of Total Billed Charges,59% of total billed charges,218.01,59,,,Percent of Total Billed Charges,59% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.86,89,,,Percent of total Billed Charges,89% of total Billed charges,310.38,84,,,Percent of Total Billed Charges,84% of Total Billed charges,328.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.38,328.86,
RFB TONGUE,T990300161,CDM,450,RC,41599,HCPCS,Outpatient,,,243.5,121.75,,187.5,77,,,Percent of Total Billed Charges,77% of total billed charges,62.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,143.67,59,,,Percent of Total Billed Charges,59% of total billed charges,143.67,100,,,case rate,pays based on per visit,143.67,59,,,case rate,pays based on per visit,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.67,59,,,Percent of Total Billed Charges,59% of total billed charges,143.67,59,,,Percent of Total Billed Charges,59% of total billed charges,204.54,84,,,Percent of Total Billed Charges,84% of total billed charges,199.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.72,89,,,Percent of total Billed Charges,89% of total Billed charges,204.54,84,,,Percent of Total Billed Charges,84% of Total Billed charges,216.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,77,,,Percent of total Billed charges,77% of total billed charges,206.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.88,216.72,
LAC PALATE < 2 CM,T990300162,CDM,450,RC,42180,HCPCS,Outpatient,,,312,156,,240.24,77,,,Percent of Total Billed Charges,77% of total billed charges,79.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.08,59,,,Percent of Total Billed Charges,59% of total billed charges,184.08,100,,,case rate,pays based on per visit,184.08,59,,,case rate,pays based on per visit,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.08,59,,,Percent of Total Billed Charges,59% of total billed charges,184.08,59,,,Percent of Total Billed Charges,59% of total billed charges,262.08,84,,,Percent of Total Billed Charges,84% of total billed charges,255.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.68,89,,,Percent of total Billed Charges,89% of total Billed charges,262.08,84,,,Percent of Total Billed Charges,84% of Total Billed charges,277.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.24,77,,,Percent of total Billed charges,77% of total billed charges,265.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78,277.68,
RFB PHARYNX,T990300163,CDM,450,RC,42809,HCPCS,Outpatient,,,243.5,121.75,,187.5,77,,,Percent of Total Billed Charges,77% of total billed charges,62.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,143.67,59,,,Percent of Total Billed Charges,59% of total billed charges,143.67,100,,,case rate,pays based on per visit,143.67,59,,,case rate,pays based on per visit,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.67,59,,,Percent of Total Billed Charges,59% of total billed charges,143.67,59,,,Percent of Total Billed Charges,59% of total billed charges,204.54,84,,,Percent of Total Billed Charges,84% of total billed charges,199.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.72,89,,,Percent of total Billed Charges,89% of total Billed charges,204.54,84,,,Percent of Total Billed Charges,84% of Total Billed charges,216.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,77,,,Percent of total Billed charges,77% of total billed charges,206.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.88,216.72,
GASTRIC INTUBATION/LAVAGE,T990300164,CDM,450,RC,43753,HCPCS,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236,59,,,Percent of Total Billed Charges,59% of total billed charges,236,100,,,case rate,pays based on per visit,236,59,,,case rate,pays based on per visit,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236,59,,,Percent of Total Billed Charges,59% of total billed charges,236,59,,,Percent of Total Billed Charges,59% of total billed charges,336,84,,,Percent of Total Billed Charges,84% of total billed charges,328,82,,,Percent of Total Billed Charges,82% of total billed charges ,356,89,,,Percent of total Billed Charges,89% of total Billed charges,336,84,,,Percent of Total Billed Charges,84% of Total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
CHG GASTRO TUBE PERCUT W/O IMG,T990300165,CDM,450,RC,43762,HCPCS,Outpatient,,,301.5,150.75,,232.16,77,,,Percent of Total Billed Charges,77% of total billed charges,76.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,177.89,100,,,case rate,pays based on per visit,177.89,59,,,case rate,pays based on per visit,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,253.26,84,,,Percent of Total Billed Charges,84% of total billed charges,247.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.34,89,,,Percent of total Billed Charges,89% of total Billed charges,253.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,268.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.16,77,,,Percent of total Billed charges,77% of total billed charges,256.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,268.34,
I & D PERIANAL ABSCESS,T990300166,CDM,450,RC,46050,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,189.39,100,,,case rate,pays based on per visit,189.39,59,,,case rate,pays based on per visit,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,285.69,89,,,Percent of total Billed Charges,89% of total Billed charges,269.64,84,,,Percent of Total Billed Charges,84% of Total Billed charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,160.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,285.69,
I&D THROMBOSED EXT HEMORRHOID,T990300167,CDM,450,RC,46083,HCPCS,Outpatient,,,400.5,200.25,,308.39,77,,,Percent of Total Billed Charges,77% of total billed charges,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,100,,,case rate,pays based on per visit,236.3,59,,,case rate,pays based on per visit,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,336.42,84,,,Percent of Total Billed Charges,84% of total billed charges,328.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.45,89,,,Percent of total Billed Charges,89% of total Billed charges,336.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.39,77,,,Percent of total Billed charges,77% of total billed charges,340.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.13,356.45,
"BLADDER IRRIG, SIMPLE, LAVAGE",T990300168,CDM,450,RC,51700,HCPCS,Outpatient,,,487,243.5,,374.99,77,,,Percent of Total Billed Charges,77% of total billed charges,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,287.33,59,,,Percent of Total Billed Charges,59% of total billed charges,287.33,100,,,case rate,pays based on per visit,287.33,59,,,case rate,pays based on per visit,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.33,59,,,Percent of Total Billed Charges,59% of total billed charges,287.33,59,,,Percent of Total Billed Charges,59% of total billed charges,409.08,84,,,Percent of Total Billed Charges,84% of total billed charges,399.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,433.43,89,,,Percent of total Billed Charges,89% of total Billed charges,409.08,84,,,Percent of Total Billed Charges,84% of Total Billed charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.99,77,,,Percent of total Billed charges,77% of total billed charges,413.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,243.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.75,433.43,
INSERTION NON-DWELLING CATH,T990300169,CDM,450,RC,51701,HCPCS,Outpatient,,,162.5,81.25,,125.13,77,,,Percent of Total Billed Charges,77% of total billed charges,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.88,59,,,Percent of Total Billed Charges,59% of total billed charges,95.88,100,,,case rate,pays based on per visit,95.88,59,,,case rate,pays based on per visit,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.88,59,,,Percent of Total Billed Charges,59% of total billed charges,95.88,59,,,Percent of Total Billed Charges,59% of total billed charges,136.5,84,,,Percent of Total Billed Charges,84% of total billed charges,133.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.63,89,,,Percent of total Billed Charges,89% of total Billed charges,136.5,84,,,Percent of Total Billed Charges,84% of Total Billed charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.13,77,,,Percent of total Billed charges,77% of total billed charges,138.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.63,144.63,
"INSERTION FOLEY, SIMPLE",T990300170,CDM,450,RC,51702,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.16,59,,,Percent of Total Billed Charges,59% of total billed charges,73.16,100,,,case rate,pays based on per visit,73.16,59,,,case rate,pays based on per visit,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.16,59,,,Percent of Total Billed Charges,59% of total billed charges,73.16,59,,,Percent of Total Billed Charges,59% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.36,89,,,Percent of total Billed Charges,89% of total Billed charges,104.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,110.36,
"INSERTION FOLEY, COMPLICATED",T990300171,CDM,450,RC,51703,HCPCS,Outpatient,,,235.5,117.75,,181.34,77,,,Percent of Total Billed Charges,77% of total billed charges,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.95,59,,,Percent of Total Billed Charges,59% of total billed charges,138.95,100,,,case rate,pays based on per visit,138.95,59,,,case rate,pays based on per visit,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.95,59,,,Percent of Total Billed Charges,59% of total billed charges,138.95,59,,,Percent of Total Billed Charges,59% of total billed charges,197.82,84,,,Percent of Total Billed Charges,84% of total billed charges,193.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,209.6,89,,,Percent of total Billed Charges,89% of total Billed charges,197.82,84,,,Percent of Total Billed Charges,84% of Total Billed charges,209.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.34,77,,,Percent of total Billed charges,77% of total billed charges,200.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.88,209.6,
"I & D EPIDID, TESTIS &/OR SCRO",T990300172,CDM,450,RC,54700,HCPCS,Outpatient,,,400.5,200.25,,308.39,77,,,Percent of Total Billed Charges,77% of total billed charges,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,100,,,case rate,pays based on per visit,236.3,59,,,case rate,pays based on per visit,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,336.42,84,,,Percent of Total Billed Charges,84% of total billed charges,328.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.45,89,,,Percent of total Billed Charges,89% of total Billed charges,336.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.39,77,,,Percent of total Billed charges,77% of total billed charges,340.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.13,356.45,
I & D VULVA R PERINEAL ABSCESS,T990300173,CDM,450,RC,56405,HCPCS,Outpatient,,,400.5,200.25,,308.39,77,,,Percent of Total Billed Charges,77% of total billed charges,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,100,,,case rate,pays based on per visit,236.3,59,,,case rate,pays based on per visit,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,236.3,59,,,Percent of Total Billed Charges,59% of total billed charges,336.42,84,,,Percent of Total Billed Charges,84% of total billed charges,328.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.45,89,,,Percent of total Billed Charges,89% of total Billed charges,336.42,84,,,Percent of Total Billed Charges,84% of Total Billed charges,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.39,77,,,Percent of total Billed charges,77% of total billed charges,340.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.13,356.45,
I & D BARTHOLIN'S ABSCESS,T990300174,CDM,450,RC,56420,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,189.39,100,,,case rate,pays based on per visit,189.39,59,,,case rate,pays based on per visit,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,189.39,59,,,Percent of Total Billed Charges,59% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,285.69,89,,,Percent of total Billed Charges,89% of total Billed charges,269.64,84,,,Percent of Total Billed Charges,84% of Total Billed charges,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,160.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.25,285.69,
VAGINAL DELIVERY,T990300175,CDM,450,RC,59409,HCPCS,Outpatient,,,994,497,,765.38,77,,,Percent of Total Billed Charges,77% of total billed charges,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,586.46,100,,,case rate,pays based on per visit,586.46,59,,,case rate,pays based on per visit,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,586.46,59,,,Percent of Total Billed Charges,59% of total billed charges,834.96,84,,,Percent of Total Billed Charges,84% of total billed charges,815.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,884.66,89,,,Percent of total Billed Charges,89% of total Billed charges,834.96,84,,,Percent of Total Billed Charges,84% of Total Billed charges,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.38,77,,,Percent of total Billed charges,77% of total billed charges,844.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,497,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,405.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,884.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.5,884.66,
LUMBAR SPINAL PUNCTURE,T990300176,CDM,450,RC,62270,HCPCS,Outpatient,,,878,439,,676.06,77,,,Percent of Total Billed Charges,77% of total billed charges,223.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,518.02,59,,,Percent of Total Billed Charges,59% of total billed charges,518.02,100,,,case rate,pays based on per visit,518.02,59,,,case rate,pays based on per visit,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.02,59,,,Percent of Total Billed Charges,59% of total billed charges,518.02,59,,,Percent of Total Billed Charges,59% of total billed charges,737.52,84,,,Percent of Total Billed Charges,84% of total billed charges,719.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,781.42,89,,,Percent of total Billed Charges,89% of total Billed charges,737.52,84,,,Percent of Total Billed Charges,84% of Total Billed charges,781.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.06,77,,,Percent of total Billed charges,77% of total billed charges,746.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,439,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,781.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.5,781.42,
PERIPHERAL NERV/OTH BLOCK,T990300177,CDM,450,RC,64450,HCPCS,Outpatient,,,874.5,437.25,,673.37,77,,,Percent of Total Billed Charges,77% of total billed charges,223,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,515.96,59,,,Percent of Total Billed Charges,59% of total billed charges,515.96,100,,,case rate,pays based on per visit,515.96,59,,,case rate,pays based on per visit,218.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,515.96,59,,,Percent of Total Billed Charges,59% of total billed charges,515.96,59,,,Percent of Total Billed Charges,59% of total billed charges,734.58,84,,,Percent of Total Billed Charges,84% of total billed charges,717.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,778.31,89,,,Percent of total Billed Charges,89% of total Billed charges,734.58,84,,,Percent of Total Billed Charges,84% of Total Billed charges,778.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,356.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,356.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,77,,,Percent of total Billed charges,77% of total billed charges,743.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,251.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,437.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,356.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.63,778.31,
RFB SUPERFICIAL EYE CONJUNCTIV,T990300178,CDM,450,RC,65205,HCPCS,Outpatient,,,153,76.5,,117.81,77,,,Percent of Total Billed Charges,77% of total billed charges,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.27,59,,,Percent of Total Billed Charges,59% of total billed charges,90.27,100,,,case rate,pays based on per visit,90.27,59,,,case rate,pays based on per visit,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.27,59,,,Percent of Total Billed Charges,59% of total billed charges,90.27,59,,,Percent of Total Billed Charges,59% of total billed charges,128.52,84,,,Percent of Total Billed Charges,84% of total billed charges,125.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.17,89,,,Percent of total Billed Charges,89% of total Billed charges,128.52,84,,,Percent of Total Billed Charges,84% of Total Billed charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.81,77,,,Percent of total Billed charges,77% of total billed charges,130.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.25,136.17,
RFB EMBEDDED SCLERA/CONJUNCTIV,T990300179,CDM,450,RC,65210,HCPCS,Outpatient,,,174,87,,133.98,77,,,Percent of Total Billed Charges,77% of total billed charges,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.66,59,,,Percent of Total Billed Charges,59% of total billed charges,102.66,100,,,case rate,pays based on per visit,102.66,59,,,case rate,pays based on per visit,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.66,59,,,Percent of Total Billed Charges,59% of total billed charges,102.66,59,,,Percent of Total Billed Charges,59% of total billed charges,146.16,84,,,Percent of Total Billed Charges,84% of total billed charges,142.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.16,84,,,Percent of Total Billed Charges,84% of Total Billed charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.98,77,,,Percent of total Billed charges,77% of total billed charges,147.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.5,154.86,
"RFB,CORNEAL W/O SLIT LAMP",T990300180,CDM,450,RC,65220,HCPCS,Outpatient,,,202.5,101.25,,155.93,77,,,Percent of Total Billed Charges,77% of total billed charges,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.48,59,,,Percent of Total Billed Charges,59% of total billed charges,119.48,100,,,case rate,pays based on per visit,119.48,59,,,case rate,pays based on per visit,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.48,59,,,Percent of Total Billed Charges,59% of total billed charges,119.48,59,,,Percent of Total Billed Charges,59% of total billed charges,170.1,84,,,Percent of Total Billed Charges,84% of total billed charges,166.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,180.23,89,,,Percent of total Billed Charges,89% of total Billed charges,170.1,84,,,Percent of Total Billed Charges,84% of Total Billed charges,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.93,77,,,Percent of total Billed charges,77% of total billed charges,172.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.63,180.23,
"RFB, CORNEAL W/SLIT LAMP",T990300181,CDM,450,RC,65222,HCPCS,Outpatient,,,301.5,150.75,,232.16,77,,,Percent of Total Billed Charges,77% of total billed charges,76.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,177.89,100,,,case rate,pays based on per visit,177.89,59,,,case rate,pays based on per visit,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,177.89,59,,,Percent of Total Billed Charges,59% of total billed charges,253.26,84,,,Percent of Total Billed Charges,84% of total billed charges,247.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.34,89,,,Percent of total Billed Charges,89% of total Billed charges,253.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,268.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.16,77,,,Percent of total Billed charges,77% of total billed charges,256.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,268.34,
"RFB, EYELID EMBEDDED",T990300182,CDM,450,RC,67938,HCPCS,Outpatient,,,164.5,82.25,,126.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.06,59,,,Percent of Total Billed Charges,59% of total billed charges,97.06,100,,,case rate,pays based on per visit,97.06,59,,,case rate,pays based on per visit,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.06,59,,,Percent of Total Billed Charges,59% of total billed charges,97.06,59,,,Percent of Total Billed Charges,59% of total billed charges,138.18,84,,,Percent of Total Billed Charges,84% of total billed charges,134.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.41,89,,,Percent of total Billed Charges,89% of total Billed charges,138.18,84,,,Percent of Total Billed Charges,84% of Total Billed charges,146.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.67,77,,,Percent of total Billed charges,77% of total billed charges,139.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.13,146.41,
"RFB, EXT EAR, W/O ANES",T990300183,CDM,450,RC,69200,HCPCS,Outpatient,,,207.5,103.75,,159.78,77,,,Percent of Total Billed Charges,77% of total billed charges,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.43,59,,,Percent of Total Billed Charges,59% of total billed charges,122.43,100,,,case rate,pays based on per visit,122.43,59,,,case rate,pays based on per visit,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,59,,,Percent of Total Billed Charges,59% of total billed charges,122.43,59,,,Percent of Total Billed Charges,59% of total billed charges,174.3,84,,,Percent of Total Billed Charges,84% of total billed charges,170.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.68,89,,,Percent of total Billed Charges,89% of total Billed charges,174.3,84,,,Percent of Total Billed Charges,84% of Total Billed charges,184.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.78,77,,,Percent of total Billed charges,77% of total billed charges,176.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.88,184.68,
REM IMPAC CERUMEN W/IRIG/LAV U,T990300184,CDM,450,RC,69209,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.83,59,,,Percent of Total Billed Charges,59% of total billed charges,80.83,100,,,case rate,pays based on per visit,80.83,59,,,case rate,pays based on per visit,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.83,59,,,Percent of Total Billed Charges,59% of total billed charges,80.83,59,,,Percent of Total Billed Charges,59% of total billed charges,115.08,84,,,Percent of Total Billed Charges,84% of total billed charges,112.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.93,89,,,Percent of total Billed Charges,89% of total Billed charges,115.08,84,,,Percent of Total Billed Charges,84% of Total Billed charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,121.93,
REMOVE IMPACT CERUMEN EAR,T990300185,CDM,450,RC,69210,HCPCS,Outpatient,,,98.5,49.25,,75.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.12,59,,,Percent of Total Billed Charges,59% of total billed charges,58.12,100,,,case rate,pays based on per visit,58.12,59,,,case rate,pays based on per visit,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.12,59,,,Percent of Total Billed Charges,59% of total billed charges,58.12,59,,,Percent of Total Billed Charges,59% of total billed charges,82.74,84,,,Percent of Total Billed Charges,84% of total billed charges,80.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.67,89,,,Percent of total Billed Charges,89% of total Billed charges,82.74,84,,,Percent of Total Billed Charges,84% of Total Billed charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,77,,,Percent of total Billed charges,77% of total billed charges,83.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.63,87.67,
IMMUNIZATION ADM,T990300186,CDM,771,RC,90471,HCPCS,Outpatient,,,94.5,47.25,,72.77,77,,,Percent of Total Billed Charges,77% of total billed charges,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.93,74,,,Percent of Total Billed Charges,74% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,65.21,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,84,,,Percent of Total Billed Charges,84% of total billed charges,77.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.11,89,,,Percent of total Billed Charges,89% of total Billed charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.77,77,,,Percent of total Billed charges,77% of total billed charges,80.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,38.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.63,84.11,
CARDIAC ARREST W/INJECT/INFUSI,T990300187,CDM,450,RC,92950,HCPCS,Outpatient,,,2383.5,1191.75,,1835.3,77,,,Percent of Total Billed Charges,77% of total billed charges,607.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,744.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1406.27,59,,,Percent of Total Billed Charges,59% of total billed charges,1406.27,100,,,case rate,pays based on per visit,1406.27,59,,,case rate,pays based on per visit,595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1406.27,59,,,Percent of Total Billed Charges,59% of total billed charges,1406.27,59,,,Percent of Total Billed Charges,59% of total billed charges,2002.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1954.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2121.32,89,,,Percent of total Billed Charges,89% of total Billed charges,2002.14,84,,,Percent of Total Billed Charges,84% of Total Billed charges,2121.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,972.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,972.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,972.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1835.3,77,,,Percent of total Billed charges,77% of total billed charges,2025.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,685.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1191.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,972.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2121.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,595.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,595.88,2121.32,
TEMP TRANSCUTANEOUS PACING,T990300188,CDM,450,RC,92953,HCPCS,Outpatient,,,448,224,,344.96,77,,,Percent of Total Billed Charges,77% of total billed charges,114.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.32,59,,,Percent of Total Billed Charges,59% of total billed charges,264.32,100,,,case rate,pays based on per visit,264.32,59,,,case rate,pays based on per visit,112,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.32,59,,,Percent of Total Billed Charges,59% of total billed charges,264.32,59,,,Percent of Total Billed Charges,59% of total billed charges,376.32,84,,,Percent of Total Billed Charges,84% of total billed charges,367.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,398.72,89,,,Percent of total Billed Charges,89% of total Billed charges,376.32,84,,,Percent of Total Billed Charges,84% of Total Billed charges,398.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.96,77,,,Percent of total Billed charges,77% of total billed charges,380.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,224,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112,398.72,
CARDIOVERSION,T990300189,CDM,360,RC,92960,HCPCS,Outpatient,,,1158.5,579.25,,892.05,77,,,Percent of Total Billed Charges,77% of total billed charges,295.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,857.29,74,,,Percent of Total Billed Charges,74% of total billed charges,799.37,69,,,Percent of Total Billed Charges,69% of total billed charges,799.37,69,,,Percent of Total Billed Charges,69% of total billed charges,289.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,799.37,69,,,Percent of Total Billed Charges,69% of total billed charges,799.37,69,,,Percent of Total Billed Charges,69% of total billed charges,973.14,84,,,Percent of Total Billed Charges,84% of total billed charges,949.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,1031.07,89,,,Percent of total Billed Charges,89% of total Billed charges,973.14,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1031.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,472.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,472.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,472.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,892.05,77,,,Percent of total Billed charges,77% of total billed charges,984.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1261,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,472.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,289.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1092,100,,,Fee Schedule,100% of UMR Fee Schedule,289.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.63,1261,
"Instruct/Eval Resp Device, ED",T990300193,CDM,410,RC,94664,HCPCS,Outpatient,,,256,128,,197.12,77,,,Percent of Total Billed Charges,77% of total billed charges,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.44,74,,,Percent of Total Billed Charges,74% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,215.04,84,,,Percent of Total Billed Charges,84% of total billed charges,209.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,227.84,89,,,Percent of total Billed Charges,89% of total Billed charges,227.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.12,77,,,Percent of total Billed charges,77% of total billed charges,217.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64,227.84,
WOUND DEBRIDEMENT,T990300204,CDM,450,RC,97597,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,84.37,100,,,case rate,pays based on per visit,84.37,59,,,case rate,pays based on per visit,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.27,89,,,Percent of total Billed Charges,89% of total Billed charges,120.12,84,,,Percent of Total Billed Charges,84% of Total Billed charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.75,127.27,
IPECAC ADMIN/OBSERVATION,T990300205,CDM,450,RC,99175,HCPCS,Outpatient,,,183.5,91.75,,141.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.27,59,,,Percent of Total Billed Charges,59% of total billed charges,108.27,100,,,case rate,pays based on per visit,108.27,59,,,case rate,pays based on per visit,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.27,59,,,Percent of Total Billed Charges,59% of total billed charges,108.27,59,,,Percent of Total Billed Charges,59% of total billed charges,154.14,84,,,Percent of Total Billed Charges,84% of total billed charges,150.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.32,89,,,Percent of total Billed Charges,89% of total Billed charges,154.14,84,,,Percent of Total Billed Charges,84% of Total Billed charges,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.3,77,,,Percent of total Billed charges,77% of total billed charges,155.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.88,163.32,
EP 1-MINOR OP,T990300206,CDM,510,RC,99211,HCPCS,Outpatient,,,125.5,62.75,,96.64,77,,,Percent of Total Billed Charges,77% of total billed charges,32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,51.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.64,77,,,Percent of total Billed charges,77% of total billed charges,106.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.38,111.7,
EP 1-MINOR OP,T990300206,CDM,510,RC,G0463,HCPCS,Outpatient,,,125.5,62.75,,96.64,77,,,Percent of Total Billed Charges,77% of total billed charges,32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,51.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.64,77,,,Percent of total Billed charges,77% of total billed charges,106.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.38,111.7,
E.R. CATEGORY #1,T990300207,CDM,450,RC,99281,HCPCS,Outpatient,,,383,191.5,,294.91,77,,,Percent of Total Billed Charges,77% of total billed charges,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.97,59,,,Percent of Total Billed Charges,59% of total billed charges,225.97,100,,,case rate,pays based on per visit,225.97,59,,,case rate,pays based on per visit,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,59,,,Percent of Total Billed Charges,59% of total billed charges,225.97,59,,,Percent of Total Billed Charges,59% of total billed charges,321.72,84,,,Percent of Total Billed Charges,84% of total billed charges,314.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,340.87,89,,,Percent of total Billed Charges,89% of total Billed charges,321.72,84,,,Percent of Total Billed Charges,84% of Total Billed charges,340.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.91,77,,,Percent of total Billed charges,77% of total billed charges,325.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,550,100,,,Case Rate,Pays based on per visit rate,156.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476,100,,,Case Rate,Pays based on per visit rate,95.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.75,550,
E.R. CATEGORY #2,T990300208,CDM,450,RC,99282,HCPCS,Outpatient,,,561.5,280.75,,432.36,77,,,Percent of Total Billed Charges,77% of total billed charges,143.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,331.29,59,,,Percent of Total Billed Charges,59% of total billed charges,331.29,100,,,case rate,pays based on per visit,331.29,59,,,case rate,pays based on per visit,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.29,59,,,Percent of Total Billed Charges,59% of total billed charges,331.29,59,,,Percent of Total Billed Charges,59% of total billed charges,471.66,84,,,Percent of Total Billed Charges,84% of total billed charges,460.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,499.74,89,,,Percent of total Billed Charges,89% of total Billed charges,471.66,84,,,Percent of Total Billed Charges,84% of Total Billed charges,499.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,432.36,77,,,Percent of total Billed charges,77% of total billed charges,477.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,736,100,,,Case Rate,Pays based on per visit rate,229.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637,100,,,Case Rate,Pays based on per visit rate,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.38,736,
E.R. CATEGORY #3,T990300209,CDM,450,RC,99283,HCPCS,Outpatient,,,806,403,,620.62,77,,,Percent of Total Billed Charges,77% of total billed charges,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,475.54,59,,,Percent of Total Billed Charges,59% of total billed charges,475.54,100,,,case rate,pays based on per visit,475.54,59,,,case rate,pays based on per visit,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.54,59,,,Percent of Total Billed Charges,59% of total billed charges,475.54,59,,,Percent of Total Billed Charges,59% of total billed charges,677.04,84,,,Percent of Total Billed Charges,84% of total billed charges,660.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,717.34,89,,,Percent of total Billed Charges,89% of total Billed charges,677.04,84,,,Percent of Total Billed Charges,84% of Total Billed charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,328.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,620.62,77,,,Percent of total Billed charges,77% of total billed charges,685.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,999,100,,,Case Rate,Pays based on per visit rate,328.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,864,100,,,Case Rate,Pays based on per visit rate,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.5,999,
E.R. CATEGORY #4,T990300210,CDM,450,RC,99284,HCPCS,Outpatient,,,1276.5,638.25,,982.91,77,,,Percent of Total Billed Charges,77% of total billed charges,325.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,753.14,59,,,Percent of Total Billed Charges,59% of total billed charges,753.14,100,,,case rate,pays based on per visit,753.14,59,,,case rate,pays based on per visit,319.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,753.14,59,,,Percent of Total Billed Charges,59% of total billed charges,753.14,59,,,Percent of Total Billed Charges,59% of total billed charges,1072.26,84,,,Percent of Total Billed Charges,84% of total billed charges,1046.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,1136.09,89,,,Percent of total Billed Charges,89% of total Billed charges,1072.26,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1136.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,319.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.91,77,,,Percent of total Billed charges,77% of total billed charges,1085.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,366.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1580,100,,,Case Rate,Pays based on per visit rate,520.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,319.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368,100,,,Case Rate,Pays based on per visit rate,319.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.13,1580,
E.R. CATEGORY #5,T990300211,CDM,450,RC,99285,HCPCS,Outpatient,,,1736,868,,1336.72,77,,,Percent of Total Billed Charges,77% of total billed charges,442.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1024.24,59,,,Percent of Total Billed Charges,59% of total billed charges,1024.24,100,,,case rate,pays based on per visit,1024.24,59,,,case rate,pays based on per visit,434,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1024.24,59,,,Percent of Total Billed Charges,59% of total billed charges,1024.24,59,,,Percent of Total Billed Charges,59% of total billed charges,1458.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1423.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1545.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1458.24,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1545.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,708.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,708.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,708.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,434,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.72,77,,,Percent of total Billed charges,77% of total billed charges,1475.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,499.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4232,100,,,Case Rate,Pays based on per visit rate,708.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,434,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3662,100,,,Case Rate,Pays based on per visit rate,434,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434,4232,
Critical Care Initial 30-74min,T990300212,CDM,450,RC,99291,HCPCS,Outpatient,,,1718.5,859.25,,1323.25,77,,,Percent of Total Billed Charges,77% of total billed charges,438.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,438.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,537.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1013.92,59,,,Percent of Total Billed Charges,59% of total billed charges,1013.92,100,,,case rate,pays based on per visit,1013.92,59,,,case rate,pays based on per visit,429.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.92,59,,,Percent of Total Billed Charges,59% of total billed charges,1013.92,59,,,Percent of Total Billed Charges,59% of total billed charges,1443.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1409.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,1529.47,89,,,Percent of total Billed Charges,89% of total Billed charges,1443.54,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1529.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,701.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,701.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,429.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1323.25,77,,,Percent of total Billed charges,77% of total billed charges,1460.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,494.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4232,100,,,Case Rate,Pays based on per visit rate,701.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,429.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3662,100,,,Case Rate,Pays based on per visit rate,429.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,429.63,4232,
Critical Care ea addt'l 30 min,T990300213,CDM,450,RC,99292,HCPCS,Outpatient,,,689,344.5,,530.53,77,,,Percent of Total Billed Charges,77% of total billed charges,175.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,215.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,406.51,59,,,Percent of Total Billed Charges,59% of total billed charges,406.51,100,,,case rate,pays based on per visit,406.51,59,,,case rate,pays based on per visit,172.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.51,59,,,Percent of Total Billed Charges,59% of total billed charges,406.51,59,,,Percent of Total Billed Charges,59% of total billed charges,578.76,84,,,Percent of Total Billed Charges,84% of total billed charges,564.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,613.21,89,,,Percent of total Billed Charges,89% of total Billed charges,578.76,84,,,Percent of Total Billed Charges,84% of Total Billed charges,613.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.53,77,,,Percent of total Billed charges,77% of total billed charges,585.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,344.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,281.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,172.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.25,613.21,
Fx Nasal closed w/manip w/o st,T990300214,CDM,450,RC,21315,HCPCS,Outpatient,,,307,153.5,,236.39,77,,,Percent of Total Billed Charges,77% of total billed charges,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.13,59,,,Percent of Total Billed Charges,59% of total billed charges,181.13,100,,,case rate,pays based on per visit,181.13,59,,,case rate,pays based on per visit,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.13,59,,,Percent of Total Billed Charges,59% of total billed charges,181.13,59,,,Percent of Total Billed Charges,59% of total billed charges,257.88,84,,,Percent of Total Billed Charges,84% of total billed charges,251.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,273.23,89,,,Percent of total Billed Charges,89% of total Billed charges,257.88,84,,,Percent of Total Billed Charges,84% of Total Billed charges,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.39,77,,,Percent of total Billed charges,77% of total billed charges,260.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.75,273.23,
VENIPUNCTURE,T990350001,CDM,300,RC,36415,HCPCS,Outpatient,,,27.5,13.75,,21.18,77,,,Percent of Total Billed Charges,77% of total billed charges,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.35,74,,,Percent of Total Billed Charges,74% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.1,84,,,Percent of Total Billed Charges,84% of total billed charges,22.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,15,500,,,fee schedule,500% of healthlink,15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.18,77,,,Percent of total Billed charges,77% of total billed charges,23.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,64,
"VENIPUNCTURE, CAPILLARY",T990350002,CDM,300,RC,36416,HCPCS,Outpatient,,,30.5,15.25,,23.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.57,74,,,Percent of Total Billed Charges,74% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,21.05,69,,,Percent of Total Billed Charges,69% of total billed charges,25.62,84,,,Percent of Total Billed Charges,84% of total billed charges,25.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.15,89,,,Percent of total Billed Charges,89% of total Billed charges,27.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.49,77,,,Percent of total Billed charges,77% of total billed charges,25.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,64,
ARTERIAL PUNCTURE,T990350003,CDM,510,RC,36600,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,54.29,
METABOLIC PANEL BASIC,T990350004,CDM,301,RC,80048,HCPCS,Outpatient,,,168.5,84.25,,129.75,77,,,Percent of Total Billed Charges,77% of total billed charges,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.69,74,,,Percent of Total Billed Charges,74% of total billed charges,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,141.54,84,,,Percent of Total Billed Charges,84% of total billed charges,138.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,500,,,fee schedule,500% of healthlink,61.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.11,120,,,Fee Schedule,120% of MO Medicaid Rate,8.11,120,,,Fee Schedule,120% of MO Medicaid Rate,8.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.75,77,,,Percent of total Billed charges,77% of total billed charges,143.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.11,120,,,Fee Schedule,120% of MO Medicaid Rate,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,143.23,
GENERAL HEALTH PANEL,T990350005,CDM,301,RC,80050,HCPCS,Outpatient,,,623.5,311.75,,480.1,77,,,Percent of Total Billed Charges,77% of total billed charges,158.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,461.39,74,,,Percent of Total Billed Charges,74% of total billed charges,430.22,69,,,Percent of Total Billed Charges,69% of total billed charges,430.22,69,,,Percent of Total Billed Charges,69% of total billed charges,155.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430.22,69,,,Percent of Total Billed Charges,69% of total billed charges,430.22,69,,,Percent of Total Billed Charges,69% of total billed charges,523.74,84,,,Percent of Total Billed Charges,84% of total billed charges,511.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,554.92,89,,,Percent of total Billed Charges,89% of total Billed charges,554.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,554.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,155.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.1,77,,,Percent of total Billed charges,77% of total billed charges,529.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,155.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,155.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,554.92,
ELECTROLYTE PANEL,T990350006,CDM,301,RC,80051,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.24,74,,,Percent of Total Billed Charges,74% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,105.84,84,,,Percent of Total Billed Charges,84% of total billed charges,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.2,500,,,fee schedule,500% of healthlink,51.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.72,120,,,Fee Schedule,120% of MO Medicaid Rate,6.72,120,,,Fee Schedule,120% of MO Medicaid Rate,6.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.72,120,,,Fee Schedule,120% of MO Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,107.1,
METABOLIC PANEL COMPREHENSIVE,T990350007,CDM,301,RC,80053,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.2,500,,,fee schedule,500% of healthlink,77.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.13,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,151.73,
OBSTETRIC PANEL,T990350008,CDM,301,RC,80055,HCPCS,Outpatient,,,567.5,283.75,,436.98,77,,,Percent of Total Billed Charges,77% of total billed charges,144.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,419.95,74,,,Percent of Total Billed Charges,74% of total billed charges,391.58,69,,,Percent of Total Billed Charges,69% of total billed charges,391.58,69,,,Percent of Total Billed Charges,69% of total billed charges,141.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.58,69,,,Percent of Total Billed Charges,69% of total billed charges,391.58,69,,,Percent of Total Billed Charges,69% of total billed charges,476.7,84,,,Percent of Total Billed Charges,84% of total billed charges,465.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,505.08,89,,,Percent of total Billed Charges,89% of total Billed charges,505.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,505.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.89,120,,,Fee Schedule,120% of MO Medicaid Rate,45.89,120,,,Fee Schedule,120% of MO Medicaid Rate,45.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,141.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.98,77,,,Percent of total Billed charges,77% of total billed charges,482.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,45.89,120,,,Fee Schedule,120% of MO Medicaid Rate,141.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,141.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.89,505.08,
HEALTH FAIR LIPID PANEL,T990350009,CDM,301,RC,80061,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.85,500,,,fee schedule,500% of healthlink,97.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,97.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,97.85,
LIPID PROFILE,T990350010,CDM,301,RC,80061,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.16,74,,,Percent of Total Billed Charges,74% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,112.56,84,,,Percent of Total Billed Charges,84% of total billed charges,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.85,500,,,fee schedule,500% of healthlink,97.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,97.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.85,113.9,
RENAL FUNCTION PANEL,T990350011,CDM,301,RC,80069,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.4,500,,,fee schedule,500% of healthlink,63.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.33,120,,,Fee Schedule,120% of MO Medicaid Rate,8.33,120,,,Fee Schedule,120% of MO Medicaid Rate,8.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.33,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,180.63,
HEPATITIS PANEL,T990350012,CDM,301,RC,80074,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,372.96,74,,,Percent of Total Billed Charges,74% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,423.36,84,,,Percent of Total Billed Charges,84% of total billed charges,413.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,346.35,500,,,fee schedule,500% of healthlink,346.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,346.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,45.72,120,,,Fee Schedule,120% of MO Medicaid Rate,45.72,120,,,Fee Schedule,120% of MO Medicaid Rate,45.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,45.72,120,,,Fee Schedule,120% of MO Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.72,428.4,
HEPATIC FUNCTION PANEL,T990350013,CDM,301,RC,80076,HCPCS,Outpatient,,,122,61,,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.28,74,,,Percent of Total Billed Charges,74% of total billed charges,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,84.18,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,84,,,Percent of Total Billed Charges,84% of total billed charges,100.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.65,500,,,fee schedule,500% of healthlink,59.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.84,103.7,
SULFONYLUREA SERUM,T990350014,CDM,301,RC,80377,HCPCS,Outpatient,,,431.5,215.75,,332.26,77,,,Percent of Total Billed Charges,77% of total billed charges,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.31,74,,,Percent of Total Billed Charges,74% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,362.46,84,,,Percent of Total Billed Charges,84% of total billed charges,353.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,384.04,89,,,Percent of total Billed Charges,89% of total Billed charges,384.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.26,77,,,Percent of total Billed charges,77% of total billed charges,366.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,384.04,
SULFONYLUREA SERUM,T990350014,CDM,301,RC,G0480,HCPCS,Outpatient,,,431.5,215.75,,332.26,77,,,Percent of Total Billed Charges,77% of total billed charges,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.31,74,,,Percent of Total Billed Charges,74% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,362.46,84,,,Percent of Total Billed Charges,84% of total billed charges,353.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,384.04,89,,,Percent of total Billed Charges,89% of total Billed charges,384.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.26,77,,,Percent of total Billed charges,77% of total billed charges,366.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,384.04,
SULFONYLUREA SERUM,T990350014,CDM,301,RC,80101,HCPCS,Outpatient,,,431.5,215.75,,332.26,77,,,Percent of Total Billed Charges,77% of total billed charges,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.31,74,,,Percent of Total Billed Charges,74% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,362.46,84,,,Percent of Total Billed Charges,84% of total billed charges,353.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.55,500,,,fee schedule,500% of healthlink,100.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.26,77,,,Percent of total Billed charges,77% of total billed charges,366.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,366.78,
CARBAMAZEPINE & METABOLITE,T990350015,CDM,301,RC,80156,HCPCS,Outpatient,,,389,194.5,,299.53,77,,,Percent of Total Billed Charges,77% of total billed charges,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,287.86,74,,,Percent of Total Billed Charges,74% of total billed charges,268.41,69,,,Percent of Total Billed Charges,69% of total billed charges,268.41,69,,,Percent of Total Billed Charges,69% of total billed charges,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.41,69,,,Percent of Total Billed Charges,69% of total billed charges,268.41,69,,,Percent of Total Billed Charges,69% of total billed charges,326.76,84,,,Percent of Total Billed Charges,84% of total billed charges,318.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.3,500,,,fee schedule,500% of healthlink,106.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.53,77,,,Percent of total Billed charges,77% of total billed charges,330.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,97.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.98,330.65,
CARBAMAZEPINE (TEGRETOL),T990350016,CDM,301,RC,80156,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.3,500,,,fee schedule,500% of healthlink,106.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.98,170,
CARBAMAZEPINE FREE,T990350017,CDM,301,RC,80157,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.8,500,,,fee schedule,500% of healthlink,96.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,113.48,
CYCLOSPORINE,T990350018,CDM,301,RC,80158,HCPCS,Outpatient,,,207,103.5,,159.39,77,,,Percent of Total Billed Charges,77% of total billed charges,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.18,74,,,Percent of Total Billed Charges,74% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,173.88,84,,,Percent of Total Billed Charges,84% of total billed charges,169.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.8,500,,,fee schedule,500% of healthlink,131.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,17.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.39,77,,,Percent of total Billed charges,77% of total billed charges,175.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.33,175.95,
Clozapine (clozaril),T990350019,CDM,301,RC,80159,HCPCS,Outpatient,,,138,69,,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.12,74,,,Percent of Total Billed Charges,74% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,84,,,Percent of Total Billed Charges,84% of total billed charges,113.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.82,89,,,Percent of total Billed Charges,89% of total Billed charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.34,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.34,122.82,
Clozapine (clozaril),T990350019,CDM,301,RC,G0480,HCPCS,Outpatient,,,138,69,,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.12,74,,,Percent of Total Billed Charges,74% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,84,,,Percent of Total Billed Charges,84% of total billed charges,113.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.82,89,,,Percent of total Billed Charges,89% of total Billed charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,122.82,
DIGOXIN SERUM,T990350020,CDM,301,RC,80162,HCPCS,Outpatient,,,211,105.5,,162.47,77,,,Percent of Total Billed Charges,77% of total billed charges,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.14,74,,,Percent of Total Billed Charges,74% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,177.24,84,,,Percent of Total Billed Charges,84% of total billed charges,173.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.95,500,,,fee schedule,500% of healthlink,96.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.74,120,,,Fee Schedule,120% of MO Medicaid Rate,12.74,120,,,Fee Schedule,120% of MO Medicaid Rate,12.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.47,77,,,Percent of total Billed charges,77% of total billed charges,179.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.74,120,,,Fee Schedule,120% of MO Medicaid Rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.74,179.35,
VALPROIC ACID (DEPAKENE),T990350021,CDM,301,RC,80164,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.9,500,,,fee schedule,500% of healthlink,98.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13,120,,,Fee Schedule,120% of MO Medicaid Rate,13,120,,,Fee Schedule,120% of MO Medicaid Rate,13,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,151.73,
EVEROLIMUS,T990350022,CDM,301,RC,80169,HCPCS,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,218.3,74,,,Percent of Total Billed Charges,74% of total billed charges,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,203.55,69,,,Percent of Total Billed Charges,69% of total billed charges,247.8,84,,,Percent of Total Billed Charges,84% of total billed charges,241.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,13.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.18,262.55,
GENTAMICIN SERUM,T990350023,CDM,301,RC,80170,HCPCS,Outpatient,,,215.5,107.75,,165.94,77,,,Percent of Total Billed Charges,77% of total billed charges,54.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.47,74,,,Percent of Total Billed Charges,74% of total billed charges,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.02,84,,,Percent of Total Billed Charges,84% of total billed charges,176.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.65,500,,,fee schedule,500% of healthlink,119.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,119.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.72,120,,,Fee Schedule,120% of MO Medicaid Rate,15.72,120,,,Fee Schedule,120% of MO Medicaid Rate,15.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.94,77,,,Percent of total Billed charges,77% of total billed charges,183.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.72,120,,,Fee Schedule,120% of MO Medicaid Rate,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.72,183.18,
GABAPENTIN PLASMA,T990350024,CDM,301,RC,80171,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.36,89,,,Percent of total Billed Charges,89% of total Billed charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.8,120,,,Fee Schedule,120% of MO Medicaid Rate,20.8,120,,,Fee Schedule,120% of MO Medicaid Rate,20.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.8,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.8,110.36,
HALOPERIDOL (HALDOL),T990350025,CDM,301,RC,80173,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.3,500,,,fee schedule,500% of healthlink,106.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.14,120,,,Fee Schedule,120% of MO Medicaid Rate,15.14,120,,,Fee Schedule,120% of MO Medicaid Rate,15.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.14,120,,,Fee Schedule,120% of MO Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,140.25,
LAMOTRIGINE (LAMICTAL),T990350026,CDM,301,RC,80175,HCPCS,Outpatient,,,167.5,83.75,,128.98,77,,,Percent of Total Billed Charges,77% of total billed charges,42.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.95,74,,,Percent of Total Billed Charges,74% of total billed charges,115.58,69,,,Percent of Total Billed Charges,69% of total billed charges,115.58,69,,,Percent of Total Billed Charges,69% of total billed charges,41.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.58,69,,,Percent of Total Billed Charges,69% of total billed charges,115.58,69,,,Percent of Total Billed Charges,69% of total billed charges,140.7,84,,,Percent of Total Billed Charges,84% of total billed charges,137.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.08,89,,,Percent of total Billed Charges,89% of total Billed charges,149.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.98,77,,,Percent of total Billed charges,77% of total billed charges,142.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,41.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,149.08,
LEVETIRACETAM (KEPPRA),T990350027,CDM,301,RC,80177,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.44,74,,,Percent of Total Billed Charges,74% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,173.04,84,,,Percent of Total Billed Charges,84% of total billed charges,168.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.34,89,,,Percent of total Billed Charges,89% of total Billed charges,183.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,183.34,
LITHIUM SERUM,T990350028,CDM,301,RC,80178,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.25,500,,,fee schedule,500% of healthlink,48.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.34,120,,,Fee Schedule,120% of MO Medicaid Rate,6.34,120,,,Fee Schedule,120% of MO Medicaid Rate,6.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.34,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,103.28,
OXCARBAZEPINE,T990350029,CDM,301,RC,80183,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.12,74,,,Percent of Total Billed Charges,74% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,211.82,
PHENOBARBITAL SERUM,T990350030,CDM,301,RC,80184,HCPCS,Outpatient,,,124.5,62.25,,95.87,77,,,Percent of Total Billed Charges,77% of total billed charges,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.13,74,,,Percent of Total Billed Charges,74% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,104.58,84,,,Percent of Total Billed Charges,84% of total billed charges,102.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.6,500,,,fee schedule,500% of healthlink,83.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.69,120,,,Fee Schedule,120% of MO Medicaid Rate,14.69,120,,,Fee Schedule,120% of MO Medicaid Rate,14.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.87,77,,,Percent of total Billed charges,77% of total billed charges,105.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.69,120,,,Fee Schedule,120% of MO Medicaid Rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,105.83,
PHENYTOIN SERUM,T990350031,CDM,301,RC,80185,HCPCS,Outpatient,,,148.5,74.25,,114.35,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.89,74,,,Percent of Total Billed Charges,74% of total billed charges,102.47,69,,,Percent of Total Billed Charges,69% of total billed charges,102.47,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.47,69,,,Percent of Total Billed Charges,69% of total billed charges,102.47,69,,,Percent of Total Billed Charges,69% of total billed charges,124.74,84,,,Percent of Total Billed Charges,84% of total billed charges,121.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.8,500,,,fee schedule,500% of healthlink,96.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.35,77,,,Percent of total Billed charges,77% of total billed charges,126.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,126.23,
PHENYTOIN FREE,T990350032,CDM,301,RC,80186,HCPCS,Outpatient,,,134.5,67.25,,103.57,77,,,Percent of Total Billed Charges,77% of total billed charges,34.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.53,74,,,Percent of Total Billed Charges,74% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,112.98,84,,,Percent of Total Billed Charges,84% of total billed charges,110.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.5,500,,,fee schedule,500% of healthlink,100.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.2,120,,,Fee Schedule,120% of MO Medicaid Rate,13.2,120,,,Fee Schedule,120% of MO Medicaid Rate,13.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.57,77,,,Percent of total Billed charges,77% of total billed charges,114.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.2,120,,,Fee Schedule,120% of MO Medicaid Rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.2,114.33,
PRIMIDONE,T990350033,CDM,301,RC,80188,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,132.72,84,,,Percent of Total Billed Charges,84% of total billed charges,129.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.15,500,,,fee schedule,500% of healthlink,121.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,121.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.92,120,,,Fee Schedule,120% of MO Medicaid Rate,15.92,120,,,Fee Schedule,120% of MO Medicaid Rate,15.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.92,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.92,134.3,
SIROLIMUS,T990350034,CDM,301,RC,80195,HCPCS,Outpatient,,,653.5,326.75,,503.2,77,,,Percent of Total Billed Charges,77% of total billed charges,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,483.59,74,,,Percent of Total Billed Charges,74% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,450.92,69,,,Percent of Total Billed Charges,69% of total billed charges,548.94,84,,,Percent of Total Billed Charges,84% of total billed charges,535.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.2,500,,,fee schedule,500% of healthlink,100.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,13.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,503.2,77,,,Percent of total Billed charges,77% of total billed charges,555.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,163.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.18,555.48,
TACROLIMUS (FK506),T990350035,CDM,301,RC,80197,HCPCS,Outpatient,,,378.5,189.25,,291.45,77,,,Percent of Total Billed Charges,77% of total billed charges,96.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.09,74,,,Percent of Total Billed Charges,74% of total billed charges,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,317.94,84,,,Percent of Total Billed Charges,84% of total billed charges,310.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.2,500,,,fee schedule,500% of healthlink,100.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,13.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.45,77,,,Percent of total Billed charges,77% of total billed charges,321.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.18,120,,,Fee Schedule,120% of MO Medicaid Rate,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.18,321.73,
"THEOPHYLLINE, SERUM",T990350036,CDM,301,RC,80198,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.3,500,,,fee schedule,500% of healthlink,103.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,103.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.57,120,,,Fee Schedule,120% of MO Medicaid Rate,13.57,120,,,Fee Schedule,120% of MO Medicaid Rate,13.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.57,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.57,216.33,
TOBRAMYCIN,T990350037,CDM,301,RC,80200,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.86,74,,,Percent of Total Billed Charges,74% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,116.76,84,,,Percent of Total Billed Charges,84% of total billed charges,113.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.65,500,,,fee schedule,500% of healthlink,117.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,118.15,
TOPRIAMATE,T990350038,CDM,301,RC,80201,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,87,500,,,fee schedule,500% of healthlink,87,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.44,120,,,Fee Schedule,120% of MO Medicaid Rate,11.44,120,,,Fee Schedule,120% of MO Medicaid Rate,11.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.44,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.44,151.73,
"VANCOMYCIN, SERUM",T990350039,CDM,301,RC,80202,HCPCS,Outpatient,,,209.5,104.75,,161.32,77,,,Percent of Total Billed Charges,77% of total billed charges,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.03,74,,,Percent of Total Billed Charges,74% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,175.98,84,,,Percent of Total Billed Charges,84% of total billed charges,171.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.9,500,,,fee schedule,500% of healthlink,98.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13,120,,,Fee Schedule,120% of MO Medicaid Rate,13,120,,,Fee Schedule,120% of MO Medicaid Rate,13,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.32,77,,,Percent of total Billed charges,77% of total billed charges,178.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13,120,,,Fee Schedule,120% of MO Medicaid Rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,178.08,
ZONISAMIDE (ZONEGRAN),T990350040,CDM,301,RC,80203,HCPCS,Outpatient,,,196.5,98.25,,151.31,77,,,Percent of Total Billed Charges,77% of total billed charges,50.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.41,74,,,Percent of Total Billed Charges,74% of total billed charges,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,165.06,84,,,Percent of Total Billed Charges,84% of total billed charges,161.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.89,89,,,Percent of total Billed Charges,89% of total Billed charges,174.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.31,77,,,Percent of total Billed charges,77% of total billed charges,167.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,174.89,
AMIODARONE SERUM,T990350041,CDM,301,RC,80299,HCPCS,Outpatient,,,211,105.5,,162.47,77,,,Percent of Total Billed Charges,77% of total billed charges,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.14,74,,,Percent of Total Billed Charges,74% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,177.24,84,,,Percent of Total Billed Charges,84% of total billed charges,173.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.47,77,,,Percent of total Billed charges,77% of total billed charges,179.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,179.35,
AMIODARONE SERUM,T990350041,CDM,301,RC,83789,HCPCS,Outpatient,,,211,105.5,,162.47,77,,,Percent of Total Billed Charges,77% of total billed charges,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.14,74,,,Percent of Total Billed Charges,74% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,145.59,69,,,Percent of Total Billed Charges,69% of total billed charges,177.24,84,,,Percent of Total Billed Charges,84% of total billed charges,173.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.47,77,,,Percent of total Billed charges,77% of total billed charges,179.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,179.35,
ANTI-DRUG AB,T990350042,CDM,301,RC,80299,HCPCS,Outpatient,,,1269.5,634.75,,977.52,77,,,Percent of Total Billed Charges,77% of total billed charges,323.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,939.43,74,,,Percent of Total Billed Charges,74% of total billed charges,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1066.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1040.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,977.52,77,,,Percent of total Billed charges,77% of total billed charges,1079.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,364.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,1079.08,
BENZTROPINE,T990350043,CDM,301,RC,80299,HCPCS,Outpatient,,,183,91.5,,140.91,77,,,Percent of Total Billed Charges,77% of total billed charges,46.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.42,74,,,Percent of Total Billed Charges,74% of total billed charges,126.27,69,,,Percent of Total Billed Charges,69% of total billed charges,126.27,69,,,Percent of Total Billed Charges,69% of total billed charges,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.27,69,,,Percent of Total Billed Charges,69% of total billed charges,126.27,69,,,Percent of Total Billed Charges,69% of total billed charges,153.72,84,,,Percent of Total Billed Charges,84% of total billed charges,150.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.91,77,,,Percent of total Billed charges,77% of total billed charges,155.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,155.55,
FLECAINIDE,T990350044,CDM,301,RC,80299,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,140.25,
ISONIAZID,T990350045,CDM,301,RC,80299,HCPCS,Outpatient,,,242.5,121.25,,186.73,77,,,Percent of Total Billed Charges,77% of total billed charges,61.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.45,74,,,Percent of Total Billed Charges,74% of total billed charges,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,167.33,69,,,Percent of Total Billed Charges,69% of total billed charges,203.7,84,,,Percent of Total Billed Charges,84% of total billed charges,198.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,77,,,Percent of total Billed charges,77% of total billed charges,206.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,60.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,206.13,
LACOSAMIDE,T990350046,CDM,301,RC,80299,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,223.55,
QUETIAPINE SERUM,T990350047,CDM,301,RC,80299,HCPCS,Outpatient,,,436.5,218.25,,336.11,77,,,Percent of Total Billed Charges,77% of total billed charges,111.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.01,74,,,Percent of Total Billed Charges,74% of total billed charges,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,301.19,69,,,Percent of Total Billed Charges,69% of total billed charges,366.66,84,,,Percent of Total Billed Charges,84% of total billed charges,357.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.11,77,,,Percent of total Billed charges,77% of total billed charges,371.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,371.03,
VIROCONAZOLE,T990350048,CDM,301,RC,80299,HCPCS,Outpatient,,,471.5,235.75,,363.06,77,,,Percent of Total Billed Charges,77% of total billed charges,120.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,348.91,74,,,Percent of Total Billed Charges,74% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,396.06,84,,,Percent of Total Billed Charges,84% of total billed charges,386.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.06,77,,,Percent of total Billed charges,77% of total billed charges,400.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,400.78,
AMPHETAMINES QUAL. URINE,T990350049,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
BARBITURATES QUAL. URINE,T990350050,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
BENZODIAZAPINES QUAL URINE,T990350051,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
CANNABINOIDS QUAL. URINE,T990350052,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
COCAINE QUAL. URINE,T990350053,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
DRUG OF ABUSE PER ENCOUNTER,T990350054,CDM,301,RC,80306,HCPCS,Outpatient,,,247,123.5,,190.19,77,,,Percent of Total Billed Charges,77% of total billed charges,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.78,74,,,Percent of Total Billed Charges,74% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,207.48,84,,,Percent of Total Billed Charges,84% of total billed charges,202.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.83,89,,,Percent of total Billed Charges,89% of total Billed charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.19,77,,,Percent of total Billed charges,77% of total billed charges,209.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,219.83,
DRUG OF ABUSE PER ENCOUNTER,T990350054,CDM,301,RC,G0480,HCPCS,Outpatient,,,247,123.5,,190.19,77,,,Percent of Total Billed Charges,77% of total billed charges,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.78,74,,,Percent of Total Billed Charges,74% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,170.43,69,,,Percent of Total Billed Charges,69% of total billed charges,207.48,84,,,Percent of Total Billed Charges,84% of total billed charges,202.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.83,89,,,Percent of total Billed Charges,89% of total Billed charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.19,77,,,Percent of total Billed charges,77% of total billed charges,209.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,219.83,
METHADONE QUAL. URINE,T990350055,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
METHAMPHETAMINE QUAL. URINE,T990350056,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
OPIATES QUAL. URINE,T990350057,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
OXYCODONE QUAL. URINE,T990350058,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
PHENCYCLIDINE QUAL URINE,T990350059,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
PROPOXYPHENE QUAL. URINE,T990350060,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
TC ANTIDEPRESSANTS QUAL. URINE,T990350061,CDM,301,RC,80306,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.97,89,,,Percent of total Billed Charges,89% of total Billed charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,16.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.45,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.45,64.97,
ALCOHOL ETHYL URINE QUAL,T990350062,CDM,301,RC,80307,HCPCS,Outpatient,,,138,69,,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.12,74,,,Percent of Total Billed Charges,74% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,84,,,Percent of Total Billed Charges,84% of total billed charges,113.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.82,89,,,Percent of total Billed Charges,89% of total Billed charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.5,122.82,
AMPHETAMINE,T990350063,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
"AMPHETAMINE, RL",T990350064,CDM,301,RC,80307,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,64,
BARBITURATES,T990350065,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
BENZODIAZEPINES,T990350066,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
BENZOYLECOGINE,T990350067,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
CANNABINOIDS,T990350068,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
COCAINE,T990350069,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
"COCAINE, RL",T990350070,CDM,301,RC,80307,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,64,
COTININE,T990350071,CDM,301,RC,80307,HCPCS,Outpatient,,,287.5,143.75,,221.38,77,,,Percent of Total Billed Charges,77% of total billed charges,73.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,212.75,74,,,Percent of Total Billed Charges,74% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,198.38,69,,,Percent of Total Billed Charges,69% of total billed charges,241.5,84,,,Percent of Total Billed Charges,84% of total billed charges,235.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,255.88,89,,,Percent of total Billed Charges,89% of total Billed charges,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.38,77,,,Percent of total Billed charges,77% of total billed charges,244.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,71.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,255.88,
DRUG SCREEN COMP EA CLASS,T990350072,CDM,301,RC,80307,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.26,74,,,Percent of Total Billed Charges,74% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,83.16,84,,,Percent of Total Billed Charges,84% of total billed charges,81.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.75,88.11,
DRUG SCREEN COMP QUAL,T990350073,CDM,301,RC,80307,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.77,89,,,Percent of total Billed Charges,89% of total Billed charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.77,
DRUG SCREEN EACH DRUG CLASS,T990350074,CDM,301,RC,80307,HCPCS,Outpatient,,,64.5,32.25,,49.67,77,,,Percent of Total Billed Charges,77% of total billed charges,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.73,74,,,Percent of Total Billed Charges,74% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.18,84,,,Percent of Total Billed Charges,84% of total billed charges,52.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.41,89,,,Percent of total Billed Charges,89% of total Billed charges,57.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.67,77,,,Percent of total Billed charges,77% of total billed charges,54.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,64,
DRUG SCREEN MULTI-CLASS QUAL.,T990350075,CDM,301,RC,80307,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.44,74,,,Percent of Total Billed Charges,74% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,173.04,84,,,Percent of Total Billed Charges,84% of total billed charges,168.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.34,89,,,Percent of total Billed Charges,89% of total Billed charges,183.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.5,183.34,
DRUG SCREEN QUAL SERUM,T990350076,CDM,301,RC,80307,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.2,74,,,Percent of Total Billed Charges,74% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,109.2,84,,,Percent of Total Billed Charges,84% of total billed charges,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,115.7,
HEROIN,T990350077,CDM,301,RC,80307,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.13,117.93,
KETAMINE URINE,T990350078,CDM,301,RC,80307,HCPCS,Outpatient,,,467,233.5,,359.59,77,,,Percent of Total Billed Charges,77% of total billed charges,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.58,74,,,Percent of Total Billed Charges,74% of total billed charges,322.23,69,,,Percent of Total Billed Charges,69% of total billed charges,322.23,69,,,Percent of Total Billed Charges,69% of total billed charges,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.23,69,,,Percent of Total Billed Charges,69% of total billed charges,322.23,69,,,Percent of Total Billed Charges,69% of total billed charges,392.28,84,,,Percent of Total Billed Charges,84% of total billed charges,382.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.63,89,,,Percent of total Billed Charges,89% of total Billed charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.59,77,,,Percent of total Billed charges,77% of total billed charges,396.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,116.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,415.63,
MARIJUANA,T990350079,CDM,301,RC,80307,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,64,
METHADONE,T990350080,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
METHAQUALONE,T990350081,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
OPIATES,T990350082,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
"OPIATES, RL",T990350083,CDM,301,RC,80307,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,64,
PHENCYCLIDINE,T990350084,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
"PHENCYCLIDINE, RL",T990350085,CDM,301,RC,80307,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,64,
PROPOXYPHENE,T990350086,CDM,301,RC,80307,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.16,89,,,Percent of total Billed Charges,89% of total Billed charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,64,
SULFONYLUREA URINE,T990350087,CDM,301,RC,80307,HCPCS,Outpatient,,,431.5,215.75,,332.26,77,,,Percent of Total Billed Charges,77% of total billed charges,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.31,74,,,Percent of Total Billed Charges,74% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,297.74,69,,,Percent of Total Billed Charges,69% of total billed charges,362.46,84,,,Percent of Total Billed Charges,84% of total billed charges,353.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,384.04,89,,,Percent of total Billed Charges,89% of total Billed charges,384.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,59.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.26,77,,,Percent of total Billed charges,77% of total billed charges,366.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.65,120,,,Fee Schedule,120% of MO Medicaid Rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,107.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,384.04,
ALCOHOL,T990350088,CDM,301,RC,80320,HCPCS,Outpatient,,,160,80,,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.4,74,,,Percent of Total Billed Charges,74% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,84,,,Percent of Total Billed Charges,84% of total billed charges,131.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.4,89,,,Percent of total Billed Charges,89% of total Billed charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,142.4,
ALCOHOL,T990350088,CDM,301,RC,G0480,HCPCS,Outpatient,,,160,80,,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.4,74,,,Percent of Total Billed Charges,74% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,84,,,Percent of Total Billed Charges,84% of total billed charges,131.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.4,89,,,Percent of total Billed Charges,89% of total Billed charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40,142.4,
ALCOHOL (ETHANOL) SERUM,T990350089,CDM,301,RC,80320,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,129.94,
ALCOHOL (ETHANOL) SERUM,T990350089,CDM,301,RC,G0480,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,129.94,
ETHYL GLUCURONIDE URINE,T990350090,CDM,301,RC,80321,HCPCS,Outpatient,,,191,95.5,,147.07,77,,,Percent of Total Billed Charges,77% of total billed charges,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.34,74,,,Percent of Total Billed Charges,74% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,160.44,84,,,Percent of Total Billed Charges,84% of total billed charges,156.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.99,89,,,Percent of total Billed Charges,89% of total Billed charges,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.07,77,,,Percent of total Billed charges,77% of total billed charges,162.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.75,169.99,
ETHYL GLUCURONIDE URINE,T990350090,CDM,301,RC,83788,HCPCS,Outpatient,,,191,95.5,,147.07,77,,,Percent of Total Billed Charges,77% of total billed charges,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.34,74,,,Percent of Total Billed Charges,74% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,160.44,84,,,Percent of Total Billed Charges,84% of total billed charges,156.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.07,77,,,Percent of total Billed charges,77% of total billed charges,162.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.75,162.35,
CONTININE,T990350091,CDM,301,RC,G0480,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.38,175.78,
CONTININE,T990350091,CDM,301,RC,80323,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.38,175.78,
AMPHETAMINES GC/MS,T990350092,CDM,301,RC,80324,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
AMPHETAMINES GC/MS,T990350092,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
METHAMPHETAMINE ISOMERS D & L,T990350093,CDM,301,RC,80324,HCPCS,Outpatient,,,344,172,,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.56,74,,,Percent of Total Billed Charges,74% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,288.96,84,,,Percent of Total Billed Charges,84% of total billed charges,282.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,306.16,
METHAMPHETAMINE ISOMERS D & L,T990350093,CDM,301,RC,G0480,HCPCS,Outpatient,,,344,172,,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.56,74,,,Percent of Total Billed Charges,74% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,288.96,84,,,Percent of Total Billed Charges,84% of total billed charges,282.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,306.16,
METHAMPHETAMINE LC/MS/MS,T990350094,CDM,301,RC,80324,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
METHAMPHETAMINE LC/MS/MS,T990350094,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
DIHYDROTESTOSTERONE,T990350095,CDM,301,RC,82642,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.1,117.93,
DIHYDROTESTOSTERONE FREE,T990350096,CDM,301,RC,82642,HCPCS,Outpatient,,,458,229,,352.66,77,,,Percent of Total Billed Charges,77% of total billed charges,116.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,338.92,74,,,Percent of Total Billed Charges,74% of total billed charges,316.02,69,,,Percent of Total Billed Charges,69% of total billed charges,316.02,69,,,Percent of Total Billed Charges,69% of total billed charges,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.02,69,,,Percent of Total Billed Charges,69% of total billed charges,316.02,69,,,Percent of Total Billed Charges,69% of total billed charges,384.72,84,,,Percent of Total Billed Charges,84% of total billed charges,375.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,407.62,89,,,Percent of total Billed Charges,89% of total Billed charges,407.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.66,77,,,Percent of total Billed charges,77% of total billed charges,389.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,114.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.1,407.62,
ACETAMINOPHEN SERUM,T990350097,CDM,301,RC,80329,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,129.94,
"SALICYLATE, SERUM",T990350098,CDM,301,RC,G0480,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.24,74,,,Percent of Total Billed Charges,74% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,105.84,84,,,Percent of Total Billed Charges,84% of total billed charges,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,112.14,
"SALICYLATE, SERUM",T990350098,CDM,301,RC,80329,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.24,74,,,Percent of Total Billed Charges,74% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,105.84,84,,,Percent of Total Billed Charges,84% of total billed charges,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,112.14,
AMITRIPTYLINE,T990350099,CDM,301,RC,80335,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.37,89,,,Percent of total Billed Charges,89% of total Billed charges,114.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,114.37,
AMITRIPTYLINE,T990350099,CDM,301,RC,G0480,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.37,89,,,Percent of total Billed Charges,89% of total Billed charges,114.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,114.37,
AMITRIPTYLINE QUANTITATIVE MS,T990350100,CDM,301,RC,80335,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.13,117.93,
CLOMIPRAMINE,T990350101,CDM,301,RC,80335,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.87,89,,,Percent of total Billed Charges,89% of total Billed charges,158.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.63,158.87,
NORTRIPTYLINE (AVENTYL),T990350102,CDM,301,RC,80335,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.82,89,,,Percent of total Billed Charges,89% of total Billed charges,118.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.38,118.82,
NORTRIPTYLINE QUANTITATIVE MS,T990350103,CDM,301,RC,80335,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.13,117.93,
NORTRIPTYLINE QUANTITATIVE MS,T990350103,CDM,301,RC,G0480,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.93,89,,,Percent of total Billed Charges,89% of total Billed charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.13,117.93,
TRICYCLIC ANTIDEPRESSANT MS,T990350104,CDM,301,RC,80337,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
TRICYCLIC ANTIDEPRESSANT MS,T990350104,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
ETHOSUXIMIDE,T990350105,CDM,301,RC,80339,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
ETHOSUXIMIDE,T990350105,CDM,301,RC,80299,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,99.95,
BARBITURATES GS/MS,T990350106,CDM,301,RC,80345,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
BARBITURATES GS/MS,T990350106,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
BARBITURATES PANEL STOOL,T990350107,CDM,301,RC,80345,HCPCS,Outpatient,,,592,296,,455.84,77,,,Percent of Total Billed Charges,77% of total billed charges,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.08,74,,,Percent of Total Billed Charges,74% of total billed charges,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,497.28,84,,,Percent of Total Billed Charges,84% of total billed charges,485.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,526.88,89,,,Percent of total Billed Charges,89% of total Billed charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.84,77,,,Percent of total Billed charges,77% of total billed charges,503.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,526.88,
BARBITURATES PANEL STOOL,T990350107,CDM,301,RC,G0480,HCPCS,Outpatient,,,592,296,,455.84,77,,,Percent of Total Billed Charges,77% of total billed charges,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.08,74,,,Percent of Total Billed Charges,74% of total billed charges,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,408.48,69,,,Percent of Total Billed Charges,69% of total billed charges,497.28,84,,,Percent of Total Billed Charges,84% of total billed charges,485.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,526.88,89,,,Percent of total Billed Charges,89% of total Billed charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,526.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.84,77,,,Percent of total Billed charges,77% of total billed charges,503.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,148,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,526.88,
BDNZODIAZEPINES QUANTITATIVE,T990350108,CDM,301,RC,80346,HCPCS,Outpatient,,,463.5,231.75,,356.9,77,,,Percent of Total Billed Charges,77% of total billed charges,118.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.99,74,,,Percent of Total Billed Charges,74% of total billed charges,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,389.34,84,,,Percent of Total Billed Charges,84% of total billed charges,380.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,412.52,89,,,Percent of total Billed Charges,89% of total Billed charges,412.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.9,77,,,Percent of total Billed charges,77% of total billed charges,393.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,412.52,
BDNZODIAZEPINES QUANTITATIVE,T990350108,CDM,301,RC,G0480,HCPCS,Outpatient,,,463.5,231.75,,356.9,77,,,Percent of Total Billed Charges,77% of total billed charges,118.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,342.99,74,,,Percent of Total Billed Charges,74% of total billed charges,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,319.82,69,,,Percent of Total Billed Charges,69% of total billed charges,389.34,84,,,Percent of Total Billed Charges,84% of total billed charges,380.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,412.52,89,,,Percent of total Billed Charges,89% of total Billed charges,412.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,412.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356.9,77,,,Percent of total Billed charges,77% of total billed charges,393.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,115.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,412.52,
BENZODIAZEPINE GC/MS,T990350109,CDM,301,RC,80346,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
BENZODIAZEPINE GC/MS,T990350109,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
CLOBAZAM,T990350110,CDM,301,RC,G6031,HCPCS,Outpatient,,,292,146,,224.84,77,,,Percent of Total Billed Charges,77% of total billed charges,74.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,216.08,74,,,Percent of Total Billed Charges,74% of total billed charges,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,245.28,84,,,Percent of Total Billed Charges,84% of total billed charges,239.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,259.88,89,,,Percent of total Billed Charges,89% of total Billed charges,259.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.84,77,,,Percent of total Billed charges,77% of total billed charges,248.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,259.88,
CLOBAZAM,T990350110,CDM,301,RC,80346,HCPCS,Outpatient,,,292,146,,224.84,77,,,Percent of Total Billed Charges,77% of total billed charges,74.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,216.08,74,,,Percent of Total Billed Charges,74% of total billed charges,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,201.48,69,,,Percent of Total Billed Charges,69% of total billed charges,245.28,84,,,Percent of Total Billed Charges,84% of total billed charges,239.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,259.88,89,,,Percent of total Billed Charges,89% of total Billed charges,259.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.84,77,,,Percent of total Billed charges,77% of total billed charges,248.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,259.88,
CLONAZEPAM,T990350111,CDM,301,RC,G6031,HCPCS,Outpatient,,,110.5,55.25,,85.09,77,,,Percent of Total Billed Charges,77% of total billed charges,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.77,74,,,Percent of Total Billed Charges,74% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,92.82,84,,,Percent of Total Billed Charges,84% of total billed charges,90.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.35,89,,,Percent of total Billed Charges,89% of total Billed charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.09,77,,,Percent of total Billed charges,77% of total billed charges,93.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.63,98.35,
CLONAZEPAM,T990350111,CDM,301,RC,80346,HCPCS,Outpatient,,,110.5,55.25,,85.09,77,,,Percent of Total Billed Charges,77% of total billed charges,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.77,74,,,Percent of Total Billed Charges,74% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,92.82,84,,,Percent of Total Billed Charges,84% of total billed charges,90.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.35,89,,,Percent of total Billed Charges,89% of total Billed charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.09,77,,,Percent of total Billed charges,77% of total billed charges,93.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.63,98.35,
BUPRENORPHINE MS,T990350112,CDM,301,RC,80348,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
BUPRENORPHINE MS,T990350112,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
MARIJUANA METABOLITES GC/MS,T990350113,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
MARIJUANA METABOLITES GC/MS,T990350113,CDM,301,RC,80349,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
SYNTHETIC CANNABINOID URINE,T990350114,CDM,301,RC,80351,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,234.07,
SYNTHETIC CANNABINOID URINE,T990350114,CDM,301,RC,83788,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,223.55,
COCAINE METABOLITES GC/MS,T990350115,CDM,301,RC,80353,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
COCAINE METABOLITES GC/MS,T990350115,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
FENTANYL MS,T990350116,CDM,301,RC,80354,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
FENTANYL MS,T990350116,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
HEROIN CONFIRMATION,T990350117,CDM,301,RC,80356,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,234.07,
HEROIN CONFIRMATION,T990350117,CDM,301,RC,G0480,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,234.07,
METHADONE GC/MS,T990350118,CDM,301,RC,80358,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
METHADONE GC/MS,T990350118,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
AMPHETAMINE METABOLITES GC/MS,T990350119,CDM,301,RC,80359,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.08,89,,,Percent of total Billed Charges,89% of total Billed charges,60.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.88,64,
AMPHETAMINE METABOLITES GC/MS,T990350119,CDM,301,RC,G0480,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.08,89,,,Percent of total Billed Charges,89% of total Billed charges,60.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.88,109.85,
HYDROCODONE,T990350120,CDM,301,RC,G0480,HCPCS,Outpatient,,,365,182.5,,281.05,77,,,Percent of Total Billed Charges,77% of total billed charges,93.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.1,74,,,Percent of Total Billed Charges,74% of total billed charges,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,306.6,84,,,Percent of Total Billed Charges,84% of total billed charges,299.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.85,89,,,Percent of total Billed Charges,89% of total Billed charges,324.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.05,77,,,Percent of total Billed charges,77% of total billed charges,310.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,324.85,
HYDROCODONE,T990350120,CDM,301,RC,80361,HCPCS,Outpatient,,,365,182.5,,281.05,77,,,Percent of Total Billed Charges,77% of total billed charges,93.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.1,74,,,Percent of Total Billed Charges,74% of total billed charges,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,251.85,69,,,Percent of Total Billed Charges,69% of total billed charges,306.6,84,,,Percent of Total Billed Charges,84% of total billed charges,299.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.85,89,,,Percent of total Billed Charges,89% of total Billed charges,324.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.05,77,,,Percent of total Billed charges,77% of total billed charges,310.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,91.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,324.85,
OPIATES LC/MS/MS,T990350121,CDM,301,RC,80361,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
OPIATES LC/MS/MS,T990350121,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
OPIATES QUANTITATIVE,T990350122,CDM,301,RC,80361,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.52,74,,,Percent of Total Billed Charges,74% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,84,,,Percent of Total Billed Charges,84% of total billed charges,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.72,89,,,Percent of total Billed Charges,89% of total Billed charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37,131.72,
OPIATES QUANTITATIVE,T990350122,CDM,301,RC,G0480,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.52,74,,,Percent of Total Billed Charges,74% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,84,,,Percent of Total Billed Charges,84% of total billed charges,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.72,89,,,Percent of total Billed Charges,89% of total Billed charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37,131.72,
"OPIATES QUANTITATIVE, RL",T990350123,CDM,301,RC,80361,HCPCS,Outpatient,,,556.5,278.25,,428.51,77,,,Percent of Total Billed Charges,77% of total billed charges,141.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.81,74,,,Percent of Total Billed Charges,74% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,467.46,84,,,Percent of Total Billed Charges,84% of total billed charges,456.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.29,89,,,Percent of total Billed Charges,89% of total Billed charges,495.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.51,77,,,Percent of total Billed charges,77% of total billed charges,473.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,159.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,495.29,
"OPIATES QUANTITATIVE, RL",T990350123,CDM,301,RC,G0480,HCPCS,Outpatient,,,556.5,278.25,,428.51,77,,,Percent of Total Billed Charges,77% of total billed charges,141.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.81,74,,,Percent of Total Billed Charges,74% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,467.46,84,,,Percent of Total Billed Charges,84% of total billed charges,456.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.29,89,,,Percent of total Billed Charges,89% of total Billed charges,495.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.51,77,,,Percent of total Billed charges,77% of total billed charges,473.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,159.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,495.29,
OXYCODONE GC/MS,T990350124,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
OXYCODONE GC/MS,T990350124,CDM,301,RC,80365,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
"OXYCODONE GC/MS, RL",T990350125,CDM,301,RC,80365,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.38,175.78,
"OXYCODONE GC/MS, RL",T990350125,CDM,301,RC,G0480,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.38,175.78,
OXYCODONE QUANTITATIVE,T990350126,CDM,301,RC,80365,HCPCS,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.26,74,,,Percent of Total Billed Charges,74% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,84,,,Percent of Total Billed Charges,84% of total billed charges,204.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,221.61,89,,,Percent of total Billed Charges,89% of total Billed charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,221.61,
OXYCODONE QUANTITATIVE,T990350126,CDM,301,RC,G0480,HCPCS,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.26,74,,,Percent of Total Billed Charges,74% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,84,,,Percent of Total Billed Charges,84% of total billed charges,204.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,221.61,89,,,Percent of total Billed Charges,89% of total Billed charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,221.61,
PREGABALIN QUANT URINE,T990350127,CDM,301,RC,80366,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.32,74,,,Percent of Total Billed Charges,74% of total billed charges,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
PREGABALIN QUANT URINE,T990350127,CDM,301,RC,G0480,HCPCS,Outpatient,,,168,84,,129.36,77,,,Percent of Total Billed Charges,77% of total billed charges,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.32,74,,,Percent of Total Billed Charges,74% of total billed charges,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,69,,,Percent of Total Billed Charges,69% of total billed charges,141.12,84,,,Percent of Total Billed Charges,84% of total billed charges,137.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.52,89,,,Percent of total Billed Charges,89% of total Billed charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.36,77,,,Percent of total Billed charges,77% of total billed charges,142.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42,149.52,
PROPOXYPHENE GC/MS,T990350128,CDM,301,RC,80367,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
PROPOXYPHENE GC/MS,T990350128,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
SYNTHETIC STIMULANTS,T990350129,CDM,301,RC,80371,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,234.07,
SYNTHETIC STIMULANTS,T990350129,CDM,301,RC,83788,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,223.55,
TAPENTADOL MS,T990350130,CDM,301,RC,80372,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
TAPENTADOL MS,T990350130,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
TRAMADOL MS,T990350131,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
TRAMADOL MS,T990350131,CDM,301,RC,80373,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
URINALYSIS,T990350132,CDM,307,RC,81001,HCPCS,Outpatient,,,76.5,38.25,,58.91,77,,,Percent of Total Billed Charges,77% of total billed charges,19.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.61,74,,,Percent of Total Billed Charges,74% of total billed charges,52.79,69,,,Percent of Total Billed Charges,69% of total billed charges,52.79,69,,,Percent of Total Billed Charges,69% of total billed charges,19.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.79,69,,,Percent of Total Billed Charges,69% of total billed charges,52.79,69,,,Percent of Total Billed Charges,69% of total billed charges,64.26,84,,,Percent of Total Billed Charges,84% of total billed charges,62.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.15,500,,,fee schedule,500% of healthlink,23.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.91,77,,,Percent of total Billed charges,77% of total billed charges,65.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.04,65.03,
URINALYSIS,T990350132,CDM,307,RC,81001,HCPCS,Outpatient,,,56.5,28.25,,43.51,77,,,Percent of Total Billed Charges,77% of total billed charges,14.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.81,74,,,Percent of Total Billed Charges,74% of total billed charges,38.99,69,,,Percent of Total Billed Charges,69% of total billed charges,38.99,69,,,Percent of Total Billed Charges,69% of total billed charges,14.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.99,69,,,Percent of Total Billed Charges,69% of total billed charges,38.99,69,,,Percent of Total Billed Charges,69% of total billed charges,47.46,84,,,Percent of Total Billed Charges,84% of total billed charges,46.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.15,500,,,fee schedule,500% of healthlink,23.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,3.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,77,,,Percent of total Billed charges,77% of total billed charges,48.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.04,120,,,Fee Schedule,120% of MO Medicaid Rate,14.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.04,64,
URINALYSIS NON-AUTO MACRO,T990350133,CDM,307,RC,81002,HCPCS,Outpatient,,,51.5,25.75,,39.66,77,,,Percent of Total Billed Charges,77% of total billed charges,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.11,74,,,Percent of Total Billed Charges,74% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,43.26,84,,,Percent of Total Billed Charges,84% of total billed charges,42.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.25,500,,,fee schedule,500% of healthlink,15.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,15.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.34,120,,,Fee Schedule,120% of MO Medicaid Rate,3.34,120,,,Fee Schedule,120% of MO Medicaid Rate,3.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.66,77,,,Percent of total Billed charges,77% of total billed charges,43.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.34,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,64,
"URINALYSIS, MACRO ONLY",T990350134,CDM,307,RC,81003,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.25,500,,,fee schedule,500% of healthlink,15.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,15.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.16,120,,,Fee Schedule,120% of MO Medicaid Rate,2.16,120,,,Fee Schedule,120% of MO Medicaid Rate,2.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.16,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.16,64,
EOSINOPHIN COUNT URINE,T990350135,CDM,307,RC,81015,HCPCS,Outpatient,,,51.5,25.75,,39.66,77,,,Percent of Total Billed Charges,77% of total billed charges,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.11,74,,,Percent of Total Billed Charges,74% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,43.26,84,,,Percent of Total Billed Charges,84% of total billed charges,42.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,21,500,,,fee schedule,500% of healthlink,21,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.93,120,,,Fee Schedule,120% of MO Medicaid Rate,2.93,120,,,Fee Schedule,120% of MO Medicaid Rate,2.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.66,77,,,Percent of total Billed charges,77% of total billed charges,43.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.93,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.93,64,
"URINALYSIS, MICRO ONLY",T990350136,CDM,307,RC,81015,HCPCS,Outpatient,,,51.5,25.75,,39.66,77,,,Percent of Total Billed Charges,77% of total billed charges,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.11,74,,,Percent of Total Billed Charges,74% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,43.26,84,,,Percent of Total Billed Charges,84% of total billed charges,42.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,21,500,,,fee schedule,500% of healthlink,21,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.93,120,,,Fee Schedule,120% of MO Medicaid Rate,2.93,120,,,Fee Schedule,120% of MO Medicaid Rate,2.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.66,77,,,Percent of total Billed charges,77% of total billed charges,43.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.93,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.93,64,
URINE TOTAL VOLUME,T990350137,CDM,301,RC,81050,HCPCS,Outpatient,,,37.5,18.75,,28.88,77,,,Percent of Total Billed Charges,77% of total billed charges,9.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,84,,,Percent of Total Billed Charges,84% of total billed charges,30.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.85,500,,,fee schedule,500% of healthlink,21.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.49,120,,,Fee Schedule,120% of MO Medicaid Rate,3.49,120,,,Fee Schedule,120% of MO Medicaid Rate,3.49,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.88,77,,,Percent of total Billed charges,77% of total billed charges,31.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.49,120,,,Fee Schedule,120% of MO Medicaid Rate,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.49,64,
VOLUME MEASUREMENT,T990350138,CDM,307,RC,81050,HCPCS,Outpatient,,,37.5,18.75,,28.88,77,,,Percent of Total Billed Charges,77% of total billed charges,9.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,84,,,Percent of Total Billed Charges,84% of total billed charges,30.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.85,500,,,fee schedule,500% of healthlink,21.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.49,120,,,Fee Schedule,120% of MO Medicaid Rate,3.49,120,,,Fee Schedule,120% of MO Medicaid Rate,3.49,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.88,77,,,Percent of total Billed charges,77% of total billed charges,31.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.49,120,,,Fee Schedule,120% of MO Medicaid Rate,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,9.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.49,64,
P21 BCR-ABL-1,T990350139,CDM,300,RC,81206,HCPCS,Outpatient,,,571,285.5,,439.67,77,,,Percent of Total Billed Charges,77% of total billed charges,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,422.54,74,,,Percent of Total Billed Charges,74% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,479.64,84,,,Percent of Total Billed Charges,84% of total billed charges,468.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,508.19,89,,,Percent of total Billed Charges,89% of total Billed charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.39,120,,,Fee Schedule,120% of MO Medicaid Rate,157.39,120,,,Fee Schedule,120% of MO Medicaid Rate,157.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439.67,77,,,Percent of total Billed charges,77% of total billed charges,485.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,164.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,157.39,120,,,Fee Schedule,120% of MO Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,508.19,
P190 BCR-ABL-1,T990350140,CDM,300,RC,81207,HCPCS,Outpatient,,,571,285.5,,439.67,77,,,Percent of Total Billed Charges,77% of total billed charges,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,422.54,74,,,Percent of Total Billed Charges,74% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,479.64,84,,,Percent of Total Billed Charges,84% of total billed charges,468.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,508.19,89,,,Percent of total Billed Charges,89% of total Billed charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.04,120,,,Fee Schedule,120% of MO Medicaid Rate,139.04,120,,,Fee Schedule,120% of MO Medicaid Rate,139.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439.67,77,,,Percent of total Billed charges,77% of total billed charges,485.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,164.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,139.04,120,,,Fee Schedule,120% of MO Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,508.19,
OLIGO-SNP ARRAY,T990350141,CDM,301,RC,81229,HCPCS,Outpatient,,,8354.5,4177.25,,6432.97,77,,,Percent of Total Billed Charges,77% of total billed charges,2130.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2130.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2610.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6182.33,74,,,Percent of Total Billed Charges,74% of total billed charges,5764.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5764.61,69,,,Percent of Total Billed Charges,69% of total billed charges,2088.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5764.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7017.78,84,,,Percent of Total Billed Charges,84% of total billed charges,6850.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7435.51,89,,,Percent of total Billed Charges,89% of total Billed charges,7435.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7435.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1113.6,120,,,Fee Schedule,120% of MO Medicaid Rate,1113.6,120,,,Fee Schedule,120% of MO Medicaid Rate,1113.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,2088.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6432.97,77,,,Percent of total Billed charges,77% of total billed charges,7101.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2401.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,1113.6,120,,,Fee Schedule,120% of MO Medicaid Rate,2088.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2088.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,7435.51,
PROTHROMBIN 2021G>A VARIANT,T990350142,CDM,300,RC,81240,HCPCS,Outpatient,,,255,127.5,,196.35,77,,,Percent of Total Billed Charges,77% of total billed charges,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.7,74,,,Percent of Total Billed Charges,74% of total billed charges,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,214.2,84,,,Percent of Total Billed Charges,84% of total billed charges,209.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.95,89,,,Percent of total Billed Charges,89% of total Billed charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.06,120,,,Fee Schedule,120% of MO Medicaid Rate,63.06,120,,,Fee Schedule,120% of MO Medicaid Rate,63.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.35,77,,,Percent of total Billed charges,77% of total billed charges,216.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,63.06,120,,,Fee Schedule,120% of MO Medicaid Rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,226.95,
HEREDITARY HEMOCHROMATOSIS,T990350143,CDM,300,RC,81256,HCPCS,Outpatient,,,382,191,,294.14,77,,,Percent of Total Billed Charges,77% of total billed charges,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,282.68,74,,,Percent of Total Billed Charges,74% of total billed charges,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,320.88,84,,,Percent of Total Billed Charges,84% of total billed charges,313.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.98,89,,,Percent of total Billed Charges,89% of total Billed charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.74,120,,,Fee Schedule,120% of MO Medicaid Rate,62.74,120,,,Fee Schedule,120% of MO Medicaid Rate,62.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.14,77,,,Percent of total Billed charges,77% of total billed charges,324.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,62.74,120,,,Fee Schedule,120% of MO Medicaid Rate,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,339.98,
JAK2 MUTATION,T990350144,CDM,300,RC,81270,HCPCS,Outpatient,,,603.5,301.75,,464.7,77,,,Percent of Total Billed Charges,77% of total billed charges,153.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,446.59,74,,,Percent of Total Billed Charges,74% of total billed charges,416.42,69,,,Percent of Total Billed Charges,69% of total billed charges,416.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.42,69,,,Percent of Total Billed Charges,69% of total billed charges,416.42,69,,,Percent of Total Billed Charges,69% of total billed charges,506.94,84,,,Percent of Total Billed Charges,84% of total billed charges,494.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,537.12,89,,,Percent of total Billed Charges,89% of total Billed charges,537.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,537.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.98,120,,,Fee Schedule,120% of MO Medicaid Rate,87.98,120,,,Fee Schedule,120% of MO Medicaid Rate,87.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,150.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,464.7,77,,,Percent of total Billed charges,77% of total billed charges,512.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,87.98,120,,,Fee Schedule,120% of MO Medicaid Rate,150.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,150.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,537.12,
MTHFR DNA,T990350145,CDM,301,RC,81291,HCPCS,Outpatient,,,476.5,238.25,,366.91,77,,,Percent of Total Billed Charges,77% of total billed charges,121.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,352.61,74,,,Percent of Total Billed Charges,74% of total billed charges,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,400.26,84,,,Percent of Total Billed Charges,84% of total billed charges,390.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,424.09,89,,,Percent of total Billed Charges,89% of total Billed charges,424.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.72,120,,,Fee Schedule,120% of MO Medicaid Rate,62.72,120,,,Fee Schedule,120% of MO Medicaid Rate,62.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.91,77,,,Percent of total Billed charges,77% of total billed charges,405.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,62.72,120,,,Fee Schedule,120% of MO Medicaid Rate,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,424.09,
PCA3,T990350146,CDM,300,RC,81313,HCPCS,Outpatient,,,784.5,392.25,,604.07,77,,,Percent of Total Billed Charges,77% of total billed charges,200.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,580.53,74,,,Percent of Total Billed Charges,74% of total billed charges,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,658.98,84,,,Percent of Total Billed Charges,84% of total billed charges,643.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,698.21,89,,,Percent of total Billed Charges,89% of total Billed charges,698.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,698.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,244.85,120,,,Fee Schedule,120% of MO Medicaid Rate,244.85,120,,,Fee Schedule,120% of MO Medicaid Rate,244.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.07,77,,,Percent of total Billed charges,77% of total billed charges,666.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,244.85,120,,,Fee Schedule,120% of MO Medicaid Rate,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,698.21,
19911A-->G MUTATION ANALYSIS,T990350147,CDM,307,RC,81400,HCPCS,Outpatient,,,1839,919.5,,1416.03,77,,,Percent of Total Billed Charges,77% of total billed charges,468.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,468.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1360.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1268.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1544.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1507.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1636.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1636.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1636.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.39,120,,,Fee Schedule,120% of MO Medicaid Rate,61.39,120,,,Fee Schedule,120% of MO Medicaid Rate,61.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.03,77,,,Percent of total Billed charges,77% of total billed charges,1563.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,528.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,61.39,120,,,Fee Schedule,120% of MO Medicaid Rate,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,459.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,1636.71,
JAK2 EXONS 12 & 13,T990350148,CDM,300,RC,81403,HCPCS,Outpatient,,,806,403,,620.62,77,,,Percent of Total Billed Charges,77% of total billed charges,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,596.44,74,,,Percent of Total Billed Charges,74% of total billed charges,556.14,69,,,Percent of Total Billed Charges,69% of total billed charges,556.14,69,,,Percent of Total Billed Charges,69% of total billed charges,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.14,69,,,Percent of Total Billed Charges,69% of total billed charges,556.14,69,,,Percent of Total Billed Charges,69% of total billed charges,677.04,84,,,Percent of Total Billed Charges,84% of total billed charges,660.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,717.34,89,,,Percent of total Billed Charges,89% of total Billed charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,717.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.79,120,,,Fee Schedule,120% of MO Medicaid Rate,177.79,120,,,Fee Schedule,120% of MO Medicaid Rate,177.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,620.62,77,,,Percent of total Billed charges,77% of total billed charges,685.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,177.79,120,,,Fee Schedule,120% of MO Medicaid Rate,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,201.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,717.34,
ACETONE SEMIQUANTITATIVE,T990350149,CDM,301,RC,82009,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.95,500,,,fee schedule,500% of healthlink,32.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,32.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.33,120,,,Fee Schedule,120% of MO Medicaid Rate,4.33,120,,,Fee Schedule,120% of MO Medicaid Rate,4.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.33,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.33,64,
KETONES QUANTITATIVE,T990350150,CDM,301,RC,82010,HCPCS,Outpatient,,,356.5,178.25,,274.51,77,,,Percent of Total Billed Charges,77% of total billed charges,90.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.81,74,,,Percent of Total Billed Charges,74% of total billed charges,245.99,69,,,Percent of Total Billed Charges,69% of total billed charges,245.99,69,,,Percent of Total Billed Charges,69% of total billed charges,89.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.99,69,,,Percent of Total Billed Charges,69% of total billed charges,245.99,69,,,Percent of Total Billed Charges,69% of total billed charges,299.46,84,,,Percent of Total Billed Charges,84% of total billed charges,292.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.65,500,,,fee schedule,500% of healthlink,59.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,89.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.51,77,,,Percent of total Billed charges,77% of total billed charges,303.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,89.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,89.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.84,303.03,
ADRENOCORTICOTROPIC HORMONE,T990350151,CDM,301,RC,82024,HCPCS,Outpatient,,,210.5,105.25,,162.09,77,,,Percent of Total Billed Charges,77% of total billed charges,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.77,74,,,Percent of Total Billed Charges,74% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,176.82,84,,,Percent of Total Billed Charges,84% of total billed charges,172.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,282,500,,,fee schedule,500% of healthlink,282,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,282,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.09,77,,,Percent of total Billed charges,77% of total billed charges,178.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,37.07,120,,,Fee Schedule,120% of MO Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,282,
ALBUMIN SERUM,T990350152,CDM,301,RC,82040,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.15,500,,,fee schedule,500% of healthlink,36.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,36.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.75,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.75,120,,,Fee Schedule,120% of MO Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,70.13,
"ALBUMIN SERUM, RL",T990350153,CDM,301,RC,82040,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.15,500,,,fee schedule,500% of healthlink,36.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,36.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.75,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.75,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,89.68,
ALBUMIN CSF,T990350154,CDM,301,RC,82042,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,7.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,109.23,
ALBUMIN FLUID,T990350155,CDM,301,RC,82042,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,7.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,109.23,
MICROALBUMIN URINE QUANT,T990350156,CDM,301,RC,82043,HCPCS,Outpatient,,,119.5,59.75,,92.02,77,,,Percent of Total Billed Charges,77% of total billed charges,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.43,74,,,Percent of Total Billed Charges,74% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,100.38,84,,,Percent of Total Billed Charges,84% of total billed charges,97.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.25,500,,,fee schedule,500% of healthlink,42.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,5.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.02,77,,,Percent of total Billed charges,77% of total billed charges,101.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.54,101.58,
ALDOLASE,T990350157,CDM,301,RC,82085,HCPCS,Outpatient,,,135.5,67.75,,104.34,77,,,Percent of Total Billed Charges,77% of total billed charges,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.27,74,,,Percent of Total Billed Charges,74% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,113.82,84,,,Percent of Total Billed Charges,84% of total billed charges,111.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.85,500,,,fee schedule,500% of healthlink,70.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,70.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,9.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.34,77,,,Percent of total Billed charges,77% of total billed charges,115.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.31,115.18,
ALDOSTERONE 24HR URINE,T990350158,CDM,301,RC,82088,HCPCS,Outpatient,,,320.5,160.25,,246.79,77,,,Percent of Total Billed Charges,77% of total billed charges,81.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.17,74,,,Percent of Total Billed Charges,74% of total billed charges,221.15,69,,,Percent of Total Billed Charges,69% of total billed charges,221.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.15,69,,,Percent of Total Billed Charges,69% of total billed charges,221.15,69,,,Percent of Total Billed Charges,69% of total billed charges,269.22,84,,,Percent of Total Billed Charges,84% of total billed charges,262.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,297.5,500,,,fee schedule,500% of healthlink,297.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,297.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,39.12,120,,,Fee Schedule,120% of MO Medicaid Rate,39.12,120,,,Fee Schedule,120% of MO Medicaid Rate,39.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.79,77,,,Percent of total Billed charges,77% of total billed charges,272.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,39.12,120,,,Fee Schedule,120% of MO Medicaid Rate,80.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,80.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.12,297.5,
ALDOSTERONE SERUM,T990350159,CDM,301,RC,82088,HCPCS,Outpatient,,,479.5,239.75,,369.22,77,,,Percent of Total Billed Charges,77% of total billed charges,122.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.83,74,,,Percent of Total Billed Charges,74% of total billed charges,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,330.86,69,,,Percent of Total Billed Charges,69% of total billed charges,402.78,84,,,Percent of Total Billed Charges,84% of total billed charges,393.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,297.5,500,,,fee schedule,500% of healthlink,297.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,297.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,39.12,120,,,Fee Schedule,120% of MO Medicaid Rate,39.12,120,,,Fee Schedule,120% of MO Medicaid Rate,39.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.22,77,,,Percent of total Billed charges,77% of total billed charges,407.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,39.12,120,,,Fee Schedule,120% of MO Medicaid Rate,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,119.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.12,407.58,
ALPHA 1 ANTITRYPSIN,T990350160,CDM,301,RC,82103,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.05,500,,,fee schedule,500% of healthlink,98.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.9,120,,,Fee Schedule,120% of MO Medicaid Rate,12.9,120,,,Fee Schedule,120% of MO Medicaid Rate,12.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.9,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,160.65,
ALPHA-1-ANTITRYPSIN PHENOTYPE,T990350161,CDM,301,RC,82104,HCPCS,Outpatient,,,207,103.5,,159.39,77,,,Percent of Total Billed Charges,77% of total billed charges,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.18,74,,,Percent of Total Billed Charges,74% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,173.88,84,,,Percent of Total Billed Charges,84% of total billed charges,169.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.55,500,,,fee schedule,500% of healthlink,105.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,13.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.39,77,,,Percent of total Billed charges,77% of total billed charges,175.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,175.95,
AFP,T990350162,CDM,301,RC,82105,HCPCS,Outpatient,,,210.5,105.25,,162.09,77,,,Percent of Total Billed Charges,77% of total billed charges,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.77,74,,,Percent of Total Billed Charges,74% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,176.82,84,,,Percent of Total Billed Charges,84% of total billed charges,172.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.45,500,,,fee schedule,500% of healthlink,122.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.09,77,,,Percent of total Billed charges,77% of total billed charges,178.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.09,178.93,
AFP SERUM TUMOR MARKER,T990350163,CDM,301,RC,82105,HCPCS,Outpatient,,,210.5,105.25,,162.09,77,,,Percent of Total Billed Charges,77% of total billed charges,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.77,74,,,Percent of Total Billed Charges,74% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,176.82,84,,,Percent of Total Billed Charges,84% of total billed charges,172.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.45,500,,,fee schedule,500% of healthlink,122.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.09,77,,,Percent of total Billed charges,77% of total billed charges,178.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.09,178.93,
AFP4-AFP,T990350164,CDM,300,RC,82105,HCPCS,Outpatient,,,210.5,105.25,,162.09,77,,,Percent of Total Billed Charges,77% of total billed charges,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.77,74,,,Percent of Total Billed Charges,74% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,176.82,84,,,Percent of Total Billed Charges,84% of total billed charges,172.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.45,500,,,fee schedule,500% of healthlink,122.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,16.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.09,77,,,Percent of total Billed charges,77% of total billed charges,178.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.09,120,,,Fee Schedule,120% of MO Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.09,178.93,
AFP/AFP-L3,T990350165,CDM,301,RC,82107,HCPCS,Outpatient,,,284,142,,218.68,77,,,Percent of Total Billed Charges,77% of total billed charges,72.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,210.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,238.56,84,,,Percent of Total Billed Charges,84% of total billed charges,232.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.2,500,,,fee schedule,500% of healthlink,470.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,470.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,61.82,120,,,Fee Schedule,120% of MO Medicaid Rate,61.82,120,,,Fee Schedule,120% of MO Medicaid Rate,61.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.68,77,,,Percent of total Billed charges,77% of total billed charges,241.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,61.82,120,,,Fee Schedule,120% of MO Medicaid Rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,470.2,
CYSTATHIONINE,T990350166,CDM,301,RC,82131,HCPCS,Outpatient,,,264.5,132.25,,203.67,77,,,Percent of Total Billed Charges,77% of total billed charges,67.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.73,74,,,Percent of Total Billed Charges,74% of total billed charges,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,222.18,84,,,Percent of Total Billed Charges,84% of total billed charges,216.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.06,120,,,Fee Schedule,120% of MO Medicaid Rate,22.06,120,,,Fee Schedule,120% of MO Medicaid Rate,22.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.67,77,,,Percent of total Billed charges,77% of total billed charges,224.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.06,120,,,Fee Schedule,120% of MO Medicaid Rate,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.06,224.83,
CYSTINE 24 HOUR URINE,T990350167,CDM,301,RC,82131,HCPCS,Outpatient,,,264.5,132.25,,203.67,77,,,Percent of Total Billed Charges,77% of total billed charges,67.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.73,74,,,Percent of Total Billed Charges,74% of total billed charges,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,182.51,69,,,Percent of Total Billed Charges,69% of total billed charges,222.18,84,,,Percent of Total Billed Charges,84% of total billed charges,216.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.06,120,,,Fee Schedule,120% of MO Medicaid Rate,22.06,120,,,Fee Schedule,120% of MO Medicaid Rate,22.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.67,77,,,Percent of total Billed charges,77% of total billed charges,224.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.06,120,,,Fee Schedule,120% of MO Medicaid Rate,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.06,224.83,
AMINO ACID ANALYSIS,T990350168,CDM,301,RC,82139,HCPCS,Outpatient,,,364,182,,280.28,77,,,Percent of Total Billed Charges,77% of total billed charges,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,269.36,74,,,Percent of Total Billed Charges,74% of total billed charges,251.16,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,69,,,Percent of Total Billed Charges,69% of total billed charges,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.16,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,69,,,Percent of Total Billed Charges,69% of total billed charges,305.76,84,,,Percent of Total Billed Charges,84% of total billed charges,298.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.28,77,,,Percent of total Billed charges,77% of total billed charges,309.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,309.4,
AMINO ACID URINE QUANTITATIVE,T990350169,CDM,300,RC,82139,HCPCS,Outpatient,,,392,196,,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,290.08,74,,,Percent of Total Billed Charges,74% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,329.28,84,,,Percent of Total Billed Charges,84% of total billed charges,321.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,333.2,
AMMONIA PLASMA,T990350170,CDM,301,RC,82140,HCPCS,Outpatient,,,203,101.5,,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.22,74,,,Percent of Total Billed Charges,74% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,170.52,84,,,Percent of Total Billed Charges,84% of total billed charges,166.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.4,500,,,fee schedule,500% of healthlink,106.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.98,172.55,
AMMONIA URINE,T990350171,CDM,301,RC,82140,HCPCS,Outpatient,,,203,101.5,,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.22,74,,,Percent of Total Billed Charges,74% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,170.52,84,,,Percent of Total Billed Charges,84% of total billed charges,166.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.4,500,,,fee schedule,500% of healthlink,106.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,13.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.98,120,,,Fee Schedule,120% of MO Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.98,172.55,
AMYLASE BODY FLUID,T990350173,CDM,301,RC,82150,HCPCS,Outpatient,,,144.5,72.25,,111.27,77,,,Percent of Total Billed Charges,77% of total billed charges,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.93,74,,,Percent of Total Billed Charges,74% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,121.38,84,,,Percent of Total Billed Charges,84% of total billed charges,118.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,77,,,Percent of total Billed charges,77% of total billed charges,122.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.22,122.83,
AMYLASE PERITONEAL FLUID,T990350174,CDM,301,RC,82150,HCPCS,Outpatient,,,144.5,72.25,,111.27,77,,,Percent of Total Billed Charges,77% of total billed charges,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.93,74,,,Percent of Total Billed Charges,74% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,121.38,84,,,Percent of Total Billed Charges,84% of total billed charges,118.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,77,,,Percent of total Billed charges,77% of total billed charges,122.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.22,122.83,
AMYLASE PLEURAL FLUID,T990350175,CDM,301,RC,82150,HCPCS,Outpatient,,,144.5,72.25,,111.27,77,,,Percent of Total Billed Charges,77% of total billed charges,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.93,74,,,Percent of Total Billed Charges,74% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,121.38,84,,,Percent of Total Billed Charges,84% of total billed charges,118.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,77,,,Percent of total Billed charges,77% of total billed charges,122.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.22,122.83,
AMYLASE SERUM,T990350176,CDM,301,RC,82150,HCPCS,Outpatient,,,144.5,72.25,,111.27,77,,,Percent of Total Billed Charges,77% of total billed charges,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.93,74,,,Percent of Total Billed Charges,74% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,121.38,84,,,Percent of Total Billed Charges,84% of total billed charges,118.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,77,,,Percent of total Billed charges,77% of total billed charges,122.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.22,122.83,
AMYLASE URINE,T990350177,CDM,301,RC,82150,HCPCS,Outpatient,,,144.5,72.25,,111.27,77,,,Percent of Total Billed Charges,77% of total billed charges,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.93,74,,,Percent of Total Billed Charges,74% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,99.71,69,,,Percent of Total Billed Charges,69% of total billed charges,121.38,84,,,Percent of Total Billed Charges,84% of total billed charges,118.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,6.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,77,,,Percent of total Billed charges,77% of total billed charges,122.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.22,122.83,
ANDROSTENIDIONE,T990350178,CDM,301,RC,82157,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.7,500,,,fee schedule,500% of healthlink,213.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,213.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.1,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.1,213.7,
ACE CSF,T990350179,CDM,301,RC,82164,HCPCS,Outpatient,,,183.5,91.75,,141.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.79,74,,,Percent of Total Billed Charges,74% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.14,84,,,Percent of Total Billed Charges,84% of total billed charges,150.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.55,500,,,fee schedule,500% of healthlink,106.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,14.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.3,77,,,Percent of total Billed charges,77% of total billed charges,155.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.02,155.98,
ANGIOTENSIN CONVERTING ENZYME,T990350180,CDM,301,RC,82164,HCPCS,Outpatient,,,183.5,91.75,,141.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.79,74,,,Percent of Total Billed Charges,74% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.14,84,,,Percent of Total Billed Charges,84% of total billed charges,150.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.55,500,,,fee schedule,500% of healthlink,106.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,14.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.3,77,,,Percent of total Billed charges,77% of total billed charges,155.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.02,155.98,
APOLIPOPROTEIN,T990350181,CDM,301,RC,82172,HCPCS,Outpatient,,,228,114,,175.56,77,,,Percent of Total Billed Charges,77% of total billed charges,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.72,74,,,Percent of Total Billed Charges,74% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,191.52,84,,,Percent of Total Billed Charges,84% of total billed charges,186.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.1,500,,,fee schedule,500% of healthlink,113.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,113.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.24,120,,,Fee Schedule,120% of MO Medicaid Rate,20.24,120,,,Fee Schedule,120% of MO Medicaid Rate,20.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.56,77,,,Percent of total Billed charges,77% of total billed charges,193.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.24,120,,,Fee Schedule,120% of MO Medicaid Rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,193.8,
ARSENIC,T990350182,CDM,301,RC,82175,HCPCS,Outpatient,,,111,55.5,,85.47,77,,,Percent of Total Billed Charges,77% of total billed charges,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.14,74,,,Percent of Total Billed Charges,74% of total billed charges,76.59,69,,,Percent of Total Billed Charges,69% of total billed charges,76.59,69,,,Percent of Total Billed Charges,69% of total billed charges,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.59,69,,,Percent of Total Billed Charges,69% of total billed charges,76.59,69,,,Percent of Total Billed Charges,69% of total billed charges,93.24,84,,,Percent of Total Billed Charges,84% of total billed charges,91.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.5,500,,,fee schedule,500% of healthlink,138.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,138.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.2,120,,,Fee Schedule,120% of MO Medicaid Rate,18.2,120,,,Fee Schedule,120% of MO Medicaid Rate,18.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.47,77,,,Percent of total Billed charges,77% of total billed charges,94.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.2,120,,,Fee Schedule,120% of MO Medicaid Rate,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.2,138.5,
VITAMIN C,T990350183,CDM,301,RC,82180,HCPCS,Outpatient,,,60.5,30.25,,46.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.77,74,,,Percent of Total Billed Charges,74% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,50.82,84,,,Percent of Total Billed Charges,84% of total billed charges,49.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.85,500,,,fee schedule,500% of healthlink,63.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.49,120,,,Fee Schedule,120% of MO Medicaid Rate,9.49,120,,,Fee Schedule,120% of MO Medicaid Rate,9.49,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.59,77,,,Percent of total Billed charges,77% of total billed charges,51.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.49,120,,,Fee Schedule,120% of MO Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,64,
BETA 2 MICROGLOBULIN SERUM,T990350184,CDM,301,RC,82232,HCPCS,Outpatient,,,204.5,102.25,,157.47,77,,,Percent of Total Billed Charges,77% of total billed charges,52.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,171.78,84,,,Percent of Total Billed Charges,84% of total billed charges,167.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.1,500,,,fee schedule,500% of healthlink,118.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,118.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.53,120,,,Fee Schedule,120% of MO Medicaid Rate,15.53,120,,,Fee Schedule,120% of MO Medicaid Rate,15.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.47,77,,,Percent of total Billed charges,77% of total billed charges,173.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.53,120,,,Fee Schedule,120% of MO Medicaid Rate,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.53,173.83,
BILE ACIDS TOTAL,T990350185,CDM,301,RC,82239,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.55,500,,,fee schedule,500% of healthlink,61.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.43,120,,,Fee Schedule,120% of MO Medicaid Rate,16.43,120,,,Fee Schedule,120% of MO Medicaid Rate,16.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.43,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.43,76.5,
BILIRUBIN TOTAL,T990350186,CDM,301,RC,82247,HCPCS,Outpatient,,,73.5,36.75,,56.6,77,,,Percent of Total Billed Charges,77% of total billed charges,18.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.39,74,,,Percent of Total Billed Charges,74% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,61.74,84,,,Percent of Total Billed Charges,84% of total billed charges,60.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.65,500,,,fee schedule,500% of healthlink,36.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,36.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.81,120,,,Fee Schedule,120% of MO Medicaid Rate,4.81,120,,,Fee Schedule,120% of MO Medicaid Rate,4.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.6,77,,,Percent of total Billed charges,77% of total billed charges,62.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.81,120,,,Fee Schedule,120% of MO Medicaid Rate,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,64,
BILIRUBIN DIRECT,T990350187,CDM,301,RC,82248,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.65,500,,,fee schedule,500% of healthlink,36.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,36.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.81,120,,,Fee Schedule,120% of MO Medicaid Rate,4.81,120,,,Fee Schedule,120% of MO Medicaid Rate,4.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.81,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,103.28,
OCCULT BLOOD STOOL 3 SPECIMENS,T990350188,CDM,301,RC,82270,HCPCS,Outpatient,,,64.5,32.25,,49.67,77,,,Percent of Total Billed Charges,77% of total billed charges,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.73,74,,,Percent of Total Billed Charges,74% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.18,84,,,Percent of Total Billed Charges,84% of total billed charges,52.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.67,77,,,Percent of total Billed charges,77% of total billed charges,54.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.2,64,
APT DOWNEY GASTRIC/STOOL,T990350189,CDM,301,RC,82271,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.1,74,,,Percent of Total Billed Charges,74% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,84,,,Percent of Total Billed Charges,84% of total billed charges,94.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,97.75,
GASTROCCULT,T990350190,CDM,301,RC,82271,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.1,74,,,Percent of Total Billed Charges,74% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,84,,,Percent of Total Billed Charges,84% of total billed charges,94.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,97.75,
OCCULT BLOOD OTHER,T990350191,CDM,301,RC,82271,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.1,74,,,Percent of Total Billed Charges,74% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,84,,,Percent of Total Billed Charges,84% of total billed charges,94.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,5.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.1,120,,,Fee Schedule,120% of MO Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,97.75,
OCCULT BLOOD STOOL 1 SPECIMENS,T990350192,CDM,301,RC,82272,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.06,120,,,Fee Schedule,120% of MO Medicaid Rate,4.06,120,,,Fee Schedule,120% of MO Medicaid Rate,4.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.06,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.06,64,
FECAL GLOBIN,T990350193,CDM,300,RC,G0328,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.1,500,,,fee schedule,500% of healthlink,116.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,116.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,17.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.33,116.1,
FECAL GLOBIN,T990350193,CDM,300,RC,82274,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.1,500,,,fee schedule,500% of healthlink,116.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,116.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.28,120,,,Fee Schedule,120% of MO Medicaid Rate,15.28,120,,,Fee Schedule,120% of MO Medicaid Rate,15.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.28,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.28,116.1,
CADMIUM,T990350194,CDM,301,RC,82300,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.44,74,,,Percent of Total Billed Charges,74% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,173.04,84,,,Percent of Total Billed Charges,84% of total billed charges,168.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.95,500,,,fee schedule,500% of healthlink,168.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,168.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.69,120,,,Fee Schedule,120% of MO Medicaid Rate,22.69,120,,,Fee Schedule,120% of MO Medicaid Rate,22.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.69,120,,,Fee Schedule,120% of MO Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,175.1,
"VITAMIN D,25 HYDROXY",T990350195,CDM,301,RC,82306,HCPCS,Outpatient,,,295.5,147.75,,227.54,77,,,Percent of Total Billed Charges,77% of total billed charges,75.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,218.67,74,,,Percent of Total Billed Charges,74% of total billed charges,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,248.22,84,,,Percent of Total Billed Charges,84% of total billed charges,242.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.1,500,,,fee schedule,500% of healthlink,216.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,216.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.42,120,,,Fee Schedule,120% of MO Medicaid Rate,28.42,120,,,Fee Schedule,120% of MO Medicaid Rate,28.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.54,77,,,Percent of total Billed charges,77% of total billed charges,251.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.42,120,,,Fee Schedule,120% of MO Medicaid Rate,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,251.18,
CALCITONIN,T990350196,CDM,301,RC,82308,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.5,500,,,fee schedule,500% of healthlink,195.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,195.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.72,120,,,Fee Schedule,120% of MO Medicaid Rate,25.72,120,,,Fee Schedule,120% of MO Medicaid Rate,25.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,25.72,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.72,195.5,
CALCIUM ATOMIC ABSORPTION,T990350197,CDM,301,RC,82310,HCPCS,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.65,500,,,fee schedule,500% of healthlink,37.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,4.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,70.98,
CALCIUM SERUM,T990350198,CDM,301,RC,82310,HCPCS,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.65,500,,,fee schedule,500% of healthlink,37.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,4.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,70.98,
CALCIUM URINE,T990350199,CDM,301,RC,82310,HCPCS,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.65,500,,,fee schedule,500% of healthlink,37.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,4.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.94,120,,,Fee Schedule,120% of MO Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,70.98,
CALCIUM IONIZED,T990350200,CDM,301,RC,82330,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.75,500,,,fee schedule,500% of healthlink,99.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.13,120,,,Fee Schedule,120% of MO Medicaid Rate,13.13,120,,,Fee Schedule,120% of MO Medicaid Rate,13.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.13,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.13,144.93,
CALCIUM URINE (TIMED),T990350201,CDM,301,RC,82340,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.78,120,,,Fee Schedule,120% of MO Medicaid Rate,5.78,120,,,Fee Schedule,120% of MO Medicaid Rate,5.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.78,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,64,
CALCIUM URINE QUANT. TIMED,T990350202,CDM,301,RC,82340,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.78,120,,,Fee Schedule,120% of MO Medicaid Rate,5.78,120,,,Fee Schedule,120% of MO Medicaid Rate,5.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.78,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,64,
STONE ANALYSIS SPECTROSCOPY,T990350204,CDM,301,RC,82365,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.15,500,,,fee schedule,500% of healthlink,94.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,12.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.38,144.93,
CARBON DIOXIDE (CO2),T990350205,CDM,301,RC,82374,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.05,500,,,fee schedule,500% of healthlink,23.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.68,120,,,Fee Schedule,120% of MO Medicaid Rate,4.68,120,,,Fee Schedule,120% of MO Medicaid Rate,4.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.68,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,64.6,
COH-CARBOXYHEMOGLOBIN,T990350206,CDM,301,RC,82375,HCPCS,Outpatient,,,114,57,,87.78,77,,,Percent of Total Billed Charges,77% of total billed charges,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.36,74,,,Percent of Total Billed Charges,74% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,95.76,84,,,Percent of Total Billed Charges,84% of total billed charges,93.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,90,500,,,fee schedule,500% of healthlink,90,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,90,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.82,120,,,Fee Schedule,120% of MO Medicaid Rate,11.82,120,,,Fee Schedule,120% of MO Medicaid Rate,11.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.78,77,,,Percent of total Billed charges,77% of total billed charges,96.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.82,120,,,Fee Schedule,120% of MO Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.82,96.9,
CARCINOEMBRYONIC AB (CEA),T990350207,CDM,301,RC,82378,HCPCS,Outpatient,,,220.5,110.25,,169.79,77,,,Percent of Total Billed Charges,77% of total billed charges,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.17,74,,,Percent of Total Billed Charges,74% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,185.22,84,,,Percent of Total Billed Charges,84% of total billed charges,180.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.5,500,,,fee schedule,500% of healthlink,138.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,138.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.19,120,,,Fee Schedule,120% of MO Medicaid Rate,18.19,120,,,Fee Schedule,120% of MO Medicaid Rate,18.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.79,77,,,Percent of total Billed charges,77% of total billed charges,187.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.19,120,,,Fee Schedule,120% of MO Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.19,187.43,
CARNITINE,T990350208,CDM,301,RC,82379,HCPCS,Outpatient,,,378.5,189.25,,291.45,77,,,Percent of Total Billed Charges,77% of total billed charges,96.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.09,74,,,Percent of Total Billed Charges,74% of total billed charges,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,261.17,69,,,Percent of Total Billed Charges,69% of total billed charges,317.94,84,,,Percent of Total Billed Charges,84% of total billed charges,310.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,16.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.45,77,,,Percent of total Billed charges,77% of total billed charges,321.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.19,120,,,Fee Schedule,120% of MO Medicaid Rate,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,94.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,321.73,
CAROTENE BETA,T990350209,CDM,301,RC,82380,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.35,500,,,fee schedule,500% of healthlink,67.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,67.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.84,120,,,Fee Schedule,120% of MO Medicaid Rate,8.84,120,,,Fee Schedule,120% of MO Medicaid Rate,8.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.84,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,105.4,
CATECHOLAMINES FRACT PLASMA,T990350210,CDM,301,RC,82384,HCPCS,Outpatient,,,316.5,158.25,,243.71,77,,,Percent of Total Billed Charges,77% of total billed charges,80.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.21,74,,,Percent of Total Billed Charges,74% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,265.86,84,,,Percent of Total Billed Charges,84% of total billed charges,259.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.35,500,,,fee schedule,500% of healthlink,184.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,184.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.24,120,,,Fee Schedule,120% of MO Medicaid Rate,24.24,120,,,Fee Schedule,120% of MO Medicaid Rate,24.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.71,77,,,Percent of total Billed charges,77% of total billed charges,269.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.24,120,,,Fee Schedule,120% of MO Medicaid Rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.24,269.03,
CATECHOLAMINES URINE,T990350211,CDM,301,RC,82384,HCPCS,Outpatient,,,316.5,158.25,,243.71,77,,,Percent of Total Billed Charges,77% of total billed charges,80.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.21,74,,,Percent of Total Billed Charges,74% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,265.86,84,,,Percent of Total Billed Charges,84% of total billed charges,259.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.35,500,,,fee schedule,500% of healthlink,184.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,184.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.24,120,,,Fee Schedule,120% of MO Medicaid Rate,24.24,120,,,Fee Schedule,120% of MO Medicaid Rate,24.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.71,77,,,Percent of total Billed charges,77% of total billed charges,269.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.24,120,,,Fee Schedule,120% of MO Medicaid Rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.24,269.03,
CERULOPLASMIN,T990350213,CDM,301,RC,82390,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.82,74,,,Percent of Total Billed Charges,74% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.4,500,,,fee schedule,500% of healthlink,78.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,78.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.31,121.55,
LEPTIN,T990350214,CDM,301,RC,82397,HCPCS,Outpatient,,,189.5,94.75,,145.92,77,,,Percent of Total Billed Charges,77% of total billed charges,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.23,74,,,Percent of Total Billed Charges,74% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,159.18,84,,,Percent of Total Billed Charges,84% of total billed charges,155.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.15,500,,,fee schedule,500% of healthlink,103.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,103.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,13.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.92,77,,,Percent of total Billed charges,77% of total billed charges,161.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,161.08,
PAPP-A,T990350215,CDM,301,RC,82397,HCPCS,Outpatient,,,189.5,94.75,,145.92,77,,,Percent of Total Billed Charges,77% of total billed charges,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.23,74,,,Percent of Total Billed Charges,74% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,159.18,84,,,Percent of Total Billed Charges,84% of total billed charges,155.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.15,500,,,fee schedule,500% of healthlink,103.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,103.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,13.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.92,77,,,Percent of total Billed charges,77% of total billed charges,161.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,161.08,
TSH RECEPTOR AB,T990350216,CDM,301,RC,82397,HCPCS,Outpatient,,,189.5,94.75,,145.92,77,,,Percent of Total Billed Charges,77% of total billed charges,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.23,74,,,Percent of Total Billed Charges,74% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,159.18,84,,,Percent of Total Billed Charges,84% of total billed charges,155.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.15,500,,,fee schedule,500% of healthlink,103.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,103.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,13.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.92,77,,,Percent of total Billed charges,77% of total billed charges,161.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.55,120,,,Fee Schedule,120% of MO Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,161.08,
CHLORIDE SERUM,T990350217,CDM,301,RC,82435,HCPCS,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.75,74,,,Percent of Total Billed Charges,74% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,84,,,Percent of Total Billed Charges,84% of total billed charges,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,33.5,500,,,fee schedule,500% of healthlink,33.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,33.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.42,120,,,Fee Schedule,120% of MO Medicaid Rate,4.42,120,,,Fee Schedule,120% of MO Medicaid Rate,4.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.42,120,,,Fee Schedule,120% of MO Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,74.38,
CHLORIDE URINE,T990350218,CDM,301,RC,82436,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.7,500,,,fee schedule,500% of healthlink,36.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,36.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.52,120,,,Fee Schedule,120% of MO Medicaid Rate,5.52,120,,,Fee Schedule,120% of MO Medicaid Rate,5.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.52,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,64,
CHLORIDE FECES,T990350220,CDM,301,RC,82438,HCPCS,Outpatient,,,126.5,63.25,,97.41,77,,,Percent of Total Billed Charges,77% of total billed charges,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.61,74,,,Percent of Total Billed Charges,74% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,106.26,84,,,Percent of Total Billed Charges,84% of total billed charges,103.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.7,500,,,fee schedule,500% of healthlink,35.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,35.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.8,120,,,Fee Schedule,120% of MO Medicaid Rate,4.8,120,,,Fee Schedule,120% of MO Medicaid Rate,4.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.41,77,,,Percent of total Billed charges,77% of total billed charges,107.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.8,120,,,Fee Schedule,120% of MO Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.8,107.53,
CHLORIDE VITREOUS FLUID,T990350221,CDM,301,RC,82438,HCPCS,Outpatient,,,126.5,63.25,,97.41,77,,,Percent of Total Billed Charges,77% of total billed charges,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.61,74,,,Percent of Total Billed Charges,74% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,106.26,84,,,Percent of Total Billed Charges,84% of total billed charges,103.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.7,500,,,fee schedule,500% of healthlink,35.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,35.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.8,120,,,Fee Schedule,120% of MO Medicaid Rate,4.8,120,,,Fee Schedule,120% of MO Medicaid Rate,4.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.41,77,,,Percent of total Billed charges,77% of total billed charges,107.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.8,120,,,Fee Schedule,120% of MO Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.8,107.53,
CHLORANATED HYDROCARBONS,T990350222,CDM,301,RC,82441,HCPCS,Outpatient,,,209.5,104.75,,161.32,77,,,Percent of Total Billed Charges,77% of total billed charges,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.03,74,,,Percent of Total Billed Charges,74% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,175.98,84,,,Percent of Total Billed Charges,84% of total billed charges,171.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.32,77,,,Percent of total Billed charges,77% of total billed charges,178.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,178.08,
VOLATILES,T990350223,CDM,301,RC,82441,HCPCS,Outpatient,,,209.5,104.75,,161.32,77,,,Percent of Total Billed Charges,77% of total billed charges,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.03,74,,,Percent of Total Billed Charges,74% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,69,,,Percent of Total Billed Charges,69% of total billed charges,175.98,84,,,Percent of Total Billed Charges,84% of total billed charges,171.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.32,77,,,Percent of total Billed charges,77% of total billed charges,178.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,178.08,
"CHOLESTEROL TOTAL, SERUM",T990350224,CDM,301,RC,82465,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.8,500,,,fee schedule,500% of healthlink,31.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.18,64,
NMR CHOLESTEROL,T990350225,CDM,301,RC,82465,HCPCS,Outpatient,,,81.5,40.75,,62.76,77,,,Percent of Total Billed Charges,77% of total billed charges,20.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.31,74,,,Percent of Total Billed Charges,74% of total billed charges,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,68.46,84,,,Percent of Total Billed Charges,84% of total billed charges,66.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.8,500,,,fee schedule,500% of healthlink,31.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,4.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.76,77,,,Percent of total Billed charges,77% of total billed charges,69.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.18,120,,,Fee Schedule,120% of MO Medicaid Rate,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.18,69.28,
CHOLINESTERASE,T990350226,CDM,301,RC,82480,HCPCS,Outpatient,,,60.5,30.25,,46.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.77,74,,,Percent of Total Billed Charges,74% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,50.82,84,,,Percent of Total Billed Charges,84% of total billed charges,49.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.55,500,,,fee schedule,500% of healthlink,57.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,57.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.55,120,,,Fee Schedule,120% of MO Medicaid Rate,7.55,120,,,Fee Schedule,120% of MO Medicaid Rate,7.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.59,77,,,Percent of total Billed charges,77% of total billed charges,51.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.55,120,,,Fee Schedule,120% of MO Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.55,64,
CHROMIUM SERUM,T990350227,CDM,301,RC,82495,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185,74,,,Percent of Total Billed Charges,74% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,210,84,,,Percent of Total Billed Charges,84% of total billed charges,205,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.05,500,,,fee schedule,500% of healthlink,148.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,148.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.46,120,,,Fee Schedule,120% of MO Medicaid Rate,19.46,120,,,Fee Schedule,120% of MO Medicaid Rate,19.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.46,120,,,Fee Schedule,120% of MO Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,212.5,
CITRATE URINE,T990350228,CDM,301,RC,82507,HCPCS,Outpatient,,,297.5,148.75,,229.08,77,,,Percent of Total Billed Charges,77% of total billed charges,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.15,74,,,Percent of Total Billed Charges,74% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,249.9,84,,,Percent of Total Billed Charges,84% of total billed charges,243.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,203,500,,,fee schedule,500% of healthlink,203,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,203,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.69,120,,,Fee Schedule,120% of MO Medicaid Rate,26.69,120,,,Fee Schedule,120% of MO Medicaid Rate,26.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,77,,,Percent of total Billed charges,77% of total billed charges,252.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.69,120,,,Fee Schedule,120% of MO Medicaid Rate,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.69,252.88,
CITRIC ACID 24 HR UR CREA,T990350229,CDM,301,RC,82507,HCPCS,Outpatient,,,297.5,148.75,,229.08,77,,,Percent of Total Billed Charges,77% of total billed charges,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.15,74,,,Percent of Total Billed Charges,74% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,205.28,69,,,Percent of Total Billed Charges,69% of total billed charges,249.9,84,,,Percent of Total Billed Charges,84% of total billed charges,243.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,203,500,,,fee schedule,500% of healthlink,203,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,203,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.69,120,,,Fee Schedule,120% of MO Medicaid Rate,26.69,120,,,Fee Schedule,120% of MO Medicaid Rate,26.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,77,,,Percent of total Billed charges,77% of total billed charges,252.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.69,120,,,Fee Schedule,120% of MO Medicaid Rate,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,74.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.69,252.88,
COLLAGEN CROSS LINKS,T990350231,CDM,301,RC,82523,HCPCS,Outpatient,,,236,118,,181.72,77,,,Percent of Total Billed Charges,77% of total billed charges,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.64,74,,,Percent of Total Billed Charges,74% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,198.24,84,,,Percent of Total Billed Charges,84% of total billed charges,193.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.45,500,,,fee schedule,500% of healthlink,136.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,136.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.93,120,,,Fee Schedule,120% of MO Medicaid Rate,17.93,120,,,Fee Schedule,120% of MO Medicaid Rate,17.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.72,77,,,Percent of total Billed charges,77% of total billed charges,200.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.93,120,,,Fee Schedule,120% of MO Medicaid Rate,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.93,200.6,
N-TELOPEPTIDE RAND URINE,T990350232,CDM,301,RC,82523,HCPCS,Outpatient,,,236,118,,181.72,77,,,Percent of Total Billed Charges,77% of total billed charges,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.64,74,,,Percent of Total Billed Charges,74% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,162.84,69,,,Percent of Total Billed Charges,69% of total billed charges,198.24,84,,,Percent of Total Billed Charges,84% of total billed charges,193.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.45,500,,,fee schedule,500% of healthlink,136.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,136.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.93,120,,,Fee Schedule,120% of MO Medicaid Rate,17.93,120,,,Fee Schedule,120% of MO Medicaid Rate,17.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.72,77,,,Percent of total Billed charges,77% of total billed charges,200.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.93,120,,,Fee Schedule,120% of MO Medicaid Rate,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.93,200.6,
COPPER,T990350233,CDM,301,RC,82525,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.6,500,,,fee schedule,500% of healthlink,90.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,90.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.9,120,,,Fee Schedule,120% of MO Medicaid Rate,11.9,120,,,Fee Schedule,120% of MO Medicaid Rate,11.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.9,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,131.33,
COPPER URINE,T990350234,CDM,301,RC,82525,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.6,500,,,fee schedule,500% of healthlink,90.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,90.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.9,120,,,Fee Schedule,120% of MO Medicaid Rate,11.9,120,,,Fee Schedule,120% of MO Medicaid Rate,11.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.9,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,131.33,
CORTICOSTERONE,T990350235,CDM,301,RC,82528,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,372.96,74,,,Percent of Total Billed Charges,74% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,423.36,84,,,Percent of Total Billed Charges,84% of total billed charges,413.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.3,500,,,fee schedule,500% of healthlink,164.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,164.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.61,120,,,Fee Schedule,120% of MO Medicaid Rate,21.61,120,,,Fee Schedule,120% of MO Medicaid Rate,21.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.61,120,,,Fee Schedule,120% of MO Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.61,428.4,
CORTISOL FREE 24HR URINE,T990350236,CDM,301,RC,82530,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.05,500,,,fee schedule,500% of healthlink,122.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.03,120,,,Fee Schedule,120% of MO Medicaid Rate,16.03,120,,,Fee Schedule,120% of MO Medicaid Rate,16.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.03,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,180.63,
CORTISOL FREE LC/MS/MS,T990350237,CDM,301,RC,82530,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.05,500,,,fee schedule,500% of healthlink,122.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.03,120,,,Fee Schedule,120% of MO Medicaid Rate,16.03,120,,,Fee Schedule,120% of MO Medicaid Rate,16.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.03,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,180.63,
CORTISOL SERUM,T990350238,CDM,301,RC,82533,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.05,500,,,fee schedule,500% of healthlink,119.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,119.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.65,144.93,
CORTISOL TOTAL LC/MS/MS,T990350239,CDM,301,RC,82533,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.05,500,,,fee schedule,500% of healthlink,119.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,119.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.65,180.63,
DEXAMETHASONE SUPPRESSION,T990350240,CDM,301,RC,82533,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.05,500,,,fee schedule,500% of healthlink,119.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,119.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.65,180.63,
SALIVA CORTISOL,T990350241,CDM,301,RC,82533,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.05,500,,,fee schedule,500% of healthlink,119.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,119.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,15.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.65,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.65,180.63,
DOPAMINE,T990350242,CDM,301,RC,82542,HCPCS,Outpatient,,,73,36.5,,56.21,77,,,Percent of Total Billed Charges,77% of total billed charges,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.02,74,,,Percent of Total Billed Charges,74% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,50.37,69,,,Percent of Total Billed Charges,69% of total billed charges,61.32,84,,,Percent of Total Billed Charges,84% of total billed charges,59.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.21,77,,,Percent of total Billed charges,77% of total billed charges,62.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.25,131.85,
EPINEPHRINE,T990350243,CDM,301,RC,82542,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,170,
NOREPINEPHRINE,T990350244,CDM,301,RC,82542,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,170,
PORPHYRINS TOTAL,T990350245,CDM,301,RC,82542,HCPCS,Outpatient,,,275.5,137.75,,212.14,77,,,Percent of Total Billed Charges,77% of total billed charges,70.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,203.87,74,,,Percent of Total Billed Charges,74% of total billed charges,190.1,69,,,Percent of Total Billed Charges,69% of total billed charges,190.1,69,,,Percent of Total Billed Charges,69% of total billed charges,68.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.1,69,,,Percent of Total Billed Charges,69% of total billed charges,190.1,69,,,Percent of Total Billed Charges,69% of total billed charges,231.42,84,,,Percent of Total Billed Charges,84% of total billed charges,225.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,68.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.14,77,,,Percent of total Billed charges,77% of total billed charges,234.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,68.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,68.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,234.18,
PREGABALN (LYRICA),T990350246,CDM,301,RC,82542,HCPCS,Outpatient,,,448.5,224.25,,345.35,77,,,Percent of Total Billed Charges,77% of total billed charges,114.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,331.89,74,,,Percent of Total Billed Charges,74% of total billed charges,309.47,69,,,Percent of Total Billed Charges,69% of total billed charges,309.47,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.47,69,,,Percent of Total Billed Charges,69% of total billed charges,309.47,69,,,Percent of Total Billed Charges,69% of total billed charges,376.74,84,,,Percent of Total Billed Charges,84% of total billed charges,367.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,112.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.35,77,,,Percent of total Billed charges,77% of total billed charges,381.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,112.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,112.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,381.23,
CREATINE KINASE (CK) TOTAL,T990350247,CDM,301,RC,82550,HCPCS,Outpatient,,,100.5,50.25,,77.39,77,,,Percent of Total Billed Charges,77% of total billed charges,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.37,74,,,Percent of Total Billed Charges,74% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.42,84,,,Percent of Total Billed Charges,84% of total billed charges,82.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.55,500,,,fee schedule,500% of healthlink,47.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.24,120,,,Fee Schedule,120% of MO Medicaid Rate,6.24,120,,,Fee Schedule,120% of MO Medicaid Rate,6.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.39,77,,,Percent of total Billed charges,77% of total billed charges,85.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.24,120,,,Fee Schedule,120% of MO Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,85.43,
CKISO-CK ISOENZYMES,T990350248,CDM,301,RC,82552,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.26,74,,,Percent of Total Billed Charges,74% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,83.16,84,,,Percent of Total Billed Charges,84% of total billed charges,81.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.8,500,,,fee schedule,500% of healthlink,97.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,97.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,12.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.85,120,,,Fee Schedule,120% of MO Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.85,97.8,
CREATINE KINASE (CK) MB,T990350249,CDM,301,RC,82553,HCPCS,Outpatient,,,182,91,,140.14,77,,,Percent of Total Billed Charges,77% of total billed charges,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.68,74,,,Percent of Total Billed Charges,74% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,125.58,69,,,Percent of Total Billed Charges,69% of total billed charges,152.88,84,,,Percent of Total Billed Charges,84% of total billed charges,149.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.3,500,,,fee schedule,500% of healthlink,84.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.09,120,,,Fee Schedule,120% of MO Medicaid Rate,11.09,120,,,Fee Schedule,120% of MO Medicaid Rate,11.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.14,77,,,Percent of total Billed charges,77% of total billed charges,154.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.09,120,,,Fee Schedule,120% of MO Medicaid Rate,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.09,154.7,
CREATININE SERUM,T990350250,CDM,301,RC,82565,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.4,500,,,fee schedule,500% of healthlink,37.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.91,120,,,Fee Schedule,120% of MO Medicaid Rate,4.91,120,,,Fee Schedule,120% of MO Medicaid Rate,4.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.91,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,64,
CREATININE URINE,T990350251,CDM,301,RC,82570,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,64,
CR-CREATININE CLEARANCE,T990350255,CDM,301,RC,82575,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,132.72,84,,,Percent of Total Billed Charges,84% of total billed charges,129.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.95,500,,,fee schedule,500% of healthlink,68.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,68.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.07,120,,,Fee Schedule,120% of MO Medicaid Rate,9.07,120,,,Fee Schedule,120% of MO Medicaid Rate,9.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.07,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.07,134.3,
CRYOGLOBULIN (% CRYOCRIT),T990350256,CDM,301,RC,82595,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,85,
VITAMIN B12,T990350257,CDM,301,RC,82607,HCPCS,Outpatient,,,191,95.5,,147.07,77,,,Percent of Total Billed Charges,77% of total billed charges,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.34,74,,,Percent of Total Billed Charges,74% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,160.44,84,,,Percent of Total Billed Charges,84% of total billed charges,156.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.05,500,,,fee schedule,500% of healthlink,110.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,110.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.47,120,,,Fee Schedule,120% of MO Medicaid Rate,14.47,120,,,Fee Schedule,120% of MO Medicaid Rate,14.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.07,77,,,Percent of total Billed charges,77% of total billed charges,162.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.47,120,,,Fee Schedule,120% of MO Medicaid Rate,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,162.35,
DHEA,T990350258,CDM,301,RC,82626,HCPCS,Outpatient,,,317.5,158.75,,244.48,77,,,Percent of Total Billed Charges,77% of total billed charges,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.95,74,,,Percent of Total Billed Charges,74% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,266.7,84,,,Percent of Total Billed Charges,84% of total billed charges,260.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.5,500,,,fee schedule,500% of healthlink,184.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,184.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.25,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.48,77,,,Percent of total Billed charges,77% of total billed charges,269.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.25,120,,,Fee Schedule,120% of MO Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,269.88,
DHEA SULFATE,T990350259,CDM,301,RC,82627,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,162.3,500,,,fee schedule,500% of healthlink,162.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,162.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.34,120,,,Fee Schedule,120% of MO Medicaid Rate,21.34,120,,,Fee Schedule,120% of MO Medicaid Rate,21.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.34,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.34,216.33,
DEOXYCORTICOSTERONE,T990350260,CDM,301,RC,82633,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,372.96,74,,,Percent of Total Billed Charges,74% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,423.36,84,,,Percent of Total Billed Charges,84% of total billed charges,413.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.15,500,,,fee schedule,500% of healthlink,226.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,226.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,29.74,120,,,Fee Schedule,120% of MO Medicaid Rate,29.74,120,,,Fee Schedule,120% of MO Medicaid Rate,29.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,29.74,120,,,Fee Schedule,120% of MO Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.74,428.4,
DIBUCAINE NUMBER,T990350261,CDM,301,RC,82638,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.4,500,,,fee schedule,500% of healthlink,89.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,89.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.76,89.4,
"VITAMIN D,1,25 DIHYDROXY",T990350262,CDM,301,RC,82652,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.54,74,,,Percent of Total Billed Charges,74% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,353.64,84,,,Percent of Total Billed Charges,84% of total billed charges,345.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,281,500,,,fee schedule,500% of healthlink,281,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,281,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,36.96,120,,,Fee Schedule,120% of MO Medicaid Rate,36.96,120,,,Fee Schedule,120% of MO Medicaid Rate,36.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,36.96,120,,,Fee Schedule,120% of MO Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.96,357.85,
PANCREATIC ELASTASE 1,T990350263,CDM,301,RC,82656,HCPCS,Outpatient,,,1212,606,,933.24,77,,,Percent of Total Billed Charges,77% of total billed charges,309.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,896.88,74,,,Percent of Total Billed Charges,74% of total billed charges,836.28,69,,,Percent of Total Billed Charges,69% of total billed charges,836.28,69,,,Percent of Total Billed Charges,69% of total billed charges,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.28,69,,,Percent of Total Billed Charges,69% of total billed charges,836.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.08,84,,,Percent of Total Billed Charges,84% of total billed charges,993.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.24,77,,,Percent of total Billed charges,77% of total billed charges,1030.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,303,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,1030.2,
NEUTROPHIL FNCTN OCIDATV BURST,T990350264,CDM,301,RC,82657,HCPCS,Outpatient,,,401.5,200.75,,309.16,77,,,Percent of Total Billed Charges,77% of total billed charges,102.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,297.11,74,,,Percent of Total Billed Charges,74% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,337.26,84,,,Percent of Total Billed Charges,84% of total billed charges,329.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,21.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.16,77,,,Percent of total Billed charges,77% of total billed charges,341.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.28,120,,,Fee Schedule,120% of MO Medicaid Rate,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.28,341.28,
ERYTHROPOIETIN (EPO),T990350265,CDM,301,RC,82668,HCPCS,Outpatient,,,217.5,108.75,,167.48,77,,,Percent of Total Billed Charges,77% of total billed charges,55.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.95,74,,,Percent of Total Billed Charges,74% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,150.08,69,,,Percent of Total Billed Charges,69% of total billed charges,182.7,84,,,Percent of Total Billed Charges,84% of total billed charges,178.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.25,500,,,fee schedule,500% of healthlink,137.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,137.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.04,120,,,Fee Schedule,120% of MO Medicaid Rate,18.04,120,,,Fee Schedule,120% of MO Medicaid Rate,18.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.48,77,,,Percent of total Billed charges,77% of total billed charges,184.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.04,120,,,Fee Schedule,120% of MO Medicaid Rate,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.04,184.88,
ESTRADIOL (E2),T990350266,CDM,301,RC,82670,HCPCS,Outpatient,,,295.5,147.75,,227.54,77,,,Percent of Total Billed Charges,77% of total billed charges,75.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,218.67,74,,,Percent of Total Billed Charges,74% of total billed charges,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,203.9,69,,,Percent of Total Billed Charges,69% of total billed charges,248.22,84,,,Percent of Total Billed Charges,84% of total billed charges,242.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,204,500,,,fee schedule,500% of healthlink,204,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,204,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.82,120,,,Fee Schedule,120% of MO Medicaid Rate,26.82,120,,,Fee Schedule,120% of MO Medicaid Rate,26.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.54,77,,,Percent of total Billed charges,77% of total billed charges,251.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.82,120,,,Fee Schedule,120% of MO Medicaid Rate,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,73.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.82,251.18,
ESTROGENS TOTAL,T990350267,CDM,301,RC,82672,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.3,500,,,fee schedule,500% of healthlink,158.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,158.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.83,120,,,Fee Schedule,120% of MO Medicaid Rate,20.83,120,,,Fee Schedule,120% of MO Medicaid Rate,20.83,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.83,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,216.33,
ESTRIOL (E3),T990350268,CDM,301,RC,82677,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.55,500,,,fee schedule,500% of healthlink,176.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,176.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,23.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.21,222.28,
ESTRIOL LC/MS/MS,T990350269,CDM,301,RC,82677,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.55,500,,,fee schedule,500% of healthlink,176.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,176.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,23.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.21,222.28,
ESTRONE,T990350270,CDM,301,RC,82679,HCPCS,Outpatient,,,317.5,158.75,,244.48,77,,,Percent of Total Billed Charges,77% of total billed charges,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.95,74,,,Percent of Total Billed Charges,74% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,266.7,84,,,Percent of Total Billed Charges,84% of total billed charges,260.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.25,500,,,fee schedule,500% of healthlink,182.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,182.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.95,120,,,Fee Schedule,120% of MO Medicaid Rate,23.95,120,,,Fee Schedule,120% of MO Medicaid Rate,23.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.48,77,,,Percent of total Billed charges,77% of total billed charges,269.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.95,120,,,Fee Schedule,120% of MO Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.95,269.88,
ESTRONE SULFATE,T990350271,CDM,301,RC,82679,HCPCS,Outpatient,,,317.5,158.75,,244.48,77,,,Percent of Total Billed Charges,77% of total billed charges,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.95,74,,,Percent of Total Billed Charges,74% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,266.7,84,,,Percent of Total Billed Charges,84% of total billed charges,260.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.25,500,,,fee schedule,500% of healthlink,182.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,182.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.95,120,,,Fee Schedule,120% of MO Medicaid Rate,23.95,120,,,Fee Schedule,120% of MO Medicaid Rate,23.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.48,77,,,Percent of total Billed charges,77% of total billed charges,269.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.95,120,,,Fee Schedule,120% of MO Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.95,269.88,
ETHYLENE GLYCOL,T990350272,CDM,300,RC,82693,HCPCS,Outpatient,,,302,151,,232.54,77,,,Percent of Total Billed Charges,77% of total billed charges,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.48,74,,,Percent of Total Billed Charges,74% of total billed charges,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,253.68,84,,,Percent of Total Billed Charges,84% of total billed charges,247.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.75,500,,,fee schedule,500% of healthlink,108.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,108.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.3,120,,,Fee Schedule,120% of MO Medicaid Rate,14.3,120,,,Fee Schedule,120% of MO Medicaid Rate,14.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.54,77,,,Percent of total Billed charges,77% of total billed charges,256.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.3,120,,,Fee Schedule,120% of MO Medicaid Rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,256.7,
FECAL FAT QUALITATIVE,T990350273,CDM,301,RC,82705,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.25,500,,,fee schedule,500% of healthlink,25.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.9,120,,,Fee Schedule,120% of MO Medicaid Rate,4.9,120,,,Fee Schedule,120% of MO Medicaid Rate,4.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.9,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.9,144.93,
FECAL FAT QUANTITATIVE,T990350274,CDM,301,RC,82710,HCPCS,Outpatient,,,245.5,122.75,,189.04,77,,,Percent of Total Billed Charges,77% of total billed charges,62.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.67,74,,,Percent of Total Billed Charges,74% of total billed charges,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,206.22,84,,,Percent of Total Billed Charges,84% of total billed charges,201.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.85,500,,,fee schedule,500% of healthlink,46.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.04,77,,,Percent of total Billed charges,77% of total billed charges,208.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,208.68,
FERRITIN,T990350275,CDM,301,RC,82728,HCPCS,Outpatient,,,201,100.5,,154.77,77,,,Percent of Total Billed Charges,77% of total billed charges,51.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.74,74,,,Percent of Total Billed Charges,74% of total billed charges,138.69,69,,,Percent of Total Billed Charges,69% of total billed charges,138.69,69,,,Percent of Total Billed Charges,69% of total billed charges,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.69,69,,,Percent of Total Billed Charges,69% of total billed charges,138.69,69,,,Percent of Total Billed Charges,69% of total billed charges,168.84,84,,,Percent of Total Billed Charges,84% of total billed charges,164.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.45,500,,,fee schedule,500% of healthlink,99.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.08,120,,,Fee Schedule,120% of MO Medicaid Rate,13.08,120,,,Fee Schedule,120% of MO Medicaid Rate,13.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.77,77,,,Percent of total Billed charges,77% of total billed charges,170.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.08,120,,,Fee Schedule,120% of MO Medicaid Rate,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.08,170.85,
FETAL FIBRONECTIN,T990350276,CDM,301,RC,82731,HCPCS,Outpatient,,,881.5,440.75,,678.76,77,,,Percent of Total Billed Charges,77% of total billed charges,224.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,275.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,652.31,74,,,Percent of Total Billed Charges,74% of total billed charges,608.24,69,,,Percent of Total Billed Charges,69% of total billed charges,608.24,69,,,Percent of Total Billed Charges,69% of total billed charges,220.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,608.24,69,,,Percent of Total Billed Charges,69% of total billed charges,608.24,69,,,Percent of Total Billed Charges,69% of total billed charges,740.46,84,,,Percent of Total Billed Charges,84% of total billed charges,722.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.2,500,,,fee schedule,500% of healthlink,470.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,470.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,61.82,120,,,Fee Schedule,120% of MO Medicaid Rate,61.82,120,,,Fee Schedule,120% of MO Medicaid Rate,61.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,220.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,678.76,77,,,Percent of total Billed charges,77% of total billed charges,749.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,253.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,61.82,120,,,Fee Schedule,120% of MO Medicaid Rate,220.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,220.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,749.28,
FOLIC ACID,T990350277,CDM,301,RC,82746,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.35,500,,,fee schedule,500% of healthlink,107.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.11,120,,,Fee Schedule,120% of MO Medicaid Rate,14.11,120,,,Fee Schedule,120% of MO Medicaid Rate,14.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.11,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,144.93,
FOLATES RBC FOLATE,T990350278,CDM,301,RC,82747,HCPCS,Outpatient,,,185,92.5,,142.45,77,,,Percent of Total Billed Charges,77% of total billed charges,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.9,74,,,Percent of Total Billed Charges,74% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,127.65,69,,,Percent of Total Billed Charges,69% of total billed charges,155.4,84,,,Percent of Total Billed Charges,84% of total billed charges,151.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.45,500,,,fee schedule,500% of healthlink,126.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,126.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.94,120,,,Fee Schedule,120% of MO Medicaid Rate,16.94,120,,,Fee Schedule,120% of MO Medicaid Rate,16.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.45,77,,,Percent of total Billed charges,77% of total billed charges,157.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.94,120,,,Fee Schedule,120% of MO Medicaid Rate,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,157.25,
GAL-1-P-URIDYLTRANSFERASE RBC,T990350279,CDM,301,RC,82775,HCPCS,Outpatient,,,51,25.5,,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.74,74,,,Percent of Total Billed Charges,74% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,84,,,Percent of Total Billed Charges,84% of total billed charges,41.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.75,500,,,fee schedule,500% of healthlink,153.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,153.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.22,120,,,Fee Schedule,120% of MO Medicaid Rate,20.22,120,,,Fee Schedule,120% of MO Medicaid Rate,20.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.22,120,,,Fee Schedule,120% of MO Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.75,153.75,
NEO GALACTOSE-1-PHOSPHATE QNT,T990350280,CDM,301,RC,82775,HCPCS,Outpatient,,,51,25.5,,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.74,74,,,Percent of Total Billed Charges,74% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,84,,,Percent of Total Billed Charges,84% of total billed charges,41.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.75,500,,,fee schedule,500% of healthlink,153.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,153.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.22,120,,,Fee Schedule,120% of MO Medicaid Rate,20.22,120,,,Fee Schedule,120% of MO Medicaid Rate,20.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.22,120,,,Fee Schedule,120% of MO Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.75,153.75,
CSF IgG INDEX,T990350281,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
CSF IgG SYNTHESIS RATE,T990350282,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
IMMUNOGLOBIN A (IgA),T990350283,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
IMMUNOGLOBIN D (IgD),T990350284,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
IMMUNOGLOBIN G (IgG),T990350285,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
IMMUNOGLOBIN M (IgM),T990350286,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
IMMUNOGLOBULIN G CSF,T990350287,CDM,301,RC,82784,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,8.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.93,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.93,112.63,
IMMUNOGLOBIN E,T990350288,CDM,300,RC,82785,HCPCS,Outpatient,,,141,70.5,,108.57,77,,,Percent of Total Billed Charges,77% of total billed charges,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.34,74,,,Percent of Total Billed Charges,74% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,118.44,84,,,Percent of Total Billed Charges,84% of total billed charges,115.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.25,500,,,fee schedule,500% of healthlink,120.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,120.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,15.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.57,77,,,Percent of total Billed charges,77% of total billed charges,119.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.79,120.25,
IMMUNOGLOBIN E (IgE),T990350289,CDM,301,RC,82785,HCPCS,Outpatient,,,141,70.5,,108.57,77,,,Percent of Total Billed Charges,77% of total billed charges,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.34,74,,,Percent of Total Billed Charges,74% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,97.29,69,,,Percent of Total Billed Charges,69% of total billed charges,118.44,84,,,Percent of Total Billed Charges,84% of total billed charges,115.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.25,500,,,fee schedule,500% of healthlink,120.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,120.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,15.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.57,77,,,Percent of total Billed charges,77% of total billed charges,119.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.79,120.25,
IGA SUBCLASSES EACH,T990350290,CDM,301,RC,82787,HCPCS,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.4,500,,,fee schedule,500% of healthlink,25.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.69,120,,,Fee Schedule,120% of MO Medicaid Rate,7.69,120,,,Fee Schedule,120% of MO Medicaid Rate,7.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.69,120,,,Fee Schedule,120% of MO Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.69,93.08,
IGG SUBCLASSES EACH,T990350291,CDM,301,RC,82787,HCPCS,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.4,500,,,fee schedule,500% of healthlink,25.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.69,120,,,Fee Schedule,120% of MO Medicaid Rate,7.69,120,,,Fee Schedule,120% of MO Medicaid Rate,7.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.69,120,,,Fee Schedule,120% of MO Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.69,93.08,
VENOUS pH,T990350292,CDM,301,RC,82800,HCPCS,Outpatient,,,93,46.5,,71.61,77,,,Percent of Total Billed Charges,77% of total billed charges,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.82,74,,,Percent of Total Billed Charges,74% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,78.12,84,,,Percent of Total Billed Charges,84% of total billed charges,76.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.85,500,,,fee schedule,500% of healthlink,61.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.56,120,,,Fee Schedule,120% of MO Medicaid Rate,10.56,120,,,Fee Schedule,120% of MO Medicaid Rate,10.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.61,77,,,Percent of total Billed charges,77% of total billed charges,79.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.56,120,,,Fee Schedule,120% of MO Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.56,79.05,
BLOOD GASES CHARGE,T990350293,CDM,301,RC,82805,HCPCS,Outpatient,,,303.5,151.75,,233.7,77,,,Percent of Total Billed Charges,77% of total billed charges,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.59,74,,,Percent of Total Billed Charges,74% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,254.94,84,,,Percent of Total Billed Charges,84% of total billed charges,248.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.15,500,,,fee schedule,500% of healthlink,207.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,207.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,75.61,120,,,Fee Schedule,120% of MO Medicaid Rate,75.61,120,,,Fee Schedule,120% of MO Medicaid Rate,75.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.7,77,,,Percent of total Billed charges,77% of total billed charges,257.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,75.61,120,,,Fee Schedule,120% of MO Medicaid Rate,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,257.98,
COH-O2 SATURATION DIRECT MEASU,T990350294,CDM,301,RC,82810,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.7,500,,,fee schedule,500% of healthlink,63.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.37,120,,,Fee Schedule,120% of MO Medicaid Rate,9.37,120,,,Fee Schedule,120% of MO Medicaid Rate,9.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.37,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.37,64,
GASTRIN SERUM,T990350295,CDM,301,RC,82941,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.82,74,,,Percent of Total Billed Charges,74% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.75,500,,,fee schedule,500% of healthlink,128.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,128.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.92,120,,,Fee Schedule,120% of MO Medicaid Rate,16.92,120,,,Fee Schedule,120% of MO Medicaid Rate,16.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.92,120,,,Fee Schedule,120% of MO Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,128.75,
GLUCAGON,T990350296,CDM,301,RC,82943,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.02,74,,,Percent of Total Billed Charges,74% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,103.32,84,,,Percent of Total Billed Charges,84% of total billed charges,100.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.72,120,,,Fee Schedule,120% of MO Medicaid Rate,13.72,120,,,Fee Schedule,120% of MO Medicaid Rate,13.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.72,120,,,Fee Schedule,120% of MO Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,104.55,
GLUCOSE CSF,T990350297,CDM,301,RC,82945,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,89.68,
GLUCOSE PERITONEAL FLUID,T990350298,CDM,301,RC,82945,HCPCS,Outpatient,,,93,46.5,,71.61,77,,,Percent of Total Billed Charges,77% of total billed charges,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.82,74,,,Percent of Total Billed Charges,74% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,78.12,84,,,Percent of Total Billed Charges,84% of total billed charges,76.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.61,77,,,Percent of total Billed charges,77% of total billed charges,79.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,79.05,
GLUCOSE PLEURAL FLUID,T990350299,CDM,301,RC,82945,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,103.28,
GLUCOSE SYNOVIAL FLUID,T990350300,CDM,301,RC,82945,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,75.23,
GLUCOSE 2HR PP,T990350301,CDM,301,RC,82947,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,64,
GLUCOSE FASTING,T990350302,CDM,301,RC,82947,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,64,
GLUCOSE SERUM,T990350303,CDM,301,RC,82947,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.65,500,,,fee schedule,500% of healthlink,28.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,3.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.77,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,64,
GLUCOSE 1 HR,T990350304,CDM,301,RC,82950,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.65,500,,,fee schedule,500% of healthlink,34.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,34.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,4.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,64,
GLUCOSE TOLERANCE (PREG),T990350305,CDM,301,RC,82951,HCPCS,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,94,500,,,fee schedule,500% of healthlink,94,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.35,184.03,
GLUCOSE TOLERANCE EA ADDL >3,T990350306,CDM,301,RC,82952,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.6,500,,,fee schedule,500% of healthlink,28.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.76,120,,,Fee Schedule,120% of MO Medicaid Rate,3.76,120,,,Fee Schedule,120% of MO Medicaid Rate,3.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.76,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,64,
G 6 PD QUANTITATIVE,T990350309,CDM,301,RC,82955,HCPCS,Outpatient,,,157,78.5,,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.18,74,,,Percent of Total Billed Charges,74% of total billed charges,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,131.88,84,,,Percent of Total Billed Charges,84% of total billed charges,128.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.8,500,,,fee schedule,500% of healthlink,70.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,70.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,9.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.31,133.45,
GLUCOSE CLEARED FOR HOME USE,T990350310,CDM,301,RC,82962,HCPCS,Outpatient,,,40.5,20.25,,31.19,77,,,Percent of Total Billed Charges,77% of total billed charges,10.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.97,74,,,Percent of Total Billed Charges,74% of total billed charges,27.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.95,69,,,Percent of Total Billed Charges,69% of total billed charges,10.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.95,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,84,,,Percent of Total Billed Charges,84% of total billed charges,33.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.1,500,,,fee schedule,500% of healthlink,17.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.14,120,,,Fee Schedule,120% of MO Medicaid Rate,3.14,120,,,Fee Schedule,120% of MO Medicaid Rate,3.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,10.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.19,77,,,Percent of total Billed charges,77% of total billed charges,34.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.14,120,,,Fee Schedule,120% of MO Medicaid Rate,10.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,10.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.14,64,
GAMMA GLUTAMYL TRANSPEPTIDASE,T990350311,CDM,301,RC,82977,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.88,74,,,Percent of Total Billed Charges,74% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,94.08,84,,,Percent of Total Billed Charges,84% of total billed charges,91.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.55,500,,,fee schedule,500% of healthlink,52.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,52.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.91,120,,,Fee Schedule,120% of MO Medicaid Rate,6.91,120,,,Fee Schedule,120% of MO Medicaid Rate,6.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.91,120,,,Fee Schedule,120% of MO Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.91,95.2,
FRUCTOSAMINE,T990350312,CDM,301,RC,82985,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.31,74,,,Percent of Total Billed Charges,74% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,84,,,Percent of Total Billed Charges,84% of total billed charges,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.05,500,,,fee schedule,500% of healthlink,110.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,110.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.08,120,,,Fee Schedule,120% of MO Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,111.78,
FOLLICLE STIMULATING HORMONE,T990350313,CDM,301,RC,83001,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.7,500,,,fee schedule,500% of healthlink,135.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,135.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.83,120,,,Fee Schedule,120% of MO Medicaid Rate,17.83,120,,,Fee Schedule,120% of MO Medicaid Rate,17.83,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.83,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.83,167.88,
LUTEININZING HORMONE (LH),T990350314,CDM,301,RC,83002,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.2,500,,,fee schedule,500% of healthlink,135.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,135.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.77,120,,,Fee Schedule,120% of MO Medicaid Rate,17.77,120,,,Fee Schedule,120% of MO Medicaid Rate,17.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.77,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.77,167.88,
HUMAN GROWTH HORMONE SERUM,T990350315,CDM,301,RC,83003,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.7,500,,,fee schedule,500% of healthlink,121.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,121.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16,120,,,Fee Schedule,120% of MO Medicaid Rate,16,120,,,Fee Schedule,120% of MO Medicaid Rate,16,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16,144.93,
HAPTOGLOBIN,T990350316,CDM,301,RC,83010,HCPCS,Outpatient,,,149,74.5,,114.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.26,74,,,Percent of Total Billed Charges,74% of total billed charges,102.81,69,,,Percent of Total Billed Charges,69% of total billed charges,102.81,69,,,Percent of Total Billed Charges,69% of total billed charges,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.81,69,,,Percent of Total Billed Charges,69% of total billed charges,102.81,69,,,Percent of Total Billed Charges,69% of total billed charges,125.16,84,,,Percent of Total Billed Charges,84% of total billed charges,122.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.85,500,,,fee schedule,500% of healthlink,91.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,91.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.07,120,,,Fee Schedule,120% of MO Medicaid Rate,12.07,120,,,Fee Schedule,120% of MO Medicaid Rate,12.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.73,77,,,Percent of total Billed charges,77% of total billed charges,126.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.07,120,,,Fee Schedule,120% of MO Medicaid Rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.07,126.65,
H. pylori UREA BREATH TEST,T990350317,CDM,301,RC,83013,HCPCS,Outpatient,,,246.5,123.25,,189.81,77,,,Percent of Total Billed Charges,77% of total billed charges,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.41,74,,,Percent of Total Billed Charges,74% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,207.06,84,,,Percent of Total Billed Charges,84% of total billed charges,202.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,491.75,500,,,fee schedule,500% of healthlink,491.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,491.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,64.66,120,,,Fee Schedule,120% of MO Medicaid Rate,64.66,120,,,Fee Schedule,120% of MO Medicaid Rate,64.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.81,77,,,Percent of total Billed charges,77% of total billed charges,209.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,64.66,120,,,Fee Schedule,120% of MO Medicaid Rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,491.75,
COBALT,T990350318,CDM,301,RC,83018,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.3,500,,,fee schedule,500% of healthlink,160.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,160.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.07,120,,,Fee Schedule,120% of MO Medicaid Rate,21.07,120,,,Fee Schedule,120% of MO Medicaid Rate,21.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.07,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,180.63,
SILVER HEAVY METAL,T990350319,CDM,301,RC,83018,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.3,500,,,fee schedule,500% of healthlink,160.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,160.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.07,120,,,Fee Schedule,120% of MO Medicaid Rate,21.07,120,,,Fee Schedule,120% of MO Medicaid Rate,21.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.07,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,180.63,
NEO HGB F ELECTROPHORESIS,T990350320,CDM,301,RC,83020,HCPCS,Outpatient,,,44,22,,33.88,77,,,Percent of Total Billed Charges,77% of total billed charges,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.56,74,,,Percent of Total Billed Charges,74% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,30.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36.96,84,,,Percent of Total Billed Charges,84% of total billed charges,36.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,94,500,,,fee schedule,500% of healthlink,94,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,77,,,Percent of total Billed charges,77% of total billed charges,37.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,94,
HE-HGB FRACTION CHROMATOGRAPH,T990350321,CDM,301,RC,83021,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,17.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.33,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.33,180.63,
HEMOGLOBIN (Hgb) A1C,T990350322,CDM,301,RC,83036,HCPCS,Outpatient,,,114,57,,87.78,77,,,Percent of Total Billed Charges,77% of total billed charges,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.36,74,,,Percent of Total Billed Charges,74% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,95.76,84,,,Percent of Total Billed Charges,84% of total billed charges,93.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.85,500,,,fee schedule,500% of healthlink,70.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,70.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,9.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.78,77,,,Percent of total Billed charges,77% of total billed charges,96.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.31,96.9,
COH-METHEMOGLOBIN,T990350323,CDM,301,RC,83050,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.06,74,,,Percent of Total Billed Charges,74% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,57.96,84,,,Percent of Total Billed Charges,84% of total billed charges,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.45,500,,,fee schedule,500% of healthlink,53.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,53.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.87,120,,,Fee Schedule,120% of MO Medicaid Rate,7.87,120,,,Fee Schedule,120% of MO Medicaid Rate,7.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.87,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.87,64,
Histamine,T990350324,CDM,301,RC,83088,HCPCS,Outpatient,,,228,114,,175.56,77,,,Percent of Total Billed Charges,77% of total billed charges,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.72,74,,,Percent of Total Billed Charges,74% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,191.52,84,,,Percent of Total Billed Charges,84% of total billed charges,186.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.05,500,,,fee schedule,500% of healthlink,38.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.34,120,,,Fee Schedule,120% of MO Medicaid Rate,28.34,120,,,Fee Schedule,120% of MO Medicaid Rate,28.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.56,77,,,Percent of total Billed charges,77% of total billed charges,193.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.34,120,,,Fee Schedule,120% of MO Medicaid Rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.34,193.8,
HISTAMINE WHOLE BLOOD,T990350325,CDM,301,RC,83088,HCPCS,Outpatient,,,265.5,132.75,,204.44,77,,,Percent of Total Billed Charges,77% of total billed charges,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,74,,,Percent of Total Billed Charges,74% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,223.02,84,,,Percent of Total Billed Charges,84% of total billed charges,217.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.05,500,,,fee schedule,500% of healthlink,38.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.34,120,,,Fee Schedule,120% of MO Medicaid Rate,28.34,120,,,Fee Schedule,120% of MO Medicaid Rate,28.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.44,77,,,Percent of total Billed charges,77% of total billed charges,225.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.34,120,,,Fee Schedule,120% of MO Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.34,225.68,
CARDIO IQ HOMOCYSTEINE,T990350326,CDM,301,RC,83090,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,123.15,
HOMOCYSTEINE SERUM,T990350327,CDM,301,RC,83090,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185,74,,,Percent of Total Billed Charges,74% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,210,84,,,Percent of Total Billed Charges,84% of total billed charges,205,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,212.5,
HOMOCYSTEINE URINE,T990350328,CDM,301,RC,83090,HCPCS,Outpatient,,,362,181,,278.74,77,,,Percent of Total Billed Charges,77% of total billed charges,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,267.88,74,,,Percent of Total Billed Charges,74% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,304.08,84,,,Percent of Total Billed Charges,84% of total billed charges,296.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.74,77,,,Percent of total Billed charges,77% of total billed charges,307.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,307.7,
HYMOCYSTEINE,T990350329,CDM,301,RC,83090,HCPCS,Outpatient,,,220.5,110.25,,169.79,77,,,Percent of Total Billed Charges,77% of total billed charges,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.17,74,,,Percent of Total Billed Charges,74% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,185.22,84,,,Percent of Total Billed Charges,84% of total billed charges,180.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.15,500,,,fee schedule,500% of healthlink,123.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,17.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.79,77,,,Percent of total Billed charges,77% of total billed charges,187.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.2,120,,,Fee Schedule,120% of MO Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,187.43,
HVA 24 HR URINE,T990350330,CDM,301,RC,83150,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.1,500,,,fee schedule,500% of healthlink,76.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,76.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.5,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.5,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,180.63,
5 HIAA,T990350331,CDM,301,RC,83497,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.15,500,,,fee schedule,500% of healthlink,94.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,12.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.38,124.1,
17-HYDROXYPROGESTERONE LC/MS/M,T990350332,CDM,301,RC,83498,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.3,500,,,fee schedule,500% of healthlink,198.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,198.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,26.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.08,347.23,
17-OH PROGESTERONE ACTH RESPNS,T990350333,CDM,301,RC,83498,HCPCS,Outpatient,,,302,151,,232.54,77,,,Percent of Total Billed Charges,77% of total billed charges,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.48,74,,,Percent of Total Billed Charges,74% of total billed charges,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,208.38,69,,,Percent of Total Billed Charges,69% of total billed charges,253.68,84,,,Percent of Total Billed Charges,84% of total billed charges,247.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.3,500,,,fee schedule,500% of healthlink,198.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,198.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,26.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.54,77,,,Percent of total Billed charges,77% of total billed charges,256.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.08,256.7,
NEO 17-d-HYDROXYPROGESTERONE,T990350334,CDM,301,RC,83498,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.3,500,,,fee schedule,500% of healthlink,198.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,198.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,26.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.08,120,,,Fee Schedule,120% of MO Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,198.3,
ACCA IgA,T990350335,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
ACTIN AB IgG,T990350336,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
ALCA IgG,T990350337,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
AMCA IgG,T990350338,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
AQUAPORIN-4 AB,T990350339,CDM,301,RC,83516,HCPCS,Outpatient,,,1451.5,725.75,,1117.66,77,,,Percent of Total Billed Charges,77% of total billed charges,370.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1074.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1001.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1001.54,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1001.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1219.26,84,,,Percent of Total Billed Charges,84% of total billed charges,1190.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,362.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1117.66,77,,,Percent of total Billed charges,77% of total billed charges,1233.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,362.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,362.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,1233.78,
GASTRIC PARIETAL CELL AB,T990350340,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
GLIADIN AB IgA BY EIA,T990350341,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
HISTONE AB,T990350342,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
MYOSITIS IMMUNOASSAYS EACH,T990350343,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
Phosphatidylglycerol QL Amino,T990350344,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
TISSUE TRANSGLUTAMINASE IgG,T990350345,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
"TISSUE TRANSGLUTAMINASE, IgA",T990350346,CDM,301,RC,83516,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.25,500,,,fee schedule,500% of healthlink,84.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,170,
MICROALBUMIN UR SEMIQUANT,T990350348,CDM,301,RC,83518,HCPCS,Outpatient,,,93,46.5,QW,71.61,77,,,Percent of Total Billed Charges,77% of total billed charges,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.82,74,,,Percent of Total Billed Charges,74% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,78.12,84,,,Percent of Total Billed Charges,84% of total billed charges,76.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.6,500,,,fee schedule,500% of healthlink,54.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,54.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.25,120,,,Fee Schedule,120% of MO Medicaid Rate,9.25,120,,,Fee Schedule,120% of MO Medicaid Rate,9.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.61,77,,,Percent of total Billed charges,77% of total billed charges,79.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.25,120,,,Fee Schedule,120% of MO Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,79.05,
ACHR BLOCKING AB,T990350349,CDM,301,RC,83519,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.43,74,,,Percent of Total Billed Charges,74% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,314.08,
AChR MODULATING AB,T990350350,CDM,301,RC,83519,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,372.96,74,,,Percent of Total Billed Charges,74% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,69,,,Percent of Total Billed Charges,69% of total billed charges,423.36,84,,,Percent of Total Billed Charges,84% of total billed charges,413.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,428.4,
ALPHA SUBUNIT,T990350351,CDM,301,RC,83519,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.43,74,,,Percent of Total Billed Charges,74% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,314.08,
ANTI-T3 AUTOAB,T990350352,CDM,301,RC,83519,HCPCS,Outpatient,,,455,227.5,,350.35,77,,,Percent of Total Billed Charges,77% of total billed charges,116.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,336.7,74,,,Percent of Total Billed Charges,74% of total billed charges,313.95,69,,,Percent of Total Billed Charges,69% of total billed charges,313.95,69,,,Percent of Total Billed Charges,69% of total billed charges,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.95,69,,,Percent of Total Billed Charges,69% of total billed charges,313.95,69,,,Percent of Total Billed Charges,69% of total billed charges,382.2,84,,,Percent of Total Billed Charges,84% of total billed charges,373.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.35,77,,,Percent of total Billed charges,77% of total billed charges,386.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,113.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,386.75,
ANTI-T4 AUTOAB,T990350353,CDM,301,RC,83519,HCPCS,Outpatient,,,488,244,,375.76,77,,,Percent of Total Billed Charges,77% of total billed charges,124.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.12,74,,,Percent of Total Billed Charges,74% of total billed charges,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,336.72,69,,,Percent of Total Billed Charges,69% of total billed charges,409.92,84,,,Percent of Total Billed Charges,84% of total billed charges,400.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.76,77,,,Percent of total Billed charges,77% of total billed charges,414.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,122,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,414.8,
GAD-65,T990350354,CDM,301,RC,83519,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.43,74,,,Percent of Total Billed Charges,74% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,314.08,
MuSK AB TEST,T990350355,CDM,301,RC,83519,HCPCS,Outpatient,,,1305.5,652.75,,1005.24,77,,,Percent of Total Billed Charges,77% of total billed charges,332.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,407.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,966.07,74,,,Percent of Total Billed Charges,74% of total billed charges,900.8,69,,,Percent of Total Billed Charges,69% of total billed charges,900.8,69,,,Percent of Total Billed Charges,69% of total billed charges,326.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,900.8,69,,,Percent of Total Billed Charges,69% of total billed charges,900.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.62,84,,,Percent of Total Billed Charges,84% of total billed charges,1070.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,326.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1005.24,77,,,Percent of total Billed charges,77% of total billed charges,1109.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,375.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,326.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,326.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,1109.68,
NEOPTERIN,T990350356,CDM,301,RC,83519,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.43,74,,,Percent of Total Billed Charges,74% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,314.08,
PARANEOPLASTIC AUTOAB RIA EACH,T990350357,CDM,301,RC,83519,HCPCS,Outpatient,,,210.5,105.25,,162.09,77,,,Percent of Total Billed Charges,77% of total billed charges,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.77,74,,,Percent of Total Billed Charges,74% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,145.25,69,,,Percent of Total Billed Charges,69% of total billed charges,176.82,84,,,Percent of Total Billed Charges,84% of total billed charges,172.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.09,77,,,Percent of total Billed charges,77% of total billed charges,178.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,178.93,
PTH I RELATED PEPTIDE,T990350358,CDM,301,RC,83519,HCPCS,Outpatient,,,392,196,,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,290.08,74,,,Percent of Total Billed Charges,74% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,329.28,84,,,Percent of Total Billed Charges,84% of total billed charges,321.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,333.2,
THYROTROPIN RELEASING HORMONE,T990350359,CDM,301,RC,83519,HCPCS,Outpatient,,,938,469,,722.26,77,,,Percent of Total Billed Charges,77% of total billed charges,239.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.12,74,,,Percent of Total Billed Charges,74% of total billed charges,647.22,69,,,Percent of Total Billed Charges,69% of total billed charges,647.22,69,,,Percent of Total Billed Charges,69% of total billed charges,234.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.22,69,,,Percent of Total Billed Charges,69% of total billed charges,647.22,69,,,Percent of Total Billed Charges,69% of total billed charges,787.92,84,,,Percent of Total Billed Charges,84% of total billed charges,769.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,234.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.26,77,,,Percent of total Billed charges,77% of total billed charges,797.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,234.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,234.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,797.3,
TRYPSIN,T990350360,CDM,301,RC,83519,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.43,74,,,Percent of Total Billed Charges,74% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.65,500,,,fee schedule,500% of healthlink,98.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,98.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,17.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.66,120,,,Fee Schedule,120% of MO Medicaid Rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.66,314.08,
ANTIGLOMERULAR BASEMENT (GBM),T990350361,CDM,301,RC,83520,HCPCS,Outpatient,,,235.5,117.75,,181.34,77,,,Percent of Total Billed Charges,77% of total billed charges,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.27,74,,,Percent of Total Billed Charges,74% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,197.82,84,,,Percent of Total Billed Charges,84% of total billed charges,193.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.34,77,,,Percent of total Billed charges,77% of total billed charges,200.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,200.18,
ANTI-IgA ABS IgG CLASS,T990350362,CDM,301,RC,83520,HCPCS,Outpatient,,,561.5,280.75,,432.36,77,,,Percent of Total Billed Charges,77% of total billed charges,143.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,415.51,74,,,Percent of Total Billed Charges,74% of total billed charges,387.44,69,,,Percent of Total Billed Charges,69% of total billed charges,387.44,69,,,Percent of Total Billed Charges,69% of total billed charges,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.44,69,,,Percent of Total Billed Charges,69% of total billed charges,387.44,69,,,Percent of Total Billed Charges,69% of total billed charges,471.66,84,,,Percent of Total Billed Charges,84% of total billed charges,460.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,432.36,77,,,Percent of total Billed charges,77% of total billed charges,477.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,140.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,477.28,
ANTI-MULLERIAN HORMONE,T990350363,CDM,301,RC,83520,HCPCS,Outpatient,,,268.5,134.25,,206.75,77,,,Percent of Total Billed Charges,77% of total billed charges,68.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.69,74,,,Percent of Total Billed Charges,74% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,225.54,84,,,Percent of Total Billed Charges,84% of total billed charges,220.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.75,77,,,Percent of total Billed charges,77% of total billed charges,228.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,228.23,
BULLOUS PEMPHIGOID 180 AB,T990350364,CDM,301,RC,83520,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,147.48,
C1 INHIBITOR FUNCTIONAL,T990350365,CDM,301,RC,83520,HCPCS,Outpatient,,,207,103.5,,159.39,77,,,Percent of Total Billed Charges,77% of total billed charges,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.18,74,,,Percent of Total Billed Charges,74% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,173.88,84,,,Percent of Total Billed Charges,84% of total billed charges,169.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.39,77,,,Percent of total Billed charges,77% of total billed charges,175.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,175.95,
COTININE URINE,T990350366,CDM,301,RC,83520,HCPCS,Outpatient,,,201.5,100.75,,155.16,77,,,Percent of Total Billed Charges,77% of total billed charges,51.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.11,74,,,Percent of Total Billed Charges,74% of total billed charges,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,139.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.26,84,,,Percent of Total Billed Charges,84% of total billed charges,165.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.16,77,,,Percent of total Billed charges,77% of total billed charges,171.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,171.28,
DESMOGEIN AB EACH,T990350367,CDM,301,RC,83520,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.52,74,,,Percent of Total Billed Charges,74% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,84,,,Percent of Total Billed Charges,84% of total billed charges,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,125.8,
GLIADIN AB IgA,T990350368,CDM,301,RC,83520,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,94.55,
GLIADIN AB IgG,T990350369,CDM,301,RC,83520,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,94.55,
GLIADIN AB IgG BY EIA,T990350370,CDM,301,RC,83520,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,136.85,
GM-1 AB IgG,T990350371,CDM,301,RC,83520,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,109.23,
IMMUNOASSAY QUANTITATIVE,T990350372,CDM,301,RC,83520,HCPCS,Outpatient,,,681.5,340.75,,524.76,77,,,Percent of Total Billed Charges,77% of total billed charges,173.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,504.31,74,,,Percent of Total Billed Charges,74% of total billed charges,470.24,69,,,Percent of Total Billed Charges,69% of total billed charges,470.24,69,,,Percent of Total Billed Charges,69% of total billed charges,170.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.24,69,,,Percent of Total Billed Charges,69% of total billed charges,470.24,69,,,Percent of Total Billed Charges,69% of total billed charges,572.46,84,,,Percent of Total Billed Charges,84% of total billed charges,558.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,170.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.76,77,,,Percent of total Billed charges,77% of total billed charges,579.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,195.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,170.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,170.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,579.28,
INFLIXIMAB LEVEL,T990350373,CDM,301,RC,83520,HCPCS,Outpatient,,,1269.5,634.75,,977.52,77,,,Percent of Total Billed Charges,77% of total billed charges,323.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,939.43,74,,,Percent of Total Billed Charges,74% of total billed charges,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,875.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1066.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1040.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,977.52,77,,,Percent of total Billed charges,77% of total billed charges,1079.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,364.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,317.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,1079.08,
INHIBIN-B ELISA,T990350374,CDM,301,RC,83520,HCPCS,Outpatient,,,587.5,293.75,,452.38,77,,,Percent of Total Billed Charges,77% of total billed charges,149.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,434.75,74,,,Percent of Total Billed Charges,74% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,493.5,84,,,Percent of Total Billed Charges,84% of total billed charges,481.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.38,77,,,Percent of total Billed charges,77% of total billed charges,499.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,499.38,
"MAG IgM, EIA",T990350375,CDM,301,RC,83520,HCPCS,Outpatient,,,435.5,217.75,,335.34,77,,,Percent of Total Billed Charges,77% of total billed charges,111.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,322.27,74,,,Percent of Total Billed Charges,74% of total billed charges,300.5,69,,,Percent of Total Billed Charges,69% of total billed charges,300.5,69,,,Percent of Total Billed Charges,69% of total billed charges,108.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.5,69,,,Percent of Total Billed Charges,69% of total billed charges,300.5,69,,,Percent of Total Billed Charges,69% of total billed charges,365.82,84,,,Percent of Total Billed Charges,84% of total billed charges,357.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,108.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,77,,,Percent of total Billed charges,77% of total billed charges,370.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,108.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,108.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,370.18,
MAG-SGPG IgM,T990350376,CDM,301,RC,83520,HCPCS,Outpatient,,,221,110.5,,170.17,77,,,Percent of Total Billed Charges,77% of total billed charges,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.54,74,,,Percent of Total Billed Charges,74% of total billed charges,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,152.49,69,,,Percent of Total Billed Charges,69% of total billed charges,185.64,84,,,Percent of Total Billed Charges,84% of total billed charges,181.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.17,77,,,Percent of total Billed charges,77% of total billed charges,187.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,187.85,
MITOCHONDRIA M2 lgG,T990350377,CDM,301,RC,83520,HCPCS,Outpatient,,,84.5,42.25,,65.07,77,,,Percent of Total Billed Charges,77% of total billed charges,21.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.53,74,,,Percent of Total Billed Charges,74% of total billed charges,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,70.98,84,,,Percent of Total Billed Charges,84% of total billed charges,69.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.07,77,,,Percent of total Billed charges,77% of total billed charges,71.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,94.55,
MYELOPEROXIDASE IAQ,T990350378,CDM,301,RC,83520,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,180.63,
PARANEOPASTIC AUTOAB QNT,T990350379,CDM,301,RC,83520,HCPCS,Outpatient,,,204.5,102.25,,157.47,77,,,Percent of Total Billed Charges,77% of total billed charges,52.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,141.11,69,,,Percent of Total Billed Charges,69% of total billed charges,171.78,84,,,Percent of Total Billed Charges,84% of total billed charges,167.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.47,77,,,Percent of total Billed charges,77% of total billed charges,173.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,173.83,
PHOSPHOLIPASE A2 RECEPTOR AB,T990350380,CDM,301,RC,83520,HCPCS,Outpatient,,,582.5,291.25,,448.53,77,,,Percent of Total Billed Charges,77% of total billed charges,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,431.05,74,,,Percent of Total Billed Charges,74% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,489.3,84,,,Percent of Total Billed Charges,84% of total billed charges,477.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.53,77,,,Percent of total Billed charges,77% of total billed charges,495.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,495.13,
RHEUMATOID FACTOR IgA,T990350381,CDM,301,RC,83520,HCPCS,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,94.55,
RHEUMATOID FACTOR IgG,T990350382,CDM,301,RC,83520,HCPCS,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,94.55,
RHEUMATOID FACTOR IgM,T990350383,CDM,301,RC,83520,HCPCS,Outpatient,,,34.5,17.25,,26.57,77,,,Percent of Total Billed Charges,77% of total billed charges,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.53,74,,,Percent of Total Billed Charges,74% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,23.81,69,,,Percent of Total Billed Charges,69% of total billed charges,28.98,84,,,Percent of Total Billed Charges,84% of total billed charges,28.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,77,,,Percent of total Billed charges,77% of total billed charges,29.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,94.55,
RIBOSOMAL P AB,T990350384,CDM,301,RC,83520,HCPCS,Outpatient,,,235.5,117.75,,181.34,77,,,Percent of Total Billed Charges,77% of total billed charges,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.27,74,,,Percent of Total Billed Charges,74% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,197.82,84,,,Percent of Total Billed Charges,84% of total billed charges,193.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.34,77,,,Percent of total Billed charges,77% of total billed charges,200.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,200.18,
RIBOSOMAL P PROTEIN AB,T990350385,CDM,301,RC,83520,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,347.23,
RNA POLYMERASE III,T990350386,CDM,301,RC,83520,HCPCS,Outpatient,,,181,90.5,,139.37,77,,,Percent of Total Billed Charges,77% of total billed charges,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.94,74,,,Percent of Total Billed Charges,74% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,152.04,84,,,Percent of Total Billed Charges,84% of total billed charges,148.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,77,,,Percent of total Billed charges,77% of total billed charges,153.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,153.85,
SULFATIDE IgG,T990350387,CDM,301,RC,83520,HCPCS,Outpatient,,,560.5,280.25,,431.59,77,,,Percent of Total Billed Charges,77% of total billed charges,142.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,414.77,74,,,Percent of Total Billed Charges,74% of total billed charges,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,470.82,84,,,Percent of Total Billed Charges,84% of total billed charges,459.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.59,77,,,Percent of total Billed charges,77% of total billed charges,476.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,476.43,
SULFATIDE IgM,T990350388,CDM,301,RC,83520,HCPCS,Outpatient,,,560.5,280.25,,431.59,77,,,Percent of Total Billed Charges,77% of total billed charges,142.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,414.77,74,,,Percent of Total Billed Charges,74% of total billed charges,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,386.75,69,,,Percent of Total Billed Charges,69% of total billed charges,470.82,84,,,Percent of Total Billed Charges,84% of total billed charges,459.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.59,77,,,Percent of total Billed charges,77% of total billed charges,476.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,476.43,
TRYPTASE,T990350389,CDM,301,RC,83520,HCPCS,Outpatient,,,231.5,115.75,,178.26,77,,,Percent of Total Billed Charges,77% of total billed charges,59.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,171.31,74,,,Percent of Total Billed Charges,74% of total billed charges,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,159.74,69,,,Percent of Total Billed Charges,69% of total billed charges,194.46,84,,,Percent of Total Billed Charges,84% of total billed charges,189.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,16.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.26,77,,,Percent of total Billed charges,77% of total billed charges,196.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.57,120,,,Fee Schedule,120% of MO Medicaid Rate,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,196.78,
INSULIN,T990350390,CDM,301,RC,83525,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.16,74,,,Percent of Total Billed Charges,74% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,112.56,84,,,Percent of Total Billed Charges,84% of total billed charges,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.45,500,,,fee schedule,500% of healthlink,83.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.97,120,,,Fee Schedule,120% of MO Medicaid Rate,10.97,120,,,Fee Schedule,120% of MO Medicaid Rate,10.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.97,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.97,113.9,
INSULIN FREE (BIOACTIVE),T990350391,CDM,301,RC,83527,HCPCS,Outpatient,,,256,128,,197.12,77,,,Percent of Total Billed Charges,77% of total billed charges,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.44,74,,,Percent of Total Billed Charges,74% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,215.04,84,,,Percent of Total Billed Charges,84% of total billed charges,209.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.25,500,,,fee schedule,500% of healthlink,60.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,60.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.12,77,,,Percent of total Billed charges,77% of total billed charges,217.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.43,217.6,
FE TIBC,T990350392,CDM,301,RC,83540,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.26,74,,,Percent of Total Billed Charges,74% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,83.16,84,,,Percent of Total Billed Charges,84% of total billed charges,81.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,84.15,
IRON SERUM,T990350393,CDM,301,RC,83540,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.26,74,,,Percent of Total Billed Charges,74% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,83.16,84,,,Percent of Total Billed Charges,84% of total billed charges,81.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.3,500,,,fee schedule,500% of healthlink,47.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,84.15,
FE TOTAL BINDING CAPACITY,T990350394,CDM,301,RC,83550,HCPCS,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.4,74,,,Percent of Total Billed Charges,74% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,92.4,84,,,Percent of Total Billed Charges,84% of total billed charges,90.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.85,500,,,fee schedule,500% of healthlink,63.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.39,120,,,Fee Schedule,120% of MO Medicaid Rate,8.39,120,,,Fee Schedule,120% of MO Medicaid Rate,8.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.39,120,,,Fee Schedule,120% of MO Medicaid Rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.39,93.5,
17 KETOSTEROIDS 24 HOUR UNINE,T990350395,CDM,301,RC,83586,HCPCS,Outpatient,,,90.5,45.25,,69.69,77,,,Percent of Total Billed Charges,77% of total billed charges,23.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.97,74,,,Percent of Total Billed Charges,74% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,76.02,84,,,Percent of Total Billed Charges,84% of total billed charges,74.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.45,500,,,fee schedule,500% of healthlink,93.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,93.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.29,120,,,Fee Schedule,120% of MO Medicaid Rate,12.29,120,,,Fee Schedule,120% of MO Medicaid Rate,12.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.69,77,,,Percent of total Billed charges,77% of total billed charges,76.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.29,120,,,Fee Schedule,120% of MO Medicaid Rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.29,93.45,
KETOSTEROIDS FRACTIONATED,T990350396,CDM,301,RC,83593,HCPCS,Outpatient,,,272.5,136.25,,209.83,77,,,Percent of Total Billed Charges,77% of total billed charges,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,201.65,74,,,Percent of Total Billed Charges,74% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,228.9,84,,,Percent of Total Billed Charges,84% of total billed charges,223.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,192,500,,,fee schedule,500% of healthlink,192,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,192,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,27.36,120,,,Fee Schedule,120% of MO Medicaid Rate,27.36,120,,,Fee Schedule,120% of MO Medicaid Rate,27.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.83,77,,,Percent of total Billed charges,77% of total billed charges,231.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,27.36,120,,,Fee Schedule,120% of MO Medicaid Rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.36,231.63,
LACTIC ACID,T990350397,CDM,301,RC,83605,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.95,500,,,fee schedule,500% of healthlink,77.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.1,120,,,Fee Schedule,120% of MO Medicaid Rate,11.1,120,,,Fee Schedule,120% of MO Medicaid Rate,11.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.1,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,131.33,
LACTATE DEHYDROGENASE,T990350398,CDM,301,RC,83615,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,89.68,
LD CSF,T990350399,CDM,301,RC,83615,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,89.68,
LD PERITONEAL FLUID,T990350400,CDM,301,RC,83615,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,89.68,
LD PLEURAL FLUID,T990350401,CDM,301,RC,83615,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,89.68,
LD SYNOVIAL FLUID,T990350402,CDM,301,RC,83615,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.05,500,,,fee schedule,500% of healthlink,44.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,44.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,5.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.8,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,89.68,
LACTOFERRIN STOOL,T990350403,CDM,301,RC,83630,HCPCS,Outpatient,,,126.5,63.25,,97.41,77,,,Percent of Total Billed Charges,77% of total billed charges,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.61,74,,,Percent of Total Billed Charges,74% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,106.26,84,,,Percent of Total Billed Charges,84% of total billed charges,103.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.3,500,,,fee schedule,500% of healthlink,143.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,143.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.91,120,,,Fee Schedule,120% of MO Medicaid Rate,18.91,120,,,Fee Schedule,120% of MO Medicaid Rate,18.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.41,77,,,Percent of total Billed charges,77% of total billed charges,107.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.91,120,,,Fee Schedule,120% of MO Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.91,143.3,
LEAD,T990350404,CDM,301,RC,83655,HCPCS,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.35,500,,,fee schedule,500% of healthlink,88.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.62,120,,,Fee Schedule,120% of MO Medicaid Rate,11.62,120,,,Fee Schedule,120% of MO Medicaid Rate,11.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.62,120,,,Fee Schedule,120% of MO Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,88.35,
LIPASE RANDOM URINE,T990350405,CDM,301,RC,83690,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.3,500,,,fee schedule,500% of healthlink,50.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,50.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,6.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.61,151.73,
LIPASE SERUM,T990350406,CDM,301,RC,83690,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.3,500,,,fee schedule,500% of healthlink,50.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,50.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,6.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.61,151.73,
LIPOPROTEIN (a),T990350407,CDM,301,RC,83695,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.31,74,,,Percent of Total Billed Charges,74% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,84,,,Percent of Total Billed Charges,84% of total billed charges,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.74,120,,,Fee Schedule,120% of MO Medicaid Rate,13.74,120,,,Fee Schedule,120% of MO Medicaid Rate,13.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.74,120,,,Fee Schedule,120% of MO Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.74,111.78,
LP-PLA2(PLAC[TM]),T990350408,CDM,301,RC,83698,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,222,74,,,Percent of Total Billed Charges,74% of total billed charges,207,69,,,Percent of Total Billed Charges,69% of total billed charges,207,69,,,Percent of Total Billed Charges,69% of total billed charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207,69,,,Percent of Total Billed Charges,69% of total billed charges,207,69,,,Percent of Total Billed Charges,69% of total billed charges,252,84,,,Percent of Total Billed Charges,84% of total billed charges,246,82,,,Percent of Total Billed Charges,82% of total billed charges ,203.7,500,,,fee schedule,500% of healthlink,203.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,203.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,44.45,120,,,Fee Schedule,120% of MO Medicaid Rate,44.45,120,,,Fee Schedule,120% of MO Medicaid Rate,44.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,44.45,120,,,Fee Schedule,120% of MO Medicaid Rate,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.45,255,
VAP (TM) CHOLESTEROL TEST,T990350409,CDM,301,RC,83701,HCPCS,Outpatient,,,270.5,135.25,,208.29,77,,,Percent of Total Billed Charges,77% of total billed charges,68.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.17,74,,,Percent of Total Billed Charges,74% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,227.22,84,,,Percent of Total Billed Charges,84% of total billed charges,221.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.2,500,,,fee schedule,500% of healthlink,181.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,181.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.29,77,,,Percent of total Billed charges,77% of total billed charges,229.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,229.93,
LIPOPROTEINS,T990350410,CDM,301,RC,83704,HCPCS,Outpatient,,,127,63.5,,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.98,74,,,Percent of Total Billed Charges,74% of total billed charges,87.63,69,,,Percent of Total Billed Charges,69% of total billed charges,87.63,69,,,Percent of Total Billed Charges,69% of total billed charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.63,69,,,Percent of Total Billed Charges,69% of total billed charges,87.63,69,,,Percent of Total Billed Charges,69% of total billed charges,106.68,84,,,Percent of Total Billed Charges,84% of total billed charges,104.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.35,500,,,fee schedule,500% of healthlink,230.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,230.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,32.82,120,,,Fee Schedule,120% of MO Medicaid Rate,32.82,120,,,Fee Schedule,120% of MO Medicaid Rate,32.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.82,120,,,Fee Schedule,120% of MO Medicaid Rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,230.35,
NMR LIPOPROFILE,T990350411,CDM,301,RC,83704,HCPCS,Outpatient,,,300,150,,231,77,,,Percent of Total Billed Charges,77% of total billed charges,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,222,74,,,Percent of Total Billed Charges,74% of total billed charges,207,69,,,Percent of Total Billed Charges,69% of total billed charges,207,69,,,Percent of Total Billed Charges,69% of total billed charges,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207,69,,,Percent of Total Billed Charges,69% of total billed charges,207,69,,,Percent of Total Billed Charges,69% of total billed charges,252,84,,,Percent of Total Billed Charges,84% of total billed charges,246,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.35,500,,,fee schedule,500% of healthlink,230.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,230.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,32.82,120,,,Fee Schedule,120% of MO Medicaid Rate,32.82,120,,,Fee Schedule,120% of MO Medicaid Rate,32.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231,77,,,Percent of total Billed charges,77% of total billed charges,255,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.82,120,,,Fee Schedule,120% of MO Medicaid Rate,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.82,255,
CHOLESTEROL HDL,T990350412,CDM,301,RC,83718,HCPCS,Outpatient,,,106,53,,81.62,77,,,Percent of Total Billed Charges,77% of total billed charges,27.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.44,74,,,Percent of Total Billed Charges,74% of total billed charges,73.14,69,,,Percent of Total Billed Charges,69% of total billed charges,73.14,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.14,69,,,Percent of Total Billed Charges,69% of total billed charges,73.14,69,,,Percent of Total Billed Charges,69% of total billed charges,89.04,84,,,Percent of Total Billed Charges,84% of total billed charges,86.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.8,500,,,fee schedule,500% of healthlink,59.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.86,120,,,Fee Schedule,120% of MO Medicaid Rate,7.86,120,,,Fee Schedule,120% of MO Medicaid Rate,7.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.62,77,,,Percent of total Billed charges,77% of total billed charges,90.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.86,120,,,Fee Schedule,120% of MO Medicaid Rate,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.86,90.1,
CHOLESTEROL LDL-DIRECT,T990350413,CDM,301,RC,83721,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.65,500,,,fee schedule,500% of healthlink,69.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,69.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.08,120,,,Fee Schedule,120% of MO Medicaid Rate,10.08,120,,,Fee Schedule,120% of MO Medicaid Rate,10.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.08,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.08,144.93,
GONADOTROPIN RELEASE HORMONE,T990350414,CDM,301,RC,83727,HCPCS,Outpatient,,,948.5,474.25,,730.35,77,,,Percent of Total Billed Charges,77% of total billed charges,241.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,701.89,74,,,Percent of Total Billed Charges,74% of total billed charges,654.47,69,,,Percent of Total Billed Charges,69% of total billed charges,654.47,69,,,Percent of Total Billed Charges,69% of total billed charges,237.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.47,69,,,Percent of Total Billed Charges,69% of total billed charges,654.47,69,,,Percent of Total Billed Charges,69% of total billed charges,796.74,84,,,Percent of Total Billed Charges,84% of total billed charges,777.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.5,500,,,fee schedule,500% of healthlink,125.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,125.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.5,120,,,Fee Schedule,120% of MO Medicaid Rate,16.5,120,,,Fee Schedule,120% of MO Medicaid Rate,16.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,237.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,730.35,77,,,Percent of total Billed charges,77% of total billed charges,806.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,272.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.5,120,,,Fee Schedule,120% of MO Medicaid Rate,237.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,237.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.5,806.23,
MAGNESIUM SERUM,T990350415,CDM,301,RC,83735,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,70.3,74,,,Percent of Total Billed Charges,74% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,79.8,84,,,Percent of Total Billed Charges,84% of total billed charges,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.9,500,,,fee schedule,500% of healthlink,48.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.43,80.75,
MAGNESIUM URINE,T990350416,CDM,301,RC,83735,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,70.3,74,,,Percent of Total Billed Charges,74% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,79.8,84,,,Percent of Total Billed Charges,84% of total billed charges,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.9,500,,,fee schedule,500% of healthlink,48.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.43,80.75,
RBC MAGNESIUM,T990350417,CDM,301,RC,83735,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,70.3,74,,,Percent of Total Billed Charges,74% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,79.8,84,,,Percent of Total Billed Charges,84% of total billed charges,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.9,500,,,fee schedule,500% of healthlink,48.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.43,120,,,Fee Schedule,120% of MO Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.43,80.75,
MANGANESE SERUM/PLASMA,T990350420,CDM,301,RC,83785,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,170.2,74,,,Percent of Total Billed Charges,74% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,84,,,Percent of Total Billed Charges,84% of total billed charges,188.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.5,500,,,fee schedule,500% of healthlink,179.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,179.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.58,120,,,Fee Schedule,120% of MO Medicaid Rate,25.58,120,,,Fee Schedule,120% of MO Medicaid Rate,25.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,25.58,120,,,Fee Schedule,120% of MO Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.58,195.5,
MANGANESE WHOLE BLOOD,T990350421,CDM,301,RC,83785,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,170.2,74,,,Percent of Total Billed Charges,74% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,84,,,Percent of Total Billed Charges,84% of total billed charges,188.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.5,500,,,fee schedule,500% of healthlink,179.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,179.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.58,120,,,Fee Schedule,120% of MO Medicaid Rate,25.58,120,,,Fee Schedule,120% of MO Medicaid Rate,25.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,25.58,120,,,Fee Schedule,120% of MO Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.58,195.5,
BILE ACIDS,T990350422,CDM,301,RC,83789,HCPCS,Outpatient,,,302.5,151.25,,232.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.85,74,,,Percent of Total Billed Charges,74% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,254.1,84,,,Percent of Total Billed Charges,84% of total billed charges,248.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.93,77,,,Percent of total Billed charges,77% of total billed charges,257.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,257.13,
HYPOGLYCEMIC PANEL QUAL,T990350423,CDM,301,RC,83789,HCPCS,Outpatient,,,334.5,167.25,,257.57,77,,,Percent of Total Billed Charges,77% of total billed charges,85.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,247.53,74,,,Percent of Total Billed Charges,74% of total billed charges,230.81,69,,,Percent of Total Billed Charges,69% of total billed charges,230.81,69,,,Percent of Total Billed Charges,69% of total billed charges,83.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.81,69,,,Percent of Total Billed Charges,69% of total billed charges,230.81,69,,,Percent of Total Billed Charges,69% of total billed charges,280.98,84,,,Percent of Total Billed Charges,84% of total billed charges,274.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.57,77,,,Percent of total Billed charges,77% of total billed charges,284.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,83.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,83.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,284.33,
IODINE,T990350424,CDM,301,RC,83789,HCPCS,Outpatient,,,302.5,151.25,,232.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.85,74,,,Percent of Total Billed Charges,74% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,254.1,84,,,Percent of Total Billed Charges,84% of total billed charges,248.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.93,77,,,Percent of total Billed charges,77% of total billed charges,257.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,257.13,
NEO TANDEM MASS SPECTROMETRY,T990350425,CDM,301,RC,83789,HCPCS,Outpatient,,,56,28,,43.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.44,74,,,Percent of Total Billed Charges,74% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,84,,,Percent of Total Billed Charges,84% of total billed charges,45.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.12,77,,,Percent of total Billed charges,77% of total billed charges,47.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,131.85,
N-Methylhistamine,T990350426,CDM,301,RC,83789,HCPCS,Outpatient,,,302.5,151.25,,232.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.85,74,,,Percent of Total Billed Charges,74% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,254.1,84,,,Percent of Total Billed Charges,84% of total billed charges,248.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.93,77,,,Percent of total Billed charges,77% of total billed charges,257.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,257.13,
THIOPURINE METABOLITES,T990350427,CDM,301,RC,83789,HCPCS,Outpatient,,,302.5,151.25,,232.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.85,74,,,Percent of Total Billed Charges,74% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,254.1,84,,,Percent of Total Billed Charges,84% of total billed charges,248.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,23.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.93,77,,,Percent of total Billed charges,77% of total billed charges,257.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.14,120,,,Fee Schedule,120% of MO Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.14,257.13,
MERCURY QUANTITATIVE,T990350428,CDM,301,RC,83825,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.7,500,,,fee schedule,500% of healthlink,118.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,118.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.6,120,,,Fee Schedule,120% of MO Medicaid Rate,15.6,120,,,Fee Schedule,120% of MO Medicaid Rate,15.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.6,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.6,144.93,
METANEPHRINES 24HR URINE,T990350429,CDM,301,RC,83835,HCPCS,Outpatient,,,471.5,235.75,,363.06,77,,,Percent of Total Billed Charges,77% of total billed charges,120.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,348.91,74,,,Percent of Total Billed Charges,74% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,396.06,84,,,Percent of Total Billed Charges,84% of total billed charges,386.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.7,500,,,fee schedule,500% of healthlink,123.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,16.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.06,77,,,Percent of total Billed charges,77% of total billed charges,400.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.26,400.78,
METANEPHRINES FRACT. PLASMA,T990350430,CDM,301,RC,83835,HCPCS,Outpatient,,,471.5,235.75,,363.06,77,,,Percent of Total Billed Charges,77% of total billed charges,120.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,348.91,74,,,Percent of Total Billed Charges,74% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,325.34,69,,,Percent of Total Billed Charges,69% of total billed charges,396.06,84,,,Percent of Total Billed Charges,84% of total billed charges,386.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.7,500,,,fee schedule,500% of healthlink,123.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,16.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.06,77,,,Percent of total Billed charges,77% of total billed charges,400.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,117.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.26,400.78,
MYELIN BASIC PROTEIN CSF,T990350431,CDM,301,RC,83873,HCPCS,Outpatient,,,195,97.5,,150.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.3,74,,,Percent of Total Billed Charges,74% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,163.8,84,,,Percent of Total Billed Charges,84% of total billed charges,159.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.6,500,,,fee schedule,500% of healthlink,125.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,125.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.51,120,,,Fee Schedule,120% of MO Medicaid Rate,16.51,120,,,Fee Schedule,120% of MO Medicaid Rate,16.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.15,77,,,Percent of total Billed charges,77% of total billed charges,165.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.51,120,,,Fee Schedule,120% of MO Medicaid Rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.51,165.75,
MYOGLOBIN QUANT URINE,T990350432,CDM,301,RC,83874,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,117.66,74,,,Percent of Total Billed Charges,74% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,133.56,84,,,Percent of Total Billed Charges,84% of total billed charges,130.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.3,500,,,fee schedule,500% of healthlink,94.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.4,120,,,Fee Schedule,120% of MO Medicaid Rate,12.4,120,,,Fee Schedule,120% of MO Medicaid Rate,12.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.4,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.4,135.15,
MYOGLOBIN SERUM,T990350433,CDM,301,RC,83874,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,117.66,74,,,Percent of Total Billed Charges,74% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,133.56,84,,,Percent of Total Billed Charges,84% of total billed charges,130.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.3,500,,,fee schedule,500% of healthlink,94.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.4,120,,,Fee Schedule,120% of MO Medicaid Rate,12.4,120,,,Fee Schedule,120% of MO Medicaid Rate,12.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.4,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.4,135.15,
NATRIURETIC PEPTIDE B TYPE,T990350434,CDM,301,RC,83880,HCPCS,Outpatient,,,323,161.5,,248.71,77,,,Percent of Total Billed Charges,77% of total billed charges,82.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.02,74,,,Percent of Total Billed Charges,74% of total billed charges,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,222.87,69,,,Percent of Total Billed Charges,69% of total billed charges,271.32,84,,,Percent of Total Billed Charges,84% of total billed charges,264.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,203.7,500,,,fee schedule,500% of healthlink,203.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,203.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,37.68,120,,,Fee Schedule,120% of MO Medicaid Rate,37.68,120,,,Fee Schedule,120% of MO Medicaid Rate,37.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.71,77,,,Percent of total Billed charges,77% of total billed charges,274.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,37.68,120,,,Fee Schedule,120% of MO Medicaid Rate,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,80.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.68,274.55,
"ALPHA 2 MACROGLOBULINS, QN",T990350435,CDM,301,RC,83883,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.25,500,,,fee schedule,500% of healthlink,99.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.06,120,,,Fee Schedule,120% of MO Medicaid Rate,13.06,120,,,Fee Schedule,120% of MO Medicaid Rate,13.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.06,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,180.63,
FREE LIGHT CHAIN EACH,T990350436,CDM,301,RC,83883,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.25,500,,,fee schedule,500% of healthlink,99.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.06,120,,,Fee Schedule,120% of MO Medicaid Rate,13.06,120,,,Fee Schedule,120% of MO Medicaid Rate,13.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.06,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,180.63,
5' NUCLEOTIDASE,T990350437,CDM,301,RC,83915,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.45,500,,,fee schedule,500% of healthlink,81.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,81.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.7,120,,,Fee Schedule,120% of MO Medicaid Rate,10.7,120,,,Fee Schedule,120% of MO Medicaid Rate,10.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.7,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,105.4,
OLIGOCLONAL BANDS CFS,T990350438,CDM,301,RC,83916,HCPCS,Outpatient,,,317.5,158.75,,244.48,77,,,Percent of Total Billed Charges,77% of total billed charges,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.95,74,,,Percent of Total Billed Charges,74% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,266.7,84,,,Percent of Total Billed Charges,84% of total billed charges,260.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.8,500,,,fee schedule,500% of healthlink,146.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,146.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.29,120,,,Fee Schedule,120% of MO Medicaid Rate,26.29,120,,,Fee Schedule,120% of MO Medicaid Rate,26.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.48,77,,,Percent of total Billed charges,77% of total billed charges,269.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.29,120,,,Fee Schedule,120% of MO Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.29,269.88,
MYTHYLMALONIC ACID,T990350439,CDM,301,RC,83918,HCPCS,Outpatient,,,214,107,,164.78,77,,,Percent of Total Billed Charges,77% of total billed charges,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.36,74,,,Percent of Total Billed Charges,74% of total billed charges,147.66,69,,,Percent of Total Billed Charges,69% of total billed charges,147.66,69,,,Percent of Total Billed Charges,69% of total billed charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.66,69,,,Percent of Total Billed Charges,69% of total billed charges,147.66,69,,,Percent of Total Billed Charges,69% of total billed charges,179.76,84,,,Percent of Total Billed Charges,84% of total billed charges,175.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.2,500,,,fee schedule,500% of healthlink,120.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,120.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.66,120,,,Fee Schedule,120% of MO Medicaid Rate,22.66,120,,,Fee Schedule,120% of MO Medicaid Rate,22.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.78,77,,,Percent of total Billed charges,77% of total billed charges,181.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.66,120,,,Fee Schedule,120% of MO Medicaid Rate,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,181.9,
ORGANIC ACIDS URINE QUALITATIV,T990350440,CDM,301,RC,83919,HCPCS,Outpatient,,,587.5,293.75,,452.38,77,,,Percent of Total Billed Charges,77% of total billed charges,149.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,434.75,74,,,Percent of Total Billed Charges,74% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,405.38,69,,,Percent of Total Billed Charges,69% of total billed charges,493.5,84,,,Percent of Total Billed Charges,84% of total billed charges,481.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.2,500,,,fee schedule,500% of healthlink,120.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,120.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,15.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.38,77,,,Percent of total Billed charges,77% of total billed charges,499.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.79,120,,,Fee Schedule,120% of MO Medicaid Rate,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,146.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.79,499.38,
METHYLMALONIC ACID SERUM,T990350441,CDM,301,RC,83921,HCPCS,Outpatient,,,265.5,132.75,,204.44,77,,,Percent of Total Billed Charges,77% of total billed charges,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,74,,,Percent of Total Billed Charges,74% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,223.02,84,,,Percent of Total Billed Charges,84% of total billed charges,217.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.2,500,,,fee schedule,500% of healthlink,120.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,120.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.35,120,,,Fee Schedule,120% of MO Medicaid Rate,20.35,120,,,Fee Schedule,120% of MO Medicaid Rate,20.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.44,77,,,Percent of total Billed charges,77% of total billed charges,225.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.35,120,,,Fee Schedule,120% of MO Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.35,225.68,
OSMOLALITY SERUM,T990350442,CDM,301,RC,83930,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.25,500,,,fee schedule,500% of healthlink,48.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.34,120,,,Fee Schedule,120% of MO Medicaid Rate,6.34,120,,,Fee Schedule,120% of MO Medicaid Rate,6.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.34,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,109.23,
OSMOLALITY URINE,T990350443,CDM,301,RC,83935,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.75,500,,,fee schedule,500% of healthlink,49.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,49.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.54,120,,,Fee Schedule,120% of MO Medicaid Rate,6.54,120,,,Fee Schedule,120% of MO Medicaid Rate,6.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.54,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,109.23,
OSTEOCALCIN,T990350445,CDM,301,RC,83937,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.85,500,,,fee schedule,500% of healthlink,133.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.66,120,,,Fee Schedule,120% of MO Medicaid Rate,28.66,120,,,Fee Schedule,120% of MO Medicaid Rate,28.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.66,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.66,133.85,
OXALATE SERUM,T990350446,CDM,301,RC,83945,HCPCS,Outpatient,,,505.5,252.75,,389.24,77,,,Percent of Total Billed Charges,77% of total billed charges,128.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,374.07,74,,,Percent of Total Billed Charges,74% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,424.62,84,,,Percent of Total Billed Charges,84% of total billed charges,414.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,94,500,,,fee schedule,500% of healthlink,94,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,13.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,389.24,77,,,Percent of total Billed charges,77% of total billed charges,429.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,429.68,
OXALATE URINE,T990350447,CDM,301,RC,83945,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,94,500,,,fee schedule,500% of healthlink,94,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,13.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.87,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,94,
PTH INTACT,T990350450,CDM,301,RC,83970,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.54,74,,,Percent of Total Billed Charges,74% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,353.64,84,,,Percent of Total Billed Charges,84% of total billed charges,345.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,301.35,500,,,fee schedule,500% of healthlink,301.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,301.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,39.62,120,,,Fee Schedule,120% of MO Medicaid Rate,39.62,120,,,Fee Schedule,120% of MO Medicaid Rate,39.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,39.62,120,,,Fee Schedule,120% of MO Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.62,357.85,
PH BODY FLUID,T990350451,CDM,301,RC,83986,HCPCS,Outpatient,,,97,48.5,QW,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,82.45,
PH BODY FLUID,T990350451,CDM,301,RC,83986,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,82.45,
PH FECES,T990350452,CDM,301,RC,83986,HCPCS,Outpatient,,,97,48.5,QW,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,82.45,
PH FECES,T990350452,CDM,301,RC,83986,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,82.45,
PH URINE,T990350453,CDM,301,RC,83986,HCPCS,Outpatient,,,97,48.5,QW,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,82.45,
PH URINE,T990350453,CDM,301,RC,83986,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,82.45,
pH URINE,T990350454,CDM,301,RC,83986,HCPCS,Outpatient,,,27.5,13.75,,21.18,77,,,Percent of Total Billed Charges,77% of total billed charges,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.35,74,,,Percent of Total Billed Charges,74% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.1,84,,,Percent of Total Billed Charges,84% of total billed charges,22.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.1,500,,,fee schedule,500% of healthlink,26.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,3.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.18,77,,,Percent of total Billed charges,77% of total billed charges,23.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.43,120,,,Fee Schedule,120% of MO Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,64,
PHENCYCLIDINE GC/MS,T990350455,CDM,301,RC,83992,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.3,500,,,fee schedule,500% of healthlink,107.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,147.48,
PHENCYCLIDINE GC/MS,T990350455,CDM,301,RC,G0480,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
STOOL CALPROTECTIN,T990350456,CDM,301,RC,83993,HCPCS,Outpatient,,,437.5,218.75,,336.88,77,,,Percent of Total Billed Charges,77% of total billed charges,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.75,74,,,Percent of Total Billed Charges,74% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,367.5,84,,,Percent of Total Billed Charges,84% of total billed charges,358.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.3,500,,,fee schedule,500% of healthlink,143.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,143.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.84,120,,,Fee Schedule,120% of MO Medicaid Rate,18.84,120,,,Fee Schedule,120% of MO Medicaid Rate,18.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.88,77,,,Percent of total Billed charges,77% of total billed charges,371.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.84,120,,,Fee Schedule,120% of MO Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.84,371.88,
PHENYLALANINE,T990350457,CDM,301,RC,84030,HCPCS,Outpatient,,,156,78,,120.12,77,,,Percent of Total Billed Charges,77% of total billed charges,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.44,74,,,Percent of Total Billed Charges,74% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,107.64,69,,,Percent of Total Billed Charges,69% of total billed charges,131.04,84,,,Percent of Total Billed Charges,84% of total billed charges,127.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.12,77,,,Percent of total Billed charges,77% of total billed charges,132.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.28,132.6,
ACID PHOSPHATASE PROSTATIC,T990350458,CDM,301,RC,84066,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.5,500,,,fee schedule,500% of healthlink,70.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,70.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.26,120,,,Fee Schedule,120% of MO Medicaid Rate,9.26,120,,,Fee Schedule,120% of MO Medicaid Rate,9.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.26,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.26,144.93,
ALK PHOS BONE SPECIFIC,T990350459,CDM,301,RC,84075,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.04,74,,,Percent of Total Billed Charges,74% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,80.64,84,,,Percent of Total Billed Charges,84% of total billed charges,78.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,81.6,
ALK PHOS SERUM,T990350460,CDM,301,RC,84075,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.04,74,,,Percent of Total Billed Charges,74% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,80.64,84,,,Percent of Total Billed Charges,84% of total billed charges,78.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,81.6,
ALKALINE PHOSPHATASE SERUM,T990350461,CDM,301,RC,84075,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.04,74,,,Percent of Total Billed Charges,74% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,80.64,84,,,Percent of Total Billed Charges,84% of total billed charges,78.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,81.6,
ALK PHOS ISOENZYMES,T990350462,CDM,301,RC,84080,HCPCS,Outpatient,,,153,76.5,,117.81,77,,,Percent of Total Billed Charges,77% of total billed charges,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.22,74,,,Percent of Total Billed Charges,74% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,128.52,84,,,Percent of Total Billed Charges,84% of total billed charges,125.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.95,500,,,fee schedule,500% of healthlink,107.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.18,120,,,Fee Schedule,120% of MO Medicaid Rate,14.18,120,,,Fee Schedule,120% of MO Medicaid Rate,14.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.81,77,,,Percent of total Billed charges,77% of total billed charges,130.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.18,120,,,Fee Schedule,120% of MO Medicaid Rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,130.05,
PHOSPHORUS SERUM,T990350463,CDM,301,RC,84100,HCPCS,Outpatient,,,83,41.5,,63.91,77,,,Percent of Total Billed Charges,77% of total billed charges,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.42,74,,,Percent of Total Billed Charges,74% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,69.72,84,,,Percent of Total Billed Charges,84% of total billed charges,68.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.65,500,,,fee schedule,500% of healthlink,34.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,34.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.55,120,,,Fee Schedule,120% of MO Medicaid Rate,4.55,120,,,Fee Schedule,120% of MO Medicaid Rate,4.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.91,77,,,Percent of total Billed charges,77% of total billed charges,70.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.55,120,,,Fee Schedule,120% of MO Medicaid Rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,70.55,
PHOSPHATE URINE,T990350464,CDM,301,RC,84105,HCPCS,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.3,500,,,fee schedule,500% of healthlink,35.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,35.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,5.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.54,64,
PHOSPHORUS 24HR URINE,T990350465,CDM,301,RC,84105,HCPCS,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.3,500,,,fee schedule,500% of healthlink,35.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,35.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,5.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.54,120,,,Fee Schedule,120% of MO Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.54,64,
PAMG-1 RAPID ASSAY FOR ROM,T990350467,CDM,300,RC,84112,HCPCS,Outpatient,,,307.5,153.75,,236.78,77,,,Percent of Total Billed Charges,77% of total billed charges,78.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.55,74,,,Percent of Total Billed Charges,74% of total billed charges,212.18,69,,,Percent of Total Billed Charges,69% of total billed charges,212.18,69,,,Percent of Total Billed Charges,69% of total billed charges,76.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.18,69,,,Percent of Total Billed Charges,69% of total billed charges,212.18,69,,,Percent of Total Billed Charges,69% of total billed charges,258.3,84,,,Percent of Total Billed Charges,84% of total billed charges,252.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,273.68,89,,,Percent of total Billed Charges,89% of total Billed charges,273.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,273.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.18,120,,,Fee Schedule,120% of MO Medicaid Rate,94.18,120,,,Fee Schedule,120% of MO Medicaid Rate,94.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,76.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.78,77,,,Percent of total Billed charges,77% of total billed charges,261.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,94.18,120,,,Fee Schedule,120% of MO Medicaid Rate,76.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,76.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,273.68,
PORPHYRINS FRACT QUANT,T990350468,CDM,301,RC,84120,HCPCS,Outpatient,,,108.5,54.25,,83.55,77,,,Percent of Total Billed Charges,77% of total billed charges,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.29,74,,,Percent of Total Billed Charges,74% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,91.14,84,,,Percent of Total Billed Charges,84% of total billed charges,88.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.35,500,,,fee schedule,500% of healthlink,107.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.11,120,,,Fee Schedule,120% of MO Medicaid Rate,14.11,120,,,Fee Schedule,120% of MO Medicaid Rate,14.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.55,77,,,Percent of total Billed charges,77% of total billed charges,92.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.11,120,,,Fee Schedule,120% of MO Medicaid Rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,107.35,
PORPHYRINS FECES,T990350469,CDM,301,RC,84126,HCPCS,Outpatient,,,784.5,392.25,,604.07,77,,,Percent of Total Billed Charges,77% of total billed charges,200.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,580.53,74,,,Percent of Total Billed Charges,74% of total billed charges,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,541.31,69,,,Percent of Total Billed Charges,69% of total billed charges,658.98,84,,,Percent of Total Billed Charges,84% of total billed charges,643.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.95,500,,,fee schedule,500% of healthlink,185.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,37.54,120,,,Fee Schedule,120% of MO Medicaid Rate,37.54,120,,,Fee Schedule,120% of MO Medicaid Rate,37.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,604.07,77,,,Percent of total Billed charges,77% of total billed charges,666.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,37.54,120,,,Fee Schedule,120% of MO Medicaid Rate,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,196.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.54,666.83,
POTASSIUM SERUM,T990350470,CDM,301,RC,84132,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,33.5,500,,,fee schedule,500% of healthlink,33.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,33.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,4.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,64,
POTASSIUM URINE,T990350471,CDM,301,RC,84133,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.4,500,,,fee schedule,500% of healthlink,31.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.54,120,,,Fee Schedule,120% of MO Medicaid Rate,4.54,120,,,Fee Schedule,120% of MO Medicaid Rate,4.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.54,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,64,
PREALBUMIN,T990350474,CDM,301,RC,84134,HCPCS,Outpatient,,,183.5,91.75,,141.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.79,74,,,Percent of Total Billed Charges,74% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.14,84,,,Percent of Total Billed Charges,84% of total billed charges,150.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.5,500,,,fee schedule,500% of healthlink,106.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14,120,,,Fee Schedule,120% of MO Medicaid Rate,14,120,,,Fee Schedule,120% of MO Medicaid Rate,14,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.3,77,,,Percent of total Billed charges,77% of total billed charges,155.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14,120,,,Fee Schedule,120% of MO Medicaid Rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,155.98,
PREGNENOLONE,T990350475,CDM,301,RC,84140,HCPCS,Outpatient,,,380.5,190.25,,292.99,77,,,Percent of Total Billed Charges,77% of total billed charges,97.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,281.57,74,,,Percent of Total Billed Charges,74% of total billed charges,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,69,,,Percent of Total Billed Charges,69% of total billed charges,319.62,84,,,Percent of Total Billed Charges,84% of total billed charges,312.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.35,500,,,fee schedule,500% of healthlink,100.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.84,120,,,Fee Schedule,120% of MO Medicaid Rate,19.84,120,,,Fee Schedule,120% of MO Medicaid Rate,19.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.99,77,,,Percent of total Billed charges,77% of total billed charges,323.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.84,120,,,Fee Schedule,120% of MO Medicaid Rate,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,95.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.84,323.43,
PROGESTERONE,T990350476,CDM,301,RC,84144,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.82,74,,,Percent of Total Billed Charges,74% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.3,500,,,fee schedule,500% of healthlink,152.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,152.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.02,120,,,Fee Schedule,120% of MO Medicaid Rate,20.02,120,,,Fee Schedule,120% of MO Medicaid Rate,20.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.02,120,,,Fee Schedule,120% of MO Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,152.3,
PROCALCITONIN,T990350477,CDM,301,RC,84145,HCPCS,Outpatient,,,255,127.5,,196.35,77,,,Percent of Total Billed Charges,77% of total billed charges,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.7,74,,,Percent of Total Billed Charges,74% of total billed charges,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,175.95,69,,,Percent of Total Billed Charges,69% of total billed charges,214.2,84,,,Percent of Total Billed Charges,84% of total billed charges,209.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.95,89,,,Percent of total Billed Charges,89% of total Billed charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.35,77,,,Percent of total Billed charges,77% of total billed charges,216.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.12,226.95,
PROLACTIN,T990350478,CDM,301,RC,84146,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.5,500,,,fee schedule,500% of healthlink,141.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.6,120,,,Fee Schedule,120% of MO Medicaid Rate,18.6,120,,,Fee Schedule,120% of MO Medicaid Rate,18.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.6,120,,,Fee Schedule,120% of MO Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.6,141.5,
"2,3-DINOR-11 b-PROSTAGLANDIN U",T990350479,CDM,301,RC,84150,HCPCS,Outpatient,,,1326,663,,1021.02,77,,,Percent of Total Billed Charges,77% of total billed charges,338.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,414.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,981.24,74,,,Percent of Total Billed Charges,74% of total billed charges,914.94,69,,,Percent of Total Billed Charges,69% of total billed charges,914.94,69,,,Percent of Total Billed Charges,69% of total billed charges,331.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,914.94,69,,,Percent of Total Billed Charges,69% of total billed charges,914.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1113.84,84,,,Percent of Total Billed Charges,84% of total billed charges,1087.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.25,500,,,fee schedule,500% of healthlink,182.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,182.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,40.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,331.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1021.02,77,,,Percent of total Billed charges,77% of total billed charges,1127.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,381.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,40.09,120,,,Fee Schedule,120% of MO Medicaid Rate,331.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,331.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.09,1127.1,
PSA DIAGNOSTIC,T990350480,CDM,301,RC,84153,HCPCS,Outpatient,,,181,90.5,,139.37,77,,,Percent of Total Billed Charges,77% of total billed charges,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.94,74,,,Percent of Total Billed Charges,74% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,152.04,84,,,Percent of Total Billed Charges,84% of total billed charges,148.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,77,,,Percent of total Billed charges,77% of total billed charges,153.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,153.85,
PSA FREE TOTAL,T990350481,CDM,301,RC,84153,HCPCS,Outpatient,,,181,90.5,,139.37,77,,,Percent of Total Billed Charges,77% of total billed charges,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.94,74,,,Percent of Total Billed Charges,74% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,152.04,84,,,Percent of Total Billed Charges,84% of total billed charges,148.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,77,,,Percent of total Billed charges,77% of total billed charges,153.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,153.85,
PSA SCREENING ONLY,T990350482,CDM,300,RC,G0103,HCPCS,Outpatient,,,181,90.5,,139.37,77,,,Percent of Total Billed Charges,77% of total billed charges,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.94,74,,,Percent of Total Billed Charges,74% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,152.04,84,,,Percent of Total Billed Charges,84% of total billed charges,148.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,18.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,77,,,Percent of total Billed charges,77% of total billed charges,153.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.53,120,,,Fee Schedule,120% of MO Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.53,153.85,
PSA SCREENING ONLY,T990350482,CDM,300,RC,84153,HCPCS,Outpatient,,,181,90.5,,139.37,77,,,Percent of Total Billed Charges,77% of total billed charges,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.94,74,,,Percent of Total Billed Charges,74% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,152.04,84,,,Percent of Total Billed Charges,84% of total billed charges,148.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,77,,,Percent of total Billed charges,77% of total billed charges,153.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,153.85,
PSA SCREEN-LAB FAIR,T990350483,CDM,300,RC,84153,HCPCS,Outpatient,,,15,7.5,,11.55,77,,,Percent of Total Billed Charges,77% of total billed charges,3.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.1,74,,,Percent of Total Billed Charges,74% of total billed charges,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,69,,,Percent of Total Billed Charges,69% of total billed charges,12.6,84,,,Percent of Total Billed Charges,84% of total billed charges,12.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,77,,,Percent of total Billed charges,77% of total billed charges,12.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,3.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.75,134.25,
PSA FREE,T990350484,CDM,301,RC,84154,HCPCS,Outpatient,,,265.5,132.75,,204.44,77,,,Percent of Total Billed Charges,77% of total billed charges,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,74,,,Percent of Total Billed Charges,74% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,223.02,84,,,Percent of Total Billed Charges,84% of total billed charges,217.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.25,500,,,fee schedule,500% of healthlink,134.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,17.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.44,77,,,Percent of total Billed charges,77% of total billed charges,225.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.65,120,,,Fee Schedule,120% of MO Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,225.68,
PROTEIN TOTAL SERUM,T990350485,CDM,301,RC,84155,HCPCS,Outpatient,,,90.5,45.25,,69.69,77,,,Percent of Total Billed Charges,77% of total billed charges,23.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.97,74,,,Percent of Total Billed Charges,74% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,76.02,84,,,Percent of Total Billed Charges,84% of total billed charges,74.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,3.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.69,77,,,Percent of total Billed charges,77% of total billed charges,76.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.52,76.93,
TOTAL PROTEIN,T990350486,CDM,301,RC,84155,HCPCS,Outpatient,,,90.5,45.25,,69.69,77,,,Percent of Total Billed Charges,77% of total billed charges,23.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.97,74,,,Percent of Total Billed Charges,74% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,62.45,69,,,Percent of Total Billed Charges,69% of total billed charges,76.02,84,,,Percent of Total Billed Charges,84% of total billed charges,74.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,3.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.69,77,,,Percent of total Billed charges,77% of total billed charges,76.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.52,76.93,
PROTEIN TOTAL URINE,T990350487,CDM,301,RC,84156,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,3.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.52,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.52,109.23,
PROTEIN TOTAL CSF,T990350489,CDM,301,RC,84157,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,103.28,
PROTEIN TOTAL PERITONEAL FLUID,T990350490,CDM,301,RC,84157,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,103.28,
PROTEIN TOTAL PLEURAL FLUID,T990350491,CDM,301,RC,84157,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,103.28,
PROTEIN TOTAL SYNOVIAL FLUID,T990350492,CDM,301,RC,84157,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,500,,,fee schedule,500% of healthlink,26.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,26.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,3.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.84,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,103.28,
ITA,T990350493,CDM,301,RC,84163,HCPCS,Outpatient,,,268.5,134.25,,206.75,77,,,Percent of Total Billed Charges,77% of total billed charges,68.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.69,74,,,Percent of Total Billed Charges,74% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,185.27,69,,,Percent of Total Billed Charges,69% of total billed charges,225.54,84,,,Percent of Total Billed Charges,84% of total billed charges,220.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.75,77,,,Percent of total Billed charges,77% of total billed charges,228.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,67.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,228.23,
PROTEIN ELECTROPHOR SERUM,T990350494,CDM,301,RC,84165,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.86,74,,,Percent of Total Billed Charges,74% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,116.76,84,,,Percent of Total Billed Charges,84% of total billed charges,113.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.4,500,,,fee schedule,500% of healthlink,78.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,78.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.31,118.15,
PROTEIN ELECTROPHOR URINE,T990350495,CDM,301,RC,84166,HCPCS,Outpatient,,,214.5,107.25,,165.17,77,,,Percent of Total Billed Charges,77% of total billed charges,54.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.73,74,,,Percent of Total Billed Charges,74% of total billed charges,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,180.18,84,,,Percent of Total Billed Charges,84% of total billed charges,175.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,500,,,fee schedule,500% of healthlink,130.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.11,120,,,Fee Schedule,120% of MO Medicaid Rate,17.11,120,,,Fee Schedule,120% of MO Medicaid Rate,17.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.17,77,,,Percent of total Billed charges,77% of total billed charges,182.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.11,120,,,Fee Schedule,120% of MO Medicaid Rate,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,182.33,
PROTEIN ELECTROPHORESIS CSF,T990350496,CDM,300,RC,84166,HCPCS,Outpatient,,,214.5,107.25,,165.17,77,,,Percent of Total Billed Charges,77% of total billed charges,54.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.73,74,,,Percent of Total Billed Charges,74% of total billed charges,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,148.01,69,,,Percent of Total Billed Charges,69% of total billed charges,180.18,84,,,Percent of Total Billed Charges,84% of total billed charges,175.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,500,,,fee schedule,500% of healthlink,130.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.11,120,,,Fee Schedule,120% of MO Medicaid Rate,17.11,120,,,Fee Schedule,120% of MO Medicaid Rate,17.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.17,77,,,Percent of total Billed charges,77% of total billed charges,182.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.11,120,,,Fee Schedule,120% of MO Medicaid Rate,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,182.33,
ANTI-68 KD (HSP-70) AB,T990350498,CDM,301,RC,84181,HCPCS,Outpatient,,,485,242.5,,373.45,77,,,Percent of Total Billed Charges,77% of total billed charges,123.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,358.9,74,,,Percent of Total Billed Charges,74% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,334.65,69,,,Percent of Total Billed Charges,69% of total billed charges,407.4,84,,,Percent of Total Billed Charges,84% of total billed charges,397.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.35,500,,,fee schedule,500% of healthlink,124.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,124.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,16.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.45,77,,,Percent of total Billed charges,77% of total billed charges,412.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,121.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.34,412.25,
HU AB WESTERN BLOT,T990350499,CDM,301,RC,84181,HCPCS,Outpatient,,,60.5,30.25,,46.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.77,74,,,Percent of Total Billed Charges,74% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,50.82,84,,,Percent of Total Billed Charges,84% of total billed charges,49.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.35,500,,,fee schedule,500% of healthlink,124.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,124.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,16.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.59,77,,,Percent of total Billed charges,77% of total billed charges,51.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.13,124.35,
MAG IgM AB BY WESTERN BLOT,T990350500,CDM,301,RC,84182,HCPCS,Outpatient,,,662.5,331.25,,510.13,77,,,Percent of Total Billed Charges,77% of total billed charges,168.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,490.25,74,,,Percent of Total Billed Charges,74% of total billed charges,457.13,69,,,Percent of Total Billed Charges,69% of total billed charges,457.13,69,,,Percent of Total Billed Charges,69% of total billed charges,165.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.13,69,,,Percent of Total Billed Charges,69% of total billed charges,457.13,69,,,Percent of Total Billed Charges,69% of total billed charges,556.5,84,,,Percent of Total Billed Charges,84% of total billed charges,543.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.85,500,,,fee schedule,500% of healthlink,49.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,49.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.03,120,,,Fee Schedule,120% of MO Medicaid Rate,28.03,120,,,Fee Schedule,120% of MO Medicaid Rate,28.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,165.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.13,77,,,Percent of total Billed charges,77% of total billed charges,563.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.03,120,,,Fee Schedule,120% of MO Medicaid Rate,165.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,165.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.03,563.13,
PROTOPORPHYRIN FREE RBC,T990350501,CDM,301,RC,84202,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.02,74,,,Percent of Total Billed Charges,74% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,103.32,84,,,Percent of Total Billed Charges,84% of total billed charges,100.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.75,500,,,fee schedule,500% of healthlink,104.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,104.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.78,120,,,Fee Schedule,120% of MO Medicaid Rate,13.78,120,,,Fee Schedule,120% of MO Medicaid Rate,13.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.78,120,,,Fee Schedule,120% of MO Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.78,104.75,
ZINC PROTOPORPHYRIN,T990350502,CDM,301,RC,84202,HCPCS,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,48.1,74,,,Percent of Total Billed Charges,74% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,44.85,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,84,,,Percent of Total Billed Charges,84% of total billed charges,53.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.75,500,,,fee schedule,500% of healthlink,104.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,104.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.78,120,,,Fee Schedule,120% of MO Medicaid Rate,13.78,120,,,Fee Schedule,120% of MO Medicaid Rate,13.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.78,120,,,Fee Schedule,120% of MO Medicaid Rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.78,104.75,
PROINSULIN,T990350503,CDM,301,RC,84206,HCPCS,Outpatient,,,321.5,160.75,,247.56,77,,,Percent of Total Billed Charges,77% of total billed charges,81.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.91,74,,,Percent of Total Billed Charges,74% of total billed charges,221.84,69,,,Percent of Total Billed Charges,69% of total billed charges,221.84,69,,,Percent of Total Billed Charges,69% of total billed charges,80.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.84,69,,,Percent of Total Billed Charges,69% of total billed charges,221.84,69,,,Percent of Total Billed Charges,69% of total billed charges,270.06,84,,,Percent of Total Billed Charges,84% of total billed charges,263.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.05,500,,,fee schedule,500% of healthlink,130.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.62,120,,,Fee Schedule,120% of MO Medicaid Rate,25.62,120,,,Fee Schedule,120% of MO Medicaid Rate,25.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.56,77,,,Percent of total Billed charges,77% of total billed charges,273.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,25.62,120,,,Fee Schedule,120% of MO Medicaid Rate,80.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,80.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.62,273.28,
VITAMIN B6,T990350504,CDM,301,RC,84207,HCPCS,Outpatient,,,207,103.5,,159.39,77,,,Percent of Total Billed Charges,77% of total billed charges,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.18,74,,,Percent of Total Billed Charges,74% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,173.88,84,,,Percent of Total Billed Charges,84% of total billed charges,169.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,26.98,120,,,Fee Schedule,120% of MO Medicaid Rate,26.98,120,,,Fee Schedule,120% of MO Medicaid Rate,26.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.39,77,,,Percent of total Billed charges,77% of total billed charges,175.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.98,120,,,Fee Schedule,120% of MO Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.98,175.95,
PYRUVATE,T990350505,CDM,301,RC,84210,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.1,74,,,Percent of Total Billed Charges,74% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,79.35,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,84,,,Percent of Total Billed Charges,84% of total billed charges,94.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.25,500,,,fee schedule,500% of healthlink,79.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,79.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.9,120,,,Fee Schedule,120% of MO Medicaid Rate,13.9,120,,,Fee Schedule,120% of MO Medicaid Rate,13.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.9,120,,,Fee Schedule,120% of MO Medicaid Rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,97.75,
THYROTROPIN-BIND INHIB IG,T990350506,CDM,301,RC,84235,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,382.05,500,,,fee schedule,500% of healthlink,382.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,382.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,68.38,120,,,Fee Schedule,120% of MO Medicaid Rate,68.38,120,,,Fee Schedule,120% of MO Medicaid Rate,68.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,68.38,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,382.05,
AChR BINDING AB,T990350507,CDM,301,RC,84238,HCPCS,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.38,74,,,Percent of Total Billed Charges,74% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,283.08,84,,,Percent of Total Billed Charges,84% of total billed charges,276.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.95,500,,,fee schedule,500% of healthlink,266.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,266.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,35.1,120,,,Fee Schedule,120% of MO Medicaid Rate,35.1,120,,,Fee Schedule,120% of MO Medicaid Rate,35.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,35.1,120,,,Fee Schedule,120% of MO Medicaid Rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,286.45,
SOULUBLE TRANSFERRIN RECEPTOR,T990350508,CDM,301,RC,84238,HCPCS,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.38,74,,,Percent of Total Billed Charges,74% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,283.08,84,,,Percent of Total Billed Charges,84% of total billed charges,276.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.95,500,,,fee schedule,500% of healthlink,266.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,266.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,35.1,120,,,Fee Schedule,120% of MO Medicaid Rate,35.1,120,,,Fee Schedule,120% of MO Medicaid Rate,35.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,35.1,120,,,Fee Schedule,120% of MO Medicaid Rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,286.45,
RENIN ACTIVITY,T990350509,CDM,301,RC,84244,HCPCS,Outpatient,,,316.5,158.25,,243.71,77,,,Percent of Total Billed Charges,77% of total billed charges,80.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.21,74,,,Percent of Total Billed Charges,74% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,218.39,69,,,Percent of Total Billed Charges,69% of total billed charges,265.86,84,,,Percent of Total Billed Charges,84% of total billed charges,259.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.6,500,,,fee schedule,500% of healthlink,160.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,160.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.11,120,,,Fee Schedule,120% of MO Medicaid Rate,21.11,120,,,Fee Schedule,120% of MO Medicaid Rate,21.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.71,77,,,Percent of total Billed charges,77% of total billed charges,269.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.11,120,,,Fee Schedule,120% of MO Medicaid Rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.11,269.03,
SELENIUM,T990350510,CDM,301,RC,84255,HCPCS,Outpatient,,,278.5,139.25,,214.45,77,,,Percent of Total Billed Charges,77% of total billed charges,71.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,206.09,74,,,Percent of Total Billed Charges,74% of total billed charges,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,233.94,84,,,Percent of Total Billed Charges,84% of total billed charges,228.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.35,500,,,fee schedule,500% of healthlink,186.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,186.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.5,120,,,Fee Schedule,120% of MO Medicaid Rate,24.5,120,,,Fee Schedule,120% of MO Medicaid Rate,24.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.45,77,,,Percent of total Billed charges,77% of total billed charges,236.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.5,120,,,Fee Schedule,120% of MO Medicaid Rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,236.73,
SEROTONIN,T990350511,CDM,301,RC,84260,HCPCS,Outpatient,,,348,174,,267.96,77,,,Percent of Total Billed Charges,77% of total billed charges,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,257.52,74,,,Percent of Total Billed Charges,74% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,292.32,84,,,Percent of Total Billed Charges,84% of total billed charges,285.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.15,500,,,fee schedule,500% of healthlink,226.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,226.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,29.74,120,,,Fee Schedule,120% of MO Medicaid Rate,29.74,120,,,Fee Schedule,120% of MO Medicaid Rate,29.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.96,77,,,Percent of total Billed charges,77% of total billed charges,295.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,29.74,120,,,Fee Schedule,120% of MO Medicaid Rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.74,295.8,
SEX HORMONE BINDING GLOBULIN,T990350512,CDM,301,RC,84270,HCPCS,Outpatient,,,370.5,185.25,,285.29,77,,,Percent of Total Billed Charges,77% of total billed charges,94.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.17,74,,,Percent of Total Billed Charges,74% of total billed charges,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.65,69,,,Percent of Total Billed Charges,69% of total billed charges,311.22,84,,,Percent of Total Billed Charges,84% of total billed charges,303.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.65,500,,,fee schedule,500% of healthlink,158.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,158.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.86,120,,,Fee Schedule,120% of MO Medicaid Rate,20.86,120,,,Fee Schedule,120% of MO Medicaid Rate,20.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.29,77,,,Percent of total Billed charges,77% of total billed charges,314.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.86,120,,,Fee Schedule,120% of MO Medicaid Rate,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,92.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.86,314.93,
"SODIUM, SERUM",T990350513,CDM,301,RC,84295,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,500,,,fee schedule,500% of healthlink,35.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,35.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.61,120,,,Fee Schedule,120% of MO Medicaid Rate,4.61,120,,,Fee Schedule,120% of MO Medicaid Rate,4.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.61,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,64,
SODIUM URINE,T990350514,CDM,301,RC,84300,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.25,500,,,fee schedule,500% of healthlink,25.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.85,120,,,Fee Schedule,120% of MO Medicaid Rate,4.85,120,,,Fee Schedule,120% of MO Medicaid Rate,4.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.85,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.85,64,
SODIUM STOOL,T990350517,CDM,301,RC,84302,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,70.3,74,,,Percent of Total Billed Charges,74% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,79.8,84,,,Percent of Total Billed Charges,84% of total billed charges,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.25,500,,,fee schedule,500% of healthlink,25.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.66,120,,,Fee Schedule,120% of MO Medicaid Rate,4.66,120,,,Fee Schedule,120% of MO Medicaid Rate,4.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.66,120,,,Fee Schedule,120% of MO Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.66,80.75,
INSULIN LIKE GROWTH FACTOR I,T990350518,CDM,301,RC,84305,HCPCS,Outpatient,,,265.5,132.75,,204.44,77,,,Percent of Total Billed Charges,77% of total billed charges,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,74,,,Percent of Total Billed Charges,74% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,223.02,84,,,Percent of Total Billed Charges,84% of total billed charges,217.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.2,500,,,fee schedule,500% of healthlink,155.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,155.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.4,120,,,Fee Schedule,120% of MO Medicaid Rate,20.4,120,,,Fee Schedule,120% of MO Medicaid Rate,20.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.44,77,,,Percent of total Billed charges,77% of total billed charges,225.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.4,120,,,Fee Schedule,120% of MO Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.4,225.68,
SOMATOSTATIN,T990350519,CDM,301,RC,84307,HCPCS,Outpatient,,,421.5,210.75,,324.56,77,,,Percent of Total Billed Charges,77% of total billed charges,107.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.91,74,,,Percent of Total Billed Charges,74% of total billed charges,290.84,69,,,Percent of Total Billed Charges,69% of total billed charges,290.84,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.84,69,,,Percent of Total Billed Charges,69% of total billed charges,290.84,69,,,Percent of Total Billed Charges,69% of total billed charges,354.06,84,,,Percent of Total Billed Charges,84% of total billed charges,345.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.5,500,,,fee schedule,500% of healthlink,133.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.54,120,,,Fee Schedule,120% of MO Medicaid Rate,17.54,120,,,Fee Schedule,120% of MO Medicaid Rate,17.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.56,77,,,Percent of total Billed charges,77% of total billed charges,358.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.54,120,,,Fee Schedule,120% of MO Medicaid Rate,105.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,105.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.54,358.28,
ARYLSULFATASE A LEUKOCYTES,T990350520,CDM,301,RC,84311,HCPCS,Outpatient,,,112.5,56.25,,86.63,77,,,Percent of Total Billed Charges,77% of total billed charges,28.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.25,74,,,Percent of Total Billed Charges,74% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,94.5,84,,,Percent of Total Billed Charges,84% of total billed charges,92.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,7.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.63,77,,,Percent of total Billed charges,77% of total billed charges,95.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.78,95.63,
POTASSIUM FECES,T990350521,CDM,301,RC,84311,HCPCS,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.88,74,,,Percent of Total Billed Charges,74% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,94.08,84,,,Percent of Total Billed Charges,84% of total billed charges,91.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,7.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.78,95.2,
SPECTROPHOTOMETRY CHOL PL FLD,T990350522,CDM,301,RC,84311,HCPCS,Outpatient,,,112.5,56.25,,86.63,77,,,Percent of Total Billed Charges,77% of total billed charges,28.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.25,74,,,Percent of Total Billed Charges,74% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,69,,,Percent of Total Billed Charges,69% of total billed charges,94.5,84,,,Percent of Total Billed Charges,84% of total billed charges,92.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,7.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.63,77,,,Percent of total Billed charges,77% of total billed charges,95.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.78,120,,,Fee Schedule,120% of MO Medicaid Rate,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.78,95.63,
"SPECIFIC GRAVITY, NON-URINE",T990350523,CDM,301,RC,84315,HCPCS,Outpatient,,,215.5,107.75,,165.94,77,,,Percent of Total Billed Charges,77% of total billed charges,54.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.47,74,,,Percent of Total Billed Charges,74% of total billed charges,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,148.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.02,84,,,Percent of Total Billed Charges,84% of total billed charges,176.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.3,500,,,fee schedule,500% of healthlink,18.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,18.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.14,120,,,Fee Schedule,120% of MO Medicaid Rate,3.14,120,,,Fee Schedule,120% of MO Medicaid Rate,3.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.94,77,,,Percent of total Billed charges,77% of total billed charges,183.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.14,120,,,Fee Schedule,120% of MO Medicaid Rate,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.14,183.18,
FECAL REDUCING SUBSTANCES,T990350524,CDM,301,RC,84376,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.28,109.23,
GALACTOSE-1-PHOSPHATE,T990350525,CDM,301,RC,84378,HCPCS,Outpatient,,,164.5,82.25,,126.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.73,74,,,Percent of Total Billed Charges,74% of total billed charges,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,138.18,84,,,Percent of Total Billed Charges,84% of total billed charges,134.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.15,500,,,fee schedule,500% of healthlink,84.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.67,77,,,Percent of total Billed charges,77% of total billed charges,139.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,139.83,
GLYCOMARK,T990350526,CDM,301,RC,84378,HCPCS,Outpatient,,,164.5,82.25,,126.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.73,74,,,Percent of Total Billed Charges,74% of total billed charges,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,69,,,Percent of Total Billed Charges,69% of total billed charges,138.18,84,,,Percent of Total Billed Charges,84% of total billed charges,134.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.15,500,,,fee schedule,500% of healthlink,84.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.67,77,,,Percent of total Billed charges,77% of total billed charges,139.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,139.83,
SULFATE URINE,T990350527,CDM,301,RC,84392,HCPCS,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.65,500,,,fee schedule,500% of healthlink,34.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,34.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.27,120,,,Fee Schedule,120% of MO Medicaid Rate,5.27,120,,,Fee Schedule,120% of MO Medicaid Rate,5.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.27,64,
"TESTOSTERONE FREE, SERUM",T990350530,CDM,301,RC,84402,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.9,500,,,fee schedule,500% of healthlink,185.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.44,120,,,Fee Schedule,120% of MO Medicaid Rate,24.44,120,,,Fee Schedule,120% of MO Medicaid Rate,24.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.44,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.44,216.33,
"TESTOSTERONE TOTAL, SERUM",T990350531,CDM,301,RC,84403,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.5,500,,,fee schedule,500% of healthlink,188.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,188.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.77,120,,,Fee Schedule,120% of MO Medicaid Rate,24.77,120,,,Fee Schedule,120% of MO Medicaid Rate,24.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.77,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.77,216.33,
VITAMIN B1,T990350532,CDM,301,RC,84425,HCPCS,Outpatient,,,142.5,71.25,,109.73,77,,,Percent of Total Billed Charges,77% of total billed charges,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.45,74,,,Percent of Total Billed Charges,74% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,119.7,84,,,Percent of Total Billed Charges,84% of total billed charges,116.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.38,120,,,Fee Schedule,120% of MO Medicaid Rate,20.38,120,,,Fee Schedule,120% of MO Medicaid Rate,20.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.73,77,,,Percent of total Billed charges,77% of total billed charges,121.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.38,120,,,Fee Schedule,120% of MO Medicaid Rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.38,121.13,
"VITAMIN B1, PLASMA",T990350533,CDM,301,RC,84425,HCPCS,Outpatient,,,142.5,71.25,,109.73,77,,,Percent of Total Billed Charges,77% of total billed charges,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.45,74,,,Percent of Total Billed Charges,74% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,119.7,84,,,Percent of Total Billed Charges,84% of total billed charges,116.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.38,120,,,Fee Schedule,120% of MO Medicaid Rate,20.38,120,,,Fee Schedule,120% of MO Medicaid Rate,20.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.73,77,,,Percent of total Billed charges,77% of total billed charges,121.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.38,120,,,Fee Schedule,120% of MO Medicaid Rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.38,121.13,
THYROGLOBULIN AB,T990350534,CDM,302,RC,84432,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.25,500,,,fee schedule,500% of healthlink,117.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,15.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.41,144.93,
THYROGLOBULIN QUANT,T990350535,CDM,301,RC,84432,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.25,500,,,fee schedule,500% of healthlink,117.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,15.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.41,144.93,
THYROGLOBULIN TUMOR MARKER MML,T990350536,CDM,301,RC,84432,HCPCS,Outpatient,,,302.5,151.25,,232.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.85,74,,,Percent of Total Billed Charges,74% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,254.1,84,,,Percent of Total Billed Charges,84% of total billed charges,248.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.25,500,,,fee schedule,500% of healthlink,117.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,15.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.93,77,,,Percent of total Billed charges,77% of total billed charges,257.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.41,120,,,Fee Schedule,120% of MO Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.41,257.13,
T4 (THYROXINE),T990350537,CDM,301,RC,84436,HCPCS,Outpatient,,,114,57,,87.78,77,,,Percent of Total Billed Charges,77% of total billed charges,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.36,74,,,Percent of Total Billed Charges,74% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,78.66,69,,,Percent of Total Billed Charges,69% of total billed charges,95.76,84,,,Percent of Total Billed Charges,84% of total billed charges,93.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.15,500,,,fee schedule,500% of healthlink,50.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,50.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.59,120,,,Fee Schedule,120% of MO Medicaid Rate,6.59,120,,,Fee Schedule,120% of MO Medicaid Rate,6.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.78,77,,,Percent of total Billed charges,77% of total billed charges,96.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.59,120,,,Fee Schedule,120% of MO Medicaid Rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.59,96.9,
NEO THYROXINE WITH ELUTION,T990350538,CDM,301,RC,84437,HCPCS,Outpatient,,,19,9.5,,14.63,77,,,Percent of Total Billed Charges,77% of total billed charges,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.06,74,,,Percent of Total Billed Charges,74% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,13.11,69,,,Percent of Total Billed Charges,69% of total billed charges,15.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,77,,,Percent of total Billed charges,77% of total billed charges,16.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,64,
T4 FREE BY DIRECT DIALYSIS,T990350539,CDM,301,RC,84439,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.85,500,,,fee schedule,500% of healthlink,65.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,65.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.65,120,,,Fee Schedule,120% of MO Medicaid Rate,8.65,120,,,Fee Schedule,120% of MO Medicaid Rate,8.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.65,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.65,141.1,
"T4, FREE",T990350540,CDM,301,RC,84439,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.85,500,,,fee schedule,500% of healthlink,65.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,65.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.65,120,,,Fee Schedule,120% of MO Medicaid Rate,8.65,120,,,Fee Schedule,120% of MO Medicaid Rate,8.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.65,120,,,Fee Schedule,120% of MO Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.65,113.48,
THYROXIN BINDING GLOBULIN,T990350541,CDM,301,RC,84442,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.95,500,,,fee schedule,500% of healthlink,107.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.18,120,,,Fee Schedule,120% of MO Medicaid Rate,14.18,120,,,Fee Schedule,120% of MO Medicaid Rate,14.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.18,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,160.65,
NEO TSH,T990350542,CDM,301,RC,84443,HCPCS,Outpatient,,,51.5,25.75,,39.66,77,,,Percent of Total Billed Charges,77% of total billed charges,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.11,74,,,Percent of Total Billed Charges,74% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,69,,,Percent of Total Billed Charges,69% of total billed charges,43.26,84,,,Percent of Total Billed Charges,84% of total billed charges,42.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.65,500,,,fee schedule,500% of healthlink,122.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.66,77,,,Percent of total Billed charges,77% of total billed charges,43.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,12.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.88,122.65,
"TSH, ULTRASENSITIVE",T990350543,CDM,301,RC,84443,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.65,500,,,fee schedule,500% of healthlink,122.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,122.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,140.25,
THYROID STIMULATING IG,T990350544,CDM,301,RC,84445,HCPCS,Outpatient,,,355.5,177.75,,273.74,77,,,Percent of Total Billed Charges,77% of total billed charges,90.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.07,74,,,Percent of Total Billed Charges,74% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,298.62,84,,,Percent of Total Billed Charges,84% of total billed charges,291.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,203.7,500,,,fee schedule,500% of healthlink,203.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,203.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,48.82,120,,,Fee Schedule,120% of MO Medicaid Rate,48.82,120,,,Fee Schedule,120% of MO Medicaid Rate,48.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.74,77,,,Percent of total Billed charges,77% of total billed charges,302.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,48.82,120,,,Fee Schedule,120% of MO Medicaid Rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,302.18,
VITAMIN E (TOCOPHEROL),T990350545,CDM,301,RC,84446,HCPCS,Outpatient,,,178,89,,137.06,77,,,Percent of Total Billed Charges,77% of total billed charges,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.72,74,,,Percent of Total Billed Charges,74% of total billed charges,122.82,69,,,Percent of Total Billed Charges,69% of total billed charges,122.82,69,,,Percent of Total Billed Charges,69% of total billed charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.82,69,,,Percent of Total Billed Charges,69% of total billed charges,122.82,69,,,Percent of Total Billed Charges,69% of total billed charges,149.52,84,,,Percent of Total Billed Charges,84% of total billed charges,145.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.5,500,,,fee schedule,500% of healthlink,103.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,103.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.61,120,,,Fee Schedule,120% of MO Medicaid Rate,13.61,120,,,Fee Schedule,120% of MO Medicaid Rate,13.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.06,77,,,Percent of total Billed charges,77% of total billed charges,151.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.61,120,,,Fee Schedule,120% of MO Medicaid Rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,151.3,
AST/SGOT,T990350546,CDM,301,RC,84450,HCPCS,Outpatient,,,73.5,36.75,,56.6,77,,,Percent of Total Billed Charges,77% of total billed charges,18.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.39,74,,,Percent of Total Billed Charges,74% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,50.72,69,,,Percent of Total Billed Charges,69% of total billed charges,61.74,84,,,Percent of Total Billed Charges,84% of total billed charges,60.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.75,500,,,fee schedule,500% of healthlink,37.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.6,77,,,Percent of total Billed charges,77% of total billed charges,62.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,64,
ALANINE AMINOTRANSFERASE,T990350547,CDM,301,RC,84460,HCPCS,Outpatient,,,70.5,35.25,,54.29,77,,,Percent of Total Billed Charges,77% of total billed charges,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.17,74,,,Percent of Total Billed Charges,74% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,59.22,84,,,Percent of Total Billed Charges,84% of total billed charges,57.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.65,500,,,fee schedule,500% of healthlink,38.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.09,120,,,Fee Schedule,120% of MO Medicaid Rate,5.09,120,,,Fee Schedule,120% of MO Medicaid Rate,5.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,77,,,Percent of total Billed charges,77% of total billed charges,59.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.09,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.09,64,
TRANSFERRIN,T990350548,CDM,301,RC,84466,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.2,500,,,fee schedule,500% of healthlink,93.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,93.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.24,120,,,Fee Schedule,120% of MO Medicaid Rate,12.24,120,,,Fee Schedule,120% of MO Medicaid Rate,12.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.24,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,146.2,
TRIGLYCERIDES FLUID,T990350549,CDM,301,RC,84478,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,42,500,,,fee schedule,500% of healthlink,42,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.51,90.53,
"TRIGLYCERIDES, SERUM",T990350550,CDM,301,RC,84478,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,42,500,,,fee schedule,500% of healthlink,42,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.51,73.1,
"T3, UPTAKE",T990350551,CDM,301,RC,84479,HCPCS,Outpatient,,,125.5,62.75,,96.64,77,,,Percent of Total Billed Charges,77% of total billed charges,32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.87,74,,,Percent of Total Billed Charges,74% of total billed charges,86.6,69,,,Percent of Total Billed Charges,69% of total billed charges,86.6,69,,,Percent of Total Billed Charges,69% of total billed charges,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.6,69,,,Percent of Total Billed Charges,69% of total billed charges,86.6,69,,,Percent of Total Billed Charges,69% of total billed charges,105.42,84,,,Percent of Total Billed Charges,84% of total billed charges,102.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.64,77,,,Percent of total Billed charges,77% of total billed charges,106.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,106.68,
T3 by RIA,T990350552,CDM,301,RC,84480,HCPCS,Outpatient,,,134.5,67.25,,103.57,77,,,Percent of Total Billed Charges,77% of total billed charges,34.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.53,74,,,Percent of Total Billed Charges,74% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,112.98,84,,,Percent of Total Billed Charges,84% of total billed charges,110.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.5,500,,,fee schedule,500% of healthlink,103.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,103.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.61,120,,,Fee Schedule,120% of MO Medicaid Rate,13.61,120,,,Fee Schedule,120% of MO Medicaid Rate,13.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.57,77,,,Percent of total Billed charges,77% of total billed charges,114.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.61,120,,,Fee Schedule,120% of MO Medicaid Rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,114.33,
"T3 FREE, SERUM",T990350553,CDM,301,RC,84481,HCPCS,Outpatient,,,134.5,67.25,,103.57,77,,,Percent of Total Billed Charges,77% of total billed charges,34.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.53,74,,,Percent of Total Billed Charges,74% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,92.81,69,,,Percent of Total Billed Charges,69% of total billed charges,112.98,84,,,Percent of Total Billed Charges,84% of total billed charges,110.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.7,500,,,fee schedule,500% of healthlink,123.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,16.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.57,77,,,Percent of total Billed charges,77% of total billed charges,114.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.26,120,,,Fee Schedule,120% of MO Medicaid Rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.26,123.7,
T3 REVERSE,T990350554,CDM,301,RC,84482,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.05,500,,,fee schedule,500% of healthlink,115.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,115.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.12,120,,,Fee Schedule,120% of MO Medicaid Rate,15.12,120,,,Fee Schedule,120% of MO Medicaid Rate,15.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.12,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,180.63,
TROPONIN-I,T990350555,CDM,301,RC,84484,HCPCS,Outpatient,,,194.5,97.25,,149.77,77,,,Percent of Total Billed Charges,77% of total billed charges,49.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,143.93,74,,,Percent of Total Billed Charges,74% of total billed charges,134.21,69,,,Percent of Total Billed Charges,69% of total billed charges,134.21,69,,,Percent of Total Billed Charges,69% of total billed charges,48.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.21,69,,,Percent of Total Billed Charges,69% of total billed charges,134.21,69,,,Percent of Total Billed Charges,69% of total billed charges,163.38,84,,,Percent of Total Billed Charges,84% of total billed charges,159.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.85,500,,,fee schedule,500% of healthlink,71.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,71.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.96,120,,,Fee Schedule,120% of MO Medicaid Rate,11.96,120,,,Fee Schedule,120% of MO Medicaid Rate,11.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.77,77,,,Percent of total Billed charges,77% of total billed charges,165.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.96,120,,,Fee Schedule,120% of MO Medicaid Rate,48.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,48.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.96,165.33,
TYROSINE,T990350556,CDM,301,RC,84510,HCPCS,Outpatient,,,272.5,136.25,,209.83,77,,,Percent of Total Billed Charges,77% of total billed charges,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,201.65,74,,,Percent of Total Billed Charges,74% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,228.9,84,,,Percent of Total Billed Charges,84% of total billed charges,223.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.9,500,,,fee schedule,500% of healthlink,75.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,75.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.2,120,,,Fee Schedule,120% of MO Medicaid Rate,10.2,120,,,Fee Schedule,120% of MO Medicaid Rate,10.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.83,77,,,Percent of total Billed charges,77% of total billed charges,231.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.2,120,,,Fee Schedule,120% of MO Medicaid Rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.2,231.63,
BUN (BLOOD UREA NITROGEN),T990350557,CDM,301,RC,84520,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.8,500,,,fee schedule,500% of healthlink,28.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.79,120,,,Fee Schedule,120% of MO Medicaid Rate,3.79,120,,,Fee Schedule,120% of MO Medicaid Rate,3.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.79,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.79,64,
UREA URINE,T990350558,CDM,301,RC,84540,HCPCS,Outpatient,,,102.5,51.25,,78.93,77,,,Percent of Total Billed Charges,77% of total billed charges,26.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.85,74,,,Percent of Total Billed Charges,74% of total billed charges,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,70.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.1,84,,,Percent of Total Billed Charges,84% of total billed charges,84.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.25,500,,,fee schedule,500% of healthlink,25.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.33,120,,,Fee Schedule,120% of MO Medicaid Rate,5.33,120,,,Fee Schedule,120% of MO Medicaid Rate,5.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.93,77,,,Percent of total Billed charges,77% of total billed charges,87.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.33,120,,,Fee Schedule,120% of MO Medicaid Rate,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,87.13,
UREA NITROGEN CLEARANCE,T990350559,CDM,301,RC,84545,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.2,500,,,fee schedule,500% of healthlink,48.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.91,120,,,Fee Schedule,120% of MO Medicaid Rate,6.91,120,,,Fee Schedule,120% of MO Medicaid Rate,6.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.91,120,,,Fee Schedule,120% of MO Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.91,113.48,
"URIC ACID, SERUM",T990350560,CDM,301,RC,84550,HCPCS,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.34,74,,,Percent of Total Billed Charges,74% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,76.44,84,,,Percent of Total Billed Charges,84% of total billed charges,74.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.95,500,,,fee schedule,500% of healthlink,32.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,32.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.33,120,,,Fee Schedule,120% of MO Medicaid Rate,4.33,120,,,Fee Schedule,120% of MO Medicaid Rate,4.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.33,120,,,Fee Schedule,120% of MO Medicaid Rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.33,77.35,
URIC ACID URINE,T990350561,CDM,301,RC,84560,HCPCS,Outpatient,,,86.5,43.25,,66.61,77,,,Percent of Total Billed Charges,77% of total billed charges,22.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.01,74,,,Percent of Total Billed Charges,74% of total billed charges,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,72.66,84,,,Percent of Total Billed Charges,84% of total billed charges,70.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.25,500,,,fee schedule,500% of healthlink,25.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.87,120,,,Fee Schedule,120% of MO Medicaid Rate,4.87,120,,,Fee Schedule,120% of MO Medicaid Rate,4.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.61,77,,,Percent of total Billed charges,77% of total billed charges,73.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.87,120,,,Fee Schedule,120% of MO Medicaid Rate,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,73.53,
VMA 24HR URINE,T990350564,CDM,301,RC,84585,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.82,74,,,Percent of Total Billed Charges,74% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.2,500,,,fee schedule,500% of healthlink,113.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,113.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.88,120,,,Fee Schedule,120% of MO Medicaid Rate,14.88,120,,,Fee Schedule,120% of MO Medicaid Rate,14.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.88,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,164.05,
VASOACTIVE INTEST POLYPEP,T990350565,CDM,301,RC,84586,HCPCS,Outpatient,,,317.5,158.75,,244.48,77,,,Percent of Total Billed Charges,77% of total billed charges,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,234.95,74,,,Percent of Total Billed Charges,74% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,219.08,69,,,Percent of Total Billed Charges,69% of total billed charges,266.7,84,,,Percent of Total Billed Charges,84% of total billed charges,260.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.5,500,,,fee schedule,500% of healthlink,43.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.91,120,,,Fee Schedule,120% of MO Medicaid Rate,33.91,120,,,Fee Schedule,120% of MO Medicaid Rate,33.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.48,77,,,Percent of total Billed charges,77% of total billed charges,269.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.91,120,,,Fee Schedule,120% of MO Medicaid Rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,79.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,269.88,
ANTIDIURETIC HORMONE,T990350566,CDM,301,RC,84588,HCPCS,Outpatient,,,235.5,117.75,,181.34,77,,,Percent of Total Billed Charges,77% of total billed charges,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,174.27,74,,,Percent of Total Billed Charges,74% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,69,,,Percent of Total Billed Charges,69% of total billed charges,197.82,84,,,Percent of Total Billed Charges,84% of total billed charges,193.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,203.7,500,,,fee schedule,500% of healthlink,203.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,203.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,32.58,120,,,Fee Schedule,120% of MO Medicaid Rate,32.58,120,,,Fee Schedule,120% of MO Medicaid Rate,32.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.34,77,,,Percent of total Billed charges,77% of total billed charges,200.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.58,120,,,Fee Schedule,120% of MO Medicaid Rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,58.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.58,203.7,
VITAMIN A,T990350567,CDM,301,RC,84590,HCPCS,Outpatient,,,223,111.5,,171.71,77,,,Percent of Total Billed Charges,77% of total billed charges,56.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.02,74,,,Percent of Total Billed Charges,74% of total billed charges,153.87,69,,,Percent of Total Billed Charges,69% of total billed charges,153.87,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.87,69,,,Percent of Total Billed Charges,69% of total billed charges,153.87,69,,,Percent of Total Billed Charges,69% of total billed charges,187.32,84,,,Percent of Total Billed Charges,84% of total billed charges,182.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,67,500,,,fee schedule,500% of healthlink,67,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,67,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.14,120,,,Fee Schedule,120% of MO Medicaid Rate,11.14,120,,,Fee Schedule,120% of MO Medicaid Rate,11.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.71,77,,,Percent of total Billed charges,77% of total billed charges,189.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.14,120,,,Fee Schedule,120% of MO Medicaid Rate,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.14,189.55,
VITAMIN B3 (NIACIN),T990350568,CDM,301,RC,84591,HCPCS,Outpatient,,,282.5,141.25,,217.53,77,,,Percent of Total Billed Charges,77% of total billed charges,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.05,74,,,Percent of Total Billed Charges,74% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,237.3,84,,,Percent of Total Billed Charges,84% of total billed charges,231.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,67,500,,,fee schedule,500% of healthlink,67,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,67,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.37,120,,,Fee Schedule,120% of MO Medicaid Rate,16.37,120,,,Fee Schedule,120% of MO Medicaid Rate,16.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,77,,,Percent of total Billed charges,77% of total billed charges,240.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.37,120,,,Fee Schedule,120% of MO Medicaid Rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.37,240.13,
VITAMIN B7 (BIOTIN),T990350569,CDM,301,RC,84591,HCPCS,Outpatient,,,282.5,141.25,,217.53,77,,,Percent of Total Billed Charges,77% of total billed charges,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.05,74,,,Percent of Total Billed Charges,74% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,237.3,84,,,Percent of Total Billed Charges,84% of total billed charges,231.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,67,500,,,fee schedule,500% of healthlink,67,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,67,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.37,120,,,Fee Schedule,120% of MO Medicaid Rate,16.37,120,,,Fee Schedule,120% of MO Medicaid Rate,16.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,77,,,Percent of total Billed charges,77% of total billed charges,240.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.37,120,,,Fee Schedule,120% of MO Medicaid Rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.37,240.13,
VITAMIN K,T990350570,CDM,301,RC,84597,HCPCS,Outpatient,,,287,143.5,,220.99,77,,,Percent of Total Billed Charges,77% of total billed charges,73.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,212.38,74,,,Percent of Total Billed Charges,74% of total billed charges,198.03,69,,,Percent of Total Billed Charges,69% of total billed charges,198.03,69,,,Percent of Total Billed Charges,69% of total billed charges,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.03,69,,,Percent of Total Billed Charges,69% of total billed charges,198.03,69,,,Percent of Total Billed Charges,69% of total billed charges,241.08,84,,,Percent of Total Billed Charges,84% of total billed charges,235.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.1,500,,,fee schedule,500% of healthlink,76.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,76.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.16,120,,,Fee Schedule,120% of MO Medicaid Rate,13.16,120,,,Fee Schedule,120% of MO Medicaid Rate,13.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.99,77,,,Percent of total Billed charges,77% of total billed charges,243.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.16,120,,,Fee Schedule,120% of MO Medicaid Rate,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,71.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.16,243.95,
ZINC,T990350571,CDM,301,RC,84630,HCPCS,Outpatient,,,175.5,87.75,,135.14,77,,,Percent of Total Billed Charges,77% of total billed charges,44.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.87,74,,,Percent of Total Billed Charges,74% of total billed charges,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,147.42,84,,,Percent of Total Billed Charges,84% of total billed charges,143.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.15,500,,,fee schedule,500% of healthlink,83.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.93,120,,,Fee Schedule,120% of MO Medicaid Rate,10.93,120,,,Fee Schedule,120% of MO Medicaid Rate,10.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.14,77,,,Percent of total Billed charges,77% of total billed charges,149.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.93,120,,,Fee Schedule,120% of MO Medicaid Rate,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,149.18,
C-PEPTIDE SERUM,T990350572,CDM,301,RC,84681,HCPCS,Outpatient,,,256,128,,197.12,77,,,Percent of Total Billed Charges,77% of total billed charges,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.44,74,,,Percent of Total Billed Charges,74% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,215.04,84,,,Percent of Total Billed Charges,84% of total billed charges,209.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.9,500,,,fee schedule,500% of healthlink,151.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,151.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.12,77,,,Percent of total Billed charges,77% of total billed charges,217.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,217.6,
BETA hCG,T990350573,CDM,300,RC,84702,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,65.45,
HCG QUANT TUMOR MARKER,T990350574,CDM,301,RC,84702,HCPCS,Outpatient,,,207.5,103.75,,159.78,77,,,Percent of Total Billed Charges,77% of total billed charges,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.55,74,,,Percent of Total Billed Charges,74% of total billed charges,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,174.3,84,,,Percent of Total Billed Charges,84% of total billed charges,170.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.78,77,,,Percent of total Billed charges,77% of total billed charges,176.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,176.38,
HCG QUANTITATIVE,T990350575,CDM,301,RC,84702,HCPCS,Outpatient,,,207.5,103.75,,159.78,77,,,Percent of Total Billed Charges,77% of total billed charges,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.55,74,,,Percent of Total Billed Charges,74% of total billed charges,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,143.18,69,,,Percent of Total Billed Charges,69% of total billed charges,174.3,84,,,Percent of Total Billed Charges,84% of total billed charges,170.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,51,500,,,fee schedule,500% of healthlink,51,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.78,77,,,Percent of total Billed charges,77% of total billed charges,176.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,176.38,
HCG QUALITATIVE SERUM,T990350576,CDM,301,RC,84703,HCPCS,Outpatient,,,110.5,55.25,,85.09,77,,,Percent of Total Billed Charges,77% of total billed charges,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.77,74,,,Percent of Total Billed Charges,74% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,76.25,69,,,Percent of Total Billed Charges,69% of total billed charges,92.82,84,,,Percent of Total Billed Charges,84% of total billed charges,90.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.85,500,,,fee schedule,500% of healthlink,54.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,54.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.21,120,,,Fee Schedule,120% of MO Medicaid Rate,7.21,120,,,Fee Schedule,120% of MO Medicaid Rate,7.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.09,77,,,Percent of total Billed charges,77% of total billed charges,93.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.21,120,,,Fee Schedule,120% of MO Medicaid Rate,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.21,93.93,
HCG QUALITATIVE URINE,T990350577,CDM,307,RC,84703,HCPCS,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.22,74,,,Percent of Total Billed Charges,74% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,86.52,84,,,Percent of Total Billed Charges,84% of total billed charges,84.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.85,500,,,fee schedule,500% of healthlink,54.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,54.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.21,120,,,Fee Schedule,120% of MO Medicaid Rate,7.21,120,,,Fee Schedule,120% of MO Medicaid Rate,7.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.21,120,,,Fee Schedule,120% of MO Medicaid Rate,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.21,87.55,
CHOLESTEROL PLEURAL FLUID,T990350578,CDM,301,RC,84999,HCPCS,Outpatient,,,26,13,,20.02,77,,,Percent of Total Billed Charges,77% of total billed charges,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.24,74,,,Percent of Total Billed Charges,74% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17.94,69,,,Percent of Total Billed Charges,69% of total billed charges,21.84,84,,,Percent of Total Billed Charges,84% of total billed charges,21.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.14,89,,,Percent of total Billed Charges,89% of total Billed charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.02,77,,,Percent of total Billed charges,77% of total billed charges,22.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.5,64,
DESMOGEIN ELISA,T990350579,CDM,301,RC,84999,HCPCS,Outpatient,,,88,44,,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.12,74,,,Percent of Total Billed Charges,74% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,73.92,84,,,Percent of Total Billed Charges,84% of total billed charges,72.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.32,89,,,Percent of total Billed Charges,89% of total Billed charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22,78.32,
OSMOLALITY FECES,T990350580,CDM,301,RC,84999,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
POTASSIUM FECES,T990350581,CDM,301,RC,84999,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
BLEEDING TIME,T990350582,CDM,305,RC,85002,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,70.3,74,,,Percent of Total Billed Charges,74% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,65.55,69,,,Percent of Total Billed Charges,69% of total billed charges,79.8,84,,,Percent of Total Billed Charges,84% of total billed charges,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,500,,,fee schedule,500% of healthlink,32.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,32.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.62,120,,,Fee Schedule,120% of MO Medicaid Rate,4.62,120,,,Fee Schedule,120% of MO Medicaid Rate,4.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.62,120,,,Fee Schedule,120% of MO Medicaid Rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,80.75,
AUTOMATED DIFFERENTIAL WBC,T990350583,CDM,305,RC,85004,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,75.23,
CBC MANUAL DIFFERENTIAL,T990350584,CDM,305,RC,85007,HCPCS,Outpatient,,,57,28.5,,43.89,77,,,Percent of Total Billed Charges,77% of total billed charges,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.18,74,,,Percent of Total Billed Charges,74% of total billed charges,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,39.33,69,,,Percent of Total Billed Charges,69% of total billed charges,47.88,84,,,Percent of Total Billed Charges,84% of total billed charges,46.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,21,500,,,fee schedule,500% of healthlink,21,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.65,120,,,Fee Schedule,120% of MO Medicaid Rate,3.65,120,,,Fee Schedule,120% of MO Medicaid Rate,3.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.89,77,,,Percent of total Billed charges,77% of total billed charges,48.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.65,120,,,Fee Schedule,120% of MO Medicaid Rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.65,64,
HEMATOCRIT SPUN,T990350585,CDM,305,RC,85013,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.3,500,,,fee schedule,500% of healthlink,17.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.72,120,,,Fee Schedule,120% of MO Medicaid Rate,6.72,120,,,Fee Schedule,120% of MO Medicaid Rate,6.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.72,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,64,
HEMATOCRIT,T990350586,CDM,305,RC,85014,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.3,500,,,fee schedule,500% of healthlink,17.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.27,120,,,Fee Schedule,120% of MO Medicaid Rate,2.27,120,,,Fee Schedule,120% of MO Medicaid Rate,2.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.27,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.27,64,
HEMOGLOBIN,T990350587,CDM,305,RC,85018,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.3,500,,,fee schedule,500% of healthlink,17.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.27,120,,,Fee Schedule,120% of MO Medicaid Rate,2.27,120,,,Fee Schedule,120% of MO Medicaid Rate,2.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.27,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.27,64,
CBC w/PLT w/AUTO DIFF,T990350588,CDM,300,RC,85025,HCPCS,Outpatient,,,103.5,51.75,,79.7,77,,,Percent of Total Billed Charges,77% of total billed charges,26.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.59,74,,,Percent of Total Billed Charges,74% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,84,,,Percent of Total Billed Charges,84% of total billed charges,84.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.75,500,,,fee schedule,500% of healthlink,56.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,56.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.7,77,,,Percent of total Billed charges,77% of total billed charges,87.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.45,87.98,
Direct Pay CBC w/PLT Auto diff,T990350589,CDM,999,RC,85025,HCPCS,Outpatient,,,31.5,15.75,,24.26,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.71,125,,,fee schedule,125% of cms fee schedule,23.31,74,,,Percent of Total Billed Charges,74% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,100,,,fee schedule,100% of cms fee schedule,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,26.46,84,,,Percent of Total Billed Charges,84% of total billed charges,25.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.75,500,,,fee schedule,500% of healthlink,56.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,56.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.77,100,,,fee schedule,100% of cms fee schedule,24.26,77,,,Percent of total Billed charges,77% of total billed charges,26.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,7.45,120,,,Fee Schedule,120% of MO Medicaid Rate,7.77,100,,,Fee Schedule,100% of CMS OPPS Rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,7.45,56.75,
CBC w/PLT,T990350590,CDM,305,RC,85027,HCPCS,Outpatient,,,103.5,51.75,,79.7,77,,,Percent of Total Billed Charges,77% of total billed charges,26.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.59,74,,,Percent of Total Billed Charges,74% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,71.42,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,84,,,Percent of Total Billed Charges,84% of total billed charges,84.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.7,77,,,Percent of total Billed charges,77% of total billed charges,87.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,87.98,
RED BLOOD CELL (RBC) COUNT,T990350591,CDM,305,RC,85041,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.06,74,,,Percent of Total Billed Charges,74% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,57.96,84,,,Percent of Total Billed Charges,84% of total billed charges,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,21,500,,,fee schedule,500% of healthlink,21,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.89,120,,,Fee Schedule,120% of MO Medicaid Rate,2.89,120,,,Fee Schedule,120% of MO Medicaid Rate,2.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,64,
RETICULOCYTE COUNT,T990350592,CDM,305,RC,85046,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.3,500,,,fee schedule,500% of healthlink,35.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,35.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.34,120,,,Fee Schedule,120% of MO Medicaid Rate,5.34,120,,,Fee Schedule,120% of MO Medicaid Rate,5.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.34,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,75.23,
LEUKOCYTE (WBC) AUTOMATED,T990350593,CDM,305,RC,85048,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.55,500,,,fee schedule,500% of healthlink,18.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,18.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.44,120,,,Fee Schedule,120% of MO Medicaid Rate,2.44,120,,,Fee Schedule,120% of MO Medicaid Rate,2.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.44,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.44,64,
WHITE BLOOD CELL (WBC) COUNT,T990350594,CDM,305,RC,85048,HCPCS,Outpatient,,,54.5,27.25,,41.97,77,,,Percent of Total Billed Charges,77% of total billed charges,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.33,74,,,Percent of Total Billed Charges,74% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,37.61,69,,,Percent of Total Billed Charges,69% of total billed charges,45.78,84,,,Percent of Total Billed Charges,84% of total billed charges,44.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.55,500,,,fee schedule,500% of healthlink,18.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,18.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.44,120,,,Fee Schedule,120% of MO Medicaid Rate,2.44,120,,,Fee Schedule,120% of MO Medicaid Rate,2.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,77,,,Percent of total Billed charges,77% of total billed charges,46.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.44,120,,,Fee Schedule,120% of MO Medicaid Rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.44,64,
PLATELET COUNT,T990350595,CDM,305,RC,85049,HCPCS,Outpatient,,,70.5,35.25,,54.29,77,,,Percent of Total Billed Charges,77% of total billed charges,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.17,74,,,Percent of Total Billed Charges,74% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,59.22,84,,,Percent of Total Billed Charges,84% of total billed charges,57.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.65,500,,,fee schedule,500% of healthlink,32.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,32.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.3,120,,,Fee Schedule,120% of MO Medicaid Rate,4.3,120,,,Fee Schedule,120% of MO Medicaid Rate,4.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,77,,,Percent of total Billed charges,77% of total billed charges,59.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.3,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.3,64,
PATHOLOGY SMEAR REVIEW,T990350596,CDM,302,RC,85060,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.31,89,,,Percent of total Billed Charges,89% of total Billed charges,66.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.63,66.31,
FACTOR II ACTIVITY,T990350597,CDM,305,RC,85210,HCPCS,Outpatient,,,447.5,223.75,,344.58,77,,,Percent of Total Billed Charges,77% of total billed charges,114.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,331.15,74,,,Percent of Total Billed Charges,74% of total billed charges,308.78,69,,,Percent of Total Billed Charges,69% of total billed charges,308.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.78,69,,,Percent of Total Billed Charges,69% of total billed charges,308.78,69,,,Percent of Total Billed Charges,69% of total billed charges,375.9,84,,,Percent of Total Billed Charges,84% of total billed charges,366.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.8,500,,,fee schedule,500% of healthlink,94.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.46,120,,,Fee Schedule,120% of MO Medicaid Rate,12.46,120,,,Fee Schedule,120% of MO Medicaid Rate,12.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,111.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.58,77,,,Percent of total Billed charges,77% of total billed charges,380.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.46,120,,,Fee Schedule,120% of MO Medicaid Rate,111.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,111.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.46,380.38,
FACTOR V ACTIVITY,T990350598,CDM,305,RC,85220,HCPCS,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.38,74,,,Percent of Total Billed Charges,74% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,232.53,69,,,Percent of Total Billed Charges,69% of total billed charges,283.08,84,,,Percent of Total Billed Charges,84% of total billed charges,276.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.94,120,,,Fee Schedule,120% of MO Medicaid Rate,16.94,120,,,Fee Schedule,120% of MO Medicaid Rate,16.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.94,120,,,Fee Schedule,120% of MO Medicaid Rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.94,286.45,
FACTOR VII ACTIVITY CLOTTING,T990350599,CDM,305,RC,85230,HCPCS,Outpatient,,,220.5,110.25,,169.79,77,,,Percent of Total Billed Charges,77% of total billed charges,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.17,74,,,Percent of Total Billed Charges,74% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,185.22,84,,,Percent of Total Billed Charges,84% of total billed charges,180.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.79,77,,,Percent of total Billed charges,77% of total billed charges,187.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.18,187.43,
FACTOR VIII ACTIVITY,T990350600,CDM,305,RC,85240,HCPCS,Outpatient,,,253,126.5,,194.81,77,,,Percent of Total Billed Charges,77% of total billed charges,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.22,74,,,Percent of Total Billed Charges,74% of total billed charges,174.57,69,,,Percent of Total Billed Charges,69% of total billed charges,174.57,69,,,Percent of Total Billed Charges,69% of total billed charges,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.57,69,,,Percent of Total Billed Charges,69% of total billed charges,174.57,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,84,,,Percent of Total Billed Charges,84% of total billed charges,207.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.81,77,,,Percent of total Billed charges,77% of total billed charges,215.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.18,215.05,
RISTOCETIN COFACTOR,T990350601,CDM,305,RC,85245,HCPCS,Outpatient,,,257,128.5,,197.89,77,,,Percent of Total Billed Charges,77% of total billed charges,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.18,74,,,Percent of Total Billed Charges,74% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,215.88,84,,,Percent of Total Billed Charges,84% of total billed charges,210.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.55,500,,,fee schedule,500% of healthlink,167.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,167.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.89,77,,,Percent of total Billed charges,77% of total billed charges,218.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.02,218.45,
VON WILLEBRAND FACTOR AG,T990350602,CDM,305,RC,85246,HCPCS,Outpatient,,,355,177.5,,273.35,77,,,Percent of Total Billed Charges,77% of total billed charges,90.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.7,74,,,Percent of Total Billed Charges,74% of total billed charges,244.95,69,,,Percent of Total Billed Charges,69% of total billed charges,244.95,69,,,Percent of Total Billed Charges,69% of total billed charges,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.95,69,,,Percent of Total Billed Charges,69% of total billed charges,244.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.2,84,,,Percent of Total Billed Charges,84% of total billed charges,291.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.55,500,,,fee schedule,500% of healthlink,167.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,167.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.35,77,,,Percent of total Billed charges,77% of total billed charges,301.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,88.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.02,301.75,
VON VILLEBRAND MULTIMERIC ANA,T990350603,CDM,305,RC,85247,HCPCS,Outpatient,,,284,142,,218.68,77,,,Percent of Total Billed Charges,77% of total billed charges,72.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,210.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,195.96,69,,,Percent of Total Billed Charges,69% of total billed charges,238.56,84,,,Percent of Total Billed Charges,84% of total billed charges,232.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.55,500,,,fee schedule,500% of healthlink,167.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,167.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,22.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.68,77,,,Percent of total Billed charges,77% of total billed charges,241.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.02,120,,,Fee Schedule,120% of MO Medicaid Rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.02,241.4,
FACTOR IX ACTIVITY,T990350604,CDM,305,RC,85250,HCPCS,Outpatient,,,613,306.5,,472.01,77,,,Percent of Total Billed Charges,77% of total billed charges,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,453.62,74,,,Percent of Total Billed Charges,74% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,422.97,69,,,Percent of Total Billed Charges,69% of total billed charges,514.92,84,,,Percent of Total Billed Charges,84% of total billed charges,502.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.28,120,,,Fee Schedule,120% of MO Medicaid Rate,18.28,120,,,Fee Schedule,120% of MO Medicaid Rate,18.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,472.01,77,,,Percent of total Billed charges,77% of total billed charges,521.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.28,120,,,Fee Schedule,120% of MO Medicaid Rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,153.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.28,521.05,
FACTOR X ACTIVITY,T990350605,CDM,305,RC,85260,HCPCS,Outpatient,,,220.5,110.25,,169.79,77,,,Percent of Total Billed Charges,77% of total billed charges,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.17,74,,,Percent of Total Billed Charges,74% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,152.15,69,,,Percent of Total Billed Charges,69% of total billed charges,185.22,84,,,Percent of Total Billed Charges,84% of total billed charges,180.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.79,77,,,Percent of total Billed charges,77% of total billed charges,187.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.18,187.43,
FACTOR XI ACTIVITY,T990350606,CDM,305,RC,85270,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,170.2,74,,,Percent of Total Billed Charges,74% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,158.7,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,84,,,Percent of Total Billed Charges,84% of total billed charges,188.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,17.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.18,120,,,Fee Schedule,120% of MO Medicaid Rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.18,195.5,
FACTOR XII,T990350607,CDM,305,RC,85280,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.76,74,,,Percent of Total Billed Charges,74% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,190.4,
FACTOR XII ACTIVITY,T990350608,CDM,305,RC,85280,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.76,74,,,Percent of Total Billed Charges,74% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,190.4,
FACTOR XIII FUNCTIONAL,T990350609,CDM,305,RC,85290,HCPCS,Outpatient,,,348,174,,267.96,77,,,Percent of Total Billed Charges,77% of total billed charges,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,257.52,74,,,Percent of Total Billed Charges,74% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,292.32,84,,,Percent of Total Billed Charges,84% of total billed charges,285.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.85,500,,,fee schedule,500% of healthlink,101.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,101.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.68,120,,,Fee Schedule,120% of MO Medicaid Rate,15.68,120,,,Fee Schedule,120% of MO Medicaid Rate,15.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.96,77,,,Percent of total Billed charges,77% of total billed charges,295.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.68,120,,,Fee Schedule,120% of MO Medicaid Rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.68,295.8,
ANTITHROMBIN III (FUNCTIONAL),T990350610,CDM,305,RC,85300,HCPCS,Outpatient,,,152.5,76.25,,117.43,77,,,Percent of Total Billed Charges,77% of total billed charges,38.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.85,74,,,Percent of Total Billed Charges,74% of total billed charges,105.23,69,,,Percent of Total Billed Charges,69% of total billed charges,105.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.23,69,,,Percent of Total Billed Charges,69% of total billed charges,105.23,69,,,Percent of Total Billed Charges,69% of total billed charges,128.1,84,,,Percent of Total Billed Charges,84% of total billed charges,125.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.05,500,,,fee schedule,500% of healthlink,38.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.38,120,,,Fee Schedule,120% of MO Medicaid Rate,11.38,120,,,Fee Schedule,120% of MO Medicaid Rate,11.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,77,,,Percent of total Billed charges,77% of total billed charges,129.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.38,120,,,Fee Schedule,120% of MO Medicaid Rate,38.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,129.63,
ANTITHROMBIN III AG,T990350611,CDM,305,RC,85301,HCPCS,Outpatient,,,282.5,141.25,,217.53,77,,,Percent of Total Billed Charges,77% of total billed charges,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.05,74,,,Percent of Total Billed Charges,74% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,194.93,69,,,Percent of Total Billed Charges,69% of total billed charges,237.3,84,,,Percent of Total Billed Charges,84% of total billed charges,231.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.95,500,,,fee schedule,500% of healthlink,78.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,78.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,77,,,Percent of total Billed charges,77% of total billed charges,240.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.37,240.13,
PROTEIN C AG,T990350612,CDM,300,RC,85302,HCPCS,Outpatient,,,628.5,314.25,,483.95,77,,,Percent of Total Billed Charges,77% of total billed charges,160.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,465.09,74,,,Percent of Total Billed Charges,74% of total billed charges,433.67,69,,,Percent of Total Billed Charges,69% of total billed charges,433.67,69,,,Percent of Total Billed Charges,69% of total billed charges,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.67,69,,,Percent of Total Billed Charges,69% of total billed charges,433.67,69,,,Percent of Total Billed Charges,69% of total billed charges,527.94,84,,,Percent of Total Billed Charges,84% of total billed charges,515.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.75,500,,,fee schedule,500% of healthlink,87.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,483.95,77,,,Percent of total Billed charges,77% of total billed charges,534.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,157.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,534.23,
PROTEIN C FUNCTIONAL,T990350613,CDM,300,RC,85303,HCPCS,Outpatient,,,228,114,,175.56,77,,,Percent of Total Billed Charges,77% of total billed charges,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.72,74,,,Percent of Total Billed Charges,74% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,157.32,69,,,Percent of Total Billed Charges,69% of total billed charges,191.52,84,,,Percent of Total Billed Charges,84% of total billed charges,186.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.05,500,,,fee schedule,500% of healthlink,95.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.28,120,,,Fee Schedule,120% of MO Medicaid Rate,13.28,120,,,Fee Schedule,120% of MO Medicaid Rate,13.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.56,77,,,Percent of total Billed charges,77% of total billed charges,193.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.28,120,,,Fee Schedule,120% of MO Medicaid Rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.28,193.8,
PROTEIN S TOTAL AG,T990350614,CDM,305,RC,85305,HCPCS,Outpatient,,,281,140.5,,216.37,77,,,Percent of Total Billed Charges,77% of total billed charges,71.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,207.94,74,,,Percent of Total Billed Charges,74% of total billed charges,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,70.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,236.04,84,,,Percent of Total Billed Charges,84% of total billed charges,230.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.65,500,,,fee schedule,500% of healthlink,84.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.14,120,,,Fee Schedule,120% of MO Medicaid Rate,11.14,120,,,Fee Schedule,120% of MO Medicaid Rate,11.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,70.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.37,77,,,Percent of total Billed charges,77% of total billed charges,238.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.14,120,,,Fee Schedule,120% of MO Medicaid Rate,70.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,70.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.14,238.85,
PROTEIN S FREE,T990350615,CDM,305,RC,85306,HCPCS,Outpatient,,,341,170.5,,262.57,77,,,Percent of Total Billed Charges,77% of total billed charges,86.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,252.34,74,,,Percent of Total Billed Charges,74% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,286.44,84,,,Percent of Total Billed Charges,84% of total billed charges,279.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.85,500,,,fee schedule,500% of healthlink,111.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,111.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,14.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.57,77,,,Percent of total Billed charges,77% of total billed charges,289.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.7,289.85,
PROTEIN S FUNCTIONAL,T990350616,CDM,305,RC,85306,HCPCS,Outpatient,,,341,170.5,,262.57,77,,,Percent of Total Billed Charges,77% of total billed charges,86.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,252.34,74,,,Percent of Total Billed Charges,74% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,286.44,84,,,Percent of Total Billed Charges,84% of total billed charges,279.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.85,500,,,fee schedule,500% of healthlink,111.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,111.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,14.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.57,77,,,Percent of total Billed charges,77% of total billed charges,289.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.7,289.85,
ACTIVATED PROTEIN C RESISTANCE,T990350617,CDM,305,RC,85307,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.86,74,,,Percent of Total Billed Charges,74% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,116.76,84,,,Percent of Total Billed Charges,84% of total billed charges,113.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.85,500,,,fee schedule,500% of healthlink,111.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,111.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,14.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.7,120,,,Fee Schedule,120% of MO Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.7,118.15,
FACTOR XII INHIBITOR,T990350618,CDM,305,RC,85335,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,94,500,,,fee schedule,500% of healthlink,94,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.35,180.63,
EUGLOBULIN CLOT LYSIS TIME,T990350619,CDM,305,RC,85360,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.2,500,,,fee schedule,500% of healthlink,61.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.06,120,,,Fee Schedule,120% of MO Medicaid Rate,8.06,120,,,Fee Schedule,120% of MO Medicaid Rate,8.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.06,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.06,278.8,
FIBRINOGEN DEGRADATION PRODUCT,T990350620,CDM,305,RC,85362,HCPCS,Outpatient,,,135.5,67.75,,104.34,77,,,Percent of Total Billed Charges,77% of total billed charges,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.27,74,,,Percent of Total Billed Charges,74% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,113.82,84,,,Percent of Total Billed Charges,84% of total billed charges,111.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,6.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.34,77,,,Percent of total Billed charges,77% of total billed charges,115.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.61,120,,,Fee Schedule,120% of MO Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.61,115.18,
D DIMER QUANT,T990350621,CDM,305,RC,85379,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,207.2,74,,,Percent of Total Billed Charges,74% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,235.2,84,,,Percent of Total Billed Charges,84% of total billed charges,229.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.25,500,,,fee schedule,500% of healthlink,74.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,238,
FIBRINOGEN ACTIVITY,T990350622,CDM,305,RC,85384,HCPCS,Outpatient,,,195,97.5,,150.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.3,74,,,Percent of Total Billed Charges,74% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,134.55,69,,,Percent of Total Billed Charges,69% of total billed charges,163.8,84,,,Percent of Total Billed Charges,84% of total billed charges,159.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,62,500,,,fee schedule,500% of healthlink,62,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.32,120,,,Fee Schedule,120% of MO Medicaid Rate,9.32,120,,,Fee Schedule,120% of MO Medicaid Rate,9.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.15,77,,,Percent of total Billed charges,77% of total billed charges,165.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.32,120,,,Fee Schedule,120% of MO Medicaid Rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,48.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.32,165.75,
HEPARIN (XA INHIBITION),T990350623,CDM,305,RC,85520,HCPCS,Outpatient,,,456.5,228.25,,351.51,77,,,Percent of Total Billed Charges,77% of total billed charges,116.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,337.81,74,,,Percent of Total Billed Charges,74% of total billed charges,314.99,69,,,Percent of Total Billed Charges,69% of total billed charges,314.99,69,,,Percent of Total Billed Charges,69% of total billed charges,114.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.99,69,,,Percent of Total Billed Charges,69% of total billed charges,314.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.46,84,,,Percent of Total Billed Charges,84% of total billed charges,374.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.2,500,,,fee schedule,500% of healthlink,61.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,12.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,114.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.51,77,,,Percent of total Billed charges,77% of total billed charges,388.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,114.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,114.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.56,388.03,
"HEPARIN ANTI-Xa, LMWH",T990350624,CDM,300,RC,85520,HCPCS,Outpatient,,,244.5,122.25,,188.27,77,,,Percent of Total Billed Charges,77% of total billed charges,62.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.93,74,,,Percent of Total Billed Charges,74% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,205.38,84,,,Percent of Total Billed Charges,84% of total billed charges,200.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.2,500,,,fee schedule,500% of healthlink,61.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,12.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.27,77,,,Percent of total Billed charges,77% of total billed charges,207.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.56,207.83,
"HEPARIN ANTI-Xa, UFH",T990350625,CDM,300,RC,85520,HCPCS,Outpatient,,,244.5,122.25,,188.27,77,,,Percent of Total Billed Charges,77% of total billed charges,62.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.93,74,,,Percent of Total Billed Charges,74% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,205.38,84,,,Percent of Total Billed Charges,84% of total billed charges,200.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.2,500,,,fee schedule,500% of healthlink,61.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,12.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.27,77,,,Percent of total Billed charges,77% of total billed charges,207.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.56,120,,,Fee Schedule,120% of MO Medicaid Rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.56,207.83,
LEUKOCYTE ALKALINE PHOSPHATASE,T990350626,CDM,305,RC,85540,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.8,500,,,fee schedule,500% of healthlink,62.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.26,120,,,Fee Schedule,120% of MO Medicaid Rate,8.26,120,,,Fee Schedule,120% of MO Medicaid Rate,8.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.26,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.26,136.85,
LYSOZYME 24 HOUR URINE,T990350627,CDM,305,RC,85549,HCPCS,Outpatient,,,491,245.5,,378.07,77,,,Percent of Total Billed Charges,77% of total billed charges,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,363.34,74,,,Percent of Total Billed Charges,74% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,412.44,84,,,Percent of Total Billed Charges,84% of total billed charges,402.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.95,500,,,fee schedule,500% of healthlink,136.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,136.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18,120,,,Fee Schedule,120% of MO Medicaid Rate,18,120,,,Fee Schedule,120% of MO Medicaid Rate,18,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.07,77,,,Percent of total Billed charges,77% of total billed charges,417.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18,120,,,Fee Schedule,120% of MO Medicaid Rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,417.35,
HEXAGONAL PHASE NEUTRALIZATION,T990350628,CDM,305,RC,85597,HCPCS,Outpatient,,,261,130.5,,200.97,77,,,Percent of Total Billed Charges,77% of total billed charges,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.14,74,,,Percent of Total Billed Charges,74% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,219.24,84,,,Percent of Total Billed Charges,84% of total billed charges,214.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.25,500,,,fee schedule,500% of healthlink,131.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.97,77,,,Percent of total Billed charges,77% of total billed charges,221.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.26,221.85,
PHOSPHOLIPID NEUTRALIZATION,T990350629,CDM,305,RC,85597,HCPCS,Outpatient,,,261,130.5,,200.97,77,,,Percent of Total Billed Charges,77% of total billed charges,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.14,74,,,Percent of Total Billed Charges,74% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,219.24,84,,,Percent of Total Billed Charges,84% of total billed charges,214.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.25,500,,,fee schedule,500% of healthlink,131.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.97,77,,,Percent of total Billed charges,77% of total billed charges,221.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.26,221.85,
PLATELET NEUTRALIZATION,T990350630,CDM,305,RC,85597,HCPCS,Outpatient,,,261,130.5,,200.97,77,,,Percent of Total Billed Charges,77% of total billed charges,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.14,74,,,Percent of Total Billed Charges,74% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,180.09,69,,,Percent of Total Billed Charges,69% of total billed charges,219.24,84,,,Percent of Total Billed Charges,84% of total billed charges,214.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.25,500,,,fee schedule,500% of healthlink,131.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.97,77,,,Percent of total Billed charges,77% of total billed charges,221.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.26,221.85,
PROTHROMBIN TIME,T990350631,CDM,305,RC,85610,HCPCS,Outpatient,,,71,35.5,,54.67,77,,,Percent of Total Billed Charges,77% of total billed charges,18.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.54,74,,,Percent of Total Billed Charges,74% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,59.64,84,,,Percent of Total Billed Charges,84% of total billed charges,58.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.7,500,,,fee schedule,500% of healthlink,28.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,28.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.12,120,,,Fee Schedule,120% of MO Medicaid Rate,4.12,120,,,Fee Schedule,120% of MO Medicaid Rate,4.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.67,77,,,Percent of total Billed charges,77% of total billed charges,60.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.12,120,,,Fee Schedule,120% of MO Medicaid Rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.12,64,
PT MIX CORR,T990350633,CDM,305,RC,85611,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.55,500,,,fee schedule,500% of healthlink,25.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.78,120,,,Fee Schedule,120% of MO Medicaid Rate,3.78,120,,,Fee Schedule,120% of MO Medicaid Rate,3.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.78,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.78,75.23,
DRVVT SCREEN,T990350634,CDM,305,RC,85613,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.85,500,,,fee schedule,500% of healthlink,69.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,69.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.19,120,,,Fee Schedule,120% of MO Medicaid Rate,9.19,120,,,Fee Schedule,120% of MO Medicaid Rate,9.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.19,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.19,216.33,
LA DRVVT CONFIRM,T990350635,CDM,305,RC,85613,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.85,500,,,fee schedule,500% of healthlink,69.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,69.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.19,120,,,Fee Schedule,120% of MO Medicaid Rate,9.19,120,,,Fee Schedule,120% of MO Medicaid Rate,9.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.19,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.19,216.33,
WESTERGREN SEDIMENTATION,T990350636,CDM,305,RC,85651,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.9,500,,,fee schedule,500% of healthlink,25.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,75.23,
HEMOGLOBIN (Hgb) SOLUBILITY,T990350637,CDM,305,RC,85660,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.31,74,,,Percent of Total Billed Charges,74% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,84,,,Percent of Total Billed Charges,84% of total billed charges,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.3,500,,,fee schedule,500% of healthlink,40.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.28,111.78,
THROMBIN CLOTTING TIME,T990350638,CDM,305,RC,85670,HCPCS,Outpatient,,,108,54,,83.16,77,,,Percent of Total Billed Charges,77% of total billed charges,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.92,74,,,Percent of Total Billed Charges,74% of total billed charges,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,74.52,69,,,Percent of Total Billed Charges,69% of total billed charges,90.72,84,,,Percent of Total Billed Charges,84% of total billed charges,88.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.2,500,,,fee schedule,500% of healthlink,42.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.53,120,,,Fee Schedule,120% of MO Medicaid Rate,5.53,120,,,Fee Schedule,120% of MO Medicaid Rate,5.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.16,77,,,Percent of total Billed charges,77% of total billed charges,91.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.53,120,,,Fee Schedule,120% of MO Medicaid Rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.53,91.8,
PTT,T990350639,CDM,305,RC,85730,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,90.53,
PTT (LAC) SCREEN,T990350640,CDM,305,RC,85730,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,90.53,
PTT ACTIVATED,T990350641,CDM,305,RC,85730,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,90.53,
PTT APC-RESISTANCE,T990350642,CDM,305,RC,85730,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,90.53,
STACLOT-LA PTT I,T990350643,CDM,305,RC,85730,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,90.53,
STACLOT-LA PTT II,T990350644,CDM,305,RC,85730,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.8,500,,,fee schedule,500% of healthlink,43.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,5.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,90.53,
PTT MIX/CORR/INCUBATE,T990350645,CDM,305,RC,85732,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.86,74,,,Percent of Total Billed Charges,74% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,116.76,84,,,Percent of Total Billed Charges,84% of total billed charges,113.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,118.15,
PTT PLASMA FRACTIONS,T990350646,CDM,305,RC,85732,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.86,74,,,Percent of Total Billed Charges,74% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,95.91,69,,,Percent of Total Billed Charges,69% of total billed charges,116.76,84,,,Percent of Total Billed Charges,84% of total billed charges,113.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.25,500,,,fee schedule,500% of healthlink,47.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,47.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,6.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.2,120,,,Fee Schedule,120% of MO Medicaid Rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,118.15,
VISCOSITY SERUM,T990350647,CDM,305,RC,85810,HCPCS,Outpatient,,,164,82,,126.28,77,,,Percent of Total Billed Charges,77% of total billed charges,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.36,74,,,Percent of Total Billed Charges,74% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,137.76,84,,,Percent of Total Billed Charges,84% of total billed charges,134.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.85,500,,,fee schedule,500% of healthlink,77.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.2,120,,,Fee Schedule,120% of MO Medicaid Rate,11.2,120,,,Fee Schedule,120% of MO Medicaid Rate,11.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.28,77,,,Percent of total Billed charges,77% of total billed charges,139.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.2,120,,,Fee Schedule,120% of MO Medicaid Rate,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.2,139.4,
ALLERGEN IgG,T990350648,CDM,302,RC,86001,HCPCS,Outpatient,,,29,14.5,,22.33,77,,,Percent of Total Billed Charges,77% of total billed charges,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.46,74,,,Percent of Total Billed Charges,74% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,20.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24.36,84,,,Percent of Total Billed Charges,84% of total billed charges,23.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.5,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.33,77,,,Percent of total Billed charges,77% of total billed charges,24.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.5,120,,,Fee Schedule,120% of MO Medicaid Rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,7.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,64,
CACAO BEAN (CHOCOLATE) IgG,T990350649,CDM,302,RC,86001,HCPCS,Outpatient,,,206,103,,158.62,77,,,Percent of Total Billed Charges,77% of total billed charges,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.44,74,,,Percent of Total Billed Charges,74% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,142.14,69,,,Percent of Total Billed Charges,69% of total billed charges,173.04,84,,,Percent of Total Billed Charges,84% of total billed charges,168.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.5,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,120,,,Fee Schedule,120% of MO Medicaid Rate,7.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.62,77,,,Percent of total Billed charges,77% of total billed charges,175.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.5,120,,,Fee Schedule,120% of MO Medicaid Rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.5,175.1,
ALLERGEN HAZELNUT,T990350650,CDM,302,RC,86003,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,73.1,
ALLERGEN MELONS,T990350651,CDM,302,RC,86003,HCPCS,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,160.23,
ALLERGEN PROF VIII EACH,T990350652,CDM,302,RC,86003,HCPCS,Outpatient,,,27.5,13.75,,21.18,77,,,Percent of Total Billed Charges,77% of total billed charges,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.35,74,,,Percent of Total Billed Charges,74% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.1,84,,,Percent of Total Billed Charges,84% of total billed charges,22.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.18,77,,,Percent of total Billed charges,77% of total billed charges,23.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
ALLERGEN RICE,T990350653,CDM,302,RC,86003,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,73.1,
ALLERGEN-Aspergillus fumagatis,T990350654,CDM,302,RC,86003,HCPCS,Outpatient,,,27.5,13.75,,21.18,77,,,Percent of Total Billed Charges,77% of total billed charges,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.35,74,,,Percent of Total Billed Charges,74% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.1,84,,,Percent of Total Billed Charges,84% of total billed charges,22.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.18,77,,,Percent of total Billed charges,77% of total billed charges,23.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
ALLERTEN IgE HOP (FRUIT CONE),T990350655,CDM,302,RC,86003,HCPCS,Outpatient,,,138,69,,106.26,77,,,Percent of Total Billed Charges,77% of total billed charges,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.12,74,,,Percent of Total Billed Charges,74% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,95.22,69,,,Percent of Total Billed Charges,69% of total billed charges,115.92,84,,,Percent of Total Billed Charges,84% of total billed charges,113.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.26,77,,,Percent of total Billed charges,77% of total billed charges,117.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,34.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,117.3,
ALMOND IgE,T990350656,CDM,302,RC,86003,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64.6,
ALPHA GAL IgE,T990350657,CDM,302,RC,86003,HCPCS,Outpatient,,,191.5,95.75,,147.46,77,,,Percent of Total Billed Charges,77% of total billed charges,48.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.71,74,,,Percent of Total Billed Charges,74% of total billed charges,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,132.14,69,,,Percent of Total Billed Charges,69% of total billed charges,160.86,84,,,Percent of Total Billed Charges,84% of total billed charges,157.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.46,77,,,Percent of total Billed charges,77% of total billed charges,162.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,162.78,
AMMONIATED LATEX EXTRACT,T990350658,CDM,302,RC,86003,HCPCS,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,93.08,
Amoxicillin IgE,T990350659,CDM,302,RC,86003,HCPCS,Outpatient,,,526.5,263.25,,405.41,77,,,Percent of Total Billed Charges,77% of total billed charges,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,389.61,74,,,Percent of Total Billed Charges,74% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,442.26,84,,,Percent of Total Billed Charges,84% of total billed charges,431.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.41,77,,,Percent of total Billed charges,77% of total billed charges,447.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,447.53,
Ampicillin IgE,T990350660,CDM,302,RC,86003,HCPCS,Outpatient,,,1161.5,580.75,,894.36,77,,,Percent of Total Billed Charges,77% of total billed charges,296.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,296.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,859.51,74,,,Percent of Total Billed Charges,74% of total billed charges,801.44,69,,,Percent of Total Billed Charges,69% of total billed charges,801.44,69,,,Percent of Total Billed Charges,69% of total billed charges,290.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,801.44,69,,,Percent of Total Billed Charges,69% of total billed charges,801.44,69,,,Percent of Total Billed Charges,69% of total billed charges,975.66,84,,,Percent of Total Billed Charges,84% of total billed charges,952.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,290.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,894.36,77,,,Percent of total Billed charges,77% of total billed charges,987.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,290.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,290.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,987.28,
BANANA IgE,T990350661,CDM,302,RC,86003,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
BUFFERED LATEX,T990350662,CDM,302,RC,86003,HCPCS,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,93.08,
CANTALOUPE IgE,T990350663,CDM,302,RC,86003,HCPCS,Outpatient,,,164,82,,126.28,77,,,Percent of Total Billed Charges,77% of total billed charges,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.36,74,,,Percent of Total Billed Charges,74% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,113.16,69,,,Percent of Total Billed Charges,69% of total billed charges,137.76,84,,,Percent of Total Billed Charges,84% of total billed charges,134.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.28,77,,,Percent of total Billed charges,77% of total billed charges,139.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,139.4,
CASHEW NUT IgE,T990350664,CDM,302,RC,86003,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64.6,
Cephalosporin IgE,T990350665,CDM,302,RC,86003,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,167.88,
ECHINOCOCCUS IgE,T990350666,CDM,302,RC,86003,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,86.7,
EGG YOLK IgE,T990350667,CDM,302,RC,86003,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
GLOVE LATEX EXTRACT,T990350668,CDM,302,RC,86003,HCPCS,Outpatient,,,109.5,54.75,,84.32,77,,,Percent of Total Billed Charges,77% of total billed charges,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.03,74,,,Percent of Total Billed Charges,74% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,75.56,69,,,Percent of Total Billed Charges,69% of total billed charges,91.98,84,,,Percent of Total Billed Charges,84% of total billed charges,89.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.32,77,,,Percent of total Billed charges,77% of total billed charges,93.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,93.08,
IMCAP EACH ALLERGEN,T990350669,CDM,302,RC,86003,HCPCS,Outpatient,,,27.5,13.75,,21.18,77,,,Percent of Total Billed Charges,77% of total billed charges,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.35,74,,,Percent of Total Billed Charges,74% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.1,84,,,Percent of Total Billed Charges,84% of total billed charges,22.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.18,77,,,Percent of total Billed charges,77% of total billed charges,23.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
IMCAP-EACH ALLERGEN,T990350670,CDM,302,RC,86003,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
OAT IgE,T990350671,CDM,302,RC,86003,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,109.23,
PAPER WASP IgE,T990350672,CDM,302,RC,86003,HCPCS,Outpatient,,,96,48,,73.92,77,,,Percent of Total Billed Charges,77% of total billed charges,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.04,74,,,Percent of Total Billed Charges,74% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,66.24,69,,,Percent of Total Billed Charges,69% of total billed charges,80.64,84,,,Percent of Total Billed Charges,84% of total billed charges,78.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.92,77,,,Percent of total Billed charges,77% of total billed charges,81.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,81.6,
PEANUT (F13) IgE,T990350673,CDM,302,RC,86003,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,109.23,
PECAN NUT IgE,T990350674,CDM,302,RC,86003,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64.6,
Penicilloyl G,T990350675,CDM,302,RC,86003,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
Penicilloyl V,T990350676,CDM,302,RC,86003,HCPCS,Outpatient,,,74.5,37.25,,57.37,77,,,Percent of Total Billed Charges,77% of total billed charges,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.13,74,,,Percent of Total Billed Charges,74% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.41,69,,,Percent of Total Billed Charges,69% of total billed charges,62.58,84,,,Percent of Total Billed Charges,84% of total billed charges,61.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.37,77,,,Percent of total Billed charges,77% of total billed charges,63.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
RASPBERRY IgE,T990350677,CDM,302,RC,86003,HCPCS,Outpatient,,,142.5,71.25,,109.73,77,,,Percent of Total Billed Charges,77% of total billed charges,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.45,74,,,Percent of Total Billed Charges,74% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,98.33,69,,,Percent of Total Billed Charges,69% of total billed charges,119.7,84,,,Percent of Total Billed Charges,84% of total billed charges,116.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.73,77,,,Percent of total Billed charges,77% of total billed charges,121.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,121.13,
RED MULBERRY IgE,T990350678,CDM,302,RC,86003,HCPCS,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,160.23,
SOYBEAN IgE,T990350679,CDM,302,RC,86003,HCPCS,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.1,500,,,fee schedule,500% of healthlink,38.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,38.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,5,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5,120,,,Fee Schedule,120% of MO Medicaid Rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,64,
ANCA SCREEN,T990350680,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
ANCA-IBD SCREEN,T990350681,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
ANCA-IBD TITER,T990350682,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
ATYPICAL P ANCA TITER,T990350683,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
C-ANCA,T990350684,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
MYELOPEROXIDASE AB,T990350685,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
P-ANCA,T990350686,CDM,302,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
PROTEINASE-3 AB,T990350687,CDM,300,RC,86021,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.95,500,,,fee schedule,500% of healthlink,17.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,17.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,158.95,
HEPARIN INDUCED PLT AB,T990350688,CDM,302,RC,86022,HCPCS,Outpatient,,,407.5,203.75,,313.78,77,,,Percent of Total Billed Charges,77% of total billed charges,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,301.55,74,,,Percent of Total Billed Charges,74% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,342.3,84,,,Percent of Total Billed Charges,84% of total billed charges,334.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.25,500,,,fee schedule,500% of healthlink,77.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.78,77,,,Percent of total Billed charges,77% of total billed charges,346.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,346.38,
PLATELET AB INDIRECT EACH,T990350689,CDM,302,RC,86022,HCPCS,Outpatient,,,120.5,60.25,,92.79,77,,,Percent of Total Billed Charges,77% of total billed charges,30.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.17,74,,,Percent of Total Billed Charges,74% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.15,69,,,Percent of Total Billed Charges,69% of total billed charges,101.22,84,,,Percent of Total Billed Charges,84% of total billed charges,98.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.25,500,,,fee schedule,500% of healthlink,77.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.79,77,,,Percent of total Billed charges,77% of total billed charges,102.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,102.43,
SEROTONIN RELEASE ASSAY,T990350690,CDM,302,RC,86022,HCPCS,Outpatient,,,407.5,203.75,,313.78,77,,,Percent of Total Billed Charges,77% of total billed charges,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,301.55,74,,,Percent of Total Billed Charges,74% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,342.3,84,,,Percent of Total Billed Charges,84% of total billed charges,334.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.25,500,,,fee schedule,500% of healthlink,77.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.78,77,,,Percent of total Billed charges,77% of total billed charges,346.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,346.38,
PLATELET AB DIRECT,T990350691,CDM,302,RC,86023,HCPCS,Outpatient,,,239,119.5,,184.03,77,,,Percent of Total Billed Charges,77% of total billed charges,60.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.86,74,,,Percent of Total Billed Charges,74% of total billed charges,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,200.76,84,,,Percent of Total Billed Charges,84% of total billed charges,195.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.95,500,,,fee schedule,500% of healthlink,90.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,90.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,11.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.03,77,,,Percent of total Billed charges,77% of total billed charges,203.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.95,203.15,
ANTINUCLEAR AB (ANA),T990350692,CDM,302,RC,86038,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.25,500,,,fee schedule,500% of healthlink,88.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.6,120,,,Fee Schedule,120% of MO Medicaid Rate,11.6,120,,,Fee Schedule,120% of MO Medicaid Rate,11.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.6,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.6,144.93,
CENTROMERE AB SCREEN,T990350693,CDM,302,RC,86038,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.25,500,,,fee schedule,500% of healthlink,88.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.6,120,,,Fee Schedule,120% of MO Medicaid Rate,11.6,120,,,Fee Schedule,120% of MO Medicaid Rate,11.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.6,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.6,144.93,
ANA TITER AND PATTERN,T990350694,CDM,302,RC,86039,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.5,500,,,fee schedule,500% of healthlink,81.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,81.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.7,120,,,Fee Schedule,120% of MO Medicaid Rate,10.7,120,,,Fee Schedule,120% of MO Medicaid Rate,10.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.7,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,141.1,
ASO SCREEN,T990350695,CDM,302,RC,86063,HCPCS,Outpatient,,,115.5,57.75,,88.94,77,,,Percent of Total Billed Charges,77% of total billed charges,29.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.47,74,,,Percent of Total Billed Charges,74% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,97.02,84,,,Percent of Total Billed Charges,84% of total billed charges,94.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.2,500,,,fee schedule,500% of healthlink,42.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.53,120,,,Fee Schedule,120% of MO Medicaid Rate,5.53,120,,,Fee Schedule,120% of MO Medicaid Rate,5.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.94,77,,,Percent of total Billed charges,77% of total billed charges,98.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.53,120,,,Fee Schedule,120% of MO Medicaid Rate,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.53,98.18,
C-REACTIVE PROTEIN,T990350696,CDM,302,RC,86140,HCPCS,Outpatient,,,151.5,75.75,,116.66,77,,,Percent of Total Billed Charges,77% of total billed charges,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.11,74,,,Percent of Total Billed Charges,74% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,127.26,84,,,Percent of Total Billed Charges,84% of total billed charges,124.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.66,77,,,Percent of total Billed charges,77% of total billed charges,128.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,128.78,
CARDIO CRP,T990350697,CDM,302,RC,86141,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.43,180.63,
BETA 2 GLYCOPROTEIN AB IgA,T990350698,CDM,302,RC,86146,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.54,74,,,Percent of Total Billed Charges,74% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,353.64,84,,,Percent of Total Billed Charges,84% of total billed charges,345.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,357.85,
BETA 2 GLYCOPROTEIN AB IgG,T990350699,CDM,302,RC,86146,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.54,74,,,Percent of Total Billed Charges,74% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,353.64,84,,,Percent of Total Billed Charges,84% of total billed charges,345.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,357.85,
BETA 2 GLYCOPROTEIN AB IgM,T990350700,CDM,302,RC,86146,HCPCS,Outpatient,,,421,210.5,,324.17,77,,,Percent of Total Billed Charges,77% of total billed charges,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.54,74,,,Percent of Total Billed Charges,74% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,290.49,69,,,Percent of Total Billed Charges,69% of total billed charges,353.64,84,,,Percent of Total Billed Charges,84% of total billed charges,345.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.17,77,,,Percent of total Billed charges,77% of total billed charges,357.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,105.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,357.85,
ANTICARDIOLIPIN AB IgA,T990350701,CDM,302,RC,86147,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,216.33,
ANTICARDIOLIPIN AB IgG,T990350702,CDM,302,RC,86147,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,216.33,
ANTICARDIOLIPIN AB IgM,T990350703,CDM,302,RC,86147,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,216.33,
CARDIOLIPIN AB SCREEN,T990350704,CDM,302,RC,86147,HCPCS,Outpatient,,,254.5,127.25,,195.97,77,,,Percent of Total Billed Charges,77% of total billed charges,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.33,74,,,Percent of Total Billed Charges,74% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,175.61,69,,,Percent of Total Billed Charges,69% of total billed charges,213.78,84,,,Percent of Total Billed Charges,84% of total billed charges,208.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.7,500,,,fee schedule,500% of healthlink,185.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,185.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,24.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.97,77,,,Percent of total Billed charges,77% of total billed charges,216.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.43,120,,,Fee Schedule,120% of MO Medicaid Rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.43,216.33,
PHOSPHATIDYLSERINE AB IgA,T990350705,CDM,302,RC,86148,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.25,500,,,fee schedule,500% of healthlink,117.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.42,144.93,
PHOSPHATIDYLSERINE AB IgG,T990350706,CDM,302,RC,86148,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.25,500,,,fee schedule,500% of healthlink,117.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.42,144.93,
PHOSPHATIDYLSERINE AB IgM,T990350707,CDM,302,RC,86148,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.25,500,,,fee schedule,500% of healthlink,117.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,117.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.42,144.93,
COLD HEMAGGLUTININS,T990350708,CDM,302,RC,86157,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,58.85,500,,,fee schedule,500% of healthlink,58.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,58.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.73,120,,,Fee Schedule,120% of MO Medicaid Rate,7.73,120,,,Fee Schedule,120% of MO Medicaid Rate,7.73,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.73,120,,,Fee Schedule,120% of MO Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,222.28,
COMPLEMENT COMPONENT C1,T990350709,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C2,T990350710,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C3,T990350711,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C4,T990350712,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C5,T990350713,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C6,T990350714,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C7,T990350715,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C8,T990350716,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT COMPONENT C9,T990350717,CDM,302,RC,86160,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,158.1,
COMPLEMENT CH50 TOTAL,T990350719,CDM,302,RC,86162,HCPCS,Outpatient,,,251,125.5,,193.27,77,,,Percent of Total Billed Charges,77% of total billed charges,64.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.74,74,,,Percent of Total Billed Charges,74% of total billed charges,173.19,69,,,Percent of Total Billed Charges,69% of total billed charges,173.19,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.19,69,,,Percent of Total Billed Charges,69% of total billed charges,173.19,69,,,Percent of Total Billed Charges,69% of total billed charges,210.84,84,,,Percent of Total Billed Charges,84% of total billed charges,205.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.35,500,,,fee schedule,500% of healthlink,148.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,148.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.27,77,,,Percent of total Billed charges,77% of total billed charges,213.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,213.35,
CYCLIC CITRULLINE PEPTIDE,T990350720,CDM,302,RC,86200,HCPCS,Outpatient,,,310.5,155.25,,239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,79.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,229.77,74,,,Percent of Total Billed Charges,74% of total billed charges,214.25,69,,,Percent of Total Billed Charges,69% of total billed charges,214.25,69,,,Percent of Total Billed Charges,69% of total billed charges,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.25,69,,,Percent of Total Billed Charges,69% of total billed charges,214.25,69,,,Percent of Total Billed Charges,69% of total billed charges,260.82,84,,,Percent of Total Billed Charges,84% of total billed charges,254.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.55,500,,,fee schedule,500% of healthlink,94.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.09,77,,,Percent of total Billed charges,77% of total billed charges,263.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,77.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.43,263.93,
ANTI DNase B (STREPTOCOCCUS),T990350721,CDM,302,RC,86215,HCPCS,Outpatient,,,208,104,,160.16,77,,,Percent of Total Billed Charges,77% of total billed charges,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.92,74,,,Percent of Total Billed Charges,74% of total billed charges,143.52,69,,,Percent of Total Billed Charges,69% of total billed charges,143.52,69,,,Percent of Total Billed Charges,69% of total billed charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,69,,,Percent of Total Billed Charges,69% of total billed charges,143.52,69,,,Percent of Total Billed Charges,69% of total billed charges,174.72,84,,,Percent of Total Billed Charges,84% of total billed charges,170.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.75,500,,,fee schedule,500% of healthlink,96.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.16,77,,,Percent of total Billed charges,77% of total billed charges,176.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,176.8,
ANTI dsDNA AB,T990350722,CDM,302,RC,86225,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.3,500,,,fee schedule,500% of healthlink,100.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.19,120,,,Fee Schedule,120% of MO Medicaid Rate,13.19,120,,,Fee Schedule,120% of MO Medicaid Rate,13.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.19,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.19,167.88,
ANTI JO 1,T990350723,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
ANTI SS A IgG,T990350724,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
ANTI SS B IgG,T990350725,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
ANTISCLERODERMA 70 AB,T990350726,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
CHROMATIN (NUCLEOSOMAL) AB,T990350727,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
ENA SCREEN,T990350728,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
EXTRACTABLE NUCLEAR ABS EACH,T990350729,CDM,302,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
JO-1 AB,T990350730,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
PM-SCL AB,T990350731,CDM,302,RC,86235,HCPCS,Outpatient,,,113,56.5,,87.01,77,,,Percent of Total Billed Charges,77% of total billed charges,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.62,74,,,Percent of Total Billed Charges,74% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,94.92,84,,,Percent of Total Billed Charges,84% of total billed charges,92.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.01,77,,,Percent of total Billed charges,77% of total billed charges,96.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,130.9,
RNP AB,T990350732,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
RNP IgG AUTOAB,T990350733,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
SCLERODERMA (SCL-70) AB,T990350734,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
Sm (SMITH) IgG AUTOAB,T990350735,CDM,301,RC,86235,HCPCS,Outpatient,,,184.5,92.25,,142.07,77,,,Percent of Total Billed Charges,77% of total billed charges,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.53,74,,,Percent of Total Billed Charges,74% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,127.31,69,,,Percent of Total Billed Charges,69% of total billed charges,154.98,84,,,Percent of Total Billed Charges,84% of total billed charges,151.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.9,500,,,fee schedule,500% of healthlink,130.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,130.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,17.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.07,77,,,Percent of total Billed charges,77% of total billed charges,156.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.21,120,,,Fee Schedule,120% of MO Medicaid Rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.21,156.83,
ANTIADRENAL AB SCREEN,T990350736,CDM,302,RC,86255,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,224.4,
ENDOMYSIAL AB IgA,T990350737,CDM,302,RC,86255,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,224.4,
HU AB,T990350738,CDM,302,RC,86255,HCPCS,Outpatient,,,290.5,145.25,,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,246.93,
MOG-IGG1,T990350739,CDM,301,RC,86255,HCPCS,Outpatient,,,2026.5,1013.25,,1560.41,77,,,Percent of Total Billed Charges,77% of total billed charges,516.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1499.61,74,,,Percent of Total Billed Charges,74% of total billed charges,1398.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1398.29,69,,,Percent of Total Billed Charges,69% of total billed charges,506.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1398.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1398.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1702.26,84,,,Percent of Total Billed Charges,84% of total billed charges,1661.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,506.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1560.41,77,,,Percent of total Billed charges,77% of total billed charges,1722.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,506.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,506.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,1722.53,
MYOCARDIAL AB,T990350740,CDM,302,RC,86255,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,224.4,
PHOSPHOLIPASE A2 RECEPTOR AB,T990350741,CDM,301,RC,86255,HCPCS,Outpatient,,,541,270.5,,416.57,77,,,Percent of Total Billed Charges,77% of total billed charges,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,400.34,74,,,Percent of Total Billed Charges,74% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,454.44,84,,,Percent of Total Billed Charges,84% of total billed charges,443.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.57,77,,,Percent of total Billed charges,77% of total billed charges,459.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,459.85,
RETICULIN AB IgA,T990350742,CDM,302,RC,86255,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,224.4,
SKELETAL MUSCLE AB w/REFL TITE,T990350743,CDM,302,RC,86255,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,224.4,
ANTI STRIATED MUSCLE AB TITER,T990350744,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
ANTIADRENAL TITER/PATTERN,T990350745,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
ANTIMITOCHONDRIAL AB,T990350746,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
DNA AB TITER,T990350747,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
ENDOMYSIAL AB Titer,T990350748,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
HU AB TITER,T990350749,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
MITOCHONDRIAL AB TITER,T990350750,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
MYOCARDIAL AB TITER,T990350751,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
PARANEOPLASTIC AUTOAB TITER EA,T990350752,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
RETICULIN AB IgA TITER,T990350753,CDM,302,RC,86256,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,151.73,
CANCER ANTIGEN (CA) 15-3,T990350754,CDM,302,RC,86300,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.9,500,,,fee schedule,500% of healthlink,151.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,151.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,180.63,
CANCER ANTIGEN (CA) 27.29,T990350755,CDM,302,RC,86300,HCPCS,Outpatient,,,212.5,106.25,,163.63,77,,,Percent of Total Billed Charges,77% of total billed charges,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,157.25,74,,,Percent of Total Billed Charges,74% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,146.63,69,,,Percent of Total Billed Charges,69% of total billed charges,178.5,84,,,Percent of Total Billed Charges,84% of total billed charges,174.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.9,500,,,fee schedule,500% of healthlink,151.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,151.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.63,77,,,Percent of total Billed charges,77% of total billed charges,180.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,53.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,180.63,
CARBOHYDRATE AB (CA) 19-9,T990350756,CDM,302,RC,86301,HCPCS,Outpatient,,,238.5,119.25,,183.65,77,,,Percent of Total Billed Charges,77% of total billed charges,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.49,74,,,Percent of Total Billed Charges,74% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,200.34,84,,,Percent of Total Billed Charges,84% of total billed charges,195.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.9,500,,,fee schedule,500% of healthlink,151.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,151.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.65,77,,,Percent of total Billed charges,77% of total billed charges,202.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,202.73,
CANCER ANTIGEN (CA) 125,T990350757,CDM,302,RC,86304,HCPCS,Outpatient,,,265.5,132.75,,204.44,77,,,Percent of Total Billed Charges,77% of total billed charges,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.47,74,,,Percent of Total Billed Charges,74% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,183.2,69,,,Percent of Total Billed Charges,69% of total billed charges,223.02,84,,,Percent of Total Billed Charges,84% of total billed charges,217.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.9,500,,,fee schedule,500% of healthlink,151.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,151.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.44,77,,,Percent of total Billed charges,77% of total billed charges,225.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,225.68,
HE4 Ovarian CA Monitoring,T990350758,CDM,302,RC,86305,HCPCS,Outpatient,,,811,405.5,,624.47,77,,,Percent of Total Billed Charges,77% of total billed charges,206.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,600.14,74,,,Percent of Total Billed Charges,74% of total billed charges,559.59,69,,,Percent of Total Billed Charges,69% of total billed charges,559.59,69,,,Percent of Total Billed Charges,69% of total billed charges,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,559.59,69,,,Percent of Total Billed Charges,69% of total billed charges,559.59,69,,,Percent of Total Billed Charges,69% of total billed charges,681.24,84,,,Percent of Total Billed Charges,84% of total billed charges,665.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,721.79,89,,,Percent of total Billed Charges,89% of total Billed charges,721.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,721.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,624.47,77,,,Percent of total Billed charges,77% of total billed charges,689.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,233.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,202.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,721.79,
MONONUCLEOSIS SCREEN,T990350759,CDM,302,RC,86308,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,90.53,
CHROMOGRANIN A,T990350760,CDM,302,RC,86316,HCPCS,Outpatient,,,439.5,219.75,,338.42,77,,,Percent of Total Billed Charges,77% of total billed charges,112.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,325.23,74,,,Percent of Total Billed Charges,74% of total billed charges,303.26,69,,,Percent of Total Billed Charges,69% of total billed charges,303.26,69,,,Percent of Total Billed Charges,69% of total billed charges,109.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.26,69,,,Percent of Total Billed Charges,69% of total billed charges,303.26,69,,,Percent of Total Billed Charges,69% of total billed charges,369.18,84,,,Percent of Total Billed Charges,84% of total billed charges,360.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.9,500,,,fee schedule,500% of healthlink,151.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,151.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,19.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,77,,,Percent of total Billed charges,77% of total billed charges,373.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.97,120,,,Fee Schedule,120% of MO Medicaid Rate,109.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.97,373.58,
RABIES TITER-RESPONSE,T990350761,CDM,302,RC,86317,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.45,500,,,fee schedule,500% of healthlink,109.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,144.93,
STREP PNEUMO SEROTYPES EACH,T990350762,CDM,302,RC,86317,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.45,500,,,fee schedule,500% of healthlink,109.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,144.93,
CRYCORIT IMMUNODIFFUSION,T990350763,CDM,302,RC,86329,HCPCS,Outpatient,,,80,40,,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.2,74,,,Percent of Total Billed Charges,74% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,67.2,84,,,Percent of Total Billed Charges,84% of total billed charges,65.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.55,500,,,fee schedule,500% of healthlink,102.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,102.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.49,120,,,Fee Schedule,120% of MO Medicaid Rate,13.49,120,,,Fee Schedule,120% of MO Medicaid Rate,13.49,120,,,Fee Schedule,120% of MO of Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.49,120,,,Fee Schedule,120% of MO Medicaid Rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.49,102.55,
Immudodiffusion Ouchtelony,T990350764,CDM,302,RC,86331,HCPCS,Outpatient,,,100.5,50.25,,77.39,77,,,Percent of Total Billed Charges,77% of total billed charges,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.37,74,,,Percent of Total Billed Charges,74% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.42,84,,,Percent of Total Billed Charges,84% of total billed charges,82.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.5,500,,,fee schedule,500% of healthlink,87.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.39,77,,,Percent of total Billed charges,77% of total billed charges,85.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,87.5,
IMMUNOFIXATION SERUM,T990350765,CDM,302,RC,86334,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.1,500,,,fee schedule,500% of healthlink,163.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,163.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,21.44,120,,,Fee Schedule,120% of MO Medicaid Rate,21.44,120,,,Fee Schedule,120% of MO Medicaid Rate,21.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.44,163.1,
IMMUNOFIXATION URINE,T990350766,CDM,300,RC,86335,HCPCS,Outpatient,,,151.5,75.75,,116.66,77,,,Percent of Total Billed Charges,77% of total billed charges,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.11,74,,,Percent of Total Billed Charges,74% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,127.26,84,,,Percent of Total Billed Charges,84% of total billed charges,124.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.25,500,,,fee schedule,500% of healthlink,214.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,214.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.18,120,,,Fee Schedule,120% of MO Medicaid Rate,28.18,120,,,Fee Schedule,120% of MO Medicaid Rate,28.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.66,77,,,Percent of total Billed charges,77% of total billed charges,128.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.18,120,,,Fee Schedule,120% of MO Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.18,214.25,
INHIBIN A ULTRASENSITIVE,T990350767,CDM,302,RC,86336,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.48,74,,,Percent of Total Billed Charges,74% of total billed charges,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,127.68,84,,,Percent of Total Billed Charges,84% of total billed charges,124.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.75,500,,,fee schedule,500% of healthlink,113.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,113.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.96,120,,,Fee Schedule,120% of MO Medicaid Rate,14.96,120,,,Fee Schedule,120% of MO Medicaid Rate,14.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.96,120,,,Fee Schedule,120% of MO Medicaid Rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.96,129.2,
INSULIN AUTOAB,T990350768,CDM,302,RC,86337,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.52,74,,,Percent of Total Billed Charges,74% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,84,,,Percent of Total Billed Charges,84% of total billed charges,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.35,500,,,fee schedule,500% of healthlink,156.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,156.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.54,120,,,Fee Schedule,120% of MO Medicaid Rate,20.54,120,,,Fee Schedule,120% of MO Medicaid Rate,20.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,20.54,120,,,Fee Schedule,120% of MO Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.54,156.35,
INTRINSIC FACTOR BLOCKING AB,T990350769,CDM,302,RC,86340,HCPCS,Outpatient,,,278.5,139.25,,214.45,77,,,Percent of Total Billed Charges,77% of total billed charges,71.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,206.09,74,,,Percent of Total Billed Charges,74% of total billed charges,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,192.17,69,,,Percent of Total Billed Charges,69% of total billed charges,233.94,84,,,Percent of Total Billed Charges,84% of total billed charges,228.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.05,500,,,fee schedule,500% of healthlink,110.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,110.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.47,120,,,Fee Schedule,120% of MO Medicaid Rate,14.47,120,,,Fee Schedule,120% of MO Medicaid Rate,14.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.45,77,,,Percent of total Billed charges,77% of total billed charges,236.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.47,120,,,Fee Schedule,120% of MO Medicaid Rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,236.73,
IA-2 AB,T990350770,CDM,302,RC,86341,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,359.64,74,,,Percent of Total Billed Charges,74% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,408.24,84,,,Percent of Total Billed Charges,84% of total billed charges,398.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.65,500,,,fee schedule,500% of healthlink,83.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.62,413.1,
ISLET CELL AB SCREEN,T990350771,CDM,302,RC,86341,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,359.64,74,,,Percent of Total Billed Charges,74% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,408.24,84,,,Percent of Total Billed Charges,84% of total billed charges,398.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.65,500,,,fee schedule,500% of healthlink,83.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.62,413.1,
ISLET CELL AB TITER,T990350772,CDM,302,RC,86341,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,359.64,74,,,Percent of Total Billed Charges,74% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,408.24,84,,,Percent of Total Billed Charges,84% of total billed charges,398.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.65,500,,,fee schedule,500% of healthlink,83.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.62,413.1,
ZINC TRANSPORTER 8 AB,T990350773,CDM,301,RC,86341,HCPCS,Outpatient,,,197,98.5,,151.69,77,,,Percent of Total Billed Charges,77% of total billed charges,50.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.78,74,,,Percent of Total Billed Charges,74% of total billed charges,135.93,69,,,Percent of Total Billed Charges,69% of total billed charges,135.93,69,,,Percent of Total Billed Charges,69% of total billed charges,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.93,69,,,Percent of Total Billed Charges,69% of total billed charges,135.93,69,,,Percent of Total Billed Charges,69% of total billed charges,165.48,84,,,Percent of Total Billed Charges,84% of total billed charges,161.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.65,500,,,fee schedule,500% of healthlink,83.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,22.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.69,77,,,Percent of total Billed charges,77% of total billed charges,167.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.62,120,,,Fee Schedule,120% of MO Medicaid Rate,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.62,167.45,
CU Index tm,T990350774,CDM,302,RC,86343,HCPCS,Outpatient,,,526.5,263.25,,405.41,77,,,Percent of Total Billed Charges,77% of total billed charges,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,389.61,74,,,Percent of Total Billed Charges,74% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,442.26,84,,,Percent of Total Billed Charges,84% of total billed charges,431.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,91,500,,,fee schedule,500% of healthlink,91,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,91,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,11.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.41,77,,,Percent of total Billed charges,77% of total billed charges,447.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.95,447.53,
LYMPHOCYTE AG STIM SCRN PPD,T990350775,CDM,302,RC,86353,HCPCS,Outpatient,,,600.5,300.25,,462.39,77,,,Percent of Total Billed Charges,77% of total billed charges,153.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,444.37,74,,,Percent of Total Billed Charges,74% of total billed charges,414.35,69,,,Percent of Total Billed Charges,69% of total billed charges,414.35,69,,,Percent of Total Billed Charges,69% of total billed charges,150.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.35,69,,,Percent of Total Billed Charges,69% of total billed charges,414.35,69,,,Percent of Total Billed Charges,69% of total billed charges,504.42,84,,,Percent of Total Billed Charges,84% of total billed charges,492.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,357.9,500,,,fee schedule,500% of healthlink,357.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,357.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,47.06,120,,,Fee Schedule,120% of MO Medicaid Rate,47.06,120,,,Fee Schedule,120% of MO Medicaid Rate,47.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,150.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,462.39,77,,,Percent of total Billed charges,77% of total billed charges,510.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,47.06,120,,,Fee Schedule,120% of MO Medicaid Rate,150.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,150.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.06,510.43,
B CELLS TOTAL COUNT,T990350776,CDM,300,RC,86355,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.85,500,,,fee schedule,500% of healthlink,133.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.22,141.1,
NATURAL KILLER CELLS TOTAL CNT,T990350777,CDM,300,RC,86357,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.85,500,,,fee schedule,500% of healthlink,133.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.22,141.1,
T CELLS TOTAL COUNT,T990350778,CDM,302,RC,86359,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.85,500,,,fee schedule,500% of healthlink,133.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,36.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,36.22,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.22,141.1,
ABSOLUTE CD4 & CD8 CNT W/RATIO,T990350779,CDM,302,RC,86360,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.85,500,,,fee schedule,500% of healthlink,133.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,45.1,120,,,Fee Schedule,120% of MO Medicaid Rate,45.1,120,,,Fee Schedule,120% of MO Medicaid Rate,45.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,45.1,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.5,141.1,
CD4/CD8 RATIO PROFILE,T990350780,CDM,302,RC,86360,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.85,500,,,fee schedule,500% of healthlink,133.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,133.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,45.1,120,,,Fee Schedule,120% of MO Medicaid Rate,45.1,120,,,Fee Schedule,120% of MO Medicaid Rate,45.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,45.1,120,,,Fee Schedule,120% of MO Medicaid Rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.5,141.1,
LYMPHOCYTE SUBSET PANL 5,T990350781,CDM,302,RC,86361,HCPCS,Outpatient,,,179,89.5,,137.83,77,,,Percent of Total Billed Charges,77% of total billed charges,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.46,74,,,Percent of Total Billed Charges,74% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,150.36,84,,,Percent of Total Billed Charges,84% of total billed charges,146.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.95,500,,,fee schedule,500% of healthlink,66.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,66.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.7,120,,,Fee Schedule,120% of MO Medicaid Rate,25.7,120,,,Fee Schedule,120% of MO Medicaid Rate,25.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.83,77,,,Percent of total Billed charges,77% of total billed charges,152.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,25.7,120,,,Fee Schedule,120% of MO Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.7,152.15,
LIVER KIDNEY MICROSOMAL IgG,T990350782,CDM,302,RC,86376,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.25,500,,,fee schedule,500% of healthlink,106.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.97,120,,,Fee Schedule,120% of MO Medicaid Rate,13.97,120,,,Fee Schedule,120% of MO Medicaid Rate,13.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.97,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,146.2,
THYROID PEROXIDASE AB,T990350783,CDM,302,RC,86376,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.25,500,,,fee schedule,500% of healthlink,106.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,106.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.97,120,,,Fee Schedule,120% of MO Medicaid Rate,13.97,120,,,Fee Schedule,120% of MO Medicaid Rate,13.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.97,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,146.2,
CRYPTOCOCCAL AG,T990350784,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
H. INFLUENZAE B AG,T990350785,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
N. MENINGITID B E.COLI K1,T990350786,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
N. MENINGITIDIS C W135,T990350787,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
N. MENINGITIDIS GROUP A Y,T990350788,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
S. PNEUMONIAE AG,T990350789,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
STREPTOCOCCUS GROUP B,T990350790,CDM,302,RC,86403,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.4,500,,,fee schedule,500% of healthlink,74.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,11.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.08,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.08,74.4,
CRYPTOCOCCUS AG TITER,T990350791,CDM,302,RC,86406,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.52,74,,,Percent of Total Billed Charges,74% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,102.12,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,84,,,Percent of Total Billed Charges,84% of total billed charges,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.65,500,,,fee schedule,500% of healthlink,77.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.21,120,,,Fee Schedule,120% of MO Medicaid Rate,10.21,120,,,Fee Schedule,120% of MO Medicaid Rate,10.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.21,120,,,Fee Schedule,120% of MO Medicaid Rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,125.8,
RA FACTOR SCREEN,T990350792,CDM,302,RC,86430,HCPCS,Outpatient,,,98,49,,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.52,74,,,Percent of Total Billed Charges,74% of total billed charges,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,69,,,Percent of Total Billed Charges,69% of total billed charges,82.32,84,,,Percent of Total Billed Charges,84% of total billed charges,80.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.45,500,,,fee schedule,500% of healthlink,41.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,41.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.89,120,,,Fee Schedule,120% of MO Medicaid Rate,5.89,120,,,Fee Schedule,120% of MO Medicaid Rate,5.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.89,120,,,Fee Schedule,120% of MO Medicaid Rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.89,83.3,
RA FACTOR QUANTITATIVE,T990350793,CDM,302,RC,86431,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.45,500,,,fee schedule,500% of healthlink,41.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,41.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.44,120,,,Fee Schedule,120% of MO Medicaid Rate,5.44,120,,,Fee Schedule,120% of MO Medicaid Rate,5.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.44,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,89.68,
RHEUMATOID FACTOR,T990350794,CDM,302,RC,86431,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.45,500,,,fee schedule,500% of healthlink,41.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,41.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.44,120,,,Fee Schedule,120% of MO Medicaid Rate,5.44,120,,,Fee Schedule,120% of MO Medicaid Rate,5.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.44,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,89.68,
QUANTIFERON TB GOLD,T990350795,CDM,302,RC,86480,HCPCS,Outpatient,,,289.5,144.75,,222.92,77,,,Percent of Total Billed Charges,77% of total billed charges,73.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.23,74,,,Percent of Total Billed Charges,74% of total billed charges,199.76,69,,,Percent of Total Billed Charges,69% of total billed charges,199.76,69,,,Percent of Total Billed Charges,69% of total billed charges,72.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.76,69,,,Percent of Total Billed Charges,69% of total billed charges,199.76,69,,,Percent of Total Billed Charges,69% of total billed charges,243.18,84,,,Percent of Total Billed Charges,84% of total billed charges,237.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.45,500,,,fee schedule,500% of healthlink,452.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,452.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,59.5,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.92,77,,,Percent of total Billed charges,77% of total billed charges,246.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.5,120,,,Fee Schedule,120% of MO Medicaid Rate,72.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,72.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,452.45,
RPR (RAPID PLASMA REAGIN),T990350796,CDM,302,RC,86592,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,65.88,
VDRL CSF,T990350797,CDM,302,RC,86592,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,65.88,
VDRL SERUM,T990350798,CDM,302,RC,86592,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,65.88,
RPR TITER,T990350799,CDM,302,RC,86593,HCPCS,Outpatient,,,79.5,39.75,,61.22,77,,,Percent of Total Billed Charges,77% of total billed charges,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.83,74,,,Percent of Total Billed Charges,74% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,66.78,84,,,Percent of Total Billed Charges,84% of total billed charges,65.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.15,500,,,fee schedule,500% of healthlink,32.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,32.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.22,120,,,Fee Schedule,120% of MO Medicaid Rate,4.22,120,,,Fee Schedule,120% of MO Medicaid Rate,4.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,77,,,Percent of total Billed charges,77% of total billed charges,67.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.22,120,,,Fee Schedule,120% of MO Medicaid Rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.22,67.58,
ADENOVIRUS AB,T990350800,CDM,302,RC,86603,HCPCS,Outpatient,,,160,80,,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.4,74,,,Percent of Total Billed Charges,74% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,84,,,Percent of Total Billed Charges,84% of total billed charges,131.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.95,500,,,fee schedule,500% of healthlink,93.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,93.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,12.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.35,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.35,136,
ASPERGILLAS AB,T990350801,CDM,302,RC,86606,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.9,500,,,fee schedule,500% of healthlink,109.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,109.9,
ASPERGILLAS FLAVUS AB,T990350802,CDM,302,RC,86606,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.9,500,,,fee schedule,500% of healthlink,109.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,109.9,
ASPERGILLAS NIGER AB,T990350803,CDM,300,RC,86606,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.9,500,,,fee schedule,500% of healthlink,109.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,109.9,
ASPERGILLUS ANTIBODY SCREEN,T990350804,CDM,302,RC,86606,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.9,500,,,fee schedule,500% of healthlink,109.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,109.9,
ASPERGILLUS fumigatus,T990350805,CDM,302,RC,86606,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.9,500,,,fee schedule,500% of healthlink,109.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,14.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.45,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.45,109.9,
BACTERIUM AB,T990350806,CDM,302,RC,86609,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,94.05,
B. HENSELAE IgG TITER,T990350807,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
B. HENSELAE IgM TITER,T990350808,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
B. QUINTANA IgG TITER,T990350809,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
B. QUINTANA IgM TITER,T990350810,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
CAT SCRATCH B. henselae IgG AB,T990350811,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
CAT SCRATCH B. henselae IgM AB,T990350812,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
CAT SCRATCH B. quintana IgG AB,T990350813,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
CAT SCRATCH B. quintana IgM AB,T990350814,CDM,302,RC,86611,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,109.23,
BLASTOMYCES AB,T990350815,CDM,302,RC,86612,HCPCS,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.2,500,,,fee schedule,500% of healthlink,94.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,12.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.38,120,,,Fee Schedule,120% of MO Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.38,94.2,
B. PERTUSSIS IgM 1,T990350816,CDM,302,RC,86615,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,131.33,
B. PERTUSSIS IgM 2,T990350817,CDM,302,RC,86615,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,131.33,
BORDETELLA PERTUSSIS AB IgA,T990350818,CDM,302,RC,86615,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,131.33,
BORDETELLA PERTUSSIS AB IgG,T990350819,CDM,302,RC,86615,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,131.33,
BORDETELLA PERTUSSIS AB IgM,T990350820,CDM,302,RC,86615,HCPCS,Outpatient,,,154.5,77.25,,118.97,77,,,Percent of Total Billed Charges,77% of total billed charges,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.33,74,,,Percent of Total Billed Charges,74% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,106.61,69,,,Percent of Total Billed Charges,69% of total billed charges,129.78,84,,,Percent of Total Billed Charges,84% of total billed charges,126.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.97,77,,,Percent of total Billed charges,77% of total billed charges,131.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,131.33,
LYME DISEASE IGG/IGM WB,T990350821,CDM,302,RC,86617,HCPCS,Outpatient,,,108.5,54.25,,83.55,77,,,Percent of Total Billed Charges,77% of total billed charges,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.29,74,,,Percent of Total Billed Charges,74% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,91.14,84,,,Percent of Total Billed Charges,84% of total billed charges,88.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.05,500,,,fee schedule,500% of healthlink,113.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,113.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.87,120,,,Fee Schedule,120% of MO Medicaid Rate,14.87,120,,,Fee Schedule,120% of MO Medicaid Rate,14.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.55,77,,,Percent of total Billed charges,77% of total billed charges,92.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.87,120,,,Fee Schedule,120% of MO Medicaid Rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,113.05,
LYME DISEASE EIA,T990350822,CDM,302,RC,86618,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.35,500,,,fee schedule,500% of healthlink,124.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,124.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,16.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.34,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.34,136.85,
BRUCELLA IgG EIA,T990350823,CDM,302,RC,86622,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,500,,,fee schedule,500% of healthlink,65.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,65.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.57,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.57,136.85,
BRUCELLA IgM EIA,T990350824,CDM,302,RC,86622,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,500,,,fee schedule,500% of healthlink,65.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,65.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.57,120,,,Fee Schedule,120% of MO Medicaid Rate,8.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.57,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.57,136.85,
CANDIDA AB EACH,T990350825,CDM,302,RC,86628,HCPCS,Outpatient,,,75.5,37.75,,58.14,77,,,Percent of Total Billed Charges,77% of total billed charges,19.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.87,74,,,Percent of Total Billed Charges,74% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,63.42,84,,,Percent of Total Billed Charges,84% of total billed charges,61.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.65,500,,,fee schedule,500% of healthlink,87.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,11.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.14,77,,,Percent of total Billed charges,77% of total billed charges,64.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.52,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.52,87.65,
CHLAMYDIA pneumoniae IgA,T990350826,CDM,302,RC,86631,HCPCS,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.35,500,,,fee schedule,500% of healthlink,86.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,86.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.34,86.35,
CHLAMYDIA pneumoniae IgG,T990350827,CDM,302,RC,86631,HCPCS,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.35,500,,,fee schedule,500% of healthlink,86.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,86.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.34,86.35,
CHLAMYDIA PSITTACI,T990350828,CDM,302,RC,86631,HCPCS,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.35,500,,,fee schedule,500% of healthlink,86.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,86.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.34,86.35,
CHLAMYDIA PSITTACI IgG,T990350829,CDM,302,RC,86631,HCPCS,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.35,500,,,fee schedule,500% of healthlink,86.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,86.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.34,86.35,
CHLAMYDIA trachomatis IgA,T990350830,CDM,302,RC,86631,HCPCS,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.35,500,,,fee schedule,500% of healthlink,86.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,86.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.34,86.35,
CHLAMYDIA trachomatis IgG,T990350831,CDM,302,RC,86631,HCPCS,Outpatient,,,79,39.5,,60.83,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.46,74,,,Percent of Total Billed Charges,74% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.51,69,,,Percent of Total Billed Charges,69% of total billed charges,66.36,84,,,Percent of Total Billed Charges,84% of total billed charges,64.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.35,500,,,fee schedule,500% of healthlink,86.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,86.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,11.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.83,77,,,Percent of total Billed charges,77% of total billed charges,67.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.34,120,,,Fee Schedule,120% of MO Medicaid Rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.34,86.35,
CHLAMYDIA pneumoniae IgM,T990350832,CDM,302,RC,86632,HCPCS,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.75,74,,,Percent of Total Billed Charges,74% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,84,,,Percent of Total Billed Charges,84% of total billed charges,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.65,500,,,fee schedule,500% of healthlink,92.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,92.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,12.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.17,92.65,
CHLAMYDIA PSITTACI IgM,T990350833,CDM,302,RC,86632,HCPCS,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.75,74,,,Percent of Total Billed Charges,74% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,84,,,Percent of Total Billed Charges,84% of total billed charges,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.65,500,,,fee schedule,500% of healthlink,92.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,92.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,12.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.17,92.65,
CHLAMYDIA trachomatis IgM,T990350834,CDM,302,RC,86632,HCPCS,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.75,74,,,Percent of Total Billed Charges,74% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,60.38,69,,,Percent of Total Billed Charges,69% of total billed charges,73.5,84,,,Percent of Total Billed Charges,84% of total billed charges,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.65,500,,,fee schedule,500% of healthlink,92.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,92.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,12.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.17,120,,,Fee Schedule,120% of MO Medicaid Rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.17,92.65,
COCCIDIOIDES AB CF,T990350835,CDM,302,RC,86635,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.5,74,,,Percent of Total Billed Charges,74% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,63,84,,,Percent of Total Billed Charges,84% of total billed charges,61.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.75,500,,,fee schedule,500% of healthlink,83.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,83.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11,120,,,Fee Schedule,120% of MO Medicaid Rate,11,120,,,Fee Schedule,120% of MO Medicaid Rate,11,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11,120,,,Fee Schedule,120% of MO Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,83.75,
Q FEVER IgG PHASE I SCRN,T990350836,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgG PHASE I TITER,T990350837,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgG PHASE II SCRN,T990350838,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgG PHASE II TITR,T990350839,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgM PHASE I SCRN,T990350840,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgM PHASE I TITER,T990350841,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgM PHASE II SCRN,T990350842,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
Q FEVER IgM PHASE II TITR,T990350843,CDM,302,RC,86638,HCPCS,Outpatient,,,77.5,38.75,,59.68,77,,,Percent of Total Billed Charges,77% of total billed charges,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.35,74,,,Percent of Total Billed Charges,74% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,53.48,69,,,Percent of Total Billed Charges,69% of total billed charges,65.1,84,,,Percent of Total Billed Charges,84% of total billed charges,63.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.8,500,,,fee schedule,500% of healthlink,25.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,25.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,11.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,77,,,Percent of total Billed charges,77% of total billed charges,65.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.63,120,,,Fee Schedule,120% of MO Medicaid Rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.63,65.88,
CMV AB IgG BY EIA,T990350844,CDM,302,RC,86644,HCPCS,Outpatient,,,207,103.5,,159.39,77,,,Percent of Total Billed Charges,77% of total billed charges,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.18,74,,,Percent of Total Billed Charges,74% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,173.88,84,,,Percent of Total Billed Charges,84% of total billed charges,169.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.39,77,,,Percent of total Billed charges,77% of total billed charges,175.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.81,175.95,
CMV AB IgM BY EIA,T990350845,CDM,302,RC,86645,HCPCS,Outpatient,,,250.5,125.25,,192.89,77,,,Percent of Total Billed Charges,77% of total billed charges,63.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.37,74,,,Percent of Total Billed Charges,74% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,210.42,84,,,Percent of Total Billed Charges,84% of total billed charges,205.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,500,,,fee schedule,500% of healthlink,123,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.89,77,,,Percent of total Billed charges,77% of total billed charges,212.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,212.93,
California Encephalitis,T990350846,CDM,302,RC,86651,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.4,500,,,fee schedule,500% of healthlink,61.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,73.1,
Eastern Equine Encephalitis,T990350847,CDM,302,RC,86652,HCPCS,Outpatient,,,93,46.5,,71.61,77,,,Percent of Total Billed Charges,77% of total billed charges,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.82,74,,,Percent of Total Billed Charges,74% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.17,69,,,Percent of Total Billed Charges,69% of total billed charges,78.12,84,,,Percent of Total Billed Charges,84% of total billed charges,76.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.4,500,,,fee schedule,500% of healthlink,61.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.61,77,,,Percent of total Billed charges,77% of total billed charges,79.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,79.05,
St. Louis Encephalitis,T990350848,CDM,302,RC,86653,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.4,500,,,fee schedule,500% of healthlink,61.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,65.45,
Western Equine Encephalitis,T990350849,CDM,302,RC,86654,HCPCS,Outpatient,,,100.5,50.25,,77.39,77,,,Percent of Total Billed Charges,77% of total billed charges,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.37,74,,,Percent of Total Billed Charges,74% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.42,84,,,Percent of Total Billed Charges,84% of total billed charges,82.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.4,500,,,fee schedule,500% of healthlink,61.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.39,77,,,Percent of total Billed charges,77% of total billed charges,85.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,85.43,
Coxsackie AB each,T990350850,CDM,302,RC,86658,HCPCS,Outpatient,,,38.5,19.25,,29.65,77,,,Percent of Total Billed Charges,77% of total billed charges,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.49,74,,,Percent of Total Billed Charges,74% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,32.34,84,,,Percent of Total Billed Charges,84% of total billed charges,31.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.15,500,,,fee schedule,500% of healthlink,95.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.5,120,,,Fee Schedule,120% of MO Medicaid Rate,12.5,120,,,Fee Schedule,120% of MO Medicaid Rate,12.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.65,77,,,Percent of total Billed charges,77% of total billed charges,32.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.5,120,,,Fee Schedule,120% of MO Medicaid Rate,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,95.15,
POLIOVIRUS EACH TYPE,T990350851,CDM,301,RC,86658,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.15,500,,,fee schedule,500% of healthlink,95.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.5,120,,,Fee Schedule,120% of MO Medicaid Rate,12.5,120,,,Fee Schedule,120% of MO Medicaid Rate,12.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,95.15,
EBV EARLY AG D AG IgG,T990350852,CDM,302,RC,86663,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.8,500,,,fee schedule,500% of healthlink,95.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.59,120,,,Fee Schedule,120% of MO Medicaid Rate,12.59,120,,,Fee Schedule,120% of MO Medicaid Rate,12.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.59,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.59,136.85,
EBV EARLY AG R+D IgG,T990350853,CDM,302,RC,86663,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.8,500,,,fee schedule,500% of healthlink,95.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.59,120,,,Fee Schedule,120% of MO Medicaid Rate,12.59,120,,,Fee Schedule,120% of MO Medicaid Rate,12.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.59,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.59,136.85,
"EBV AB to NUCLEAR AG, IgG",T990350854,CDM,302,RC,86664,HCPCS,Outpatient,,,96.5,48.25,,74.31,77,,,Percent of Total Billed Charges,77% of total billed charges,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.41,74,,,Percent of Total Billed Charges,74% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,66.59,69,,,Percent of Total Billed Charges,69% of total billed charges,81.06,84,,,Percent of Total Billed Charges,84% of total billed charges,79.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.7,500,,,fee schedule,500% of healthlink,111.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,111.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.68,120,,,Fee Schedule,120% of MO Medicaid Rate,14.68,120,,,Fee Schedule,120% of MO Medicaid Rate,14.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.31,77,,,Percent of total Billed charges,77% of total billed charges,82.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.68,120,,,Fee Schedule,120% of MO Medicaid Rate,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.68,111.7,
"EBV AB to VIRAL CAPSID AG, IgG",T990350855,CDM,302,RC,86665,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.82,74,,,Percent of Total Billed Charges,74% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.4,500,,,fee schedule,500% of healthlink,132.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,132.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.41,120,,,Fee Schedule,120% of MO Medicaid Rate,17.41,120,,,Fee Schedule,120% of MO Medicaid Rate,17.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.41,120,,,Fee Schedule,120% of MO Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.41,132.4,
"EBV AB to VIRAL CAPSID AG, IgM",T990350856,CDM,302,RC,86665,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.82,74,,,Percent of Total Billed Charges,74% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,98.67,69,,,Percent of Total Billed Charges,69% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.4,500,,,fee schedule,500% of healthlink,132.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,132.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.41,120,,,Fee Schedule,120% of MO Medicaid Rate,17.41,120,,,Fee Schedule,120% of MO Medicaid Rate,17.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.41,120,,,Fee Schedule,120% of MO Medicaid Rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.41,132.4,
EHRLICHIA IgG HME,T990350857,CDM,302,RC,86666,HCPCS,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,169.58,
EHRLICHIA IgM HME,T990350858,CDM,302,RC,86666,HCPCS,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.55,500,,,fee schedule,500% of healthlink,46.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,46.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,9.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.77,120,,,Fee Schedule,120% of MO Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.77,169.58,
FRANCISELLA TULARENSIS AB DF,T990350859,CDM,302,RC,86668,HCPCS,Outpatient,,,223.5,111.75,,172.1,77,,,Percent of Total Billed Charges,77% of total billed charges,56.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.39,74,,,Percent of Total Billed Charges,74% of total billed charges,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,154.22,69,,,Percent of Total Billed Charges,69% of total billed charges,187.74,84,,,Percent of Total Billed Charges,84% of total billed charges,183.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.4,500,,,fee schedule,500% of healthlink,63.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.58,120,,,Fee Schedule,120% of MO Medicaid Rate,13.58,120,,,Fee Schedule,120% of MO Medicaid Rate,13.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.1,77,,,Percent of total Billed charges,77% of total billed charges,189.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.58,120,,,Fee Schedule,120% of MO Medicaid Rate,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,55.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.58,189.98,
SACCHAROMYCES cerevisiae IgA,T990350860,CDM,302,RC,86671,HCPCS,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.3,500,,,fee schedule,500% of healthlink,59.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.76,169.58,
SACCHAROMYUCES cerevisiae IgG,T990350861,CDM,302,RC,86671,HCPCS,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.3,500,,,fee schedule,500% of healthlink,59.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.76,169.58,
SPOROTHRIX AB LA SERUM,T990350862,CDM,302,RC,86671,HCPCS,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.3,500,,,fee schedule,500% of healthlink,59.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,11.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.76,120,,,Fee Schedule,120% of MO Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.76,169.58,
"GIARDIA lamblia AB, IgA",T990350863,CDM,302,RC,86674,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.5,500,,,fee schedule,500% of healthlink,107.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,14.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.12,113.48,
"GIARDIA lamblia AB, IgG",T990350864,CDM,302,RC,86674,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.5,500,,,fee schedule,500% of healthlink,107.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,14.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.12,113.48,
"GIARDIA lamblia AB, IgM",T990350865,CDM,302,RC,86674,HCPCS,Outpatient,,,133.5,66.75,,102.8,77,,,Percent of Total Billed Charges,77% of total billed charges,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.79,74,,,Percent of Total Billed Charges,74% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,92.12,69,,,Percent of Total Billed Charges,69% of total billed charges,112.14,84,,,Percent of Total Billed Charges,84% of total billed charges,109.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.5,500,,,fee schedule,500% of healthlink,107.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,107.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,14.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.8,77,,,Percent of total Billed charges,77% of total billed charges,113.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.12,120,,,Fee Schedule,120% of MO Medicaid Rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.12,113.48,
H. pylori AB IgA,T990350866,CDM,302,RC,86677,HCPCS,Outpatient,,,237,118.5,,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.38,74,,,Percent of Total Billed Charges,74% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,199.08,84,,,Percent of Total Billed Charges,84% of total billed charges,194.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.95,500,,,fee schedule,500% of healthlink,105.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,201.45,
H. pylori AB IgG QUANT,T990350867,CDM,302,RC,86677,HCPCS,Outpatient,,,237,118.5,,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.38,74,,,Percent of Total Billed Charges,74% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,199.08,84,,,Percent of Total Billed Charges,84% of total billed charges,194.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.95,500,,,fee schedule,500% of healthlink,105.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,201.45,
H. PYLORI AB WESTERN BLOT EACH,T990350868,CDM,302,RC,86677,HCPCS,Outpatient,,,237,118.5,,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.38,74,,,Percent of Total Billed Charges,74% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,199.08,84,,,Percent of Total Billed Charges,84% of total billed charges,194.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.95,500,,,fee schedule,500% of healthlink,105.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,201.45,
HELICOBACTER PYLORI AB IgM,T990350869,CDM,302,RC,86677,HCPCS,Outpatient,,,237,118.5,,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.38,74,,,Percent of Total Billed Charges,74% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,199.08,84,,,Percent of Total Billed Charges,84% of total billed charges,194.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.95,500,,,fee schedule,500% of healthlink,105.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,201.45,
CYSTICERCUS AB,T990350870,CDM,302,RC,86682,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185,74,,,Percent of Total Billed Charges,74% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,210,84,,,Percent of Total Billed Charges,84% of total billed charges,205,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.6,500,,,fee schedule,500% of healthlink,75.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,75.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.48,120,,,Fee Schedule,120% of MO Medicaid Rate,12.48,120,,,Fee Schedule,120% of MO Medicaid Rate,12.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.48,120,,,Fee Schedule,120% of MO Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.48,212.5,
STRONGYLOIDES IgG AB,T990350871,CDM,302,RC,86682,HCPCS,Outpatient,,,250,125,,192.5,77,,,Percent of Total Billed Charges,77% of total billed charges,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185,74,,,Percent of Total Billed Charges,74% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,172.5,69,,,Percent of Total Billed Charges,69% of total billed charges,210,84,,,Percent of Total Billed Charges,84% of total billed charges,205,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.6,500,,,fee schedule,500% of healthlink,75.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,75.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.48,120,,,Fee Schedule,120% of MO Medicaid Rate,12.48,120,,,Fee Schedule,120% of MO Medicaid Rate,12.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.5,77,,,Percent of total Billed charges,77% of total billed charges,212.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.48,120,,,Fee Schedule,120% of MO Medicaid Rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.48,212.5,
HAEMOPHILUS INFLUENZA B IgG,T990350872,CDM,302,RC,86684,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.65,500,,,fee schedule,500% of healthlink,115.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,115.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.2,120,,,Fee Schedule,120% of MO Medicaid Rate,15.2,120,,,Fee Schedule,120% of MO Medicaid Rate,15.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.2,120,,,Fee Schedule,120% of MO Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.2,140.25,
HIV-1 CONFIRMATION WB,T990350873,CDM,301,RC,86689,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.12,74,,,Percent of Total Billed Charges,74% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,202.3,
HTLV I/II AB WESTERN BLOT,T990350874,CDM,302,RC,86689,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.12,74,,,Percent of Total Billed Charges,74% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,164.22,69,,,Percent of Total Billed Charges,69% of total billed charges,199.92,84,,,Percent of Total Billed Charges,84% of total billed charges,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,202.3,
HSV IgM AB w/REFLEX TITER,T990350875,CDM,302,RC,86694,HCPCS,Outpatient,,,189.5,94.75,,145.92,77,,,Percent of Total Billed Charges,77% of total billed charges,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.23,74,,,Percent of Total Billed Charges,74% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,159.18,84,,,Percent of Total Billed Charges,84% of total billed charges,155.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.92,77,,,Percent of total Billed charges,77% of total billed charges,161.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.81,161.08,
HSV 1 IgM AB,T990350876,CDM,302,RC,86695,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,136.85,
HSV I IgG AB,T990350877,CDM,302,RC,86695,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.25,500,,,fee schedule,500% of healthlink,96.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,12.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.66,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.66,136.85,
HSV 2 IgG INHIBITION ELISA,T990350878,CDM,302,RC,86696,HCPCS,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,184.03,
"HSV 2 IgG, HERPESELECT AB",T990350879,CDM,302,RC,86696,HCPCS,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,184.03,
HSV 2 IgM AB,T990350880,CDM,302,RC,86696,HCPCS,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,184.03,
HSV II IgG AB,T990350881,CDM,302,RC,86696,HCPCS,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,184.03,
HISTOPLASMA AB,T990350882,CDM,302,RC,86698,HCPCS,Outpatient,,,75.5,37.75,,58.14,77,,,Percent of Total Billed Charges,77% of total billed charges,19.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.87,74,,,Percent of Total Billed Charges,74% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,52.1,69,,,Percent of Total Billed Charges,69% of total billed charges,63.42,84,,,Percent of Total Billed Charges,84% of total billed charges,61.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.25,500,,,fee schedule,500% of healthlink,91.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,91.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.24,120,,,Fee Schedule,120% of MO Medicaid Rate,13.24,120,,,Fee Schedule,120% of MO Medicaid Rate,13.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.14,77,,,Percent of total Billed charges,77% of total billed charges,64.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.24,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.24,91.25,
HIV-1 AB,T990350883,CDM,302,RC,86701,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.8,500,,,fee schedule,500% of healthlink,64.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,64.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.53,120,,,Fee Schedule,120% of MO Medicaid Rate,8.53,120,,,Fee Schedule,120% of MO Medicaid Rate,8.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.53,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.53,144.93,
HIV 1/2 SCREEN/RESCREEN,T990350884,CDM,301,RC,86703,HCPCS,Outpatient,,,179,89.5,,137.83,77,,,Percent of Total Billed Charges,77% of total billed charges,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.46,74,,,Percent of Total Billed Charges,74% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,150.36,84,,,Percent of Total Billed Charges,84% of total billed charges,146.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.1,500,,,fee schedule,500% of healthlink,100.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,100.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.15,120,,,Fee Schedule,120% of MO Medicaid Rate,13.15,120,,,Fee Schedule,120% of MO Medicaid Rate,13.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.83,77,,,Percent of total Billed charges,77% of total billed charges,152.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.15,120,,,Fee Schedule,120% of MO Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.15,152.15,
"HEPATITIS B CORE AB, TOTAL",T990350885,CDM,302,RC,86704,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,109.23,
"HEPATITIS B CORE AB, IgM",T990350886,CDM,302,RC,86705,HCPCS,Outpatient,,,124.5,62.25,,95.87,77,,,Percent of Total Billed Charges,77% of total billed charges,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.13,74,,,Percent of Total Billed Charges,74% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,85.91,69,,,Percent of Total Billed Charges,69% of total billed charges,104.58,84,,,Percent of Total Billed Charges,84% of total billed charges,102.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.9,500,,,fee schedule,500% of healthlink,85.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,85.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.29,120,,,Fee Schedule,120% of MO Medicaid Rate,11.29,120,,,Fee Schedule,120% of MO Medicaid Rate,11.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.87,77,,,Percent of total Billed charges,77% of total billed charges,105.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.29,120,,,Fee Schedule,120% of MO Medicaid Rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,105.83,
HEPATITIS B SURFACE AB,T990350887,CDM,302,RC,86706,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.4,500,,,fee schedule,500% of healthlink,78.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,78.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.31,112.2,
HEPATITIS Be AB,T990350888,CDM,302,RC,86707,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.45,500,,,fee schedule,500% of healthlink,84.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.1,120,,,Fee Schedule,120% of MO Medicaid Rate,11.1,120,,,Fee Schedule,120% of MO Medicaid Rate,11.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.1,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,105.4,
"HEPATITIS A AB, TOTAL",T990350889,CDM,302,RC,86708,HCPCS,Outpatient,,,144,72,,110.88,77,,,Percent of Total Billed Charges,77% of total billed charges,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.56,74,,,Percent of Total Billed Charges,74% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,120.96,84,,,Percent of Total Billed Charges,84% of total billed charges,118.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.45,500,,,fee schedule,500% of healthlink,90.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,90.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.88,77,,,Percent of total Billed charges,77% of total billed charges,122.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.89,122.4,
"HEPATITIS A AB, IgM",T990350890,CDM,302,RC,86709,HCPCS,Outpatient,,,146.5,73.25,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.41,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.06,84,,,Percent of Total Billed Charges,84% of total billed charges,120.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.2,500,,,fee schedule,500% of healthlink,82.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,82.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.8,120,,,Fee Schedule,120% of MO Medicaid Rate,10.8,120,,,Fee Schedule,120% of MO Medicaid Rate,10.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.8,120,,,Fee Schedule,120% of MO Medicaid Rate,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,124.53,
INFLUENZA TYPE A AB,T990350891,CDM,302,RC,86710,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.8,500,,,fee schedule,500% of healthlink,55.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,55.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.01,120,,,Fee Schedule,120% of MO Medicaid Rate,13.01,120,,,Fee Schedule,120% of MO Medicaid Rate,13.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.01,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.01,103.28,
INFLUENZA TYPE B AB,T990350892,CDM,302,RC,86710,HCPCS,Outpatient,,,121.5,60.75,,93.56,77,,,Percent of Total Billed Charges,77% of total billed charges,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.91,74,,,Percent of Total Billed Charges,74% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,83.84,69,,,Percent of Total Billed Charges,69% of total billed charges,102.06,84,,,Percent of Total Billed Charges,84% of total billed charges,99.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.8,500,,,fee schedule,500% of healthlink,55.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,55.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.01,120,,,Fee Schedule,120% of MO Medicaid Rate,13.01,120,,,Fee Schedule,120% of MO Medicaid Rate,13.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.56,77,,,Percent of total Billed charges,77% of total billed charges,103.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.01,120,,,Fee Schedule,120% of MO Medicaid Rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.01,103.28,
L. pneumophila EACH AB,T990350893,CDM,302,RC,86713,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.02,74,,,Percent of Total Billed Charges,74% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,84.87,69,,,Percent of Total Billed Charges,69% of total billed charges,103.32,84,,,Percent of Total Billed Charges,84% of total billed charges,100.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.75,500,,,fee schedule,500% of healthlink,111.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,111.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.69,120,,,Fee Schedule,120% of MO Medicaid Rate,14.69,120,,,Fee Schedule,120% of MO Medicaid Rate,14.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.69,120,,,Fee Schedule,120% of MO Medicaid Rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,111.75,
MUMPS AB IgG,T990350894,CDM,302,RC,86735,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,117.66,74,,,Percent of Total Billed Charges,74% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,133.56,84,,,Percent of Total Billed Charges,84% of total billed charges,130.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.3,500,,,fee schedule,500% of healthlink,95.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.53,135.15,
MUMPS AB IgM,T990350895,CDM,302,RC,86735,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,117.66,74,,,Percent of Total Billed Charges,74% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,133.56,84,,,Percent of Total Billed Charges,84% of total billed charges,130.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.3,500,,,fee schedule,500% of healthlink,95.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,95.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,12.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.53,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.53,135.15,
MYCOPLASMA pneumoniae IgG AB,T990350896,CDM,302,RC,86738,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.7,500,,,fee schedule,500% of healthlink,96.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,12.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,146.2,
MYCOPLASMA pneumoniae IgM AB,T990350897,CDM,302,RC,86738,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.7,500,,,fee schedule,500% of healthlink,96.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,96.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,12.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,146.2,
PAROVIRUS B19 IgG AB,T990350898,CDM,302,RC,86747,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.75,500,,,fee schedule,500% of healthlink,109.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.42,120,,,Fee Schedule,120% of MO Medicaid Rate,14.42,120,,,Fee Schedule,120% of MO Medicaid Rate,14.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.42,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.42,146.2,
PAROVIRUS B19 IgM AB,T990350899,CDM,302,RC,86747,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.75,500,,,fee schedule,500% of healthlink,109.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.42,120,,,Fee Schedule,120% of MO Medicaid Rate,14.42,120,,,Fee Schedule,120% of MO Medicaid Rate,14.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.42,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.42,146.2,
BABESIA MICROTI AB EACH,T990350900,CDM,302,RC,86753,HCPCS,Outpatient,,,116,58,,89.32,77,,,Percent of Total Billed Charges,77% of total billed charges,29.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.84,74,,,Percent of Total Billed Charges,74% of total billed charges,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,80.04,69,,,Percent of Total Billed Charges,69% of total billed charges,97.44,84,,,Percent of Total Billed Charges,84% of total billed charges,95.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.75,500,,,fee schedule,500% of healthlink,42.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.32,77,,,Percent of total Billed charges,77% of total billed charges,98.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.89,98.6,
TRYPANOSOMA CRUZI AB IGG,T990350901,CDM,302,RC,86753,HCPCS,Outpatient,,,544.5,272.25,,419.27,77,,,Percent of Total Billed Charges,77% of total billed charges,138.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,402.93,74,,,Percent of Total Billed Charges,74% of total billed charges,375.71,69,,,Percent of Total Billed Charges,69% of total billed charges,375.71,69,,,Percent of Total Billed Charges,69% of total billed charges,136.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.71,69,,,Percent of Total Billed Charges,69% of total billed charges,375.71,69,,,Percent of Total Billed Charges,69% of total billed charges,457.38,84,,,Percent of Total Billed Charges,84% of total billed charges,446.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.75,500,,,fee schedule,500% of healthlink,42.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,11.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,136.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.27,77,,,Percent of total Billed charges,77% of total billed charges,462.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,156.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.89,120,,,Fee Schedule,120% of MO Medicaid Rate,136.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,136.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.89,462.83,
RICKETTSIAL IgG QUANT,T990350902,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
RICKETTSIAL IgM QUANT,T990350903,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
RMSF AB TITER IgG,T990350904,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
RMSF AB TITER IgM,T990350905,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
TYPHUS FEVER AB SCREEN IgG,T990350906,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
TYPHUS FEVER AB SCREEN IgM,T990350907,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
TYPHUS FEVER AB TITER IgG,T990350908,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
TYPHUS FEVER AB TITER IgM,T990350909,CDM,302,RC,86757,HCPCS,Outpatient,,,265,132.5,,204.05,77,,,Percent of Total Billed Charges,77% of total billed charges,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,196.1,74,,,Percent of Total Billed Charges,74% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,182.85,69,,,Percent of Total Billed Charges,69% of total billed charges,222.6,84,,,Percent of Total Billed Charges,84% of total billed charges,217.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.3,500,,,fee schedule,500% of healthlink,141.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,141.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,18.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.05,77,,,Percent of total Billed charges,77% of total billed charges,225.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.58,120,,,Fee Schedule,120% of MO Medicaid Rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.58,225.25,
"RUBELLA AB, IgG Immune Status",T990350910,CDM,302,RC,86762,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.81,167.88,
RUBELLA IgM AB,T990350911,CDM,302,RC,86762,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.81,167.88,
MEASLES AB IgM,T990350912,CDM,302,RC,86765,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,160.65,
MEASLES IgG AB (RUBEOLA),T990350913,CDM,302,RC,86765,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,160.65,
"COV-19 ANTI IGG,IGM TOTAL,IMMU",T990350914,CDM,300,RC,86769,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,52.66,125,,,fee schedule,125% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,42.13,100,,,fee schedule,100% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,36.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.13,100,,,fee schedule,100% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,42.13,100,,,Fee Schedule,100% of CMS OPPS Rate,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,36.4,64,
"COVID-19 ANTIBODY IGG, IMMUNOA",T990350915,CDM,300,RC,86769,HCPCS,Outpatient,,,244.5,122.25,,188.27,77,,,Percent of Total Billed Charges,77% of total billed charges,62.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.93,74,,,Percent of Total Billed Charges,74% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,168.71,69,,,Percent of Total Billed Charges,69% of total billed charges,205.38,84,,,Percent of Total Billed Charges,84% of total billed charges,200.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.61,89,,,Percent of total Billed Charges,89% of total Billed charges,217.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,36.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.27,77,,,Percent of total Billed charges,77% of total billed charges,207.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,36.4,120,,,Fee Schedule,120% of MO Medicaid Rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.4,217.61,
TETANUS ANTITOXOID AB,T990350916,CDM,302,RC,86774,HCPCS,Outpatient,,,418.5,209.25,,322.25,77,,,Percent of Total Billed Charges,77% of total billed charges,106.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,309.69,74,,,Percent of Total Billed Charges,74% of total billed charges,288.77,69,,,Percent of Total Billed Charges,69% of total billed charges,288.77,69,,,Percent of Total Billed Charges,69% of total billed charges,104.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.77,69,,,Percent of Total Billed Charges,69% of total billed charges,288.77,69,,,Percent of Total Billed Charges,69% of total billed charges,351.54,84,,,Percent of Total Billed Charges,84% of total billed charges,343.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.05,500,,,fee schedule,500% of healthlink,108.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,108.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.21,120,,,Fee Schedule,120% of MO Medicaid Rate,14.21,120,,,Fee Schedule,120% of MO Medicaid Rate,14.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,104.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.25,77,,,Percent of total Billed charges,77% of total billed charges,355.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.21,120,,,Fee Schedule,120% of MO Medicaid Rate,104.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,104.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.21,355.73,
TOXOPLASMA IgG AB,T990350917,CDM,302,RC,86777,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.82,74,,,Percent of Total Billed Charges,74% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.81,164.05,
TOXOPLASMA IgM AB,T990350918,CDM,302,RC,86778,HCPCS,Outpatient,,,179,89.5,,137.83,77,,,Percent of Total Billed Charges,77% of total billed charges,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.46,74,,,Percent of Total Billed Charges,74% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,150.36,84,,,Percent of Total Billed Charges,84% of total billed charges,146.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.15,500,,,fee schedule,500% of healthlink,105.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.82,120,,,Fee Schedule,120% of MO Medicaid Rate,13.82,120,,,Fee Schedule,120% of MO Medicaid Rate,13.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.83,77,,,Percent of total Billed charges,77% of total billed charges,152.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.82,120,,,Fee Schedule,120% of MO Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,152.15,
FTA-ABS,T990350919,CDM,302,RC,86780,HCPCS,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.26,74,,,Percent of Total Billed Charges,74% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,83.16,84,,,Percent of Total Billed Charges,84% of total billed charges,81.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,12.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.71,120,,,Fee Schedule,120% of MO Medicaid Rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,24.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,88.11,
VZV AB IgG,T990350920,CDM,302,RC,86787,HCPCS,Outpatient,,,251.5,125.75,,193.66,77,,,Percent of Total Billed Charges,77% of total billed charges,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.11,74,,,Percent of Total Billed Charges,74% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,211.26,84,,,Percent of Total Billed Charges,84% of total billed charges,206.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.66,77,,,Percent of total Billed charges,77% of total billed charges,213.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,213.78,
VZV AB IgM,T990350921,CDM,302,RC,86787,HCPCS,Outpatient,,,251.5,125.75,,193.66,77,,,Percent of Total Billed Charges,77% of total billed charges,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.11,74,,,Percent of Total Billed Charges,74% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,173.54,69,,,Percent of Total Billed Charges,69% of total billed charges,211.26,84,,,Percent of Total Billed Charges,84% of total billed charges,206.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.66,77,,,Percent of total Billed charges,77% of total billed charges,213.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,213.78,
WEST NILE VIRUS IgM,T990350922,CDM,302,RC,86788,HCPCS,Outpatient,,,203,101.5,,156.31,77,,,Percent of Total Billed Charges,77% of total billed charges,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.22,74,,,Percent of Total Billed Charges,74% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,140.07,69,,,Percent of Total Billed Charges,69% of total billed charges,170.52,84,,,Percent of Total Billed Charges,84% of total billed charges,166.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,500,,,fee schedule,500% of healthlink,123,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.31,77,,,Percent of total Billed charges,77% of total billed charges,172.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,172.55,
WEST NILE VIRUS IgG,T990350923,CDM,302,RC,86789,HCPCS,Outpatient,,,199,99.5,,153.23,77,,,Percent of Total Billed Charges,77% of total billed charges,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.26,74,,,Percent of Total Billed Charges,74% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,167.16,84,,,Percent of Total Billed Charges,84% of total billed charges,163.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.1,500,,,fee schedule,500% of healthlink,105.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,13.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.23,77,,,Percent of total Billed charges,77% of total billed charges,169.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.81,120,,,Fee Schedule,120% of MO Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.81,169.15,
HERPES VIRUS 6 EACH,T990350924,CDM,302,RC,86790,HCPCS,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,160.23,
HSV IgM AB Titer,T990350925,CDM,302,RC,86790,HCPCS,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,160.23,
HTLV I/II AB EIA,T990350926,CDM,302,RC,86790,HCPCS,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,160.23,
PARAINFLUENZA VIRUS EA TYPE,T990350927,CDM,302,RC,86790,HCPCS,Outpatient,,,188.5,94.25,,145.15,77,,,Percent of Total Billed Charges,77% of total billed charges,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.49,74,,,Percent of Total Billed Charges,74% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,130.07,69,,,Percent of Total Billed Charges,69% of total billed charges,158.34,84,,,Percent of Total Billed Charges,84% of total billed charges,154.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.05,500,,,fee schedule,500% of healthlink,94.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,94.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,12.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.15,77,,,Percent of total Billed charges,77% of total billed charges,160.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.36,120,,,Fee Schedule,120% of MO Medicaid Rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.36,160.23,
THYROGLOBULIN AB,T990350928,CDM,302,RC,86800,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.1,500,,,fee schedule,500% of healthlink,116.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,116.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.26,120,,,Fee Schedule,120% of MO Medicaid Rate,15.26,120,,,Fee Schedule,120% of MO Medicaid Rate,15.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.26,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.26,144.93,
THYROGLOBULIN AB SCREEN MML,T990350929,CDM,301,RC,86800,HCPCS,Outpatient,,,302.5,151.25,,232.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.85,74,,,Percent of Total Billed Charges,74% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,208.73,69,,,Percent of Total Billed Charges,69% of total billed charges,254.1,84,,,Percent of Total Billed Charges,84% of total billed charges,248.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.1,500,,,fee schedule,500% of healthlink,116.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,116.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.26,120,,,Fee Schedule,120% of MO Medicaid Rate,15.26,120,,,Fee Schedule,120% of MO Medicaid Rate,15.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.93,77,,,Percent of total Billed charges,77% of total billed charges,257.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.26,120,,,Fee Schedule,120% of MO Medicaid Rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.26,257.13,
HEPATITIS C AB,T990350931,CDM,302,RC,86803,HCPCS,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.2,500,,,fee schedule,500% of healthlink,104.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,104.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.69,120,,,Fee Schedule,120% of MO Medicaid Rate,13.69,120,,,Fee Schedule,120% of MO Medicaid Rate,13.69,120,,,Fee Schedule,120% of MO of Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.69,120,,,Fee Schedule,120% of MO Medicaid Rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,104.2,
HEPATITIS C VIRUS AB RIBA,T990350932,CDM,302,RC,86804,HCPCS,Outpatient,,,303.5,151.75,,233.7,77,,,Percent of Total Billed Charges,77% of total billed charges,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.59,74,,,Percent of Total Billed Charges,74% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,209.42,69,,,Percent of Total Billed Charges,69% of total billed charges,254.94,84,,,Percent of Total Billed Charges,84% of total billed charges,248.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.05,500,,,fee schedule,500% of healthlink,113.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,113.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.87,120,,,Fee Schedule,120% of MO Medicaid Rate,14.87,120,,,Fee Schedule,120% of MO Medicaid Rate,14.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.7,77,,,Percent of total Billed charges,77% of total billed charges,257.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.87,120,,,Fee Schedule,120% of MO Medicaid Rate,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,75.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,257.98,
HLA-B27 AG,T990350933,CDM,302,RC,86812,HCPCS,Outpatient,,,608.5,304.25,,468.55,77,,,Percent of Total Billed Charges,77% of total billed charges,155.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,450.29,74,,,Percent of Total Billed Charges,74% of total billed charges,419.87,69,,,Percent of Total Billed Charges,69% of total billed charges,419.87,69,,,Percent of Total Billed Charges,69% of total billed charges,152.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.87,69,,,Percent of Total Billed Charges,69% of total billed charges,419.87,69,,,Percent of Total Billed Charges,69% of total billed charges,511.14,84,,,Percent of Total Billed Charges,84% of total billed charges,498.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.4,500,,,fee schedule,500% of healthlink,188.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,188.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,24.77,120,,,Fee Schedule,120% of MO Medicaid Rate,24.77,120,,,Fee Schedule,120% of MO Medicaid Rate,24.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,152.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.55,77,,,Percent of total Billed charges,77% of total billed charges,517.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,174.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,24.77,120,,,Fee Schedule,120% of MO Medicaid Rate,152.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,152.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.77,517.23,
ANTI-COMPLEMENT,T990350934,CDM,300,RC,86880,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,112.2,
ANTI-IgG,T990350935,CDM,390,RC,86880,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,260,
DIRECT ANTIGLOBULIN,T990350936,CDM,390,RC,86880,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,260,
"ID Amplidie Probe, EA organism",T990350937,CDM,300,RC,87150,HCPCS,Outpatient,,,64.5,32.25,,49.67,77,,,Percent of Total Billed Charges,77% of total billed charges,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.73,74,,,Percent of Total Billed Charges,74% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.18,84,,,Percent of Total Billed Charges,84% of total billed charges,52.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.41,89,,,Percent of total Billed Charges,89% of total Billed charges,57.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.67,77,,,Percent of total Billed charges,77% of total billed charges,54.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,64,
LEGIONELLA PNEUMOPHILIA ag DFA,T990350938,CDM,300,RC,87278,HCPCS,Outpatient,,,193,96.5,,148.61,77,,,Percent of Total Billed Charges,77% of total billed charges,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.82,74,,,Percent of Total Billed Charges,74% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,133.17,69,,,Percent of Total Billed Charges,69% of total billed charges,162.12,84,,,Percent of Total Billed Charges,84% of total billed charges,158.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.98,120,,,Fee Schedule,120% of MO Medicaid Rate,14.98,120,,,Fee Schedule,120% of MO Medicaid Rate,14.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.61,77,,,Percent of total Billed charges,77% of total billed charges,164.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.98,120,,,Fee Schedule,120% of MO Medicaid Rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,48.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.98,164.05,
HELICOBACTER PYLORI AG,T990350939,CDM,306,RC,G0480,HCPCS,Outpatient,,,147.5,73.75,,113.58,77,,,Percent of Total Billed Charges,77% of total billed charges,37.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.15,74,,,Percent of Total Billed Charges,74% of total billed charges,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,123.9,84,,,Percent of Total Billed Charges,84% of total billed charges,120.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.28,89,,,Percent of total Billed Charges,89% of total Billed charges,131.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,109.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.58,77,,,Percent of total Billed charges,77% of total billed charges,125.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,109.85,120,,,Fee Schedule,120% of MO Medicaid Rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.88,131.28,
HELICOBACTER PYLORI AG,T990350939,CDM,306,RC,87338,HCPCS,Outpatient,,,147.5,73.75,,113.58,77,,,Percent of Total Billed Charges,77% of total billed charges,37.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.15,74,,,Percent of Total Billed Charges,74% of total billed charges,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,101.78,69,,,Percent of Total Billed Charges,69% of total billed charges,123.9,84,,,Percent of Total Billed Charges,84% of total billed charges,120.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.6,500,,,fee schedule,500% of healthlink,54.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,54.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.8,120,,,Fee Schedule,120% of MO Medicaid Rate,13.8,120,,,Fee Schedule,120% of MO Medicaid Rate,13.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.58,77,,,Percent of total Billed charges,77% of total billed charges,125.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.8,120,,,Fee Schedule,120% of MO Medicaid Rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,125.38,
HEPATITIS B SURFACE AG,T990350940,CDM,306,RC,87340,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.05,500,,,fee schedule,500% of healthlink,74.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.91,109.23,
HEPATITIS B SURFACE AG CONFIRM,T990350941,CDM,302,RC,87341,HCPCS,Outpatient,,,94,47,,72.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.56,74,,,Percent of Total Billed Charges,74% of total billed charges,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,64.86,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,84,,,Percent of Total Billed Charges,84% of total billed charges,77.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.05,500,,,fee schedule,500% of healthlink,74.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,74.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,9.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.38,77,,,Percent of total Billed charges,77% of total billed charges,79.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.91,120,,,Fee Schedule,120% of MO Medicaid Rate,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,23.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.91,79.9,
HEPATITIS BE AG,T990350942,CDM,302,RC,87350,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.15,500,,,fee schedule,500% of healthlink,84.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,84.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,11.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.06,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.06,144.93,
HISTOPLASMA AG SERUM,T990350943,CDM,302,RC,87385,HCPCS,Outpatient,,,386.5,193.25,,297.61,77,,,Percent of Total Billed Charges,77% of total billed charges,98.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,286.01,74,,,Percent of Total Billed Charges,74% of total billed charges,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,324.66,84,,,Percent of Total Billed Charges,84% of total billed charges,316.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.61,77,,,Percent of total Billed charges,77% of total billed charges,328.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,328.53,
HISTOPLASMA AG URINE,T990350944,CDM,302,RC,87385,HCPCS,Outpatient,,,386.5,193.25,,297.61,77,,,Percent of Total Billed Charges,77% of total billed charges,98.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,286.01,74,,,Percent of Total Billed Charges,74% of total billed charges,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,266.69,69,,,Percent of Total Billed Charges,69% of total billed charges,324.66,84,,,Percent of Total Billed Charges,84% of total billed charges,316.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.61,77,,,Percent of total Billed charges,77% of total billed charges,328.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,96.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,328.53,
"HISTOPLASMA AG URINE, RL",T990350945,CDM,302,RC,87385,HCPCS,Outpatient,,,526.5,263.25,,405.41,77,,,Percent of Total Billed Charges,77% of total billed charges,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,389.61,74,,,Percent of Total Billed Charges,74% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,363.29,69,,,Percent of Total Billed Charges,69% of total billed charges,442.26,84,,,Percent of Total Billed Charges,84% of total billed charges,431.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,12.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.41,77,,,Percent of total Billed charges,77% of total billed charges,447.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.72,120,,,Fee Schedule,120% of MO Medicaid Rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,131.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,447.53,
HIV 1/2 AB w/p 24 AG,T990350946,CDM,306,RC,87389,HCPCS,Outpatient,,,174,87,,133.98,77,,,Percent of Total Billed Charges,77% of total billed charges,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.76,74,,,Percent of Total Billed Charges,74% of total billed charges,120.06,69,,,Percent of Total Billed Charges,69% of total billed charges,120.06,69,,,Percent of Total Billed Charges,69% of total billed charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.06,69,,,Percent of Total Billed Charges,69% of total billed charges,120.06,69,,,Percent of Total Billed Charges,69% of total billed charges,146.16,84,,,Percent of Total Billed Charges,84% of total billed charges,142.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.86,89,,,Percent of total Billed Charges,89% of total Billed charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.11,120,,,Fee Schedule,120% of MO Medicaid Rate,23.11,120,,,Fee Schedule,120% of MO Medicaid Rate,23.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.98,77,,,Percent of total Billed charges,77% of total billed charges,147.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.11,120,,,Fee Schedule,120% of MO Medicaid Rate,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.11,154.86,
HIV-1 p24 (ICD) AG CONFIRM,T990350947,CDM,306,RC,87390,HCPCS,Outpatient,,,205,102.5,,157.85,77,,,Percent of Total Billed Charges,77% of total billed charges,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.7,74,,,Percent of Total Billed Charges,74% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,172.2,84,,,Percent of Total Billed Charges,84% of total billed charges,168.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.8,500,,,fee schedule,500% of healthlink,128.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,128.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.09,120,,,Fee Schedule,120% of MO Medicaid Rate,23.09,120,,,Fee Schedule,120% of MO Medicaid Rate,23.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.85,77,,,Percent of total Billed charges,77% of total billed charges,174.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.09,120,,,Fee Schedule,120% of MO Medicaid Rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.09,174.25,
HIV-1 p24 (ICD) AG SCREEN,T990350948,CDM,306,RC,87390,HCPCS,Outpatient,,,205,102.5,,157.85,77,,,Percent of Total Billed Charges,77% of total billed charges,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.7,74,,,Percent of Total Billed Charges,74% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,172.2,84,,,Percent of Total Billed Charges,84% of total billed charges,168.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.8,500,,,fee schedule,500% of healthlink,128.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,128.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.09,120,,,Fee Schedule,120% of MO Medicaid Rate,23.09,120,,,Fee Schedule,120% of MO Medicaid Rate,23.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.85,77,,,Percent of total Billed charges,77% of total billed charges,174.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.09,120,,,Fee Schedule,120% of MO Medicaid Rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.09,174.25,
SARS CoV2 ANTIGEN,T990350949,CDM,300,RC,87426,HCPCS,Outpatient,,,147,73.5,,113.19,77,,,Percent of Total Billed Charges,77% of total billed charges,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.78,74,,,Percent of Total Billed Charges,74% of total billed charges,101.43,69,,,Percent of Total Billed Charges,69% of total billed charges,101.43,69,,,Percent of Total Billed Charges,69% of total billed charges,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.43,69,,,Percent of Total Billed Charges,69% of total billed charges,101.43,69,,,Percent of Total Billed Charges,69% of total billed charges,123.48,84,,,Percent of Total Billed Charges,84% of total billed charges,120.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.83,89,,,Percent of total Billed Charges,89% of total Billed charges,130.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.53,120,,,Fee Schedule,120% of MO Medicaid Rate,30.53,120,,,Fee Schedule,120% of MO Medicaid Rate,30.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.19,77,,,Percent of total Billed charges,77% of total billed charges,124.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,30.53,120,,,Fee Schedule,120% of MO Medicaid Rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.53,130.83,
CRYPTOCOCCUS AG CSF,T990350950,CDM,306,RC,87449,HCPCS,Outpatient,,,437.5,218.75,,336.88,77,,,Percent of Total Billed Charges,77% of total billed charges,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.75,74,,,Percent of Total Billed Charges,74% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,367.5,84,,,Percent of Total Billed Charges,84% of total billed charges,358.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.88,77,,,Percent of total Billed charges,77% of total billed charges,371.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,371.88,
LEGIONELLA URINARY AG,T990350951,CDM,306,RC,87449,HCPCS,Outpatient,,,437.5,218.75,,336.88,77,,,Percent of Total Billed Charges,77% of total billed charges,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.75,74,,,Percent of Total Billed Charges,74% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,367.5,84,,,Percent of Total Billed Charges,84% of total billed charges,358.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.88,77,,,Percent of total Billed charges,77% of total billed charges,371.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,371.88,
NOROVIRUS STOOL,T990350952,CDM,306,RC,87449,HCPCS,Outpatient,,,267,133.5,,205.59,77,,,Percent of Total Billed Charges,77% of total billed charges,68.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.58,74,,,Percent of Total Billed Charges,74% of total billed charges,184.23,69,,,Percent of Total Billed Charges,69% of total billed charges,184.23,69,,,Percent of Total Billed Charges,69% of total billed charges,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.23,69,,,Percent of Total Billed Charges,69% of total billed charges,184.23,69,,,Percent of Total Billed Charges,69% of total billed charges,224.28,84,,,Percent of Total Billed Charges,84% of total billed charges,218.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.59,77,,,Percent of total Billed charges,77% of total billed charges,226.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,226.95,
B. burgdorferi DNA PCR CSF,T990350953,CDM,306,RC,87476,HCPCS,Outpatient,,,753,376.5,,579.81,77,,,Percent of Total Billed Charges,77% of total billed charges,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557.22,74,,,Percent of Total Billed Charges,74% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,632.52,84,,,Percent of Total Billed Charges,84% of total billed charges,617.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.81,77,,,Percent of total Billed charges,77% of total billed charges,640.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,640.05,
CANDIDA GLABRATA/KRUSEI,T990350954,CDM,306,RC,87481,HCPCS,Outpatient,,,71,35.5,,54.67,77,,,Percent of Total Billed Charges,77% of total billed charges,18.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.54,74,,,Percent of Total Billed Charges,74% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,59.64,84,,,Percent of Total Billed Charges,84% of total billed charges,58.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.67,77,,,Percent of total Billed charges,77% of total billed charges,60.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.75,256.25,
CANDIDA SPECIES,T990350955,CDM,306,RC,87481,HCPCS,Outpatient,,,71,35.5,,54.67,77,,,Percent of Total Billed Charges,77% of total billed charges,18.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.54,74,,,Percent of Total Billed Charges,74% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,48.99,69,,,Percent of Total Billed Charges,69% of total billed charges,59.64,84,,,Percent of Total Billed Charges,84% of total billed charges,58.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.67,77,,,Percent of total Billed charges,77% of total billed charges,60.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.75,256.25,
CHLAMYDIA pneumoniae PCR,T990350956,CDM,306,RC,87486,HCPCS,Outpatient,,,474.5,237.25,,365.37,77,,,Percent of Total Billed Charges,77% of total billed charges,121,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.13,74,,,Percent of Total Billed Charges,74% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,398.58,84,,,Percent of Total Billed Charges,84% of total billed charges,389.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.37,77,,,Percent of total Billed charges,77% of total billed charges,403.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,403.33,
"Chlamydia pneumoniae, amp prob",T990350957,CDM,300,RC,87486,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,256.25,
CMV NDA QUAL REAL-TIME PCR,T990350958,CDM,306,RC,87496,HCPCS,Outpatient,,,375.5,187.75,,289.14,77,,,Percent of Total Billed Charges,77% of total billed charges,95.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.87,74,,,Percent of Total Billed Charges,74% of total billed charges,259.1,69,,,Percent of Total Billed Charges,69% of total billed charges,259.1,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.1,69,,,Percent of Total Billed Charges,69% of total billed charges,259.1,69,,,Percent of Total Billed Charges,69% of total billed charges,315.42,84,,,Percent of Total Billed Charges,84% of total billed charges,307.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,93.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.14,77,,,Percent of total Billed charges,77% of total billed charges,319.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,93.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,93.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,319.18,
METHYLATED SEPTIN 9,T990350959,CDM,306,RC,87497,HCPCS,Outpatient,,,685.5,342.75,,527.84,77,,,Percent of Total Billed Charges,77% of total billed charges,174.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,507.27,74,,,Percent of Total Billed Charges,74% of total billed charges,473,69,,,Percent of Total Billed Charges,69% of total billed charges,473,69,,,Percent of Total Billed Charges,69% of total billed charges,171.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473,69,,,Percent of Total Billed Charges,69% of total billed charges,473,69,,,Percent of Total Billed Charges,69% of total billed charges,575.82,84,,,Percent of Total Billed Charges,84% of total billed charges,562.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,171.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.84,77,,,Percent of total Billed charges,77% of total billed charges,582.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,197.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,171.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,171.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,582.68,
ENTEROVIRUS RNA PCR,T990350960,CDM,306,RC,87498,HCPCS,Outpatient,,,692,346,,532.84,77,,,Percent of Total Billed Charges,77% of total billed charges,176.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,512.08,74,,,Percent of Total Billed Charges,74% of total billed charges,477.48,69,,,Percent of Total Billed Charges,69% of total billed charges,477.48,69,,,Percent of Total Billed Charges,69% of total billed charges,173,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,477.48,69,,,Percent of Total Billed Charges,69% of total billed charges,477.48,69,,,Percent of Total Billed Charges,69% of total billed charges,581.28,84,,,Percent of Total Billed Charges,84% of total billed charges,567.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,173,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.84,77,,,Percent of total Billed charges,77% of total billed charges,588.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,198.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,173,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,173,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,588.2,
HEPATITIS B VIRAL DNA,T990350961,CDM,306,RC,87517,HCPCS,Outpatient,,,651,325.5,,501.27,77,,,Percent of Total Billed Charges,77% of total billed charges,166.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,481.74,74,,,Percent of Total Billed Charges,74% of total billed charges,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,546.84,84,,,Percent of Total Billed Charges,84% of total billed charges,533.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.27,77,,,Percent of total Billed charges,77% of total billed charges,553.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,553.35,
HCV RNA QUAL PCR,T990350962,CDM,306,RC,87521,HCPCS,Outpatient,,,442,221,,340.34,77,,,Percent of Total Billed Charges,77% of total billed charges,112.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.08,74,,,Percent of Total Billed Charges,74% of total billed charges,304.98,69,,,Percent of Total Billed Charges,69% of total billed charges,304.98,69,,,Percent of Total Billed Charges,69% of total billed charges,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.98,69,,,Percent of Total Billed Charges,69% of total billed charges,304.98,69,,,Percent of Total Billed Charges,69% of total billed charges,371.28,84,,,Percent of Total Billed Charges,84% of total billed charges,362.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.34,77,,,Percent of total Billed charges,77% of total billed charges,375.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,375.7,
HCV RNA QNT REAL TIME PCR,T990350963,CDM,306,RC,87522,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,312.7,
HEPATITIS C VIRUS AB RNA,T990350964,CDM,306,RC,87522,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,312.7,
HEPTIMAX TM HCV RNA,T990350965,CDM,306,RC,87522,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,312.7,
HERPES SIMPLEX VIRUS 1 & 2 PCR,T990350966,CDM,306,RC,87529,HCPCS,Outpatient,,,515.5,257.75,,396.94,77,,,Percent of Total Billed Charges,77% of total billed charges,131.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,381.47,74,,,Percent of Total Billed Charges,74% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,433.02,84,,,Percent of Total Billed Charges,84% of total billed charges,422.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.94,77,,,Percent of total Billed charges,77% of total billed charges,438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,438.18,
HIV-1 RNA QUAL TMA,T990350967,CDM,306,RC,87535,HCPCS,Outpatient,,,1493,746.5,,1149.61,77,,,Percent of Total Billed Charges,77% of total billed charges,380.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,380.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,466.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1104.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1030.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1030.17,69,,,Percent of Total Billed Charges,69% of total billed charges,373.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1030.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1030.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1254.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1224.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,373.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1149.61,77,,,Percent of total Billed charges,77% of total billed charges,1269.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,429.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,373.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,373.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,1269.05,
HIV 1 RNA QN PCR V1.5,T990350968,CDM,306,RC,87536,HCPCS,Outpatient,,,526,263,,405.02,77,,,Percent of Total Billed Charges,77% of total billed charges,134.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,389.24,74,,,Percent of Total Billed Charges,74% of total billed charges,362.94,69,,,Percent of Total Billed Charges,69% of total billed charges,362.94,69,,,Percent of Total Billed Charges,69% of total billed charges,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.94,69,,,Percent of Total Billed Charges,69% of total billed charges,362.94,69,,,Percent of Total Billed Charges,69% of total billed charges,441.84,84,,,Percent of Total Billed Charges,84% of total billed charges,431.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,621.2,500,,,fee schedule,500% of healthlink,621.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,621.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,81.7,120,,,Fee Schedule,120% of MO Medicaid Rate,81.7,120,,,Fee Schedule,120% of MO Medicaid Rate,81.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.02,77,,,Percent of total Billed charges,77% of total billed charges,447.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,81.7,120,,,Fee Schedule,120% of MO Medicaid Rate,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,131.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,621.2,
MYCOPLASMA pneumo.DNA PCR,T990350969,CDM,306,RC,87541,HCPCS,Outpatient,,,474.5,237.25,,365.37,77,,,Percent of Total Billed Charges,77% of total billed charges,121,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.13,74,,,Percent of Total Billed Charges,74% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,398.58,84,,,Percent of Total Billed Charges,84% of total billed charges,389.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.37,77,,,Percent of total Billed charges,77% of total billed charges,403.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,403.33,
LEGIONELLA pneumo.DNA PCR,T990350970,CDM,306,RC,87581,HCPCS,Outpatient,,,474.5,237.25,,365.37,77,,,Percent of Total Billed Charges,77% of total billed charges,121,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.13,74,,,Percent of Total Billed Charges,74% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,327.41,69,,,Percent of Total Billed Charges,69% of total billed charges,398.58,84,,,Percent of Total Billed Charges,84% of total billed charges,389.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.37,77,,,Percent of total Billed charges,77% of total billed charges,403.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,118.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,403.33,
"Mycoplasma pneumoniae, amp pro",T990350971,CDM,300,RC,87581,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,256.25,
"FLU/RSV ONLY, 3 Target Multipl",T990350972,CDM,300,RC,87631,HCPCS,Outpatient,,,444,222,,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.56,74,,,Percent of Total Billed Charges,74% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,372.96,84,,,Percent of Total Billed Charges,84% of total billed charges,364.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.16,89,,,Percent of total Billed Charges,89% of total Billed charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.92,120,,,Fee Schedule,120% of MO Medicaid Rate,136.92,120,,,Fee Schedule,120% of MO Medicaid Rate,136.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,136.92,120,,,Fee Schedule,120% of MO Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,395.16,
"Resp Virus, Mutliplex 3-5 targ",T990350973,CDM,300,RC,87631,HCPCS,Outpatient,,,609.5,304.75,,469.32,77,,,Percent of Total Billed Charges,77% of total billed charges,155.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,451.03,74,,,Percent of Total Billed Charges,74% of total billed charges,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,511.98,84,,,Percent of Total Billed Charges,84% of total billed charges,499.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,542.46,89,,,Percent of total Billed Charges,89% of total Billed charges,542.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,542.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.92,120,,,Fee Schedule,120% of MO Medicaid Rate,136.92,120,,,Fee Schedule,120% of MO Medicaid Rate,136.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,469.32,77,,,Percent of total Billed charges,77% of total billed charges,518.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,136.92,120,,,Fee Schedule,120% of MO Medicaid Rate,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,542.46,
RESPIRATORY VIRUS PCR PANEL I,T990350974,CDM,306,RC,87632,HCPCS,Outpatient,,,6763,3381.5,,5207.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1724.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1724.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2113.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5004.62,74,,,Percent of Total Billed Charges,74% of total billed charges,4666.47,69,,,Percent of Total Billed Charges,69% of total billed charges,4666.47,69,,,Percent of Total Billed Charges,69% of total billed charges,1690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4666.47,69,,,Percent of Total Billed Charges,69% of total billed charges,4666.47,69,,,Percent of Total Billed Charges,69% of total billed charges,5680.92,84,,,Percent of Total Billed Charges,84% of total billed charges,5545.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6019.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6019.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6019.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,209.33,120,,,Fee Schedule,120% of MO Medicaid Rate,209.33,120,,,Fee Schedule,120% of MO Medicaid Rate,209.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,1690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5207.51,77,,,Percent of total Billed charges,77% of total billed charges,5748.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1944.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,209.33,120,,,Fee Schedule,120% of MO Medicaid Rate,1690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1690.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,6019.07,
Resp Virus Multiplex 12-25 Tar,T990350975,CDM,300,RC,87633,HCPCS,Outpatient,,,725,362.5,,558.25,77,,,Percent of Total Billed Charges,77% of total billed charges,184.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,536.5,74,,,Percent of Total Billed Charges,74% of total billed charges,500.25,69,,,Percent of Total Billed Charges,69% of total billed charges,500.25,69,,,Percent of Total Billed Charges,69% of total billed charges,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,500.25,69,,,Percent of Total Billed Charges,69% of total billed charges,500.25,69,,,Percent of Total Billed Charges,69% of total billed charges,609,84,,,Percent of Total Billed Charges,84% of total billed charges,594.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,645.25,89,,,Percent of total Billed Charges,89% of total Billed charges,645.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,645.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.1,120,,,Fee Schedule,120% of MO Medicaid Rate,400.1,120,,,Fee Schedule,120% of MO Medicaid Rate,400.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.25,77,,,Percent of total Billed charges,77% of total billed charges,616.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,400.1,120,,,Fee Schedule,120% of MO Medicaid Rate,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,181.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,645.25,
"RSV AMPL PROBE, SINGLE TEST",T990350976,CDM,300,RC,87634,HCPCS,Outpatient,,,270.5,135.25,,208.29,77,,,Percent of Total Billed Charges,77% of total billed charges,68.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.17,74,,,Percent of Total Billed Charges,74% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,227.22,84,,,Percent of Total Billed Charges,84% of total billed charges,221.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.75,89,,,Percent of total Billed Charges,89% of total Billed charges,240.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.39,120,,,Fee Schedule,120% of MO Medicaid Rate,67.39,120,,,Fee Schedule,120% of MO Medicaid Rate,67.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.29,77,,,Percent of total Billed charges,77% of total billed charges,229.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,67.39,120,,,Fee Schedule,120% of MO Medicaid Rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,240.75,
COVID BioFire w/Mini Resp,T990350977,CDM,300,RC,87635,HCPCS,Outpatient,,,216.5,108.25,,166.71,77,,,Percent of Total Billed Charges,77% of total billed charges,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.21,74,,,Percent of Total Billed Charges,74% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,149.39,69,,,Percent of Total Billed Charges,69% of total billed charges,181.86,84,,,Percent of Total Billed Charges,84% of total billed charges,177.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,192.69,89,,,Percent of total Billed Charges,89% of total Billed charges,192.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,44.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.71,77,,,Percent of total Billed charges,77% of total billed charges,184.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,192.69,
COVID SARS CoV2 RNA,T990350978,CDM,300,RC,U0002,HCPCS,Outpatient,,,290.5,145.25,,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.55,89,,,Percent of total Billed Charges,89% of total Billed charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,43.85,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,258.55,
COVID SARS CoV2 RNA,T990350978,CDM,300,RC,87635,HCPCS,Outpatient,,,290.5,145.25,,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.55,89,,,Percent of total Billed Charges,89% of total Billed charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,44.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,258.55,
"COVID SARS CoV2 RNA, RL",T990350979,CDM,300,RC,87635,HCPCS,Outpatient,,,290.5,145.25,,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.55,89,,,Percent of total Billed Charges,89% of total Billed charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,44.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,44.33,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,258.55,
"COVID SARS CoV2 RNA, RL",T990350979,CDM,300,RC,U0002,HCPCS,Outpatient,,,290.5,145.25,,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.55,89,,,Percent of total Billed Charges,89% of total Billed charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.85,120,,,Fee Schedule,120% of MO Medicaid Rate,43.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,43.85,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,258.55,
"RSV, FLU A&B 3 TARGET ONLY",T990350980,CDM,300,RC,87637,HCPCS,Outpatient,,,454.5,227.25,,349.97,77,,,Percent of Total Billed Charges,77% of total billed charges,115.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,336.33,74,,,Percent of Total Billed Charges,74% of total billed charges,313.61,69,,,Percent of Total Billed Charges,69% of total billed charges,313.61,69,,,Percent of Total Billed Charges,69% of total billed charges,113.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.61,69,,,Percent of Total Billed Charges,69% of total billed charges,313.61,69,,,Percent of Total Billed Charges,69% of total billed charges,381.78,84,,,Percent of Total Billed Charges,84% of total billed charges,372.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.51,89,,,Percent of total Billed Charges,89% of total Billed charges,404.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,113.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.97,77,,,Percent of total Billed charges,77% of total billed charges,386.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,113.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,113.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,404.51,
MRSA PCR,T990350981,CDM,306,RC,87641,HCPCS,Outpatient,,,160,80,,123.2,77,,,Percent of Total Billed Charges,77% of total billed charges,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.4,74,,,Percent of Total Billed Charges,74% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,110.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,84,,,Percent of Total Billed Charges,84% of total billed charges,131.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.2,77,,,Percent of total Billed charges,77% of total billed charges,136,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,256.25,
SURESWAB TRICHOMONAS RNA,T990350982,CDM,306,RC,87661,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,234.07,
TRICHOMONAS VAGINALIS,T990350983,CDM,306,RC,87661,HCPCS,Outpatient,,,80.5,40.25,,61.99,77,,,Percent of Total Billed Charges,77% of total billed charges,20.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.57,74,,,Percent of Total Billed Charges,74% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,84,,,Percent of Total Billed Charges,84% of total billed charges,66.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.65,89,,,Percent of total Billed Charges,89% of total Billed charges,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.99,77,,,Percent of total Billed charges,77% of total billed charges,68.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.13,71.65,
ADENOVIRUS DNA QUAL PCR,T990350984,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
"Amplified Probe tech, ea organ",T990350985,CDM,300,RC,87798,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,256.25,
ASPERGILLAS PCR EA SPECIES,T990350986,CDM,306,RC,87798,HCPCS,Outpatient,,,330,165,,254.1,77,,,Percent of Total Billed Charges,77% of total billed charges,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,244.2,74,,,Percent of Total Billed Charges,74% of total billed charges,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,277.2,84,,,Percent of Total Billed Charges,84% of total billed charges,270.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.1,77,,,Percent of total Billed charges,77% of total billed charges,280.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,280.5,
B. PERTUSSIS DNA QL PCR,T990350987,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
B.PARAPERTUSSIS DNA QL PCR,T990350988,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
LEPTOSPIRA DNA PCR,T990350989,CDM,306,RC,87798,HCPCS,Outpatient,,,824.5,412.25,,634.87,77,,,Percent of Total Billed Charges,77% of total billed charges,210.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.13,74,,,Percent of Total Billed Charges,74% of total billed charges,568.91,69,,,Percent of Total Billed Charges,69% of total billed charges,568.91,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,568.91,69,,,Percent of Total Billed Charges,69% of total billed charges,568.91,69,,,Percent of Total Billed Charges,69% of total billed charges,692.58,84,,,Percent of Total Billed Charges,84% of total billed charges,676.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,206.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.87,77,,,Percent of total Billed charges,77% of total billed charges,700.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,206.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,206.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,700.83,
MONKEYPOX VIRUS DNA,T990350990,CDM,306,RC,87798,HCPCS,Outpatient,,,270.5,135.25,,208.29,77,,,Percent of Total Billed Charges,77% of total billed charges,68.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.17,74,,,Percent of Total Billed Charges,74% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,186.65,69,,,Percent of Total Billed Charges,69% of total billed charges,227.22,84,,,Percent of Total Billed Charges,84% of total billed charges,221.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.29,77,,,Percent of total Billed charges,77% of total billed charges,229.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,67.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,256.25,
WHIPPLE'S DNA QUAL by PCR,T990350991,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
BACTERIAL VAGINOSIS,T990350993,CDM,306,RC,87801,HCPCS,Outpatient,,,135.5,67.75,,104.34,77,,,Percent of Total Billed Charges,77% of total billed charges,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.27,74,,,Percent of Total Billed Charges,74% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,113.82,84,,,Percent of Total Billed Charges,84% of total billed charges,111.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,512.45,500,,,fee schedule,500% of healthlink,512.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,512.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,67.39,120,,,Fee Schedule,120% of MO Medicaid Rate,67.39,120,,,Fee Schedule,120% of MO Medicaid Rate,67.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.34,77,,,Percent of total Billed charges,77% of total billed charges,115.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,67.39,120,,,Fee Schedule,120% of MO Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.88,512.45,
DETERMINE HIV 1/2 AG/AB COMBO,T990350994,CDM,301,RC,87806,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.45,120,,,Fee Schedule,120% of MO Medicaid Rate,31.45,120,,,Fee Schedule,120% of MO Medicaid Rate,31.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,31.45,120,,,Fee Schedule,120% of MO Medicaid Rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.45,129.94,
Strep Pneumonia Ag Urine,T990350995,CDM,302,RC,87899,HCPCS,Outpatient,,,135.5,67.75,,104.34,77,,,Percent of Total Billed Charges,77% of total billed charges,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.27,74,,,Percent of Total Billed Charges,74% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,93.5,69,,,Percent of Total Billed Charges,69% of total billed charges,113.82,84,,,Percent of Total Billed Charges,84% of total billed charges,111.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.34,77,,,Percent of total Billed charges,77% of total billed charges,115.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.42,115.18,
PHENOTYPE HIV,T990350996,CDM,306,RC,87900,HCPCS,Outpatient,,,235,117.5,,180.95,77,,,Percent of Total Billed Charges,77% of total billed charges,59.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.9,74,,,Percent of Total Billed Charges,74% of total billed charges,162.15,69,,,Percent of Total Billed Charges,69% of total billed charges,162.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.15,69,,,Percent of Total Billed Charges,69% of total billed charges,162.15,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,84,,,Percent of Total Billed Charges,84% of total billed charges,192.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,951.55,500,,,fee schedule,500% of healthlink,951.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,951.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,125.14,120,,,Fee Schedule,120% of MO Medicaid Rate,125.14,120,,,Fee Schedule,120% of MO Medicaid Rate,125.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.95,77,,,Percent of total Billed charges,77% of total billed charges,199.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,125.14,120,,,Fee Schedule,120% of MO Medicaid Rate,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,58.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,951.55,
GENOTYPE DNA HIV,T990350997,CDM,306,RC,87901,HCPCS,Outpatient,,,576,288,,443.52,77,,,Percent of Total Billed Charges,77% of total billed charges,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,426.24,74,,,Percent of Total Billed Charges,74% of total billed charges,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,397.44,69,,,Percent of Total Billed Charges,69% of total billed charges,483.84,84,,,Percent of Total Billed Charges,84% of total billed charges,472.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1879.4,500,,,fee schedule,500% of healthlink,1879.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,1879.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,443.52,77,,,Percent of total Billed charges,77% of total billed charges,489.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,165.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,144,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,1879.4,
HCV RNA GENOTYPE 3 NS5a,T990350998,CDM,306,RC,87902,HCPCS,Outpatient,,,1546.5,773.25,,1190.81,77,,,Percent of Total Billed Charges,77% of total billed charges,394.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,394.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,483.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1144.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1067.09,69,,,Percent of Total Billed Charges,69% of total billed charges,1067.09,69,,,Percent of Total Billed Charges,69% of total billed charges,386.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1067.09,69,,,Percent of Total Billed Charges,69% of total billed charges,1067.09,69,,,Percent of Total Billed Charges,69% of total billed charges,1299.06,84,,,Percent of Total Billed Charges,84% of total billed charges,1268.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,1879.4,500,,,fee schedule,500% of healthlink,1879.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,1879.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,386.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1190.81,77,,,Percent of total Billed charges,77% of total billed charges,1314.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,444.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,386.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,386.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,1879.4,
HCV RNA GENOTYPE LiPA,T990350999,CDM,306,RC,87902,HCPCS,Outpatient,,,382,191,,294.14,77,,,Percent of Total Billed Charges,77% of total billed charges,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,282.68,74,,,Percent of Total Billed Charges,74% of total billed charges,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,263.58,69,,,Percent of Total Billed Charges,69% of total billed charges,320.88,84,,,Percent of Total Billed Charges,84% of total billed charges,313.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1879.4,500,,,fee schedule,500% of healthlink,1879.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,1879.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.14,77,,,Percent of total Billed charges,77% of total billed charges,324.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,95.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,1879.4,
HEPATITIS C VIRUS GENOTYPE,T990351000,CDM,300,RC,87902,HCPCS,Outpatient,,,1525.5,762.75,,1174.64,77,,,Percent of Total Billed Charges,77% of total billed charges,389,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1128.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1052.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1052.6,69,,,Percent of Total Billed Charges,69% of total billed charges,381.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1052.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1052.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1281.42,84,,,Percent of Total Billed Charges,84% of total billed charges,1250.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1879.4,500,,,fee schedule,500% of healthlink,1879.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,1879.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,381.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.64,77,,,Percent of total Billed charges,77% of total billed charges,1296.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,438.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,247.15,120,,,Fee Schedule,120% of MO Medicaid Rate,381.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,381.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,1879.4,
FINE NEEDLE ASP INTRP & RPRT,T990351001,CDM,300,RC,88173,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.76,74,,,Percent of Total Billed Charges,74% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.36,89,,,Percent of total Billed Charges,89% of total Billed charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.14,120,,,Fee Schedule,120% of MO Medicaid Rate,87.14,120,,,Fee Schedule,120% of MO Medicaid Rate,87.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,87.14,120,,,Fee Schedule,120% of MO Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,199.36,
"FISH-TISUE SITU, ea add Probe",T990351002,CDM,300,RC,88364,HCPCS,Outpatient,,,335.5,167.75,,258.34,77,,,Percent of Total Billed Charges,77% of total billed charges,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,248.27,74,,,Percent of Total Billed Charges,74% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,281.82,84,,,Percent of Total Billed Charges,84% of total billed charges,275.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,298.6,89,,,Percent of total Billed Charges,89% of total Billed charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.59,120,,,Fee Schedule,120% of MO Medicaid Rate,96.59,120,,,Fee Schedule,120% of MO Medicaid Rate,96.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.34,77,,,Percent of total Billed charges,77% of total billed charges,285.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,96.59,120,,,Fee Schedule,120% of MO Medicaid Rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,298.6,
SP CHROM IN SITU HYBRID,T990351003,CDM,300,RC,88365,HCPCS,Outpatient,,,335.5,167.75,,258.34,77,,,Percent of Total Billed Charges,77% of total billed charges,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,248.27,74,,,Percent of Total Billed Charges,74% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,231.5,69,,,Percent of Total Billed Charges,69% of total billed charges,281.82,84,,,Percent of Total Billed Charges,84% of total billed charges,275.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,298.6,89,,,Percent of total Billed Charges,89% of total Billed charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.5,120,,,Fee Schedule,120% of MO Medicaid Rate,129.5,120,,,Fee Schedule,120% of MO Medicaid Rate,129.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.34,77,,,Percent of total Billed charges,77% of total billed charges,285.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,129.5,120,,,Fee Schedule,120% of MO Medicaid Rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,298.6,
CELL COUNT & DIFF FLUID OTHER,T990351004,CDM,309,RC,89051,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.2,74,,,Percent of Total Billed Charges,74% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,109.2,84,,,Percent of Total Billed Charges,84% of total billed charges,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,110.5,
CELL COUNT & DIFF PLEURAL FLUI,T990351005,CDM,309,RC,89051,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.2,74,,,Percent of Total Billed Charges,74% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,109.2,84,,,Percent of Total Billed Charges,84% of total billed charges,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,110.5,
CELL COUNT CSF,T990351006,CDM,309,RC,89051,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.2,74,,,Percent of Total Billed Charges,74% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,109.2,84,,,Percent of Total Billed Charges,84% of total billed charges,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,110.5,
CELL COUNT SYNOVIAL,T990351007,CDM,300,RC,89051,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.2,74,,,Percent of Total Billed Charges,74% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,89.7,69,,,Percent of Total Billed Charges,69% of total billed charges,109.2,84,,,Percent of Total Billed Charges,84% of total billed charges,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,110.5,
FECAL LEUKOCYTE (WBC),T990351008,CDM,300,RC,89055,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.07,74,,,Percent of Total Billed Charges,74% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,72.8,69,,,Percent of Total Billed Charges,69% of total billed charges,88.62,84,,,Percent of Total Billed Charges,84% of total billed charges,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.5,500,,,fee schedule,500% of healthlink,30.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,30.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,89.68,
CRYSTAL ANALYSIS POLARIZ LIGHT,T990351009,CDM,309,RC,89060,HCPCS,Outpatient,,,151.5,75.75,,116.66,77,,,Percent of Total Billed Charges,77% of total billed charges,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.11,74,,,Percent of Total Billed Charges,74% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,127.26,84,,,Percent of Total Billed Charges,84% of total billed charges,124.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.2,500,,,fee schedule,500% of healthlink,52.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,52.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.03,120,,,Fee Schedule,120% of MO Medicaid Rate,7.03,120,,,Fee Schedule,120% of MO Medicaid Rate,7.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.66,77,,,Percent of total Billed charges,77% of total billed charges,128.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.03,120,,,Fee Schedule,120% of MO Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,128.78,
"SEMEN ANALYSIS, POST VASE.",T990351010,CDM,309,RC,89321,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,11.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.57,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.57,136.85,
COLLECTION FEE,T990351011,CDM,300,RC,99001,HCPCS,Outpatient,,,38.5,19.25,,29.65,77,,,Percent of Total Billed Charges,77% of total billed charges,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.49,74,,,Percent of Total Billed Charges,74% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,26.57,69,,,Percent of Total Billed Charges,69% of total billed charges,32.34,84,,,Percent of Total Billed Charges,84% of total billed charges,31.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.27,89,,,Percent of total Billed Charges,89% of total Billed charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.65,77,,,Percent of total Billed charges,77% of total billed charges,32.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,9.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,64,
CHAIN OF CUSTODY DOT,T990351012,CDM,971,RC,99199,HCPCS,Outpatient,,,31.5,15.75,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,19.53,62,,,Percent of total Billed Charges,62% of total billed charges,19.53,62,,,Fee Schedule,62% of Healthlink HMO Fee Schedule,19.53,62,,,Fee Schedule,62% of Healthlink PPO Fee Schedule,28.35,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,28.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,28.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.53,28.35,
CHAIN OF CUSTODY NON DOT,T990351013,CDM,300,RC,99199,HCPCS,Outpatient,,,31.5,15.75,,24.26,77,,,Percent of Total Billed Charges,77% of total billed charges,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.31,74,,,Percent of Total Billed Charges,74% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,26.46,84,,,Percent of Total Billed Charges,84% of total billed charges,25.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.04,89,,,Percent of total Billed Charges,89% of total Billed charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.26,77,,,Percent of total Billed charges,77% of total billed charges,26.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,64,
Direct P Vitamin D 25; OH Tota,T990351014,CDM,999,RC,,,Outpatient,,,78,39,,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,57.72,74,,,Percent of Total Billed Charges,74% of total billed charges,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,65.52,84,,,Percent of Total Billed Charges,84% of total billed charges,63.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.42,89,,,Percent of total Billed Charges,89% of total Billed charges,69.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,31.82,69.42,
Direct Pay ABO/RH Type,T990351015,CDM,999,RC,,,Outpatient,,,62.5,31.25,,48.13,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,46.25,74,,,Percent of Total Billed Charges,74% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,43.13,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,84,,,Percent of Total Billed Charges,84% of total billed charges,51.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.63,89,,,Percent of total Billed Charges,89% of total Billed charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,48.13,77,,,Percent of total Billed charges,77% of total billed charges,53.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,25.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,25.5,55.63,
Direct Pay Comp Met Panel,T990351016,CDM,999,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,41.83,
Direct Pay GLU AIC Lipid,T990351017,CDM,999,RC,,,Outpatient,,,103,51.5,,79.31,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,76.22,74,,,Percent of Total Billed Charges,74% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,71.07,69,,,Percent of Total Billed Charges,69% of total billed charges,86.52,84,,,Percent of Total Billed Charges,84% of total billed charges,84.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.67,89,,,Percent of total Billed Charges,89% of total Billed charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,79.31,77,,,Percent of total Billed charges,77% of total billed charges,87.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,42.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,42.02,91.67,
Direct Pay PSA Screening,T990351018,CDM,999,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,41.83,
Direct Pay TSH only,T990351019,CDM,999,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.18,41.83,
Direct Pay Wellness Panel,T990351020,CDM,999,RC,,,Outpatient,,,234,117,,180.18,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,173.16,74,,,Percent of Total Billed Charges,74% of total billed charges,161.46,69,,,Percent of Total Billed Charges,69% of total billed charges,161.46,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,161.46,69,,,Percent of Total Billed Charges,69% of total billed charges,161.46,69,,,Percent of Total Billed Charges,69% of total billed charges,196.56,84,,,Percent of Total Billed Charges,84% of total billed charges,191.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.26,89,,,Percent of total Billed Charges,89% of total Billed charges,208.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,180.18,77,,,Percent of total Billed charges,77% of total billed charges,198.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,95.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,95.47,208.26,
Direct Pay Wellness Panel +PSA,T990351021,CDM,999,RC,,,Outpatient,,,281,140.5,,216.37,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,207.94,74,,,Percent of Total Billed Charges,74% of total billed charges,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,193.89,69,,,Percent of Total Billed Charges,69% of total billed charges,236.04,84,,,Percent of Total Billed Charges,84% of total billed charges,230.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.09,89,,,Percent of total Billed Charges,89% of total Billed charges,250.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,216.37,77,,,Percent of total Billed charges,77% of total billed charges,238.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,114.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,114.65,250.09,
PATERNITY COLLECTION FEE,T990351022,CDM,300,RC,,,Outpatient,,,53.5,26.75,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.59,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.94,84,,,Percent of Total Billed Charges,84% of total billed charges,43.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,64,
QUEST TO BILL INSURANCE,T990351023,CDM,300,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,64,
ARC XHEA Licensed RBC Panel,T990351024,CDM,300,RC,0001U,HCPCS,Outpatient,,,571,285.5,,439.67,77,,,Percent of Total Billed Charges,77% of total billed charges,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,422.54,74,,,Percent of Total Billed Charges,74% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,69,,,Percent of Total Billed Charges,69% of total billed charges,479.64,84,,,Percent of Total Billed Charges,84% of total billed charges,468.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,508.19,89,,,Percent of total Billed Charges,89% of total Billed charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.2,120,,,Fee Schedule,120% of MO Medicaid Rate,691.2,120,,,Fee Schedule,120% of MO Medicaid Rate,691.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439.67,77,,,Percent of total Billed charges,77% of total billed charges,485.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,164.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,691.2,120,,,Fee Schedule,120% of MO Medicaid Rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,142.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,691.2,
"SARS CoV2, FLuAB (3 target)",T990351025,CDM,300,RC,0240U,HCPCS,Outpatient,,,563,281.5,,433.51,77,,,Percent of Total Billed Charges,77% of total billed charges,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,416.62,74,,,Percent of Total Billed Charges,74% of total billed charges,388.47,69,,,Percent of Total Billed Charges,69% of total billed charges,388.47,69,,,Percent of Total Billed Charges,69% of total billed charges,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.47,69,,,Percent of Total Billed Charges,69% of total billed charges,388.47,69,,,Percent of Total Billed Charges,69% of total billed charges,472.92,84,,,Percent of Total Billed Charges,84% of total billed charges,461.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,501.07,89,,,Percent of total Billed Charges,89% of total Billed charges,501.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,501.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.51,77,,,Percent of total Billed charges,77% of total billed charges,478.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,140.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,501.07,
"SARS CoV2,FLuAB, RSV(4 target)",T990351026,CDM,300,RC,0241U,HCPCS,Outpatient,,,609.5,304.75,,469.32,77,,,Percent of Total Billed Charges,77% of total billed charges,155.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,451.03,74,,,Percent of Total Billed Charges,74% of total billed charges,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,420.56,69,,,Percent of Total Billed Charges,69% of total billed charges,511.98,84,,,Percent of Total Billed Charges,84% of total billed charges,499.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,542.46,89,,,Percent of total Billed Charges,89% of total Billed charges,542.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,542.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,123.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,469.32,77,,,Percent of total Billed charges,77% of total billed charges,518.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,123.23,120,,,Fee Schedule,120% of MO Medicaid Rate,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,152.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,542.46,
C TRACHOMATIS N GONORRHOEAE,T990351027,CDM,306,RC,0353U,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,59.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,129.94,
OP COLLECTION COVID-19,T990351028,CDM,300,RC,C9803,HCPCS,Outpatient,,,82.5,41.25,,63.53,77,,,Percent of Total Billed Charges,77% of total billed charges,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.05,74,,,Percent of Total Billed Charges,74% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,56.93,69,,,Percent of Total Billed Charges,69% of total billed charges,69.3,84,,,Percent of Total Billed Charges,84% of total billed charges,67.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.43,89,,,Percent of total Billed Charges,89% of total Billed charges,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.53,77,,,Percent of total Billed charges,77% of total billed charges,70.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.63,73.43,
TCA QUAL URINE-MEDICARE,T990351029,CDM,301,RC,G0431,HCPCS,Outpatient,,,46,23,,35.42,77,,,Percent of Total Billed Charges,77% of total billed charges,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.04,74,,,Percent of Total Billed Charges,74% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,31.74,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,84,,,Percent of Total Billed Charges,84% of total billed charges,37.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.94,89,,,Percent of total Billed Charges,89% of total Billed charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.42,77,,,Percent of total Billed charges,77% of total billed charges,39.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,11.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,64,
MILEAGE 1 PATIENT,T990351030,CDM,300,RC,P9604,HCPCS,Outpatient,,,32,16,,24.64,77,,,Percent of Total Billed Charges,77% of total billed charges,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.68,74,,,Percent of Total Billed Charges,74% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.08,69,,,Percent of Total Billed Charges,69% of total billed charges,26.88,84,,,Percent of Total Billed Charges,84% of total billed charges,26.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.48,89,,,Percent of total Billed Charges,89% of total Billed charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.64,77,,,Percent of total Billed charges,77% of total billed charges,27.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8,64,
MILEAGE 10 PATIENTS,T990351031,CDM,300,RC,P9604,HCPCS,Outpatient,,,7,3.5,,5.39,77,,,Percent of Total Billed Charges,77% of total billed charges,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.18,74,,,Percent of Total Billed Charges,74% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5.88,84,,,Percent of Total Billed Charges,84% of total billed charges,5.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.39,77,,,Percent of total Billed charges,77% of total billed charges,5.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.75,64,
MILEAGE 11 PATIENTS,T990351032,CDM,300,RC,P9604,HCPCS,Outpatient,,,7,3.5,,5.39,77,,,Percent of Total Billed Charges,77% of total billed charges,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.18,74,,,Percent of Total Billed Charges,74% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5.88,84,,,Percent of Total Billed Charges,84% of total billed charges,5.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.39,77,,,Percent of total Billed charges,77% of total billed charges,5.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.75,64,
MILEAGE 12 PATIENTS,T990351033,CDM,300,RC,P9604,HCPCS,Outpatient,,,7,3.5,,5.39,77,,,Percent of Total Billed Charges,77% of total billed charges,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.18,74,,,Percent of Total Billed Charges,74% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5.88,84,,,Percent of Total Billed Charges,84% of total billed charges,5.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.39,77,,,Percent of total Billed charges,77% of total billed charges,5.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.75,64,
MILEAGE 13 PATIENTS,T990351034,CDM,300,RC,P9604,HCPCS,Outpatient,,,7,3.5,,5.39,77,,,Percent of Total Billed Charges,77% of total billed charges,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.18,74,,,Percent of Total Billed Charges,74% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5.88,84,,,Percent of Total Billed Charges,84% of total billed charges,5.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.39,77,,,Percent of total Billed charges,77% of total billed charges,5.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.75,64,
MILEAGE 14 PATIENTS,T990351035,CDM,300,RC,P9604,HCPCS,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,64,
MILEAGE 15 PATIENTS,T990351036,CDM,300,RC,P9604,HCPCS,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,64,
MILEAGE 16 PATIENTS,T990351037,CDM,300,RC,P9604,HCPCS,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,64,
MILEAGE 17 PATIENTS,T990351038,CDM,300,RC,P9604,HCPCS,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,64,
MILEAGE 18 PATIENTS,T990351039,CDM,300,RC,P9604,HCPCS,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,64,
MILEAGE 19 PATIENTS,T990351040,CDM,300,RC,P9604,HCPCS,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,64,
MILEAGE 2 PATIENTS,T990351041,CDM,300,RC,P9604,HCPCS,Outpatient,,,17,8.5,,13.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.58,74,,,Percent of Total Billed Charges,74% of total billed charges,11.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.73,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.73,69,,,Percent of Total Billed Charges,69% of total billed charges,14.28,84,,,Percent of Total Billed Charges,84% of total billed charges,13.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.13,89,,,Percent of total Billed Charges,89% of total Billed charges,15.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.09,77,,,Percent of total Billed charges,77% of total billed charges,14.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,64,
MILEAGE 20 PATIENTS,T990351042,CDM,300,RC,P9604,HCPCS,Outpatient,,,6,3,,4.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.44,74,,,Percent of Total Billed Charges,74% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,4.14,69,,,Percent of Total Billed Charges,69% of total billed charges,5.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.34,89,,,Percent of total Billed Charges,89% of total Billed charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,77,,,Percent of total Billed charges,77% of total billed charges,5.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.5,64,
MILEAGE 3 PATIENTS,T990351043,CDM,300,RC,P9604,HCPCS,Outpatient,,,12,6,,9.24,77,,,Percent of Total Billed Charges,77% of total billed charges,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.88,74,,,Percent of Total Billed Charges,74% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,8.28,69,,,Percent of Total Billed Charges,69% of total billed charges,10.08,84,,,Percent of Total Billed Charges,84% of total billed charges,9.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.68,89,,,Percent of total Billed Charges,89% of total Billed charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.24,77,,,Percent of total Billed charges,77% of total billed charges,10.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3,64,
MILEAGE 4 PATIENTS,T990351044,CDM,300,RC,P9604,HCPCS,Outpatient,,,10,5,,7.7,77,,,Percent of Total Billed Charges,77% of total billed charges,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.4,74,,,Percent of Total Billed Charges,74% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,6.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8.4,84,,,Percent of Total Billed Charges,84% of total billed charges,8.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.7,77,,,Percent of total Billed charges,77% of total billed charges,8.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.5,64,
MILEAGE 5 PATIENTS,T990351045,CDM,300,RC,P9604,HCPCS,Outpatient,,,9,4.5,,6.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.66,74,,,Percent of Total Billed Charges,74% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7.56,84,,,Percent of Total Billed Charges,84% of total billed charges,7.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.93,77,,,Percent of total Billed charges,77% of total billed charges,7.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.25,64,
MILEAGE 6 PATIENTS,T990351046,CDM,300,RC,P9604,HCPCS,Outpatient,,,8.5,4.25,,6.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.29,74,,,Percent of Total Billed Charges,74% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,7.14,84,,,Percent of Total Billed Charges,84% of total billed charges,6.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.57,89,,,Percent of total Billed Charges,89% of total Billed charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.55,77,,,Percent of total Billed charges,77% of total billed charges,7.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.13,64,
MILEAGE 7 PATIENTS,T990351047,CDM,300,RC,P9604,HCPCS,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,64,
MILEAGE 8 PATIENTS,T990351048,CDM,300,RC,P9604,HCPCS,Outpatient,,,7.5,3.75,,5.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.55,74,,,Percent of Total Billed Charges,74% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,84,,,Percent of Total Billed Charges,84% of total billed charges,6.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.68,89,,,Percent of total Billed Charges,89% of total Billed charges,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,77,,,Percent of total Billed charges,77% of total billed charges,6.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,64,
MILEAGE 9 PATIENTS,T990351049,CDM,300,RC,P9604,HCPCS,Outpatient,,,7.5,3.75,,5.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.55,74,,,Percent of Total Billed Charges,74% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,5.18,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,84,,,Percent of Total Billed Charges,84% of total billed charges,6.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.68,89,,,Percent of total Billed Charges,89% of total Billed charges,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,77,,,Percent of total Billed charges,77% of total billed charges,6.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,64,
Hgb F (Fetal) Rosette,T990351050,CDM,305,RC,,,Outpatient,,,254.28,127.14,,195.8,77,,,Percent of Total Billed Charges,77% of total billed charges,64.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.17,74,,,Percent of Total Billed Charges,74% of total billed charges,175.45,69,,,Percent of Total Billed Charges,69% of total billed charges,175.45,69,,,Percent of Total Billed Charges,69% of total billed charges,63.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,69,,,Percent of Total Billed Charges,69% of total billed charges,175.45,69,,,Percent of Total Billed Charges,69% of total billed charges,213.6,84,,,Percent of Total Billed Charges,84% of total billed charges,208.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.31,89,,,Percent of total Billed Charges,89% of total Billed charges,226.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.8,77,,,Percent of total Billed charges,77% of total billed charges,216.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,103.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,63.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,226.31,
Dexamethasone,T990351051,CDM,301,RC,80299,HCPCS,Outpatient,,,342,171,,263.34,77,,,Percent of Total Billed Charges,77% of total billed charges,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,253.08,74,,,Percent of Total Billed Charges,74% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,235.98,69,,,Percent of Total Billed Charges,69% of total billed charges,287.28,84,,,Percent of Total Billed Charges,84% of total billed charges,280.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.95,500,,,fee schedule,500% of healthlink,99.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,17.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.34,77,,,Percent of total Billed charges,77% of total billed charges,290.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.89,120,,,Fee Schedule,120% of MO Medicaid Rate,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,85.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.89,290.7,
Misc Test -hold for new charge,T990351052,CDM,300,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,64,
Coenzyme Q10,T990351053,CDM,301,RC,82542,HCPCS,Outpatient,,,224,112,,172.48,77,,,Percent of Total Billed Charges,77% of total billed charges,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.76,74,,,Percent of Total Billed Charges,74% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,154.56,69,,,Percent of Total Billed Charges,69% of total billed charges,188.16,84,,,Percent of Total Billed Charges,84% of total billed charges,183.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.48,77,,,Percent of total Billed charges,77% of total billed charges,190.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,190.4,
Omega 3-6,T990351054,CDM,301,RC,82542,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.85,500,,,fee schedule,500% of healthlink,131.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,23.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.12,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,170,
Cystatin C w/GFR,T990351055,CDM,301,RC,82610,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.68,74,,,Percent of Total Billed Charges,74% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,84,,,Percent of Total Billed Charges,84% of total billed charges,354.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.25,500,,,fee schedule,500% of healthlink,99.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,99.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.77,120,,,Fee Schedule,120% of MO Medicaid Rate,17.77,120,,,Fee Schedule,120% of MO Medicaid Rate,17.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.77,120,,,Fee Schedule,120% of MO Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.77,367.2,
Tetanus Antitoxoid,T990351056,CDM,302,RC,86774,HCPCS,Outpatient,,,125,62.5,,96.25,77,,,Percent of Total Billed Charges,77% of total billed charges,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.5,74,,,Percent of Total Billed Charges,74% of total billed charges,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,86.25,69,,,Percent of Total Billed Charges,69% of total billed charges,105,84,,,Percent of Total Billed Charges,84% of total billed charges,102.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.05,500,,,fee schedule,500% of healthlink,108.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,108.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.21,120,,,Fee Schedule,120% of MO Medicaid Rate,14.21,120,,,Fee Schedule,120% of MO Medicaid Rate,14.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,77,,,Percent of total Billed charges,77% of total billed charges,106.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.21,120,,,Fee Schedule,120% of MO Medicaid Rate,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.21,108.05,
Strep pneum ImmAssy Serotype,T990351057,CDM,302,RC,86317,HCPCS,Outpatient,,,37,18.5,,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.38,74,,,Percent of Total Billed Charges,74% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,31.08,84,,,Percent of Total Billed Charges,84% of total billed charges,30.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.45,500,,,fee schedule,500% of healthlink,109.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,109.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,14.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.39,120,,,Fee Schedule,120% of MO Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.25,109.45,
"Cell Count, Peritoneal Fluid",T990351058,CDM,300,RC,89051,HCPCS,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,103.6,74,,,Percent of Total Billed Charges,74% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,96.6,69,,,Percent of Total Billed Charges,69% of total billed charges,117.6,84,,,Percent of Total Billed Charges,84% of total billed charges,114.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.2,500,,,fee schedule,500% of healthlink,40.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,5.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.38,120,,,Fee Schedule,120% of MO Medicaid Rate,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,119,
"Triglyceride, Peritoneal Fluid",T990351059,CDM,300,RC,84478,HCPCS,Outpatient,,,120,60,,92.4,77,,,Percent of Total Billed Charges,77% of total billed charges,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.8,74,,,Percent of Total Billed Charges,74% of total billed charges,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,82.8,69,,,Percent of Total Billed Charges,69% of total billed charges,100.8,84,,,Percent of Total Billed Charges,84% of total billed charges,98.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,42,500,,,fee schedule,500% of healthlink,42,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,42,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,5.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.4,77,,,Percent of total Billed charges,77% of total billed charges,102,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.51,120,,,Fee Schedule,120% of MO Medicaid Rate,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,30,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.51,102,
"Albumin, Peritoneal",T990351060,CDM,301,RC,82042,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,7.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,76.5,
H. pylorii IgG Qual,T990360001,CDM,302,RC,86677,HCPCS,Outpatient,,,237,118.5,,182.49,77,,,Percent of Total Billed Charges,77% of total billed charges,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.38,74,,,Percent of Total Billed Charges,74% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,163.53,69,,,Percent of Total Billed Charges,69% of total billed charges,199.08,84,,,Percent of Total Billed Charges,84% of total billed charges,194.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.95,500,,,fee schedule,500% of healthlink,105.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,105.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.49,77,,,Percent of total Billed charges,77% of total billed charges,201.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,201.45,
AFB CONCENTRATION,T990360002,CDM,306,RC,87015,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.75,500,,,fee schedule,500% of healthlink,48.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.41,76.5,
Cryptosporidium Concentration,T990360003,CDM,306,RC,87015,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.75,500,,,fee schedule,500% of healthlink,48.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.41,76.5,
PARASITE CONCENTRATION,T990360004,CDM,306,RC,87015,HCPCS,Outpatient,,,177.5,88.75,,136.68,77,,,Percent of Total Billed Charges,77% of total billed charges,45.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.35,74,,,Percent of Total Billed Charges,74% of total billed charges,122.48,69,,,Percent of Total Billed Charges,69% of total billed charges,122.48,69,,,Percent of Total Billed Charges,69% of total billed charges,44.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.48,69,,,Percent of Total Billed Charges,69% of total billed charges,122.48,69,,,Percent of Total Billed Charges,69% of total billed charges,149.1,84,,,Percent of Total Billed Charges,84% of total billed charges,145.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.75,500,,,fee schedule,500% of healthlink,48.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,6.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.68,77,,,Percent of total Billed charges,77% of total billed charges,150.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.41,120,,,Fee Schedule,120% of MO Medicaid Rate,44.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.41,150.88,
CULTURE BLOOD,T990360005,CDM,306,RC,87040,HCPCS,Outpatient,,,199,99.5,,153.23,77,,,Percent of Total Billed Charges,77% of total billed charges,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.26,74,,,Percent of Total Billed Charges,74% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,167.16,84,,,Percent of Total Billed Charges,84% of total billed charges,163.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.35,500,,,fee schedule,500% of healthlink,75.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,75.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,9.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.23,77,,,Percent of total Billed charges,77% of total billed charges,169.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.9,169.15,
CULT SALMONELLA/SHIGELLA,T990360006,CDM,306,RC,87045,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.85,500,,,fee schedule,500% of healthlink,68.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,68.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,9.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,136.85,
CULTURE CAMPYLOBACTER,T990360007,CDM,306,RC,87046,HCPCS,Outpatient,,,126.5,63.25,,97.41,77,,,Percent of Total Billed Charges,77% of total billed charges,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.61,74,,,Percent of Total Billed Charges,74% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,106.26,84,,,Percent of Total Billed Charges,84% of total billed charges,103.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.85,500,,,fee schedule,500% of healthlink,68.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,68.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,9.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.41,77,,,Percent of total Billed charges,77% of total billed charges,107.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,107.53,
YERSINIA CULTURE,T990360008,CDM,306,RC,87046,HCPCS,Outpatient,,,126.5,63.25,,97.41,77,,,Percent of Total Billed Charges,77% of total billed charges,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.61,74,,,Percent of Total Billed Charges,74% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,87.29,69,,,Percent of Total Billed Charges,69% of total billed charges,106.26,84,,,Percent of Total Billed Charges,84% of total billed charges,103.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.85,500,,,fee schedule,500% of healthlink,68.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,68.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,9.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.41,77,,,Percent of total Billed charges,77% of total billed charges,107.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.06,120,,,Fee Schedule,120% of MO Medicaid Rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,107.53,
CULTURE AEROBIC BACTERIA,T990360009,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE AEROBIC ENVIRONMENTAL,T990360010,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE CSF,T990360011,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE EAR,T990360012,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE EYE,T990360013,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE GENITAL ROUTINE,T990360014,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE NASOPHARYNGEAL,T990360015,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE SPUTUM,T990360016,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE THROAT ROUTINE,T990360017,CDM,306,RC,87070,HCPCS,Outpatient,,,186,93,,143.22,77,,,Percent of Total Billed Charges,77% of total billed charges,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.64,74,,,Percent of Total Billed Charges,74% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,128.34,69,,,Percent of Total Billed Charges,69% of total billed charges,156.24,84,,,Percent of Total Billed Charges,84% of total billed charges,152.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.85,500,,,fee schedule,500% of healthlink,62.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,62.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,8.27,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.22,77,,,Percent of total Billed charges,77% of total billed charges,158.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.27,120,,,Fee Schedule,120% of MO Medicaid Rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,46.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.27,158.1,
CULTURE ANAEROBE,T990360018,CDM,306,RC,87075,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.05,500,,,fee schedule,500% of healthlink,51.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.08,120,,,Fee Schedule,120% of MO Medicaid Rate,9.08,120,,,Fee Schedule,120% of MO Medicaid Rate,9.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.08,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,136.85,
ANAEROBE ID PER ISOLATE,T990360019,CDM,306,RC,87076,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,59,500,,,fee schedule,500% of healthlink,59,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.75,120,,,Fee Schedule,120% of MO Medicaid Rate,7.75,120,,,Fee Schedule,120% of MO Medicaid Rate,7.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.75,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,144.93,
AEROBE ID PER ISOLATE,T990360020,CDM,306,RC,87077,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,59,500,,,fee schedule,500% of healthlink,59,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.75,120,,,Fee Schedule,120% of MO Medicaid Rate,7.75,120,,,Fee Schedule,120% of MO Medicaid Rate,7.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.75,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,144.93,
CULTURE NEISSERIA GONORRHOEAE,T990360021,CDM,306,RC,87081,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.45,500,,,fee schedule,500% of healthlink,48.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,6.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,109.23,
CULTURE THROAT BETA STREP,T990360022,CDM,306,RC,87081,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.45,500,,,fee schedule,500% of healthlink,48.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,6.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,109.23,
STREP GRP B CULTURE SCREEN,T990360023,CDM,306,RC,87081,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.45,500,,,fee schedule,500% of healthlink,48.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,6.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.36,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,109.23,
URINE CULTURE,T990360024,CDM,306,RC,87086,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.05,500,,,fee schedule,500% of healthlink,51.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.74,120,,,Fee Schedule,120% of MO Medicaid Rate,7.74,120,,,Fee Schedule,120% of MO Medicaid Rate,7.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.74,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.74,109.23,
PRESUMPTIVE ORGANISM ID URINE,T990360025,CDM,306,RC,87088,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.76,120,,,Fee Schedule,120% of MO Medicaid Rate,7.76,120,,,Fee Schedule,120% of MO Medicaid Rate,7.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.76,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.76,73.1,
CULT FUNGI-SKIN/HAIR/NAIL,T990360026,CDM,306,RC,87101,HCPCS,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.4,74,,,Percent of Total Billed Charges,74% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,92.4,84,,,Percent of Total Billed Charges,84% of total billed charges,90.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.05,500,,,fee schedule,500% of healthlink,51.05,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,51.05,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.39,120,,,Fee Schedule,120% of MO Medicaid Rate,7.39,120,,,Fee Schedule,120% of MO Medicaid Rate,7.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.39,120,,,Fee Schedule,120% of MO Medicaid Rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.39,93.5,
CULTURE FUNGUS ISOLATION,T990360027,CDM,306,RC,87102,HCPCS,Outpatient,,,151.5,75.75,,116.66,77,,,Percent of Total Billed Charges,77% of total billed charges,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.11,74,,,Percent of Total Billed Charges,74% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,104.54,69,,,Percent of Total Billed Charges,69% of total billed charges,127.26,84,,,Percent of Total Billed Charges,84% of total billed charges,124.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.3,500,,,fee schedule,500% of healthlink,61.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.06,120,,,Fee Schedule,120% of MO Medicaid Rate,8.06,120,,,Fee Schedule,120% of MO Medicaid Rate,8.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.66,77,,,Percent of total Billed charges,77% of total billed charges,128.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.06,120,,,Fee Schedule,120% of MO Medicaid Rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,37.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.06,128.78,
FUNGUS ID,T990360028,CDM,306,RC,87106,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.16,74,,,Percent of Total Billed Charges,74% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,112.56,84,,,Percent of Total Billed Charges,84% of total billed charges,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.35,500,,,fee schedule,500% of healthlink,75.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,75.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,9.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.9,113.9,
CULTURE MOLD ID,T990360029,CDM,306,RC,87107,HCPCS,Outpatient,,,119.5,59.75,,92.02,77,,,Percent of Total Billed Charges,77% of total billed charges,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.43,74,,,Percent of Total Billed Charges,74% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,100.38,84,,,Percent of Total Billed Charges,84% of total billed charges,97.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.35,500,,,fee schedule,500% of healthlink,75.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,75.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,9.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.02,77,,,Percent of total Billed charges,77% of total billed charges,101.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.9,120,,,Fee Schedule,120% of MO Medicaid Rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.9,101.58,
CULTURE CHLAMYDIA,T990360030,CDM,306,RC,87110,HCPCS,Outpatient,,,100.5,50.25,,77.39,77,,,Percent of Total Billed Charges,77% of total billed charges,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.37,74,,,Percent of Total Billed Charges,74% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,69.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.42,84,,,Percent of Total Billed Charges,84% of total billed charges,82.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,143,500,,,fee schedule,500% of healthlink,143,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,143,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.39,77,,,Percent of total Billed charges,77% of total billed charges,85.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.82,143,
CULTURE ACID FAST,T990360031,CDM,306,RC,87116,HCPCS,Outpatient,,,153.5,76.75,,118.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.59,74,,,Percent of Total Billed Charges,74% of total billed charges,105.92,69,,,Percent of Total Billed Charges,69% of total billed charges,105.92,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.92,69,,,Percent of Total Billed Charges,69% of total billed charges,105.92,69,,,Percent of Total Billed Charges,69% of total billed charges,128.94,84,,,Percent of Total Billed Charges,84% of total billed charges,125.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.2,500,,,fee schedule,500% of healthlink,61.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,61.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,10.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.2,77,,,Percent of total Billed charges,77% of total billed charges,130.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.37,120,,,Fee Schedule,120% of MO Medicaid Rate,38.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,38.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.37,130.48,
AFB ID PER ISOLATE,T990360032,CDM,306,RC,87118,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.9,500,,,fee schedule,500% of healthlink,79.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,79.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,14.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,14.02,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.02,144.93,
CULTURE TYPE IMMUNOFLUORESCEN,T990360033,CDM,306,RC,87140,HCPCS,Outpatient,,,33.5,16.75,,25.8,77,,,Percent of Total Billed Charges,77% of total billed charges,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.79,74,,,Percent of Total Billed Charges,74% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,69,,,Percent of Total Billed Charges,69% of total billed charges,28.14,84,,,Percent of Total Billed Charges,84% of total billed charges,27.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.65,500,,,fee schedule,500% of healthlink,40.65,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.65,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.34,120,,,Fee Schedule,120% of MO Medicaid Rate,5.34,120,,,Fee Schedule,120% of MO Medicaid Rate,5.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.8,77,,,Percent of total Billed charges,77% of total billed charges,28.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.34,120,,,Fee Schedule,120% of MO Medicaid Rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,8.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.34,64,
GAS LIQUID CHROMATOGRAPHY,T990360034,CDM,306,RC,87143,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.45,500,,,fee schedule,500% of healthlink,91.45,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,91.45,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.01,120,,,Fee Schedule,120% of MO Medicaid Rate,12.01,120,,,Fee Schedule,120% of MO Medicaid Rate,12.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.01,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,109.23,
PBP2a,T990360035,CDM,306,RC,87147,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.5,500,,,fee schedule,500% of healthlink,30.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,30.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,73.1,
STAPH/STREP ID,T990360036,CDM,306,RC,87147,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.5,500,,,fee schedule,500% of healthlink,30.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,30.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,73.1,
ID BY DIRECT PROBE,T990360037,CDM,306,RC,87149,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.35,500,,,fee schedule,500% of healthlink,146.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,146.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,146.35,
Arthropod Identification,T990360038,CDM,307,RC,87168,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,109.23,
PARASITE IDENTIFICATION EXT,T990360039,CDM,306,RC,87168,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,109.23,
PARASITE ID WORM,T990360040,CDM,306,RC,87169,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.76,74,,,Percent of Total Billed Charges,74% of total billed charges,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,51.06,69,,,Percent of Total Billed Charges,69% of total billed charges,62.16,84,,,Percent of Total Billed Charges,84% of total billed charges,60.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.13,120,,,Fee Schedule,120% of MO Medicaid Rate,4.13,120,,,Fee Schedule,120% of MO Medicaid Rate,4.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.13,120,,,Fee Schedule,120% of MO Medicaid Rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.13,64,
PINWORM PREPARATION,T990360041,CDM,306,RC,87172,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,64.6,
OVA & PARASITES STOOL,T990360042,CDM,306,RC,87177,HCPCS,Outpatient,,,132.5,66.25,,102.03,77,,,Percent of Total Billed Charges,77% of total billed charges,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.05,74,,,Percent of Total Billed Charges,74% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,91.43,69,,,Percent of Total Billed Charges,69% of total billed charges,111.3,84,,,Percent of Total Billed Charges,84% of total billed charges,108.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.95,500,,,fee schedule,500% of healthlink,64.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,64.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.54,120,,,Fee Schedule,120% of MO Medicaid Rate,8.54,120,,,Fee Schedule,120% of MO Medicaid Rate,8.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.03,77,,,Percent of total Billed charges,77% of total billed charges,112.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.54,120,,,Fee Schedule,120% of MO Medicaid Rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.54,112.63,
CLINDAMYCIN RESISTANCE,T990360043,CDM,306,RC,87184,HCPCS,Outpatient,,,199.5,99.75,,153.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.63,74,,,Percent of Total Billed Charges,74% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,137.66,69,,,Percent of Total Billed Charges,69% of total billed charges,167.58,84,,,Percent of Total Billed Charges,84% of total billed charges,163.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.35,500,,,fee schedule,500% of healthlink,50.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,50.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.18,120,,,Fee Schedule,120% of MO Medicaid Rate,7.18,120,,,Fee Schedule,120% of MO Medicaid Rate,7.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.62,77,,,Percent of total Billed charges,77% of total billed charges,169.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.18,120,,,Fee Schedule,120% of MO Medicaid Rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.18,169.58,
CARBA-NP,T990360044,CDM,306,RC,87185,HCPCS,Outpatient,,,88,44,,67.76,77,,,Percent of Total Billed Charges,77% of total billed charges,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.12,74,,,Percent of Total Billed Charges,74% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.72,69,,,Percent of Total Billed Charges,69% of total billed charges,73.92,84,,,Percent of Total Billed Charges,84% of total billed charges,72.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.2,500,,,fee schedule,500% of healthlink,10.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,10.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,4.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,77,,,Percent of total Billed charges,77% of total billed charges,74.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.56,120,,,Fee Schedule,120% of MO Medicaid Rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,74.8,
ANAEROBE SUSCEPTIBILITY,T990360045,CDM,306,RC,87186,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.4,74,,,Percent of Total Billed Charges,74% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,176.4,84,,,Percent of Total Billed Charges,84% of total billed charges,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.1,500,,,fee schedule,500% of healthlink,63.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.3,178.5,
ANTIBIOTIC SENSITIVE,T990360046,CDM,306,RC,87186,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.4,74,,,Percent of Total Billed Charges,74% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,176.4,84,,,Percent of Total Billed Charges,84% of total billed charges,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.1,500,,,fee schedule,500% of healthlink,63.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.3,178.5,
SENSITIVITY YEAST,T990360047,CDM,306,RC,87186,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.4,74,,,Percent of Total Billed Charges,74% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,176.4,84,,,Percent of Total Billed Charges,84% of total billed charges,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.1,500,,,fee schedule,500% of healthlink,63.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.3,178.5,
SUSCEPTIBILITY AZTREONAM,T990360048,CDM,306,RC,87186,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.4,74,,,Percent of Total Billed Charges,74% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,176.4,84,,,Percent of Total Billed Charges,84% of total billed charges,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.1,500,,,fee schedule,500% of healthlink,63.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.3,178.5,
SUSCEPTIBILITY MIC,T990360049,CDM,306,RC,87186,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.4,74,,,Percent of Total Billed Charges,74% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,144.9,69,,,Percent of Total Billed Charges,69% of total billed charges,176.4,84,,,Percent of Total Billed Charges,84% of total billed charges,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.1,500,,,fee schedule,500% of healthlink,63.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,63.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,8.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.3,120,,,Fee Schedule,120% of MO Medicaid Rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.3,178.5,
SUSCEPTIBILITY MYCOBACTERIA,T990360050,CDM,306,RC,87190,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.8,500,,,fee schedule,500% of healthlink,4.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,4.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.01,120,,,Fee Schedule,120% of MO Medicaid Rate,7.01,120,,,Fee Schedule,120% of MO Medicaid Rate,7.01,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.01,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.8,75.23,
GRAM STAIN,T990360051,CDM,306,RC,87205,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.06,74,,,Percent of Total Billed Charges,74% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,57.96,84,,,Percent of Total Billed Charges,84% of total billed charges,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.5,500,,,fee schedule,500% of healthlink,30.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,30.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,64,
"GRAM STAIN, RL",T990360052,CDM,306,RC,87205,HCPCS,Outpatient,,,78,39,,60.06,77,,,Percent of Total Billed Charges,77% of total billed charges,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.72,74,,,Percent of Total Billed Charges,74% of total billed charges,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,53.82,69,,,Percent of Total Billed Charges,69% of total billed charges,65.52,84,,,Percent of Total Billed Charges,84% of total billed charges,63.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.5,500,,,fee schedule,500% of healthlink,30.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,30.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.06,77,,,Percent of total Billed charges,77% of total billed charges,66.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,66.3,
ACID FAST SMEAR,T990360053,CDM,306,RC,87206,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,76.5,
FLUORESCENT FUNGAL STAIN,T990360054,CDM,306,RC,87206,HCPCS,Outpatient,,,90,45,,69.3,77,,,Percent of Total Billed Charges,77% of total billed charges,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.6,74,,,Percent of Total Billed Charges,74% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,62.1,69,,,Percent of Total Billed Charges,69% of total billed charges,75.6,84,,,Percent of Total Billed Charges,84% of total billed charges,73.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.3,77,,,Percent of total Billed charges,77% of total billed charges,76.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,76.5,
CYCLOSPORA AND ISOSPORA,T990360055,CDM,306,RC,87207,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,132.72,84,,,Percent of Total Billed Charges,84% of total billed charges,129.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.75,500,,,fee schedule,500% of healthlink,43.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.75,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.75,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,134.3,
MALARIA SMEAR,T990360056,CDM,306,RC,87207,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.48,74,,,Percent of Total Billed Charges,74% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,69,,,Percent of Total Billed Charges,69% of total billed charges,85.68,84,,,Percent of Total Billed Charges,84% of total billed charges,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.75,500,,,fee schedule,500% of healthlink,43.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,43.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.75,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,120,,,Fee Schedule,120% of MO Medicaid Rate,5.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.75,120,,,Fee Schedule,120% of MO Medicaid Rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.75,86.7,
TRICHROME STAIN,T990360057,CDM,306,RC,87209,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.2,500,,,fee schedule,500% of healthlink,131.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,131.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,17.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.26,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.26,131.2,
INDIA INK PREP,T990360058,CDM,306,RC,87210,HCPCS,Outpatient,,,70.5,35.25,,54.29,77,,,Percent of Total Billed Charges,77% of total billed charges,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.17,74,,,Percent of Total Billed Charges,74% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,59.22,84,,,Percent of Total Billed Charges,84% of total billed charges,57.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.58,120,,,Fee Schedule,120% of MO Medicaid Rate,5.58,120,,,Fee Schedule,120% of MO Medicaid Rate,5.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,77,,,Percent of total Billed charges,77% of total billed charges,59.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.58,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,64,
WET PREP FOR YEAST AND PARASIT,T990360059,CDM,306,RC,87210,HCPCS,Outpatient,,,70.5,35.25,,54.29,77,,,Percent of Total Billed Charges,77% of total billed charges,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.17,74,,,Percent of Total Billed Charges,74% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,59.22,84,,,Percent of Total Billed Charges,84% of total billed charges,57.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.58,120,,,Fee Schedule,120% of MO Medicaid Rate,5.58,120,,,Fee Schedule,120% of MO Medicaid Rate,5.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,77,,,Percent of total Billed charges,77% of total billed charges,59.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.58,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,64,
KOH PREP SKIN HAIR NAIL,T990360060,CDM,306,RC,87220,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.06,74,,,Percent of Total Billed Charges,74% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,57.96,84,,,Percent of Total Billed Charges,84% of total billed charges,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,64,
TISSUE KOH,T990360061,CDM,306,RC,87220,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.06,74,,,Percent of Total Billed Charges,74% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,47.61,69,,,Percent of Total Billed Charges,69% of total billed charges,57.96,84,,,Percent of Total Billed Charges,84% of total billed charges,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,500,,,fee schedule,500% of healthlink,31.15,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,31.15,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,4.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.09,120,,,Fee Schedule,120% of MO Medicaid Rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,64,
CULTURE VIRUS,T990360062,CDM,306,RC,87252,HCPCS,Outpatient,,,270,135,,207.9,77,,,Percent of Total Billed Charges,77% of total billed charges,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.8,74,,,Percent of Total Billed Charges,74% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,186.3,69,,,Percent of Total Billed Charges,69% of total billed charges,226.8,84,,,Percent of Total Billed Charges,84% of total billed charges,221.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.3,500,,,fee schedule,500% of healthlink,190.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,190.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.02,120,,,Fee Schedule,120% of MO Medicaid Rate,25.02,120,,,Fee Schedule,120% of MO Medicaid Rate,25.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.9,77,,,Percent of total Billed charges,77% of total billed charges,229.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,25.02,120,,,Fee Schedule,120% of MO Medicaid Rate,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.02,229.5,
VIRUS INOCULATION SHLL VL EACH,T990360063,CDM,307,RC,87254,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.75,500,,,fee schedule,500% of healthlink,142.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,142.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,18.77,120,,,Fee Schedule,120% of MO Medicaid Rate,18.77,120,,,Fee Schedule,120% of MO Medicaid Rate,18.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,18.77,120,,,Fee Schedule,120% of MO Medicaid Rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.77,170,
CULTURE HSV,T990360064,CDM,306,RC,87255,HCPCS,Outpatient,,,60.5,30.25,,46.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.77,74,,,Percent of Total Billed Charges,74% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,41.75,69,,,Percent of Total Billed Charges,69% of total billed charges,50.82,84,,,Percent of Total Billed Charges,84% of total billed charges,49.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,247.2,500,,,fee schedule,500% of healthlink,247.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,247.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.59,77,,,Percent of total Billed charges,77% of total billed charges,51.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,15.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.13,247.2,
CRYPTOSPORIDIUM AG STOOL,T990360065,CDM,306,RC,87272,HCPCS,Outpatient,,,189.5,94.75,,145.92,77,,,Percent of Total Billed Charges,77% of total billed charges,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.23,74,,,Percent of Total Billed Charges,74% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,159.18,84,,,Percent of Total Billed Charges,84% of total billed charges,155.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.92,77,,,Percent of total Billed charges,77% of total billed charges,161.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,161.08,
RSV DFA,T990360066,CDM,306,RC,87280,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.76,74,,,Percent of Total Billed Charges,74% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,85.56,69,,,Percent of Total Billed Charges,69% of total billed charges,104.16,84,,,Percent of Total Billed Charges,84% of total billed charges,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.88,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.88,105.4,
ADENOVIRUS EIA,T990360067,CDM,306,RC,87301,HCPCS,Outpatient,,,199,99.5,,153.23,77,,,Percent of Total Billed Charges,77% of total billed charges,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.26,74,,,Percent of Total Billed Charges,74% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,167.16,84,,,Percent of Total Billed Charges,84% of total billed charges,163.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.23,77,,,Percent of total Billed charges,77% of total billed charges,169.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,169.15,
C. DIFFICULE TOXIN A,T990360068,CDM,306,RC,87324,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,136.85,
CRYPTOCOCCUS AG SCREEN,T990360069,CDM,306,RC,87327,HCPCS,Outpatient,,,196.5,98.25,,151.31,77,,,Percent of Total Billed Charges,77% of total billed charges,50.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.41,74,,,Percent of Total Billed Charges,74% of total billed charges,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,135.59,69,,,Percent of Total Billed Charges,69% of total billed charges,165.06,84,,,Percent of Total Billed Charges,84% of total billed charges,161.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.88,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,120,,,Fee Schedule,120% of MO Medicaid Rate,12.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.31,77,,,Percent of total Billed charges,77% of total billed charges,167.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.88,120,,,Fee Schedule,120% of MO Medicaid Rate,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.88,167.03,
GIARDIA lamblia AG STOOL,T990360070,CDM,306,RC,87329,HCPCS,Outpatient,,,181,90.5,,139.37,77,,,Percent of Total Billed Charges,77% of total billed charges,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.94,74,,,Percent of Total Billed Charges,74% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,124.89,69,,,Percent of Total Billed Charges,69% of total billed charges,152.04,84,,,Percent of Total Billed Charges,84% of total billed charges,148.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,77,,,Percent of total Billed charges,77% of total billed charges,153.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,153.85,
ENTAMOEBA histolytica AG,T990360071,CDM,306,RC,87337,HCPCS,Outpatient,,,243.5,121.75,,187.5,77,,,Percent of Total Billed Charges,77% of total billed charges,62.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.19,74,,,Percent of Total Billed Charges,74% of total billed charges,168.02,69,,,Percent of Total Billed Charges,69% of total billed charges,168.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.02,69,,,Percent of Total Billed Charges,69% of total billed charges,168.02,69,,,Percent of Total Billed Charges,69% of total billed charges,204.54,84,,,Percent of Total Billed Charges,84% of total billed charges,199.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.5,77,,,Percent of total Billed charges,77% of total billed charges,206.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,60.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,206.98,
H.PYLORI AG,T990360072,CDM,306,RC,87338,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.6,500,,,fee schedule,500% of healthlink,54.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,54.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.8,120,,,Fee Schedule,120% of MO Medicaid Rate,13.8,120,,,Fee Schedule,120% of MO Medicaid Rate,13.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.8,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,278.8,
RSV EIA,T990360073,CDM,306,RC,87420,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,13.34,120,,,Fee Schedule,120% of MO Medicaid Rate,13.34,120,,,Fee Schedule,120% of MO Medicaid Rate,13.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,13.34,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.34,144.93,
ROTAVIRUS,T990360074,CDM,306,RC,87425,HCPCS,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.26,74,,,Percent of Total Billed Charges,74% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,84,,,Percent of Total Billed Charges,84% of total billed charges,204.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,211.65,
SHIGA TOXINS w/E.COLI-EIA,T990360075,CDM,300,RC,87427,HCPCS,Outpatient,,,272.5,136.25,,209.83,77,,,Percent of Total Billed Charges,77% of total billed charges,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,201.65,74,,,Percent of Total Billed Charges,74% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,228.9,84,,,Percent of Total Billed Charges,84% of total billed charges,223.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.83,77,,,Percent of total Billed charges,77% of total billed charges,231.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,231.63,
STREP A RAPID,T990360076,CDM,306,RC,87430,HCPCS,Outpatient,,,128.5,64.25,,98.95,77,,,Percent of Total Billed Charges,77% of total billed charges,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.09,74,,,Percent of Total Billed Charges,74% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,88.67,69,,,Percent of Total Billed Charges,69% of total billed charges,107.94,84,,,Percent of Total Billed Charges,84% of total billed charges,105.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,16.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.95,77,,,Percent of total Billed charges,77% of total billed charges,109.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.13,120,,,Fee Schedule,120% of MO Medicaid Rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,109.23,
C. DIFFICILE AG,T990360077,CDM,306,RC,87449,HCPCS,Outpatient,,,437.5,218.75,,336.88,77,,,Percent of Total Billed Charges,77% of total billed charges,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.75,74,,,Percent of Total Billed Charges,74% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,367.5,84,,,Percent of Total Billed Charges,84% of total billed charges,358.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.88,77,,,Percent of total Billed charges,77% of total billed charges,371.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,371.88,
NOROVIRUS STOOL,T990360078,CDM,302,RC,87449,HCPCS,Outpatient,,,437.5,218.75,,336.88,77,,,Percent of Total Billed Charges,77% of total billed charges,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,323.75,74,,,Percent of Total Billed Charges,74% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,301.88,69,,,Percent of Total Billed Charges,69% of total billed charges,367.5,84,,,Percent of Total Billed Charges,84% of total billed charges,358.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,11.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.88,77,,,Percent of total Billed charges,77% of total billed charges,371.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.5,120,,,Fee Schedule,120% of MO Medicaid Rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,109.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.5,371.88,
Lyme Disease DNA PCR,T990360079,CDM,307,RC,87476,HCPCS,Outpatient,,,753,376.5,,579.81,77,,,Percent of Total Billed Charges,77% of total billed charges,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557.22,74,,,Percent of Total Billed Charges,74% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,519.57,69,,,Percent of Total Billed Charges,69% of total billed charges,632.52,84,,,Percent of Total Billed Charges,84% of total billed charges,617.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.81,77,,,Percent of total Billed charges,77% of total billed charges,640.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,188.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,640.05,
CANDIDA DNA PROBE,T990360080,CDM,306,RC,87480,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.35,500,,,fee schedule,500% of healthlink,146.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,146.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,146.35,
CHLAMYDIA TRACHOMATIS,T990360081,CDM,306,RC,87491,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.88,256.25,
C.DIFFICILE TOXIN GENE(S),T990360083,CDM,306,RC,87493,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.92,89,,,Percent of total Billed Charges,89% of total Billed charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,120,,,Fee Schedule,120% of MO Medicaid Rate,35.77,120,,,Fee Schedule,120% of MO Medicaid Rate,35.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,35.77,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,291.92,
CMV QUANT PCR,T990360084,CDM,306,RC,87497,HCPCS,Outpatient,,,246.5,123.25,,189.81,77,,,Percent of Total Billed Charges,77% of total billed charges,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.41,74,,,Percent of Total Billed Charges,74% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,207.06,84,,,Percent of Total Billed Charges,84% of total billed charges,202.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.81,77,,,Percent of total Billed charges,77% of total billed charges,209.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,312.7,
ENTEROVIRUS AMPLIFIED PROBE,T990360085,CDM,306,RC,87498,HCPCS,Outpatient,,,541,270.5,,416.57,77,,,Percent of Total Billed Charges,77% of total billed charges,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,400.34,74,,,Percent of Total Billed Charges,74% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,454.44,84,,,Percent of Total Billed Charges,84% of total billed charges,443.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.57,77,,,Percent of total Billed charges,77% of total billed charges,459.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,459.85,
INFLUENZA FIRST TWO SUBTYPES,T990360086,CDM,306,RC,87502,HCPCS,Outpatient,,,332.5,166.25,,256.03,77,,,Percent of Total Billed Charges,77% of total billed charges,84.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,246.05,74,,,Percent of Total Billed Charges,74% of total billed charges,229.43,69,,,Percent of Total Billed Charges,69% of total billed charges,229.43,69,,,Percent of Total Billed Charges,69% of total billed charges,83.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.43,69,,,Percent of Total Billed Charges,69% of total billed charges,229.43,69,,,Percent of Total Billed Charges,69% of total billed charges,279.3,84,,,Percent of Total Billed Charges,84% of total billed charges,272.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.93,89,,,Percent of total Billed Charges,89% of total Billed charges,295.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.97,120,,,Fee Schedule,120% of MO Medicaid Rate,91.97,120,,,Fee Schedule,120% of MO Medicaid Rate,91.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,77,,,Percent of total Billed charges,77% of total billed charges,282.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,91.97,120,,,Fee Schedule,120% of MO Medicaid Rate,83.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,83.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,295.93,
INFLUENZA ADD TYPE (H1N1),T990360087,CDM,306,RC,87503,HCPCS,Outpatient,,,113,56.5,,87.01,77,,,Percent of Total Billed Charges,77% of total billed charges,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.62,74,,,Percent of Total Billed Charges,74% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,77.97,69,,,Percent of Total Billed Charges,69% of total billed charges,94.92,84,,,Percent of Total Billed Charges,84% of total billed charges,92.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.57,89,,,Percent of total Billed Charges,89% of total Billed charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.04,120,,,Fee Schedule,120% of MO Medicaid Rate,28.04,120,,,Fee Schedule,120% of MO Medicaid Rate,28.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.01,77,,,Percent of total Billed charges,77% of total billed charges,96.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.04,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.04,100.57,
GARDNERELLA DNA PROBE,T990360088,CDM,306,RC,87510,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.35,500,,,fee schedule,500% of healthlink,146.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,146.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,146.35,
HSV 1 & 2 QUANT PCR,T990360089,CDM,306,RC,87530,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,312.7,
NEISSERIA GONORRHOEAE,T990360090,CDM,306,RC,87591,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.88,256.25,
SMHW-HUMAN PAPILLOMAVIRUS,T990360092,CDM,306,RC,87623,HCPCS,Outpatient,,,53.5,26.75,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.59,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.94,84,,,Percent of Total Billed Charges,84% of total billed charges,43.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,64,
HUMAN PAPILLOMAVIRUS EACH,T990360093,CDM,306,RC,87624,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
HPV GENOTYPE EACH,T990360094,CDM,306,RC,87625,HCPCS,Outpatient,,,67.5,33.75,,51.98,77,,,Percent of Total Billed Charges,77% of total billed charges,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.95,74,,,Percent of Total Billed Charges,74% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,46.58,69,,,Percent of Total Billed Charges,69% of total billed charges,56.7,84,,,Percent of Total Billed Charges,84% of total billed charges,55.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.08,89,,,Percent of total Billed Charges,89% of total Billed charges,60.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,120,,,Fee Schedule,120% of MO Medicaid Rate,38.93,120,,,Fee Schedule,120% of MO Medicaid Rate,38.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.98,77,,,Percent of total Billed charges,77% of total billed charges,57.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,38.93,120,,,Fee Schedule,120% of MO Medicaid Rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.88,64,
STREP A PCR,T990360095,CDM,306,RC,87651,HCPCS,Outpatient,,,145,72.5,,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.3,74,,,Percent of Total Billed Charges,74% of total billed charges,100.05,69,,,Percent of Total Billed Charges,69% of total billed charges,100.05,69,,,Percent of Total Billed Charges,69% of total billed charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.05,69,,,Percent of Total Billed Charges,69% of total billed charges,100.05,69,,,Percent of Total Billed Charges,69% of total billed charges,121.8,84,,,Percent of Total Billed Charges,84% of total billed charges,118.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,256.25,
TRICHOMONAS DNA PROBE,T990360096,CDM,306,RC,87660,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.35,500,,,fee schedule,500% of healthlink,146.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,146.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,19.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,19.25,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,146.35,
DETECT AGENT NOS DNA PCR,T990360097,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
EHRLICHIA CHAFFEENSIS,T990360098,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
ENTEROVIRUS RNA QUAL RT PCR,T990360099,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
INFUENZA A RNA,T990360100,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
MRSA PCR,T990360101,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
RHINOVIRUS RNA RT PCR,T990360102,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
VZV DNA QUAL RT-PCR,T990360103,CDM,306,RC,87798,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.25,500,,,fee schedule,500% of healthlink,256.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,256.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,33.68,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,347.23,
BK VIRUS DNA QUANT PCR,T990360104,CDM,306,RC,87799,HCPCS,Outpatient,,,625,312.5,,481.25,77,,,Percent of Total Billed Charges,77% of total billed charges,159.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.5,74,,,Percent of Total Billed Charges,74% of total billed charges,431.25,69,,,Percent of Total Billed Charges,69% of total billed charges,431.25,69,,,Percent of Total Billed Charges,69% of total billed charges,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.25,69,,,Percent of Total Billed Charges,69% of total billed charges,431.25,69,,,Percent of Total Billed Charges,69% of total billed charges,525,84,,,Percent of Total Billed Charges,84% of total billed charges,512.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.25,77,,,Percent of total Billed charges,77% of total billed charges,531.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,156.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,531.25,
EBV QUANT PCR,T990360105,CDM,306,RC,87799,HCPCS,Outpatient,,,537.5,268.75,,413.88,77,,,Percent of Total Billed Charges,77% of total billed charges,137.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,397.75,74,,,Percent of Total Billed Charges,74% of total billed charges,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,451.5,84,,,Percent of Total Billed Charges,84% of total billed charges,440.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,413.88,77,,,Percent of total Billed charges,77% of total billed charges,456.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,456.88,
VZV DNA QUANT RT-PCR,T990360106,CDM,306,RC,87799,HCPCS,Outpatient,,,537.5,268.75,,413.88,77,,,Percent of Total Billed Charges,77% of total billed charges,137.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,397.75,74,,,Percent of Total Billed Charges,74% of total billed charges,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,370.88,69,,,Percent of Total Billed Charges,69% of total billed charges,451.5,84,,,Percent of Total Billed Charges,84% of total billed charges,440.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,312.7,500,,,fee schedule,500% of healthlink,312.7,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,312.7,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,41.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,413.88,77,,,Percent of total Billed charges,77% of total billed charges,456.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,41.12,120,,,Fee Schedule,120% of MO Medicaid Rate,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,134.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.12,456.88,
INFLUENZA A DIRECT AG,T990360107,CDM,306,RC,87804,HCPCS,Outpatient,,,134,67,QW,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.16,74,,,Percent of Total Billed Charges,74% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,112.56,84,,,Percent of Total Billed Charges,84% of total billed charges,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,15.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,113.9,
INFLUENZA B DIRECT AG,T990360108,CDM,306,RC,87804,HCPCS,Outpatient,,,134,67,QW,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.16,74,,,Percent of Total Billed Charges,74% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,92.46,69,,,Percent of Total Billed Charges,69% of total billed charges,112.56,84,,,Percent of Total Billed Charges,84% of total billed charges,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,15.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.89,120,,,Fee Schedule,120% of MO Medicaid Rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,113.9,
RSV BY ITC,T990360109,CDM,306,RC,87807,HCPCS,Outpatient,,,144,72,,110.88,77,,,Percent of Total Billed Charges,77% of total billed charges,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.56,74,,,Percent of Total Billed Charges,74% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,99.36,69,,,Percent of Total Billed Charges,69% of total billed charges,120.96,84,,,Percent of Total Billed Charges,84% of total billed charges,118.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,12.58,120,,,Fee Schedule,120% of MO Medicaid Rate,12.58,120,,,Fee Schedule,120% of MO Medicaid Rate,12.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.88,77,,,Percent of total Billed charges,77% of total billed charges,122.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,12.58,120,,,Fee Schedule,120% of MO Medicaid Rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,122.4,
RESPIRATORY SYNCYTIAL VIRUS,T990360110,CDM,306,RC,87899,HCPCS,Outpatient,,,170.5,85.25,QW,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.42,144.93,
RESPIRATORY SYNCYTIAL VIRUS,T990360110,CDM,306,RC,87899,HCPCS,Outpatient,,,170.5,85.25,,131.29,77,,,Percent of Total Billed Charges,77% of total billed charges,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.17,74,,,Percent of Total Billed Charges,74% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,117.65,69,,,Percent of Total Billed Charges,69% of total billed charges,143.22,84,,,Percent of Total Billed Charges,84% of total billed charges,139.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.6,500,,,fee schedule,500% of healthlink,87.6,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,87.6,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,15.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.29,77,,,Percent of total Billed charges,77% of total billed charges,144.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.42,120,,,Fee Schedule,120% of MO Medicaid Rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,42.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.42,144.93,
FECAL MUCUS,T990360111,CDM,306,RC,87999,HCPCS,Outpatient,,,77,38.5,,59.29,77,,,Percent of Total Billed Charges,77% of total billed charges,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.98,74,,,Percent of Total Billed Charges,74% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,53.13,69,,,Percent of Total Billed Charges,69% of total billed charges,64.68,84,,,Percent of Total Billed Charges,84% of total billed charges,63.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.53,89,,,Percent of total Billed Charges,89% of total Billed charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,77,,,Percent of total Billed charges,77% of total billed charges,65.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,19.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,68.53,
CYSTIC FIBROSIS,T990370001,CDM,310,RC,81220,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.92,89,,,Percent of total Billed Charges,89% of total Billed charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,534.34,120,,,Fee Schedule,120% of MO Medicaid Rate,534.34,120,,,Fee Schedule,120% of MO Medicaid Rate,534.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,534.34,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,534.34,
HC CYTOGEN MICROARRAY SNP VAR,T990370002,CDM,310,RC,81229,HCPCS,Outpatient,,,3483,1741.5,,2681.91,77,,,Percent of Total Billed Charges,77% of total billed charges,888.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,888.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1088.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2577.42,74,,,Percent of Total Billed Charges,74% of total billed charges,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2925.72,84,,,Percent of Total Billed Charges,84% of total billed charges,2856.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3099.87,89,,,Percent of total Billed Charges,89% of total Billed charges,3099.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3099.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1113.6,120,,,Fee Schedule,120% of MO Medicaid Rate,1113.6,120,,,Fee Schedule,120% of MO Medicaid Rate,1113.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2681.91,77,,,Percent of total Billed charges,77% of total billed charges,2960.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1001.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,1113.6,120,,,Fee Schedule,120% of MO Medicaid Rate,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,3099.87,
FACTOR V LEIDEN MUTATION,T990370003,CDM,310,RC,81241,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.92,89,,,Percent of total Billed Charges,89% of total Billed charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.43,120,,,Fee Schedule,120% of MO Medicaid Rate,70.43,120,,,Fee Schedule,120% of MO Medicaid Rate,70.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,70.43,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,291.92,
MTHFR,T990370004,CDM,310,RC,81291,HCPCS,Outpatient,,,524,262,,403.48,77,,,Percent of Total Billed Charges,77% of total billed charges,133.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,387.76,74,,,Percent of Total Billed Charges,74% of total billed charges,361.56,69,,,Percent of Total Billed Charges,69% of total billed charges,361.56,69,,,Percent of Total Billed Charges,69% of total billed charges,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.56,69,,,Percent of Total Billed Charges,69% of total billed charges,361.56,69,,,Percent of Total Billed Charges,69% of total billed charges,440.16,84,,,Percent of Total Billed Charges,84% of total billed charges,429.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.36,89,,,Percent of total Billed Charges,89% of total Billed charges,466.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.72,120,,,Fee Schedule,120% of MO Medicaid Rate,62.72,120,,,Fee Schedule,120% of MO Medicaid Rate,62.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.48,77,,,Percent of total Billed charges,77% of total billed charges,445.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,62.72,120,,,Fee Schedule,120% of MO Medicaid Rate,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,131,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.72,466.36,
ALPHA-1 ANTITRYPSIN MUTATION,T990370005,CDM,310,RC,81332,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,194.62,74,,,Percent of Total Billed Charges,74% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,181.47,69,,,Percent of Total Billed Charges,69% of total billed charges,220.92,84,,,Percent of Total Billed Charges,84% of total billed charges,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.9,120,,,Fee Schedule,120% of MO Medicaid Rate,41.9,120,,,Fee Schedule,120% of MO Medicaid Rate,41.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,41.9,120,,,Fee Schedule,120% of MO Medicaid Rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.9,234.07,
TPMT GENOTYPE,T990370006,CDM,310,RC,81335,HCPCS,Outpatient,,,743,371.5,,572.11,77,,,Percent of Total Billed Charges,77% of total billed charges,189.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,549.82,74,,,Percent of Total Billed Charges,74% of total billed charges,512.67,69,,,Percent of Total Billed Charges,69% of total billed charges,512.67,69,,,Percent of Total Billed Charges,69% of total billed charges,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,512.67,69,,,Percent of Total Billed Charges,69% of total billed charges,512.67,69,,,Percent of Total Billed Charges,69% of total billed charges,624.12,84,,,Percent of Total Billed Charges,84% of total billed charges,609.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,661.27,89,,,Percent of total Billed Charges,89% of total Billed charges,661.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,661.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.81,120,,,Fee Schedule,120% of MO Medicaid Rate,167.81,120,,,Fee Schedule,120% of MO Medicaid Rate,167.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.11,77,,,Percent of total Billed charges,77% of total billed charges,631.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,167.81,120,,,Fee Schedule,120% of MO Medicaid Rate,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,185.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,661.27,
CYTOPATHOLOGY,T990370007,CDM,310,RC,88104,HCPCS,Outpatient,,,222.5,111.25,,171.33,77,,,Percent of Total Billed Charges,77% of total billed charges,56.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,164.65,74,,,Percent of Total Billed Charges,74% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,186.9,84,,,Percent of Total Billed Charges,84% of total billed charges,182.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.03,89,,,Percent of total Billed Charges,89% of total Billed charges,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.82,120,,,Fee Schedule,120% of MO Medicaid Rate,39.82,120,,,Fee Schedule,120% of MO Medicaid Rate,39.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.33,77,,,Percent of total Billed charges,77% of total billed charges,189.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,39.82,120,,,Fee Schedule,120% of MO Medicaid Rate,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.82,198.03,
CYTO-CELLULAR ENHANCEMENT LIQ,T990370008,CDM,310,RC,88112,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.49,74,,,Percent of Total Billed Charges,74% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,69,,,Percent of Total Billed Charges,69% of total billed charges,74.34,84,,,Percent of Total Billed Charges,84% of total billed charges,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.77,89,,,Percent of total Billed Charges,89% of total Billed charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.32,120,,,Fee Schedule,120% of MO Medicaid Rate,37.32,120,,,Fee Schedule,120% of MO Medicaid Rate,37.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,37.32,120,,,Fee Schedule,120% of MO Medicaid Rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,81,
CYTOPATH CELL ENHANCE TECH,T990370009,CDM,310,RC,88112,HCPCS,Outpatient,,,163.5,81.75,,125.9,77,,,Percent of Total Billed Charges,77% of total billed charges,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.99,74,,,Percent of Total Billed Charges,74% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,137.34,84,,,Percent of Total Billed Charges,84% of total billed charges,134.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.52,89,,,Percent of total Billed Charges,89% of total Billed charges,145.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.32,120,,,Fee Schedule,120% of MO Medicaid Rate,37.32,120,,,Fee Schedule,120% of MO Medicaid Rate,37.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.9,77,,,Percent of total Billed charges,77% of total billed charges,138.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,37.32,120,,,Fee Schedule,120% of MO Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.32,145.52,
CYTOPATH C/V INTERP BY PHYS,T990370010,CDM,310,RC,88141,HCPCS,Outpatient,,,100,50,,77,77,,,Percent of Total Billed Charges,77% of total billed charges,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74,74,,,Percent of Total Billed Charges,74% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,69,,,Percent of Total Billed Charges,69% of total billed charges,69,69,,,Percent of Total Billed Charges,69% of total billed charges,84,84,,,Percent of Total Billed Charges,84% of total billed charges,82,82,,,Percent of Total Billed Charges,82% of total billed charges ,89,89,,,Percent of total Billed Charges,89% of total Billed charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,77,,,Percent of total Billed charges,77% of total billed charges,85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25,89,
CYTOPATH C/V AUTO W/ RESCREEN,T990370011,CDM,311,RC,88142,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.48,74,,,Percent of Total Billed Charges,74% of total billed charges,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,104.88,69,,,Percent of Total Billed Charges,69% of total billed charges,127.68,84,,,Percent of Total Billed Charges,84% of total billed charges,124.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.25,500,,,fee schedule,500% of healthlink,110.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,110.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,129.2,
SMHW-CYTOPATH C/V AUTO THIN,T990370012,CDM,311,RC,88142,HCPCS,Outpatient,,,24,12,,18.48,77,,,Percent of Total Billed Charges,77% of total billed charges,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.76,74,,,Percent of Total Billed Charges,74% of total billed charges,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,16.56,69,,,Percent of Total Billed Charges,69% of total billed charges,20.16,84,,,Percent of Total Billed Charges,84% of total billed charges,19.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.25,500,,,fee schedule,500% of healthlink,110.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,110.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.48,77,,,Percent of total Billed charges,77% of total billed charges,20.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6,110.25,
FINE NDL ASP DX 1ST EA STUDY,T990370013,CDM,310,RC,88172,HCPCS,Outpatient,,,84.5,42.25,,65.07,77,,,Percent of Total Billed Charges,77% of total billed charges,21.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.53,74,,,Percent of Total Billed Charges,74% of total billed charges,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,58.31,69,,,Percent of Total Billed Charges,69% of total billed charges,70.98,84,,,Percent of Total Billed Charges,84% of total billed charges,69.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.21,89,,,Percent of total Billed Charges,89% of total Billed charges,75.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,19.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.07,77,,,Percent of total Billed charges,77% of total billed charges,71.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,19.44,120,,,Fee Schedule,120% of MO Medicaid Rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,21.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,81,
CYTOPATH C/V AUTO THIN LAYER,T990370014,CDM,311,RC,88175,HCPCS,Outpatient,,,189.5,94.75,,145.92,77,,,Percent of Total Billed Charges,77% of total billed charges,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.23,74,,,Percent of Total Billed Charges,74% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,130.76,69,,,Percent of Total Billed Charges,69% of total billed charges,159.18,84,,,Percent of Total Billed Charges,84% of total billed charges,155.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.3,500,,,fee schedule,500% of healthlink,134.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,134.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,25.54,120,,,Fee Schedule,120% of MO Medicaid Rate,25.54,120,,,Fee Schedule,120% of MO Medicaid Rate,25.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.92,77,,,Percent of total Billed charges,77% of total billed charges,161.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,25.54,120,,,Fee Schedule,120% of MO Medicaid Rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,47.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.54,161.08,
FLOW CYTOMETRY FIRST MARKER,T990370015,CDM,311,RC,88184,HCPCS,Outpatient,,,179.5,89.75,,138.22,77,,,Percent of Total Billed Charges,77% of total billed charges,45.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.83,74,,,Percent of Total Billed Charges,74% of total billed charges,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,150.78,84,,,Percent of Total Billed Charges,84% of total billed charges,147.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.76,89,,,Percent of total Billed Charges,89% of total Billed charges,159.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.6,120,,,Fee Schedule,120% of MO Medicaid Rate,69.6,120,,,Fee Schedule,120% of MO Medicaid Rate,69.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.22,77,,,Percent of total Billed charges,77% of total billed charges,152.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,69.6,120,,,Fee Schedule,120% of MO Medicaid Rate,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.88,159.76,
FLOW CYTOMETRY EA. ADD. MARKER,T990370016,CDM,311,RC,88185,HCPCS,Outpatient,,,157,78.5,,120.89,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.18,74,,,Percent of Total Billed Charges,74% of total billed charges,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,108.33,69,,,Percent of Total Billed Charges,69% of total billed charges,131.88,84,,,Percent of Total Billed Charges,84% of total billed charges,128.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.73,89,,,Percent of total Billed Charges,89% of total Billed charges,139.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.26,120,,,Fee Schedule,120% of MO Medicaid Rate,22.26,120,,,Fee Schedule,120% of MO Medicaid Rate,22.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.89,77,,,Percent of total Billed charges,77% of total billed charges,133.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,22.26,120,,,Fee Schedule,120% of MO Medicaid Rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.26,139.73,
FLOW CYTOMETRY INTERP 2-8,T990370017,CDM,311,RC,88187,HCPCS,Outpatient,,,173.5,86.75,,133.6,77,,,Percent of Total Billed Charges,77% of total billed charges,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.39,74,,,Percent of Total Billed Charges,74% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,119.72,69,,,Percent of Total Billed Charges,69% of total billed charges,145.74,84,,,Percent of Total Billed Charges,84% of total billed charges,142.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.42,89,,,Percent of total Billed Charges,89% of total Billed charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.6,77,,,Percent of total Billed charges,77% of total billed charges,147.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,70.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,43.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.38,154.42,
FLOW CYTOMETRY INTERP 9-15,T990370018,CDM,311,RC,88188,HCPCS,Outpatient,,,191,95.5,,147.07,77,,,Percent of Total Billed Charges,77% of total billed charges,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,141.34,74,,,Percent of Total Billed Charges,74% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,131.79,69,,,Percent of Total Billed Charges,69% of total billed charges,160.44,84,,,Percent of Total Billed Charges,84% of total billed charges,156.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.99,89,,,Percent of total Billed Charges,89% of total Billed charges,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.07,77,,,Percent of total Billed charges,77% of total billed charges,162.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,77.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.75,169.99,
FLOW CYTOMETRY INTERP 16+,T990370019,CDM,311,RC,88189,HCPCS,Outpatient,,,166,83,,127.82,77,,,Percent of Total Billed Charges,77% of total billed charges,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.84,74,,,Percent of Total Billed Charges,74% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,114.54,69,,,Percent of Total Billed Charges,69% of total billed charges,139.44,84,,,Percent of Total Billed Charges,84% of total billed charges,136.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,147.74,89,,,Percent of total Billed Charges,89% of total Billed charges,147.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.82,77,,,Percent of total Billed charges,77% of total billed charges,141.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,67.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,41.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.5,147.74,
CHROMOSOME TISSUE CULTURE,T990370020,CDM,310,RC,88230,HCPCS,Outpatient,,,376,188,,289.52,77,,,Percent of Total Billed Charges,77% of total billed charges,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,278.24,74,,,Percent of Total Billed Charges,74% of total billed charges,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,315.84,84,,,Percent of Total Billed Charges,84% of total billed charges,308.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,850.5,500,,,fee schedule,500% of healthlink,850.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,850.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,111.83,120,,,Fee Schedule,120% of MO Medicaid Rate,111.83,120,,,Fee Schedule,120% of MO Medicaid Rate,111.83,120,,,Fee Schedule,120% of MO of Medicaid Rate,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.52,77,,,Percent of total Billed charges,77% of total billed charges,319.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,111.83,120,,,Fee Schedule,120% of MO Medicaid Rate,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,850.5,
TISSUE CULTURE LYMPHOCYTE,T990370021,CDM,310,RC,88230,HCPCS,Outpatient,,,376,188,,289.52,77,,,Percent of Total Billed Charges,77% of total billed charges,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,278.24,74,,,Percent of Total Billed Charges,74% of total billed charges,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,259.44,69,,,Percent of Total Billed Charges,69% of total billed charges,315.84,84,,,Percent of Total Billed Charges,84% of total billed charges,308.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,850.5,500,,,fee schedule,500% of healthlink,850.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,850.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,111.83,120,,,Fee Schedule,120% of MO Medicaid Rate,111.83,120,,,Fee Schedule,120% of MO Medicaid Rate,111.83,120,,,Fee Schedule,120% of MO of Medicaid Rate,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.52,77,,,Percent of total Billed charges,77% of total billed charges,319.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,111.83,120,,,Fee Schedule,120% of MO Medicaid Rate,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,850.5,
TISSUE CULUTRE SOLID BIOPSY,T990370022,CDM,310,RC,88233,HCPCS,Outpatient,,,730.5,365.25,,562.49,77,,,Percent of Total Billed Charges,77% of total billed charges,186.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,540.57,74,,,Percent of Total Billed Charges,74% of total billed charges,504.05,69,,,Percent of Total Billed Charges,69% of total billed charges,504.05,69,,,Percent of Total Billed Charges,69% of total billed charges,182.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,504.05,69,,,Percent of Total Billed Charges,69% of total billed charges,504.05,69,,,Percent of Total Billed Charges,69% of total billed charges,613.62,84,,,Percent of Total Billed Charges,84% of total billed charges,599.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1027.4,500,,,fee schedule,500% of healthlink,1027.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,1027.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,135.1,120,,,Fee Schedule,120% of MO Medicaid Rate,135.1,120,,,Fee Schedule,120% of MO Medicaid Rate,135.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,182.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562.49,77,,,Percent of total Billed charges,77% of total billed charges,620.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,210.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,135.1,120,,,Fee Schedule,120% of MO Medicaid Rate,182.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,182.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,1027.4,
CHROMOSOME ANALYSIS 15-20,T990370023,CDM,310,RC,88262,HCPCS,Outpatient,,,1019,509.5,,784.63,77,,,Percent of Total Billed Charges,77% of total billed charges,259.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,318.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,754.06,74,,,Percent of Total Billed Charges,74% of total billed charges,703.11,69,,,Percent of Total Billed Charges,69% of total billed charges,703.11,69,,,Percent of Total Billed Charges,69% of total billed charges,254.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.11,69,,,Percent of Total Billed Charges,69% of total billed charges,703.11,69,,,Percent of Total Billed Charges,69% of total billed charges,855.96,84,,,Percent of Total Billed Charges,84% of total billed charges,835.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,909.9,500,,,fee schedule,500% of healthlink,909.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,909.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,120.47,120,,,Fee Schedule,120% of MO Medicaid Rate,120.47,120,,,Fee Schedule,120% of MO Medicaid Rate,120.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,254.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,784.63,77,,,Percent of total Billed charges,77% of total billed charges,866.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,292.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,120.47,120,,,Fee Schedule,120% of MO Medicaid Rate,254.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,254.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,909.9,
CHROMOSOME ANALYSIS 45 CELLS,T990370025,CDM,310,RC,88263,HCPCS,Outpatient,,,518.5,259.25,,399.25,77,,,Percent of Total Billed Charges,77% of total billed charges,132.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.69,74,,,Percent of Total Billed Charges,74% of total billed charges,357.77,69,,,Percent of Total Billed Charges,69% of total billed charges,357.77,69,,,Percent of Total Billed Charges,69% of total billed charges,129.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.77,69,,,Percent of Total Billed Charges,69% of total billed charges,357.77,69,,,Percent of Total Billed Charges,69% of total billed charges,435.54,84,,,Percent of Total Billed Charges,84% of total billed charges,425.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,1097.1,500,,,fee schedule,500% of healthlink,1097.1,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,1097.1,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,144.28,120,,,Fee Schedule,120% of MO Medicaid Rate,144.28,120,,,Fee Schedule,120% of MO Medicaid Rate,144.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,129.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.25,77,,,Percent of total Billed charges,77% of total billed charges,440.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,144.28,120,,,Fee Schedule,120% of MO Medicaid Rate,129.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,129.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,1097.1,
FISH- CYTOGENETICS DNA PROBE,T990370026,CDM,310,RC,88271,HCPCS,Outpatient,,,249,124.5,,191.73,77,,,Percent of Total Billed Charges,77% of total billed charges,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,184.26,74,,,Percent of Total Billed Charges,74% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,171.81,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,84,,,Percent of Total Billed Charges,84% of total billed charges,204.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.35,500,,,fee schedule,500% of healthlink,156.35,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,156.35,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,20.56,120,,,Fee Schedule,120% of MO Medicaid Rate,20.56,120,,,Fee Schedule,120% of MO Medicaid Rate,20.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.73,77,,,Percent of total Billed charges,77% of total billed charges,211.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,20.56,120,,,Fee Schedule,120% of MO Medicaid Rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,62.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.56,211.65,
CHROMOSOSME IN SITU 10-30 CELL,T990370029,CDM,310,RC,88273,HCPCS,Outpatient,,,414,207,,318.78,77,,,Percent of Total Billed Charges,77% of total billed charges,105.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,306.36,74,,,Percent of Total Billed Charges,74% of total billed charges,285.66,69,,,Percent of Total Billed Charges,69% of total billed charges,285.66,69,,,Percent of Total Billed Charges,69% of total billed charges,103.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.66,69,,,Percent of Total Billed Charges,69% of total billed charges,285.66,69,,,Percent of Total Billed Charges,69% of total billed charges,347.76,84,,,Percent of Total Billed Charges,84% of total billed charges,339.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.55,500,,,fee schedule,500% of healthlink,234.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,234.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.41,120,,,Fee Schedule,120% of MO Medicaid Rate,33.41,120,,,Fee Schedule,120% of MO Medicaid Rate,33.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,103.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.78,77,,,Percent of total Billed charges,77% of total billed charges,351.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,33.41,120,,,Fee Schedule,120% of MO Medicaid Rate,103.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,103.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.41,351.9,
CYTOGENETICS 100-300,T990370030,CDM,310,RC,88275,HCPCS,Outpatient,,,651,325.5,,501.27,77,,,Percent of Total Billed Charges,77% of total billed charges,166.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,481.74,74,,,Percent of Total Billed Charges,74% of total billed charges,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,449.19,69,,,Percent of Total Billed Charges,69% of total billed charges,546.84,84,,,Percent of Total Billed Charges,84% of total billed charges,533.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,293.2,500,,,fee schedule,500% of healthlink,293.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,293.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,49.14,120,,,Fee Schedule,120% of MO Medicaid Rate,49.14,120,,,Fee Schedule,120% of MO Medicaid Rate,49.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.27,77,,,Percent of total Billed charges,77% of total billed charges,553.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,49.14,120,,,Fee Schedule,120% of MO Medicaid Rate,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,162.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.14,553.35,
CHROMOSOME ADD HIGH RES STUDY,T990370032,CDM,310,RC,88289,HCPCS,Outpatient,,,257,128.5,,197.89,77,,,Percent of Total Billed Charges,77% of total billed charges,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.18,74,,,Percent of Total Billed Charges,74% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,215.88,84,,,Percent of Total Billed Charges,84% of total billed charges,210.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.4,500,,,fee schedule,500% of healthlink,251.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,251.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,33.05,120,,,Fee Schedule,120% of MO Medicaid Rate,33.05,120,,,Fee Schedule,120% of MO Medicaid Rate,33.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.89,77,,,Percent of total Billed charges,77% of total billed charges,218.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,33.05,120,,,Fee Schedule,120% of MO Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.05,251.4,
INTERPRETATION AND REPORT,T990370033,CDM,310,RC,88291,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
CAN-CYTOGENE INTRP & REPORT,T990370034,CDM,319,RC,88291,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
CHROMOSOME ANAL. INTERP & RPT,T990370035,CDM,311,RC,88291,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
CHROMOSOME INTERP & REPORT,T990370036,CDM,310,RC,88291,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
INTERPET & REPORT CLL B-CELL,T990370037,CDM,310,RC,88291,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
INTERPRETATION & REPORT,T990370038,CDM,310,RC,88291,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.21,74,,,Percent of Total Billed Charges,74% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,80.39,69,,,Percent of Total Billed Charges,69% of total billed charges,97.86,84,,,Percent of Total Billed Charges,84% of total billed charges,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,103.69,
LVL I PATH GROSS EXAM ONLY TC,T990370039,CDM,310,RC,88300,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.6,74,,,Percent of Total Billed Charges,74% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,33.6,84,,,Percent of Total Billed Charges,84% of total billed charges,32.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.6,89,,,Percent of total Billed Charges,89% of total Billed charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.97,120,,,Fee Schedule,120% of MO Medicaid Rate,10.97,120,,,Fee Schedule,120% of MO Medicaid Rate,10.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,10.97,120,,,Fee Schedule,120% of MO Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,81,
LVL II PATH GROSS & MICRO TC,T990370040,CDM,310,RC,88302,HCPCS,Outpatient,,,158,79,,121.66,77,,,Percent of Total Billed Charges,77% of total billed charges,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.02,69,,,Percent of Total Billed Charges,69% of total billed charges,132.72,84,,,Percent of Total Billed Charges,84% of total billed charges,129.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.62,89,,,Percent of total Billed Charges,89% of total Billed charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,120,,,Fee Schedule,120% of MO Medicaid Rate,24.46,120,,,Fee Schedule,120% of MO Medicaid Rate,24.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.66,77,,,Percent of total Billed charges,77% of total billed charges,134.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,24.46,120,,,Fee Schedule,120% of MO Medicaid Rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,39.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.46,140.62,
LVL III PATH GROSS & MICRO TC,T990370041,CDM,310,RC,88304,HCPCS,Outpatient,,,174.5,87.25,,134.37,77,,,Percent of Total Billed Charges,77% of total billed charges,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.13,74,,,Percent of Total Billed Charges,74% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,146.58,84,,,Percent of Total Billed Charges,84% of total billed charges,143.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.31,89,,,Percent of total Billed Charges,89% of total Billed charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.47,120,,,Fee Schedule,120% of MO Medicaid Rate,29.47,120,,,Fee Schedule,120% of MO Medicaid Rate,29.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.37,77,,,Percent of total Billed charges,77% of total billed charges,148.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,29.47,120,,,Fee Schedule,120% of MO Medicaid Rate,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.47,155.31,
LVL IV PATH GROSS & MICRO TC,T990370042,CDM,310,RC,88305,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.15,74,,,Percent of Total Billed Charges,74% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,136.28,69,,,Percent of Total Billed Charges,69% of total billed charges,165.9,84,,,Percent of Total Billed Charges,84% of total billed charges,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,120,,,Fee Schedule,120% of MO Medicaid Rate,32.62,120,,,Fee Schedule,120% of MO Medicaid Rate,32.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,32.62,120,,,Fee Schedule,120% of MO Medicaid Rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,175.78,
LVL V PATH GROSS & MICRO TC,T990370043,CDM,310,RC,88307,HCPCS,Outpatient,,,219,109.5,,168.63,77,,,Percent of Total Billed Charges,77% of total billed charges,55.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.06,74,,,Percent of Total Billed Charges,74% of total billed charges,151.11,69,,,Percent of Total Billed Charges,69% of total billed charges,151.11,69,,,Percent of Total Billed Charges,69% of total billed charges,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.11,69,,,Percent of Total Billed Charges,69% of total billed charges,151.11,69,,,Percent of Total Billed Charges,69% of total billed charges,183.96,84,,,Percent of Total Billed Charges,84% of total billed charges,179.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.91,89,,,Percent of total Billed Charges,89% of total Billed charges,194.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.97,120,,,Fee Schedule,120% of MO Medicaid Rate,195.97,120,,,Fee Schedule,120% of MO Medicaid Rate,195.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.63,77,,,Percent of total Billed charges,77% of total billed charges,186.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,195.97,120,,,Fee Schedule,120% of MO Medicaid Rate,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,54.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.75,195.97,
LVL VI PATH GROSS & MICRO TC,T990370044,CDM,310,RC,88309,HCPCS,Outpatient,,,304,152,,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.96,74,,,Percent of Total Billed Charges,74% of total billed charges,209.76,69,,,Percent of Total Billed Charges,69% of total billed charges,209.76,69,,,Percent of Total Billed Charges,69% of total billed charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.76,69,,,Percent of Total Billed Charges,69% of total billed charges,209.76,69,,,Percent of Total Billed Charges,69% of total billed charges,255.36,84,,,Percent of Total Billed Charges,84% of total billed charges,249.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,276.89,120,,,Fee Schedule,120% of MO Medicaid Rate,276.89,120,,,Fee Schedule,120% of MO Medicaid Rate,276.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,276.89,120,,,Fee Schedule,120% of MO Medicaid Rate,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,276.89,
IMMUNOCYTOLOGY AB GRP I TC,T990370045,CDM,310,RC,88312,HCPCS,Outpatient,,,187.5,93.75,,144.38,77,,,Percent of Total Billed Charges,77% of total billed charges,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.75,74,,,Percent of Total Billed Charges,74% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,157.5,84,,,Percent of Total Billed Charges,84% of total billed charges,153.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,166.88,89,,,Percent of total Billed Charges,89% of total Billed charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.9,120,,,Fee Schedule,120% of MO Medicaid Rate,80.9,120,,,Fee Schedule,120% of MO Medicaid Rate,80.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.38,77,,,Percent of total Billed charges,77% of total billed charges,159.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,80.9,120,,,Fee Schedule,120% of MO Medicaid Rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.88,166.88,
IMMUNOCYTOLOGY AB GRP II TC,T990370046,CDM,310,RC,88313,HCPCS,Outpatient,,,187.5,93.75,,144.38,77,,,Percent of Total Billed Charges,77% of total billed charges,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.75,74,,,Percent of Total Billed Charges,74% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,157.5,84,,,Percent of Total Billed Charges,84% of total billed charges,153.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,166.88,89,,,Percent of total Billed Charges,89% of total Billed charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,120,,,Fee Schedule,120% of MO Medicaid Rate,65.54,120,,,Fee Schedule,120% of MO Medicaid Rate,65.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.38,77,,,Percent of total Billed charges,77% of total billed charges,159.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,65.54,120,,,Fee Schedule,120% of MO Medicaid Rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.88,166.88,
CONSULT & RPT REF SLIDES PREP,T990370047,CDM,310,RC,88321,HCPCS,Outpatient,,,513,256.5,,395.01,77,,,Percent of Total Billed Charges,77% of total billed charges,130.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,379.62,74,,,Percent of Total Billed Charges,74% of total billed charges,353.97,69,,,Percent of Total Billed Charges,69% of total billed charges,353.97,69,,,Percent of Total Billed Charges,69% of total billed charges,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,353.97,69,,,Percent of Total Billed Charges,69% of total billed charges,353.97,69,,,Percent of Total Billed Charges,69% of total billed charges,430.92,84,,,Percent of Total Billed Charges,84% of total billed charges,420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,456.57,89,,,Percent of total Billed Charges,89% of total Billed charges,456.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,456.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.01,77,,,Percent of total Billed charges,77% of total billed charges,436.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,128.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,456.57,
CONSULT & RPT REF MAT REQ PREP,T990370048,CDM,310,RC,88323,HCPCS,Outpatient,,,538,269,,414.26,77,,,Percent of Total Billed Charges,77% of total billed charges,137.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,398.12,74,,,Percent of Total Billed Charges,74% of total billed charges,371.22,69,,,Percent of Total Billed Charges,69% of total billed charges,371.22,69,,,Percent of Total Billed Charges,69% of total billed charges,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,371.22,69,,,Percent of Total Billed Charges,69% of total billed charges,371.22,69,,,Percent of Total Billed Charges,69% of total billed charges,451.92,84,,,Percent of Total Billed Charges,84% of total billed charges,441.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,478.82,89,,,Percent of total Billed Charges,89% of total Billed charges,478.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.33,120,,,Fee Schedule,120% of MO Medicaid Rate,26.33,120,,,Fee Schedule,120% of MO Medicaid Rate,26.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.26,77,,,Percent of total Billed charges,77% of total billed charges,457.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,26.33,120,,,Fee Schedule,120% of MO Medicaid Rate,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,134.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.33,478.82,
FROZEN SECTION INTRAOP CONSULT,T990370049,CDM,310,RC,88329,HCPCS,Outpatient,,,245.5,122.75,,189.04,77,,,Percent of Total Billed Charges,77% of total billed charges,62.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.67,74,,,Percent of Total Billed Charges,74% of total billed charges,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,169.4,69,,,Percent of Total Billed Charges,69% of total billed charges,206.22,84,,,Percent of Total Billed Charges,84% of total billed charges,201.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.5,89,,,Percent of total Billed Charges,89% of total Billed charges,218.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.04,77,,,Percent of total Billed charges,77% of total billed charges,208.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,61.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,218.5,
FROZEN SECIONT 1ST SPECIMEN,T990370050,CDM,310,RC,88331,HCPCS,Outpatient,,,233.5,116.75,,179.8,77,,,Percent of Total Billed Charges,77% of total billed charges,59.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.79,74,,,Percent of Total Billed Charges,74% of total billed charges,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,161.12,69,,,Percent of Total Billed Charges,69% of total billed charges,196.14,84,,,Percent of Total Billed Charges,84% of total billed charges,191.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.82,89,,,Percent of total Billed Charges,89% of total Billed charges,207.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.57,120,,,Fee Schedule,120% of MO Medicaid Rate,38.57,120,,,Fee Schedule,120% of MO Medicaid Rate,38.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.8,77,,,Percent of total Billed charges,77% of total billed charges,198.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,38.57,120,,,Fee Schedule,120% of MO Medicaid Rate,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,58.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.57,207.82,
FROZEN SECTION EA ADD SPECIMAN,T990370051,CDM,310,RC,88332,HCPCS,Outpatient,,,178.5,89.25,,137.45,77,,,Percent of Total Billed Charges,77% of total billed charges,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.09,74,,,Percent of Total Billed Charges,74% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,123.17,69,,,Percent of Total Billed Charges,69% of total billed charges,149.94,84,,,Percent of Total Billed Charges,84% of total billed charges,146.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.87,89,,,Percent of total Billed Charges,89% of total Billed charges,158.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,23.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.45,77,,,Percent of total Billed charges,77% of total billed charges,151.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,23.21,120,,,Fee Schedule,120% of MO Medicaid Rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,44.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.21,158.87,
FROZEN SECTION TOUCH PREP,T990370052,CDM,310,RC,88333,HCPCS,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.85,89,,,Percent of total Billed Charges,89% of total Billed charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,120,,,Fee Schedule,120% of MO Medicaid Rate,30.1,120,,,Fee Schedule,120% of MO Medicaid Rate,30.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,30.1,120,,,Fee Schedule,120% of MO Medicaid Rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,146.85,
ANTIBODY STAIN EA ADD PROC,T990370053,CDM,310,RC,88341,HCPCS,Outpatient,,,250.5,125.25,,192.89,77,,,Percent of Total Billed Charges,77% of total billed charges,63.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.37,74,,,Percent of Total Billed Charges,74% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,210.42,84,,,Percent of Total Billed Charges,84% of total billed charges,205.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.95,89,,,Percent of total Billed Charges,89% of total Billed charges,222.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.89,120,,,Fee Schedule,120% of MO Medicaid Rate,54.89,120,,,Fee Schedule,120% of MO Medicaid Rate,54.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.89,77,,,Percent of total Billed charges,77% of total billed charges,212.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,54.89,120,,,Fee Schedule,120% of MO Medicaid Rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.89,222.95,
IMMUNOCYTOCHEMISTRY EA AB STN,T990370054,CDM,310,RC,88342,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,207.2,74,,,Percent of Total Billed Charges,74% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,235.2,84,,,Percent of Total Billed Charges,84% of total billed charges,229.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.78,120,,,Fee Schedule,120% of MO Medicaid Rate,61.78,120,,,Fee Schedule,120% of MO Medicaid Rate,61.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,61.78,120,,,Fee Schedule,120% of MO Medicaid Rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.78,249.2,
IMMUNOCYTOCHEM AB EA MPLX,T990370055,CDM,310,RC,88344,HCPCS,Outpatient,,,423.5,211.75,,326.1,77,,,Percent of Total Billed Charges,77% of total billed charges,107.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.39,74,,,Percent of Total Billed Charges,74% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,355.74,84,,,Percent of Total Billed Charges,84% of total billed charges,347.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,376.92,89,,,Percent of total Billed Charges,89% of total Billed charges,376.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.29,120,,,Fee Schedule,120% of MO Medicaid Rate,122.29,120,,,Fee Schedule,120% of MO Medicaid Rate,122.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.1,77,,,Percent of total Billed charges,77% of total billed charges,359.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,122.29,120,,,Fee Schedule,120% of MO Medicaid Rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,376.92,
MORPHOMETRIC ANALYSIS EA AB ST,T990370056,CDM,310,RC,88360,HCPCS,Outpatient,,,327,163.5,,251.79,77,,,Percent of Total Billed Charges,77% of total billed charges,83.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,241.98,74,,,Percent of Total Billed Charges,74% of total billed charges,225.63,69,,,Percent of Total Billed Charges,69% of total billed charges,225.63,69,,,Percent of Total Billed Charges,69% of total billed charges,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.63,69,,,Percent of Total Billed Charges,69% of total billed charges,225.63,69,,,Percent of Total Billed Charges,69% of total billed charges,274.68,84,,,Percent of Total Billed Charges,84% of total billed charges,268.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.03,89,,,Percent of total Billed Charges,89% of total Billed charges,291.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.43,120,,,Fee Schedule,120% of MO Medicaid Rate,72.43,120,,,Fee Schedule,120% of MO Medicaid Rate,72.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,77,,,Percent of total Billed charges,77% of total billed charges,277.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,72.43,120,,,Fee Schedule,120% of MO Medicaid Rate,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,81.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,291.03,
MORPHOMETRIC ANAL TUMOR CMPUT,T990370057,CDM,310,RC,88361,HCPCS,Outpatient,,,305.5,152.75,,235.24,77,,,Percent of Total Billed Charges,77% of total billed charges,77.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.07,74,,,Percent of Total Billed Charges,74% of total billed charges,210.8,69,,,Percent of Total Billed Charges,69% of total billed charges,210.8,69,,,Percent of Total Billed Charges,69% of total billed charges,76.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.8,69,,,Percent of Total Billed Charges,69% of total billed charges,210.8,69,,,Percent of Total Billed Charges,69% of total billed charges,256.62,84,,,Percent of Total Billed Charges,84% of total billed charges,250.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,271.9,89,,,Percent of total Billed Charges,89% of total Billed charges,271.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.55,120,,,Fee Schedule,120% of MO Medicaid Rate,70.55,120,,,Fee Schedule,120% of MO Medicaid Rate,70.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,76.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.24,77,,,Percent of total Billed charges,77% of total billed charges,259.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,70.55,120,,,Fee Schedule,120% of MO Medicaid Rate,76.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,76.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,271.9,
MORPH ANL SITU MANUAL MPLX,T990370058,CDM,310,RC,88377,HCPCS,Outpatient,,,1426.5,713.25,,1098.41,77,,,Percent of Total Billed Charges,77% of total billed charges,363.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,363.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,445.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1055.61,74,,,Percent of Total Billed Charges,74% of total billed charges,984.29,69,,,Percent of Total Billed Charges,69% of total billed charges,984.29,69,,,Percent of Total Billed Charges,69% of total billed charges,356.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,984.29,69,,,Percent of Total Billed Charges,69% of total billed charges,984.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1198.26,84,,,Percent of Total Billed Charges,84% of total billed charges,1169.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,1269.59,89,,,Percent of total Billed Charges,89% of total Billed charges,1269.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,312.34,120,,,Fee Schedule,120% of MO Medicaid Rate,312.34,120,,,Fee Schedule,120% of MO Medicaid Rate,312.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,356.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.41,77,,,Percent of total Billed charges,77% of total billed charges,1212.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,410.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,312.34,120,,,Fee Schedule,120% of MO Medicaid Rate,356.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,356.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,1269.59,
CRYSTAL ID/TISSUE/BF NON-URINE,T990370059,CDM,310,RC,89060,HCPCS,Outpatient,,,202.5,101.25,,155.93,77,,,Percent of Total Billed Charges,77% of total billed charges,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.85,74,,,Percent of Total Billed Charges,74% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,170.1,84,,,Percent of Total Billed Charges,84% of total billed charges,166.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.2,500,,,fee schedule,500% of healthlink,52.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,52.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.03,120,,,Fee Schedule,120% of MO Medicaid Rate,7.03,120,,,Fee Schedule,120% of MO Medicaid Rate,7.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.93,77,,,Percent of total Billed charges,77% of total billed charges,172.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,7.03,120,,,Fee Schedule,120% of MO Medicaid Rate,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,172.13,
PATH ZERO CHARGE,T990370060,CDM,310,RC,99999,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,70,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,70,81,
NO CHARGE,T990370062,CDM,310,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,70,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,70,81,
PROSTAT GROSS/MICRO,T990370063,CDM,310,RC,88305,HCPCS,Outpatient,,,667,333.5,,513.59,77,,,Percent of Total Billed Charges,77% of total billed charges,170.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,493.58,74,,,Percent of Total Billed Charges,74% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,560.28,84,,,Percent of Total Billed Charges,84% of total billed charges,546.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,593.63,89,,,Percent of total Billed Charges,89% of total Billed charges,593.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,593.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,120,,,Fee Schedule,120% of MO Medicaid Rate,32.62,120,,,Fee Schedule,120% of MO Medicaid Rate,32.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.59,77,,,Percent of total Billed charges,77% of total billed charges,566.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,191.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,32.62,120,,,Fee Schedule,120% of MO Medicaid Rate,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,593.63,
PROSTAT GROSS/MICRO,T990370063,CDM,310,RC,G0416,HCPCS,Outpatient,,,667,333.5,,513.59,77,,,Percent of Total Billed Charges,77% of total billed charges,170.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,493.58,74,,,Percent of Total Billed Charges,74% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,460.23,69,,,Percent of Total Billed Charges,69% of total billed charges,560.28,84,,,Percent of Total Billed Charges,84% of total billed charges,546.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,593.63,89,,,Percent of total Billed Charges,89% of total Billed charges,593.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,593.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,272.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,513.59,77,,,Percent of total Billed charges,77% of total billed charges,566.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,191.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,272.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,166.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,593.63,
TRECH TUBE CHG W/FISTULA TRACT,T990380001,CDM,410,RC,31502,HCPCS,Outpatient,,,832,416,,640.64,77,,,Percent of Total Billed Charges,77% of total billed charges,212.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,212.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,260,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,615.68,74,,,Percent of Total Billed Charges,74% of total billed charges,574.08,69,,,Percent of Total Billed Charges,69% of total billed charges,574.08,69,,,Percent of Total Billed Charges,69% of total billed charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.08,69,,,Percent of Total Billed Charges,69% of total billed charges,574.08,69,,,Percent of Total Billed Charges,69% of total billed charges,698.88,84,,,Percent of Total Billed Charges,84% of total billed charges,682.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,740.48,89,,,Percent of total Billed Charges,89% of total Billed charges,740.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,740.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,339.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.64,77,,,Percent of total Billed charges,77% of total billed charges,707.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,239.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,339.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,208,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,740.48,
HGB F (FETAL) CHEMICAL,T990380002,CDM,301,RC,83030,HCPCS,Outpatient,,,202.5,101.25,,155.93,77,,,Percent of Total Billed Charges,77% of total billed charges,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.85,74,,,Percent of Total Billed Charges,74% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,170.1,84,,,Percent of Total Billed Charges,84% of total billed charges,166.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.4,500,,,fee schedule,500% of healthlink,60.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,60.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,10.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.93,77,,,Percent of total Billed charges,77% of total billed charges,172.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,10.31,120,,,Fee Schedule,120% of MO Medicaid Rate,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.31,172.13,
HGB F (FETAL) KLEIHAUER BETKE,T990380003,CDM,305,RC,85460,HCPCS,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.5,500,,,fee schedule,500% of healthlink,56.5,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,56.5,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.42,120,,,Fee Schedule,120% of MO Medicaid Rate,7.42,120,,,Fee Schedule,120% of MO Medicaid Rate,7.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.42,120,,,Fee Schedule,120% of MO Medicaid Rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.42,278.8,
ARC HGB S,T990380004,CDM,305,RC,85660,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.31,74,,,Percent of Total Billed Charges,74% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,90.74,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,84,,,Percent of Total Billed Charges,84% of total billed charges,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.3,500,,,fee schedule,500% of healthlink,40.3,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,40.3,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,5.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.28,120,,,Fee Schedule,120% of MO Medicaid Rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.28,111.78,
ARC PLATELET AB ELISA,T990380005,CDM,309,RC,86022,HCPCS,Outpatient,,,407.5,203.75,,313.78,77,,,Percent of Total Billed Charges,77% of total billed charges,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,301.55,74,,,Percent of Total Billed Charges,74% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,342.3,84,,,Percent of Total Billed Charges,84% of total billed charges,334.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.25,500,,,fee schedule,500% of healthlink,77.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.78,77,,,Percent of total Billed charges,77% of total billed charges,346.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,346.38,
ARC PLATELET AB XM,T990380006,CDM,309,RC,86022,HCPCS,Outpatient,,,407.5,203.75,,313.78,77,,,Percent of Total Billed Charges,77% of total billed charges,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,301.55,74,,,Percent of Total Billed Charges,74% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,342.3,84,,,Percent of Total Billed Charges,84% of total billed charges,334.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.25,500,,,fee schedule,500% of healthlink,77.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.78,77,,,Percent of total Billed charges,77% of total billed charges,346.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,346.38,
"ARC PLT, HPA1-a TYPING",T990380007,CDM,309,RC,86022,HCPCS,Outpatient,,,407.5,203.75,,313.78,77,,,Percent of Total Billed Charges,77% of total billed charges,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,301.55,74,,,Percent of Total Billed Charges,74% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,281.18,69,,,Percent of Total Billed Charges,69% of total billed charges,342.3,84,,,Percent of Total Billed Charges,84% of total billed charges,334.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.25,500,,,fee schedule,500% of healthlink,77.25,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,77.25,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.78,77,,,Percent of total Billed charges,77% of total billed charges,346.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,17.63,120,,,Fee Schedule,120% of MO Medicaid Rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,101.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,346.38,
ARC PLATELET ASSOCIATED IgG,T990380008,CDM,309,RC,86023,HCPCS,Outpatient,,,239,119.5,,184.03,77,,,Percent of Total Billed Charges,77% of total billed charges,60.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.86,74,,,Percent of Total Billed Charges,74% of total billed charges,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,164.91,69,,,Percent of Total Billed Charges,69% of total billed charges,200.76,84,,,Percent of Total Billed Charges,84% of total billed charges,195.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.95,500,,,fee schedule,500% of healthlink,90.95,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,90.95,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,11.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.03,77,,,Percent of total Billed charges,77% of total billed charges,203.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.95,120,,,Fee Schedule,120% of MO Medicaid Rate,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,59.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.95,203.15,
ARC COLD AGGLUTININ SCREEN,T990380009,CDM,390,RC,86156,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.9,500,,,fee schedule,500% of healthlink,48.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,48.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.74,120,,,Fee Schedule,120% of MO Medicaid Rate,7.74,120,,,Fee Schedule,120% of MO Medicaid Rate,7.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,7.74,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.74,260,
ARC COLD AGGLUTININ TITER,T990380010,CDM,390,RC,86157,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,58.85,500,,,fee schedule,500% of healthlink,58.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,58.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.73,120,,,Fee Schedule,120% of MO Medicaid Rate,7.73,120,,,Fee Schedule,120% of MO Medicaid Rate,7.73,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,7.73,120,,,Fee Schedule,120% of MO Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,260,
CMV NEGATIVE SURCHARGE,T990380011,CDM,302,RC,86645,HCPCS,Outpatient,,,250.5,125.25,,192.89,77,,,Percent of Total Billed Charges,77% of total billed charges,63.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.37,74,,,Percent of Total Billed Charges,74% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,172.85,69,,,Percent of Total Billed Charges,69% of total billed charges,210.42,84,,,Percent of Total Billed Charges,84% of total billed charges,205.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,500,,,fee schedule,500% of healthlink,123,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,123,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,16.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.89,77,,,Percent of total Billed charges,77% of total billed charges,212.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,16.18,120,,,Fee Schedule,120% of MO Medicaid Rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,62.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.18,212.93,
ARC ANTIBODY SCREEN,T990380012,CDM,309,RC,86850,HCPCS,Outpatient,,,179,89.5,,137.83,77,,,Percent of Total Billed Charges,77% of total billed charges,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.46,74,,,Percent of Total Billed Charges,74% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,123.51,69,,,Percent of Total Billed Charges,69% of total billed charges,150.36,84,,,Percent of Total Billed Charges,84% of total billed charges,146.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.31,89,,,Percent of total Billed Charges,89% of total Billed charges,159.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.37,120,,,Fee Schedule,120% of MO Medicaid Rate,9.37,120,,,Fee Schedule,120% of MO Medicaid Rate,9.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.83,77,,,Percent of total Billed charges,77% of total billed charges,152.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.37,120,,,Fee Schedule,120% of MO Medicaid Rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,44.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.37,159.31,
ARC ELUTION,T990380013,CDM,390,RC,86860,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,260,
ARC ANTIBODY ID,T990380014,CDM,309,RC,86870,HCPCS,Outpatient,,,280,140,,215.6,77,,,Percent of Total Billed Charges,77% of total billed charges,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,207.2,74,,,Percent of Total Billed Charges,74% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,193.2,69,,,Percent of Total Billed Charges,69% of total billed charges,235.2,84,,,Percent of Total Billed Charges,84% of total billed charges,229.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,249.2,89,,,Percent of total Billed Charges,89% of total Billed charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,249.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,279.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.6,77,,,Percent of total Billed charges,77% of total billed charges,238,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,70,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,279.6,
ARC DAT,T990380015,CDM,309,RC,86880,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,112.2,
COOMBS DIRECT,T990380016,CDM,300,RC,86880,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,500,,,fee schedule,500% of healthlink,39.2,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,39.2,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,5.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.17,112.2,
ARC AB ID EA REAGENT CELL,T990380017,CDM,309,RC,86885,HCPCS,Outpatient,,,106.5,53.25,,82.01,77,,,Percent of Total Billed Charges,77% of total billed charges,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.81,74,,,Percent of Total Billed Charges,74% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,73.49,69,,,Percent of Total Billed Charges,69% of total billed charges,89.46,84,,,Percent of Total Billed Charges,84% of total billed charges,87.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.75,500,,,fee schedule,500% of healthlink,41.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,41.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,5.48,120,,,Fee Schedule,120% of MO Medicaid Rate,5.48,120,,,Fee Schedule,120% of MO Medicaid Rate,5.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.01,77,,,Percent of total Billed charges,77% of total billed charges,90.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,5.48,120,,,Fee Schedule,120% of MO Medicaid Rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,26.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.48,90.53,
ARC INDIRECT TITER,T990380018,CDM,300,RC,86886,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,222.28,
COOMBS INDIRECT,T990380019,CDM,300,RC,86886,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.8,500,,,fee schedule,500% of healthlink,37.8,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,37.8,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,4.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.97,120,,,Fee Schedule,120% of MO Medicaid Rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.97,222.28,
AUTOLOGOUS SERVICE FEE,T990380020,CDM,309,RC,86890,HCPCS,Outpatient,,,246.5,123.25,,189.81,77,,,Percent of Total Billed Charges,77% of total billed charges,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.41,74,,,Percent of Total Billed Charges,74% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,207.06,84,,,Percent of Total Billed Charges,84% of total billed charges,202.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.39,89,,,Percent of total Billed Charges,89% of total Billed charges,219.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.81,77,,,Percent of total Billed charges,77% of total billed charges,209.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,219.39,
ABO GROUP,T990380021,CDM,300,RC,86900,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.75,500,,,fee schedule,500% of healthlink,21.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,100.3,
ARC ABO,T990380022,CDM,309,RC,86900,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.75,500,,,fee schedule,500% of healthlink,21.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,100.3,
ARC Rh,T990380023,CDM,309,RC,86901,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.75,500,,,fee schedule,500% of healthlink,21.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,100.3,
Rh FACTOR,T990380024,CDM,300,RC,86901,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.75,500,,,fee schedule,500% of healthlink,21.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,21.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,2.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,2.87,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,100.3,
ARC AG TYPE PER UNIT HOSP SEG,T990380025,CDM,309,RC,86902,HCPCS,Outpatient,,,276,138,,212.52,77,,,Percent of Total Billed Charges,77% of total billed charges,70.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.24,74,,,Percent of Total Billed Charges,74% of total billed charges,190.44,69,,,Percent of Total Billed Charges,69% of total billed charges,190.44,69,,,Percent of Total Billed Charges,69% of total billed charges,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.44,69,,,Percent of Total Billed Charges,69% of total billed charges,190.44,69,,,Percent of Total Billed Charges,69% of total billed charges,231.84,84,,,Percent of Total Billed Charges,84% of total billed charges,226.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.64,89,,,Percent of total Billed Charges,89% of total Billed charges,245.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.1,120,,,Fee Schedule,120% of MO Medicaid Rate,6.1,120,,,Fee Schedule,120% of MO Medicaid Rate,6.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,77,,,Percent of total Billed charges,77% of total billed charges,234.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.1,120,,,Fee Schedule,120% of MO Medicaid Rate,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.1,245.64,
"ARC AG ACRN W/PT""S SRM EA UNIT",T990380026,CDM,309,RC,86904,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.4,500,,,fee schedule,500% of healthlink,69.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,69.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,15.68,120,,,Fee Schedule,120% of MO Medicaid Rate,15.68,120,,,Fee Schedule,120% of MO Medicaid Rate,15.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,15.68,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.68,185.3,
"ARC PHENOTYPE, PATIENT",T990380027,CDM,309,RC,86905,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.9,500,,,fee schedule,500% of healthlink,27.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,27.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.67,120,,,Fee Schedule,120% of MO Medicaid Rate,3.67,120,,,Fee Schedule,120% of MO Medicaid Rate,3.67,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.67,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,160.65,
Rh WEAK D TESTING,T990380028,CDM,300,RC,86905,HCPCS,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.9,500,,,fee schedule,500% of healthlink,27.9,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,27.9,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,3.67,120,,,Fee Schedule,120% of MO Medicaid Rate,3.67,120,,,Fee Schedule,120% of MO Medicaid Rate,3.67,120,,,Fee Schedule,120% of MO of Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,3.67,120,,,Fee Schedule,120% of MO Medicaid Rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,160.65,
"ARC PHENOTYPE, Rh",T990380029,CDM,300,RC,86906,HCPCS,Outpatient,,,245,122.5,,188.65,77,,,Percent of Total Billed Charges,77% of total billed charges,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.3,74,,,Percent of Total Billed Charges,74% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,205.8,84,,,Percent of Total Billed Charges,84% of total billed charges,200.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.55,500,,,fee schedule,500% of healthlink,56.55,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,56.55,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,7.44,120,,,Fee Schedule,120% of MO Medicaid Rate,7.44,120,,,Fee Schedule,120% of MO Medicaid Rate,7.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.65,77,,,Percent of total Billed charges,77% of total billed charges,208.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,7.44,120,,,Fee Schedule,120% of MO Medicaid Rate,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.44,208.25,
ARC IS XM,T990380030,CDM,390,RC,86920,HCPCS,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.72,74,,,Percent of Total Billed Charges,74% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,260,
"XM, IS, EACH UNIT",T990380031,CDM,300,RC,86920,HCPCS,Outpatient,,,205,102.5,,157.85,77,,,Percent of Total Billed Charges,77% of total billed charges,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.7,74,,,Percent of Total Billed Charges,74% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,141.45,69,,,Percent of Total Billed Charges,69% of total billed charges,172.2,84,,,Percent of Total Billed Charges,84% of total billed charges,168.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.45,89,,,Percent of total Billed Charges,89% of total Billed charges,182.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.85,77,,,Percent of total Billed charges,77% of total billed charges,174.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.25,182.45,
"XM, 37, EACH UNIT",T990380032,CDM,300,RC,86921,HCPCS,Outpatient,,,199,99.5,,153.23,77,,,Percent of Total Billed Charges,77% of total billed charges,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,147.26,74,,,Percent of Total Billed Charges,74% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,137.31,69,,,Percent of Total Billed Charges,69% of total billed charges,167.16,84,,,Percent of Total Billed Charges,84% of total billed charges,163.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,177.11,89,,,Percent of total Billed Charges,89% of total Billed charges,177.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.23,77,,,Percent of total Billed charges,77% of total billed charges,169.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,49.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.75,177.11,
ARC AG XM,T990380033,CDM,390,RC,86922,HCPCS,Outpatient,,,89.5,44.75,,68.92,77,,,Percent of Total Billed Charges,77% of total billed charges,22.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.23,74,,,Percent of Total Billed Charges,74% of total billed charges,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.76,69,,,Percent of Total Billed Charges,69% of total billed charges,75.18,84,,,Percent of Total Billed Charges,84% of total billed charges,73.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.66,89,,,Percent of total Billed Charges,89% of total Billed charges,79.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.92,77,,,Percent of total Billed charges,77% of total billed charges,76.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,22.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.38,260,
XM IgG,T990380034,CDM,300,RC,86922,HCPCS,Outpatient,,,509.5,254.75,,392.32,77,,,Percent of Total Billed Charges,77% of total billed charges,129.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.03,74,,,Percent of Total Billed Charges,74% of total billed charges,351.56,69,,,Percent of Total Billed Charges,69% of total billed charges,351.56,69,,,Percent of Total Billed Charges,69% of total billed charges,127.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.56,69,,,Percent of Total Billed Charges,69% of total billed charges,351.56,69,,,Percent of Total Billed Charges,69% of total billed charges,427.98,84,,,Percent of Total Billed Charges,84% of total billed charges,417.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,453.46,89,,,Percent of total Billed Charges,89% of total Billed charges,453.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,453.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,127.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.32,77,,,Percent of total Billed charges,77% of total billed charges,433.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,127.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,127.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,453.46,
ARC THAWING PRODUCTS,T990380035,CDM,309,RC,86927,HCPCS,Outpatient,,,181.5,90.75,,139.76,77,,,Percent of Total Billed Charges,77% of total billed charges,46.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.31,74,,,Percent of Total Billed Charges,74% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,152.46,84,,,Percent of Total Billed Charges,84% of total billed charges,148.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.54,89,,,Percent of total Billed Charges,89% of total Billed charges,161.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.76,77,,,Percent of total Billed charges,77% of total billed charges,154.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.38,161.54,
FFP THAW EACH UNIT,T990380036,CDM,300,RC,86927,HCPCS,Outpatient,,,181.5,90.75,,139.76,77,,,Percent of Total Billed Charges,77% of total billed charges,46.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.31,74,,,Percent of Total Billed Charges,74% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,152.46,84,,,Percent of Total Billed Charges,84% of total billed charges,148.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.54,89,,,Percent of total Billed Charges,89% of total Billed charges,161.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.76,77,,,Percent of total Billed charges,77% of total billed charges,154.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.38,161.54,
DONATH LANSTEINER EACH TUBE,T990380037,CDM,309,RC,86940,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.85,500,,,fee schedule,500% of healthlink,59.85,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,59.85,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,8.41,120,,,Fee Schedule,120% of MO Medicaid Rate,8.41,120,,,Fee Schedule,120% of MO Medicaid Rate,8.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,8.41,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.41,136.85,
DONATH LANSTEINER INCUBATE EA,T990380038,CDM,309,RC,86941,HCPCS,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.4,500,,,fee schedule,500% of healthlink,88.4,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88.4,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,11.62,120,,,Fee Schedule,120% of MO Medicaid Rate,11.62,120,,,Fee Schedule,120% of MO Medicaid Rate,11.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,11.62,120,,,Fee Schedule,120% of MO Medicaid Rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,136.85,
IRRADIATION SURCHARGE,T990380039,CDM,309,RC,86945,HCPCS,Outpatient,,,229.5,114.75,,176.72,77,,,Percent of Total Billed Charges,77% of total billed charges,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,169.83,74,,,Percent of Total Billed Charges,74% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,192.78,84,,,Percent of Total Billed Charges,84% of total billed charges,188.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,204.26,89,,,Percent of total Billed Charges,89% of total Billed charges,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.72,77,,,Percent of total Billed charges,77% of total billed charges,195.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.48,204.26,
ARC PRETREAT RBC,T990380040,CDM,309,RC,86970,HCPCS,Outpatient,,,232,116,,178.64,77,,,Percent of Total Billed Charges,77% of total billed charges,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,171.68,74,,,Percent of Total Billed Charges,74% of total billed charges,160.08,69,,,Percent of Total Billed Charges,69% of total billed charges,160.08,69,,,Percent of Total Billed Charges,69% of total billed charges,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.08,69,,,Percent of Total Billed Charges,69% of total billed charges,160.08,69,,,Percent of Total Billed Charges,69% of total billed charges,194.88,84,,,Percent of Total Billed Charges,84% of total billed charges,190.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,206.48,89,,,Percent of total Billed Charges,89% of total Billed charges,206.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.64,77,,,Percent of total Billed charges,77% of total billed charges,197.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.48,206.48,
ARC PRETREAT W/ ENZYMES,T990380041,CDM,309,RC,86971,HCPCS,Outpatient,,,118,59,,90.86,77,,,Percent of Total Billed Charges,77% of total billed charges,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.32,74,,,Percent of Total Billed Charges,74% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,81.42,69,,,Percent of Total Billed Charges,69% of total billed charges,99.12,84,,,Percent of Total Billed Charges,84% of total billed charges,96.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.02,89,,,Percent of total Billed Charges,89% of total Billed charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,279.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.86,77,,,Percent of total Billed charges,77% of total billed charges,100.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,29.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,279.6,
ARC RETICULOCYTE SEPARATION,T990380042,CDM,309,RC,86972,HCPCS,Outpatient,,,246.5,123.25,,189.81,77,,,Percent of Total Billed Charges,77% of total billed charges,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.41,74,,,Percent of Total Billed Charges,74% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,207.06,84,,,Percent of Total Billed Charges,84% of total billed charges,202.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.39,89,,,Percent of total Billed Charges,89% of total Billed charges,219.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.81,77,,,Percent of total Billed charges,77% of total billed charges,209.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,219.39,
ARC INCUBATE W/ DRUGS,T990380043,CDM,309,RC,86975,HCPCS,Outpatient,,,333.5,166.75,,256.8,77,,,Percent of Total Billed Charges,77% of total billed charges,85.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,246.79,74,,,Percent of Total Billed Charges,74% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,280.14,84,,,Percent of Total Billed Charges,84% of total billed charges,273.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,296.82,89,,,Percent of total Billed Charges,89% of total Billed charges,296.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.4,120,,,Fee Schedule,120% of MO Medicaid Rate,259.4,120,,,Fee Schedule,120% of MO Medicaid Rate,259.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.8,77,,,Percent of total Billed charges,77% of total billed charges,283.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,259.4,120,,,Fee Schedule,120% of MO Medicaid Rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,296.82,
ARC DILUTION OF SERUM,T990380044,CDM,300,RC,86976,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.48,89,,,Percent of total Billed Charges,89% of total Billed charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.68,117.48,
ARC INHIBITION OF SERUM,T990380045,CDM,309,RC,86977,HCPCS,Outpatient,,,204,102,,157.08,77,,,Percent of Total Billed Charges,77% of total billed charges,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.96,74,,,Percent of Total Billed Charges,74% of total billed charges,140.76,69,,,Percent of Total Billed Charges,69% of total billed charges,140.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.76,69,,,Percent of Total Billed Charges,69% of total billed charges,140.76,69,,,Percent of Total Billed Charges,69% of total billed charges,171.36,84,,,Percent of Total Billed Charges,84% of total billed charges,167.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.56,89,,,Percent of total Billed Charges,89% of total Billed charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,143.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.08,77,,,Percent of total Billed charges,77% of total billed charges,173.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,143.18,120,,,Fee Schedule,120% of MO Medicaid Rate,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51,181.56,
ARC AUTOLOGOUS ADSORPTION,T990380046,CDM,309,RC,86978,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.48,194.02,
ARC DIFF ADSORPTION,T990380047,CDM,309,RC,86978,HCPCS,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.48,194.02,
ARC AG NEG ORDER ROUTINE HRS,T990380049,CDM,390,RC,,,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,88.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,260,
ARC AG NEG UNITES ORDER CALLIN,T990380050,CDM,390,RC,,,Outpatient,,,362,181,,278.74,77,,,Percent of Total Billed Charges,77% of total billed charges,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,267.88,74,,,Percent of Total Billed Charges,74% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,304.08,84,,,Percent of Total Billed Charges,84% of total billed charges,296.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,322.18,89,,,Percent of total Billed Charges,89% of total Billed charges,322.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.74,77,,,Percent of total Billed charges,77% of total billed charges,307.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,147.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,322.18,
ARC AG NEGATIVE 1 AG 1ST UNIT,T990380051,CDM,390,RC,,,Outpatient,,,468,234,,360.36,77,,,Percent of Total Billed Charges,77% of total billed charges,119.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,346.32,74,,,Percent of Total Billed Charges,74% of total billed charges,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,322.92,69,,,Percent of Total Billed Charges,69% of total billed charges,393.12,84,,,Percent of Total Billed Charges,84% of total billed charges,383.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,416.52,89,,,Percent of total Billed Charges,89% of total Billed charges,416.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,416.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,360.36,77,,,Percent of total Billed charges,77% of total billed charges,397.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,190.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,117,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,416.52,
ARC AG NEGATIVE AG ADDTL UNIT,T990380052,CDM,390,RC,,,Outpatient,,,260,130,,200.2,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.4,74,,,Percent of Total Billed Charges,74% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,218.4,84,,,Percent of Total Billed Charges,84% of total billed charges,213.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.4,89,,,Percent of total Billed Charges,89% of total Billed charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.2,77,,,Percent of total Billed charges,77% of total billed charges,221,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,260,
ARC AG SCREENING 1-10 UNITS,T990380053,CDM,309,RC,86902,HCPCS,Outpatient,,,132,66,,101.64,77,,,Percent of Total Billed Charges,77% of total billed charges,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.68,74,,,Percent of Total Billed Charges,74% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,91.08,69,,,Percent of Total Billed Charges,69% of total billed charges,110.88,84,,,Percent of Total Billed Charges,84% of total billed charges,108.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.48,89,,,Percent of total Billed Charges,89% of total Billed charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.1,120,,,Fee Schedule,120% of MO Medicaid Rate,6.1,120,,,Fee Schedule,120% of MO Medicaid Rate,6.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.64,77,,,Percent of total Billed charges,77% of total billed charges,112.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,6.1,120,,,Fee Schedule,120% of MO Medicaid Rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.1,117.48,
ARC AG SCREENING 11-20 UNITS,T990380054,CDM,390,RC,,,Outpatient,,,189,94.5,,145.53,77,,,Percent of Total Billed Charges,77% of total billed charges,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.86,74,,,Percent of Total Billed Charges,74% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,130.41,69,,,Percent of Total Billed Charges,69% of total billed charges,158.76,84,,,Percent of Total Billed Charges,84% of total billed charges,154.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.21,89,,,Percent of total Billed Charges,89% of total Billed charges,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.53,77,,,Percent of total Billed charges,77% of total billed charges,160.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,77.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,47.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.25,260,
ARC AG SCREENING 21-30 UNITS,T990380055,CDM,390,RC,,,Outpatient,,,246.5,123.25,,189.81,77,,,Percent of Total Billed Charges,77% of total billed charges,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,182.41,74,,,Percent of Total Billed Charges,74% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,170.09,69,,,Percent of Total Billed Charges,69% of total billed charges,207.06,84,,,Percent of Total Billed Charges,84% of total billed charges,202.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.39,89,,,Percent of total Billed Charges,89% of total Billed charges,219.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.81,77,,,Percent of total Billed charges,77% of total billed charges,209.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,100.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,61.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.63,260,
ARC AG SCREENING 31-40 UNITS,T990380056,CDM,390,RC,,,Outpatient,,,304.5,152.25,,234.47,77,,,Percent of Total Billed Charges,77% of total billed charges,77.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.33,74,,,Percent of Total Billed Charges,74% of total billed charges,210.11,69,,,Percent of Total Billed Charges,69% of total billed charges,210.11,69,,,Percent of Total Billed Charges,69% of total billed charges,76.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.11,69,,,Percent of Total Billed Charges,69% of total billed charges,210.11,69,,,Percent of Total Billed Charges,69% of total billed charges,255.78,84,,,Percent of Total Billed Charges,84% of total billed charges,249.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,271.01,89,,,Percent of total Billed Charges,89% of total Billed charges,271.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.47,77,,,Percent of total Billed charges,77% of total billed charges,258.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,124.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,76.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.13,271.01,
ARC AG SCREENING 41-50 UNITS,T990380057,CDM,390,RC,,,Outpatient,,,362,181,,278.74,77,,,Percent of Total Billed Charges,77% of total billed charges,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,267.88,74,,,Percent of Total Billed Charges,74% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,249.78,69,,,Percent of Total Billed Charges,69% of total billed charges,304.08,84,,,Percent of Total Billed Charges,84% of total billed charges,296.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,322.18,89,,,Percent of total Billed Charges,89% of total Billed charges,322.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,322.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.74,77,,,Percent of total Billed charges,77% of total billed charges,307.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,147.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,90.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,322.18,
ARC AG SCREENING 51-60 UNITS,T990380058,CDM,390,RC,,,Outpatient,,,419.5,209.75,,323.02,77,,,Percent of Total Billed Charges,77% of total billed charges,106.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,310.43,74,,,Percent of Total Billed Charges,74% of total billed charges,289.46,69,,,Percent of Total Billed Charges,69% of total billed charges,289.46,69,,,Percent of Total Billed Charges,69% of total billed charges,104.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.46,69,,,Percent of Total Billed Charges,69% of total billed charges,289.46,69,,,Percent of Total Billed Charges,69% of total billed charges,352.38,84,,,Percent of Total Billed Charges,84% of total billed charges,343.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,373.36,89,,,Percent of total Billed Charges,89% of total Billed charges,373.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,373.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.02,77,,,Percent of total Billed charges,77% of total billed charges,356.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,171.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,104.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.88,373.36,
ARC AG SCREENING 61-70 UNITS,T990380059,CDM,390,RC,,,Outpatient,,,476.5,238.25,,366.91,77,,,Percent of Total Billed Charges,77% of total billed charges,121.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,352.61,74,,,Percent of Total Billed Charges,74% of total billed charges,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,328.79,69,,,Percent of Total Billed Charges,69% of total billed charges,400.26,84,,,Percent of Total Billed Charges,84% of total billed charges,390.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,424.09,89,,,Percent of total Billed Charges,89% of total Billed charges,424.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.91,77,,,Percent of total Billed charges,77% of total billed charges,405.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,194.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,119.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.13,424.09,
ARC COMPLEX PRED FOR ADS,T990380060,CDM,390,RC,,,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,88.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,260,
ARC FRESH BLOOD COMP,T990380061,CDM,390,RC,,,Outpatient,,,165,82.5,,127.05,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.1,74,,,Percent of Total Billed Charges,74% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,113.85,69,,,Percent of Total Billed Charges,69% of total billed charges,138.6,84,,,Percent of Total Billed Charges,84% of total billed charges,135.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.85,89,,,Percent of total Billed Charges,89% of total Billed charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.05,77,,,Percent of total Billed charges,77% of total billed charges,140.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,260,
ARC IRL SAMPL URGNT AFTER HRS,T990380062,CDM,390,RC,,,Outpatient,,,491,245.5,,378.07,77,,,Percent of Total Billed Charges,77% of total billed charges,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,363.34,74,,,Percent of Total Billed Charges,74% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,412.44,84,,,Percent of Total Billed Charges,84% of total billed charges,402.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.99,89,,,Percent of total Billed Charges,89% of total Billed charges,436.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.07,77,,,Percent of total Billed charges,77% of total billed charges,417.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,200.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.75,436.99,
ARC MISC ADSORPTIONS EA,T990380063,CDM,390,RC,,,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,232.74,89,,,Percent of total Billed Charges,89% of total Billed charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,106.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.38,260,
ARC SPCL RECRUITMENT PRODUCTS,T990380064,CDM,390,RC,,,Outpatient,,,218,109,,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.02,89,,,Percent of total Billed Charges,89% of total Billed charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,88.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.5,260,
ARC UNITE SEARCH FEE FOR RBC'S,T990380065,CDM,390,RC,,,Outpatient,,,146.5,73.25,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.41,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.06,84,,,Percent of Total Billed Charges,84% of total billed charges,120.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,59.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,260,
GEL RBC PREP PER CELL,T990380066,CDM,309,RC,86970,HCPCS,Outpatient,,,89,44.5,,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.86,74,,,Percent of Total Billed Charges,74% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,61.41,69,,,Percent of Total Billed Charges,69% of total billed charges,74.76,84,,,Percent of Total Billed Charges,84% of total billed charges,72.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.21,89,,,Percent of total Billed Charges,89% of total Billed charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,32.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,32.48,120,,,Fee Schedule,120% of MO Medicaid Rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,79.21,
HYPOTONIC WASH RBC SEPARATION,T990380067,CDM,390,RC,,,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.29,89,,,Percent of total Billed Charges,89% of total Billed charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,65.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.25,260,
Panel (dummy charge),T990380068,CDM,300,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,55,64,
RBC AG NEG ARDP HIGH/RARE UNIT,T990380069,CDM,390,RC,,,Outpatient,,,505.5,252.75,,389.24,77,,,Percent of Total Billed Charges,77% of total billed charges,128.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,374.07,74,,,Percent of Total Billed Charges,74% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,424.62,84,,,Percent of Total Billed Charges,84% of total billed charges,414.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,449.9,89,,,Percent of total Billed Charges,89% of total Billed charges,449.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,449.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,389.24,77,,,Percent of total Billed charges,77% of total billed charges,429.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,206.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.38,449.9,
RBG AG NEG PHENO/UNIT,T990380070,CDM,390,RC,,,Outpatient,,,328,164,,252.56,77,,,Percent of Total Billed Charges,77% of total billed charges,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.72,74,,,Percent of Total Billed Charges,74% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,226.32,69,,,Percent of Total Billed Charges,69% of total billed charges,275.52,84,,,Percent of Total Billed Charges,84% of total billed charges,268.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.92,89,,,Percent of total Billed Charges,89% of total Billed charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.56,77,,,Percent of total Billed charges,77% of total billed charges,278.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,133.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82,291.92,
ARC ABO DISCREPANCY RES,T990380079,CDM,390,RC,,,Outpatient,,,202.5,101.25,,155.93,77,,,Percent of Total Billed Charges,77% of total billed charges,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.85,74,,,Percent of Total Billed Charges,74% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,139.73,69,,,Percent of Total Billed Charges,69% of total billed charges,170.1,84,,,Percent of Total Billed Charges,84% of total billed charges,166.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,180.23,89,,,Percent of total Billed Charges,89% of total Billed charges,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.93,77,,,Percent of total Billed charges,77% of total billed charges,172.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,82.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.63,260,
ARC IGA TESTING,T990380080,CDM,390,RC,,,Outpatient,,,499,249.5,,384.23,77,,,Percent of Total Billed Charges,77% of total billed charges,127.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,369.26,74,,,Percent of Total Billed Charges,74% of total billed charges,344.31,69,,,Percent of Total Billed Charges,69% of total billed charges,344.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.31,69,,,Percent of Total Billed Charges,69% of total billed charges,344.31,69,,,Percent of Total Billed Charges,69% of total billed charges,419.16,84,,,Percent of Total Billed Charges,84% of total billed charges,409.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,444.11,89,,,Percent of total Billed Charges,89% of total Billed charges,444.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.23,77,,,Percent of total Billed charges,77% of total billed charges,424.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,203.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,124.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.75,444.11,
ARC IMPORT FEE,T990380081,CDM,390,RC,,,Outpatient,,,534.5,267.25,,411.57,77,,,Percent of Total Billed Charges,77% of total billed charges,136.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,136.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,395.53,74,,,Percent of Total Billed Charges,74% of total billed charges,368.81,69,,,Percent of Total Billed Charges,69% of total billed charges,368.81,69,,,Percent of Total Billed Charges,69% of total billed charges,133.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,368.81,69,,,Percent of Total Billed Charges,69% of total billed charges,368.81,69,,,Percent of Total Billed Charges,69% of total billed charges,448.98,84,,,Percent of Total Billed Charges,84% of total billed charges,438.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,475.71,89,,,Percent of total Billed Charges,89% of total Billed charges,475.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.57,77,,,Percent of total Billed charges,77% of total billed charges,454.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,153.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,218.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,133.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,133.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.63,475.71,
ARC MONOCYTE MONOLAYER ASSAY,T990380082,CDM,390,RC,,,Outpatient,,,2060.5,1030.25,,1586.59,77,,,Percent of Total Billed Charges,77% of total billed charges,525.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,525.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,643.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1524.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1421.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1421.75,69,,,Percent of Total Billed Charges,69% of total billed charges,515.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1421.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1421.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1730.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1689.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1833.85,89,,,Percent of total Billed Charges,89% of total Billed charges,1833.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1833.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,515.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1586.59,77,,,Percent of total Billed charges,77% of total billed charges,1751.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,592.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,840.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,515.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,515.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1833.85,
ARC STROMAL ADSORPTION,T990380083,CDM,390,RC,,,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,193.51,74,,,Percent of Total Billed Charges,74% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,180.44,69,,,Percent of Total Billed Charges,69% of total billed charges,219.66,84,,,Percent of Total Billed Charges,84% of total billed charges,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,232.74,89,,,Percent of total Billed Charges,89% of total Billed charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,106.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.38,260,
ARC SUPER DAT,T990380084,CDM,390,RC,,,Outpatient,,,181.5,90.75,,139.76,77,,,Percent of Total Billed Charges,77% of total billed charges,46.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.31,74,,,Percent of Total Billed Charges,74% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,125.24,69,,,Percent of Total Billed Charges,69% of total billed charges,152.46,84,,,Percent of Total Billed Charges,84% of total billed charges,148.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.54,89,,,Percent of total Billed Charges,89% of total Billed charges,161.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.76,77,,,Percent of total Billed charges,77% of total billed charges,154.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,74.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,45.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.38,260,
ARC THAW RARE RGT RBCS,T990380085,CDM,390,RC,,,Outpatient,,,161,80.5,,123.97,77,,,Percent of Total Billed Charges,77% of total billed charges,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.14,74,,,Percent of Total Billed Charges,74% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.09,69,,,Percent of Total Billed Charges,69% of total billed charges,135.24,84,,,Percent of Total Billed Charges,84% of total billed charges,132.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.29,89,,,Percent of total Billed Charges,89% of total Billed charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.97,77,,,Percent of total Billed charges,77% of total billed charges,136.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,65.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,40.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.25,260,
DIRECTED SERVICE FEE,T990380086,CDM,390,RC,,,Outpatient,,,174.5,87.25,,134.37,77,,,Percent of Total Billed Charges,77% of total billed charges,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.13,74,,,Percent of Total Billed Charges,74% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,146.58,84,,,Percent of Total Billed Charges,84% of total billed charges,143.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.31,89,,,Percent of total Billed Charges,89% of total Billed charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.37,77,,,Percent of total Billed charges,77% of total billed charges,148.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,71.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.63,260,
PLT HLA MATCH SURCHARGE,T990380087,CDM,390,RC,,,Outpatient,,,722.5,361.25,,556.33,77,,,Percent of Total Billed Charges,77% of total billed charges,184.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,534.65,74,,,Percent of Total Billed Charges,74% of total billed charges,498.53,69,,,Percent of Total Billed Charges,69% of total billed charges,498.53,69,,,Percent of Total Billed Charges,69% of total billed charges,180.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.53,69,,,Percent of Total Billed Charges,69% of total billed charges,498.53,69,,,Percent of Total Billed Charges,69% of total billed charges,606.9,84,,,Percent of Total Billed Charges,84% of total billed charges,592.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,643.03,89,,,Percent of total Billed Charges,89% of total Billed charges,643.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,294.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.33,77,,,Percent of total Billed charges,77% of total billed charges,614.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,294.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,180.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,180.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.63,643.03,
"RBC, LEUK REDU",T990380088,CDM,390,RC,P9016,HCPCS,Outpatient,,,662,331,,509.74,77,,,Percent of Total Billed Charges,77% of total billed charges,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,489.88,74,,,Percent of Total Billed Charges,74% of total billed charges,456.78,69,,,Percent of Total Billed Charges,69% of total billed charges,456.78,69,,,Percent of Total Billed Charges,69% of total billed charges,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.78,69,,,Percent of Total Billed Charges,69% of total billed charges,456.78,69,,,Percent of Total Billed Charges,69% of total billed charges,556.08,84,,,Percent of Total Billed Charges,84% of total billed charges,542.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,589.18,89,,,Percent of total Billed Charges,89% of total Billed charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,589.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,509.74,77,,,Percent of total Billed charges,77% of total billed charges,562.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,165.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.5,589.18,
FRESH FROZEN PLASMA,T990380090,CDM,390,RC,P9017,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,260,
PLT PHER LEU-RED,T990380091,CDM,390,RC,P9035,HCPCS,Outpatient,,,1259.5,629.75,,969.82,77,,,Percent of Total Billed Charges,77% of total billed charges,321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,932.03,74,,,Percent of Total Billed Charges,74% of total billed charges,869.06,69,,,Percent of Total Billed Charges,69% of total billed charges,869.06,69,,,Percent of Total Billed Charges,69% of total billed charges,314.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,869.06,69,,,Percent of Total Billed Charges,69% of total billed charges,869.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1057.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1032.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1120.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1120.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,314.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,969.82,77,,,Percent of total Billed charges,77% of total billed charges,1070.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,362.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,314.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,314.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1120.96,
PLT PHER LEU-RED IRRAD,T990380092,CDM,390,RC,P9037,HCPCS,Outpatient,,,1440.5,720.25,,1109.19,77,,,Percent of Total Billed Charges,77% of total billed charges,367.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,367.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,450.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1065.97,74,,,Percent of Total Billed Charges,74% of total billed charges,993.95,69,,,Percent of Total Billed Charges,69% of total billed charges,993.95,69,,,Percent of Total Billed Charges,69% of total billed charges,360.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,993.95,69,,,Percent of Total Billed Charges,69% of total billed charges,993.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1210.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1181.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,1282.05,89,,,Percent of total Billed Charges,89% of total Billed charges,1282.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,360.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1109.19,77,,,Percent of total Billed charges,77% of total billed charges,1224.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,414.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,360.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,360.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1282.05,
"RBC, LEUK REDU, IRRAD",T990380093,CDM,390,RC,P9040,HCPCS,Outpatient,,,842.5,421.25,,648.73,77,,,Percent of Total Billed Charges,77% of total billed charges,214.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,623.45,74,,,Percent of Total Billed Charges,74% of total billed charges,581.33,69,,,Percent of Total Billed Charges,69% of total billed charges,581.33,69,,,Percent of Total Billed Charges,69% of total billed charges,210.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.33,69,,,Percent of Total Billed Charges,69% of total billed charges,581.33,69,,,Percent of Total Billed Charges,69% of total billed charges,707.7,84,,,Percent of Total Billed Charges,84% of total billed charges,690.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,749.83,89,,,Percent of total Billed Charges,89% of total Billed charges,749.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,749.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,210.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.73,77,,,Percent of total Billed charges,77% of total billed charges,716.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,210.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,210.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.63,749.83,
RBC LEUKOCYTE REDUC CMV-,T990380094,CDM,390,RC,P9051,HCPCS,Outpatient,,,860,430,,662.2,77,,,Percent of Total Billed Charges,77% of total billed charges,219.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,636.4,74,,,Percent of Total Billed Charges,74% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,722.4,84,,,Percent of Total Billed Charges,84% of total billed charges,705.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,765.4,89,,,Percent of total Billed Charges,89% of total Billed charges,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.2,77,,,Percent of total Billed charges,77% of total billed charges,731,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215,765.4,
PLT PHER LEUK REDUC MATCH,T990380095,CDM,390,RC,P9052,HCPCS,Outpatient,,,1978.5,989.25,,1523.45,77,,,Percent of Total Billed Charges,77% of total billed charges,504.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1464.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1365.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1365.17,69,,,Percent of Total Billed Charges,69% of total billed charges,494.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1365.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1365.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1661.94,84,,,Percent of Total Billed Charges,84% of total billed charges,1622.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1760.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1760.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1760.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,494.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1523.45,77,,,Percent of total Billed charges,77% of total billed charges,1681.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,568.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,494.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,494.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1760.87,
PLT PHER LEUK RED CMV-IR,T990380096,CDM,390,RC,P9053,HCPCS,Outpatient,,,1639,819.5,,1262.03,77,,,Percent of Total Billed Charges,77% of total billed charges,417.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,512.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1212.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1130.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1130.91,69,,,Percent of Total Billed Charges,69% of total billed charges,409.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1130.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1130.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1376.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1343.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1458.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1458.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1458.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,409.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1262.03,77,,,Percent of total Billed charges,77% of total billed charges,1393.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,471.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,409.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,409.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1458.71,
RBC LEUKO REDUCE DEGLYCER,T990380097,CDM,390,RC,P9054,HCPCS,Outpatient,,,2076.5,1038.25,,1598.91,77,,,Percent of Total Billed Charges,77% of total billed charges,529.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,529.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,648.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1536.61,74,,,Percent of Total Billed Charges,74% of total billed charges,1432.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1432.79,69,,,Percent of Total Billed Charges,69% of total billed charges,519.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1432.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1432.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1744.26,84,,,Percent of Total Billed Charges,84% of total billed charges,1702.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,1848.09,89,,,Percent of total Billed Charges,89% of total Billed charges,1848.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1848.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,519.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1598.91,77,,,Percent of total Billed charges,77% of total billed charges,1765.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,596.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,519.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,519.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1848.09,
PLT PHER LEUKO REDUC CMV-,T990380098,CDM,390,RC,P9055,HCPCS,Outpatient,,,1458,729,,1122.66,77,,,Percent of Total Billed Charges,77% of total billed charges,371.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,371.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,455.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1078.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1006.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1006.02,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1006.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1006.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1224.72,84,,,Percent of Total Billed Charges,84% of total billed charges,1195.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1297.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1297.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1297.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,364.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1122.66,77,,,Percent of total Billed charges,77% of total billed charges,1239.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,419.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,364.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,364.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,1297.62,
"RBC, LEUKO REDU DEGLY IRRA",T990380099,CDM,390,RC,P9057,HCPCS,Outpatient,,,2256.5,1128.25,,1737.51,77,,,Percent of Total Billed Charges,77% of total billed charges,575.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,575.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1669.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1556.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1556.99,69,,,Percent of Total Billed Charges,69% of total billed charges,564.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1556.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1556.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1895.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1850.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,2008.29,89,,,Percent of total Billed Charges,89% of total Billed charges,2008.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2008.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,564.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1737.51,77,,,Percent of total Billed charges,77% of total billed charges,1918.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,648.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,564.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,564.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,2008.29,
RBC LEUKO REDUC CMV-IRRA,T990380100,CDM,390,RC,P9058,HCPCS,Outpatient,,,1040,520,,800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,265.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.6,74,,,Percent of Total Billed Charges,74% of total billed charges,717.6,69,,,Percent of Total Billed Charges,69% of total billed charges,717.6,69,,,Percent of Total Billed Charges,69% of total billed charges,260,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.6,69,,,Percent of Total Billed Charges,69% of total billed charges,717.6,69,,,Percent of Total Billed Charges,69% of total billed charges,873.6,84,,,Percent of Total Billed Charges,84% of total billed charges,852.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,925.6,89,,,Percent of total Billed Charges,89% of total Billed charges,925.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,260,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.8,77,,,Percent of total Billed charges,77% of total billed charges,884,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,299,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,260,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,260,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260,925.6,
FRESH FROZEN PLASMA 8-24 HOURS,T990380101,CDM,390,RC,P9059,HCPCS,Outpatient,,,200,100,,154,77,,,Percent of Total Billed Charges,77% of total billed charges,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148,74,,,Percent of Total Billed Charges,74% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138,69,,,Percent of Total Billed Charges,69% of total billed charges,138,69,,,Percent of Total Billed Charges,69% of total billed charges,168,84,,,Percent of Total Billed Charges,84% of total billed charges,164,82,,,Percent of Total Billed Charges,82% of total billed charges ,178,89,,,Percent of total Billed Charges,89% of total Billed charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154,77,,,Percent of total Billed charges,77% of total billed charges,170,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,50,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50,260,
TISSUE PATH III G & M 1 SPEC.,T990390001,CDM,312,RC,88304,HCPCS,Outpatient,,,174.5,87.25,,134.37,77,,,Percent of Total Billed Charges,77% of total billed charges,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.13,74,,,Percent of Total Billed Charges,74% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,120.41,69,,,Percent of Total Billed Charges,69% of total billed charges,146.58,84,,,Percent of Total Billed Charges,84% of total billed charges,143.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.31,89,,,Percent of total Billed Charges,89% of total Billed charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.47,120,,,Fee Schedule,120% of MO Medicaid Rate,29.47,120,,,Fee Schedule,120% of MO Medicaid Rate,29.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.37,77,,,Percent of total Billed charges,77% of total billed charges,148.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,29.47,120,,,Fee Schedule,120% of MO Medicaid Rate,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,43.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.47,155.31,
DECALCIFICATION TISSUE,T990390002,CDM,312,RC,88311,HCPCS,Outpatient,,,31.5,15.75,,24.26,77,,,Percent of Total Billed Charges,77% of total billed charges,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.31,74,,,Percent of Total Billed Charges,74% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,26.46,84,,,Percent of Total Billed Charges,84% of total billed charges,25.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.04,89,,,Percent of total Billed Charges,89% of total Billed charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.84,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.26,77,,,Percent of total Billed charges,77% of total billed charges,26.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,7.84,120,,,Fee Schedule,120% of MO Medicaid Rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.84,81,
HISTO SPECIAL STAIN GROUP 1,T990390003,CDM,312,RC,88312,HCPCS,Outpatient,,,187.5,93.75,,144.38,77,,,Percent of Total Billed Charges,77% of total billed charges,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.75,74,,,Percent of Total Billed Charges,74% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,129.38,69,,,Percent of Total Billed Charges,69% of total billed charges,157.5,84,,,Percent of Total Billed Charges,84% of total billed charges,153.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,166.88,89,,,Percent of total Billed Charges,89% of total Billed charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.9,120,,,Fee Schedule,120% of MO Medicaid Rate,80.9,120,,,Fee Schedule,120% of MO Medicaid Rate,80.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.38,77,,,Percent of total Billed charges,77% of total billed charges,159.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81,100,,,Case Rate,Pays based on per visit rate,80.9,120,,,Fee Schedule,120% of MO Medicaid Rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70,100,,,Case Rate,Pays based on per visit rate,46.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.88,166.88,
TISSUE PAT,T990390004,CDM,312,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,70,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,70,81,
DRAIN/INJ JOINT/BURSA W/O US,T990400001,CDM,320,RC,20610,HCPCS,Outpatient,,,469.5,234.75,,361.52,77,,,Percent of Total Billed Charges,77% of total billed charges,119.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,347.43,74,,,Percent of Total Billed Charges,74% of total billed charges,323.96,69,,,Percent of Total Billed Charges,69% of total billed charges,323.96,69,,,Percent of Total Billed Charges,69% of total billed charges,117.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.96,69,,,Percent of Total Billed Charges,69% of total billed charges,323.96,69,,,Percent of Total Billed Charges,69% of total billed charges,394.38,84,,,Percent of Total Billed Charges,84% of total billed charges,384.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,417.86,89,,,Percent of total Billed Charges,89% of total Billed charges,417.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.52,77,,,Percent of total Billed charges,77% of total billed charges,399.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,191.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,117.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,117.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.38,417.86,
"ARTHROGRAM, SHOULDER",T990400005,CDM,322,RC,23350,HCPCS,Outpatient,,,748,374,,575.96,77,,,Percent of Total Billed Charges,77% of total billed charges,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.52,74,,,Percent of Total Billed Charges,74% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,628.32,84,,,Percent of Total Billed Charges,84% of total billed charges,613.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.72,89,,,Percent of total Billed Charges,89% of total Billed charges,665.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.96,77,,,Percent of total Billed charges,77% of total billed charges,635.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,305.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187,665.72,
"ARTHROGRAM, WRIST",T990400006,CDM,322,RC,25246,HCPCS,Outpatient,,,748,374,,575.96,77,,,Percent of Total Billed Charges,77% of total billed charges,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.52,74,,,Percent of Total Billed Charges,74% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,628.32,84,,,Percent of Total Billed Charges,84% of total billed charges,613.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.72,89,,,Percent of total Billed Charges,89% of total Billed charges,665.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.96,77,,,Percent of total Billed charges,77% of total billed charges,635.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,305.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187,665.72,
"ARTHROGRAM, KNEE",T990400007,CDM,322,RC,27369,HCPCS,Outpatient,,,748,374,,575.96,77,,,Percent of Total Billed Charges,77% of total billed charges,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.52,74,,,Percent of Total Billed Charges,74% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,628.32,84,,,Percent of Total Billed Charges,84% of total billed charges,613.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.72,89,,,Percent of total Billed Charges,89% of total Billed charges,665.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.96,77,,,Percent of total Billed charges,77% of total billed charges,635.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,305.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187,665.72,
PICC OP DOUBLE LUMEN,T990400008,CDM,761,RC,36573,HCPCS,Outpatient,,,1907.5,953.75,,1468.78,77,,,Percent of Total Billed Charges,77% of total billed charges,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1411.55,74,,,Percent of Total Billed Charges,74% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1602.3,84,,,Percent of Total Billed Charges,84% of total billed charges,1564.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,1697.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.78,77,,,Percent of total Billed charges,77% of total billed charges,1621.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,548.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,953.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.88,1697.68,
PICC OP TRIPLE LUMEN,T990400009,CDM,761,RC,36573,HCPCS,Outpatient,,,1924,962,,1481.48,77,,,Percent of Total Billed Charges,77% of total billed charges,490.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,490.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,601.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1423.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1327.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1327.56,69,,,Percent of Total Billed Charges,69% of total billed charges,481,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1327.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1327.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1616.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1577.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1712.36,89,,,Percent of total Billed Charges,89% of total Billed charges,1712.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,784.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,784.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,784.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,481,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1481.48,77,,,Percent of total Billed charges,77% of total billed charges,1635.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,553.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,962,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,784.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,481,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1712.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,481,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481,1712.36,
CHOLANGIOGRAM POST OP,T990400010,CDM,761,RC,47531,HCPCS,Outpatient,,,879,439.5,,676.83,77,,,Percent of Total Billed Charges,77% of total billed charges,224.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,650.46,74,,,Percent of Total Billed Charges,74% of total billed charges,606.51,69,,,Percent of Total Billed Charges,69% of total billed charges,606.51,69,,,Percent of Total Billed Charges,69% of total billed charges,219.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,606.51,69,,,Percent of Total Billed Charges,69% of total billed charges,606.51,69,,,Percent of Total Billed Charges,69% of total billed charges,738.36,84,,,Percent of Total Billed Charges,84% of total billed charges,720.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,782.31,89,,,Percent of total Billed Charges,89% of total Billed charges,782.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,782.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.83,77,,,Percent of total Billed charges,77% of total billed charges,747.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,439.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,358.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,782.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.75,782.31,
CATH & INTRO NS/CONT MAT,T990400011,CDM,320,RC,58340,HCPCS,Outpatient,,,396.5,198.25,,305.31,77,,,Percent of Total Billed Charges,77% of total billed charges,101.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,293.41,74,,,Percent of Total Billed Charges,74% of total billed charges,273.59,69,,,Percent of Total Billed Charges,69% of total billed charges,273.59,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.59,69,,,Percent of Total Billed Charges,69% of total billed charges,273.59,69,,,Percent of Total Billed Charges,69% of total billed charges,333.06,84,,,Percent of Total Billed Charges,84% of total billed charges,325.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,352.89,89,,,Percent of total Billed Charges,89% of total Billed charges,352.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,352.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.31,77,,,Percent of total Billed charges,77% of total billed charges,337.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,161.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,99.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,352.89,
LUMBAR PUNCTURE,T990400012,CDM,320,RC,62270,HCPCS,Outpatient,,,878,439,,676.06,77,,,Percent of Total Billed Charges,77% of total billed charges,223.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,223.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,274.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,649.72,74,,,Percent of Total Billed Charges,74% of total billed charges,605.82,69,,,Percent of Total Billed Charges,69% of total billed charges,605.82,69,,,Percent of Total Billed Charges,69% of total billed charges,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,605.82,69,,,Percent of Total Billed Charges,69% of total billed charges,605.82,69,,,Percent of Total Billed Charges,69% of total billed charges,737.52,84,,,Percent of Total Billed Charges,84% of total billed charges,719.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,781.42,89,,,Percent of total Billed Charges,89% of total Billed charges,781.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,676.06,77,,,Percent of total Billed charges,77% of total billed charges,746.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,252.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,358.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,219.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.5,781.42,
MANDIBLE,T990400013,CDM,320,RC,70110,HCPCS,Outpatient,,,462,231,,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.88,74,,,Percent of Total Billed Charges,74% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,388.08,84,,,Percent of Total Billed Charges,84% of total billed charges,378.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,138,400,,,fee schedule,400% of healthlink fee schedule,129.38,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,138,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,392.7,
MANDIBLE,T990400013,CDM,320,RC,70110,HCPCS,Outpatient,,,462,231,TC,355.74,77,,,Percent of Total Billed Charges,77% of total billed charges,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.88,74,,,Percent of Total Billed Charges,74% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,318.78,69,,,Percent of Total Billed Charges,69% of total billed charges,388.08,84,,,Percent of Total Billed Charges,84% of total billed charges,378.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,138,400,,,fee schedule,400% of healthlink fee schedule,129.38,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,138,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.74,77,,,Percent of total Billed charges,77% of total billed charges,392.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,115.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,392.7,
MASTOID,T990400014,CDM,320,RC,70130,HCPCS,Outpatient,,,414.5,207.25,,319.17,77,,,Percent of Total Billed Charges,77% of total billed charges,105.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,306.73,74,,,Percent of Total Billed Charges,74% of total billed charges,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,348.18,84,,,Percent of Total Billed Charges,84% of total billed charges,339.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.32,400,,,fee schedule,400% of healthlink fee schedule,183.11,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,195.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.17,77,,,Percent of total Billed charges,77% of total billed charges,352.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.23,352.33,
MASTOID,T990400014,CDM,320,RC,70130,HCPCS,Outpatient,,,414.5,207.25,TC,319.17,77,,,Percent of Total Billed Charges,77% of total billed charges,105.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,306.73,74,,,Percent of Total Billed Charges,74% of total billed charges,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,286.01,69,,,Percent of Total Billed Charges,69% of total billed charges,348.18,84,,,Percent of Total Billed Charges,84% of total billed charges,339.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.32,400,,,fee schedule,400% of healthlink fee schedule,183.11,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,195.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,319.17,77,,,Percent of total Billed charges,77% of total billed charges,352.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,103.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.23,352.33,
FACIAL BONE,T990400015,CDM,320,RC,70150,HCPCS,Outpatient,,,469,234.5,TC,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,347.06,74,,,Percent of Total Billed Charges,74% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,393.96,84,,,Percent of Total Billed Charges,84% of total billed charges,384.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.6,400,,,fee schedule,400% of healthlink fee schedule,136.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,145.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.88,398.65,
FACIAL BONE,T990400015,CDM,320,RC,70150,HCPCS,Outpatient,,,469,234.5,,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,347.06,74,,,Percent of Total Billed Charges,74% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,393.96,84,,,Percent of Total Billed Charges,84% of total billed charges,384.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.6,400,,,fee schedule,400% of healthlink fee schedule,136.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,145.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.88,398.65,
NASAL BONE,T990400016,CDM,320,RC,70160,HCPCS,Outpatient,,,349,174.5,,268.73,77,,,Percent of Total Billed Charges,77% of total billed charges,89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.26,74,,,Percent of Total Billed Charges,74% of total billed charges,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,293.16,84,,,Percent of Total Billed Charges,84% of total billed charges,286.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.72,400,,,fee schedule,400% of healthlink fee schedule,104.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,111.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,27.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.73,77,,,Percent of total Billed charges,77% of total billed charges,296.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.02,296.65,
NASAL BONE,T990400016,CDM,320,RC,70160,HCPCS,Outpatient,,,349,174.5,TC,268.73,77,,,Percent of Total Billed Charges,77% of total billed charges,89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.26,74,,,Percent of Total Billed Charges,74% of total billed charges,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,240.81,69,,,Percent of Total Billed Charges,69% of total billed charges,293.16,84,,,Percent of Total Billed Charges,84% of total billed charges,286.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.72,400,,,fee schedule,400% of healthlink fee schedule,104.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,111.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,27.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.73,77,,,Percent of total Billed charges,77% of total billed charges,296.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.02,120,,,Fee Schedule,120% of MO Medicaid Rate,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,87.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.02,296.65,
ORBIT,T990400017,CDM,320,RC,70200,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.04,400,,,fee schedule,400% of healthlink fee schedule,142.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,152.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.88,272.85,
ORBIT,T990400017,CDM,320,RC,70200,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.04,400,,,fee schedule,400% of healthlink fee schedule,142.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,152.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,31.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,31.88,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.88,272.85,
SINUSES LESS 3 VIEW,T990400018,CDM,320,RC,70210,HCPCS,Outpatient,,,274,137,,210.98,77,,,Percent of Total Billed Charges,77% of total billed charges,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,202.76,74,,,Percent of Total Billed Charges,74% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,230.16,84,,,Percent of Total Billed Charges,84% of total billed charges,224.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.2,400,,,fee schedule,400% of healthlink fee schedule,93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,99.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.98,77,,,Percent of total Billed charges,77% of total billed charges,232.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,271,
SINUSES LESS 3 VIEW,T990400018,CDM,320,RC,70210,HCPCS,Outpatient,,,274,137,TC,210.98,77,,,Percent of Total Billed Charges,77% of total billed charges,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,202.76,74,,,Percent of Total Billed Charges,74% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,189.06,69,,,Percent of Total Billed Charges,69% of total billed charges,230.16,84,,,Percent of Total Billed Charges,84% of total billed charges,224.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.2,400,,,fee schedule,400% of healthlink fee schedule,93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,99.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.98,77,,,Percent of total Billed charges,77% of total billed charges,232.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,68.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,271,
SINUSES ROUTINE 3 VIEW,T990400019,CDM,320,RC,70220,HCPCS,Outpatient,,,427,213.5,,328.79,77,,,Percent of Total Billed Charges,77% of total billed charges,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.98,74,,,Percent of Total Billed Charges,74% of total billed charges,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,358.68,84,,,Percent of Total Billed Charges,84% of total billed charges,350.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.96,400,,,fee schedule,400% of healthlink fee schedule,121.84,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,129.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,24.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,77,,,Percent of total Billed charges,77% of total billed charges,362.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.9,362.95,
SINUSES ROUTINE 3 VIEW,T990400019,CDM,320,RC,70220,HCPCS,Outpatient,,,427,213.5,TC,328.79,77,,,Percent of Total Billed Charges,77% of total billed charges,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.98,74,,,Percent of Total Billed Charges,74% of total billed charges,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,294.63,69,,,Percent of Total Billed Charges,69% of total billed charges,358.68,84,,,Percent of Total Billed Charges,84% of total billed charges,350.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.96,400,,,fee schedule,400% of healthlink fee schedule,121.84,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,129.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,24.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,77,,,Percent of total Billed charges,77% of total billed charges,362.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,24.9,120,,,Fee Schedule,120% of MO Medicaid Rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.9,362.95,
SELLA TURCICIA,T990400020,CDM,320,RC,70240,HCPCS,Outpatient,,,229.5,114.75,,176.72,77,,,Percent of Total Billed Charges,77% of total billed charges,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,169.83,74,,,Percent of Total Billed Charges,74% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,192.78,84,,,Percent of Total Billed Charges,84% of total billed charges,188.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.76,400,,,fee schedule,400% of healthlink fee schedule,96.34,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,102.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.72,77,,,Percent of total Billed charges,77% of total billed charges,195.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,271,
SELLA TURCICIA,T990400020,CDM,320,RC,70240,HCPCS,Outpatient,,,229.5,114.75,TC,176.72,77,,,Percent of Total Billed Charges,77% of total billed charges,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,169.83,74,,,Percent of Total Billed Charges,74% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,158.36,69,,,Percent of Total Billed Charges,69% of total billed charges,192.78,84,,,Percent of Total Billed Charges,84% of total billed charges,188.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.76,400,,,fee schedule,400% of healthlink fee schedule,96.34,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,102.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.72,77,,,Percent of total Billed charges,77% of total billed charges,195.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,271,
SKULL AP LAT,T990400021,CDM,320,RC,70250,HCPCS,Outpatient,,,323.5,161.75,,249.1,77,,,Percent of Total Billed Charges,77% of total billed charges,82.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.39,74,,,Percent of Total Billed Charges,74% of total billed charges,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,271.74,84,,,Percent of Total Billed Charges,84% of total billed charges,265.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.52,400,,,fee schedule,400% of healthlink fee schedule,115.8,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,123.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.1,77,,,Percent of total Billed charges,77% of total billed charges,274.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.6,274.98,
SKULL AP LAT,T990400021,CDM,320,RC,70250,HCPCS,Outpatient,,,323.5,161.75,TC,249.1,77,,,Percent of Total Billed Charges,77% of total billed charges,82.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.39,74,,,Percent of Total Billed Charges,74% of total billed charges,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,223.22,69,,,Percent of Total Billed Charges,69% of total billed charges,271.74,84,,,Percent of Total Billed Charges,84% of total billed charges,265.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.52,400,,,fee schedule,400% of healthlink fee schedule,115.8,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,123.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.1,77,,,Percent of total Billed charges,77% of total billed charges,274.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.6,274.98,
SKULL ROUTINE,T990400022,CDM,320,RC,70260,HCPCS,Outpatient,,,492,246,,378.84,77,,,Percent of Total Billed Charges,77% of total billed charges,125.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,364.08,74,,,Percent of Total Billed Charges,74% of total billed charges,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,413.28,84,,,Percent of Total Billed Charges,84% of total billed charges,403.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.6,400,,,fee schedule,400% of healthlink fee schedule,153.38,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,163.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.84,77,,,Percent of total Billed charges,77% of total billed charges,418.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.55,418.2,
SKULL ROUTINE,T990400022,CDM,320,RC,70260,HCPCS,Outpatient,,,492,246,TC,378.84,77,,,Percent of Total Billed Charges,77% of total billed charges,125.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,364.08,74,,,Percent of Total Billed Charges,74% of total billed charges,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,339.48,69,,,Percent of Total Billed Charges,69% of total billed charges,413.28,84,,,Percent of Total Billed Charges,84% of total billed charges,403.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.6,400,,,fee schedule,400% of healthlink fee schedule,153.38,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,163.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.84,77,,,Percent of total Billed charges,77% of total billed charges,418.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,123,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.55,418.2,
TMJ,T990400023,CDM,320,RC,70330,HCPCS,Outpatient,,,475.5,237.75,,366.14,77,,,Percent of Total Billed Charges,77% of total billed charges,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.87,74,,,Percent of Total Billed Charges,74% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,399.42,84,,,Percent of Total Billed Charges,84% of total billed charges,389.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,162.88,400,,,fee schedule,400% of healthlink fee schedule,152.7,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,162.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,38.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.14,77,,,Percent of total Billed charges,77% of total billed charges,404.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.28,404.18,
TMJ,T990400023,CDM,320,RC,70330,HCPCS,Outpatient,,,475.5,237.75,TC,366.14,77,,,Percent of Total Billed Charges,77% of total billed charges,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.87,74,,,Percent of Total Billed Charges,74% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,399.42,84,,,Percent of Total Billed Charges,84% of total billed charges,389.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,162.88,400,,,fee schedule,400% of healthlink fee schedule,152.7,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,162.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,38.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.14,77,,,Percent of total Billed charges,77% of total billed charges,404.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,38.28,120,,,Fee Schedule,120% of MO Medicaid Rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.28,404.18,
SOFT TISS NECK,T990400024,CDM,320,RC,70360,HCPCS,Outpatient,,,350.5,175.25,TC,269.89,77,,,Percent of Total Billed Charges,77% of total billed charges,89.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,259.37,74,,,Percent of Total Billed Charges,74% of total billed charges,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,294.42,84,,,Percent of Total Billed Charges,84% of total billed charges,287.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.16,400,,,fee schedule,400% of healthlink fee schedule,89.21,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,95.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.89,77,,,Percent of total Billed charges,77% of total billed charges,297.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.65,297.93,
SOFT TISS NECK,T990400024,CDM,320,RC,70360,HCPCS,Outpatient,,,350.5,175.25,,269.89,77,,,Percent of Total Billed Charges,77% of total billed charges,89.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,259.37,74,,,Percent of Total Billed Charges,74% of total billed charges,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,241.85,69,,,Percent of Total Billed Charges,69% of total billed charges,294.42,84,,,Percent of Total Billed Charges,84% of total billed charges,287.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.16,400,,,fee schedule,400% of healthlink fee schedule,89.21,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,95.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.89,77,,,Percent of total Billed charges,77% of total billed charges,297.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,87.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.65,297.93,
SIALOGRAM,T990400025,CDM,320,RC,70390,HCPCS,Outpatient,,,1159,579.5,,892.43,77,,,Percent of Total Billed Charges,77% of total billed charges,295.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,857.66,74,,,Percent of Total Billed Charges,74% of total billed charges,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,973.56,84,,,Percent of Total Billed Charges,84% of total billed charges,950.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,348.28,400,,,fee schedule,400% of healthlink fee schedule,326.51,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,348.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,93.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,892.43,77,,,Percent of total Billed charges,77% of total billed charges,985.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.3,985.15,
SIALOGRAM,T990400025,CDM,320,RC,70390,HCPCS,Outpatient,,,1159,579.5,TC,892.43,77,,,Percent of Total Billed Charges,77% of total billed charges,295.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,295.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,362.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,857.66,74,,,Percent of Total Billed Charges,74% of total billed charges,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,799.71,69,,,Percent of Total Billed Charges,69% of total billed charges,973.56,84,,,Percent of Total Billed Charges,84% of total billed charges,950.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,348.28,400,,,fee schedule,400% of healthlink fee schedule,326.51,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,348.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,93.3,120,,,Fee Schedule,120% of MO of Medicaid Rate,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,892.43,77,,,Percent of total Billed charges,77% of total billed charges,985.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,333.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,93.3,120,,,Fee Schedule,120% of MO Medicaid Rate,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,289.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.3,985.15,
CHEST 1 VIEW,T990400026,CDM,324,RC,71045,HCPCS,Outpatient,,,408.5,204.25,,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,363.57,89,,,Percent of total Billed Charges,89% of total Billed charges,363.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,363.57,
CHEST 1 VIEW,T990400026,CDM,324,RC,71045,HCPCS,Outpatient,,,408.5,204.25,TC,314.55,77,,,Percent of Total Billed Charges,77% of total billed charges,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,302.29,74,,,Percent of Total Billed Charges,74% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,281.87,69,,,Percent of Total Billed Charges,69% of total billed charges,343.14,84,,,Percent of Total Billed Charges,84% of total billed charges,334.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,363.57,89,,,Percent of total Billed Charges,89% of total Billed charges,363.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,314.55,77,,,Percent of total Billed charges,77% of total billed charges,347.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,102.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,363.57,
CHEST 2 VIEW,T990400027,CDM,324,RC,71046,HCPCS,Outpatient,,,423.5,211.75,TC,326.1,77,,,Percent of Total Billed Charges,77% of total billed charges,107.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.39,74,,,Percent of Total Billed Charges,74% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,355.74,84,,,Percent of Total Billed Charges,84% of total billed charges,347.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,376.92,89,,,Percent of total Billed Charges,89% of total Billed charges,376.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.1,77,,,Percent of total Billed charges,77% of total billed charges,359.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,376.92,
CHEST 2 VIEW,T990400027,CDM,324,RC,71046,HCPCS,Outpatient,,,423.5,211.75,,326.1,77,,,Percent of Total Billed Charges,77% of total billed charges,107.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.39,74,,,Percent of Total Billed Charges,74% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,292.22,69,,,Percent of Total Billed Charges,69% of total billed charges,355.74,84,,,Percent of Total Billed Charges,84% of total billed charges,347.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,376.92,89,,,Percent of total Billed Charges,89% of total Billed charges,376.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,376.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.1,77,,,Percent of total Billed charges,77% of total billed charges,359.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,105.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,376.92,
CHEST COMP 4 VIEW,T990400028,CDM,324,RC,71048,HCPCS,Outpatient,,,687.5,343.75,TC,529.38,77,,,Percent of Total Billed Charges,77% of total billed charges,175.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,508.75,74,,,Percent of Total Billed Charges,74% of total billed charges,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,577.5,84,,,Percent of Total Billed Charges,84% of total billed charges,563.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,611.88,89,,,Percent of total Billed Charges,89% of total Billed charges,611.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,611.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,529.38,77,,,Percent of total Billed charges,77% of total billed charges,584.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,197.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.55,611.88,
CHEST COMP 4 VIEW,T990400028,CDM,324,RC,71048,HCPCS,Outpatient,,,687.5,343.75,,529.38,77,,,Percent of Total Billed Charges,77% of total billed charges,175.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,508.75,74,,,Percent of Total Billed Charges,74% of total billed charges,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,474.38,69,,,Percent of Total Billed Charges,69% of total billed charges,577.5,84,,,Percent of Total Billed Charges,84% of total billed charges,563.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,611.88,89,,,Percent of total Billed Charges,89% of total Billed charges,611.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,611.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,529.38,77,,,Percent of total Billed charges,77% of total billed charges,584.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,197.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,171.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.55,611.88,
"RIBS LEFT UNILAT, MIN 3 VIEWS",T990400029,CDM,320,RC,71101,HCPCS,Outpatient,,,444,222,LT,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.56,74,,,Percent of Total Billed Charges,74% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,372.96,84,,,Percent of Total Billed Charges,84% of total billed charges,364.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.16,400,,,fee schedule,400% of healthlink fee schedule,127.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,377.4,
"RIBS LEFT UNILAT, MIN 3 VIEWS",T990400029,CDM,320,RC,71101,HCPCS,Outpatient,,,444,222,LT,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.56,74,,,Percent of Total Billed Charges,74% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,372.96,84,,,Percent of Total Billed Charges,84% of total billed charges,364.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.16,400,,,fee schedule,400% of healthlink fee schedule,127.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,377.4,
"RIBS RIGHT UNILAT, MIN 3 VIEWS",T990400030,CDM,320,RC,71101,HCPCS,Outpatient,,,444,222,RT,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.56,74,,,Percent of Total Billed Charges,74% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,372.96,84,,,Percent of Total Billed Charges,84% of total billed charges,364.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.16,400,,,fee schedule,400% of healthlink fee schedule,127.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,377.4,
"RIBS RIGHT UNILAT, MIN 3 VIEWS",T990400030,CDM,320,RC,71101,HCPCS,Outpatient,,,444,222,RT,341.88,77,,,Percent of Total Billed Charges,77% of total billed charges,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.56,74,,,Percent of Total Billed Charges,74% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,306.36,69,,,Percent of Total Billed Charges,69% of total billed charges,372.96,84,,,Percent of Total Billed Charges,84% of total billed charges,364.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.16,400,,,fee schedule,400% of healthlink fee schedule,127.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,26.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.88,77,,,Percent of total Billed charges,77% of total billed charges,377.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.76,120,,,Fee Schedule,120% of MO Medicaid Rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,111,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,377.4,
BILATERAL RIBS,T990400031,CDM,320,RC,71111,HCPCS,Outpatient,,,934.5,467.25,,719.57,77,,,Percent of Total Billed Charges,77% of total billed charges,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,691.53,74,,,Percent of Total Billed Charges,74% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,784.98,84,,,Percent of Total Billed Charges,84% of total billed charges,766.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.76,400,,,fee schedule,400% of healthlink fee schedule,170.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,181.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,719.57,77,,,Percent of total Billed charges,77% of total billed charges,794.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,794.33,
BILATERAL RIBS,T990400031,CDM,320,RC,71111,HCPCS,Outpatient,,,934.5,467.25,TC,719.57,77,,,Percent of Total Billed Charges,77% of total billed charges,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,691.53,74,,,Percent of Total Billed Charges,74% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,784.98,84,,,Percent of Total Billed Charges,84% of total billed charges,766.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.76,400,,,fee schedule,400% of healthlink fee schedule,170.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,181.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,34.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,719.57,77,,,Percent of total Billed charges,77% of total billed charges,794.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,34.02,120,,,Fee Schedule,120% of MO Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,794.33,
STERNUM,T990400032,CDM,320,RC,71120,HCPCS,Outpatient,,,330.5,165.25,,254.49,77,,,Percent of Total Billed Charges,77% of total billed charges,84.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,244.57,74,,,Percent of Total Billed Charges,74% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,277.62,84,,,Percent of Total Billed Charges,84% of total billed charges,271.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.44,400,,,fee schedule,400% of healthlink fee schedule,102.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,109.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.49,77,,,Percent of total Billed charges,77% of total billed charges,280.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,280.93,
STERNUM,T990400032,CDM,320,RC,71120,HCPCS,Outpatient,,,330.5,165.25,TC,254.49,77,,,Percent of Total Billed Charges,77% of total billed charges,84.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,244.57,74,,,Percent of Total Billed Charges,74% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,228.05,69,,,Percent of Total Billed Charges,69% of total billed charges,277.62,84,,,Percent of Total Billed Charges,84% of total billed charges,271.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.44,400,,,fee schedule,400% of healthlink fee schedule,102.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,109.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.49,77,,,Percent of total Billed charges,77% of total billed charges,280.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,82.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,280.93,
STERNO CLAV JT,T990400033,CDM,320,RC,71130,HCPCS,Outpatient,,,378,189,TC,291.06,77,,,Percent of Total Billed Charges,77% of total billed charges,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.72,74,,,Percent of Total Billed Charges,74% of total billed charges,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,317.52,84,,,Percent of Total Billed Charges,84% of total billed charges,309.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.76,400,,,fee schedule,400% of healthlink fee schedule,119.78,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,127.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.06,77,,,Percent of total Billed charges,77% of total billed charges,321.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,321.3,
STERNO CLAV JT,T990400033,CDM,320,RC,71130,HCPCS,Outpatient,,,378,189,,291.06,77,,,Percent of Total Billed Charges,77% of total billed charges,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.72,74,,,Percent of Total Billed Charges,74% of total billed charges,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,260.82,69,,,Percent of Total Billed Charges,69% of total billed charges,317.52,84,,,Percent of Total Billed Charges,84% of total billed charges,309.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.76,400,,,fee schedule,400% of healthlink fee schedule,119.78,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,127.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,28.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.06,77,,,Percent of total Billed charges,77% of total billed charges,321.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.25,120,,,Fee Schedule,120% of MO Medicaid Rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,321.3,
EMP WELL LUNG CA SCREENING,T990400034,CDM,352,RC,71271,HCPCS,Outpatient,,,2062.5,1031.25,,1588.13,77,,,Percent of Total Billed Charges,77% of total billed charges,525.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,525.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,644.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1026.27,350,,,fee schedule,350% of bcbs fee schedule,1423.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1423.13,69,,,Percent of Total Billed Charges,69% of total billed charges,515.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1423.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1423.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1732.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1691.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,1835.63,89,,,Percent of total Billed Charges,89% of total Billed charges,1835.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,515.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1588.13,77,,,Percent of total Billed charges,77% of total billed charges,1753.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,592.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,515.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,515.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.48,1835.63,
SINGLE SPINE VIEW,T990400035,CDM,320,RC,72020,HCPCS,Outpatient,,,335,167.5,TC,257.95,77,,,Percent of Total Billed Charges,77% of total billed charges,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,247.9,74,,,Percent of Total Billed Charges,74% of total billed charges,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,281.4,84,,,Percent of Total Billed Charges,84% of total billed charges,274.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.6,400,,,fee schedule,400% of healthlink fee schedule,76.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,81.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.95,77,,,Percent of total Billed charges,77% of total billed charges,284.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.18,284.75,
SINGLE SPINE VIEW,T990400035,CDM,320,RC,72020,HCPCS,Outpatient,,,335,167.5,,257.95,77,,,Percent of Total Billed Charges,77% of total billed charges,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,247.9,74,,,Percent of Total Billed Charges,74% of total billed charges,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,231.15,69,,,Percent of Total Billed Charges,69% of total billed charges,281.4,84,,,Percent of Total Billed Charges,84% of total billed charges,274.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.6,400,,,fee schedule,400% of healthlink fee schedule,76.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,81.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,15.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.95,77,,,Percent of total Billed charges,77% of total billed charges,284.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.18,120,,,Fee Schedule,120% of MO Medicaid Rate,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,83.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.18,284.75,
C-SPINE 2 3 VIEWS,T990400036,CDM,320,RC,72040,HCPCS,Outpatient,,,483.5,241.75,TC,372.3,77,,,Percent of Total Billed Charges,77% of total billed charges,123.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,357.79,74,,,Percent of Total Billed Charges,74% of total billed charges,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,406.14,84,,,Percent of Total Billed Charges,84% of total billed charges,396.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.92,400,,,fee schedule,400% of healthlink fee schedule,120.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,128.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.3,77,,,Percent of total Billed charges,77% of total billed charges,410.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.12,410.98,
C-SPINE 2 3 VIEWS,T990400036,CDM,320,RC,72040,HCPCS,Outpatient,,,483.5,241.75,,372.3,77,,,Percent of Total Billed Charges,77% of total billed charges,123.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,357.79,74,,,Percent of Total Billed Charges,74% of total billed charges,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,333.62,69,,,Percent of Total Billed Charges,69% of total billed charges,406.14,84,,,Percent of Total Billed Charges,84% of total billed charges,396.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.92,400,,,fee schedule,400% of healthlink fee schedule,120.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,128.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,26.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,372.3,77,,,Percent of total Billed charges,77% of total billed charges,410.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.12,120,,,Fee Schedule,120% of MO Medicaid Rate,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,120.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.12,410.98,
C-SPINE WOBL,T990400037,CDM,320,RC,72050,HCPCS,Outpatient,,,708.5,354.25,,545.55,77,,,Percent of Total Billed Charges,77% of total billed charges,180.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.29,74,,,Percent of Total Billed Charges,74% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,595.14,84,,,Percent of Total Billed Charges,84% of total billed charges,580.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.52,400,,,fee schedule,400% of healthlink fee schedule,170.18,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,181.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,36.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.55,77,,,Percent of total Billed charges,77% of total billed charges,602.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.46,602.23,
C-SPINE WOBL,T990400037,CDM,320,RC,72050,HCPCS,Outpatient,,,708.5,354.25,TC,545.55,77,,,Percent of Total Billed Charges,77% of total billed charges,180.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.29,74,,,Percent of Total Billed Charges,74% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,595.14,84,,,Percent of Total Billed Charges,84% of total billed charges,580.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.52,400,,,fee schedule,400% of healthlink fee schedule,170.18,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,181.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,36.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.55,77,,,Percent of total Billed charges,77% of total billed charges,602.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,36.46,120,,,Fee Schedule,120% of MO Medicaid Rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.46,602.23,
C-SPINE COMP INC FLEX EXT,T990400038,CDM,320,RC,72052,HCPCS,Outpatient,,,650,325,,500.5,77,,,Percent of Total Billed Charges,77% of total billed charges,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,481,74,,,Percent of Total Billed Charges,74% of total billed charges,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,546,84,,,Percent of Total Billed Charges,84% of total billed charges,533,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.88,400,,,fee schedule,400% of healthlink fee schedule,212.7,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,226.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,500.5,77,,,Percent of total Billed charges,77% of total billed charges,552.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.44,552.5,
C-SPINE COMP INC FLEX EXT,T990400038,CDM,320,RC,72052,HCPCS,Outpatient,,,650,325,TC,500.5,77,,,Percent of Total Billed Charges,77% of total billed charges,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,481,74,,,Percent of Total Billed Charges,74% of total billed charges,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,448.5,69,,,Percent of Total Billed Charges,69% of total billed charges,546,84,,,Percent of Total Billed Charges,84% of total billed charges,533,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.88,400,,,fee schedule,400% of healthlink fee schedule,212.7,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,226.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,43.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,500.5,77,,,Percent of total Billed charges,77% of total billed charges,552.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,43.44,120,,,Fee Schedule,120% of MO Medicaid Rate,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,162.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.44,552.5,
T SPINE 2 VIEW,T990400039,CDM,320,RC,72070,HCPCS,Outpatient,,,332,166,,255.64,77,,,Percent of Total Billed Charges,77% of total billed charges,84.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.68,74,,,Percent of Total Billed Charges,74% of total billed charges,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,278.88,84,,,Percent of Total Billed Charges,84% of total billed charges,272.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.72,400,,,fee schedule,400% of healthlink fee schedule,107.55,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,114.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.64,77,,,Percent of total Billed charges,77% of total billed charges,282.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,282.2,
T SPINE 2 VIEW,T990400039,CDM,320,RC,72070,HCPCS,Outpatient,,,332,166,TC,255.64,77,,,Percent of Total Billed Charges,77% of total billed charges,84.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.68,74,,,Percent of Total Billed Charges,74% of total billed charges,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,229.08,69,,,Percent of Total Billed Charges,69% of total billed charges,278.88,84,,,Percent of Total Billed Charges,84% of total billed charges,272.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.72,400,,,fee schedule,400% of healthlink fee schedule,107.55,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,114.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.64,77,,,Percent of total Billed charges,77% of total billed charges,282.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,282.2,
T SPINE 3 VIEW,T990400040,CDM,320,RC,72072,HCPCS,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.56,400,,,fee schedule,400% of healthlink fee schedule,123.34,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,131.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.31,368.05,
T SPINE 3 VIEW,T990400040,CDM,320,RC,72072,HCPCS,Outpatient,,,433,216.5,TC,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.56,400,,,fee schedule,400% of healthlink fee schedule,123.34,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,131.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,28.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.31,120,,,Fee Schedule,120% of MO Medicaid Rate,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.31,368.05,
THORACOLUMBAR 2 VIEW,T990400041,CDM,320,RC,72080,HCPCS,Outpatient,,,510.5,255.25,TC,393.09,77,,,Percent of Total Billed Charges,77% of total billed charges,130.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.77,74,,,Percent of Total Billed Charges,74% of total billed charges,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,428.82,84,,,Percent of Total Billed Charges,84% of total billed charges,418.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.44,400,,,fee schedule,400% of healthlink fee schedule,111.98,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,119.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.09,77,,,Percent of total Billed charges,77% of total billed charges,433.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.46,433.93,
THORACOLUMBAR 2 VIEW,T990400041,CDM,320,RC,72080,HCPCS,Outpatient,,,510.5,255.25,,393.09,77,,,Percent of Total Billed Charges,77% of total billed charges,130.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.77,74,,,Percent of Total Billed Charges,74% of total billed charges,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,352.25,69,,,Percent of Total Billed Charges,69% of total billed charges,428.82,84,,,Percent of Total Billed Charges,84% of total billed charges,418.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.44,400,,,fee schedule,400% of healthlink fee schedule,111.98,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,119.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.09,77,,,Percent of total Billed charges,77% of total billed charges,433.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,127.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.46,433.93,
SCOLIOSIS SERIES,T990400042,CDM,320,RC,72082,HCPCS,Outpatient,,,394.5,197.25,,303.77,77,,,Percent of Total Billed Charges,77% of total billed charges,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,291.93,74,,,Percent of Total Billed Charges,74% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,331.38,84,,,Percent of Total Billed Charges,84% of total billed charges,323.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,351.11,89,,,Percent of total Billed Charges,89% of total Billed charges,351.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,351.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,50.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.77,77,,,Percent of total Billed charges,77% of total billed charges,335.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.14,351.11,
SCOLIOSIS SERIES,T990400042,CDM,320,RC,72082,HCPCS,Outpatient,,,394.5,197.25,TC,303.77,77,,,Percent of Total Billed Charges,77% of total billed charges,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,291.93,74,,,Percent of Total Billed Charges,74% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,272.21,69,,,Percent of Total Billed Charges,69% of total billed charges,331.38,84,,,Percent of Total Billed Charges,84% of total billed charges,323.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,351.11,89,,,Percent of total Billed Charges,89% of total Billed charges,351.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,351.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,50.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.77,77,,,Percent of total Billed charges,77% of total billed charges,335.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,50.14,120,,,Fee Schedule,120% of MO Medicaid Rate,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,98.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.14,351.11,
SCOLIOSIS STY W/SUPINE & ERECT,T990400043,CDM,320,RC,72083,HCPCS,Outpatient,,,723.5,361.75,,557.1,77,,,Percent of Total Billed Charges,77% of total billed charges,184.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.39,74,,,Percent of Total Billed Charges,74% of total billed charges,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,607.74,84,,,Percent of Total Billed Charges,84% of total billed charges,593.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,643.92,89,,,Percent of total Billed Charges,89% of total Billed charges,643.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,55.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.1,77,,,Percent of total Billed charges,77% of total billed charges,614.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.91,643.92,
SCOLIOSIS STY W/SUPINE & ERECT,T990400043,CDM,320,RC,72083,HCPCS,Outpatient,,,723.5,361.75,TC,557.1,77,,,Percent of Total Billed Charges,77% of total billed charges,184.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.39,74,,,Percent of Total Billed Charges,74% of total billed charges,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,499.22,69,,,Percent of Total Billed Charges,69% of total billed charges,607.74,84,,,Percent of Total Billed Charges,84% of total billed charges,593.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,643.92,89,,,Percent of total Billed Charges,89% of total Billed charges,643.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,55.91,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.1,77,,,Percent of total Billed charges,77% of total billed charges,614.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,55.91,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,180.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.91,643.92,
L SPINE 2 3 VIEW,T990400044,CDM,320,RC,72100,HCPCS,Outpatient,,,515.5,257.75,,396.94,77,,,Percent of Total Billed Charges,77% of total billed charges,131.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,381.47,74,,,Percent of Total Billed Charges,74% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,433.02,84,,,Percent of Total Billed Charges,84% of total billed charges,422.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.68,400,,,fee schedule,400% of healthlink fee schedule,125.33,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,133.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.94,77,,,Percent of total Billed charges,77% of total billed charges,438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.41,438.18,
L SPINE 2 3 VIEW,T990400044,CDM,320,RC,72100,HCPCS,Outpatient,,,515.5,257.75,TC,396.94,77,,,Percent of Total Billed Charges,77% of total billed charges,131.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,381.47,74,,,Percent of Total Billed Charges,74% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,355.7,69,,,Percent of Total Billed Charges,69% of total billed charges,433.02,84,,,Percent of Total Billed Charges,84% of total billed charges,422.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,133.68,400,,,fee schedule,400% of healthlink fee schedule,125.33,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,133.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,26.41,120,,,Fee Schedule,120% of MO of Medicaid Rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.94,77,,,Percent of total Billed charges,77% of total billed charges,438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,148.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,26.41,120,,,Fee Schedule,120% of MO Medicaid Rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,128.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.41,438.18,
L SPINE W OBLS,T990400045,CDM,320,RC,72110,HCPCS,Outpatient,,,625.5,312.75,,481.64,77,,,Percent of Total Billed Charges,77% of total billed charges,159.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.87,74,,,Percent of Total Billed Charges,74% of total billed charges,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,525.42,84,,,Percent of Total Billed Charges,84% of total billed charges,512.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,189.8,400,,,fee schedule,400% of healthlink fee schedule,177.94,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,189.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,35.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.64,77,,,Percent of total Billed charges,77% of total billed charges,531.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.23,531.68,
L SPINE W OBLS,T990400045,CDM,320,RC,72110,HCPCS,Outpatient,,,625.5,312.75,TC,481.64,77,,,Percent of Total Billed Charges,77% of total billed charges,159.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.87,74,,,Percent of Total Billed Charges,74% of total billed charges,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,431.6,69,,,Percent of Total Billed Charges,69% of total billed charges,525.42,84,,,Percent of Total Billed Charges,84% of total billed charges,512.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,189.8,400,,,fee schedule,400% of healthlink fee schedule,177.94,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,189.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,35.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.64,77,,,Percent of total Billed charges,77% of total billed charges,531.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,35.23,120,,,Fee Schedule,120% of MO Medicaid Rate,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,156.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.23,531.68,
L SPINE COMP INCL FLEX EX,T990400046,CDM,320,RC,72114,HCPCS,Outpatient,,,720,360,,554.4,77,,,Percent of Total Billed Charges,77% of total billed charges,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.8,74,,,Percent of Total Billed Charges,74% of total billed charges,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,604.8,84,,,Percent of Total Billed Charges,84% of total billed charges,590.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,247,400,,,fee schedule,400% of healthlink fee schedule,231.56,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,247,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,43.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.4,77,,,Percent of total Billed charges,77% of total billed charges,612,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.14,612,
L SPINE COMP INCL FLEX EX,T990400046,CDM,320,RC,72114,HCPCS,Outpatient,,,720,360,TC,554.4,77,,,Percent of Total Billed Charges,77% of total billed charges,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.8,74,,,Percent of Total Billed Charges,74% of total billed charges,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,496.8,69,,,Percent of Total Billed Charges,69% of total billed charges,604.8,84,,,Percent of Total Billed Charges,84% of total billed charges,590.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,247,400,,,fee schedule,400% of healthlink fee schedule,231.56,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,247,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,43.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.4,77,,,Percent of total Billed charges,77% of total billed charges,612,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,43.14,120,,,Fee Schedule,120% of MO Medicaid Rate,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,180,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.14,612,
RAD EXAM L-SPINE BEND 2/3 VIEW,T990400047,CDM,320,RC,72120,HCPCS,Outpatient,,,582.5,291.25,,448.53,77,,,Percent of Total Billed Charges,77% of total billed charges,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,431.05,74,,,Percent of Total Billed Charges,74% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,489.3,84,,,Percent of Total Billed Charges,84% of total billed charges,477.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.52,400,,,fee schedule,400% of healthlink fee schedule,157.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,168.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,27.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.53,77,,,Percent of total Billed charges,77% of total billed charges,495.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.85,495.13,
RAD EXAM L-SPINE BEND 2/3 VIEW,T990400047,CDM,320,RC,72120,HCPCS,Outpatient,,,582.5,291.25,TC,448.53,77,,,Percent of Total Billed Charges,77% of total billed charges,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,431.05,74,,,Percent of Total Billed Charges,74% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,401.93,69,,,Percent of Total Billed Charges,69% of total billed charges,489.3,84,,,Percent of Total Billed Charges,84% of total billed charges,477.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.52,400,,,fee schedule,400% of healthlink fee schedule,157.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,168.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,27.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,448.53,77,,,Percent of total Billed charges,77% of total billed charges,495.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,167.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.85,120,,,Fee Schedule,120% of MO Medicaid Rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,145.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.85,495.13,
PELVIS,T990400048,CDM,320,RC,72170,HCPCS,Outpatient,,,290.5,145.25,,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.04,400,,,fee schedule,400% of healthlink fee schedule,82.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,271,
PELVIS,T990400048,CDM,320,RC,72170,HCPCS,Outpatient,,,290.5,145.25,TC,223.69,77,,,Percent of Total Billed Charges,77% of total billed charges,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.97,74,,,Percent of Total Billed Charges,74% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,200.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.02,84,,,Percent of Total Billed Charges,84% of total billed charges,238.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.04,400,,,fee schedule,400% of healthlink fee schedule,82.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,17.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.69,77,,,Percent of total Billed charges,77% of total billed charges,246.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,17.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,72.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.6,271,
"PELVIS, 3 VIEW",T990400049,CDM,320,RC,72190,HCPCS,Outpatient,,,395.5,197.75,,304.54,77,,,Percent of Total Billed Charges,77% of total billed charges,100.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,292.67,74,,,Percent of Total Billed Charges,74% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,332.22,84,,,Percent of Total Billed Charges,84% of total billed charges,324.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.96,400,,,fee schedule,400% of healthlink fee schedule,128.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.54,77,,,Percent of total Billed charges,77% of total billed charges,336.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.34,336.18,
"PELVIS, 3 VIEW",T990400049,CDM,320,RC,72190,HCPCS,Outpatient,,,395.5,197.75,TC,304.54,77,,,Percent of Total Billed Charges,77% of total billed charges,100.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,292.67,74,,,Percent of Total Billed Charges,74% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,272.9,69,,,Percent of Total Billed Charges,69% of total billed charges,332.22,84,,,Percent of Total Billed Charges,84% of total billed charges,324.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.96,400,,,fee schedule,400% of healthlink fee schedule,128.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,136.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,27.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,304.54,77,,,Percent of total Billed charges,77% of total billed charges,336.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.34,120,,,Fee Schedule,120% of MO Medicaid Rate,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,98.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.34,336.18,
SI JOINTS,T990400050,CDM,320,RC,72202,HCPCS,Outpatient,,,370,185,,284.9,77,,,Percent of Total Billed Charges,77% of total billed charges,94.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.8,74,,,Percent of Total Billed Charges,74% of total billed charges,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,310.8,84,,,Percent of Total Billed Charges,84% of total billed charges,303.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.04,400,,,fee schedule,400% of healthlink fee schedule,113.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,121.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.9,77,,,Percent of total Billed charges,77% of total billed charges,314.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,314.5,
SI JOINTS,T990400050,CDM,320,RC,72202,HCPCS,Outpatient,,,370,185,TC,284.9,77,,,Percent of Total Billed Charges,77% of total billed charges,94.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.8,74,,,Percent of Total Billed Charges,74% of total billed charges,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,255.3,69,,,Percent of Total Billed Charges,69% of total billed charges,310.8,84,,,Percent of Total Billed Charges,84% of total billed charges,303.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.04,400,,,fee schedule,400% of healthlink fee schedule,113.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,121.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.9,77,,,Percent of total Billed charges,77% of total billed charges,314.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,92.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,314.5,
SACRUM-COCCYX,T990400051,CDM,320,RC,72220,HCPCS,Outpatient,,,355.5,177.75,,273.74,77,,,Percent of Total Billed Charges,77% of total billed charges,90.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.07,74,,,Percent of Total Billed Charges,74% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,298.62,84,,,Percent of Total Billed Charges,84% of total billed charges,291.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.2,400,,,fee schedule,400% of healthlink fee schedule,93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,99.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.74,77,,,Percent of total Billed charges,77% of total billed charges,302.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,302.18,
SACRUM-COCCYX,T990400051,CDM,320,RC,72220,HCPCS,Outpatient,,,355.5,177.75,TC,273.74,77,,,Percent of Total Billed Charges,77% of total billed charges,90.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.07,74,,,Percent of Total Billed Charges,74% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,245.3,69,,,Percent of Total Billed Charges,69% of total billed charges,298.62,84,,,Percent of Total Billed Charges,84% of total billed charges,291.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.2,400,,,fee schedule,400% of healthlink fee schedule,93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,99.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,273.74,77,,,Percent of total Billed charges,77% of total billed charges,302.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,88.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,302.18,
MYELOGRAM CERVICAL,T990400052,CDM,320,RC,72240,HCPCS,Outpatient,,,978.5,489.25,,753.45,77,,,Percent of Total Billed Charges,77% of total billed charges,249.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,724.09,74,,,Percent of Total Billed Charges,74% of total billed charges,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,821.94,84,,,Percent of Total Billed Charges,84% of total billed charges,802.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,477.36,400,,,fee schedule,400% of healthlink fee schedule,447.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,477.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,103.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,753.45,77,,,Percent of total Billed charges,77% of total billed charges,831.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.58,831.73,
MYELOGRAM CERVICAL,T990400052,CDM,320,RC,72240,HCPCS,Outpatient,,,978.5,489.25,TC,753.45,77,,,Percent of Total Billed Charges,77% of total billed charges,249.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,724.09,74,,,Percent of Total Billed Charges,74% of total billed charges,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,675.17,69,,,Percent of Total Billed Charges,69% of total billed charges,821.94,84,,,Percent of Total Billed Charges,84% of total billed charges,802.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,477.36,400,,,fee schedule,400% of healthlink fee schedule,447.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,477.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,103.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,753.45,77,,,Percent of total Billed charges,77% of total billed charges,831.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,103.58,120,,,Fee Schedule,120% of MO Medicaid Rate,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,244.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.58,831.73,
MYELOGRAM THORACIC,T990400053,CDM,320,RC,72255,HCPCS,Outpatient,,,918,459,,706.86,77,,,Percent of Total Billed Charges,77% of total billed charges,234.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,286.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,679.32,74,,,Percent of Total Billed Charges,74% of total billed charges,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,771.12,84,,,Percent of Total Billed Charges,84% of total billed charges,752.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,435.16,400,,,fee schedule,400% of healthlink fee schedule,407.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,435.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,94.06,120,,,Fee Schedule,120% of MO Medicaid Rate,94.06,120,,,Fee Schedule,120% of MO Medicaid Rate,94.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,706.86,77,,,Percent of total Billed charges,77% of total billed charges,780.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,263.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,94.06,120,,,Fee Schedule,120% of MO Medicaid Rate,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.06,780.3,
MYELOGRAM THORACIC,T990400053,CDM,320,RC,72255,HCPCS,Outpatient,,,918,459,TC,706.86,77,,,Percent of Total Billed Charges,77% of total billed charges,234.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,286.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,679.32,74,,,Percent of Total Billed Charges,74% of total billed charges,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,633.42,69,,,Percent of Total Billed Charges,69% of total billed charges,771.12,84,,,Percent of Total Billed Charges,84% of total billed charges,752.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,435.16,400,,,fee schedule,400% of healthlink fee schedule,407.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,435.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,94.06,120,,,Fee Schedule,120% of MO Medicaid Rate,94.06,120,,,Fee Schedule,120% of MO Medicaid Rate,94.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,706.86,77,,,Percent of total Billed charges,77% of total billed charges,780.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,263.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,94.06,120,,,Fee Schedule,120% of MO Medicaid Rate,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,229.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.06,780.3,
MYELOGRAM LUMBAR,T990400054,CDM,320,RC,72265,HCPCS,Outpatient,,,1270.5,635.25,,978.29,77,,,Percent of Total Billed Charges,77% of total billed charges,323.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.17,74,,,Percent of Total Billed Charges,74% of total billed charges,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1067.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1041.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,456.76,400,,,fee schedule,400% of healthlink fee schedule,428.21,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,456.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,91.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.29,77,,,Percent of total Billed charges,77% of total billed charges,1079.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.42,1079.93,
MYELOGRAM LUMBAR,T990400054,CDM,320,RC,72265,HCPCS,Outpatient,,,1270.5,635.25,TC,978.29,77,,,Percent of Total Billed Charges,77% of total billed charges,323.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.17,74,,,Percent of Total Billed Charges,74% of total billed charges,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,876.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1067.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1041.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,456.76,400,,,fee schedule,400% of healthlink fee schedule,428.21,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,456.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,91.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.29,77,,,Percent of total Billed charges,77% of total billed charges,1079.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,91.42,120,,,Fee Schedule,120% of MO Medicaid Rate,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,317.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.42,1079.93,
CLAVICLE,T990400055,CDM,320,RC,73000,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,272.85,
CLAVICLE,T990400055,CDM,320,RC,73000,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,272.85,
SCAPULA LT,T990400056,CDM,320,RC,73010,HCPCS,Outpatient,,,321,160.5,LT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.52,400,,,fee schedule,400% of healthlink fee schedule,91.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.8,272.85,
SCAPULA LT,T990400056,CDM,320,RC,73010,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.52,400,,,fee schedule,400% of healthlink fee schedule,91.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.8,272.85,
SCAPULA RT,T990400057,CDM,320,RC,73010,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.52,400,,,fee schedule,400% of healthlink fee schedule,91.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.8,272.85,
SCAPULA RT,T990400057,CDM,320,RC,73010,HCPCS,Outpatient,,,321,160.5,RT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.52,400,,,fee schedule,400% of healthlink fee schedule,91.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,14.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,14.8,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.8,272.85,
SHOULDER LT,T990400058,CDM,320,RC,73030,HCPCS,Outpatient,,,347,173.5,LT,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.64,400,,,fee schedule,400% of healthlink fee schedule,94.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,100.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,294.95,
SHOULDER LT,T990400058,CDM,320,RC,73030,HCPCS,Outpatient,,,347,173.5,TC,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.64,400,,,fee schedule,400% of healthlink fee schedule,94.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,100.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,294.95,
SHOULDER RT,T990400059,CDM,320,RC,73030,HCPCS,Outpatient,,,347,173.5,RT,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.64,400,,,fee schedule,400% of healthlink fee schedule,94.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,100.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,294.95,
SHOULDER RT,T990400059,CDM,320,RC,73030,HCPCS,Outpatient,,,347,173.5,TC,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.64,400,,,fee schedule,400% of healthlink fee schedule,94.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,100.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,294.95,
BILAT AC JTS WWO WGT,T990400060,CDM,320,RC,73050,HCPCS,Outpatient,,,682.5,341.25,,525.53,77,,,Percent of Total Billed Charges,77% of total billed charges,174.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,505.05,74,,,Percent of Total Billed Charges,74% of total billed charges,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,573.3,84,,,Percent of Total Billed Charges,84% of total billed charges,559.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.48,400,,,fee schedule,400% of healthlink fee schedule,114.83,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,122.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,525.53,77,,,Percent of total Billed charges,77% of total billed charges,580.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,580.13,
BILAT AC JTS WWO WGT,T990400060,CDM,320,RC,73050,HCPCS,Outpatient,,,682.5,341.25,TC,525.53,77,,,Percent of Total Billed Charges,77% of total billed charges,174.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,505.05,74,,,Percent of Total Billed Charges,74% of total billed charges,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,470.93,69,,,Percent of Total Billed Charges,69% of total billed charges,573.3,84,,,Percent of Total Billed Charges,84% of total billed charges,559.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.48,400,,,fee schedule,400% of healthlink fee schedule,114.83,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,122.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,19.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,525.53,77,,,Percent of total Billed charges,77% of total billed charges,580.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,196.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.5,120,,,Fee Schedule,120% of MO Medicaid Rate,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,170.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.5,580.13,
HUMERUS LT,T990400061,CDM,320,RC,73060,HCPCS,Outpatient,,,322.5,161.25,TC,248.33,77,,,Percent of Total Billed Charges,77% of total billed charges,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,238.65,74,,,Percent of Total Billed Charges,74% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,270.9,84,,,Percent of Total Billed Charges,84% of total billed charges,264.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.04,400,,,fee schedule,400% of healthlink fee schedule,91.91,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,98.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.33,77,,,Percent of total Billed charges,77% of total billed charges,274.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,274.13,
HUMERUS LT,T990400061,CDM,320,RC,73060,HCPCS,Outpatient,,,322.5,161.25,LT,248.33,77,,,Percent of Total Billed Charges,77% of total billed charges,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,238.65,74,,,Percent of Total Billed Charges,74% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,270.9,84,,,Percent of Total Billed Charges,84% of total billed charges,264.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.04,400,,,fee schedule,400% of healthlink fee schedule,91.91,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,98.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.33,77,,,Percent of total Billed charges,77% of total billed charges,274.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,274.13,
HUMERUS RT,T990400062,CDM,320,RC,73060,HCPCS,Outpatient,,,322.5,161.25,RT,248.33,77,,,Percent of Total Billed Charges,77% of total billed charges,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,238.65,74,,,Percent of Total Billed Charges,74% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,270.9,84,,,Percent of Total Billed Charges,84% of total billed charges,264.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.04,400,,,fee schedule,400% of healthlink fee schedule,91.91,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,98.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.33,77,,,Percent of total Billed charges,77% of total billed charges,274.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,274.13,
HUMERUS RT,T990400062,CDM,320,RC,73060,HCPCS,Outpatient,,,322.5,161.25,TC,248.33,77,,,Percent of Total Billed Charges,77% of total billed charges,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,238.65,74,,,Percent of Total Billed Charges,74% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,222.53,69,,,Percent of Total Billed Charges,69% of total billed charges,270.9,84,,,Percent of Total Billed Charges,84% of total billed charges,264.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.04,400,,,fee schedule,400% of healthlink fee schedule,91.91,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,98.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.33,77,,,Percent of total Billed charges,77% of total billed charges,274.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,274.13,
ELBOW LT 2 VIEW,T990400063,CDM,320,RC,73070,HCPCS,Outpatient,,,218,109,LT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.08,400,,,fee schedule,400% of healthlink fee schedule,85.39,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
ELBOW LT 2 VIEW,T990400063,CDM,320,RC,73070,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.08,400,,,fee schedule,400% of healthlink fee schedule,85.39,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
ELBOW RT 2 VIEW,T990400064,CDM,320,RC,73070,HCPCS,Outpatient,,,218,109,RT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.08,400,,,fee schedule,400% of healthlink fee schedule,85.39,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
ELBOW RT 2 VIEW,T990400064,CDM,320,RC,73070,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.08,400,,,fee schedule,400% of healthlink fee schedule,85.39,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
ELBOW LT 3 VIEW,T990400065,CDM,320,RC,73080,HCPCS,Outpatient,,,321,160.5,LT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.52,400,,,fee schedule,400% of healthlink fee schedule,112.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,120.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,272.85,
ELBOW LT 3 VIEW,T990400065,CDM,320,RC,73080,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.52,400,,,fee schedule,400% of healthlink fee schedule,112.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,120.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,272.85,
ELBOW RT 3 VIEW,T990400066,CDM,320,RC,73080,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.52,400,,,fee schedule,400% of healthlink fee schedule,112.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,120.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,272.85,
ELBOW RT 3 VIEW,T990400066,CDM,320,RC,73080,HCPCS,Outpatient,,,321,160.5,RT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.52,400,,,fee schedule,400% of healthlink fee schedule,112.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,120.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,21.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.86,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.86,272.85,
"ARTHROGRAM, ELBOW",T990400067,CDM,322,RC,73085,HCPCS,Outpatient,,,748,374,,575.96,77,,,Percent of Total Billed Charges,77% of total billed charges,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.52,74,,,Percent of Total Billed Charges,74% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,628.32,84,,,Percent of Total Billed Charges,84% of total billed charges,613.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,318.32,400,,,fee schedule,400% of healthlink fee schedule,298.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,318.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,78.71,120,,,Fee Schedule,120% of MO Medicaid Rate,78.71,120,,,Fee Schedule,120% of MO Medicaid Rate,78.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.96,77,,,Percent of total Billed charges,77% of total billed charges,635.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,78.71,120,,,Fee Schedule,120% of MO Medicaid Rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.71,635.8,
FOREARM LT,T990400068,CDM,320,RC,73090,HCPCS,Outpatient,,,308,154,LT,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.92,74,,,Percent of Total Billed Charges,74% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,258.72,84,,,Percent of Total Billed Charges,84% of total billed charges,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.43,271,
FOREARM LT,T990400068,CDM,320,RC,73090,HCPCS,Outpatient,,,308,154,TC,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.92,74,,,Percent of Total Billed Charges,74% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,258.72,84,,,Percent of Total Billed Charges,84% of total billed charges,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.43,271,
FOREARM RT,T990400069,CDM,320,RC,73090,HCPCS,Outpatient,,,308,154,RT,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.92,74,,,Percent of Total Billed Charges,74% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,258.72,84,,,Percent of Total Billed Charges,84% of total billed charges,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.43,271,
FOREARM RT,T990400069,CDM,320,RC,73090,HCPCS,Outpatient,,,308,154,TC,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.92,74,,,Percent of Total Billed Charges,74% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,258.72,84,,,Percent of Total Billed Charges,84% of total billed charges,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.43,271,
WRIST LT 2 VIEW,T990400070,CDM,320,RC,73100,HCPCS,Outpatient,,,218,109,LT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.24,400,,,fee schedule,400% of healthlink fee schedule,91.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.39,271,
WRIST LT 2 VIEW,T990400070,CDM,320,RC,73100,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.24,400,,,fee schedule,400% of healthlink fee schedule,91.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.39,271,
WRIST RT 2 VIEW,T990400071,CDM,320,RC,73100,HCPCS,Outpatient,,,218,109,RT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.24,400,,,fee schedule,400% of healthlink fee schedule,91.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.39,271,
WRIST RT 2 VIEW,T990400071,CDM,320,RC,73100,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.24,400,,,fee schedule,400% of healthlink fee schedule,91.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,97.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.39,271,
WRIST LT 3 VIEW,T990400072,CDM,320,RC,73110,HCPCS,Outpatient,,,356,178,LT,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.44,74,,,Percent of Total Billed Charges,74% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,299.04,84,,,Percent of Total Billed Charges,84% of total billed charges,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.84,400,,,fee schedule,400% of healthlink fee schedule,111.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.46,302.6,
WRIST LT 3 VIEW,T990400072,CDM,320,RC,73110,HCPCS,Outpatient,,,356,178,TC,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.44,74,,,Percent of Total Billed Charges,74% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,299.04,84,,,Percent of Total Billed Charges,84% of total billed charges,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.84,400,,,fee schedule,400% of healthlink fee schedule,111.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.46,302.6,
WRIST RT 3 VIEW,T990400073,CDM,320,RC,73110,HCPCS,Outpatient,,,356,178,TC,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.44,74,,,Percent of Total Billed Charges,74% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,299.04,84,,,Percent of Total Billed Charges,84% of total billed charges,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.84,400,,,fee schedule,400% of healthlink fee schedule,111.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.46,302.6,
WRIST RT 3 VIEW,T990400073,CDM,320,RC,73110,HCPCS,Outpatient,,,356,178,RT,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,263.44,74,,,Percent of Total Billed Charges,74% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,245.64,69,,,Percent of Total Billed Charges,69% of total billed charges,299.04,84,,,Percent of Total Billed Charges,84% of total billed charges,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.84,400,,,fee schedule,400% of healthlink fee schedule,111.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,29.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.46,120,,,Fee Schedule,120% of MO Medicaid Rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.46,302.6,
HAND LT 2 VIEW,T990400076,CDM,320,RC,73120,HCPCS,Outpatient,,,218,109,LT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,271,
HAND LT 2 VIEW,T990400076,CDM,320,RC,73120,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,271,
HAND RT 2 VIEW,T990400077,CDM,320,RC,73120,HCPCS,Outpatient,,,218,109,RT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,271,
HAND RT 2 VIEW,T990400077,CDM,320,RC,73120,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,20.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.95,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.95,271,
HAND LT 3 VIEW,T990400078,CDM,320,RC,73130,HCPCS,Outpatient,,,321,160.5,LT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.8,400,,,fee schedule,400% of healthlink fee schedule,99.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,105.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.51,272.85,
HAND LT 3 VIEW,T990400078,CDM,320,RC,73130,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.8,400,,,fee schedule,400% of healthlink fee schedule,99.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,105.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.51,272.85,
HAND RT 3 VIEW,T990400079,CDM,320,RC,73130,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.8,400,,,fee schedule,400% of healthlink fee schedule,99.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,105.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.51,272.85,
HAND RT 3 VIEW,T990400079,CDM,320,RC,73130,HCPCS,Outpatient,,,321,160.5,RT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.8,400,,,fee schedule,400% of healthlink fee schedule,99.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,105.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,25.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.51,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.51,272.85,
FINGERS 2 VIEW,T990400080,CDM,320,RC,73140,HCPCS,Outpatient,,,264,132,TC,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.4,400,,,fee schedule,400% of healthlink fee schedule,96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,102.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,27.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.94,271,
FINGERS 2 VIEW,T990400080,CDM,320,RC,73140,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.4,400,,,fee schedule,400% of healthlink fee schedule,96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,102.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,27.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.94,120,,,Fee Schedule,120% of MO Medicaid Rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.94,271,
"HIP W/PELVIS, LT",T990400081,CDM,320,RC,73501,HCPCS,Outpatient,,,401,200.5,LT,308.77,77,,,Percent of Total Billed Charges,77% of total billed charges,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296.74,74,,,Percent of Total Billed Charges,74% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,336.84,84,,,Percent of Total Billed Charges,84% of total billed charges,328.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.89,89,,,Percent of total Billed Charges,89% of total Billed charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.77,77,,,Percent of total Billed charges,77% of total billed charges,340.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,356.89,
"HIP W/PELVIS, LT",T990400081,CDM,320,RC,73501,HCPCS,Outpatient,,,401,200.5,TC,308.77,77,,,Percent of Total Billed Charges,77% of total billed charges,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296.74,74,,,Percent of Total Billed Charges,74% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,336.84,84,,,Percent of Total Billed Charges,84% of total billed charges,328.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.89,89,,,Percent of total Billed Charges,89% of total Billed charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.77,77,,,Percent of total Billed charges,77% of total billed charges,340.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,356.89,
"HIP W/PELVIS, RT",T990400082,CDM,320,RC,73501,HCPCS,Outpatient,,,401,200.5,TC,308.77,77,,,Percent of Total Billed Charges,77% of total billed charges,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296.74,74,,,Percent of Total Billed Charges,74% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,336.84,84,,,Percent of Total Billed Charges,84% of total billed charges,328.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.89,89,,,Percent of total Billed Charges,89% of total Billed charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.77,77,,,Percent of total Billed charges,77% of total billed charges,340.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,356.89,
"HIP W/PELVIS, RT",T990400082,CDM,320,RC,73501,HCPCS,Outpatient,,,401,200.5,RT,308.77,77,,,Percent of Total Billed Charges,77% of total billed charges,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296.74,74,,,Percent of Total Billed Charges,74% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,276.69,69,,,Percent of Total Billed Charges,69% of total billed charges,336.84,84,,,Percent of Total Billed Charges,84% of total billed charges,328.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,356.89,89,,,Percent of total Billed Charges,89% of total Billed charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,21.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.77,77,,,Percent of total Billed charges,77% of total billed charges,340.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.25,120,,,Fee Schedule,120% of MO Medicaid Rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,100.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.25,356.89,
HIP LT,T990400083,CDM,320,RC,73502,HCPCS,Outpatient,,,344,172,TC,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.56,74,,,Percent of Total Billed Charges,74% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,288.96,84,,,Percent of Total Billed Charges,84% of total billed charges,282.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.81,306.16,
HIP LT,T990400083,CDM,320,RC,73502,HCPCS,Outpatient,,,344,172,LT,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.56,74,,,Percent of Total Billed Charges,74% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,288.96,84,,,Percent of Total Billed Charges,84% of total billed charges,282.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.81,306.16,
HIP RT,T990400084,CDM,320,RC,73502,HCPCS,Outpatient,,,344,172,RT,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.56,74,,,Percent of Total Billed Charges,74% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,288.96,84,,,Percent of Total Billed Charges,84% of total billed charges,282.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.81,306.16,
HIP RT,T990400084,CDM,320,RC,73502,HCPCS,Outpatient,,,344,172,TC,264.88,77,,,Percent of Total Billed Charges,77% of total billed charges,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.56,74,,,Percent of Total Billed Charges,74% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,237.36,69,,,Percent of Total Billed Charges,69% of total billed charges,288.96,84,,,Percent of Total Billed Charges,84% of total billed charges,282.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.16,89,,,Percent of total Billed Charges,89% of total Billed charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,32.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.88,77,,,Percent of total Billed charges,77% of total billed charges,292.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.81,120,,,Fee Schedule,120% of MO Medicaid Rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.81,306.16,
Bilateral hips/pelvis 5 views,T990400086,CDM,320,RC,73523,HCPCS,Outpatient,,,557,278.5,,428.89,77,,,Percent of Total Billed Charges,77% of total billed charges,142.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,412.18,74,,,Percent of Total Billed Charges,74% of total billed charges,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,467.88,84,,,Percent of Total Billed Charges,84% of total billed charges,456.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.73,89,,,Percent of total Billed Charges,89% of total Billed charges,495.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.89,77,,,Percent of total Billed charges,77% of total billed charges,473.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.23,495.73,
Bilateral hips/pelvis 5 views,T990400086,CDM,320,RC,73523,HCPCS,Outpatient,,,557,278.5,TC,428.89,77,,,Percent of Total Billed Charges,77% of total billed charges,142.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,412.18,74,,,Percent of Total Billed Charges,74% of total billed charges,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,384.33,69,,,Percent of Total Billed Charges,69% of total billed charges,467.88,84,,,Percent of Total Billed Charges,84% of total billed charges,456.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.73,89,,,Percent of total Billed Charges,89% of total Billed charges,495.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,42.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.89,77,,,Percent of total Billed charges,77% of total billed charges,473.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,42.23,120,,,Fee Schedule,120% of MO Medicaid Rate,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,139.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.23,495.73,
"ARTHROGRAM, HIP",T990400087,CDM,322,RC,73525,HCPCS,Outpatient,,,748,374,,575.96,77,,,Percent of Total Billed Charges,77% of total billed charges,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.52,74,,,Percent of Total Billed Charges,74% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,516.12,69,,,Percent of Total Billed Charges,69% of total billed charges,628.32,84,,,Percent of Total Billed Charges,84% of total billed charges,613.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,317.4,400,,,fee schedule,400% of healthlink fee schedule,297.56,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,317.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.96,77,,,Percent of total Billed charges,77% of total billed charges,635.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,187,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.55,635.8,
"FEMUR, 1 VIEW",T990400088,CDM,320,RC,73551,HCPCS,Outpatient,,,153,76.5,,117.81,77,,,Percent of Total Billed Charges,77% of total billed charges,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.22,74,,,Percent of Total Billed Charges,74% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,128.52,84,,,Percent of Total Billed Charges,84% of total billed charges,125.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.17,89,,,Percent of total Billed Charges,89% of total Billed charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.81,77,,,Percent of total Billed charges,77% of total billed charges,130.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
"FEMUR, 1 VIEW",T990400088,CDM,320,RC,73551,HCPCS,Outpatient,,,153,76.5,TC,117.81,77,,,Percent of Total Billed Charges,77% of total billed charges,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.22,74,,,Percent of Total Billed Charges,74% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,105.57,69,,,Percent of Total Billed Charges,69% of total billed charges,128.52,84,,,Percent of Total Billed Charges,84% of total billed charges,125.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.17,89,,,Percent of total Billed Charges,89% of total Billed charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.81,77,,,Percent of total Billed charges,77% of total billed charges,130.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,38.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
FEMUR LT,T990400089,CDM,320,RC,73552,HCPCS,Outpatient,,,318,159,LT,244.86,77,,,Percent of Total Billed Charges,77% of total billed charges,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.32,74,,,Percent of Total Billed Charges,74% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,267.12,84,,,Percent of Total Billed Charges,84% of total billed charges,260.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,283.02,89,,,Percent of total Billed Charges,89% of total Billed charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.86,77,,,Percent of total Billed charges,77% of total billed charges,270.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,283.02,
FEMUR LT,T990400089,CDM,320,RC,73552,HCPCS,Outpatient,,,318,159,TC,244.86,77,,,Percent of Total Billed Charges,77% of total billed charges,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.32,74,,,Percent of Total Billed Charges,74% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,267.12,84,,,Percent of Total Billed Charges,84% of total billed charges,260.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,283.02,89,,,Percent of total Billed Charges,89% of total Billed charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.86,77,,,Percent of total Billed charges,77% of total billed charges,270.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,283.02,
FEMUR RT,T990400090,CDM,320,RC,73552,HCPCS,Outpatient,,,318,159,RT,244.86,77,,,Percent of Total Billed Charges,77% of total billed charges,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.32,74,,,Percent of Total Billed Charges,74% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,267.12,84,,,Percent of Total Billed Charges,84% of total billed charges,260.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,283.02,89,,,Percent of total Billed Charges,89% of total Billed charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.86,77,,,Percent of total Billed charges,77% of total billed charges,270.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,283.02,
FEMUR RT,T990400090,CDM,320,RC,73552,HCPCS,Outpatient,,,318,159,TC,244.86,77,,,Percent of Total Billed Charges,77% of total billed charges,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.32,74,,,Percent of Total Billed Charges,74% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,219.42,69,,,Percent of Total Billed Charges,69% of total billed charges,267.12,84,,,Percent of Total Billed Charges,84% of total billed charges,260.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,283.02,89,,,Percent of total Billed Charges,89% of total Billed charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.86,77,,,Percent of total Billed charges,77% of total billed charges,270.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,79.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,283.02,
KNEE 1 OR 2 VIEWS-LEFT,T990400091,CDM,320,RC,73560,HCPCS,Outpatient,,,303,151.5,LT,233.31,77,,,Percent of Total Billed Charges,77% of total billed charges,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.22,74,,,Percent of Total Billed Charges,74% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,254.52,84,,,Percent of Total Billed Charges,84% of total billed charges,248.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.32,400,,,fee schedule,400% of healthlink fee schedule,90.3,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.31,77,,,Percent of total Billed charges,77% of total billed charges,257.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.68,271,
KNEE 1 OR 2 VIEWS-LEFT,T990400091,CDM,320,RC,73560,HCPCS,Outpatient,,,303,151.5,LT,233.31,77,,,Percent of Total Billed Charges,77% of total billed charges,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.22,74,,,Percent of Total Billed Charges,74% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,254.52,84,,,Percent of Total Billed Charges,84% of total billed charges,248.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.32,400,,,fee schedule,400% of healthlink fee schedule,90.3,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.31,77,,,Percent of total Billed charges,77% of total billed charges,257.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.68,271,
KNEE 1 OR 2 VIEWS-RIGHT,T990400092,CDM,320,RC,73560,HCPCS,Outpatient,,,303,151.5,RT,233.31,77,,,Percent of Total Billed Charges,77% of total billed charges,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.22,74,,,Percent of Total Billed Charges,74% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,254.52,84,,,Percent of Total Billed Charges,84% of total billed charges,248.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.32,400,,,fee schedule,400% of healthlink fee schedule,90.3,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.31,77,,,Percent of total Billed charges,77% of total billed charges,257.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.68,271,
KNEE 1 OR 2 VIEWS-RIGHT,T990400092,CDM,320,RC,73560,HCPCS,Outpatient,,,303,151.5,RT,233.31,77,,,Percent of Total Billed Charges,77% of total billed charges,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.22,74,,,Percent of Total Billed Charges,74% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,209.07,69,,,Percent of Total Billed Charges,69% of total billed charges,254.52,84,,,Percent of Total Billed Charges,84% of total billed charges,248.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.32,400,,,fee schedule,400% of healthlink fee schedule,90.3,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.31,77,,,Percent of total Billed charges,77% of total billed charges,257.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,75.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.68,271,
BILATERAL ORTHO KNEE,T990400093,CDM,320,RC,73562,HCPCS,Outpatient,,,713,356.5,50,549.01,77,,,Percent of Total Billed Charges,77% of total billed charges,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,527.62,74,,,Percent of Total Billed Charges,74% of total billed charges,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,598.92,84,,,Percent of Total Billed Charges,84% of total billed charges,584.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.01,77,,,Percent of total Billed charges,77% of total billed charges,606.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,606.05,
BILATERAL ORTHO KNEE,T990400093,CDM,320,RC,73562,HCPCS,Outpatient,,,713,356.5,50,549.01,77,,,Percent of Total Billed Charges,77% of total billed charges,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,527.62,74,,,Percent of Total Billed Charges,74% of total billed charges,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,491.97,69,,,Percent of Total Billed Charges,69% of total billed charges,598.92,84,,,Percent of Total Billed Charges,84% of total billed charges,584.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.01,77,,,Percent of total Billed charges,77% of total billed charges,606.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,178.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,606.05,
"LT KNEE X-RAY, 3 VIEWS",T990400094,CDM,320,RC,73562,HCPCS,Outpatient,,,347,173.5,LT,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,294.95,
"LT KNEE X-RAY, 3 VIEWS",T990400094,CDM,320,RC,73562,HCPCS,Outpatient,,,347,173.5,TC,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,294.95,
"ortho LT, 3 VIEWS",T990400095,CDM,320,RC,73562,HCPCS,Outpatient,,,358,179,LT,275.66,77,,,Percent of Total Billed Charges,77% of total billed charges,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.92,74,,,Percent of Total Billed Charges,74% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,300.72,84,,,Percent of Total Billed Charges,84% of total billed charges,293.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.66,77,,,Percent of total Billed charges,77% of total billed charges,304.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,304.3,
"ortho LT, 3 VIEWS",T990400095,CDM,320,RC,73562,HCPCS,Outpatient,,,358,179,TC,275.66,77,,,Percent of Total Billed Charges,77% of total billed charges,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.92,74,,,Percent of Total Billed Charges,74% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,300.72,84,,,Percent of Total Billed Charges,84% of total billed charges,293.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.66,77,,,Percent of total Billed charges,77% of total billed charges,304.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,304.3,
"ortho RT, 3 VIEWS",T990400096,CDM,320,RC,73562,HCPCS,Outpatient,,,358,179,TC,275.66,77,,,Percent of Total Billed Charges,77% of total billed charges,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.92,74,,,Percent of Total Billed Charges,74% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,300.72,84,,,Percent of Total Billed Charges,84% of total billed charges,293.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.66,77,,,Percent of total Billed charges,77% of total billed charges,304.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,304.3,
"ortho RT, 3 VIEWS",T990400096,CDM,320,RC,73562,HCPCS,Outpatient,,,358,179,RT,275.66,77,,,Percent of Total Billed Charges,77% of total billed charges,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,264.92,74,,,Percent of Total Billed Charges,74% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,247.02,69,,,Percent of Total Billed Charges,69% of total billed charges,300.72,84,,,Percent of Total Billed Charges,84% of total billed charges,293.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,275.66,77,,,Percent of total Billed charges,77% of total billed charges,304.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,89.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,304.3,
"RT KNEE X-RAY, 3 VIEW",T990400097,CDM,320,RC,73562,HCPCS,Outpatient,,,347,173.5,RT,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,294.95,
"RT KNEE X-RAY, 3 VIEW",T990400097,CDM,320,RC,73562,HCPCS,Outpatient,,,347,173.5,TC,267.19,77,,,Percent of Total Billed Charges,77% of total billed charges,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.78,74,,,Percent of Total Billed Charges,74% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,239.43,69,,,Percent of Total Billed Charges,69% of total billed charges,291.48,84,,,Percent of Total Billed Charges,84% of total billed charges,284.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.4,400,,,fee schedule,400% of healthlink fee schedule,111,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,118.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,28.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.19,77,,,Percent of total Billed charges,77% of total billed charges,294.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,28.86,120,,,Fee Schedule,120% of MO Medicaid Rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,86.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.86,294.95,
KNEE 4 VIEWS LT W/ OR W/O OBLS,T990400099,CDM,320,RC,73564,HCPCS,Outpatient,,,431,215.5,LT,331.87,77,,,Percent of Total Billed Charges,77% of total billed charges,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.94,74,,,Percent of Total Billed Charges,74% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,362.04,84,,,Percent of Total Billed Charges,84% of total billed charges,353.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.6,400,,,fee schedule,400% of healthlink fee schedule,130.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,139.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.87,77,,,Percent of total Billed charges,77% of total billed charges,366.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,366.35,
KNEE 4 VIEWS LT W/ OR W/O OBLS,T990400099,CDM,320,RC,73564,HCPCS,Outpatient,,,431,215.5,TC,331.87,77,,,Percent of Total Billed Charges,77% of total billed charges,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.94,74,,,Percent of Total Billed Charges,74% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,362.04,84,,,Percent of Total Billed Charges,84% of total billed charges,353.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.6,400,,,fee schedule,400% of healthlink fee schedule,130.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,139.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.87,77,,,Percent of total Billed charges,77% of total billed charges,366.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,366.35,
KNEE 4 VIEWS RT W/ OR W/O OBLS,T990400100,CDM,320,RC,73564,HCPCS,Outpatient,,,431,215.5,RT,331.87,77,,,Percent of Total Billed Charges,77% of total billed charges,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.94,74,,,Percent of Total Billed Charges,74% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,362.04,84,,,Percent of Total Billed Charges,84% of total billed charges,353.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.6,400,,,fee schedule,400% of healthlink fee schedule,130.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,139.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.87,77,,,Percent of total Billed charges,77% of total billed charges,366.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,366.35,
KNEE 4 VIEWS RT W/ OR W/O OBLS,T990400100,CDM,320,RC,73564,HCPCS,Outpatient,,,431,215.5,TC,331.87,77,,,Percent of Total Billed Charges,77% of total billed charges,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,318.94,74,,,Percent of Total Billed Charges,74% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,297.39,69,,,Percent of Total Billed Charges,69% of total billed charges,362.04,84,,,Percent of Total Billed Charges,84% of total billed charges,353.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.6,400,,,fee schedule,400% of healthlink fee schedule,130.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,139.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,331.87,77,,,Percent of total Billed charges,77% of total billed charges,366.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,107.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,366.35,
"KNEE, BILAT 4 OR MORE VIEWS",T990400101,CDM,320,RC,73564,HCPCS,Outpatient,,,939.5,469.75,50,723.42,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.23,74,,,Percent of Total Billed Charges,74% of total billed charges,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,789.18,84,,,Percent of Total Billed Charges,84% of total billed charges,770.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.6,400,,,fee schedule,400% of healthlink fee schedule,130.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,139.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.42,77,,,Percent of total Billed charges,77% of total billed charges,798.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,798.58,
"KNEE, BILAT 4 OR MORE VIEWS",T990400101,CDM,320,RC,73564,HCPCS,Outpatient,,,939.5,469.75,50,723.42,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.23,74,,,Percent of Total Billed Charges,74% of total billed charges,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,648.26,69,,,Percent of Total Billed Charges,69% of total billed charges,789.18,84,,,Percent of Total Billed Charges,84% of total billed charges,770.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.6,400,,,fee schedule,400% of healthlink fee schedule,130.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,139.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,32.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.42,77,,,Percent of total Billed charges,77% of total billed charges,798.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.2,120,,,Fee Schedule,120% of MO Medicaid Rate,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,234.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,798.58,
KNEE XRAY BOTH KNEES STAND-ANT,T990400104,CDM,320,RC,73565,HCPCS,Outpatient,,,163.5,81.75,TC,125.9,77,,,Percent of Total Billed Charges,77% of total billed charges,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.99,74,,,Percent of Total Billed Charges,74% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,137.34,84,,,Percent of Total Billed Charges,84% of total billed charges,134.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.9,77,,,Percent of total Billed charges,77% of total billed charges,138.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,271,
KNEE XRAY BOTH KNEES STAND-ANT,T990400104,CDM,320,RC,73565,HCPCS,Outpatient,,,163.5,81.75,,125.9,77,,,Percent of Total Billed Charges,77% of total billed charges,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.99,74,,,Percent of Total Billed Charges,74% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,137.34,84,,,Percent of Total Billed Charges,84% of total billed charges,134.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.9,77,,,Percent of total Billed charges,77% of total billed charges,138.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,271,
ortho BOTH STAND ANT,T990400105,CDM,320,RC,73565,HCPCS,Outpatient,,,163.5,81.75,59,125.9,77,,,Percent of Total Billed Charges,77% of total billed charges,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.99,74,,,Percent of Total Billed Charges,74% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,137.34,84,,,Percent of Total Billed Charges,84% of total billed charges,134.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.9,77,,,Percent of total Billed charges,77% of total billed charges,138.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,271,
ortho BOTH STAND ANT,T990400105,CDM,320,RC,73565,HCPCS,Outpatient,,,163.5,81.75,59,125.9,77,,,Percent of Total Billed Charges,77% of total billed charges,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.99,74,,,Percent of Total Billed Charges,74% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,112.82,69,,,Percent of Total Billed Charges,69% of total billed charges,137.34,84,,,Percent of Total Billed Charges,84% of total billed charges,134.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.9,77,,,Percent of total Billed charges,77% of total billed charges,138.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,40.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,271,
TIB FIB LT,T990400106,CDM,320,RC,73590,HCPCS,Outpatient,,,315,157.5,LT,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.1,74,,,Percent of Total Billed Charges,74% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,264.6,84,,,Percent of Total Billed Charges,84% of total billed charges,258.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.6,400,,,fee schedule,400% of healthlink fee schedule,85.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.55,271,
TIB FIB LT,T990400106,CDM,320,RC,73590,HCPCS,Outpatient,,,315,157.5,TC,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.1,74,,,Percent of Total Billed Charges,74% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,264.6,84,,,Percent of Total Billed Charges,84% of total billed charges,258.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.6,400,,,fee schedule,400% of healthlink fee schedule,85.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.55,271,
TIB FIB RT,T990400107,CDM,320,RC,73590,HCPCS,Outpatient,,,315,157.5,TC,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.1,74,,,Percent of Total Billed Charges,74% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,264.6,84,,,Percent of Total Billed Charges,84% of total billed charges,258.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.6,400,,,fee schedule,400% of healthlink fee schedule,85.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.55,271,
TIB FIB RT,T990400107,CDM,320,RC,73590,HCPCS,Outpatient,,,315,157.5,RT,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.1,74,,,Percent of Total Billed Charges,74% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,217.35,69,,,Percent of Total Billed Charges,69% of total billed charges,264.6,84,,,Percent of Total Billed Charges,84% of total billed charges,258.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.6,400,,,fee schedule,400% of healthlink fee schedule,85.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.55,271,
ANKLE LT 2 VIEW,T990400108,CDM,320,RC,73600,HCPCS,Outpatient,,,218,109,LT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,271,
ANKLE LT 2 VIEW,T990400108,CDM,320,RC,73600,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,271,
ANKLE RT 2 VIEW,T990400109,CDM,320,RC,73600,HCPCS,Outpatient,,,218,109,RT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,271,
ANKLE RT 2 VIEW,T990400109,CDM,320,RC,73600,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.52,400,,,fee schedule,400% of healthlink fee schedule,86.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,92.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,22.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,22.16,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.16,271,
ANKLE LT 3 VIEWS,T990400110,CDM,320,RC,73610,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,107,400,,,fee schedule,400% of healthlink fee schedule,100.31,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,107,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,272.85,
ANKLE LT 3 VIEWS,T990400110,CDM,320,RC,73610,HCPCS,Outpatient,,,321,160.5,LT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,107,400,,,fee schedule,400% of healthlink fee schedule,100.31,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,107,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,272.85,
ANKLE RT 3 VIEWS,T990400111,CDM,320,RC,73610,HCPCS,Outpatient,,,321,160.5,RT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,107,400,,,fee schedule,400% of healthlink fee schedule,100.31,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,107,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,272.85,
ANKLE RT 3 VIEWS,T990400111,CDM,320,RC,73610,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,107,400,,,fee schedule,400% of healthlink fee schedule,100.31,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,107,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,25.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,25.81,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.81,272.85,
FOOT LT 2 VIEW,T990400112,CDM,320,RC,73620,HCPCS,Outpatient,,,218,109,LT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.96,400,,,fee schedule,400% of healthlink fee schedule,83.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.82,271,
FOOT LT 2 VIEW,T990400112,CDM,320,RC,73620,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.96,400,,,fee schedule,400% of healthlink fee schedule,83.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.82,271,
FOOT RT 2 VIEW,T990400113,CDM,320,RC,73620,HCPCS,Outpatient,,,218,109,TC,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.96,400,,,fee schedule,400% of healthlink fee schedule,83.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.82,271,
FOOT RT 2 VIEW,T990400113,CDM,320,RC,73620,HCPCS,Outpatient,,,218,109,RT,167.86,77,,,Percent of Total Billed Charges,77% of total billed charges,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.32,74,,,Percent of Total Billed Charges,74% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,150.42,69,,,Percent of Total Billed Charges,69% of total billed charges,183.12,84,,,Percent of Total Billed Charges,84% of total billed charges,178.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.96,400,,,fee schedule,400% of healthlink fee schedule,83.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,88.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,18.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.86,77,,,Percent of total Billed charges,77% of total billed charges,185.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,18.82,120,,,Fee Schedule,120% of MO Medicaid Rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,54.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.82,271,
FOOT LT 3 VIEW,T990400114,CDM,320,RC,73630,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,272.85,
FOOT LT 3 VIEW,T990400114,CDM,320,RC,73630,HCPCS,Outpatient,,,321,160.5,LT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,272.85,
FOOT RT 3 VIEW,T990400115,CDM,320,RC,73630,HCPCS,Outpatient,,,321,160.5,RT,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,272.85,
FOOT RT 3 VIEW,T990400115,CDM,320,RC,73630,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.64,400,,,fee schedule,400% of healthlink fee schedule,98.1,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,104.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,23.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.99,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.99,272.85,
CALCANEOUS,T990400116,CDM,320,RC,73650,HCPCS,Outpatient,,,311,155.5,TC,239.47,77,,,Percent of Total Billed Charges,77% of total billed charges,79.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.14,74,,,Percent of Total Billed Charges,74% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,261.24,84,,,Percent of Total Billed Charges,84% of total billed charges,255.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.32,400,,,fee schedule,400% of healthlink fee schedule,85.61,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.47,77,,,Percent of total Billed charges,77% of total billed charges,264.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
CALCANEOUS,T990400116,CDM,320,RC,73650,HCPCS,Outpatient,,,311,155.5,,239.47,77,,,Percent of Total Billed Charges,77% of total billed charges,79.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.14,74,,,Percent of Total Billed Charges,74% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,261.24,84,,,Percent of Total Billed Charges,84% of total billed charges,255.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,91.32,400,,,fee schedule,400% of healthlink fee schedule,85.61,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,91.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,19.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.47,77,,,Percent of total Billed charges,77% of total billed charges,264.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.13,120,,,Fee Schedule,120% of MO Medicaid Rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.13,271,
TOES 2 VIEW,T990400117,CDM,320,RC,73660,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.48,400,,,fee schedule,400% of healthlink fee schedule,90.45,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.65,272.85,
TOES 2 VIEW,T990400117,CDM,320,RC,73660,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.48,400,,,fee schedule,400% of healthlink fee schedule,90.45,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,96.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,20.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,20.65,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.65,272.85,
"ABDOMEN, 1 view",T990400118,CDM,320,RC,74018,HCPCS,Outpatient,,,299,149.5,,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.26,74,,,Percent of Total Billed Charges,74% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,84,,,Percent of Total Billed Charges,84% of total billed charges,245.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.43,271,
"ABDOMEN, 1 view",T990400118,CDM,320,RC,74018,HCPCS,Outpatient,,,299,149.5,TC,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.26,74,,,Percent of Total Billed Charges,74% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,84,,,Percent of Total Billed Charges,84% of total billed charges,245.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,19.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.43,120,,,Fee Schedule,120% of MO Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.43,271,
"ABDOMEN, 2 VIEW",T990400119,CDM,320,RC,74019,HCPCS,Outpatient,,,392,196,,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,290.08,74,,,Percent of Total Billed Charges,74% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,329.28,84,,,Percent of Total Billed Charges,84% of total billed charges,321.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,348.88,89,,,Percent of total Billed Charges,89% of total Billed charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.39,348.88,
"ABDOMEN, 2 VIEW",T990400119,CDM,320,RC,74019,HCPCS,Outpatient,,,392,196,TC,301.84,77,,,Percent of Total Billed Charges,77% of total billed charges,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,290.08,74,,,Percent of Total Billed Charges,74% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,270.48,69,,,Percent of Total Billed Charges,69% of total billed charges,329.28,84,,,Percent of Total Billed Charges,84% of total billed charges,321.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,348.88,89,,,Percent of total Billed Charges,89% of total Billed charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,23.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.84,77,,,Percent of total Billed charges,77% of total billed charges,333.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,112.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.39,120,,,Fee Schedule,120% of MO Medicaid Rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.39,348.88,
ABD-MOBILITY STUDY,T990400120,CDM,320,RC,74021,HCPCS,Outpatient,,,299,149.5,,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.26,74,,,Percent of Total Billed Charges,74% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,84,,,Percent of Total Billed Charges,84% of total billed charges,245.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,271,
ABD-MOBILITY STUDY,T990400120,CDM,320,RC,74021,HCPCS,Outpatient,,,299,149.5,TC,230.23,77,,,Percent of Total Billed Charges,77% of total billed charges,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.26,74,,,Percent of Total Billed Charges,74% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,206.31,69,,,Percent of Total Billed Charges,69% of total billed charges,251.16,84,,,Percent of Total Billed Charges,84% of total billed charges,245.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.11,89,,,Percent of total Billed Charges,89% of total Billed charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.23,77,,,Percent of total Billed charges,77% of total billed charges,254.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,74.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,271,
"ABDOMEN, UP TO 4 VIEW",T990400121,CDM,320,RC,74021,HCPCS,Outpatient,,,469,234.5,,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,347.06,74,,,Percent of Total Billed Charges,74% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,393.96,84,,,Percent of Total Billed Charges,84% of total billed charges,384.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,417.41,
"ABDOMEN, UP TO 4 VIEW",T990400121,CDM,320,RC,74021,HCPCS,Outpatient,,,469,234.5,TC,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,347.06,74,,,Percent of Total Billed Charges,74% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,393.96,84,,,Percent of Total Billed Charges,84% of total billed charges,384.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,27.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,27.64,120,,,Fee Schedule,120% of MO Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,417.41,
ABD OBSTRUCTION SER,T990400122,CDM,320,RC,74022,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,375.92,74,,,Percent of Total Billed Charges,74% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,426.72,84,,,Percent of Total Billed Charges,84% of total billed charges,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.84,400,,,fee schedule,400% of healthlink fee schedule,160.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,170.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.17,431.8,
ABD OBSTRUCTION SER,T990400122,CDM,320,RC,74022,HCPCS,Outpatient,,,508,254,TC,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,375.92,74,,,Percent of Total Billed Charges,74% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,350.52,69,,,Percent of Total Billed Charges,69% of total billed charges,426.72,84,,,Percent of Total Billed Charges,84% of total billed charges,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,170.84,400,,,fee schedule,400% of healthlink fee schedule,160.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,170.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,33.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,33.17,120,,,Fee Schedule,120% of MO Medicaid Rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.17,431.8,
BARIUM SWALLOW W/BARIUM,T990400123,CDM,320,RC,74220,HCPCS,Outpatient,,,604.5,302.25,,465.47,77,,,Percent of Total Billed Charges,77% of total billed charges,154.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,447.33,74,,,Percent of Total Billed Charges,74% of total billed charges,417.11,69,,,Percent of Total Billed Charges,69% of total billed charges,417.11,69,,,Percent of Total Billed Charges,69% of total billed charges,151.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,417.11,69,,,Percent of Total Billed Charges,69% of total billed charges,417.11,69,,,Percent of Total Billed Charges,69% of total billed charges,507.78,84,,,Percent of Total Billed Charges,84% of total billed charges,495.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,400,,,fee schedule,400% of healthlink fee schedule,293.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,313.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,65.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,151.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.47,77,,,Percent of total Billed charges,77% of total billed charges,513.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,151.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,151.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.64,513.83,
BARIUM SWALLOW W/BARIUM & CRYS,T990400124,CDM,320,RC,74221,HCPCS,Outpatient,,,638.5,319.25,,491.65,77,,,Percent of Total Billed Charges,77% of total billed charges,162.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,472.49,74,,,Percent of Total Billed Charges,74% of total billed charges,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,536.34,84,,,Percent of Total Billed Charges,84% of total billed charges,523.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,568.27,89,,,Percent of total Billed Charges,89% of total Billed charges,568.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,568.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.65,77,,,Percent of total Billed charges,77% of total billed charges,542.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.92,568.27,
BARIUM SWALLOW W/BARIUM & CRYS,T990400124,CDM,320,RC,74221,HCPCS,Outpatient,,,638.5,319.25,TC,491.65,77,,,Percent of Total Billed Charges,77% of total billed charges,162.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,472.49,74,,,Percent of Total Billed Charges,74% of total billed charges,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,440.57,69,,,Percent of Total Billed Charges,69% of total billed charges,536.34,84,,,Percent of Total Billed Charges,84% of total billed charges,523.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,568.27,89,,,Percent of total Billed Charges,89% of total Billed charges,568.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,568.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,491.65,77,,,Percent of total Billed charges,77% of total billed charges,542.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,159.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.92,568.27,
ESOPHAGUS BA SWALLOW(SPEECH),T990400125,CDM,320,RC,74230,HCPCS,Outpatient,,,587,293.5,,451.99,77,,,Percent of Total Billed Charges,77% of total billed charges,149.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,434.38,74,,,Percent of Total Billed Charges,74% of total billed charges,405.03,69,,,Percent of Total Billed Charges,69% of total billed charges,405.03,69,,,Percent of Total Billed Charges,69% of total billed charges,146.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,405.03,69,,,Percent of Total Billed Charges,69% of total billed charges,405.03,69,,,Percent of Total Billed Charges,69% of total billed charges,493.08,84,,,Percent of Total Billed Charges,84% of total billed charges,481.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,319.16,400,,,fee schedule,400% of healthlink fee schedule,299.21,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,319.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,95.42,120,,,Fee Schedule,120% of MO Medicaid Rate,95.42,120,,,Fee Schedule,120% of MO Medicaid Rate,95.42,120,,,Fee Schedule,120% of MO of Medicaid Rate,146.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,451.99,77,,,Percent of total Billed charges,77% of total billed charges,498.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,95.42,120,,,Fee Schedule,120% of MO Medicaid Rate,146.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,146.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.42,498.95,
UGI W/BARIUM,T990400126,CDM,320,RC,74240,HCPCS,Outpatient,,,799,399.5,,615.23,77,,,Percent of Total Billed Charges,77% of total billed charges,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,591.26,74,,,Percent of Total Billed Charges,74% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,551.31,69,,,Percent of Total Billed Charges,69% of total billed charges,671.16,84,,,Percent of Total Billed Charges,84% of total billed charges,655.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.76,400,,,fee schedule,400% of healthlink fee schedule,363.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,387.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,80.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,615.23,77,,,Percent of total Billed charges,77% of total billed charges,679.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,199.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.23,679.15,
UGI W/BARIUM & CRYSTALS,T990400127,CDM,320,RC,74246,HCPCS,Outpatient,,,841,420.5,,647.57,77,,,Percent of Total Billed Charges,77% of total billed charges,214.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,622.34,74,,,Percent of Total Billed Charges,74% of total billed charges,580.29,69,,,Percent of Total Billed Charges,69% of total billed charges,580.29,69,,,Percent of Total Billed Charges,69% of total billed charges,210.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.29,69,,,Percent of Total Billed Charges,69% of total billed charges,580.29,69,,,Percent of Total Billed Charges,69% of total billed charges,706.44,84,,,Percent of Total Billed Charges,84% of total billed charges,689.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,447.48,400,,,fee schedule,400% of healthlink fee schedule,419.51,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,447.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,92.39,120,,,Fee Schedule,120% of MO Medicaid Rate,92.39,120,,,Fee Schedule,120% of MO Medicaid Rate,92.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,210.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.57,77,,,Percent of total Billed charges,77% of total billed charges,714.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,241.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,92.39,120,,,Fee Schedule,120% of MO Medicaid Rate,210.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,210.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.39,714.85,
SMALL BOWEL SERIES,T990400128,CDM,320,RC,74248,HCPCS,Outpatient,,,904,452,,696.08,77,,,Percent of Total Billed Charges,77% of total billed charges,230.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,230.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,282.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,668.96,74,,,Percent of Total Billed Charges,74% of total billed charges,623.76,69,,,Percent of Total Billed Charges,69% of total billed charges,623.76,69,,,Percent of Total Billed Charges,69% of total billed charges,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623.76,69,,,Percent of Total Billed Charges,69% of total billed charges,623.76,69,,,Percent of Total Billed Charges,69% of total billed charges,759.36,84,,,Percent of Total Billed Charges,84% of total billed charges,741.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,804.56,89,,,Percent of total Billed Charges,89% of total Billed charges,804.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,120,,,Fee Schedule,120% of MO Medicaid Rate,47.09,120,,,Fee Schedule,120% of MO Medicaid Rate,47.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,696.08,77,,,Percent of total Billed charges,77% of total billed charges,768.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,259.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,47.09,120,,,Fee Schedule,120% of MO Medicaid Rate,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,226,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,804.56,
SM BOWEL SERIES,T990400129,CDM,320,RC,74250,HCPCS,Outpatient,,,1173.5,586.75,,903.6,77,,,Percent of Total Billed Charges,77% of total billed charges,299.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,299.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,868.39,74,,,Percent of Total Billed Charges,74% of total billed charges,809.72,69,,,Percent of Total Billed Charges,69% of total billed charges,809.72,69,,,Percent of Total Billed Charges,69% of total billed charges,293.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,809.72,69,,,Percent of Total Billed Charges,69% of total billed charges,809.72,69,,,Percent of Total Billed Charges,69% of total billed charges,985.74,84,,,Percent of Total Billed Charges,84% of total billed charges,962.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,372.08,400,,,fee schedule,400% of healthlink fee schedule,348.83,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,372.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.62,120,,,Fee Schedule,120% of MO Medicaid Rate,79.62,120,,,Fee Schedule,120% of MO Medicaid Rate,79.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,293.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,903.6,77,,,Percent of total Billed charges,77% of total billed charges,997.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,337.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,79.62,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,293.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.62,997.48,
SM BOWEL W/UGI DOUBLE,T990400130,CDM,320,RC,74251,HCPCS,Outpatient,,,1738.5,869.25,TC,1338.65,77,,,Percent of Total Billed Charges,77% of total billed charges,443.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,443.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1286.49,74,,,Percent of Total Billed Charges,74% of total billed charges,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1460.34,84,,,Percent of Total Billed Charges,84% of total billed charges,1425.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,1286.48,400,,,fee schedule,400% of healthlink fee schedule,1206.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1286.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,160.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1338.65,77,,,Percent of total Billed charges,77% of total billed charges,1477.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,499.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.48,1477.73,
SM BOWEL W/UGI DOUBLE,T990400130,CDM,320,RC,74251,HCPCS,Outpatient,,,1738.5,869.25,,1338.65,77,,,Percent of Total Billed Charges,77% of total billed charges,443.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,443.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1286.49,74,,,Percent of Total Billed Charges,74% of total billed charges,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1199.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1460.34,84,,,Percent of Total Billed Charges,84% of total billed charges,1425.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,1286.48,400,,,fee schedule,400% of healthlink fee schedule,1206.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1286.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,160.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1338.65,77,,,Percent of total Billed charges,77% of total billed charges,1477.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,499.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,160.48,120,,,Fee Schedule,120% of MO Medicaid Rate,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,434.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.48,1477.73,
BARIUM ENEMA,T990400131,CDM,320,RC,74270,HCPCS,Outpatient,,,814.5,407.25,,627.17,77,,,Percent of Total Billed Charges,77% of total billed charges,207.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,602.73,74,,,Percent of Total Billed Charges,74% of total billed charges,562.01,69,,,Percent of Total Billed Charges,69% of total billed charges,562.01,69,,,Percent of Total Billed Charges,69% of total billed charges,203.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562.01,69,,,Percent of Total Billed Charges,69% of total billed charges,562.01,69,,,Percent of Total Billed Charges,69% of total billed charges,684.18,84,,,Percent of Total Billed Charges,84% of total billed charges,667.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,541.32,400,,,fee schedule,400% of healthlink fee schedule,507.49,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,541.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,99.38,120,,,Fee Schedule,120% of MO Medicaid Rate,99.38,120,,,Fee Schedule,120% of MO Medicaid Rate,99.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,203.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,627.17,77,,,Percent of total Billed charges,77% of total billed charges,692.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,234.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,99.38,120,,,Fee Schedule,120% of MO Medicaid Rate,203.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,203.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.38,692.33,
AC BARIUM ENEMA,T990400132,CDM,320,RC,74280,HCPCS,Outpatient,,,1103.5,551.75,TC,849.7,77,,,Percent of Total Billed Charges,77% of total billed charges,281.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,281.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,816.59,74,,,Percent of Total Billed Charges,74% of total billed charges,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,926.94,84,,,Percent of Total Billed Charges,84% of total billed charges,904.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,750,400,,,fee schedule,400% of healthlink fee schedule,703.13,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,750,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,153.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,849.7,77,,,Percent of total Billed charges,77% of total billed charges,937.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,317.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.18,937.98,
AC BARIUM ENEMA,T990400132,CDM,320,RC,74280,HCPCS,Outpatient,,,1103.5,551.75,,849.7,77,,,Percent of Total Billed Charges,77% of total billed charges,281.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,281.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,816.59,74,,,Percent of Total Billed Charges,74% of total billed charges,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,761.42,69,,,Percent of Total Billed Charges,69% of total billed charges,926.94,84,,,Percent of Total Billed Charges,84% of total billed charges,904.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,750,400,,,fee schedule,400% of healthlink fee schedule,703.13,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,750,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,153.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,849.7,77,,,Percent of total Billed charges,77% of total billed charges,937.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,317.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,153.18,120,,,Fee Schedule,120% of MO Medicaid Rate,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,275.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.18,937.98,
GALLBLADDER X-RAY,T990400133,CDM,320,RC,74290,HCPCS,Outpatient,,,728,364,,560.56,77,,,Percent of Total Billed Charges,77% of total billed charges,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,538.72,74,,,Percent of Total Billed Charges,74% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,611.52,84,,,Percent of Total Billed Charges,84% of total billed charges,596.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.72,400,,,fee schedule,400% of healthlink fee schedule,225.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,240.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.56,77,,,Percent of total Billed charges,77% of total billed charges,618.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.85,618.8,
GALLBLADDER X-RAY,T990400133,CDM,320,RC,74290,HCPCS,Outpatient,,,728,364,TC,560.56,77,,,Percent of Total Billed Charges,77% of total billed charges,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,538.72,74,,,Percent of Total Billed Charges,74% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,611.52,84,,,Percent of Total Billed Charges,84% of total billed charges,596.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.72,400,,,fee schedule,400% of healthlink fee schedule,225.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,240.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.56,77,,,Percent of total Billed charges,77% of total billed charges,618.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.85,618.8,
ORAL GALLBLADDER,T990400134,CDM,320,RC,74290,HCPCS,Outpatient,,,728,364,TC,560.56,77,,,Percent of Total Billed Charges,77% of total billed charges,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,538.72,74,,,Percent of Total Billed Charges,74% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,611.52,84,,,Percent of Total Billed Charges,84% of total billed charges,596.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.72,400,,,fee schedule,400% of healthlink fee schedule,225.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,240.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.56,77,,,Percent of total Billed charges,77% of total billed charges,618.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.85,618.8,
ORAL GALLBLADDER,T990400134,CDM,320,RC,74290,HCPCS,Outpatient,,,728,364,,560.56,77,,,Percent of Total Billed Charges,77% of total billed charges,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,227.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,538.72,74,,,Percent of Total Billed Charges,74% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,502.32,69,,,Percent of Total Billed Charges,69% of total billed charges,611.52,84,,,Percent of Total Billed Charges,84% of total billed charges,596.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.72,400,,,fee schedule,400% of healthlink fee schedule,225.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,240.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,66.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.56,77,,,Percent of total Billed charges,77% of total billed charges,618.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,209.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,66.85,120,,,Fee Schedule,120% of MO Medicaid Rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,182,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.85,618.8,
OR CHOLANGIOGRAM,T990400135,CDM,320,RC,74300,HCPCS,Outpatient,,,842,421,TC,648.34,77,,,Percent of Total Billed Charges,77% of total billed charges,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,623.08,74,,,Percent of Total Billed Charges,74% of total billed charges,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,707.28,84,,,Percent of Total Billed Charges,84% of total billed charges,690.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,33.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.34,77,,,Percent of total Billed charges,77% of total billed charges,715.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.35,715.7,
OR CHOLANGIOGRAM,T990400135,CDM,320,RC,74300,HCPCS,Outpatient,,,842,421,,648.34,77,,,Percent of Total Billed Charges,77% of total billed charges,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,263.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,623.08,74,,,Percent of Total Billed Charges,74% of total billed charges,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,580.98,69,,,Percent of Total Billed Charges,69% of total billed charges,707.28,84,,,Percent of Total Billed Charges,84% of total billed charges,690.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,33.35,120,,,Fee Schedule,120% of MO of Medicaid Rate,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.34,77,,,Percent of total Billed charges,77% of total billed charges,715.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,242.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,33.35,120,,,Fee Schedule,120% of MO Medicaid Rate,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,210.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.35,715.7,
IVP,T990400136,CDM,320,RC,74400,HCPCS,Outpatient,,,955,477.5,TC,735.35,77,,,Percent of Total Billed Charges,77% of total billed charges,243.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,298.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,706.7,74,,,Percent of Total Billed Charges,74% of total billed charges,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,802.2,84,,,Percent of Total Billed Charges,84% of total billed charges,783.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.76,400,,,fee schedule,400% of healthlink fee schedule,369.15,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,393.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,104.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,735.35,77,,,Percent of total Billed charges,77% of total billed charges,811.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,274.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.86,811.75,
IVP,T990400136,CDM,320,RC,74400,HCPCS,Outpatient,,,955,477.5,,735.35,77,,,Percent of Total Billed Charges,77% of total billed charges,243.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,298.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,706.7,74,,,Percent of Total Billed Charges,74% of total billed charges,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,658.95,69,,,Percent of Total Billed Charges,69% of total billed charges,802.2,84,,,Percent of Total Billed Charges,84% of total billed charges,783.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.76,400,,,fee schedule,400% of healthlink fee schedule,369.15,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,393.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,104.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,735.35,77,,,Percent of total Billed charges,77% of total billed charges,811.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,274.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,104.86,120,,,Fee Schedule,120% of MO Medicaid Rate,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,238.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.86,811.75,
RETROGRADE PYELOGRAM,T990400137,CDM,320,RC,74420,HCPCS,Outpatient,,,934.5,467.25,,719.57,77,,,Percent of Total Billed Charges,77% of total billed charges,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,691.53,74,,,Percent of Total Billed Charges,74% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,784.98,84,,,Percent of Total Billed Charges,84% of total billed charges,766.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,719.57,77,,,Percent of total Billed charges,77% of total billed charges,794.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.64,794.33,
RETROGRADE PYELOGRAM,T990400137,CDM,320,RC,74420,HCPCS,Outpatient,,,934.5,467.25,TC,719.57,77,,,Percent of Total Billed Charges,77% of total billed charges,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,691.53,74,,,Percent of Total Billed Charges,74% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,644.81,69,,,Percent of Total Billed Charges,69% of total billed charges,784.98,84,,,Percent of Total Billed Charges,84% of total billed charges,766.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,719.57,77,,,Percent of total Billed charges,77% of total billed charges,794.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,268.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,233.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.64,794.33,
CYSTOGRAM,T990400138,CDM,320,RC,74430,HCPCS,Outpatient,,,705,352.5,,542.85,77,,,Percent of Total Billed Charges,77% of total billed charges,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,521.7,74,,,Percent of Total Billed Charges,74% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,592.2,84,,,Percent of Total Billed Charges,84% of total billed charges,578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.44,400,,,fee schedule,400% of healthlink fee schedule,269.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,287.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,40.78,120,,,Fee Schedule,120% of MO Medicaid Rate,40.78,120,,,Fee Schedule,120% of MO Medicaid Rate,40.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.85,77,,,Percent of total Billed charges,77% of total billed charges,599.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,202.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,40.78,120,,,Fee Schedule,120% of MO Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,599.25,
CYSTO URETHRO RETRO,T990400139,CDM,320,RC,74450,HCPCS,Outpatient,,,705,352.5,,542.85,77,,,Percent of Total Billed Charges,77% of total billed charges,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,521.7,74,,,Percent of Total Billed Charges,74% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,592.2,84,,,Percent of Total Billed Charges,84% of total billed charges,578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,60.02,120,,,Fee Schedule,120% of MO Medicaid Rate,60.02,120,,,Fee Schedule,120% of MO Medicaid Rate,60.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.85,77,,,Percent of total Billed charges,77% of total billed charges,599.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,202.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,60.02,120,,,Fee Schedule,120% of MO Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.02,599.25,
VCUG,T990400140,CDM,320,RC,74455,HCPCS,Outpatient,,,939,469.5,,723.03,77,,,Percent of Total Billed Charges,77% of total billed charges,239.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.86,74,,,Percent of Total Billed Charges,74% of total billed charges,647.91,69,,,Percent of Total Billed Charges,69% of total billed charges,647.91,69,,,Percent of Total Billed Charges,69% of total billed charges,234.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.91,69,,,Percent of Total Billed Charges,69% of total billed charges,647.91,69,,,Percent of Total Billed Charges,69% of total billed charges,788.76,84,,,Percent of Total Billed Charges,84% of total billed charges,769.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.68,400,,,fee schedule,400% of healthlink fee schedule,300.64,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,82.97,120,,,Fee Schedule,120% of MO Medicaid Rate,82.97,120,,,Fee Schedule,120% of MO Medicaid Rate,82.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,234.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.03,77,,,Percent of total Billed charges,77% of total billed charges,798.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,82.97,120,,,Fee Schedule,120% of MO Medicaid Rate,234.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,234.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.97,798.15,
NEPHROSTOGRAM,T990400141,CDM,320,RC,74485,HCPCS,Outpatient,,,705,352.5,,542.85,77,,,Percent of Total Billed Charges,77% of total billed charges,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,521.7,74,,,Percent of Total Billed Charges,74% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,592.2,84,,,Percent of Total Billed Charges,84% of total billed charges,578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,375.52,400,,,fee schedule,400% of healthlink fee schedule,352.05,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,375.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,77.44,120,,,Fee Schedule,120% of MO Medicaid Rate,77.44,120,,,Fee Schedule,120% of MO Medicaid Rate,77.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.85,77,,,Percent of total Billed charges,77% of total billed charges,599.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,202.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,77.44,120,,,Fee Schedule,120% of MO Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.44,599.25,
HYSTEROSALPINGOGRAM,T990400142,CDM,320,RC,74740,HCPCS,Outpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.5,74,,,Percent of Total Billed Charges,74% of total billed charges,362.25,69,,,Percent of Total Billed Charges,69% of total billed charges,362.25,69,,,Percent of Total Billed Charges,69% of total billed charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.25,69,,,Percent of Total Billed Charges,69% of total billed charges,362.25,69,,,Percent of Total Billed Charges,69% of total billed charges,441,84,,,Percent of Total Billed Charges,84% of total billed charges,430.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,273.84,400,,,fee schedule,400% of healthlink fee schedule,256.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,273.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,72.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,72.92,120,,,Fee Schedule,120% of MO Medicaid Rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.92,446.25,
SHUNT SERIES,T990400143,CDM,320,RC,75809,HCPCS,Outpatient,,,469,234.5,,361.13,77,,,Percent of Total Billed Charges,77% of total billed charges,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,146.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,347.06,74,,,Percent of Total Billed Charges,74% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,323.61,69,,,Percent of Total Billed Charges,69% of total billed charges,393.96,84,,,Percent of Total Billed Charges,84% of total billed charges,384.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,332.52,400,,,fee schedule,400% of healthlink fee schedule,311.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,332.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,58.8,120,,,Fee Schedule,120% of MO Medicaid Rate,58.8,120,,,Fee Schedule,120% of MO Medicaid Rate,58.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.13,77,,,Percent of total Billed charges,77% of total billed charges,398.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,58.8,120,,,Fee Schedule,120% of MO Medicaid Rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,117.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.8,398.65,
VENOGRAM,T990400144,CDM,320,RC,75820,HCPCS,Outpatient,,,1409.5,704.75,,1085.32,77,,,Percent of Total Billed Charges,77% of total billed charges,359.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,359.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,440.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1043.03,74,,,Percent of Total Billed Charges,74% of total billed charges,972.56,69,,,Percent of Total Billed Charges,69% of total billed charges,972.56,69,,,Percent of Total Billed Charges,69% of total billed charges,352.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,972.56,69,,,Percent of Total Billed Charges,69% of total billed charges,972.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1183.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1155.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,459.76,400,,,fee schedule,400% of healthlink fee schedule,431.03,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,459.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,55.61,120,,,Fee Schedule,120% of MO Medicaid Rate,55.61,120,,,Fee Schedule,120% of MO Medicaid Rate,55.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,352.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1085.32,77,,,Percent of total Billed charges,77% of total billed charges,1198.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,405.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,55.61,120,,,Fee Schedule,120% of MO Medicaid Rate,352.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,352.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.61,1198.08,
FLUORO (UP TO 1 HOUR),T990400145,CDM,320,RC,76000,HCPCS,Outpatient,,,348,174,,267.96,77,,,Percent of Total Billed Charges,77% of total billed charges,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,257.52,74,,,Percent of Total Billed Charges,74% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,240.12,69,,,Percent of Total Billed Charges,69% of total billed charges,292.32,84,,,Percent of Total Billed Charges,84% of total billed charges,285.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,358.16,400,,,fee schedule,400% of healthlink fee schedule,335.78,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,56.15,120,,,Fee Schedule,120% of MO Medicaid Rate,56.15,120,,,Fee Schedule,120% of MO Medicaid Rate,56.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.96,77,,,Percent of total Billed charges,77% of total billed charges,295.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,56.15,120,,,Fee Schedule,120% of MO Medicaid Rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,358.16,
FISTULOGRAM,T990400146,CDM,320,RC,76080,HCPCS,Outpatient,,,664,332,,511.28,77,,,Percent of Total Billed Charges,77% of total billed charges,169.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.36,74,,,Percent of Total Billed Charges,74% of total billed charges,458.16,69,,,Percent of Total Billed Charges,69% of total billed charges,458.16,69,,,Percent of Total Billed Charges,69% of total billed charges,166,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.16,69,,,Percent of Total Billed Charges,69% of total billed charges,458.16,69,,,Percent of Total Billed Charges,69% of total billed charges,557.76,84,,,Percent of Total Billed Charges,84% of total billed charges,544.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,219.68,400,,,fee schedule,400% of healthlink fee schedule,205.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,219.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,32.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,166,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.28,77,,,Percent of total Billed charges,77% of total billed charges,564.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,32.5,120,,,Fee Schedule,120% of MO Medicaid Rate,166,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,166,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,564.4,
SACRUM - COCCYX TOMOGRAM,T990400147,CDM,320,RC,76100,HCPCS,Outpatient,,,558.5,279.25,,430.05,77,,,Percent of Total Billed Charges,77% of total billed charges,142.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,413.29,74,,,Percent of Total Billed Charges,74% of total billed charges,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,469.14,84,,,Percent of Total Billed Charges,84% of total billed charges,457.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,516.16,400,,,fee schedule,400% of healthlink fee schedule,483.9,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,516.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,56.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430.05,77,,,Percent of total Billed charges,77% of total billed charges,474.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.51,516.16,
STERNUM TOMOGRAM,T990400148,CDM,320,RC,76100,HCPCS,Outpatient,,,558.5,279.25,,430.05,77,,,Percent of Total Billed Charges,77% of total billed charges,142.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,174.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,413.29,74,,,Percent of Total Billed Charges,74% of total billed charges,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,385.37,69,,,Percent of Total Billed Charges,69% of total billed charges,469.14,84,,,Percent of Total Billed Charges,84% of total billed charges,457.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,516.16,400,,,fee schedule,400% of healthlink fee schedule,483.9,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,516.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,56.51,120,,,Fee Schedule,120% of MO of Medicaid Rate,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430.05,77,,,Percent of total Billed charges,77% of total billed charges,474.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,56.51,120,,,Fee Schedule,120% of MO Medicaid Rate,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,139.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.51,516.16,
FLOURO INJECTION,T990400149,CDM,320,RC,77002,HCPCS,Outpatient,,,655,327.5,,504.35,77,,,Percent of Total Billed Charges,77% of total billed charges,167.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,167.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,484.7,74,,,Percent of Total Billed Charges,74% of total billed charges,451.95,69,,,Percent of Total Billed Charges,69% of total billed charges,451.95,69,,,Percent of Total Billed Charges,69% of total billed charges,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,451.95,69,,,Percent of Total Billed Charges,69% of total billed charges,451.95,69,,,Percent of Total Billed Charges,69% of total billed charges,550.2,84,,,Percent of Total Billed Charges,84% of total billed charges,537.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.24,400,,,fee schedule,400% of healthlink fee schedule,226.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,241.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,81.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,504.35,77,,,Percent of total Billed charges,77% of total billed charges,556.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,188.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,163.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.74,556.75,
"FLURO GUID PLMT BX,ASP,LCL",T990400150,CDM,320,RC,77002,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,498.76,74,,,Percent of Total Billed Charges,74% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,566.16,84,,,Percent of Total Billed Charges,84% of total billed charges,552.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.24,400,,,fee schedule,400% of healthlink fee schedule,226.16,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,241.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,81.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,81.74,120,,,Fee Schedule,120% of MO Medicaid Rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.74,572.9,
"FLUORO GUID EPID,SUBARAC,SI JT",T990400151,CDM,320,RC,77003,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,498.76,74,,,Percent of Total Billed Charges,74% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,566.16,84,,,Percent of Total Billed Charges,84% of total billed charges,552.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.92,400,,,fee schedule,400% of healthlink fee schedule,178.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,190.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,70.19,120,,,Fee Schedule,120% of MO Medicaid Rate,70.19,120,,,Fee Schedule,120% of MO Medicaid Rate,70.19,120,,,Fee Schedule,120% of MO of Medicaid Rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,70.19,120,,,Fee Schedule,120% of MO Medicaid Rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.19,572.9,
BONE AGE STUDY,T990400152,CDM,320,RC,77072,HCPCS,Outpatient,,,257,128.5,,197.89,77,,,Percent of Total Billed Charges,77% of total billed charges,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.18,74,,,Percent of Total Billed Charges,74% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,215.88,84,,,Percent of Total Billed Charges,84% of total billed charges,210.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.64,400,,,fee schedule,400% of healthlink fee schedule,77.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,82.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.89,77,,,Percent of total Billed charges,77% of total billed charges,218.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,271,
BONE AGE STUDY,T990400152,CDM,320,RC,77072,HCPCS,Outpatient,,,257,128.5,TC,197.89,77,,,Percent of Total Billed Charges,77% of total billed charges,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.18,74,,,Percent of Total Billed Charges,74% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,215.88,84,,,Percent of Total Billed Charges,84% of total billed charges,210.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.64,400,,,fee schedule,400% of healthlink fee schedule,77.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,82.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,15.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.89,77,,,Percent of total Billed charges,77% of total billed charges,218.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,15.48,120,,,Fee Schedule,120% of MO Medicaid Rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,271,
LONG BONE MEASUREMENT,T990400153,CDM,320,RC,77073,HCPCS,Outpatient,,,488.5,244.25,,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.72,400,,,fee schedule,400% of healthlink fee schedule,117.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,125.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,415.23,
LONG BONE MEASUREMENT,T990400153,CDM,320,RC,77073,HCPCS,Outpatient,,,488.5,244.25,TC,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.72,400,,,fee schedule,400% of healthlink fee schedule,117.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,125.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,415.23,
"SKELETAL SERIES, LIMITED",T990400154,CDM,320,RC,77074,HCPCS,Outpatient,,,321,160.5,,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.76,400,,,fee schedule,400% of healthlink fee schedule,230.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,245.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,51.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.92,272.85,
"SKELETAL SERIES, LIMITED",T990400154,CDM,320,RC,77074,HCPCS,Outpatient,,,321,160.5,TC,247.17,77,,,Percent of Total Billed Charges,77% of total billed charges,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,237.54,74,,,Percent of Total Billed Charges,74% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,221.49,69,,,Percent of Total Billed Charges,69% of total billed charges,269.64,84,,,Percent of Total Billed Charges,84% of total billed charges,263.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.76,400,,,fee schedule,400% of healthlink fee schedule,230.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,245.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,51.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.17,77,,,Percent of total Billed charges,77% of total billed charges,272.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,51.92,120,,,Fee Schedule,120% of MO Medicaid Rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,80.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.92,272.85,
METASTIC SKELETAL SERIES,T990400155,CDM,320,RC,77075,HCPCS,Outpatient,,,889,444.5,TC,684.53,77,,,Percent of Total Billed Charges,77% of total billed charges,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,657.86,74,,,Percent of Total Billed Charges,74% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,746.76,84,,,Percent of Total Billed Charges,84% of total billed charges,728.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,362.32,400,,,fee schedule,400% of healthlink fee schedule,339.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,362.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,74.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,684.53,77,,,Percent of total Billed charges,77% of total billed charges,755.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.23,755.65,
METASTIC SKELETAL SERIES,T990400155,CDM,320,RC,77075,HCPCS,Outpatient,,,889,444.5,,684.53,77,,,Percent of Total Billed Charges,77% of total billed charges,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,657.86,74,,,Percent of Total Billed Charges,74% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,746.76,84,,,Percent of Total Billed Charges,84% of total billed charges,728.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,362.32,400,,,fee schedule,400% of healthlink fee schedule,339.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,362.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,74.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,684.53,77,,,Percent of total Billed charges,77% of total billed charges,755.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,74.23,120,,,Fee Schedule,120% of MO Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.23,755.65,
"OSSEOUS BONE SURVEY, COMPLETE",T990400156,CDM,320,RC,77076,HCPCS,Outpatient,,,889,444.5,,684.53,77,,,Percent of Total Billed Charges,77% of total billed charges,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,657.86,74,,,Percent of Total Billed Charges,74% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,746.76,84,,,Percent of Total Billed Charges,84% of total billed charges,728.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,355.28,400,,,fee schedule,400% of healthlink fee schedule,333.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,355.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,684.53,77,,,Percent of total Billed charges,77% of total billed charges,755.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,755.65,
"OSSEOUS BONE SURVEY, COMPLETE",T990400156,CDM,320,RC,77076,HCPCS,Outpatient,,,889,444.5,TC,684.53,77,,,Percent of Total Billed Charges,77% of total billed charges,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,657.86,74,,,Percent of Total Billed Charges,74% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,613.41,69,,,Percent of Total Billed Charges,69% of total billed charges,746.76,84,,,Percent of Total Billed Charges,84% of total billed charges,728.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,355.28,400,,,fee schedule,400% of healthlink fee schedule,333.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,355.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,684.53,77,,,Percent of total Billed charges,77% of total billed charges,755.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,222.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,755.65,
"OSSEOUS BONE SURVEY, INFANT",T990400157,CDM,320,RC,77076,HCPCS,Outpatient,,,367.5,183.75,,282.98,77,,,Percent of Total Billed Charges,77% of total billed charges,93.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,271.95,74,,,Percent of Total Billed Charges,74% of total billed charges,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,308.7,84,,,Percent of Total Billed Charges,84% of total billed charges,301.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,355.28,400,,,fee schedule,400% of healthlink fee schedule,333.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,355.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.98,77,,,Percent of total Billed charges,77% of total billed charges,312.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,355.28,
"OSSEOUS BONE SURVEY, INFANT",T990400157,CDM,320,RC,77076,HCPCS,Outpatient,,,367.5,183.75,TC,282.98,77,,,Percent of Total Billed Charges,77% of total billed charges,93.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,271.95,74,,,Percent of Total Billed Charges,74% of total billed charges,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,253.58,69,,,Percent of Total Billed Charges,69% of total billed charges,308.7,84,,,Percent of Total Billed Charges,84% of total billed charges,301.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,355.28,400,,,fee schedule,400% of healthlink fee schedule,333.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,355.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.98,77,,,Percent of total Billed charges,77% of total billed charges,312.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,91.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,355.28,
EMP WELL HEARTSCORE(CT),T990400158,CDM,350,RC,,,Outpatient,,,58.5,29.25,,45.05,77,,,Percent of Total Billed Charges,77% of total billed charges,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.29,74,,,Percent of Total Billed Charges,74% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,49.14,84,,,Percent of Total Billed Charges,84% of total billed charges,47.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.07,89,,,Percent of total Billed Charges,89% of total Billed charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,77,,,Percent of total Billed charges,77% of total billed charges,49.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,23.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,889,
EMP WELL HEARTSCORE(CT),T990400158,CDM,350,RC,,,Outpatient,,,58.5,29.25,,45.05,77,,,Percent of Total Billed Charges,77% of total billed charges,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.29,74,,,Percent of Total Billed Charges,74% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,40.37,69,,,Percent of Total Billed Charges,69% of total billed charges,49.14,84,,,Percent of Total Billed Charges,84% of total billed charges,47.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.07,89,,,Percent of total Billed Charges,89% of total Billed charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,77,,,Percent of total Billed charges,77% of total billed charges,49.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,23.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,14.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.63,889,
EMP WELL HEARTSCORE(FEB ONLY),T990400159,CDM,350,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,889,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,770,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,770,889,
INFUSAPORT CHECK,T990400160,CDM,320,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,271,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,235,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,235,271,
"INJ, SI JOINTS PROFILE",T990400161,CDM,320,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,271,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,235,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,235,271,
"ORBIT, ONE CALL MEDICAL",T990400162,CDM,720,RC,,,Outpatient,,,24.5,12.25,,18.87,77,,,Percent of Total Billed Charges,77% of total billed charges,6.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.13,74,,,Percent of Total Billed Charges,74% of total billed charges,16.91,69,,,Percent of Total Billed Charges,69% of total billed charges,16.91,69,,,Percent of Total Billed Charges,69% of total billed charges,6.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.91,69,,,Percent of Total Billed Charges,69% of total billed charges,16.91,69,,,Percent of Total Billed Charges,69% of total billed charges,20.58,84,,,Percent of Total Billed Charges,84% of total billed charges,20.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.81,89,,,Percent of total Billed Charges,89% of total Billed charges,21.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.87,77,,,Percent of total Billed charges,77% of total billed charges,20.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,761,100,,,Case Rate,Pays based on per visit rate,10,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659,100,,,Case Rate,Pays based on per visit rate,6.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.13,761,
PICC IP DOUBLE LUMEN,T990400163,CDM,320,RC,36573,HCPCS,Outpatient,,,1907.5,953.75,,1468.78,77,,,Percent of Total Billed Charges,77% of total billed charges,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1411.55,74,,,Percent of Total Billed Charges,74% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1602.3,84,,,Percent of Total Billed Charges,84% of total billed charges,1564.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,1697.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.78,77,,,Percent of total Billed charges,77% of total billed charges,1621.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,548.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,778.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,1697.68,
PICC IP TRIPLE LUMEN,T990400164,CDM,320,RC,36573,HCPCS,Outpatient,,,1907.5,953.75,,1468.78,77,,,Percent of Total Billed Charges,77% of total billed charges,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1411.55,74,,,Percent of Total Billed Charges,74% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1602.3,84,,,Percent of Total Billed Charges,84% of total billed charges,1564.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,1697.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.78,77,,,Percent of total Billed charges,77% of total billed charges,1621.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,548.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,778.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,1697.68,
Timed Barium Swallow,T990400165,CDM,320,RC,74220,HCPCS,Outpatient,,,604,302,,465.08,77,,,Percent of Total Billed Charges,77% of total billed charges,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,446.96,74,,,Percent of Total Billed Charges,74% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,507.36,84,,,Percent of Total Billed Charges,84% of total billed charges,495.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,400,,,fee schedule,400% of healthlink fee schedule,293.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,313.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,65.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.08,77,,,Percent of total Billed charges,77% of total billed charges,513.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,65.64,120,,,Fee Schedule,120% of MO Medicaid Rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.64,513.4,
UGI w/Gastrografin,T990400166,CDM,320,RC,74240,HCPCS,Outpatient,,,800,400,,616,77,,,Percent of Total Billed Charges,77% of total billed charges,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,204,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,592,74,,,Percent of Total Billed Charges,74% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,552,69,,,Percent of Total Billed Charges,69% of total billed charges,552,69,,,Percent of Total Billed Charges,69% of total billed charges,672,84,,,Percent of Total Billed Charges,84% of total billed charges,656,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.76,400,,,fee schedule,400% of healthlink fee schedule,363.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,387.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,80.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,616,77,,,Percent of total Billed charges,77% of total billed charges,680,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,230,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,80.23,120,,,Fee Schedule,120% of MO Medicaid Rate,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,200,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.23,680,
XR - foreign body pediatric,T990400167,CDM,320,RC,76010,HCPCS,Outpatient,,,311,155.5,,239.47,77,,,Percent of Total Billed Charges,77% of total billed charges,79.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.14,74,,,Percent of Total Billed Charges,74% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,214.59,69,,,Percent of Total Billed Charges,69% of total billed charges,261.24,84,,,Percent of Total Billed Charges,84% of total billed charges,255.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.24,400,,,fee schedule,400% of healthlink fee schedule,88.35,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,94.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,19.18,120,,,Fee Schedule,120% of MO Medicaid Rate,19.18,120,,,Fee Schedule,120% of MO Medicaid Rate,19.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.47,77,,,Percent of total Billed charges,77% of total billed charges,264.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,19.18,120,,,Fee Schedule,120% of MO Medicaid Rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,77.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.18,271,
CT HEAD W/O CONTRAST,T990410001,CDM,351,RC,70450,HCPCS,Outpatient,,,2298,1149,,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2116.52,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,741.12,400,,,fee schedule,400% of healthlink fee schedule,694.8,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,741.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.72,2116.52,
ONE CALL-CT HEAD W/O,T990410002,CDM,351,RC,70450,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2116.52,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,741.12,400,,,fee schedule,400% of healthlink fee schedule,694.8,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,741.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2116.52,
CT HEAD WITH CONTRAST,T990410004,CDM,351,RC,70460,HCPCS,Outpatient,,,2435.5,1217.75,,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2741.69,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,976.12,400,,,fee schedule,400% of healthlink fee schedule,915.11,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,976.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,2741.69,
CT HEAD W/O & W CONTRAST,T990410006,CDM,351,RC,70470,HCPCS,Outpatient,,,2636.5,1318.25,,2030.11,77,,,Percent of Total Billed Charges,77% of total billed charges,672.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,672.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,823.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3376.14,350,,,fee schedule,350% of bcbs fee schedule,1819.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1819.19,69,,,Percent of Total Billed Charges,69% of total billed charges,659.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1819.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1819.19,69,,,Percent of Total Billed Charges,69% of total billed charges,2214.66,84,,,Percent of Total Billed Charges,84% of total billed charges,2161.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.84,400,,,fee schedule,400% of healthlink fee schedule,1101.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1174.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,659.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2030.11,77,,,Percent of total Billed charges,77% of total billed charges,2241.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,757.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,659.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,659.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3376.14,
ONE CALL-CT HEAD W W/O,T990410007,CDM,351,RC,70470,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3376.14,350,,,fee schedule,350% of bcbs fee schedule,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,84,,,Percent of Total Billed Charges,84% of total billed charges,354.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.84,400,,,fee schedule,400% of healthlink fee schedule,1101.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1174.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108,3376.14,
"CT ORB,SELLA,MAST,EAR /WO",T990410008,CDM,351,RC,70480,HCPCS,Outpatient,,,2434,1217,,1874.18,77,,,Percent of Total Billed Charges,77% of total billed charges,620.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,620.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,760.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1679.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1679.46,69,,,Percent of Total Billed Charges,69% of total billed charges,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1679.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1679.46,69,,,Percent of Total Billed Charges,69% of total billed charges,2044.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1995.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,1224.16,400,,,fee schedule,400% of healthlink fee schedule,1147.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1224.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1874.18,77,,,Percent of total Billed charges,77% of total billed charges,2068.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,699.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.56,2644.5,
"CT ORB,SELLA,MAST,EAR /W",T990410009,CDM,351,RC,70481,HCPCS,Outpatient,,,3043.5,1521.75,,2343.5,77,,,Percent of Total Billed Charges,77% of total billed charges,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,951.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4061.37,350,,,fee schedule,350% of bcbs fee schedule,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2556.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2495.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1419.88,400,,,fee schedule,400% of healthlink fee schedule,1331.14,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1419.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2343.5,77,,,Percent of total Billed charges,77% of total billed charges,2586.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,875.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.14,4061.37,
"CT ORB,SEL,MAST,EAR W/WO",T990410010,CDM,351,RC,70482,HCPCS,Outpatient,,,3043.5,1521.75,,2343.5,77,,,Percent of Total Billed Charges,77% of total billed charges,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,951.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4556.83,350,,,fee schedule,350% of bcbs fee schedule,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2556.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2495.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1608.24,400,,,fee schedule,400% of healthlink fee schedule,1507.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1608.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2343.5,77,,,Percent of total Billed charges,77% of total billed charges,2586.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,875.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.14,4556.83,
CT MAXILLOFACIAL W/O DYE,T990410011,CDM,351,RC,70486,HCPCS,Outpatient,,,2298,1149,,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1004.72,400,,,fee schedule,400% of healthlink fee schedule,941.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1004.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.72,2644.5,
ONE CALL-CT MAXILLOFACIAL W/O,T990410012,CDM,351,RC,70486,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1004.72,400,,,fee schedule,400% of healthlink fee schedule,941.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1004.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT MAXILLOFACIAL WITH,T990410014,CDM,351,RC,70487,HCPCS,Outpatient,,,2435.5,1217.75,,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3440.89,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1218.84,400,,,fee schedule,400% of healthlink fee schedule,1142.66,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1218.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3440.89,
CT MAXILLOFACIAL W & W/O,T990410015,CDM,351,RC,70488,HCPCS,Outpatient,,,3043.5,1521.75,,2343.5,77,,,Percent of Total Billed Charges,77% of total billed charges,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,951.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4292.89,350,,,fee schedule,350% of bcbs fee schedule,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2556.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2495.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1481.92,400,,,fee schedule,400% of healthlink fee schedule,1389.3,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1481.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2343.5,77,,,Percent of total Billed charges,77% of total billed charges,2586.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,875.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,4292.89,
CT NECK SOFT TISS /WO,T990410016,CDM,351,RC,70490,HCPCS,Outpatient,,,2298,1149,,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,990.8,400,,,fee schedule,400% of healthlink fee schedule,928.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,990.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.72,2644.5,
ONE CALL-CT NECK W/O,T990410017,CDM,351,RC,70490,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,990.8,400,,,fee schedule,400% of healthlink fee schedule,928.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,990.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,159.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,159.72,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT SOFT TISSUE NECK W/DYE,T990410018,CDM,351,RC,70491,HCPCS,Outpatient,,,2435.5,1217.75,,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3302.11,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1193.64,400,,,fee schedule,400% of healthlink fee schedule,1119.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1193.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3302.11,
ONE CALL-CT NECK W,T990410019,CDM,351,RC,70491,HCPCS,Outpatient,,,385,192.5,,296.45,77,,,Percent of Total Billed Charges,77% of total billed charges,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3302.11,350,,,fee schedule,350% of bcbs fee schedule,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,323.4,84,,,Percent of Total Billed Charges,84% of total billed charges,315.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1193.64,400,,,fee schedule,400% of healthlink fee schedule,1119.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1193.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.45,77,,,Percent of total Billed charges,77% of total billed charges,327.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,3302.11,
CT NECK SOFT TISSUE W/WO,T990410021,CDM,351,RC,70492,HCPCS,Outpatient,,,3028.5,1514.25,,2331.95,77,,,Percent of Total Billed Charges,77% of total billed charges,772.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4135.39,350,,,fee schedule,350% of bcbs fee schedule,2089.67,69,,,Percent of Total Billed Charges,69% of total billed charges,2089.67,69,,,Percent of Total Billed Charges,69% of total billed charges,757.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2089.67,69,,,Percent of Total Billed Charges,69% of total billed charges,2089.67,69,,,Percent of Total Billed Charges,69% of total billed charges,2543.94,84,,,Percent of Total Billed Charges,84% of total billed charges,2483.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1447.16,400,,,fee schedule,400% of healthlink fee schedule,1356.71,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1447.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,757.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2331.95,77,,,Percent of total Billed charges,77% of total billed charges,2574.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,870.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,757.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,757.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,4135.39,
ONE CALL-CT NECK W W/O,T990410022,CDM,351,RC,70492,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4135.39,350,,,fee schedule,350% of bcbs fee schedule,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,84,,,Percent of Total Billed Charges,84% of total billed charges,354.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1447.16,400,,,fee schedule,400% of healthlink fee schedule,1356.71,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1447.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108,4135.39,
CTA HEAD WWO,T990410023,CDM,350,RC,70496,HCPCS,Outpatient,,,2533.5,1266.75,,1950.8,77,,,Percent of Total Billed Charges,77% of total billed charges,646.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,646.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,791.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4617.03,350,,,fee schedule,350% of bcbs fee schedule,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2077.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2347.88,400,,,fee schedule,400% of healthlink fee schedule,2201.14,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2347.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,301.73,120,,,Fee Schedule,120% of MO Medicaid Rate,301.73,120,,,Fee Schedule,120% of MO Medicaid Rate,301.73,120,,,Fee Schedule,120% of MO of Medicaid Rate,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1950.8,77,,,Percent of total Billed charges,77% of total billed charges,2153.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,728.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,301.73,120,,,Fee Schedule,120% of MO Medicaid Rate,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,301.73,4617.03,
CTA NECK WWO,T990410024,CDM,350,RC,70498,HCPCS,Outpatient,,,2533.5,1266.75,,1950.8,77,,,Percent of Total Billed Charges,77% of total billed charges,646.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,646.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,791.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4617.03,350,,,fee schedule,350% of bcbs fee schedule,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1748.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2077.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.72,400,,,fee schedule,400% of healthlink fee schedule,2212.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2359.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,302.21,120,,,Fee Schedule,120% of MO Medicaid Rate,302.21,120,,,Fee Schedule,120% of MO Medicaid Rate,302.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1950.8,77,,,Percent of total Billed charges,77% of total billed charges,2153.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,728.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,302.21,120,,,Fee Schedule,120% of MO Medicaid Rate,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,633.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.21,4617.03,
CT CHEST W/OUT CONT,T990410025,CDM,352,RC,71250,HCPCS,Outpatient,,,2297.5,1148.75,,1769.08,77,,,Percent of Total Billed Charges,77% of total billed charges,585.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.28,69,,,Percent of Total Billed Charges,69% of total billed charges,574.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.9,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,977.16,400,,,fee schedule,400% of healthlink fee schedule,916.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,977.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,179.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.08,77,,,Percent of total Billed charges,77% of total billed charges,1952.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,574.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.52,2644.5,
ONE CALL-CT CHEST W/O,T990410026,CDM,352,RC,71250,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,977.16,400,,,fee schedule,400% of healthlink fee schedule,916.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,977.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,179.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,179.52,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT CHEST W/CONTRAST,T990410027,CDM,352,RC,71260,HCPCS,Outpatient,,,2460.5,1230.25,,1894.59,77,,,Percent of Total Billed Charges,77% of total billed charges,627.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,627.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,768.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3408.44,350,,,fee schedule,350% of bcbs fee schedule,1697.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1697.75,69,,,Percent of Total Billed Charges,69% of total billed charges,615.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1697.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1697.75,69,,,Percent of Total Billed Charges,69% of total billed charges,2066.82,84,,,Percent of Total Billed Charges,84% of total billed charges,2017.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1177.36,400,,,fee schedule,400% of healthlink fee schedule,1103.78,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1177.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,258.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,615.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.59,77,,,Percent of total Billed charges,77% of total billed charges,2091.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,707.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,615.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,615.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.72,3408.44,
ONE CALL-CT CHEST W,T990410028,CDM,352,RC,71260,HCPCS,Outpatient,,,385,192.5,,296.45,77,,,Percent of Total Billed Charges,77% of total billed charges,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3408.44,350,,,fee schedule,350% of bcbs fee schedule,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,323.4,84,,,Percent of Total Billed Charges,84% of total billed charges,315.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1177.36,400,,,fee schedule,400% of healthlink fee schedule,1103.78,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1177.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,258.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.45,77,,,Percent of total Billed charges,77% of total billed charges,327.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,258.72,120,,,Fee Schedule,120% of MO Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,3408.44,
CT CHEST W/OUT W/CONT,T990410029,CDM,352,RC,71270,HCPCS,Outpatient,,,2564.5,1282.25,,1974.67,77,,,Percent of Total Billed Charges,77% of total billed charges,653.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,653.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4288.31,350,,,fee schedule,350% of bcbs fee schedule,1769.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1769.51,69,,,Percent of Total Billed Charges,69% of total billed charges,641.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1769.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2154.18,84,,,Percent of Total Billed Charges,84% of total billed charges,2102.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,1452.36,400,,,fee schedule,400% of healthlink fee schedule,1361.59,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1452.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,230.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,641.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1974.67,77,,,Percent of total Billed charges,77% of total billed charges,2179.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,737.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,641.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,641.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.99,4288.31,
ONE CALL-CT CHEST W W/O,T990410030,CDM,352,RC,71270,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4288.31,350,,,fee schedule,350% of bcbs fee schedule,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,84,,,Percent of Total Billed Charges,84% of total billed charges,354.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1452.36,400,,,fee schedule,400% of healthlink fee schedule,1361.59,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1452.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,230.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,230.99,120,,,Fee Schedule,120% of MO Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108,4288.31,
"CT CHEST, LOW DOSE",T990410031,CDM,352,RC,71271,HCPCS,Outpatient,,,2231,1115.5,,1717.87,77,,,Percent of Total Billed Charges,77% of total billed charges,568.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,568.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,697.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1026.27,350,,,fee schedule,350% of bcbs fee schedule,1539.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1539.39,69,,,Percent of Total Billed Charges,69% of total billed charges,557.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1539.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1539.39,69,,,Percent of Total Billed Charges,69% of total billed charges,1874.04,84,,,Percent of Total Billed Charges,84% of total billed charges,1829.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,1985.59,89,,,Percent of total Billed Charges,89% of total Billed charges,1985.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1985.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,136.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,557.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1717.87,77,,,Percent of total Billed charges,77% of total billed charges,1896.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,641.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,136.48,120,,,Fee Schedule,120% of MO Medicaid Rate,557.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,557.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.48,1985.59,
CT CHEST - ANGIOGRAPHY,T990410032,CDM,352,RC,71275,HCPCS,Outpatient,,,3053.5,1526.75,,2351.2,77,,,Percent of Total Billed Charges,77% of total billed charges,778.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,778.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,954.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4612.34,350,,,fee schedule,350% of bcbs fee schedule,2106.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2106.92,69,,,Percent of Total Billed Charges,69% of total billed charges,763.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2106.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2106.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2564.94,84,,,Percent of Total Billed Charges,84% of total billed charges,2503.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,1721.12,400,,,fee schedule,400% of healthlink fee schedule,1613.55,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1721.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,298.48,120,,,Fee Schedule,120% of MO Medicaid Rate,298.48,120,,,Fee Schedule,120% of MO Medicaid Rate,298.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,763.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2351.2,77,,,Percent of total Billed charges,77% of total billed charges,2595.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,877.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,298.48,120,,,Fee Schedule,120% of MO Medicaid Rate,763.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,763.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.48,4612.34,
CT C-SPINE /WO,T990410033,CDM,352,RC,72125,HCPCS,Outpatient,,,2807.5,1403.75,,2161.78,77,,,Percent of Total Billed Charges,77% of total billed charges,715.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,715.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,877.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1937.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1937.18,69,,,Percent of Total Billed Charges,69% of total billed charges,701.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1937.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1937.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2358.3,84,,,Percent of Total Billed Charges,84% of total billed charges,2302.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,978.32,400,,,fee schedule,400% of healthlink fee schedule,917.18,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,978.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,701.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2161.78,77,,,Percent of total Billed charges,77% of total billed charges,2386.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,807.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,701.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,701.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.88,2644.5,
ONE CALL-CT C-SPINE W/O,T990410034,CDM,352,RC,72125,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,978.32,400,,,fee schedule,400% of healthlink fee schedule,917.18,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,978.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT C SPINE WITH CONTRAST,T990410035,CDM,352,RC,72126,HCPCS,Outpatient,,,2939.5,1469.75,,2263.42,77,,,Percent of Total Billed Charges,77% of total billed charges,749.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,918.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3417.75,350,,,fee schedule,350% of bcbs fee schedule,2028.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2028.26,69,,,Percent of Total Billed Charges,69% of total billed charges,734.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2028.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2028.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2469.18,84,,,Percent of Total Billed Charges,84% of total billed charges,2410.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.48,400,,,fee schedule,400% of healthlink fee schedule,1101.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1174.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,734.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2263.42,77,,,Percent of total Billed charges,77% of total billed charges,2498.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,845.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,734.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,734.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.56,3417.75,
CT C-SPINE W/WO,T990410036,CDM,352,RC,72127,HCPCS,Outpatient,,,2435.5,1217.75,,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4283.72,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1428.2,400,,,fee schedule,400% of healthlink fee schedule,1338.94,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1428.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.97,4283.72,
CT T-SPINE /WO,T990410037,CDM,352,RC,72128,HCPCS,Outpatient,,,2355,1177.5,,1813.35,77,,,Percent of Total Billed Charges,77% of total billed charges,600.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,600.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,735.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1624.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1624.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1624.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1624.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1978.2,84,,,Percent of Total Billed Charges,84% of total billed charges,1931.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,977.16,400,,,fee schedule,400% of healthlink fee schedule,916.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,977.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,588.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1813.35,77,,,Percent of total Billed charges,77% of total billed charges,2001.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,677.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,588.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,588.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.88,2644.5,
ONE CALL-CT T-SPINR W/O,T990410038,CDM,352,RC,72128,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,977.16,400,,,fee schedule,400% of healthlink fee schedule,916.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,977.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT T SPINE WITH CONTRAST,T990410039,CDM,352,RC,72129,HCPCS,Outpatient,,,2506,1253,,1929.62,77,,,Percent of Total Billed Charges,77% of total billed charges,639.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,783.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3422.3,350,,,fee schedule,350% of bcbs fee schedule,1729.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1729.14,69,,,Percent of Total Billed Charges,69% of total billed charges,626.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1729.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1729.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2105.04,84,,,Percent of Total Billed Charges,84% of total billed charges,2054.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1173.28,400,,,fee schedule,400% of healthlink fee schedule,1099.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1173.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,626.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.62,77,,,Percent of total Billed charges,77% of total billed charges,2130.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,720.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,626.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,626.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.56,3422.3,
CT T-SPINE W/WO,T990410040,CDM,352,RC,72130,HCPCS,Outpatient,,,3043.5,1521.75,,2343.5,77,,,Percent of Total Billed Charges,77% of total billed charges,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,951.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4288.31,350,,,fee schedule,350% of bcbs fee schedule,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2556.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2495.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1430.56,400,,,fee schedule,400% of healthlink fee schedule,1341.15,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1430.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,237.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2343.5,77,,,Percent of total Billed charges,77% of total billed charges,2586.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,875.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,237.97,120,,,Fee Schedule,120% of MO Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.97,4288.31,
CT L-SPINE /WO,T990410041,CDM,352,RC,72131,HCPCS,Outpatient,,,2305.5,1152.75,,1775.24,77,,,Percent of Total Billed Charges,77% of total billed charges,587.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,587.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,720.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1590.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1590.8,69,,,Percent of Total Billed Charges,69% of total billed charges,576.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1590.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1590.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1936.62,84,,,Percent of Total Billed Charges,84% of total billed charges,1890.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,973.6,400,,,fee schedule,400% of healthlink fee schedule,912.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,973.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,576.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1775.24,77,,,Percent of total Billed charges,77% of total billed charges,1959.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,662.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,576.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,576.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.88,2644.5,
ONE CALL-CT L-SPINE W/O,T990410042,CDM,352,RC,72131,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,973.6,400,,,fee schedule,400% of healthlink fee schedule,912.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,973.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,180.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,180.88,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT L SPINE WITH CONTRAST,T990410043,CDM,352,RC,72132,HCPCS,Outpatient,,,2794.5,1397.25,,2151.77,77,,,Percent of Total Billed Charges,77% of total billed charges,712.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,712.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,873.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3413.17,350,,,fee schedule,350% of bcbs fee schedule,1928.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1928.21,69,,,Percent of Total Billed Charges,69% of total billed charges,698.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1928.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1928.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.38,84,,,Percent of Total Billed Charges,84% of total billed charges,2291.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,1172.08,400,,,fee schedule,400% of healthlink fee schedule,1098.83,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1172.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,274.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,698.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2151.77,77,,,Percent of total Billed charges,77% of total billed charges,2375.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,803.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,274.56,120,,,Fee Schedule,120% of MO Medicaid Rate,698.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,698.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.56,3413.17,
CT L-SPINE W/WO,T990410044,CDM,352,RC,72133,HCPCS,Outpatient,,,2851.5,1425.75,,2195.66,77,,,Percent of Total Billed Charges,77% of total billed charges,727.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,727.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,891.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4283.72,350,,,fee schedule,350% of bcbs fee schedule,1967.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1967.54,69,,,Percent of Total Billed Charges,69% of total billed charges,712.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1967.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1967.54,69,,,Percent of Total Billed Charges,69% of total billed charges,2395.26,84,,,Percent of Total Billed Charges,84% of total billed charges,2338.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,1429.4,400,,,fee schedule,400% of healthlink fee schedule,1340.06,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1429.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,712.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2195.66,77,,,Percent of total Billed charges,77% of total billed charges,2423.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,819.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,712.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,712.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.68,4283.72,
CTA PELVIS WWO,T990410045,CDM,350,RC,72191,HCPCS,Outpatient,,,2180,1090,,1678.6,77,,,Percent of Total Billed Charges,77% of total billed charges,555.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,681.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4612.34,350,,,fee schedule,350% of bcbs fee schedule,1504.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1504.2,69,,,Percent of Total Billed Charges,69% of total billed charges,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1504.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1831.2,84,,,Percent of Total Billed Charges,84% of total billed charges,1787.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1656.44,400,,,fee schedule,400% of healthlink fee schedule,1552.91,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1656.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,294.32,120,,,Fee Schedule,120% of MO Medicaid Rate,294.32,120,,,Fee Schedule,120% of MO Medicaid Rate,294.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1678.6,77,,,Percent of total Billed charges,77% of total billed charges,1853,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,294.32,120,,,Fee Schedule,120% of MO Medicaid Rate,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,545,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.32,4612.34,
CT PELVIS W/O CONTRAST,T990410046,CDM,352,RC,72192,HCPCS,Outpatient,,,2298,1149,,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2588.95,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,917.28,400,,,fee schedule,400% of healthlink fee schedule,859.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,917.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,178.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,2588.95,
ONE CALL-CT PELVIS W/O,T990410047,CDM,350,RC,72192,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2588.95,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,917.28,400,,,fee schedule,400% of healthlink fee schedule,859.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,917.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,178.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,178.2,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2588.95,
CT PELVIS WITH CONTRAST,T990410048,CDM,350,RC,72193,HCPCS,Outpatient,,,2655.5,1327.75,,2044.74,77,,,Percent of Total Billed Charges,77% of total billed charges,677.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,829.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3237.08,350,,,fee schedule,350% of bcbs fee schedule,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2230.62,84,,,Percent of Total Billed Charges,84% of total billed charges,2177.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1112.24,400,,,fee schedule,400% of healthlink fee schedule,1042.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1112.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2044.74,77,,,Percent of total Billed charges,77% of total billed charges,2257.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,763.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.92,3237.08,
CT PELVIS WITH CONTRAST,T990410049,CDM,352,RC,72193,HCPCS,Outpatient,,,2655.5,1327.75,,2044.74,77,,,Percent of Total Billed Charges,77% of total billed charges,677.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,829.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3237.08,350,,,fee schedule,350% of bcbs fee schedule,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1832.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2230.62,84,,,Percent of Total Billed Charges,84% of total billed charges,2177.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1112.24,400,,,fee schedule,400% of healthlink fee schedule,1042.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1112.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2044.74,77,,,Percent of total Billed charges,77% of total billed charges,2257.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,763.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,663.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.92,3237.08,
ONE CALL-CT PELVIS W,T990410050,CDM,350,RC,72193,HCPCS,Outpatient,,,385,192.5,,296.45,77,,,Percent of Total Billed Charges,77% of total billed charges,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3237.08,350,,,fee schedule,350% of bcbs fee schedule,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,323.4,84,,,Percent of Total Billed Charges,84% of total billed charges,315.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1112.24,400,,,fee schedule,400% of healthlink fee schedule,1042.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1112.24,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,268.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.45,77,,,Percent of total Billed charges,77% of total billed charges,327.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,268.92,120,,,Fee Schedule,120% of MO Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,3237.08,
CT PELVIS W+W/O CONTRAST,T990410051,CDM,352,RC,72194,HCPCS,Outpatient,,,3043.5,1521.75,,2343.5,77,,,Percent of Total Billed Charges,77% of total billed charges,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,776.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,951.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4329.92,350,,,fee schedule,350% of bcbs fee schedule,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2100.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2556.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2495.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1434.2,400,,,fee schedule,400% of healthlink fee schedule,1344.56,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1434.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2343.5,77,,,Percent of total Billed charges,77% of total billed charges,2586.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,875.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,760.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,278.68,4329.92,
ONE CALL-CT PELVIS W W/O,T990410052,CDM,350,RC,72194,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4329.92,350,,,fee schedule,350% of bcbs fee schedule,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,84,,,Percent of Total Billed Charges,84% of total billed charges,354.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1434.2,400,,,fee schedule,400% of healthlink fee schedule,1344.56,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1434.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,278.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,278.68,120,,,Fee Schedule,120% of MO Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108,4329.92,
ONE CALL-CT UPPER EXT W/O,T990410053,CDM,352,RC,72200,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.82,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.72,400,,,fee schedule,400% of healthlink fee schedule,92.55,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,98.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,22.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,22.46,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.46,889,
CT LT UPPER EXT W/O CONT,T990410054,CDM,352,RC,73200,HCPCS,Outpatient,,,2298,1149,LT,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.12,400,,,fee schedule,400% of healthlink fee schedule,890.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,950.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.56,2644.5,
CT RT UPPER EXT W/O CONT,T990410055,CDM,352,RC,73200,HCPCS,Outpatient,,,2298,1149,RT,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.12,400,,,fee schedule,400% of healthlink fee schedule,890.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,950.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.56,2644.5,
CT LT UPPER EXT W/CONT,T990410056,CDM,352,RC,73201,HCPCS,Outpatient,,,2435.5,1217.75,LT,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3306.66,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1147.72,400,,,fee schedule,400% of healthlink fee schedule,1075.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1147.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3306.66,
CT RT UPPER EXT W/CONT,T990410057,CDM,352,RC,73201,HCPCS,Outpatient,,,2709,1354.5,RT,2085.93,77,,,Percent of Total Billed Charges,77% of total billed charges,690.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,690.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3306.66,350,,,fee schedule,350% of bcbs fee schedule,1869.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.21,69,,,Percent of Total Billed Charges,69% of total billed charges,677.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.56,84,,,Percent of Total Billed Charges,84% of total billed charges,2221.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1147.72,400,,,fee schedule,400% of healthlink fee schedule,1075.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1147.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,677.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2085.93,77,,,Percent of total Billed charges,77% of total billed charges,2302.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,778.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,677.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,677.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3306.66,
CT LT UPPER EXT W/WO CONT,T990410058,CDM,352,RC,73202,HCPCS,Outpatient,,,2435.5,1217.75,LT,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4413.43,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1480.56,400,,,fee schedule,400% of healthlink fee schedule,1388.03,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1480.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.14,4413.43,
CT RT UPPER EXT W/WO,T990410059,CDM,352,RC,73202,HCPCS,Outpatient,,,2435.5,1217.75,RT,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4413.43,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1480.56,400,,,fee schedule,400% of healthlink fee schedule,1388.03,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1480.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.14,4413.43,
CTA UPPER EXT WWO,T990410060,CDM,350,RC,73206,HCPCS,Outpatient,,,2077.5,1038.75,,1599.68,77,,,Percent of Total Billed Charges,77% of total billed charges,529.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,529.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,649.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4612.34,350,,,fee schedule,350% of bcbs fee schedule,1433.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1433.48,69,,,Percent of Total Billed Charges,69% of total billed charges,519.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1433.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1433.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1745.1,84,,,Percent of Total Billed Charges,84% of total billed charges,1703.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1607.88,400,,,fee schedule,400% of healthlink fee schedule,1507.39,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1607.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,271.4,120,,,Fee Schedule,120% of MO Medicaid Rate,271.4,120,,,Fee Schedule,120% of MO Medicaid Rate,271.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,519.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1599.68,77,,,Percent of total Billed charges,77% of total billed charges,1765.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,597.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,271.4,120,,,Fee Schedule,120% of MO Medicaid Rate,519.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,519.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.4,4612.34,
CT LT LOWER EXT W/O CONT,T990410061,CDM,352,RC,73700,HCPCS,Outpatient,,,2298,1149,LT,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,952.48,400,,,fee schedule,400% of healthlink fee schedule,892.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,952.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.56,2644.5,
CT RT LOWER EXTREMITY W/O CO,T990410062,CDM,352,RC,73700,HCPCS,Outpatient,,,2298,1149,RT,1769.46,77,,,Percent of Total Billed Charges,77% of total billed charges,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,718.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1585.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1884.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,952.48,400,,,fee schedule,400% of healthlink fee schedule,892.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,952.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1769.46,77,,,Percent of total Billed charges,77% of total billed charges,1953.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,574.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.56,2644.5,
ONE CALL-CT LOWER EXT W/O,T990410063,CDM,352,RC,73700,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2644.5,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,952.48,400,,,fee schedule,400% of healthlink fee schedule,892.95,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,952.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,164.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,164.56,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2644.5,
CT LT LOWER EXT W/CONT,T990410064,CDM,352,RC,73701,HCPCS,Outpatient,,,2435.5,1217.75,LT,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3343.69,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1154.8,400,,,fee schedule,400% of healthlink fee schedule,1082.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1154.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3343.69,
CT RT LOWER EXT W/CONT,T990410065,CDM,352,RC,73701,HCPCS,Outpatient,,,2909,1454.5,RT,2239.93,77,,,Percent of Total Billed Charges,77% of total billed charges,741.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,741.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,909.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3343.69,350,,,fee schedule,350% of bcbs fee schedule,2007.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2007.21,69,,,Percent of Total Billed Charges,69% of total billed charges,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2007.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2007.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2443.56,84,,,Percent of Total Billed Charges,84% of total billed charges,2385.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1154.8,400,,,fee schedule,400% of healthlink fee schedule,1082.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1154.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,238.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2239.93,77,,,Percent of total Billed charges,77% of total billed charges,2472.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,836.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,238.92,120,,,Fee Schedule,120% of MO Medicaid Rate,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,727.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.92,3343.69,
CT LT LOWER EXT W/WO CONT,T990410066,CDM,352,RC,73702,HCPCS,Outpatient,,,2435.5,1217.75,LT,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4436.57,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1482.92,400,,,fee schedule,400% of healthlink fee schedule,1390.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1482.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.14,4436.57,
CT RT LOWER EXT W/WO,T990410067,CDM,352,RC,73702,HCPCS,Outpatient,,,2435.5,1217.75,RT,1875.34,77,,,Percent of Total Billed Charges,77% of total billed charges,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,621.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,761.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4436.57,350,,,fee schedule,350% of bcbs fee schedule,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.5,69,,,Percent of Total Billed Charges,69% of total billed charges,2045.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1997.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1482.92,400,,,fee schedule,400% of healthlink fee schedule,1390.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1482.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,246.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1875.34,77,,,Percent of total Billed charges,77% of total billed charges,2070.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,700.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,246.14,120,,,Fee Schedule,120% of MO Medicaid Rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,608.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.14,4436.57,
CTA LOWER EXT WWO,T990410068,CDM,350,RC,73706,HCPCS,Outpatient,,,2192,1096,,1687.84,77,,,Percent of Total Billed Charges,77% of total billed charges,558.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,558.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,685,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4612.34,350,,,fee schedule,350% of bcbs fee schedule,1512.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1512.48,69,,,Percent of Total Billed Charges,69% of total billed charges,548,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1512.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1512.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1841.28,84,,,Percent of Total Billed Charges,84% of total billed charges,1797.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,1784.32,400,,,fee schedule,400% of healthlink fee schedule,1672.8,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1784.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,280.04,120,,,Fee Schedule,120% of MO Medicaid Rate,280.04,120,,,Fee Schedule,120% of MO Medicaid Rate,280.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,548,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1687.84,77,,,Percent of total Billed charges,77% of total billed charges,1863.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,630.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,280.04,120,,,Fee Schedule,120% of MO Medicaid Rate,548,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,548,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.04,4612.34,
CT ABD W/OUT CONTRAST,T990410069,CDM,352,RC,74150,HCPCS,Outpatient,,,2420.5,1210.25,,1863.79,77,,,Percent of Total Billed Charges,77% of total billed charges,617.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,617.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,756.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2570.37,350,,,fee schedule,350% of bcbs fee schedule,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,2033.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1984.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,935.04,400,,,fee schedule,400% of healthlink fee schedule,876.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,935.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1863.79,77,,,Percent of total Billed charges,77% of total billed charges,2057.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,695.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.65,2570.37,
ONE CALL-CT ABDOMEN W/O,T990410070,CDM,350,RC,74150,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2570.37,350,,,fee schedule,350% of bcbs fee schedule,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,935.04,400,,,fee schedule,400% of healthlink fee schedule,876.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,935.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,156.65,120,,,Fee Schedule,120% of MO Medicaid Rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,2570.37,
CT ABD W/CONTRAST,T990410071,CDM,352,RC,74160,HCPCS,Outpatient,,,2797.5,1398.75,,2154.08,77,,,Percent of Total Billed Charges,77% of total billed charges,713.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,713.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,874.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3704.86,350,,,fee schedule,350% of bcbs fee schedule,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2349.9,84,,,Percent of Total Billed Charges,84% of total billed charges,2293.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.6,400,,,fee schedule,400% of healthlink fee schedule,1197.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1277.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2154.08,77,,,Percent of total Billed charges,77% of total billed charges,2377.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,804.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.45,3704.86,
CT ABDOMEN WITH CONTRAST,T990410072,CDM,350,RC,74160,HCPCS,Outpatient,,,2797.5,1398.75,,2154.08,77,,,Percent of Total Billed Charges,77% of total billed charges,713.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,713.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,874.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3704.86,350,,,fee schedule,350% of bcbs fee schedule,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1930.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2349.9,84,,,Percent of Total Billed Charges,84% of total billed charges,2293.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.6,400,,,fee schedule,400% of healthlink fee schedule,1197.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1277.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2154.08,77,,,Percent of total Billed charges,77% of total billed charges,2377.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,804.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,699.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.45,3704.86,
ONE CALL-CT ABDOMEN W,T990410073,CDM,350,RC,74160,HCPCS,Outpatient,,,385,192.5,,296.45,77,,,Percent of Total Billed Charges,77% of total billed charges,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3704.86,350,,,fee schedule,350% of bcbs fee schedule,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,265.65,69,,,Percent of Total Billed Charges,69% of total billed charges,323.4,84,,,Percent of Total Billed Charges,84% of total billed charges,315.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.6,400,,,fee schedule,400% of healthlink fee schedule,1197.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1277.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,242.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.45,77,,,Percent of total Billed charges,77% of total billed charges,327.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,242.45,120,,,Fee Schedule,120% of MO Medicaid Rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.25,3704.86,
CT ABD W/OUT W/CONTRAST,T990410074,CDM,352,RC,74170,HCPCS,Outpatient,,,2922.5,1461.25,,2250.33,77,,,Percent of Total Billed Charges,77% of total billed charges,745.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,745.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,913.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4556.83,350,,,fee schedule,350% of bcbs fee schedule,2016.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2016.53,69,,,Percent of Total Billed Charges,69% of total billed charges,730.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2016.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2016.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2454.9,84,,,Percent of Total Billed Charges,84% of total billed charges,2396.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,1700.84,400,,,fee schedule,400% of healthlink fee schedule,1594.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1700.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,234.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,730.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2250.33,77,,,Percent of total Billed charges,77% of total billed charges,2484.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,840.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,730.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,730.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.36,4556.83,
ONE CALL-CT ABDOMEN W W/O,T990410075,CDM,350,RC,74170,HCPCS,Outpatient,,,432,216,,332.64,77,,,Percent of Total Billed Charges,77% of total billed charges,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4556.83,350,,,fee schedule,350% of bcbs fee schedule,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,298.08,69,,,Percent of Total Billed Charges,69% of total billed charges,362.88,84,,,Percent of Total Billed Charges,84% of total billed charges,354.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,1700.84,400,,,fee schedule,400% of healthlink fee schedule,1594.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1700.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,234.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.64,77,,,Percent of total Billed charges,77% of total billed charges,367.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,234.36,120,,,Fee Schedule,120% of MO Medicaid Rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,108,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108,4556.83,
CTA ABD/PELV W & W/O CONTRAST,T990410076,CDM,350,RC,74174,HCPCS,Outpatient,,,4864.5,2432.25,,3745.67,77,,,Percent of Total Billed Charges,77% of total billed charges,1240.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1240.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1520.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5803.42,350,,,fee schedule,350% of bcbs fee schedule,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,4086.18,84,,,Percent of Total Billed Charges,84% of total billed charges,3988.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,4329.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4329.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4329.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.23,120,,,Fee Schedule,120% of MO Medicaid Rate,335.23,120,,,Fee Schedule,120% of MO Medicaid Rate,335.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3745.67,77,,,Percent of total Billed charges,77% of total billed charges,4134.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1398.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,335.23,120,,,Fee Schedule,120% of MO Medicaid Rate,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.23,5803.42,
CTA ABD WWO,T990410077,CDM,350,RC,74175,HCPCS,Outpatient,,,2785.5,1392.75,,2144.84,77,,,Percent of Total Billed Charges,77% of total billed charges,710.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,710.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,870.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4617.03,350,,,fee schedule,350% of bcbs fee schedule,1922,69,,,Percent of Total Billed Charges,69% of total billed charges,1922,69,,,Percent of Total Billed Charges,69% of total billed charges,696.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922,69,,,Percent of Total Billed Charges,69% of total billed charges,1922,69,,,Percent of Total Billed Charges,69% of total billed charges,2339.82,84,,,Percent of Total Billed Charges,84% of total billed charges,2284.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1780.76,400,,,fee schedule,400% of healthlink fee schedule,1669.46,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1780.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,299.5,120,,,Fee Schedule,120% of MO Medicaid Rate,299.5,120,,,Fee Schedule,120% of MO Medicaid Rate,299.5,120,,,Fee Schedule,120% of MO of Medicaid Rate,696.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2144.84,77,,,Percent of total Billed charges,77% of total billed charges,2367.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,800.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,299.5,120,,,Fee Schedule,120% of MO Medicaid Rate,696.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,696.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.5,4617.03,
CT ABD & PELV W/O CONTRAST,T990410078,CDM,352,RC,74176,HCPCS,Outpatient,,,4864.5,2432.25,,3745.67,77,,,Percent of Total Billed Charges,77% of total billed charges,1240.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1240.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1520.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1797.18,350,,,fee schedule,350% of bcbs fee schedule,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3356.51,69,,,Percent of Total Billed Charges,69% of total billed charges,4086.18,84,,,Percent of Total Billed Charges,84% of total billed charges,3988.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,4329.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4329.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4329.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.63,120,,,Fee Schedule,120% of MO Medicaid Rate,98.63,120,,,Fee Schedule,120% of MO Medicaid Rate,98.63,120,,,Fee Schedule,120% of MO of Medicaid Rate,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3745.67,77,,,Percent of total Billed charges,77% of total billed charges,4134.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1398.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,98.63,120,,,Fee Schedule,120% of MO Medicaid Rate,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,1216.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.63,4329.41,
CT ABD & PELV WITH CONTRAST,T990410079,CDM,352,RC,74177,HCPCS,Outpatient,,,5087,2543.5,,3916.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1297.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1297.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1589.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3427.03,350,,,fee schedule,350% of bcbs fee schedule,3510.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3510.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3510.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3510.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4273.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4171.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4527.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4527.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4527.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.56,120,,,Fee Schedule,120% of MO Medicaid Rate,214.56,120,,,Fee Schedule,120% of MO Medicaid Rate,214.56,120,,,Fee Schedule,120% of MO of Medicaid Rate,1271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3916.99,77,,,Percent of total Billed charges,77% of total billed charges,4323.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1462.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,214.56,120,,,Fee Schedule,120% of MO Medicaid Rate,1271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,1271.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.56,4527.43,
CT ABD & PELV W & W/O CONTRAST,T990410080,CDM,352,RC,74178,HCPCS,Outpatient,,,5751.5,2875.75,,4428.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1466.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1466.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1797.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4529.11,350,,,fee schedule,350% of bcbs fee schedule,3968.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3968.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1437.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3968.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3968.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4831.26,84,,,Percent of Total Billed Charges,84% of total billed charges,4716.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,5118.84,89,,,Percent of total Billed Charges,89% of total Billed charges,5118.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5118.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.57,120,,,Fee Schedule,120% of MO Medicaid Rate,248.57,120,,,Fee Schedule,120% of MO Medicaid Rate,248.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,1437.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4428.66,77,,,Percent of total Billed charges,77% of total billed charges,4888.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1653.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,248.57,120,,,Fee Schedule,120% of MO Medicaid Rate,1437.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,1437.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.57,5118.84,
CT HEART SCORE,T990410081,CDM,350,RC,75571,HCPCS,Outpatient,,,75,37.5,,57.75,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,634.87,350,,,fee schedule,350% of bcbs fee schedule,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,51.75,69,,,Percent of Total Billed Charges,69% of total billed charges,63,84,,,Percent of Total Billed Charges,84% of total billed charges,61.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.75,89,,,Percent of total Billed Charges,89% of total Billed charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.75,77,,,Percent of total Billed charges,77% of total billed charges,63.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,889,
CT HEART SCORE Profile,T990410082,CDM,350,RC,75571,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,634.87,350,,,fee schedule,350% of bcbs fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,68.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,889,100,,,Case Rate,Pays based on per visit rate,68.06,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,770,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,68.06,889,
CTA RUNOFF WWO,T990410083,CDM,350,RC,75635,HCPCS,Outpatient,,,3608,1804,,2778.16,77,,,Percent of Total Billed Charges,77% of total billed charges,920.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4612.97,350,,,fee schedule,350% of bcbs fee schedule,2489.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2489.52,69,,,Percent of Total Billed Charges,69% of total billed charges,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2489.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2489.52,69,,,Percent of Total Billed Charges,69% of total billed charges,3030.72,84,,,Percent of Total Billed Charges,84% of total billed charges,2958.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1928.28,400,,,fee schedule,400% of healthlink fee schedule,1807.76,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1928.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,367.88,120,,,Fee Schedule,120% of MO Medicaid Rate,367.88,120,,,Fee Schedule,120% of MO Medicaid Rate,367.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2778.16,77,,,Percent of total Billed charges,77% of total billed charges,3066.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1037.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,367.88,120,,,Fee Schedule,120% of MO Medicaid Rate,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,902,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,367.88,4612.97,
PERCUTAN DRAIN CT US OR FLUORO,T990410084,CDM,350,RC,75989,HCPCS,Outpatient,,,884,442,,680.68,77,,,Percent of Total Billed Charges,77% of total billed charges,225.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,867.06,350,,,fee schedule,350% of bcbs fee schedule,609.96,69,,,Percent of Total Billed Charges,69% of total billed charges,609.96,69,,,Percent of Total Billed Charges,69% of total billed charges,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.96,69,,,Percent of Total Billed Charges,69% of total billed charges,609.96,69,,,Percent of Total Billed Charges,69% of total billed charges,742.56,84,,,Percent of Total Billed Charges,84% of total billed charges,724.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,472.16,400,,,fee schedule,400% of healthlink fee schedule,442.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,472.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,86,120,,,Fee Schedule,120% of MO Medicaid Rate,86,120,,,Fee Schedule,120% of MO Medicaid Rate,86,120,,,Fee Schedule,120% of MO of Medicaid Rate,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.68,77,,,Percent of total Billed charges,77% of total billed charges,751.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,86,120,,,Fee Schedule,120% of MO Medicaid Rate,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,221,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86,889,
CT LIMITED OR LOCALIZED,T990410085,CDM,352,RC,76380,HCPCS,Outpatient,,,708.5,354.25,,545.55,77,,,Percent of Total Billed Charges,77% of total billed charges,180.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1547.04,350,,,fee schedule,350% of bcbs fee schedule,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,488.87,69,,,Percent of Total Billed Charges,69% of total billed charges,595.14,84,,,Percent of Total Billed Charges,84% of total billed charges,580.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,727.32,400,,,fee schedule,400% of healthlink fee schedule,681.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,727.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,94.7,120,,,Fee Schedule,120% of MO Medicaid Rate,94.7,120,,,Fee Schedule,120% of MO Medicaid Rate,94.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.55,77,,,Percent of total Billed charges,77% of total billed charges,602.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,94.7,120,,,Fee Schedule,120% of MO Medicaid Rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,177.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.7,1547.04,
CT GUIDED ASPIRATION,T990410086,CDM,350,RC,77012,HCPCS,Outpatient,,,1845,922.5,,1420.65,77,,,Percent of Total Billed Charges,77% of total billed charges,470.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,470.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,576.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1454.46,350,,,fee schedule,350% of bcbs fee schedule,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1549.8,84,,,Percent of Total Billed Charges,84% of total billed charges,1512.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,512.08,400,,,fee schedule,400% of healthlink fee schedule,480.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,512.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1420.65,77,,,Percent of total Billed charges,77% of total billed charges,1568.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,530.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.14,1568.25,
CT GUIDED INJECTION,T990410087,CDM,350,RC,77012,HCPCS,Outpatient,,,1845,922.5,,1420.65,77,,,Percent of Total Billed Charges,77% of total billed charges,470.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,470.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,576.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1454.46,350,,,fee schedule,350% of bcbs fee schedule,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1549.8,84,,,Percent of Total Billed Charges,84% of total billed charges,1512.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,512.08,400,,,fee schedule,400% of healthlink fee schedule,480.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,512.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1420.65,77,,,Percent of total Billed charges,77% of total billed charges,1568.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,530.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.14,1568.25,
CT SOFT TISSUE W/ BIOPSY,T990410088,CDM,350,RC,77012,HCPCS,Outpatient,,,1845,922.5,,1420.65,77,,,Percent of Total Billed Charges,77% of total billed charges,470.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,470.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,576.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1454.46,350,,,fee schedule,350% of bcbs fee schedule,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1273.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1549.8,84,,,Percent of Total Billed Charges,84% of total billed charges,1512.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,512.08,400,,,fee schedule,400% of healthlink fee schedule,480.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,512.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,144.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1420.65,77,,,Percent of total Billed charges,77% of total billed charges,1568.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,530.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,144.14,120,,,Fee Schedule,120% of MO Medicaid Rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,461.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.14,1568.25,
CT LONG BONE SCANOGRAM,T990410094,CDM,352,RC,77073,HCPCS,Outpatient,,,473.5,236.75,,364.6,77,,,Percent of Total Billed Charges,77% of total billed charges,120.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.16,350,,,fee schedule,350% of bcbs fee schedule,326.72,69,,,Percent of Total Billed Charges,69% of total billed charges,326.72,69,,,Percent of Total Billed Charges,69% of total billed charges,118.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.72,69,,,Percent of Total Billed Charges,69% of total billed charges,326.72,69,,,Percent of Total Billed Charges,69% of total billed charges,397.74,84,,,Percent of Total Billed Charges,84% of total billed charges,388.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.72,400,,,fee schedule,400% of healthlink fee schedule,117.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,125.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,29.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,118.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.6,77,,,Percent of total Billed charges,77% of total billed charges,402.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,29.15,120,,,Fee Schedule,120% of MO Medicaid Rate,118.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,118.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.15,889,
EMP HEALTH CT HEART SCORE,T990410097,CDM,350,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,889,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,770,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,770,889,
EMP HEALTH CT HEART SCORE,T990410097,CDM,350,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,889,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,770,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,770,889,
Health Fair CT Heartscore,T990410098,CDM,350,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,889,
HEALTH FAIR CT LUNG SCREENING,T990410099,CDM,320,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,271,
Health Fair CT Lung Screening,T990410100,CDM,352,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,889,100,,,Case Rate,Pays based on per visit rate,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770,100,,,Case Rate,Pays based on per visit rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,889,
HEALTH FAIR HEARTSCORE,T990410101,CDM,320,RC,,,Outpatient,,,52,26,,40.04,77,,,Percent of Total Billed Charges,77% of total billed charges,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.48,74,,,Percent of Total Billed Charges,74% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,35.88,69,,,Percent of Total Billed Charges,69% of total billed charges,43.68,84,,,Percent of Total Billed Charges,84% of total billed charges,42.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,46.28,89,,,Percent of total Billed Charges,89% of total Billed charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.04,77,,,Percent of total Billed charges,77% of total billed charges,44.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,21.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13,271,
PF CT HEART SCORE,T990410102,CDM,972,RC,75571,HCPCS,Outpatient,,,19.5,9.75,26,87.55,135,,,fee schedule,135% of aetna fee schedule,22.43,115,,,fee schedule,115% of cms physician fee schedule,22.87,117.3,,,fee schedule,117.3% of cms physician fee schedule,28.03,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.43,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,94.31,100,,,fee schedule,100% of cigna fee schedule,19.5,100,,,fee schedule,100% of healthlink fee schedule,19.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,19.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,17.55,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,17.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.43,115,,,fee schedule,115% of cms fee schedule,87.55,135,,,Fee Schedule,135% of CMS Fee Schedule ,34.76,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,25.79,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,98.85,100,,,Fee Schedule,100% of UHC Fee Schedule,17.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.43,115,,,Fee Schedule,115% of CMS OPPS Rate,106.8,100,,,Fee Schedule,100% of UMR Fee Schedule,22.43,115,,,Fee Schedule,115% of CMS OPPS Rate,17.55,106.8,
FLUORODEOXYGLUCOSE F-18 FDG,T990410103,CDM,343,RC,A9552,HCPCS,Outpatient,,,615.5,307.75,,473.94,77,,,Percent of Total Billed Charges,77% of total billed charges,156.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,455.47,74,,,Percent of Total Billed Charges,74% of total billed charges,424.7,69,,,Percent of Total Billed Charges,69% of total billed charges,424.7,69,,,Percent of Total Billed Charges,69% of total billed charges,153.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,424.7,69,,,Percent of Total Billed Charges,69% of total billed charges,424.7,69,,,Percent of Total Billed Charges,69% of total billed charges,517.02,84,,,Percent of Total Billed Charges,84% of total billed charges,504.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,547.8,89,,,Percent of total Billed Charges,89% of total Billed charges,547.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,547.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473.94,77,,,Percent of total Billed charges,77% of total billed charges,523.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,176.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,307.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,153.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.88,547.8,
PET/CT STANDARD BODY,T990420001,CDM,404,RC,78815,HCPCS,Outpatient,,,6762,3381,,5206.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1724.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1724.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2113.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5003.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5680.08,84,,,Percent of Total Billed Charges,84% of total billed charges,5544.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5206.74,77,,,Percent of total Billed charges,77% of total billed charges,5747.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1944.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1986,100,,,Case Rate,Pays based on per visit rate,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1719,100,,,Case Rate,Pays based on per visit rate,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1513.87,5747.7,
PET/CT WHOLE BODE,T990420002,CDM,404,RC,78816,HCPCS,Outpatient,,,6762,3381,,5206.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1724.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1724.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2113.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5003.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4665.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5680.08,84,,,Percent of Total Billed Charges,84% of total billed charges,5544.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1513.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5206.74,77,,,Percent of total Billed charges,77% of total billed charges,5747.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1944.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1986,100,,,Case Rate,Pays based on per visit rate,1513.87,120,,,Fee Schedule,120% of MO Medicaid Rate,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1719,100,,,Case Rate,Pays based on per visit rate,1690.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1513.87,5747.7,
MRI TMJ,T990430001,CDM,614,RC,70336,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1736.84,400,,,fee schedule,400% of healthlink fee schedule,1628.29,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1736.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,289.98,120,,,Fee Schedule,120% of MO Medicaid Rate,289.98,120,,,Fee Schedule,120% of MO Medicaid Rate,289.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,289.98,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.98,3381.88,
"MRI ORBIT, FACE AND NECK /WO",T990430002,CDM,611,RC,70540,HCPCS,Outpatient,,,3140.5,1570.25,,2418.19,77,,,Percent of Total Billed Charges,77% of total billed charges,800.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,800.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,981.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,785.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2575.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,1916.48,400,,,fee schedule,400% of healthlink fee schedule,1796.7,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1916.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,288.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,785.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2418.19,77,,,Percent of total Billed charges,77% of total billed charges,2669.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,902.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,785.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,785.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.32,3385.18,
ONE CAL-MRI ORBT FACE NECK W/O,T990430003,CDM,611,RC,70540,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1916.48,400,,,fee schedule,400% of healthlink fee schedule,1796.7,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1916.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,288.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,288.32,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
"MRI ORBIT,FACE,NECK /W",T990430004,CDM,611,RC,70542,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2088,400,,,fee schedule,400% of healthlink fee schedule,1957.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2088,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,335.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.62,4310.19,
ONE CALL-MRI ORBIT FACE NECK W,T990430005,CDM,611,RC,70542,HCPCS,Outpatient,,,624,312,,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,2088,400,,,fee schedule,400% of healthlink fee schedule,1957.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2088,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,335.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,335.62,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156,4310.19,
"MRI ORBIT,FACE,NECK W/WO",T990430006,CDM,611,RC,70543,HCPCS,Outpatient,,,3834.5,1917.25,,2952.57,77,,,Percent of Total Billed Charges,77% of total billed charges,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1198.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3144.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,2637.72,400,,,fee schedule,400% of healthlink fee schedule,2472.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2637.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,568.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2952.57,77,,,Percent of total Billed charges,77% of total billed charges,3259.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1102.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,568.48,5265.34,
ONE CAL-MRI ORB FACE NECK W/WO,T990430007,CDM,611,RC,70543,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2637.72,400,,,fee schedule,400% of healthlink fee schedule,2472.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2637.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,568.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,568.48,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRA BRAIN /WO,T990430008,CDM,610,RC,70544,HCPCS,Outpatient,,,2844,1422,,2189.88,77,,,Percent of Total Billed Charges,77% of total billed charges,725.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,888.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,711,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2332.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,2117.6,400,,,fee schedule,400% of healthlink fee schedule,1985.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2117.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,711,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2189.88,77,,,Percent of total Billed charges,77% of total billed charges,2417.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,711,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,711,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.82,3385.18,
ONE CALL-MRA HEAD W/O,T990430009,CDM,610,RC,70544,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,2117.6,400,,,fee schedule,400% of healthlink fee schedule,1985.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2117.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
MRA BRAIN WITH,T990430010,CDM,610,RC,70545,HCPCS,Outpatient,,,2629,1314.5,,2024.33,77,,,Percent of Total Billed Charges,77% of total billed charges,670.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,670.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,821.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2155.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2105.76,400,,,fee schedule,400% of healthlink fee schedule,1974.15,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2105.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.58,120,,,Fee Schedule,120% of MO Medicaid Rate,306.58,120,,,Fee Schedule,120% of MO Medicaid Rate,306.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2024.33,77,,,Percent of total Billed charges,77% of total billed charges,2234.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,755.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.58,120,,,Fee Schedule,120% of MO Medicaid Rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.58,4310.19,
MRA BRAIN W AND W/OUT,T990430011,CDM,610,RC,70546,HCPCS,Outpatient,,,3834.5,1917.25,,2952.57,77,,,Percent of Total Billed Charges,77% of total billed charges,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1198.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3144.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,3161.92,400,,,fee schedule,400% of healthlink fee schedule,2964.3,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,3161.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,549.29,120,,,Fee Schedule,120% of MO Medicaid Rate,549.29,120,,,Fee Schedule,120% of MO Medicaid Rate,549.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2952.57,77,,,Percent of total Billed charges,77% of total billed charges,3259.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1102.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,549.29,120,,,Fee Schedule,120% of MO Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.29,5265.34,
MRA NECK /WO,T990430012,CDM,610,RC,70547,HCPCS,Outpatient,,,3012.5,1506.25,,2319.63,77,,,Percent of Total Billed Charges,77% of total billed charges,768.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,768.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,941.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,753.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2470.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2109.32,400,,,fee schedule,400% of healthlink fee schedule,1977.49,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2109.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,306.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,753.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.63,77,,,Percent of total Billed charges,77% of total billed charges,2560.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.82,120,,,Fee Schedule,120% of MO Medicaid Rate,753.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,753.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.82,3385.18,
MRA NECK /W,T990430013,CDM,610,RC,70548,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2211.16,400,,,fee schedule,400% of healthlink fee schedule,2072.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2211.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,311.68,120,,,Fee Schedule,120% of MO Medicaid Rate,311.68,120,,,Fee Schedule,120% of MO Medicaid Rate,311.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,311.68,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.68,4310.19,
MRA NECK WITH AND WITHOUT,T990430014,CDM,610,RC,70549,HCPCS,Outpatient,,,3834.5,1917.25,,2952.57,77,,,Percent of Total Billed Charges,77% of total billed charges,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1198.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3144.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,3165.48,400,,,fee schedule,400% of healthlink fee schedule,2967.64,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,3165.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,549.05,120,,,Fee Schedule,120% of MO Medicaid Rate,549.05,120,,,Fee Schedule,120% of MO Medicaid Rate,549.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2952.57,77,,,Percent of total Billed charges,77% of total billed charges,3259.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1102.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,549.05,120,,,Fee Schedule,120% of MO Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.05,5265.34,
MRI BRAIN W/O,T990430015,CDM,611,RC,70551,HCPCS,Outpatient,,,2899,1449.5,,2232.23,77,,,Percent of Total Billed Charges,77% of total billed charges,739.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,739.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,905.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,724.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2377.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,1999.8,400,,,fee schedule,400% of healthlink fee schedule,1874.81,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1999.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,724.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2232.23,77,,,Percent of total Billed charges,77% of total billed charges,2464.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,833.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,724.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,724.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.14,3385.18,
ONE CALL-MRI BRAIN W/O,T990430016,CDM,611,RC,70551,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1999.8,400,,,fee schedule,400% of healthlink fee schedule,1874.81,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1999.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
MRI BRAIN W/CONTRAST,T990430017,CDM,611,RC,70552,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2196.52,400,,,fee schedule,400% of healthlink fee schedule,2059.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2196.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.61,4310.19,
ONE CALL-MRI BRAIN W,T990430018,CDM,611,RC,70552,HCPCS,Outpatient,,,624,312,,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,2196.52,400,,,fee schedule,400% of healthlink fee schedule,2059.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2196.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156,4310.19,
MRI BRAIN W & W/O,T990430019,CDM,611,RC,70553,HCPCS,Outpatient,,,4127.5,2063.75,,3178.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1052.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1052.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1289.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3384.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,2659.84,400,,,fee schedule,400% of healthlink fee schedule,2493.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2659.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,575.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3178.18,77,,,Percent of total Billed charges,77% of total billed charges,3508.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1186.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.05,5265.34,
ONE CALL-MRI BRAIN W W/O,T990430020,CDM,611,RC,70553,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2659.84,400,,,fee schedule,400% of healthlink fee schedule,2493.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2659.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,575.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,575.05,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRI CHEST /WO,T990430021,CDM,614,RC,71550,HCPCS,Outpatient,,,2991,1495.5,,2303.07,77,,,Percent of Total Billed Charges,77% of total billed charges,762.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,762.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,934.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,747.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2452.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2195.64,400,,,fee schedule,400% of healthlink fee schedule,2058.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2195.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,311.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,747.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2303.07,77,,,Percent of total Billed charges,77% of total billed charges,2542.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,859.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,747.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,747.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.03,3385.18,
ONE CALL-MRI CHEST W/O,T990430022,CDM,614,RC,71550,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,2195.64,400,,,fee schedule,400% of healthlink fee schedule,2058.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2195.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,311.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,311.03,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
MRI CHEST /W,T990430023,CDM,614,RC,71551,HCPCS,Outpatient,,,2629,1314.5,,2024.33,77,,,Percent of Total Billed Charges,77% of total billed charges,670.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,670.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,821.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2155.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2426.36,400,,,fee schedule,400% of healthlink fee schedule,2274.71,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2426.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,357.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2024.33,77,,,Percent of total Billed charges,77% of total billed charges,2234.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,755.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.11,4310.19,
ONE CALL-MRI CHEST W,T990430024,CDM,614,RC,71551,HCPCS,Outpatient,,,643,321.5,,495.11,77,,,Percent of Total Billed Charges,77% of total billed charges,163.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,527.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2426.36,400,,,fee schedule,400% of healthlink fee schedule,2274.71,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2426.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,357.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.11,77,,,Percent of total Billed charges,77% of total billed charges,546.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,184.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,357.11,120,,,Fee Schedule,120% of MO Medicaid Rate,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.75,4310.19,
MRI CHEST W/WO,T990430025,CDM,614,RC,71552,HCPCS,Outpatient,,,3226.5,1613.25,,2484.41,77,,,Percent of Total Billed Charges,77% of total billed charges,822.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,822.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1008.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,806.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,2645.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3072.36,400,,,fee schedule,400% of healthlink fee schedule,2880.34,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,3072.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,594.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,806.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.41,77,,,Percent of total Billed charges,77% of total billed charges,2742.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,927.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,806.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,806.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.59,5265.34,
ONE CALL-MRI CHEST W W/O,T990430026,CDM,614,RC,71552,HCPCS,Outpatient,,,696.5,348.25,,536.31,77,,,Percent of Total Billed Charges,77% of total billed charges,177.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,174.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,571.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,2786,400,,,fee schedule,400% of healthlink fee schedule,2611.88,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2786,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,594.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,174.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,536.31,77,,,Percent of total Billed charges,77% of total billed charges,592.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,200.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,594.59,120,,,Fee Schedule,120% of MO Medicaid Rate,174.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,174.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.13,5265.34,
MRA CHEST WITH OR WITHOUT CONT,T990430027,CDM,610,RC,71555,HCPCS,Outpatient,,,3068,1534,,2362.36,77,,,Percent of Total Billed Charges,77% of total billed charges,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4598.43,295,,,fee schedule,295% of bcbs fee schedule,4291.96,285,,,fee schedule,285% of bcbs fee schedule,4291.96,285,,,fee schedule,285% of bcbs fee schedule,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4291.96,285,,,fee schedule,285% of total billed charges,4291.96,285,,,fee schedule,285% of bcbs fee schedule,4442.55,295,,,fee schedule,295% of bcbs fee schedule,2515.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.96,400,,,fee schedule,400% of healthlink fee schedule,2011.84,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2145.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,307.97,120,,,Fee Schedule,120% of MO Medicaid Rate,307.97,120,,,Fee Schedule,120% of MO Medicaid Rate,307.97,120,,,Fee Schedule,120% of MO of Medicaid Rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2362.36,77,,,Percent of total Billed charges,77% of total billed charges,2607.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,882.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,307.97,120,,,Fee Schedule,120% of MO Medicaid Rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.97,4598.43,
MRA CHEST WITH OR WITHOUT CONT,T990430027,CDM,610,RC,C8911,HCPCS,Outpatient,,,3068,1534,,2362.36,77,,,Percent of Total Billed Charges,77% of total billed charges,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5770.38,295,,,fee schedule,295% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5385.79,285,,,fee schedule,285% of total billed charges,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5574.76,295,,,fee schedule,295% of bcbs fee schedule,2515.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2362.36,77,,,Percent of total Billed charges,77% of total billed charges,2607.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,882.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,1251.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,767,5770.38,
MRI C-SPINE W/O,T990430028,CDM,612,RC,72141,HCPCS,Outpatient,,,3138,1569,,2416.26,77,,,Percent of Total Billed Charges,77% of total billed charges,800.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,800.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,980.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,784.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,2573.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,1784.96,400,,,fee schedule,400% of healthlink fee schedule,1673.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1784.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,282.67,120,,,Fee Schedule,120% of MO of Medicaid Rate,784.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2416.26,77,,,Percent of total Billed charges,77% of total billed charges,2667.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,902.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,784.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,784.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.67,3381.88,
ONE CALL-MRI C SPINE W/O,T990430029,CDM,612,RC,72141,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1784.96,400,,,fee schedule,400% of healthlink fee schedule,1673.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1784.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,282.67,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,282.67,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3381.88,
MRI C-SPINE W,T990430030,CDM,612,RC,72142,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2219.36,400,,,fee schedule,400% of healthlink fee schedule,2080.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2219.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,342.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.37,4310.19,
ONE CALL-MRI C SPINE E,T990430031,CDM,612,RC,72142,HCPCS,Outpatient,,,624,312,,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,2219.36,400,,,fee schedule,400% of healthlink fee schedule,2080.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2219.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,342.37,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,342.37,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156,4310.19,
MRI T-SPINE W/O,T990430032,CDM,612,RC,72146,HCPCS,Outpatient,,,2927.5,1463.75,,2254.18,77,,,Percent of Total Billed Charges,77% of total billed charges,746.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,746.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,914.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,731.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,2400.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1793.32,400,,,fee schedule,400% of healthlink fee schedule,1681.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1793.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,731.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2254.18,77,,,Percent of total Billed charges,77% of total billed charges,2488.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,841.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,731.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,731.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.07,3381.88,
ONE CALL-MRI T SPINE W/O,T990430033,CDM,612,RC,72146,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1793.32,400,,,fee schedule,400% of healthlink fee schedule,1681.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1793.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3381.88,
MRI T-SPINE W,T990430034,CDM,612,RC,72147,HCPCS,Outpatient,,,2629,1314.5,,2024.33,77,,,Percent of Total Billed Charges,77% of total billed charges,670.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,670.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,821.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4266.61,295,,,fee schedule,295% of bcbs fee schedule,3982.31,285,,,fee schedule,285% of bcbs fee schedule,3982.31,285,,,fee schedule,285% of bcbs fee schedule,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3982.31,285,,,fee schedule,285% of total billed charges,3982.31,285,,,fee schedule,285% of bcbs fee schedule,4122.04,295,,,fee schedule,295% of bcbs fee schedule,2155.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1980.12,400,,,fee schedule,400% of healthlink fee schedule,1856.36,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1980.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,330.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2024.33,77,,,Percent of total Billed charges,77% of total billed charges,2234.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,755.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,657.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.65,4266.61,
ONE CALL-MRI T SPINR W,T990430035,CDM,612,RC,72147,HCPCS,Outpatient,,,624,312,,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4266.61,295,,,fee schedule,295% of bcbs fee schedule,3982.31,285,,,fee schedule,285% of bcbs fee schedule,3982.31,285,,,fee schedule,285% of bcbs fee schedule,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3982.31,285,,,fee schedule,285% of total billed charges,3982.31,285,,,fee schedule,285% of bcbs fee schedule,4122.04,295,,,fee schedule,295% of bcbs fee schedule,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1980.12,400,,,fee schedule,400% of healthlink fee schedule,1856.36,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1980.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,330.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,330.65,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156,4266.61,
MRI L-SPINE W/O,T990430036,CDM,612,RC,72148,HCPCS,Outpatient,,,3186.5,1593.25,,2453.61,77,,,Percent of Total Billed Charges,77% of total billed charges,812.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,812.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,995.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,796.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,2612.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1768.92,400,,,fee schedule,400% of healthlink fee schedule,1658.36,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1768.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,796.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2453.61,77,,,Percent of total Billed charges,77% of total billed charges,2708.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,916.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,796.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,796.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.07,3381.88,
ONE CALL-MRI L SPINE W/O,T990430037,CDM,612,RC,72148,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1768.92,400,,,fee schedule,400% of healthlink fee schedule,1658.36,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1768.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,306.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306.07,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3381.88,
MRI L-SPINE W,T990430038,CDM,612,RC,72149,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2189.44,400,,,fee schedule,400% of healthlink fee schedule,2052.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2189.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.61,4310.19,
ONE CALL-MRI L SPINE W,T990430039,CDM,612,RC,72149,HCPCS,Outpatient,,,624,312,,480.48,77,,,Percent of Total Billed Charges,77% of total billed charges,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,511.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,2189.44,400,,,fee schedule,400% of healthlink fee schedule,2052.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2189.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,342.61,120,,,Fee Schedule,120% of MO of Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,480.48,77,,,Percent of total Billed charges,77% of total billed charges,530.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,342.61,120,,,Fee Schedule,120% of MO Medicaid Rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,156,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156,4310.19,
MRI C-SPINE W & W/O,T990430040,CDM,612,RC,72156,HCPCS,Outpatient,,,3704,1852,,2852.08,77,,,Percent of Total Billed Charges,77% of total billed charges,944.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,944.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,926,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3037.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,2656.04,400,,,fee schedule,400% of healthlink fee schedule,2490.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2656.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,926,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2852.08,77,,,Percent of total Billed charges,77% of total billed charges,3148.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1064.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,926,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,926,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.13,5265.34,
ONE CALL-MRI C SPINE W W/O,T990430041,CDM,612,RC,72156,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2656.04,400,,,fee schedule,400% of healthlink fee schedule,2490.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2656.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRI T-SPINE W&W/O,T990430042,CDM,612,RC,72157,HCPCS,Outpatient,,,3810,1905,,2933.7,77,,,Percent of Total Billed Charges,77% of total billed charges,971.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1190.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,952.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3124.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,2473.64,400,,,fee schedule,400% of healthlink fee schedule,2319.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2473.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,563.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,952.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2933.7,77,,,Percent of total Billed charges,77% of total billed charges,3238.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1095.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,952.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,952.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.81,5265.34,
ONE CALL-MRI T SPINE W W/O,T990430043,CDM,612,RC,72157,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2473.64,400,,,fee schedule,400% of healthlink fee schedule,2319.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2473.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,563.81,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,563.81,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRI L-SPINE W & W/O,T990430044,CDM,612,RC,72158,HCPCS,Outpatient,,,4127.5,2063.75,,3178.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1052.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1052.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1289.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3384.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,2613.64,400,,,fee schedule,400% of healthlink fee schedule,2450.29,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2613.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3178.18,77,,,Percent of total Billed charges,77% of total billed charges,3508.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1186.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,1031.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.13,5265.34,
ONE CALL-MRI L SPINE W W/O,T990430045,CDM,612,RC,72158,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2613.64,400,,,fee schedule,400% of healthlink fee schedule,2450.29,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2613.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,573.13,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,573.13,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRI PELVIS /WO,T990430046,CDM,614,RC,72195,HCPCS,Outpatient,,,2858.5,1429.25,,2201.05,77,,,Percent of Total Billed Charges,77% of total billed charges,728.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,728.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,893.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,714.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2343.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,1970.6,400,,,fee schedule,400% of healthlink fee schedule,1847.44,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1970.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,295.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,714.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2201.05,77,,,Percent of total Billed charges,77% of total billed charges,2429.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,821.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,714.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,714.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.03,3385.18,
ONE CALL-MRI PELVIS W/O,T990430047,CDM,614,RC,72195,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1970.6,400,,,fee schedule,400% of healthlink fee schedule,1847.44,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1970.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,295.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,295.03,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
MRI PELVIS /W,T990430048,CDM,612,RC,72196,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2142.12,400,,,fee schedule,400% of healthlink fee schedule,2008.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2142.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,343.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.02,4310.19,
ONE CALL-MRI PELVIS W,T990430049,CDM,614,RC,72196,HCPCS,Outpatient,,,643,321.5,,495.11,77,,,Percent of Total Billed Charges,77% of total billed charges,163.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,200.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,527.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2142.12,400,,,fee schedule,400% of healthlink fee schedule,2008.24,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2142.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,343.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.11,77,,,Percent of total Billed charges,77% of total billed charges,546.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,184.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,343.02,120,,,Fee Schedule,120% of MO Medicaid Rate,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,160.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.75,4310.19,
MRI PELVIS W/WO,T990430050,CDM,614,RC,72197,HCPCS,Outpatient,,,3834.5,1917.25,,2952.57,77,,,Percent of Total Billed Charges,77% of total billed charges,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1198.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3144.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,2688.8,400,,,fee schedule,400% of healthlink fee schedule,2520.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2688.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,571.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2952.57,77,,,Percent of total Billed charges,77% of total billed charges,3259.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1102.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.04,5265.34,
ONE CALL-MRI PELVIS W W/O,T990430051,CDM,614,RC,72197,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2688.8,400,,,fee schedule,400% of healthlink fee schedule,2520.75,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2688.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,571.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,571.04,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRA PELVIS WITH OR WITHOUT CON,T990430052,CDM,610,RC,72198,HCPCS,Outpatient,,,3068,1534,,2362.36,77,,,Percent of Total Billed Charges,77% of total billed charges,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4585.04,295,,,fee schedule,295% of bcbs fee schedule,4279.47,285,,,fee schedule,285% of bcbs fee schedule,4279.47,285,,,fee schedule,285% of bcbs fee schedule,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4279.47,285,,,fee schedule,285% of total billed charges,4279.47,285,,,fee schedule,285% of bcbs fee schedule,4429.63,295,,,fee schedule,295% of bcbs fee schedule,2515.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,2129.12,400,,,fee schedule,400% of healthlink fee schedule,1996.05,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2129.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,305.76,120,,,Fee Schedule,120% of MO Medicaid Rate,305.76,120,,,Fee Schedule,120% of MO Medicaid Rate,305.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2362.36,77,,,Percent of total Billed charges,77% of total billed charges,2607.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,882.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,305.76,120,,,Fee Schedule,120% of MO Medicaid Rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.76,4585.04,
MRA PELVIS WITH OR WITHOUT CON,T990430052,CDM,610,RC,C8920,HCPCS,Outpatient,,,3068,1534,,2362.36,77,,,Percent of Total Billed Charges,77% of total billed charges,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,782.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5770.38,295,,,fee schedule,295% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5385.79,285,,,fee schedule,285% of total billed charges,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5574.76,295,,,fee schedule,295% of bcbs fee schedule,2515.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2362.36,77,,,Percent of total Billed charges,77% of total billed charges,2607.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,882.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,1251.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,767,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,767,5770.38,
LT MRI UP EXT W/O JT W/O CONT,T990430053,CDM,610,RC,73218,HCPCS,Outpatient,,,3285.5,1642.75,LT,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1973.32,400,,,fee schedule,400% of healthlink fee schedule,1849.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1973.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.24,3385.18,
ONE CAL-MRI UP EXT W/O JT W/WO,T990430054,CDM,614,RC,73218,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1973.32,400,,,fee schedule,400% of healthlink fee schedule,1849.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1973.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,3385.18,
RT MRI UP EXT W/O JT W/O CONT,T990430055,CDM,614,RC,73218,HCPCS,Outpatient,,,3285.5,1642.75,RT,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1973.32,400,,,fee schedule,400% of healthlink fee schedule,1849.99,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1973.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,300.24,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,300.24,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.24,3385.18,
MRI UP EXT W/O JT & W/CONT,T990430059,CDM,614,RC,73219,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2117.6,400,,,fee schedule,400% of healthlink fee schedule,1985.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2117.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,346.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.98,4310.19,
ONE CALL MRI UP EXT WO/JT W/WO,T990430060,CDM,614,RC,73219,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,2117.6,400,,,fee schedule,400% of healthlink fee schedule,1985.25,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2117.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,346.98,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,346.98,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,4310.19,
MRI UPPER EXT W/O JOINT W/WO,T990430061,CDM,614,RC,73220,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2669.72,400,,,fee schedule,400% of healthlink fee schedule,2502.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2669.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,570.14,120,,,Fee Schedule,120% of MO Medicaid Rate,570.14,120,,,Fee Schedule,120% of MO Medicaid Rate,570.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,570.14,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,570.14,5265.34,
LT MRI UPPER EXT W/JT W/O CONT,T990430062,CDM,614,RC,73221,HCPCS,Outpatient,,,3285.5,1642.75,LT,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1843.04,400,,,fee schedule,400% of healthlink fee schedule,1727.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1843.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.22,3385.18,
ONE CALL-MRI UPPER EXT E JT WO,T990430063,CDM,614,RC,73221,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1843.04,400,,,fee schedule,400% of healthlink fee schedule,1727.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1843.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
RT MRI UPPER EXT W/JT WO CONT,T990430064,CDM,614,RC,73221,HCPCS,Outpatient,,,3285.5,1642.75,RT,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1843.04,400,,,fee schedule,400% of healthlink fee schedule,1727.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1843.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,285.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,285.22,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.22,3385.18,
MRI UP EXT W/JT & W/CONT,T990430065,CDM,614,RC,73222,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1986.16,400,,,fee schedule,400% of healthlink fee schedule,1862.03,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1986.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,335.54,120,,,Fee Schedule,120% of MO Medicaid Rate,335.54,120,,,Fee Schedule,120% of MO Medicaid Rate,335.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,335.54,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.54,4310.19,
MRI UP EXT W/JT-W&W/O CONT,T990430066,CDM,614,RC,73223,HCPCS,Outpatient,,,2919.5,1459.75,,2248.02,77,,,Percent of Total Billed Charges,77% of total billed charges,744.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,744.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,912.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,729.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,2393.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,2508.64,400,,,fee schedule,400% of healthlink fee schedule,2351.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2508.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,562.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,729.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2248.02,77,,,Percent of total Billed charges,77% of total billed charges,2481.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,839.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,729.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,729.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562.02,5265.34,
ONE CALL MRI UP EXT W/JT W/WO,T990430067,CDM,614,RC,73223,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,2392,400,,,fee schedule,400% of healthlink fee schedule,2242.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2392,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,562.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,562.02,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,5265.34,
LT MRI LOW EXT WO JT & WO CONT,T990430068,CDM,614,RC,73718,HCPCS,Outpatient,,,2952.5,1476.25,LT,2273.43,77,,,Percent of Total Billed Charges,77% of total billed charges,752.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2421.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.52,400,,,fee schedule,400% of healthlink fee schedule,1808.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1929.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.43,77,,,Percent of total Billed charges,77% of total billed charges,2509.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.38,3385.18,
"ONE CALL-MRI FOOT WO, LT",T990430069,CDM,614,RC,73718,HCPCS,Outpatient,,,598,299,LT,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.52,400,,,fee schedule,400% of healthlink fee schedule,1808.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1929.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
"ONE CALL-MRI FOOT WO, RT",T990430070,CDM,614,RC,73718,HCPCS,Outpatient,,,598,299,RT,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.52,400,,,fee schedule,400% of healthlink fee schedule,1808.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1929.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
RT MRI LOW EXT WO JT WO CONT,T990430071,CDM,614,RC,73718,HCPCS,Outpatient,,,2952.5,1476.25,RT,2273.43,77,,,Percent of Total Billed Charges,77% of total billed charges,752.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2421.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.52,400,,,fee schedule,400% of healthlink fee schedule,1808.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1929.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,293.38,120,,,Fee Schedule,120% of MO of Medicaid Rate,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.43,77,,,Percent of total Billed charges,77% of total billed charges,2509.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,293.38,120,,,Fee Schedule,120% of MO Medicaid Rate,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,738.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.38,3385.18,
MRI LOW EXT W/O JT & W/CONT,T990430074,CDM,614,RC,73719,HCPCS,Outpatient,,,3041.5,1520.75,,2341.96,77,,,Percent of Total Billed Charges,77% of total billed charges,775.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,775.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,950.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,760.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2494.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.36,400,,,fee schedule,400% of healthlink fee schedule,1959.71,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2090.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,336.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,760.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.96,77,,,Percent of total Billed charges,77% of total billed charges,2585.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,874.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,760.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,760.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.32,4310.19,
ONE CALL MRI LOW EXT WOJT W/WO,T990430075,CDM,614,RC,73719,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.36,400,,,fee schedule,400% of healthlink fee schedule,1959.71,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2090.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,336.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,336.32,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,4310.19,
MRI LOW EXT WO/JOINT W/WO CON,T990430076,CDM,614,RC,73720,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2668.52,400,,,fee schedule,400% of healthlink fee schedule,2501.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2668.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,569.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.9,5265.34,
ONE CAL-MRI LO EXT W/O JT W/WO,T990430077,CDM,614,RC,73720,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2668.52,400,,,fee schedule,400% of healthlink fee schedule,2501.74,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2668.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,569.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,569.9,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
LT MRI LOWER EXT W/JT WO CONT,T990430078,CDM,614,RC,73721,HCPCS,Outpatient,,,3285.5,1642.75,LT,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1880.96,400,,,fee schedule,400% of healthlink fee schedule,1763.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1880.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.88,3385.18,
ONE CAL-MRI LOWER EXT W JT W/O,T990430079,CDM,614,RC,73721,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1880.96,400,,,fee schedule,400% of healthlink fee schedule,1763.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1880.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3385.18,
RT MRI LOWER EXT W/JT WO CONT,T990430080,CDM,614,RC,73721,HCPCS,Outpatient,,,3285.5,1642.75,RT,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3385.18,295,,,fee schedule,295% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3159.62,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3159.62,285,,,fee schedule,285% of total billed charges,3159.62,285,,,fee schedule,285% of bcbs fee schedule,3270.49,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1880.96,400,,,fee schedule,400% of healthlink fee schedule,1763.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1880.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,286.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,286.88,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.88,3385.18,
MRI LOW EXT W/JT & W/CONT,T990430081,CDM,614,RC,73722,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2006.28,400,,,fee schedule,400% of healthlink fee schedule,1880.89,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2006.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,337,120,,,Fee Schedule,120% of MO Medicaid Rate,337,120,,,Fee Schedule,120% of MO Medicaid Rate,337,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,337,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337,4310.19,
MRI LOW EXT W/JT-W&W/O CONT,T990430082,CDM,614,RC,73723,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2500.32,500,,,fee schedule,500% of healthlink,2344.05,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2500.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,561.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,561.77,5265.34,
ONE CALL MRI LOW EXT W/JT W/WO,T990430083,CDM,614,RC,73723,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,2392,400,,,fee schedule,400% of healthlink fee schedule,2242.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2392,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,561.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,561.77,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,5265.34,
MRI ABDOMEN W/O,T990430084,CDM,614,RC,74181,HCPCS,Outpatient,,,2731,1365.5,,2102.87,77,,,Percent of Total Billed Charges,77% of total billed charges,696.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,696.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,853.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,682.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,2239.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,1742,400,,,fee schedule,400% of healthlink fee schedule,1633.13,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1742,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,283.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,682.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102.87,77,,,Percent of total Billed charges,77% of total billed charges,2321.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,785.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,682.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,682.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.62,3381.88,
ONE CALL-MRI ABD W/O,T990430085,CDM,614,RC,74181,HCPCS,Outpatient,,,598,299,,460.46,77,,,Percent of Total Billed Charges,77% of total billed charges,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3381.88,295,,,fee schedule,295% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3156.52,285,,,fee schedule,285% of bcbs fee schedule,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3156.52,285,,,fee schedule,285% of total billed charges,3156.52,285,,,fee schedule,285% of bcbs fee schedule,3267.27,295,,,fee schedule,295% of bcbs fee schedule,490.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,1742,400,,,fee schedule,400% of healthlink fee schedule,1633.13,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1742,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,283.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,460.46,77,,,Percent of total Billed charges,77% of total billed charges,508.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,283.62,120,,,Fee Schedule,120% of MO Medicaid Rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,149.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.5,3381.88,
MRI ABDOMEN /W,T990430087,CDM,614,RC,74182,HCPCS,Outpatient,,,3285.5,1642.75,,2529.84,77,,,Percent of Total Billed Charges,77% of total billed charges,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1026.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4310.19,295,,,fee schedule,295% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4022.89,285,,,fee schedule,285% of bcbs fee schedule,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4022.89,285,,,fee schedule,285% of total billed charges,4022.89,285,,,fee schedule,285% of bcbs fee schedule,4164.04,295,,,fee schedule,295% of bcbs fee schedule,2694.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,2371.88,400,,,fee schedule,400% of healthlink fee schedule,2223.64,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2371.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,353.95,120,,,Fee Schedule,120% of MO Medicaid Rate,353.95,120,,,Fee Schedule,120% of MO Medicaid Rate,353.95,120,,,Fee Schedule,120% of MO of Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2529.84,77,,,Percent of total Billed charges,77% of total billed charges,2792.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,944.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,353.95,120,,,Fee Schedule,120% of MO Medicaid Rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,821.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,353.95,4310.19,
MRI ABDOMEN W/WO,T990430088,CDM,614,RC,74183,HCPCS,Outpatient,,,3756.5,1878.25,,2892.51,77,,,Percent of Total Billed Charges,77% of total billed charges,957.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,957.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1173.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,939.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3080.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.36,400,,,fee schedule,400% of healthlink fee schedule,2524.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2692.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,939.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2892.51,77,,,Percent of total Billed charges,77% of total billed charges,3193.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1079.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,939.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,939.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.28,5265.34,
MRI MRCP W/W OUT CONTRAST,T990430089,CDM,614,RC,74183,HCPCS,Outpatient,,,3834.5,1917.25,,2952.57,77,,,Percent of Total Billed Charges,77% of total billed charges,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,977.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1198.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,3144.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.36,400,,,fee schedule,400% of healthlink fee schedule,2524.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2692.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2952.57,77,,,Percent of total Billed charges,77% of total billed charges,3259.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1102.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,958.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.28,5265.34,
ONE CALL-MRI ABD W W/O,T990430090,CDM,614,RC,74183,HCPCS,Outpatient,,,676,338,,520.52,77,,,Percent of Total Billed Charges,77% of total billed charges,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5265.34,295,,,fee schedule,295% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,4914.4,285,,,fee schedule,285% of bcbs fee schedule,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4914.4,285,,,fee schedule,285% of total billed charges,4914.4,285,,,fee schedule,285% of bcbs fee schedule,5086.83,295,,,fee schedule,295% of bcbs fee schedule,554.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.36,400,,,fee schedule,400% of healthlink fee schedule,2524.09,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2692.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,571.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.52,77,,,Percent of total Billed charges,77% of total billed charges,574.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,571.28,120,,,Fee Schedule,120% of MO Medicaid Rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,169,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169,5265.34,
MRA ABDOMEN WITH OR WITHOUT CO,T990430091,CDM,610,RC,C8902,HCPCS,Outpatient,,,3392,1696,,2611.84,77,,,Percent of Total Billed Charges,77% of total billed charges,864.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5770.38,295,,,fee schedule,295% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5385.79,285,,,fee schedule,285% of total billed charges,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5574.76,295,,,fee schedule,295% of bcbs fee schedule,2781.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,3018.88,89,,,Percent of total Billed Charges,89% of total Billed charges,3018.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3018.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1383.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1383.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1383.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.84,77,,,Percent of total Billed charges,77% of total billed charges,2883.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,1383.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848,5770.38,
MRA ABDOMEN WITH OR WITHOUT CO,T990430091,CDM,610,RC,74185,HCPCS,Outpatient,,,3392,1696,,2611.84,77,,,Percent of Total Billed Charges,77% of total billed charges,864.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4574.98,295,,,fee schedule,295% of bcbs fee schedule,4270.07,285,,,fee schedule,285% of bcbs fee schedule,4270.07,285,,,fee schedule,285% of bcbs fee schedule,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4270.07,285,,,fee schedule,285% of total billed charges,4270.07,285,,,fee schedule,285% of bcbs fee schedule,4419.9,295,,,fee schedule,295% of bcbs fee schedule,2781.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,2122,400,,,fee schedule,400% of healthlink fee schedule,1989.38,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,2122,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,306,120,,,Fee Schedule,120% of MO Medicaid Rate,306,120,,,Fee Schedule,120% of MO Medicaid Rate,306,120,,,Fee Schedule,120% of MO of Medicaid Rate,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.84,77,,,Percent of total Billed charges,77% of total billed charges,2883.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,306,120,,,Fee Schedule,120% of MO Medicaid Rate,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,848,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306,4574.98,
3D RECONS; MRI,T990430092,CDM,610,RC,76376,HCPCS,Outpatient,,,743.5,371.75,,572.5,77,,,Percent of Total Billed Charges,77% of total billed charges,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,599.97,295,,,fee schedule,295% of bcbs fee schedule,549.65,285,,,fee schedule,285% of bcbs fee schedule,549.65,285,,,fee schedule,285% of bcbs fee schedule,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.65,285,,,fee schedule,285% of total billed charges,549.65,285,,,fee schedule,285% of bcbs fee schedule,568.94,295,,,fee schedule,295% of bcbs fee schedule,609.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.84,400,,,fee schedule,400% of healthlink fee schedule,194.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,207.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,70.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.5,77,,,Percent of total Billed charges,77% of total billed charges,631.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,70.08,120,,,Fee Schedule,120% of MO Medicaid Rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,185.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.08,1479,
MRI GUIDE FOR NEEDLE PLCMT,T990430093,CDM,614,RC,77021,HCPCS,Outpatient,,,2979.5,1489.75,,2294.22,77,,,Percent of Total Billed Charges,77% of total billed charges,759.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,759.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,931.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3536.08,295,,,fee schedule,295% of bcbs fee schedule,3300.41,285,,,fee schedule,285% of bcbs fee schedule,3300.41,285,,,fee schedule,285% of bcbs fee schedule,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3300.41,285,,,fee schedule,285% of total billed charges,3300.41,285,,,fee schedule,285% of bcbs fee schedule,3416.22,295,,,fee schedule,295% of bcbs fee schedule,2443.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1465.6,400,,,fee schedule,400% of healthlink fee schedule,1374,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1465.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,327.34,120,,,Fee Schedule,120% of MO Medicaid Rate,327.34,120,,,Fee Schedule,120% of MO Medicaid Rate,327.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2294.22,77,,,Percent of total Billed charges,77% of total billed charges,2532.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,856.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,327.34,120,,,Fee Schedule,120% of MO Medicaid Rate,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.34,3536.08,
MRI GUIDED BREAST BX,T990430094,CDM,614,RC,77022,HCPCS,Outpatient,,,2979.5,1489.75,,2294.22,77,,,Percent of Total Billed Charges,77% of total billed charges,759.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,759.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,931.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3396.28,295,,,fee schedule,295% of bcbs fee schedule,3169.94,285,,,fee schedule,285% of bcbs fee schedule,3169.94,285,,,fee schedule,285% of bcbs fee schedule,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3169.94,285,,,fee schedule,285% of total billed charges,3169.94,285,,,fee schedule,285% of bcbs fee schedule,3281.17,295,,,fee schedule,295% of bcbs fee schedule,2443.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2294.22,77,,,Percent of total Billed charges,77% of total billed charges,2532.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,856.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,744.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.75,3396.28,
MRI BREAST W/O CONTRAST UNILAT,T990430095,CDM,614,RC,77046,HCPCS,Outpatient,,,2149,1074.5,,1654.73,77,,,Percent of Total Billed Charges,77% of total billed charges,548,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,548,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,671.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.72,295,,,fee schedule,295% of bcbs fee schedule,1343.75,285,,,fee schedule,285% of bcbs fee schedule,1343.75,285,,,fee schedule,285% of bcbs fee schedule,537.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.75,285,,,fee schedule,285% of total billed charges,1343.75,285,,,fee schedule,285% of bcbs fee schedule,1390.9,295,,,fee schedule,295% of bcbs fee schedule,1762.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,141.6,120,,,Fee Schedule,120% of MO Medicaid Rate,141.6,120,,,Fee Schedule,120% of MO Medicaid Rate,141.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,537.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1654.73,77,,,Percent of total Billed charges,77% of total billed charges,1826.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,617.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,141.6,120,,,Fee Schedule,120% of MO Medicaid Rate,537.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,537.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.6,1826.65,
"MRI BREAST W/O CONTRAST, BILAT",T990430096,CDM,614,RC,77047,HCPCS,Outpatient,,,2434,1217,,1874.18,77,,,Percent of Total Billed Charges,77% of total billed charges,620.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,620.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,760.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1431.07,295,,,fee schedule,295% of bcbs fee schedule,1335.68,285,,,fee schedule,285% of bcbs fee schedule,1335.68,285,,,fee schedule,285% of bcbs fee schedule,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.68,285,,,fee schedule,285% of total billed charges,1335.68,285,,,fee schedule,285% of bcbs fee schedule,1382.55,295,,,fee schedule,295% of bcbs fee schedule,1995.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,141,120,,,Fee Schedule,120% of MO Medicaid Rate,141,120,,,Fee Schedule,120% of MO Medicaid Rate,141,120,,,Fee Schedule,120% of MO of Medicaid Rate,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1874.18,77,,,Percent of total Billed charges,77% of total billed charges,2068.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,699.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,141,120,,,Fee Schedule,120% of MO Medicaid Rate,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,608.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,2068.9,
MRI BREAST UNILAT W/WO,T990430097,CDM,614,RC,77048,HCPCS,Outpatient,,,2551,1275.5,,1964.27,77,,,Percent of Total Billed Charges,77% of total billed charges,650.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,797.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2371.65,295,,,fee schedule,295% of bcbs fee schedule,2213.57,285,,,fee schedule,285% of bcbs fee schedule,2213.57,285,,,fee schedule,285% of bcbs fee schedule,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2213.57,285,,,fee schedule,285% of total billed charges,2213.57,285,,,fee schedule,285% of bcbs fee schedule,2291.24,295,,,fee schedule,295% of bcbs fee schedule,2091.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,233.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1964.27,77,,,Percent of total Billed charges,77% of total billed charges,2168.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,733.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.1,2371.65,
MRI BREAST UNILAT W/WO,T990430097,CDM,614,RC,C8905,HCPCS,Outpatient,,,2551,1275.5,,1964.27,77,,,Percent of Total Billed Charges,77% of total billed charges,650.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,797.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5770.38,295,,,fee schedule,295% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5385.79,285,,,fee schedule,285% of total billed charges,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5574.76,295,,,fee schedule,295% of bcbs fee schedule,2091.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1040.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1040.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1040.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1964.27,77,,,Percent of total Billed charges,77% of total billed charges,2168.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,733.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,1040.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,637.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.75,5770.38,
SHOW ME MRI BREAST UNLAT W/WO,T990430098,CDM,614,RC,77048,HCPCS,Outpatient,,,280.5,140.25,,215.99,77,,,Percent of Total Billed Charges,77% of total billed charges,71.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2371.65,295,,,fee schedule,295% of bcbs fee schedule,2213.57,285,,,fee schedule,285% of bcbs fee schedule,2213.57,285,,,fee schedule,285% of bcbs fee schedule,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2213.57,285,,,fee schedule,285% of total billed charges,2213.57,285,,,fee schedule,285% of bcbs fee schedule,2291.24,295,,,fee schedule,295% of bcbs fee schedule,230.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,233.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.99,77,,,Percent of total Billed charges,77% of total billed charges,238.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,233.1,120,,,Fee Schedule,120% of MO Medicaid Rate,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,70.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.13,2371.65,
SHOW ME PF-MRI BRST W&WO UNI,T990430099,CDM,972,RC,77048,HCPCS,Outpatient,,,110,55,26,472.55,135,,,fee schedule,135% of aetna fee schedule,126.5,115,,,fee schedule,115% of cms physician fee schedule,129.03,117.3,,,fee schedule,117.3% of cms physician fee schedule,158.13,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,126.5,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,349.1,100,,,fee schedule,100% of cigna fee schedule,110,100,,,fee schedule,100% of healthlink fee schedule,110,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,110,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,99,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.5,115,,,fee schedule,115% of cms fee schedule,472.55,135,,,Fee Schedule,135% of CMS Fee Schedule ,196.08,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,145.48,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,377.27,100,,,Fee Schedule,100% of UHC Fee Schedule,99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.5,115,,,Fee Schedule,115% of CMS OPPS Rate,367.94,100,,,Fee Schedule,100% of UMR Fee Schedule,126.5,115,,,Fee Schedule,115% of CMS OPPS Rate,99,472.55,
MRI BREAST BILAT W&W/OUT,T990430100,CDM,614,RC,77049,HCPCS,Outpatient,,,2983,1491.5,,2296.91,77,,,Percent of Total Billed Charges,77% of total billed charges,760.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,760.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,932.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2360.06,295,,,fee schedule,295% of bcbs fee schedule,2202.79,285,,,fee schedule,285% of bcbs fee schedule,2202.79,285,,,fee schedule,285% of bcbs fee schedule,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2202.79,285,,,fee schedule,285% of total billed charges,2202.79,285,,,fee schedule,285% of bcbs fee schedule,2280.08,295,,,fee schedule,295% of bcbs fee schedule,2446.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,231.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2296.91,77,,,Percent of total Billed charges,77% of total billed charges,2535.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,857.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.28,2535.55,
MRI BREAST BILAT W&W/OUT,T990430100,CDM,614,RC,C8908,HCPCS,Outpatient,,,2983,1491.5,,2296.91,77,,,Percent of Total Billed Charges,77% of total billed charges,760.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,760.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,932.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5770.38,295,,,fee schedule,295% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5385.79,285,,,fee schedule,285% of bcbs fee schedule,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5385.79,285,,,fee schedule,285% of total billed charges,5385.79,285,,,fee schedule,285% of bcbs fee schedule,5574.76,295,,,fee schedule,295% of bcbs fee schedule,2446.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,1217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1217.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2296.91,77,,,Percent of total Billed charges,77% of total billed charges,2535.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,857.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,1217.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,745.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,745.75,5770.38,
SHOW ME MRI BREAST BILAT W/WO,T990430101,CDM,614,RC,77049,HCPCS,Outpatient,,,278.5,139.25,,214.45,77,,,Percent of Total Billed Charges,77% of total billed charges,71.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2360.06,295,,,fee schedule,295% of bcbs fee schedule,2202.79,285,,,fee schedule,285% of bcbs fee schedule,2202.79,285,,,fee schedule,285% of bcbs fee schedule,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2202.79,285,,,fee schedule,285% of total billed charges,2202.79,285,,,fee schedule,285% of bcbs fee schedule,2280.08,295,,,fee schedule,295% of bcbs fee schedule,228.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,231.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.45,77,,,Percent of total Billed charges,77% of total billed charges,236.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1479,100,,,Case Rate,Pays based on per visit rate,231.28,120,,,Fee Schedule,120% of MO Medicaid Rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1280,100,,,Case Rate,Pays based on per visit rate,69.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.63,2360.06,
SHOW ME PF-MRI BRST W&WO BILAT,T990430102,CDM,972,RC,77049,HCPCS,Outpatient,,,120.5,60.25,26,483.04,135,,,fee schedule,135% of aetna fee schedule,138.58,115,,,fee schedule,115% of cms physician fee schedule,141.35,117.3,,,fee schedule,117.3% of cms physician fee schedule,173.22,143.75,,,fee schedule,143.75% of cms fee schedule ,366.31,100,,,fee schedule,100% of bcbs fee schedule,366.31,100,,,fee schedule,100% of bcbs fee schedule,366.31,100,,,fee schedule,100% of bcbs fee schedule,138.58,115,,,fee schedule,115% of cms fee schedule,366.31,100,,,fee schedule,100% of bcbs fee schedule,366.31,100,,,fee schedule,100% of bcbs fee schedule,366.31,100,,,fee schedule,100% of bcbs fee schedule,358.21,100,,,fee schedule,100% of cigna fee schedule,120.5,100,,,fee schedule,100% of healthlink fee schedule,120.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,120.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,108.45,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,108.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.58,115,,,fee schedule,115% of cms fee schedule,483.04,135,,,Fee Schedule,135% of CMS Fee Schedule ,214.79,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,159.36,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,385.63,100,,,Fee Schedule,100% of UHC Fee Schedule,108.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,138.58,115,,,Fee Schedule,115% of CMS OPPS Rate,376.09,100,,,Fee Schedule,100% of UMR Fee Schedule,138.58,115,,,Fee Schedule,115% of CMS OPPS Rate,108.45,483.04,
SOFT TISSUE NECK US,T990440003,CDM,402,RC,76536,HCPCS,Outpatient,,,782,391,,602.14,77,,,Percent of Total Billed Charges,77% of total billed charges,199.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,578.68,74,,,Percent of Total Billed Charges,74% of total billed charges,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,656.88,84,,,Percent of Total Billed Charges,84% of total billed charges,641.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,409.04,400,,,fee schedule,400% of healthlink fee schedule,383.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,409.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,77.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.14,77,,,Percent of total Billed charges,77% of total billed charges,664.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,224.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.8,664.7,
SOFT TISSUE NECK US,T990440003,CDM,402,RC,76536,HCPCS,Outpatient,,,782,391,TC,602.14,77,,,Percent of Total Billed Charges,77% of total billed charges,199.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,578.68,74,,,Percent of Total Billed Charges,74% of total billed charges,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,539.58,69,,,Percent of Total Billed Charges,69% of total billed charges,656.88,84,,,Percent of Total Billed Charges,84% of total billed charges,641.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,409.04,400,,,fee schedule,400% of healthlink fee schedule,383.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,409.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,77.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.14,77,,,Percent of total Billed charges,77% of total billed charges,664.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,224.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,77.8,120,,,Fee Schedule,120% of MO Medicaid Rate,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.8,664.7,
CHEST ULTRASOUND,T990440005,CDM,402,RC,76604,HCPCS,Outpatient,,,813,406.5,TC,626.01,77,,,Percent of Total Billed Charges,77% of total billed charges,207.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,601.62,74,,,Percent of Total Billed Charges,74% of total billed charges,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,682.92,84,,,Percent of Total Billed Charges,84% of total billed charges,666.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.04,400,,,fee schedule,400% of healthlink fee schedule,289.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,309.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,45.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,626.01,77,,,Percent of total Billed charges,77% of total billed charges,691.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,233.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.32,691.05,
CHEST ULTRASOUND,T990440005,CDM,402,RC,76604,HCPCS,Outpatient,,,813,406.5,,626.01,77,,,Percent of Total Billed Charges,77% of total billed charges,207.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,254.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,601.62,74,,,Percent of Total Billed Charges,74% of total billed charges,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,560.97,69,,,Percent of Total Billed Charges,69% of total billed charges,682.92,84,,,Percent of Total Billed Charges,84% of total billed charges,666.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.04,400,,,fee schedule,400% of healthlink fee schedule,289.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,309.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,45.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,626.01,77,,,Percent of total Billed charges,77% of total billed charges,691.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,233.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,45.32,120,,,Fee Schedule,120% of MO Medicaid Rate,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,203.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.32,691.05,
BREAST W/AXIL; BILATERAL,T990440006,CDM,402,RC,76641,HCPCS,Outpatient,,,1656.5,828.25,TC,1275.51,77,,,Percent of Total Billed Charges,77% of total billed charges,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.51,77,,,Percent of total Billed charges,77% of total billed charges,1408.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,1408.03,
BREAST W/AXIL; BILATERAL,T990440006,CDM,402,RC,76641,HCPCS,Outpatient,,,1656.5,828.25,50,1275.51,77,,,Percent of Total Billed Charges,77% of total billed charges,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.51,77,,,Percent of total Billed charges,77% of total billed charges,1408.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,414.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,1408.03,
"BREAST W/AXILLA US, LT",T990440007,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,LT,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,732.7,
"BREAST W/AXILLA US, LT",T990440007,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,TC,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,732.7,
"BREAST W/AXILLA US, RT",T990440008,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,TC,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,732.7,
"BREAST W/AXILLA US, RT",T990440008,CDM,402,RC,76641,HCPCS,Outpatient,,,862,431,RT,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.9,732.7,
SHOW ME BRST US UNIL/BILAT,T990440009,CDM,402,RC,76641,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.24,74,,,Percent of Total Billed Charges,74% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,52.44,69,,,Percent of Total Billed Charges,69% of total billed charges,63.84,84,,,Percent of Total Billed Charges,84% of total billed charges,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.9,120,,,Fee Schedule,120% of MO Medicaid Rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19,446,
SHOW ME PF-US BRST W/AXIL UNLA,T990440010,CDM,972,RC,76641,HCPCS,Outpatient,,,38.5,19.25,26,,,,,other,not seperately reimbusable,44.28,115,,,fee schedule,115% of cms physician fee schedule,45.16,117.3,,,fee schedule,117.3% of cms physician fee schedule,55.34,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,44.28,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,97.25,100,,,fee schedule,100% of cigna fee schedule,38.5,100,,,fee schedule,100% of healthlink fee schedule,38.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,38.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,34.65,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,34.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.28,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,68.63,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,50.92,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,102.45,100,,,Fee Schedule,100% of UHC Fee Schedule,34.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.28,115,,,Fee Schedule,115% of CMS OPPS Rate,114.49,100,,,Fee Schedule,100% of UMR Fee Schedule,44.28,115,,,Fee Schedule,115% of CMS OPPS Rate,34.65,114.49,
SHOW ME BRST US UNL PF LMT W/A,T990440011,CDM,972,RC,76642,HCPCS,Outpatient,,,36,18,26,106.06,135,,,fee schedule,135% of aetna fee schedule,41.4,115,,,fee schedule,115% of cms physician fee schedule,42.23,117.3,,,fee schedule,117.3% of cms physician fee schedule,51.75,143.75,,,fee schedule,143.75% of cms fee schedule ,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,41.4,115,,,fee schedule,115% of cms fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,80.41,100,,,fee schedule,100% of bcbs fee schedule,79.98,100,,,fee schedule,100% of cigna fee schedule,36,100,,,fee schedule,100% of healthlink fee schedule,36,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,36,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,32.4,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,32.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.4,115,,,fee schedule,115% of cms fee schedule,106.06,135,,,Fee Schedule,135% of CMS Fee Schedule ,64.17,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,47.61,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,83.94,100,,,Fee Schedule,100% of UHC Fee Schedule,32.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.4,115,,,Fee Schedule,115% of CMS OPPS Rate,93.81,100,,,Fee Schedule,100% of UMR Fee Schedule,41.4,115,,,Fee Schedule,115% of CMS OPPS Rate,32.4,106.06,
ABD COM ULTRASOUND,T990440015,CDM,402,RC,76700,HCPCS,Outpatient,,,955.5,477.75,,735.74,77,,,Percent of Total Billed Charges,77% of total billed charges,243.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,298.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,707.07,74,,,Percent of Total Billed Charges,74% of total billed charges,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,802.62,84,,,Percent of Total Billed Charges,84% of total billed charges,783.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,493.72,400,,,fee schedule,400% of healthlink fee schedule,462.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,493.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,72.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,735.74,77,,,Percent of total Billed charges,77% of total billed charges,812.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,274.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.62,812.18,
ABD COM ULTRASOUND,T990440015,CDM,402,RC,76700,HCPCS,Outpatient,,,955.5,477.75,TC,735.74,77,,,Percent of Total Billed Charges,77% of total billed charges,243.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,298.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,707.07,74,,,Percent of Total Billed Charges,74% of total billed charges,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,659.3,69,,,Percent of Total Billed Charges,69% of total billed charges,802.62,84,,,Percent of Total Billed Charges,84% of total billed charges,783.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,493.72,400,,,fee schedule,400% of healthlink fee schedule,462.86,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,493.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,72.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,735.74,77,,,Percent of total Billed charges,77% of total billed charges,812.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,274.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,72.62,120,,,Fee Schedule,120% of MO Medicaid Rate,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,238.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.62,812.18,
ABDOMEN RUQ OR LIMITED US,T990440016,CDM,402,RC,76705,HCPCS,Outpatient,,,831,415.5,,639.87,77,,,Percent of Total Billed Charges,77% of total billed charges,211.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,614.94,74,,,Percent of Total Billed Charges,74% of total billed charges,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,698.04,84,,,Percent of Total Billed Charges,84% of total billed charges,681.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.08,400,,,fee schedule,400% of healthlink fee schedule,354.45,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,378.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,639.87,77,,,Percent of total Billed charges,77% of total billed charges,706.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.7,706.35,
ABDOMEN RUQ OR LIMITED US,T990440016,CDM,402,RC,76705,HCPCS,Outpatient,,,831,415.5,TC,639.87,77,,,Percent of Total Billed Charges,77% of total billed charges,211.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,259.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,614.94,74,,,Percent of Total Billed Charges,74% of total billed charges,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,573.39,69,,,Percent of Total Billed Charges,69% of total billed charges,698.04,84,,,Percent of Total Billed Charges,84% of total billed charges,681.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.08,400,,,fee schedule,400% of healthlink fee schedule,354.45,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,378.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,639.87,77,,,Percent of total Billed charges,77% of total billed charges,706.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,207.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.7,706.35,
SINGLE ORGAN OR LIMITED AREA,T990440017,CDM,402,RC,76705,HCPCS,Outpatient,,,723,361.5,TC,556.71,77,,,Percent of Total Billed Charges,77% of total billed charges,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.02,74,,,Percent of Total Billed Charges,74% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,607.32,84,,,Percent of Total Billed Charges,84% of total billed charges,592.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.08,400,,,fee schedule,400% of healthlink fee schedule,354.45,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,378.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.71,77,,,Percent of total Billed charges,77% of total billed charges,614.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.7,614.55,
SINGLE ORGAN OR LIMITED AREA,T990440017,CDM,402,RC,76705,HCPCS,Outpatient,,,723,361.5,,556.71,77,,,Percent of Total Billed Charges,77% of total billed charges,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.02,74,,,Percent of Total Billed Charges,74% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,607.32,84,,,Percent of Total Billed Charges,84% of total billed charges,592.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.08,400,,,fee schedule,400% of healthlink fee schedule,354.45,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,378.08,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,54.7,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.71,77,,,Percent of total Billed charges,77% of total billed charges,614.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,54.7,120,,,Fee Schedule,120% of MO Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.7,614.55,
AAA SCREENING,T990440018,CDM,402,RC,76706,HCPCS,Outpatient,,,669,334.5,,515.13,77,,,Percent of Total Billed Charges,77% of total billed charges,170.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,495.06,74,,,Percent of Total Billed Charges,74% of total billed charges,461.61,69,,,Percent of Total Billed Charges,69% of total billed charges,461.61,69,,,Percent of Total Billed Charges,69% of total billed charges,167.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.61,69,,,Percent of Total Billed Charges,69% of total billed charges,461.61,69,,,Percent of Total Billed Charges,69% of total billed charges,561.96,84,,,Percent of Total Billed Charges,84% of total billed charges,548.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,81.71,120,,,Fee Schedule,120% of MO of Medicaid Rate,167.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,515.13,77,,,Percent of total Billed charges,77% of total billed charges,568.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,192.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,81.71,120,,,Fee Schedule,120% of MO Medicaid Rate,167.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,167.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.71,568.65,
Renal and Bladder Eval US,T990440019,CDM,402,RC,76770,HCPCS,Outpatient,,,993,496.5,,764.61,77,,,Percent of Total Billed Charges,77% of total billed charges,253.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,734.82,74,,,Percent of Total Billed Charges,74% of total billed charges,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,834.12,84,,,Percent of Total Billed Charges,84% of total billed charges,814.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.36,400,,,fee schedule,400% of healthlink fee schedule,440.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,470.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,67.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,764.61,77,,,Percent of total Billed charges,77% of total billed charges,844.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,844.05,
Renal and Bladder Eval US,T990440019,CDM,402,RC,76770,HCPCS,Outpatient,,,993,496.5,TC,764.61,77,,,Percent of Total Billed Charges,77% of total billed charges,253.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,734.82,74,,,Percent of Total Billed Charges,74% of total billed charges,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,685.17,69,,,Percent of Total Billed Charges,69% of total billed charges,834.12,84,,,Percent of Total Billed Charges,84% of total billed charges,814.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.36,400,,,fee schedule,400% of healthlink fee schedule,440.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,470.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,67.76,120,,,Fee Schedule,120% of MO of Medicaid Rate,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,764.61,77,,,Percent of total Billed charges,77% of total billed charges,844.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,285.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,67.76,120,,,Fee Schedule,120% of MO Medicaid Rate,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,248.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,844.05,
Renal Ultrasound Limited,T990440020,CDM,402,RC,76775,HCPCS,Outpatient,,,883.5,441.75,TC,680.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,653.79,74,,,Percent of Total Billed Charges,74% of total billed charges,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,742.14,84,,,Percent of Total Billed Charges,84% of total billed charges,724.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,382.56,400,,,fee schedule,400% of healthlink fee schedule,358.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,382.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,51.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.3,77,,,Percent of total Billed charges,77% of total billed charges,750.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.05,750.98,
Renal Ultrasound Limited,T990440020,CDM,402,RC,76775,HCPCS,Outpatient,,,883.5,441.75,,680.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,653.79,74,,,Percent of Total Billed Charges,74% of total billed charges,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,609.62,69,,,Percent of Total Billed Charges,69% of total billed charges,742.14,84,,,Percent of Total Billed Charges,84% of total billed charges,724.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,382.56,400,,,fee schedule,400% of healthlink fee schedule,358.65,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,382.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,51.05,120,,,Fee Schedule,120% of MO of Medicaid Rate,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.3,77,,,Percent of total Billed charges,77% of total billed charges,750.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,51.05,120,,,Fee Schedule,120% of MO Medicaid Rate,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,220.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.05,750.98,
SPINAL CANAL ULTRASOUND,T990440021,CDM,402,RC,76800,HCPCS,Outpatient,,,578.5,289.25,TC,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,448.2,400,,,fee schedule,400% of healthlink fee schedule,420.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,448.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.92,491.73,
SPINAL CANAL ULTRASOUND,T990440021,CDM,402,RC,76800,HCPCS,Outpatient,,,578.5,289.25,,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,448.2,400,,,fee schedule,400% of healthlink fee schedule,420.19,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,448.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.92,491.73,
OB 1ST TRIMESTER,T990440022,CDM,402,RC,76801,HCPCS,Outpatient,,,604,302,TC,465.08,77,,,Percent of Total Billed Charges,77% of total billed charges,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,446.96,74,,,Percent of Total Billed Charges,74% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,507.36,84,,,Percent of Total Billed Charges,84% of total billed charges,495.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,457.2,400,,,fee schedule,400% of healthlink fee schedule,428.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,457.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.08,77,,,Percent of total Billed charges,77% of total billed charges,513.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.72,513.4,
OB 1ST TRIMESTER,T990440022,CDM,402,RC,76801,HCPCS,Outpatient,,,604,302,,465.08,77,,,Percent of Total Billed Charges,77% of total billed charges,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,154.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,446.96,74,,,Percent of Total Billed Charges,74% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,416.76,69,,,Percent of Total Billed Charges,69% of total billed charges,507.36,84,,,Percent of Total Billed Charges,84% of total billed charges,495.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,457.2,400,,,fee schedule,400% of healthlink fee schedule,428.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,457.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,64.72,120,,,Fee Schedule,120% of MO of Medicaid Rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.08,77,,,Percent of total Billed charges,77% of total billed charges,513.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,173.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,64.72,120,,,Fee Schedule,120% of MO Medicaid Rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,151,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.72,513.4,
OB 1ST TRI EA ADD GESTATION,T990440023,CDM,402,RC,76802,HCPCS,Outpatient,,,484.5,242.25,,373.07,77,,,Percent of Total Billed Charges,77% of total billed charges,123.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,358.53,74,,,Percent of Total Billed Charges,74% of total billed charges,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,406.98,84,,,Percent of Total Billed Charges,84% of total billed charges,397.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.8,400,,,fee schedule,400% of healthlink fee schedule,242.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,258.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.07,77,,,Percent of total Billed charges,77% of total billed charges,411.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.54,446,
OB 1ST TRI EA ADD GESTATION,T990440023,CDM,402,RC,76802,HCPCS,Outpatient,,,484.5,242.25,TC,373.07,77,,,Percent of Total Billed Charges,77% of total billed charges,123.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,358.53,74,,,Percent of Total Billed Charges,74% of total billed charges,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,334.31,69,,,Percent of Total Billed Charges,69% of total billed charges,406.98,84,,,Percent of Total Billed Charges,84% of total billed charges,397.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.8,400,,,fee schedule,400% of healthlink fee schedule,242.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,258.8,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,27.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.07,77,,,Percent of total Billed charges,77% of total billed charges,411.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,27.54,120,,,Fee Schedule,120% of MO Medicaid Rate,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.54,446,
OB AFTER 1ST TRIMESTER,T990440024,CDM,402,RC,76805,HCPCS,Outpatient,,,783.5,391.75,,603.3,77,,,Percent of Total Billed Charges,77% of total billed charges,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,579.79,74,,,Percent of Total Billed Charges,74% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,658.14,84,,,Percent of Total Billed Charges,84% of total billed charges,642.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,522.32,400,,,fee schedule,400% of healthlink fee schedule,489.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,522.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.3,77,,,Percent of total Billed charges,77% of total billed charges,665.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.53,665.98,
OB AFTER 1ST TRIMESTER,T990440024,CDM,402,RC,76805,HCPCS,Outpatient,,,783.5,391.75,TC,603.3,77,,,Percent of Total Billed Charges,77% of total billed charges,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,579.79,74,,,Percent of Total Billed Charges,74% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,658.14,84,,,Percent of Total Billed Charges,84% of total billed charges,642.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,522.32,400,,,fee schedule,400% of healthlink fee schedule,489.68,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,522.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,80.53,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.3,77,,,Percent of total Billed charges,77% of total billed charges,665.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,80.53,120,,,Fee Schedule,120% of MO Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.53,665.98,
OB AFTER 1ST TRI EA ADD GEST,T990440025,CDM,402,RC,76810,HCPCS,Outpatient,,,783.5,391.75,,603.3,77,,,Percent of Total Billed Charges,77% of total billed charges,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,579.79,74,,,Percent of Total Billed Charges,74% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,658.14,84,,,Percent of Total Billed Charges,84% of total billed charges,642.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,373,400,,,fee schedule,400% of healthlink fee schedule,349.69,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,373,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.3,77,,,Percent of total Billed charges,77% of total billed charges,665.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.78,665.98,
OB AFTER 1ST TRI EA ADD GEST,T990440025,CDM,402,RC,76810,HCPCS,Outpatient,,,783.5,391.75,TC,603.3,77,,,Percent of Total Billed Charges,77% of total billed charges,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,579.79,74,,,Percent of Total Billed Charges,74% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,658.14,84,,,Percent of Total Billed Charges,84% of total billed charges,642.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,373,400,,,fee schedule,400% of healthlink fee schedule,349.69,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,373,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,39.78,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.3,77,,,Percent of total Billed charges,77% of total billed charges,665.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,39.78,120,,,Fee Schedule,120% of MO Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.78,665.98,
OB AFTER 1ST TRI/DETAIL FET AN,T990440026,CDM,402,RC,76811,HCPCS,Outpatient,,,783.5,391.75,,603.3,77,,,Percent of Total Billed Charges,77% of total billed charges,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,579.79,74,,,Percent of Total Billed Charges,74% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,658.14,84,,,Percent of Total Billed Charges,84% of total billed charges,642.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,707.76,400,,,fee schedule,400% of healthlink fee schedule,663.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,707.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,96.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.3,77,,,Percent of total Billed charges,77% of total billed charges,665.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.48,707.76,
OB AFTER 1ST TRI/DETAIL FET AN,T990440026,CDM,402,RC,76811,HCPCS,Outpatient,,,783.5,391.75,TC,603.3,77,,,Percent of Total Billed Charges,77% of total billed charges,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,244.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,579.79,74,,,Percent of Total Billed Charges,74% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,540.62,69,,,Percent of Total Billed Charges,69% of total billed charges,658.14,84,,,Percent of Total Billed Charges,84% of total billed charges,642.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,707.76,400,,,fee schedule,400% of healthlink fee schedule,663.53,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,707.76,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,96.48,120,,,Fee Schedule,120% of MO of Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.3,77,,,Percent of total Billed charges,77% of total billed charges,665.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,225.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,96.48,120,,,Fee Schedule,120% of MO Medicaid Rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,195.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.48,707.76,
"OB ULTRASOUND, LIMITED",T990440027,CDM,402,RC,76815,HCPCS,Outpatient,,,298.5,149.25,,229.85,77,,,Percent of Total Billed Charges,77% of total billed charges,76.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.89,74,,,Percent of Total Billed Charges,74% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,250.74,84,,,Percent of Total Billed Charges,84% of total billed charges,244.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,321.6,400,,,fee schedule,400% of healthlink fee schedule,301.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,321.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,77,,,Percent of total Billed charges,77% of total billed charges,253.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.18,446,
"OB ULTRASOUND, LIMITED",T990440027,CDM,402,RC,76815,HCPCS,Outpatient,,,298.5,149.25,TC,229.85,77,,,Percent of Total Billed Charges,77% of total billed charges,76.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,220.89,74,,,Percent of Total Billed Charges,74% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,205.97,69,,,Percent of Total Billed Charges,69% of total billed charges,250.74,84,,,Percent of Total Billed Charges,84% of total billed charges,244.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,321.6,400,,,fee schedule,400% of healthlink fee schedule,301.5,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,321.6,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,46.18,120,,,Fee Schedule,120% of MO of Medicaid Rate,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,77,,,Percent of total Billed charges,77% of total billed charges,253.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,46.18,120,,,Fee Schedule,120% of MO Medicaid Rate,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,74.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.18,446,
HI-RISK OB US F/UP EA ADD GEST,T990440028,CDM,402,RC,76816,HCPCS,Outpatient,,,1002,501,59,771.54,77,,,Percent of Total Billed Charges,77% of total billed charges,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,741.48,74,,,Percent of Total Billed Charges,74% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,841.68,84,,,Percent of Total Billed Charges,84% of total billed charges,821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,771.54,77,,,Percent of total Billed charges,77% of total billed charges,851.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,288.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,851.7,
HI-RISK OB US F/UP EA ADD GEST,T990440028,CDM,402,RC,76816,HCPCS,Outpatient,,,1002,501,59,771.54,77,,,Percent of Total Billed Charges,77% of total billed charges,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,741.48,74,,,Percent of Total Billed Charges,74% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,841.68,84,,,Percent of Total Billed Charges,84% of total billed charges,821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,771.54,77,,,Percent of total Billed charges,77% of total billed charges,851.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,288.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,851.7,
HI-RISK OB US FOLLOW UP,T990440029,CDM,402,RC,76816,HCPCS,Outpatient,,,1002,501,,771.54,77,,,Percent of Total Billed Charges,77% of total billed charges,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,741.48,74,,,Percent of Total Billed Charges,74% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,841.68,84,,,Percent of Total Billed Charges,84% of total billed charges,821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,771.54,77,,,Percent of total Billed charges,77% of total billed charges,851.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,288.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,851.7,
HI-RISK OB US FOLLOW UP,T990440029,CDM,402,RC,76816,HCPCS,Outpatient,,,1002,501,TC,771.54,77,,,Percent of Total Billed Charges,77% of total billed charges,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,313.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,741.48,74,,,Percent of Total Billed Charges,74% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,691.38,69,,,Percent of Total Billed Charges,69% of total billed charges,841.68,84,,,Percent of Total Billed Charges,84% of total billed charges,821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,771.54,77,,,Percent of total Billed charges,77% of total billed charges,851.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,288.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,250.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,851.7,
OB U/S FOLLOW-UP EA ADD GEST,T990440030,CDM,402,RC,76816,HCPCS,Outpatient,,,862,431,,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,732.7,
OB U/S FOLLOW-UP EA ADD GEST,T990440030,CDM,402,RC,76816,HCPCS,Outpatient,,,862,431,TC,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,732.7,
"OB ULTRASOUND, FOLLOW UP",T990440031,CDM,402,RC,76816,HCPCS,Outpatient,,,862,431,,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,732.7,
"OB ULTRASOUND, FOLLOW UP",T990440031,CDM,402,RC,76816,HCPCS,Outpatient,,,862,431,TC,663.74,77,,,Percent of Total Billed Charges,77% of total billed charges,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,637.88,74,,,Percent of Total Billed Charges,74% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,724.08,84,,,Percent of Total Billed Charges,84% of total billed charges,706.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.16,400,,,fee schedule,400% of healthlink fee schedule,388.28,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,414.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,63.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.74,77,,,Percent of total Billed charges,77% of total billed charges,732.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,63.2,120,,,Fee Schedule,120% of MO Medicaid Rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,215.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.2,732.7,
HI-RISK OB TRANSVAG,T990440032,CDM,402,RC,76817,HCPCS,Outpatient,,,895.5,447.75,,689.54,77,,,Percent of Total Billed Charges,77% of total billed charges,228.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,662.67,74,,,Percent of Total Billed Charges,74% of total billed charges,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,752.22,84,,,Percent of Total Billed Charges,84% of total billed charges,734.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.54,77,,,Percent of total Billed charges,77% of total billed charges,761.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,761.18,
HI-RISK OB TRANSVAG,T990440032,CDM,402,RC,76817,HCPCS,Outpatient,,,895.5,447.75,TC,689.54,77,,,Percent of Total Billed Charges,77% of total billed charges,228.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,662.67,74,,,Percent of Total Billed Charges,74% of total billed charges,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,617.9,69,,,Percent of Total Billed Charges,69% of total billed charges,752.22,84,,,Percent of Total Billed Charges,84% of total billed charges,734.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.54,77,,,Percent of total Billed charges,77% of total billed charges,761.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,223.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,761.18,
HI-RISK OB TRANVAG EA ADD GEST,T990440033,CDM,402,RC,76817,HCPCS,Outpatient,,,896,448,59,689.92,77,,,Percent of Total Billed Charges,77% of total billed charges,228.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,663.04,74,,,Percent of Total Billed Charges,74% of total billed charges,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,752.64,84,,,Percent of Total Billed Charges,84% of total billed charges,734.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.92,77,,,Percent of total Billed charges,77% of total billed charges,761.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,761.6,
HI-RISK OB TRANVAG EA ADD GEST,T990440033,CDM,402,RC,76817,HCPCS,Outpatient,,,896,448,59,689.92,77,,,Percent of Total Billed Charges,77% of total billed charges,228.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,280,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,663.04,74,,,Percent of Total Billed Charges,74% of total billed charges,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,618.24,69,,,Percent of Total Billed Charges,69% of total billed charges,752.64,84,,,Percent of Total Billed Charges,84% of total billed charges,734.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,689.92,77,,,Percent of total Billed charges,77% of total billed charges,761.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,224,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,761.6,
OB TRANSVAG,T990440034,CDM,402,RC,76817,HCPCS,Outpatient,,,723,361.5,,556.71,77,,,Percent of Total Billed Charges,77% of total billed charges,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.02,74,,,Percent of Total Billed Charges,74% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,607.32,84,,,Percent of Total Billed Charges,84% of total billed charges,592.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.71,77,,,Percent of total Billed charges,77% of total billed charges,614.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,614.55,
OB TRANSVAG,T990440034,CDM,402,RC,76817,HCPCS,Outpatient,,,723,361.5,TC,556.71,77,,,Percent of Total Billed Charges,77% of total billed charges,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.02,74,,,Percent of Total Billed Charges,74% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,607.32,84,,,Percent of Total Billed Charges,84% of total billed charges,592.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.71,77,,,Percent of total Billed charges,77% of total billed charges,614.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,614.55,
OB TRANSVAG EA ADD GESTATION,T990440035,CDM,402,RC,76817,HCPCS,Outpatient,,,723,361.5,,556.71,77,,,Percent of Total Billed Charges,77% of total billed charges,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.02,74,,,Percent of Total Billed Charges,74% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,607.32,84,,,Percent of Total Billed Charges,84% of total billed charges,592.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.71,77,,,Percent of total Billed charges,77% of total billed charges,614.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,614.55,
OB TRANSVAG EA ADD GESTATION,T990440035,CDM,402,RC,76817,HCPCS,Outpatient,,,723,361.5,TC,556.71,77,,,Percent of Total Billed Charges,77% of total billed charges,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.02,74,,,Percent of Total Billed Charges,74% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,498.87,69,,,Percent of Total Billed Charges,69% of total billed charges,607.32,84,,,Percent of Total Billed Charges,84% of total billed charges,592.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,358,400,,,fee schedule,400% of healthlink fee schedule,335.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,358,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,52.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.71,77,,,Percent of total Billed charges,77% of total billed charges,614.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,207.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,52.26,120,,,Fee Schedule,120% of MO Medicaid Rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,180.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.26,614.55,
HI-RISK BIOPHYSICAL PROFILE,T990440036,CDM,402,RC,76819,HCPCS,Outpatient,,,983,491.5,TC,756.91,77,,,Percent of Total Billed Charges,77% of total billed charges,250.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,727.42,74,,,Percent of Total Billed Charges,74% of total billed charges,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,825.72,84,,,Percent of Total Billed Charges,84% of total billed charges,806.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.91,77,,,Percent of total Billed charges,77% of total billed charges,835.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,835.55,
HI-RISK BIOPHYSICAL PROFILE,T990440036,CDM,402,RC,76819,HCPCS,Outpatient,,,983,491.5,,756.91,77,,,Percent of Total Billed Charges,77% of total billed charges,250.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,727.42,74,,,Percent of Total Billed Charges,74% of total billed charges,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,678.27,69,,,Percent of Total Billed Charges,69% of total billed charges,825.72,84,,,Percent of Total Billed Charges,84% of total billed charges,806.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.91,77,,,Percent of total Billed charges,77% of total billed charges,835.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,245.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,835.55,
HI-RISK BPP-EA ADD GESTATION,T990440037,CDM,402,RC,76819,HCPCS,Outpatient,,,982.5,491.25,59,756.53,77,,,Percent of Total Billed Charges,77% of total billed charges,250.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,727.05,74,,,Percent of Total Billed Charges,74% of total billed charges,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,825.3,84,,,Percent of Total Billed Charges,84% of total billed charges,805.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.53,77,,,Percent of total Billed charges,77% of total billed charges,835.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,835.13,
HI-RISK BPP-EA ADD GESTATION,T990440037,CDM,402,RC,76819,HCPCS,Outpatient,,,982.5,491.25,59,756.53,77,,,Percent of Total Billed Charges,77% of total billed charges,250.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,727.05,74,,,Percent of Total Billed Charges,74% of total billed charges,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,677.93,69,,,Percent of Total Billed Charges,69% of total billed charges,825.3,84,,,Percent of Total Billed Charges,84% of total billed charges,805.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.53,77,,,Percent of total Billed charges,77% of total billed charges,835.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,245.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,835.13,
OB BIOPHYSICAL PROFILE,T990440038,CDM,402,RC,76819,HCPCS,Outpatient,,,809.5,404.75,TC,623.32,77,,,Percent of Total Billed Charges,77% of total billed charges,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,599.03,74,,,Percent of Total Billed Charges,74% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,679.98,84,,,Percent of Total Billed Charges,84% of total billed charges,663.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623.32,77,,,Percent of total Billed charges,77% of total billed charges,688.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,688.08,
OB BIOPHYSICAL PROFILE,T990440038,CDM,402,RC,76819,HCPCS,Outpatient,,,809.5,404.75,,623.32,77,,,Percent of Total Billed Charges,77% of total billed charges,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,599.03,74,,,Percent of Total Billed Charges,74% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,679.98,84,,,Percent of Total Billed Charges,84% of total billed charges,663.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623.32,77,,,Percent of total Billed charges,77% of total billed charges,688.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,688.08,
OB BPP - EA ADD GESTATION,T990440039,CDM,402,RC,76819,HCPCS,Outpatient,,,809.5,404.75,,623.32,77,,,Percent of Total Billed Charges,77% of total billed charges,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,599.03,74,,,Percent of Total Billed Charges,74% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,679.98,84,,,Percent of Total Billed Charges,84% of total billed charges,663.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623.32,77,,,Percent of total Billed charges,77% of total billed charges,688.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,688.08,
OB BPP - EA ADD GESTATION,T990440039,CDM,402,RC,76819,HCPCS,Outpatient,,,809.5,404.75,59,623.32,77,,,Percent of Total Billed Charges,77% of total billed charges,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,206.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,599.03,74,,,Percent of Total Billed Charges,74% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,558.56,69,,,Percent of Total Billed Charges,69% of total billed charges,679.98,84,,,Percent of Total Billed Charges,84% of total billed charges,663.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,320.44,400,,,fee schedule,400% of healthlink fee schedule,300.41,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,320.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,44.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,623.32,77,,,Percent of total Billed charges,77% of total billed charges,688.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,232.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,44.58,120,,,Fee Schedule,120% of MO Medicaid Rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,202.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,688.08,
UMB ART DOP EA ADD GESTATION,T990440040,CDM,402,RC,76820,HCPCS,Outpatient,,,578.5,289.25,,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,160,400,,,fee schedule,400% of healthlink fee schedule,150,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,160,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,491.73,
Umbilical Artery Doppler,T990440041,CDM,402,RC,76820,HCPCS,Outpatient,,,578.5,289.25,,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,160,400,,,fee schedule,400% of healthlink fee schedule,150,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,160,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,30.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,30.77,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,491.73,
Cerebral Artery Doppler,T990440042,CDM,402,RC,76821,HCPCS,Outpatient,,,578.5,289.25,,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.28,400,,,fee schedule,400% of healthlink fee schedule,318.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,339.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,50.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.44,491.73,
Cerebral Artery Doppler,T990440042,CDM,402,RC,76821,HCPCS,Outpatient,,,578.5,289.25,TC,445.45,77,,,Percent of Total Billed Charges,77% of total billed charges,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.09,74,,,Percent of Total Billed Charges,74% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,399.17,69,,,Percent of Total Billed Charges,69% of total billed charges,485.94,84,,,Percent of Total Billed Charges,84% of total billed charges,474.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.28,400,,,fee schedule,400% of healthlink fee schedule,318.08,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,339.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,50.44,120,,,Fee Schedule,120% of MO of Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.45,77,,,Percent of total Billed charges,77% of total billed charges,491.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,50.44,120,,,Fee Schedule,120% of MO Medicaid Rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,144.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.44,491.73,
PELVIC (TRANSVAG) ULT,T990440043,CDM,402,RC,76830,HCPCS,Outpatient,,,823.5,411.75,TC,634.1,77,,,Percent of Total Billed Charges,77% of total billed charges,209.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,609.39,74,,,Percent of Total Billed Charges,74% of total billed charges,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,691.74,84,,,Percent of Total Billed Charges,84% of total billed charges,675.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,441.56,400,,,fee schedule,400% of healthlink fee schedule,413.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,441.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.1,77,,,Percent of total Billed charges,77% of total billed charges,699.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.92,699.98,
PELVIC (TRANSVAG) ULT,T990440043,CDM,402,RC,76830,HCPCS,Outpatient,,,823.5,411.75,,634.1,77,,,Percent of Total Billed Charges,77% of total billed charges,209.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,609.39,74,,,Percent of Total Billed Charges,74% of total billed charges,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,568.22,69,,,Percent of Total Billed Charges,69% of total billed charges,691.74,84,,,Percent of Total Billed Charges,84% of total billed charges,675.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,441.56,400,,,fee schedule,400% of healthlink fee schedule,413.96,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,441.56,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,79.92,120,,,Fee Schedule,120% of MO of Medicaid Rate,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.1,77,,,Percent of total Billed charges,77% of total billed charges,699.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,79.92,120,,,Fee Schedule,120% of MO Medicaid Rate,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,205.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.92,699.98,
SALINE INJ SONOHYSTER (SIS),T990440044,CDM,402,RC,76831,HCPCS,Outpatient,,,639.5,319.75,,492.42,77,,,Percent of Total Billed Charges,77% of total billed charges,163.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,199.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,473.23,74,,,Percent of Total Billed Charges,74% of total billed charges,441.26,69,,,Percent of Total Billed Charges,69% of total billed charges,441.26,69,,,Percent of Total Billed Charges,69% of total billed charges,159.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,441.26,69,,,Percent of Total Billed Charges,69% of total billed charges,441.26,69,,,Percent of Total Billed Charges,69% of total billed charges,537.18,84,,,Percent of Total Billed Charges,84% of total billed charges,524.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,439.96,400,,,fee schedule,400% of healthlink fee schedule,412.46,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,439.96,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,75.36,120,,,Fee Schedule,120% of MO Medicaid Rate,75.36,120,,,Fee Schedule,120% of MO Medicaid Rate,75.36,120,,,Fee Schedule,120% of MO of Medicaid Rate,159.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,492.42,77,,,Percent of total Billed charges,77% of total billed charges,543.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,183.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,75.36,120,,,Fee Schedule,120% of MO Medicaid Rate,159.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,159.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.36,543.58,
PELVIC (TRANABD) ULT,T990440045,CDM,402,RC,76856,HCPCS,Outpatient,,,989,494.5,,761.53,77,,,Percent of Total Billed Charges,77% of total billed charges,252.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,731.86,74,,,Percent of Total Billed Charges,74% of total billed charges,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,830.76,84,,,Percent of Total Billed Charges,84% of total billed charges,810.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.32,400,,,fee schedule,400% of healthlink fee schedule,418.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,446.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.53,77,,,Percent of total Billed charges,77% of total billed charges,840.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,840.65,
PELVIC (TRANABD) ULT,T990440045,CDM,402,RC,76856,HCPCS,Outpatient,,,989,494.5,TC,761.53,77,,,Percent of Total Billed Charges,77% of total billed charges,252.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,252.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,731.86,74,,,Percent of Total Billed Charges,74% of total billed charges,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,682.41,69,,,Percent of Total Billed Charges,69% of total billed charges,830.76,84,,,Percent of Total Billed Charges,84% of total billed charges,810.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.32,400,,,fee schedule,400% of healthlink fee schedule,418.43,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,446.32,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,67.15,120,,,Fee Schedule,120% of MO of Medicaid Rate,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,761.53,77,,,Percent of total Billed charges,77% of total billed charges,840.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,284.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,67.15,120,,,Fee Schedule,120% of MO Medicaid Rate,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,247.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,840.65,
BLADDER EVAL,T990440046,CDM,402,RC,76857,HCPCS,Outpatient,,,565.5,282.75,,435.44,77,,,Percent of Total Billed Charges,77% of total billed charges,144.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,418.47,74,,,Percent of Total Billed Charges,74% of total billed charges,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,475.02,84,,,Percent of Total Billed Charges,84% of total billed charges,463.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,357.68,400,,,fee schedule,400% of healthlink fee schedule,335.33,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,357.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,45.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.44,77,,,Percent of total Billed charges,77% of total billed charges,480.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,162.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.86,480.68,
BLADDER EVAL,T990440046,CDM,402,RC,76857,HCPCS,Outpatient,,,565.5,282.75,TC,435.44,77,,,Percent of Total Billed Charges,77% of total billed charges,144.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,176.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,418.47,74,,,Percent of Total Billed Charges,74% of total billed charges,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,390.2,69,,,Percent of Total Billed Charges,69% of total billed charges,475.02,84,,,Percent of Total Billed Charges,84% of total billed charges,463.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,357.68,400,,,fee schedule,400% of healthlink fee schedule,335.33,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,357.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,45.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,435.44,77,,,Percent of total Billed charges,77% of total billed charges,480.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,162.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,45.86,120,,,Fee Schedule,120% of MO Medicaid Rate,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,141.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.86,480.68,
SCROTUM ULTRASOUND,T990440047,CDM,402,RC,76870,HCPCS,Outpatient,,,765.5,382.75,,589.44,77,,,Percent of Total Billed Charges,77% of total billed charges,195.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,566.47,74,,,Percent of Total Billed Charges,74% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,643.02,84,,,Percent of Total Billed Charges,84% of total billed charges,627.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.64,400,,,fee schedule,400% of healthlink fee schedule,414.98,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,442.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,589.44,77,,,Percent of total Billed charges,77% of total billed charges,650.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,220.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.23,650.68,
SCROTUM ULTRASOUND,T990440047,CDM,402,RC,76870,HCPCS,Outpatient,,,765.5,382.75,TC,589.44,77,,,Percent of Total Billed Charges,77% of total billed charges,195.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,566.47,74,,,Percent of Total Billed Charges,74% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,643.02,84,,,Percent of Total Billed Charges,84% of total billed charges,627.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.64,400,,,fee schedule,400% of healthlink fee schedule,414.98,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,442.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,589.44,77,,,Percent of total Billed charges,77% of total billed charges,650.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,220.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.23,650.68,
TRANSRECTAL (TRUS),T990440048,CDM,402,RC,76872,HCPCS,Outpatient,,,828.5,414.25,TC,637.95,77,,,Percent of Total Billed Charges,77% of total billed charges,211.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,613.09,74,,,Percent of Total Billed Charges,74% of total billed charges,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,695.94,84,,,Percent of Total Billed Charges,84% of total billed charges,679.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.64,400,,,fee schedule,400% of healthlink fee schedule,485.29,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,517.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.95,77,,,Percent of total Billed charges,77% of total billed charges,704.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.55,704.23,
TRANSRECTAL (TRUS),T990440048,CDM,402,RC,76872,HCPCS,Outpatient,,,828.5,414.25,,637.95,77,,,Percent of Total Billed Charges,77% of total billed charges,211.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,211.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,613.09,74,,,Percent of Total Billed Charges,74% of total billed charges,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,571.67,69,,,Percent of Total Billed Charges,69% of total billed charges,695.94,84,,,Percent of Total Billed Charges,84% of total billed charges,679.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,517.64,400,,,fee schedule,400% of healthlink fee schedule,485.29,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,517.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,97.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,637.95,77,,,Percent of total Billed charges,77% of total billed charges,704.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,238.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,97.55,120,,,Fee Schedule,120% of MO Medicaid Rate,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,207.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.55,704.23,
US SOFT TISSUE COMPLETE,T990440049,CDM,402,RC,76881,HCPCS,Outpatient,,,819,409.5,TC,630.63,77,,,Percent of Total Billed Charges,77% of total billed charges,208.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,606.06,74,,,Percent of Total Billed Charges,74% of total billed charges,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,687.96,84,,,Percent of Total Billed Charges,84% of total billed charges,671.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,64.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.63,77,,,Percent of total Billed charges,77% of total billed charges,696.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,696.15,
US SOFT TISSUE COMPLETE,T990440049,CDM,402,RC,76881,HCPCS,Outpatient,,,819,409.5,,630.63,77,,,Percent of Total Billed Charges,77% of total billed charges,208.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,208.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,606.06,74,,,Percent of Total Billed Charges,74% of total billed charges,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,565.11,69,,,Percent of Total Billed Charges,69% of total billed charges,687.96,84,,,Percent of Total Billed Charges,84% of total billed charges,671.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,64.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.63,77,,,Percent of total Billed charges,77% of total billed charges,696.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,235.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,64.57,120,,,Fee Schedule,120% of MO Medicaid Rate,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,204.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,696.15,
US SOFT TISSUE LIMITED,T990440050,CDM,402,RC,76882,HCPCS,Outpatient,,,705,352.5,TC,542.85,77,,,Percent of Total Billed Charges,77% of total billed charges,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,521.7,74,,,Percent of Total Billed Charges,74% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,592.2,84,,,Percent of Total Billed Charges,84% of total billed charges,578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.85,77,,,Percent of total Billed charges,77% of total billed charges,599.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,202.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.07,599.25,
US SOFT TISSUE LIMITED,T990440050,CDM,402,RC,76882,HCPCS,Outpatient,,,705,352.5,,542.85,77,,,Percent of Total Billed Charges,77% of total billed charges,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,179.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,220.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,521.7,74,,,Percent of Total Billed Charges,74% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,486.45,69,,,Percent of Total Billed Charges,69% of total billed charges,592.2,84,,,Percent of Total Billed Charges,84% of total billed charges,578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,30.07,120,,,Fee Schedule,120% of MO of Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.85,77,,,Percent of total Billed charges,77% of total billed charges,599.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,202.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,30.07,120,,,Fee Schedule,120% of MO Medicaid Rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,176.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.07,599.25,
INFANT HIP ULTRASOUND,T990440054,CDM,402,RC,76885,HCPCS,Outpatient,,,498,249,,383.46,77,,,Percent of Total Billed Charges,77% of total billed charges,126.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.52,74,,,Percent of Total Billed Charges,74% of total billed charges,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,418.32,84,,,Percent of Total Billed Charges,84% of total billed charges,408.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,510.36,400,,,fee schedule,400% of healthlink fee schedule,478.46,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,510.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.46,77,,,Percent of total Billed charges,77% of total billed charges,423.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,510.36,
INFANT HIP ULTRASOUND,T990440054,CDM,402,RC,76885,HCPCS,Outpatient,,,498,249,TC,383.46,77,,,Percent of Total Billed Charges,77% of total billed charges,126.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.52,74,,,Percent of Total Billed Charges,74% of total billed charges,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,343.62,69,,,Percent of Total Billed Charges,69% of total billed charges,418.32,84,,,Percent of Total Billed Charges,84% of total billed charges,408.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,510.36,400,,,fee schedule,400% of healthlink fee schedule,478.46,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,510.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,72.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.46,77,,,Percent of total Billed charges,77% of total billed charges,423.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,72.6,120,,,Fee Schedule,120% of MO Medicaid Rate,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,124.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,510.36,
ECHO GUIDE FOR BIOPSY,T990440055,CDM,402,RC,76942,HCPCS,Outpatient,,,1056.5,528.25,,813.51,77,,,Percent of Total Billed Charges,77% of total billed charges,269.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,269.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,330.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,781.81,74,,,Percent of Total Billed Charges,74% of total billed charges,728.99,69,,,Percent of Total Billed Charges,69% of total billed charges,728.99,69,,,Percent of Total Billed Charges,69% of total billed charges,264.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,728.99,69,,,Percent of Total Billed Charges,69% of total billed charges,728.99,69,,,Percent of Total Billed Charges,69% of total billed charges,887.46,84,,,Percent of Total Billed Charges,84% of total billed charges,866.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,672,400,,,fee schedule,400% of healthlink fee schedule,630,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,672,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,101.99,120,,,Fee Schedule,120% of MO Medicaid Rate,101.99,120,,,Fee Schedule,120% of MO Medicaid Rate,101.99,120,,,Fee Schedule,120% of MO of Medicaid Rate,264.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,813.51,77,,,Percent of total Billed charges,77% of total billed charges,898.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,303.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,101.99,120,,,Fee Schedule,120% of MO Medicaid Rate,264.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,264.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.99,898.03,
AMINIOCENTESIS,T990440060,CDM,402,RC,76946,HCPCS,Outpatient,,,851.5,425.75,,655.66,77,,,Percent of Total Billed Charges,77% of total billed charges,217.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.11,74,,,Percent of Total Billed Charges,74% of total billed charges,587.54,69,,,Percent of Total Billed Charges,69% of total billed charges,587.54,69,,,Percent of Total Billed Charges,69% of total billed charges,212.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.54,69,,,Percent of Total Billed Charges,69% of total billed charges,587.54,69,,,Percent of Total Billed Charges,69% of total billed charges,715.26,84,,,Percent of Total Billed Charges,84% of total billed charges,698.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.16,400,,,fee schedule,400% of healthlink fee schedule,116.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,124.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,27.04,120,,,Fee Schedule,120% of MO Medicaid Rate,27.04,120,,,Fee Schedule,120% of MO Medicaid Rate,27.04,120,,,Fee Schedule,120% of MO of Medicaid Rate,212.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.66,77,,,Percent of total Billed charges,77% of total billed charges,723.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,27.04,120,,,Fee Schedule,120% of MO Medicaid Rate,212.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,212.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.04,723.78,
INTRA OP US GUIDANCE,T990440061,CDM,402,RC,76998,HCPCS,Outpatient,,,1063.5,531.75,,818.9,77,,,Percent of Total Billed Charges,77% of total billed charges,271.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,786.99,74,,,Percent of Total Billed Charges,74% of total billed charges,733.82,69,,,Percent of Total Billed Charges,69% of total billed charges,733.82,69,,,Percent of Total Billed Charges,69% of total billed charges,265.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.82,69,,,Percent of Total Billed Charges,69% of total billed charges,733.82,69,,,Percent of Total Billed Charges,69% of total billed charges,893.34,84,,,Percent of Total Billed Charges,84% of total billed charges,872.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,76.64,120,,,Fee Schedule,120% of MO of Medicaid Rate,265.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.9,77,,,Percent of total Billed charges,77% of total billed charges,903.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,76.64,120,,,Fee Schedule,120% of MO Medicaid Rate,265.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,265.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.64,903.98,
"ECHO, LIMITED",T990440062,CDM,483,RC,93304,HCPCS,Outpatient,,,2495,1247.5,,1921.15,77,,,Percent of Total Billed Charges,77% of total billed charges,636.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,636.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,779.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1846.3,74,,,Percent of Total Billed Charges,74% of total billed charges,1721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,623.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2095.8,84,,,Percent of Total Billed Charges,84% of total billed charges,2045.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,110.9,120,,,Fee Schedule,120% of MO Medicaid Rate,110.9,120,,,Fee Schedule,120% of MO Medicaid Rate,110.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,623.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1921.15,77,,,Percent of total Billed charges,77% of total billed charges,2120.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,717.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,498,100,,,Case Rate,Pays based on per visit rate,110.9,120,,,Fee Schedule,120% of MO Medicaid Rate,623.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431,100,,,Case Rate,Pays based on per visit rate,623.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.9,2120.75,
ECHO 2D/M MODE,T990440064,CDM,480,RC,93306,HCPCS,Outpatient,,,3175.5,1587.75,,2445.14,77,,,Percent of Total Billed Charges,77% of total billed charges,809.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,809.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,992.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2349.87,74,,,Percent of Total Billed Charges,74% of total billed charges,2191.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2191.1,69,,,Percent of Total Billed Charges,69% of total billed charges,793.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2191.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2191.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2667.42,84,,,Percent of Total Billed Charges,84% of total billed charges,2603.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,142.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,793.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2445.14,77,,,Percent of total Billed charges,77% of total billed charges,2699.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,912.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,898,100,,,Case Rate,Pays based on per visit rate,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,793.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777,100,,,Case Rate,Pays based on per visit rate,793.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.21,2699.18,
ECHO BUBBLE TEST,T990440065,CDM,480,RC,93306,HCPCS,Outpatient,,,2420.5,1210.25,,1863.79,77,,,Percent of Total Billed Charges,77% of total billed charges,617.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,617.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,756.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1791.17,74,,,Percent of Total Billed Charges,74% of total billed charges,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.15,69,,,Percent of Total Billed Charges,69% of total billed charges,2033.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1984.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,142.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1863.79,77,,,Percent of total Billed charges,77% of total billed charges,2057.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,695.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,898,100,,,Case Rate,Pays based on per visit rate,142.21,120,,,Fee Schedule,120% of MO Medicaid Rate,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777,100,,,Case Rate,Pays based on per visit rate,605.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.21,2057.43,
"ECHO, Limited - M Mode",T990440068,CDM,483,RC,93308,HCPCS,Outpatient,,,1589.5,794.75,,1223.92,77,,,Percent of Total Billed Charges,77% of total billed charges,405.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,405.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1176.23,74,,,Percent of Total Billed Charges,74% of total billed charges,1096.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.76,69,,,Percent of Total Billed Charges,69% of total billed charges,397.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1335.18,84,,,Percent of Total Billed Charges,84% of total billed charges,1303.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,85.03,120,,,Fee Schedule,120% of MO Medicaid Rate,85.03,120,,,Fee Schedule,120% of MO Medicaid Rate,85.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,397.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1223.92,77,,,Percent of total Billed charges,77% of total billed charges,1351.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,456.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,498,100,,,Case Rate,Pays based on per visit rate,85.03,120,,,Fee Schedule,120% of MO Medicaid Rate,397.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431,100,,,Case Rate,Pays based on per visit rate,397.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.03,1351.08,
LIMITED CARDIAC DOPPLER,T990440069,CDM,483,RC,93321,HCPCS,Outpatient,,,35.5,17.75,,27.34,77,,,Percent of Total Billed Charges,77% of total billed charges,9.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.27,74,,,Percent of Total Billed Charges,74% of total billed charges,24.5,69,,,Percent of Total Billed Charges,69% of total billed charges,24.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,69,,,Percent of Total Billed Charges,69% of total billed charges,24.5,69,,,Percent of Total Billed Charges,69% of total billed charges,29.82,84,,,Percent of Total Billed Charges,84% of total billed charges,29.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,27.28,120,,,Fee Schedule,120% of MO Medicaid Rate,27.28,120,,,Fee Schedule,120% of MO Medicaid Rate,27.28,120,,,Fee Schedule,120% of MO of Medicaid Rate,8.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.34,77,,,Percent of total Billed charges,77% of total billed charges,30.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,498,100,,,Case Rate,Pays based on per visit rate,27.28,120,,,Fee Schedule,120% of MO Medicaid Rate,8.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431,100,,,Case Rate,Pays based on per visit rate,8.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.88,498,
LIMITED COLOR DOPPLER,T990440070,CDM,483,RC,93325,HCPCS,Outpatient,,,86.5,43.25,,66.61,77,,,Percent of Total Billed Charges,77% of total billed charges,22.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.01,74,,,Percent of Total Billed Charges,74% of total billed charges,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,59.69,69,,,Percent of Total Billed Charges,69% of total billed charges,72.66,84,,,Percent of Total Billed Charges,84% of total billed charges,70.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,51.58,120,,,Fee Schedule,120% of MO Medicaid Rate,51.58,120,,,Fee Schedule,120% of MO Medicaid Rate,51.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.61,77,,,Percent of total Billed charges,77% of total billed charges,73.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,498,100,,,Case Rate,Pays based on per visit rate,51.58,120,,,Fee Schedule,120% of MO Medicaid Rate,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431,100,,,Case Rate,Pays based on per visit rate,21.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.63,498,
DOPPLER CAROTID BILATERAL,T990440071,CDM,921,RC,93880,HCPCS,Outpatient,,,1653.5,826.75,,1273.2,77,,,Percent of Total Billed Charges,77% of total billed charges,421.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,421.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1223.59,74,,,Percent of Total Billed Charges,74% of total billed charges,1140.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1140.92,69,,,Percent of Total Billed Charges,69% of total billed charges,413.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1140.92,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.94,84,,,Percent of Total Billed Charges,84% of total billed charges,1355.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,181.34,120,,,Fee Schedule,120% of MO Medicaid Rate,181.34,120,,,Fee Schedule,120% of MO Medicaid Rate,181.34,120,,,Fee Schedule,120% of MO of Medicaid Rate,413.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1273.2,77,,,Percent of total Billed charges,77% of total billed charges,1405.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,475.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,181.34,120,,,Fee Schedule,120% of MO Medicaid Rate,413.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,413.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.34,1405.48,
ABI-ANKLE/BRACHIAL INDCES,T990440072,CDM,921,RC,93922,HCPCS,Outpatient,,,822.5,411.25,,633.33,77,,,Percent of Total Billed Charges,77% of total billed charges,209.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,209.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,608.65,74,,,Percent of Total Billed Charges,74% of total billed charges,567.53,69,,,Percent of Total Billed Charges,69% of total billed charges,567.53,69,,,Percent of Total Billed Charges,69% of total billed charges,205.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,567.53,69,,,Percent of Total Billed Charges,69% of total billed charges,567.53,69,,,Percent of Total Billed Charges,69% of total billed charges,690.9,84,,,Percent of Total Billed Charges,84% of total billed charges,674.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,82.09,120,,,Fee Schedule,120% of MO Medicaid Rate,82.09,120,,,Fee Schedule,120% of MO Medicaid Rate,82.09,120,,,Fee Schedule,120% of MO of Medicaid Rate,205.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,633.33,77,,,Percent of total Billed charges,77% of total billed charges,699.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,236.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,82.09,120,,,Fee Schedule,120% of MO Medicaid Rate,205.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,205.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.09,728,
SEGM PRES LOW EXT,T990440073,CDM,921,RC,93923,HCPCS,Outpatient,,,1439,719.5,,1108.03,77,,,Percent of Total Billed Charges,77% of total billed charges,366.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,449.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1064.86,74,,,Percent of Total Billed Charges,74% of total billed charges,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1208.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1179.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,123.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1108.03,77,,,Percent of total Billed charges,77% of total billed charges,1223.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,413.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.31,1223.15,
SEGM PRES UPPER EXT BILAT,T990440074,CDM,921,RC,93923,HCPCS,Outpatient,,,1439,719.5,,1108.03,77,,,Percent of Total Billed Charges,77% of total billed charges,366.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,449.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1064.86,74,,,Percent of Total Billed Charges,74% of total billed charges,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,992.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1208.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1179.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,123.31,120,,,Fee Schedule,120% of MO of Medicaid Rate,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1108.03,77,,,Percent of total Billed charges,77% of total billed charges,1223.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,413.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,123.31,120,,,Fee Schedule,120% of MO Medicaid Rate,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,359.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.31,1223.15,
LOWER ART PRE/POST EXERCISE,T990440075,CDM,921,RC,93924,HCPCS,Outpatient,,,1335,667.5,,1027.95,77,,,Percent of Total Billed Charges,77% of total billed charges,340.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.9,74,,,Percent of Total Billed Charges,74% of total billed charges,921.15,69,,,Percent of Total Billed Charges,69% of total billed charges,921.15,69,,,Percent of Total Billed Charges,69% of total billed charges,333.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,921.15,69,,,Percent of Total Billed Charges,69% of total billed charges,921.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1121.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,151.39,120,,,Fee Schedule,120% of MO Medicaid Rate,151.39,120,,,Fee Schedule,120% of MO Medicaid Rate,151.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,333.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.95,77,,,Percent of total Billed charges,77% of total billed charges,1134.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,151.39,120,,,Fee Schedule,120% of MO Medicaid Rate,333.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,333.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.39,1134.75,
Low Ext Arterial Duplex Bilat,T990440076,CDM,921,RC,93925,HCPCS,Outpatient,,,2256,1128,,1737.12,77,,,Percent of Total Billed Charges,77% of total billed charges,575.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,575.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1669.44,74,,,Percent of Total Billed Charges,74% of total billed charges,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1895.04,84,,,Percent of Total Billed Charges,84% of total billed charges,1849.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,187.45,120,,,Fee Schedule,120% of MO Medicaid Rate,187.45,120,,,Fee Schedule,120% of MO Medicaid Rate,187.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1737.12,77,,,Percent of total Billed charges,77% of total billed charges,1917.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,648.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,187.45,120,,,Fee Schedule,120% of MO Medicaid Rate,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.45,1917.6,
Low Ext Arterial Duplex Unilat,T990440077,CDM,921,RC,93926,HCPCS,Outpatient,,,1247,623.5,,960.19,77,,,Percent of Total Billed Charges,77% of total billed charges,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,922.78,74,,,Percent of Total Billed Charges,74% of total billed charges,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,1047.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1022.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,108.47,120,,,Fee Schedule,120% of MO Medicaid Rate,108.47,120,,,Fee Schedule,120% of MO Medicaid Rate,108.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.19,77,,,Percent of total Billed charges,77% of total billed charges,1059.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,358.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,108.47,120,,,Fee Schedule,120% of MO Medicaid Rate,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.47,1059.95,
Up Ext Arterial Duplex Bilat,T990440078,CDM,921,RC,93930,HCPCS,Outpatient,,,2256,1128,,1737.12,77,,,Percent of Total Billed Charges,77% of total billed charges,575.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,575.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1669.44,74,,,Percent of Total Billed Charges,74% of total billed charges,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1556.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1895.04,84,,,Percent of Total Billed Charges,84% of total billed charges,1849.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,145.2,120,,,Fee Schedule,120% of MO Medicaid Rate,145.2,120,,,Fee Schedule,120% of MO Medicaid Rate,145.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1737.12,77,,,Percent of total Billed charges,77% of total billed charges,1917.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,648.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,145.2,120,,,Fee Schedule,120% of MO Medicaid Rate,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,564,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.2,1917.6,
Up Ext Arterial Duplex Unilat,T990440079,CDM,921,RC,93931,HCPCS,Outpatient,,,1247,623.5,,960.19,77,,,Percent of Total Billed Charges,77% of total billed charges,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,317.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,922.78,74,,,Percent of Total Billed Charges,74% of total billed charges,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,860.43,69,,,Percent of Total Billed Charges,69% of total billed charges,1047.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1022.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92.93,120,,,Fee Schedule,120% of MO Medicaid Rate,92.93,120,,,Fee Schedule,120% of MO Medicaid Rate,92.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.19,77,,,Percent of total Billed charges,77% of total billed charges,1059.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,358.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,92.93,120,,,Fee Schedule,120% of MO Medicaid Rate,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,311.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.93,1059.95,
LOW EXT VENOUS BILATERAL,T990440080,CDM,921,RC,93970,HCPCS,Outpatient,,,2414,1207,,1858.78,77,,,Percent of Total Billed Charges,77% of total billed charges,615.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,615.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,754.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1786.36,74,,,Percent of Total Billed Charges,74% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2027.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1979.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1858.78,77,,,Percent of total Billed charges,77% of total billed charges,2051.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,694.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.9,2051.9,
UP EXT VENOUS BILATERAL,T990440081,CDM,921,RC,93970,HCPCS,Outpatient,,,2414,1207,,1858.78,77,,,Percent of Total Billed Charges,77% of total billed charges,615.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,615.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,754.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1786.36,74,,,Percent of Total Billed Charges,74% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2027.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1979.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1858.78,77,,,Percent of total Billed charges,77% of total billed charges,2051.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,694.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.9,2051.9,
VENOUS REFLUX STUDY BILATERAL,T990440082,CDM,921,RC,93970,HCPCS,Outpatient,,,2414,1207,,1858.78,77,,,Percent of Total Billed Charges,77% of total billed charges,615.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,615.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,754.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1786.36,74,,,Percent of Total Billed Charges,74% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,1665.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2027.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1979.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,141.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1858.78,77,,,Percent of total Billed charges,77% of total billed charges,2051.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,694.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,141.9,120,,,Fee Schedule,120% of MO Medicaid Rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,603.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.9,2051.9,
LOW EXT VENOUS SINGLE,T990440083,CDM,921,RC,93971,HCPCS,Outpatient,,,1349.5,674.75,,1039.12,77,,,Percent of Total Billed Charges,77% of total billed charges,344.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,421.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,998.63,74,,,Percent of Total Billed Charges,74% of total billed charges,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1133.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1106.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.12,77,,,Percent of total Billed charges,77% of total billed charges,1147.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,387.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.16,1147.08,
UP EXT VENOUS UNILATERAL,T990440084,CDM,921,RC,93971,HCPCS,Outpatient,,,1277,638.5,,983.29,77,,,Percent of Total Billed Charges,77% of total billed charges,325.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,325.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,399.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,944.98,74,,,Percent of Total Billed Charges,74% of total billed charges,881.13,69,,,Percent of Total Billed Charges,69% of total billed charges,881.13,69,,,Percent of Total Billed Charges,69% of total billed charges,319.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,881.13,69,,,Percent of Total Billed Charges,69% of total billed charges,881.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1072.68,84,,,Percent of Total Billed Charges,84% of total billed charges,1047.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,319.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.29,77,,,Percent of total Billed charges,77% of total billed charges,1085.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,367.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,319.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,319.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.16,1085.45,
VENOUS REFLUX STUDY UNILATERAL,T990440085,CDM,921,RC,93971,HCPCS,Outpatient,,,1349.5,674.75,,1039.12,77,,,Percent of Total Billed Charges,77% of total billed charges,344.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,421.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,998.63,74,,,Percent of Total Billed Charges,74% of total billed charges,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,931.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1133.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1106.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,93.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.12,77,,,Percent of total Billed charges,77% of total billed charges,1147.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,387.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,93.16,120,,,Fee Schedule,120% of MO Medicaid Rate,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,337.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.16,1147.08,
RENAL ARTERY DOPPLER,T990440086,CDM,921,RC,93975,HCPCS,Outpatient,,,1617,808.5,,1245.09,77,,,Percent of Total Billed Charges,77% of total billed charges,412.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.58,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.73,69,,,Percent of Total Billed Charges,69% of total billed charges,404.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.28,84,,,Percent of Total Billed Charges,84% of total billed charges,1325.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,193.52,120,,,Fee Schedule,120% of MO Medicaid Rate,193.52,120,,,Fee Schedule,120% of MO Medicaid Rate,193.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,404.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.09,77,,,Percent of total Billed charges,77% of total billed charges,1374.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,193.52,120,,,Fee Schedule,120% of MO Medicaid Rate,404.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,404.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.52,1374.45,
SCROTAL DOPPLER,T990440087,CDM,921,RC,93976,HCPCS,Outpatient,,,826.5,413.25,,636.41,77,,,Percent of Total Billed Charges,77% of total billed charges,210.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,258.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,611.61,74,,,Percent of Total Billed Charges,74% of total billed charges,570.29,69,,,Percent of Total Billed Charges,69% of total billed charges,570.29,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,570.29,69,,,Percent of Total Billed Charges,69% of total billed charges,570.29,69,,,Percent of Total Billed Charges,69% of total billed charges,694.26,84,,,Percent of Total Billed Charges,84% of total billed charges,677.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,110.94,120,,,Fee Schedule,120% of MO Medicaid Rate,110.94,120,,,Fee Schedule,120% of MO Medicaid Rate,110.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,206.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,636.41,77,,,Percent of total Billed charges,77% of total billed charges,702.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,110.94,120,,,Fee Schedule,120% of MO Medicaid Rate,206.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,206.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.94,728,
AORTIC ULTRASOUND,T990440088,CDM,921,RC,93978,HCPCS,Outpatient,,,700.5,350.25,,539.39,77,,,Percent of Total Billed Charges,77% of total billed charges,178.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,178.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,218.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,518.37,74,,,Percent of Total Billed Charges,74% of total billed charges,483.35,69,,,Percent of Total Billed Charges,69% of total billed charges,483.35,69,,,Percent of Total Billed Charges,69% of total billed charges,175.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,483.35,69,,,Percent of Total Billed Charges,69% of total billed charges,483.35,69,,,Percent of Total Billed Charges,69% of total billed charges,588.42,84,,,Percent of Total Billed Charges,84% of total billed charges,574.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,131.21,120,,,Fee Schedule,120% of MO Medicaid Rate,131.21,120,,,Fee Schedule,120% of MO Medicaid Rate,131.21,120,,,Fee Schedule,120% of MO of Medicaid Rate,175.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,539.39,77,,,Percent of total Billed charges,77% of total billed charges,595.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,201.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,728,100,,,Case Rate,Pays based on per visit rate,131.21,120,,,Fee Schedule,120% of MO Medicaid Rate,175.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630,100,,,Case Rate,Pays based on per visit rate,175.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.21,728,
HEALTH FAIR TRISCAN,T990440089,CDM,320,RC,,,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,34.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,34.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.88,271,
Health Fair Triscan,T990440090,CDM,402,RC,76870,HCPCS,Outpatient,,,83.5,41.75,26,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.79,74,,,Percent of Total Billed Charges,74% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,57.62,69,,,Percent of Total Billed Charges,69% of total billed charges,70.14,84,,,Percent of Total Billed Charges,84% of total billed charges,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,334,400,,,fee schedule,400% of healthlink fee schedule,313.13,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,334,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,87.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,87.23,120,,,Fee Schedule,120% of MO Medicaid Rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.88,446,
TRISCAN PAC,T990440091,CDM,402,RC,,,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.9,74,,,Percent of Total Billed Charges,74% of total billed charges,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,113.4,84,,,Percent of Total Billed Charges,84% of total billed charges,110.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,55.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,446,
BREAST SURGICAL SPECIMEN,T990450002,CDM,320,RC,76098,HCPCS,Outpatient,,,488.5,244.25,,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,415.23,
BREAST SURGICAL SPECIMEN,T990450002,CDM,320,RC,76098,HCPCS,Outpatient,,,488.5,244.25,TC,376.15,77,,,Percent of Total Billed Charges,77% of total billed charges,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.49,74,,,Percent of Total Billed Charges,74% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,337.07,69,,,Percent of Total Billed Charges,69% of total billed charges,410.34,84,,,Percent of Total Billed Charges,84% of total billed charges,400.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,376.15,77,,,Percent of total Billed charges,77% of total billed charges,415.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,122.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.08,415.23,
SHOW ME MAM SURG SPEC PROFILE,T990450003,CDM,401,RC,76098,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,177,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,,,,,Other,Not Seperately Reimbusable,153,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,23.08,177,
SHOW ME MAM SURG SPECIMEN,T990450004,CDM,401,RC,76098,HCPCS,Outpatient,,,28.5,14.25,,21.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,19.67,69,,,Percent of Total Billed Charges,69% of total billed charges,23.94,84,,,Percent of Total Billed Charges,84% of total billed charges,23.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.28,400,,,fee schedule,400% of healthlink fee schedule,61.2,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,65.28,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,23.08,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.95,77,,,Percent of total Billed charges,77% of total billed charges,24.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,23.08,120,,,Fee Schedule,120% of MO Medicaid Rate,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,7.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.13,177,
SHOW ME PF-SURG SPECIMEN,T990450005,CDM,972,RC,76098,HCPCS,Outpatient,,,17.5,8.75,26,22.03,175,,,fee schedule,175% of aetna fee schedule,20.13,115,,,fee schedule,115% of cms physician fee schedule,20.53,117.3,,,fee schedule,117.3% of cms physician fee schedule,25.16,143.75,,,fee schedule,143.75% of cms fee schedule ,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,20.13,115,,,fee schedule,115% of cms fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,15.5,100,,,fee schedule,100% of bcbs fee schedule,39.08,100,,,fee schedule,100% of cigna fee schedule,17.5,100,,,fee schedule,100% of healthlink fee schedule,17.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,17.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,15.75,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.13,115,,,fee schedule,115% of cms fee schedule,22.03,135,,,Fee Schedule,135% of CMS Fee Schedule ,31.19,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,23.14,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,16.05,100,,,Fee Schedule,100% of UHC Fee Schedule,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.13,115,,,Fee Schedule,115% of CMS OPPS Rate,17.18,100,,,Fee Schedule,100% of UMR Fee Schedule,20.13,115,,,Fee Schedule,115% of CMS OPPS Rate,15.5,39.08,
STEROTACTIC LOCAL GUIDE BX PL,T990450006,CDM,320,RC,77022,HCPCS,Outpatient,,,543.5,271.75,,418.5,77,,,Percent of Total Billed Charges,77% of total billed charges,138.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,402.19,74,,,Percent of Total Billed Charges,74% of total billed charges,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,456.54,84,,,Percent of Total Billed Charges,84% of total billed charges,445.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,418.5,77,,,Percent of total Billed charges,77% of total billed charges,461.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,156.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.88,461.98,
STEROTACTIC LOCAL GUIDE BX PL,T990450006,CDM,320,RC,77022,HCPCS,Outpatient,,,543.5,271.75,TC,418.5,77,,,Percent of Total Billed Charges,77% of total billed charges,138.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,402.19,74,,,Percent of Total Billed Charges,74% of total billed charges,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,375.02,69,,,Percent of Total Billed Charges,69% of total billed charges,456.54,84,,,Percent of Total Billed Charges,84% of total billed charges,445.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,247.75,120,,,Fee Schedule,120% of MO of Medicaid Rate,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,418.5,77,,,Percent of total Billed charges,77% of total billed charges,461.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,156.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,247.75,120,,,Fee Schedule,120% of MO Medicaid Rate,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,135.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.88,461.98,
SHOW ME PF 3D SCRN B/U ADD ON,T990450007,CDM,972,RC,77063,HCPCS,Outpatient,,,32.5,16.25,26,66.42,135,,,fee schedule,135% of aetna fee schedule,37.38,115,,,fee schedule,115% of cms physician fee schedule,38.12,117.3,,,fee schedule,117.3% of cms physician fee schedule,46.72,143.75,,,fee schedule,143.75% of cms fee schedule ,51.31,100,,,fee schedule,100% of bcbs fee schedule,51.31,100,,,fee schedule,100% of bcbs fee schedule,51.31,100,,,fee schedule,100% of bcbs fee schedule,37.38,115,,,fee schedule,115% of cms fee schedule,51.31,100,,,fee schedule,100% of bcbs fee schedule,51.31,100,,,fee schedule,100% of bcbs fee schedule,51.31,100,,,fee schedule,100% of bcbs fee schedule,51.09,100,,,fee schedule,100% of cigna fee schedule,32.5,100,,,fee schedule,100% of healthlink fee schedule,32.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,32.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,29.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,29.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.38,115,,,fee schedule,115% of cms fee schedule,66.42,135,,,Fee Schedule,135% of CMS Fee Schedule ,57.93,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,42.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,52.92,100,,,Fee Schedule,100% of UHC Fee Schedule,29.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.38,115,,,Fee Schedule,115% of CMS OPPS Rate,66.67,100,,,Fee Schedule,100% of UMR Fee Schedule,37.38,115,,,Fee Schedule,115% of CMS OPPS Rate,29.25,66.67,
SHOW ME PF-DIAG/2D UNILAT MAM,T990450010,CDM,972,RC,77065,HCPCS,Outpatient,,,43,21.5,26,158.64,135,,,fee schedule,135% of aetna fee schedule,49.45,115,,,fee schedule,115% of cms physician fee schedule,50.44,117.3,,,fee schedule,117.3% of cms physician fee schedule,61.81,143.75,,,fee schedule,143.75% of cms fee schedule ,121.53,100,,,fee schedule,100% of bcbs fee schedule,121.53,100,,,fee schedule,100% of bcbs fee schedule,121.53,100,,,fee schedule,100% of bcbs fee schedule,49.45,115,,,fee schedule,115% of cms fee schedule,121.53,100,,,fee schedule,100% of bcbs fee schedule,121.53,100,,,fee schedule,100% of bcbs fee schedule,121.53,100,,,fee schedule,100% of bcbs fee schedule,121.21,100,,,fee schedule,100% of cigna fee schedule,43,100,,,fee schedule,100% of healthlink fee schedule,43,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,43,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,38.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,38.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.45,115,,,fee schedule,115% of cms fee schedule,158.64,135,,,Fee Schedule,135% of CMS Fee Schedule ,76.65,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,56.87,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,127.75,100,,,Fee Schedule,100% of UHC Fee Schedule,38.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.45,115,,,Fee Schedule,115% of CMS OPPS Rate,160.94,100,,,Fee Schedule,100% of UMR Fee Schedule,49.45,115,,,Fee Schedule,115% of CMS OPPS Rate,38.7,160.94,
SHOW ME DIAG 2D BILAT MAMM,T990450013,CDM,401,RC,77066,HCPCS,Outpatient,,,122.5,61.25,,94.33,77,,,Percent of Total Billed Charges,77% of total billed charges,31.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.65,74,,,Percent of Total Billed Charges,74% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,84.53,69,,,Percent of Total Billed Charges,69% of total billed charges,102.9,84,,,Percent of Total Billed Charges,84% of total billed charges,100.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,112.33,120,,,Fee Schedule,120% of MO of Medicaid Rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.33,77,,,Percent of total Billed charges,77% of total billed charges,104.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177,100,,,Case Rate,Pays based on per visit rate,112.33,120,,,Fee Schedule,120% of MO Medicaid Rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153,100,,,Case Rate,Pays based on per visit rate,30.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.63,177,
SHOW ME PF-DIAG/2D BILAT MAM,T990450014,CDM,972,RC,77066,HCPCS,Outpatient,,,53,26.5,26,201.18,135,,,fee schedule,135% of aetna fee schedule,60.95,115,,,fee schedule,115% of cms physician fee schedule,62.17,117.3,,,fee schedule,117.3% of cms physician fee schedule,76.19,143.75,,,fee schedule,143.75% of cms fee schedule ,153.62,100,,,fee schedule,100% of bcbs fee schedule,153.62,100,,,fee schedule,100% of bcbs fee schedule,153.62,100,,,fee schedule,100% of bcbs fee schedule,60.95,115,,,fee schedule,115% of cms fee schedule,153.62,100,,,fee schedule,100% of bcbs fee schedule,153.62,100,,,fee schedule,100% of bcbs fee schedule,153.62,100,,,fee schedule,100% of bcbs fee schedule,152.5,100,,,fee schedule,100% of cigna fee schedule,53,100,,,fee schedule,100% of healthlink fee schedule,53,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,53,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,47.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,47.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.95,115,,,fee schedule,115% of cms fee schedule,201.18,135,,,Fee Schedule,135% of CMS Fee Schedule ,94.47,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,70.09,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,161.57,100,,,Fee Schedule,100% of UHC Fee Schedule,47.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.95,115,,,Fee Schedule,115% of CMS OPPS Rate,203.55,100,,,Fee Schedule,100% of UMR Fee Schedule,60.95,115,,,Fee Schedule,115% of CMS OPPS Rate,47.7,203.55,
SHOW ME PF-SCRN 2D BILAT MAM,T990450016,CDM,972,RC,77067,HCPCS,Outpatient,,,53,26.5,26,162.27,135,,,fee schedule,135% of aetna fee schedule,60.95,115,,,fee schedule,115% of cms physician fee schedule,62.17,117.3,,,fee schedule,117.3% of cms physician fee schedule,76.19,143.75,,,fee schedule,143.75% of cms fee schedule ,123.42,100,,,fee schedule,100% of bcbs fee schedule,123.42,100,,,fee schedule,100% of bcbs fee schedule,123.42,100,,,fee schedule,100% of bcbs fee schedule,60.95,115,,,fee schedule,115% of cms fee schedule,123.42,100,,,fee schedule,100% of bcbs fee schedule,123.42,100,,,fee schedule,100% of bcbs fee schedule,123.42,100,,,fee schedule,100% of bcbs fee schedule,123.42,100,,,fee schedule,100% of cigna fee schedule,53,100,,,fee schedule,100% of healthlink fee schedule,53,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,53,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,47.7,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,47.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.95,115,,,fee schedule,115% of cms fee schedule,162.27,135,,,Fee Schedule,135% of CMS Fee Schedule ,94.47,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,70.09,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,129.99,100,,,Fee Schedule,100% of UHC Fee Schedule,47.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.95,115,,,Fee Schedule,115% of CMS OPPS Rate,163.76,100,,,Fee Schedule,100% of UMR Fee Schedule,60.95,115,,,Fee Schedule,115% of CMS OPPS Rate,47.7,163.76,
POST BX CLIP PLACEMENT,T990450021,CDM,320,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,271,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,235,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,235,271,
SHOW ME 3D DIAG U/B+ON PROFILE,T990450022,CDM,401,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,177,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,153,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,153,177,
SHOW ME 3D SCRN B/U+ON PROFILE,T990450023,CDM,403,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,177,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,153,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,153,177,
"BREAST BX,PERCU,AUTO VAC/ROTBX",T990450025,CDM,490,RC,,,Outpatient,,,2134.5,1067.25,,1643.57,77,,,Percent of Total Billed Charges,77% of total billed charges,544.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,544.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,667.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2212,100,,,Case rate,pays based on per visit rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per visit,533.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2102,100,,,case rate,pays based on per visit,2102,100,,,case rate,pays based on per day rate,2278,100,,,case rate,pays based on per day rate,1750.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,1899.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1792.98,84,,,Percent of Total Billed Charges,84% of Total Billed charges,1899.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1643.57,77,,,Percent of total Billed charges,77% of total billed charges,1814.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1067.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1899.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.63,2278,
SHOW ME PF 3D DIAG B/U ADD ON,T990450026,CDM,972,RC,G0279,HCPCS,Outpatient,,,32.5,16.25,26,,,,,other,not seperately reimbusable,37.38,115,,,fee schedule,115% of cms physician fee schedule,38.12,117.3,,,fee schedule,117.3% of cms physician fee schedule,46.72,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37.38,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,32.5,100,,,fee schedule,100% of healthlink fee schedule,32.5,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,32.5,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,29.25,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,29.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.38,115,,,fee schedule,115% of cms fee schedule,,,,,Other,Not Seperately Reimbusable,57.93,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,42.98,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,52.92,100,,,Fee Schedule,100% of UHC Fee Schedule,29.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.38,115,,,Fee Schedule,115% of CMS OPPS Rate,66.67,100,,,Fee Schedule,100% of UMR Fee Schedule,37.38,115,,,Fee Schedule,115% of CMS OPPS Rate,29.25,66.67,
BONE DENSITY SPECIAL,T990460003,CDM,330,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,234,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,203,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,203,234,
BODY ABSORP/COMPOSITION,T990460004,CDM,320,RC,,,Outpatient,,,27.5,13.75,,21.18,77,,,Percent of Total Billed Charges,77% of total billed charges,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.35,74,,,Percent of Total Billed Charges,74% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,18.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.1,84,,,Percent of Total Billed Charges,84% of total billed charges,22.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,11.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.18,77,,,Percent of total Billed charges,77% of total billed charges,23.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,11.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,271,
INJ FOR ID OF SENTINEL NODE,T990480001,CDM,320,RC,38792,HCPCS,Outpatient,,,674,337,,518.98,77,,,Percent of Total Billed Charges,77% of total billed charges,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,171.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,498.76,74,,,Percent of Total Billed Charges,74% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,465.06,69,,,Percent of Total Billed Charges,69% of total billed charges,566.16,84,,,Percent of Total Billed Charges,84% of total billed charges,552.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,274.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,518.98,77,,,Percent of total Billed charges,77% of total billed charges,572.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,193.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,271,100,,,Case Rate,Pays based on per visit rate,274.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235,100,,,Case Rate,Pays based on per visit rate,168.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.5,572.9,
THYROID SCAN,T990480002,CDM,341,RC,78013,HCPCS,Outpatient,,,979,489.5,,753.83,77,,,Percent of Total Billed Charges,77% of total billed charges,249.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,724.46,74,,,Percent of Total Billed Charges,74% of total billed charges,675.51,69,,,Percent of Total Billed Charges,69% of total billed charges,675.51,69,,,Percent of Total Billed Charges,69% of total billed charges,244.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,675.51,69,,,Percent of Total Billed Charges,69% of total billed charges,675.51,69,,,Percent of Total Billed Charges,69% of total billed charges,822.36,84,,,Percent of Total Billed Charges,84% of total billed charges,802.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,151.58,120,,,Fee Schedule,120% of MO Medicaid Rate,151.58,120,,,Fee Schedule,120% of MO Medicaid Rate,151.58,120,,,Fee Schedule,120% of MO of Medicaid Rate,244.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,753.83,77,,,Percent of total Billed charges,77% of total billed charges,832.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,151.58,120,,,Fee Schedule,120% of MO Medicaid Rate,244.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,244.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.58,847,
"THYROID IMAG W/UPDATE, SI",T990480003,CDM,341,RC,78014,HCPCS,Outpatient,,,1570.5,785.25,,1209.29,77,,,Percent of Total Billed Charges,77% of total billed charges,400.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,400.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,490.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1162.17,74,,,Percent of Total Billed Charges,74% of total billed charges,1083.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1083.65,69,,,Percent of Total Billed Charges,69% of total billed charges,392.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1083.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1083.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1319.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1287.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,184.1,120,,,Fee Schedule,120% of MO Medicaid Rate,184.1,120,,,Fee Schedule,120% of MO Medicaid Rate,184.1,120,,,Fee Schedule,120% of MO of Medicaid Rate,392.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1209.29,77,,,Percent of total Billed charges,77% of total billed charges,1334.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,451.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,184.1,120,,,Fee Schedule,120% of MO Medicaid Rate,392.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,392.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.1,1334.93,
THYROID PARA IMAGING_,T990480004,CDM,341,RC,78070,HCPCS,Outpatient,,,1363,681.5,,1049.51,77,,,Percent of Total Billed Charges,77% of total billed charges,347.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,347.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,425.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1008.62,74,,,Percent of Total Billed Charges,74% of total billed charges,940.47,69,,,Percent of Total Billed Charges,69% of total billed charges,940.47,69,,,Percent of Total Billed Charges,69% of total billed charges,340.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,940.47,69,,,Percent of Total Billed Charges,69% of total billed charges,940.47,69,,,Percent of Total Billed Charges,69% of total billed charges,1144.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1117.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,552.04,400,,,fee schedule,400% of healthlink fee schedule,517.54,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,552.04,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,218.46,120,,,Fee Schedule,120% of MO Medicaid Rate,218.46,120,,,Fee Schedule,120% of MO Medicaid Rate,218.46,120,,,Fee Schedule,120% of MO of Medicaid Rate,340.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.51,77,,,Percent of total Billed charges,77% of total billed charges,1158.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,391.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,218.46,120,,,Fee Schedule,120% of MO Medicaid Rate,340.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,340.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.46,1158.55,
SENTINEL NODE IDENTIFICATION,T990480005,CDM,341,RC,78195,HCPCS,Outpatient,,,1968.5,984.25,,1515.75,77,,,Percent of Total Billed Charges,77% of total billed charges,501.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,501.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,615.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1456.69,74,,,Percent of Total Billed Charges,74% of total billed charges,1358.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.27,69,,,Percent of Total Billed Charges,69% of total billed charges,492.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1358.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1653.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1614.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,1237.92,400,,,fee schedule,400% of healthlink fee schedule,1160.55,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1237.92,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.6,120,,,Fee Schedule,120% of MO Medicaid Rate,254.6,120,,,Fee Schedule,120% of MO Medicaid Rate,254.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,492.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1515.75,77,,,Percent of total Billed charges,77% of total billed charges,1673.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,565.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,254.6,120,,,Fee Schedule,120% of MO Medicaid Rate,492.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,492.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.6,1673.23,
LIVER SCAN,T990480006,CDM,341,RC,78201,HCPCS,Outpatient,,,977.5,488.75,,752.68,77,,,Percent of Total Billed Charges,77% of total billed charges,249.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,305.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,723.35,74,,,Percent of Total Billed Charges,74% of total billed charges,674.48,69,,,Percent of Total Billed Charges,69% of total billed charges,674.48,69,,,Percent of Total Billed Charges,69% of total billed charges,244.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.48,69,,,Percent of Total Billed Charges,69% of total billed charges,674.48,69,,,Percent of Total Billed Charges,69% of total billed charges,821.1,84,,,Percent of Total Billed Charges,84% of total billed charges,801.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,633.44,400,,,fee schedule,400% of healthlink fee schedule,593.85,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,633.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,146.11,120,,,Fee Schedule,120% of MO Medicaid Rate,146.11,120,,,Fee Schedule,120% of MO Medicaid Rate,146.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,244.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,752.68,77,,,Percent of total Billed charges,77% of total billed charges,830.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,281.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,146.11,120,,,Fee Schedule,120% of MO Medicaid Rate,244.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,244.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.11,847,
LIVER SCAN W/FLOW,T990480007,CDM,341,RC,78202,HCPCS,Outpatient,,,1088,544,,837.76,77,,,Percent of Total Billed Charges,77% of total billed charges,277.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,277.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,805.12,74,,,Percent of Total Billed Charges,74% of total billed charges,750.72,69,,,Percent of Total Billed Charges,69% of total billed charges,750.72,69,,,Percent of Total Billed Charges,69% of total billed charges,272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,750.72,69,,,Percent of Total Billed Charges,69% of total billed charges,750.72,69,,,Percent of Total Billed Charges,69% of total billed charges,913.92,84,,,Percent of Total Billed Charges,84% of total billed charges,892.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,723.12,400,,,fee schedule,400% of healthlink fee schedule,677.93,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,723.12,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,161,120,,,Fee Schedule,120% of MO Medicaid Rate,161,120,,,Fee Schedule,120% of MO Medicaid Rate,161,120,,,Fee Schedule,120% of MO of Medicaid Rate,272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,837.76,77,,,Percent of total Billed charges,77% of total billed charges,924.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,312.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,161,120,,,Fee Schedule,120% of MO Medicaid Rate,272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,272,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161,924.8,
LIVER SPLEEN SCAN W/OFLOW,T990480008,CDM,341,RC,78215,HCPCS,Outpatient,,,1359.5,679.75,,1046.82,77,,,Percent of Total Billed Charges,77% of total billed charges,346.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,424.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1006.03,74,,,Percent of Total Billed Charges,74% of total billed charges,938.06,69,,,Percent of Total Billed Charges,69% of total billed charges,938.06,69,,,Percent of Total Billed Charges,69% of total billed charges,339.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,938.06,69,,,Percent of Total Billed Charges,69% of total billed charges,938.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1141.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1114.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,659.84,400,,,fee schedule,400% of healthlink fee schedule,618.6,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,659.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,148.54,120,,,Fee Schedule,120% of MO Medicaid Rate,148.54,120,,,Fee Schedule,120% of MO Medicaid Rate,148.54,120,,,Fee Schedule,120% of MO of Medicaid Rate,339.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1046.82,77,,,Percent of total Billed charges,77% of total billed charges,1155.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,390.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,148.54,120,,,Fee Schedule,120% of MO Medicaid Rate,339.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,339.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.54,1155.58,
LIVER SPLEEN W/FLOW,T990480009,CDM,341,RC,78216,HCPCS,Outpatient,,,1464.5,732.25,,1127.67,77,,,Percent of Total Billed Charges,77% of total billed charges,373.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1083.73,74,,,Percent of Total Billed Charges,74% of total billed charges,1010.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1010.51,69,,,Percent of Total Billed Charges,69% of total billed charges,366.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1010.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1230.18,84,,,Percent of Total Billed Charges,84% of total billed charges,1200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,447.36,400,,,fee schedule,400% of healthlink fee schedule,419.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,447.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,92,120,,,Fee Schedule,120% of MO Medicaid Rate,92,120,,,Fee Schedule,120% of MO Medicaid Rate,92,120,,,Fee Schedule,120% of MO of Medicaid Rate,366.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1127.67,77,,,Percent of total Billed charges,77% of total billed charges,1244.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,421.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,92,120,,,Fee Schedule,120% of MO Medicaid Rate,366.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,366.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92,1244.83,
HEPATOBILLARY SCAN,T990480010,CDM,341,RC,78226,HCPCS,Outpatient,,,1686.5,843.25,,1298.61,77,,,Percent of Total Billed Charges,77% of total billed charges,430.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,527.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1248.01,74,,,Percent of Total Billed Charges,74% of total billed charges,1163.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1163.69,69,,,Percent of Total Billed Charges,69% of total billed charges,421.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1163.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1163.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1382.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,248.52,120,,,Fee Schedule,120% of MO Medicaid Rate,248.52,120,,,Fee Schedule,120% of MO Medicaid Rate,248.52,120,,,Fee Schedule,120% of MO of Medicaid Rate,421.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1298.61,77,,,Percent of total Billed charges,77% of total billed charges,1433.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,484.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,248.52,120,,,Fee Schedule,120% of MO Medicaid Rate,421.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,421.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,248.52,1433.53,
HEPATOBILLARY GALLBLADDER,T990480011,CDM,341,RC,78227,HCPCS,Outpatient,,,1936,968,,1490.72,77,,,Percent of Total Billed Charges,77% of total billed charges,493.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,493.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,605,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1432.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1335.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1335.84,69,,,Percent of Total Billed Charges,69% of total billed charges,484,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1335.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1335.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1626.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1587.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,338.45,120,,,Fee Schedule,120% of MO Medicaid Rate,338.45,120,,,Fee Schedule,120% of MO Medicaid Rate,338.45,120,,,Fee Schedule,120% of MO of Medicaid Rate,484,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1490.72,77,,,Percent of total Billed charges,77% of total billed charges,1645.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,556.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,338.45,120,,,Fee Schedule,120% of MO Medicaid Rate,484,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,484,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.45,1645.6,
GASTRIC EMPTYING STUDY,T990480012,CDM,341,RC,78264,HCPCS,Outpatient,,,1302.5,651.25,,1002.93,77,,,Percent of Total Billed Charges,77% of total billed charges,332.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,332.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,407.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,963.85,74,,,Percent of Total Billed Charges,74% of total billed charges,898.73,69,,,Percent of Total Billed Charges,69% of total billed charges,898.73,69,,,Percent of Total Billed Charges,69% of total billed charges,325.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,898.73,69,,,Percent of Total Billed Charges,69% of total billed charges,898.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1094.1,84,,,Percent of Total Billed Charges,84% of total billed charges,1068.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,989.4,400,,,fee schedule,400% of healthlink fee schedule,927.56,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,989.4,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,250.96,120,,,Fee Schedule,120% of MO Medicaid Rate,250.96,120,,,Fee Schedule,120% of MO Medicaid Rate,250.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,325.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.93,77,,,Percent of total Billed charges,77% of total billed charges,1107.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,250.96,120,,,Fee Schedule,120% of MO Medicaid Rate,325.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,325.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.96,1107.13,
GI BLEED SCAN,T990480013,CDM,341,RC,78278,HCPCS,Outpatient,,,1437,718.5,,1106.49,77,,,Percent of Total Billed Charges,77% of total billed charges,366.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,449.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1063.38,74,,,Percent of Total Billed Charges,74% of total billed charges,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1207.08,84,,,Percent of Total Billed Charges,84% of total billed charges,1178.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1197.2,400,,,fee schedule,400% of healthlink fee schedule,1122.38,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1197.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,257.94,120,,,Fee Schedule,120% of MO Medicaid Rate,257.94,120,,,Fee Schedule,120% of MO Medicaid Rate,257.94,120,,,Fee Schedule,120% of MO of Medicaid Rate,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1106.49,77,,,Percent of total Billed charges,77% of total billed charges,1221.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,413.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,257.94,120,,,Fee Schedule,120% of MO Medicaid Rate,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,257.94,1221.45,
MECKEL'S DIVERTICULM,T990480014,CDM,341,RC,78290,HCPCS,Outpatient,,,1538,769,,1184.26,77,,,Percent of Total Billed Charges,77% of total billed charges,392.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.12,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.22,69,,,Percent of Total Billed Charges,69% of total billed charges,384.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1291.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1261.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,1122.68,400,,,fee schedule,400% of healthlink fee schedule,1052.51,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1122.68,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,384.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1184.26,77,,,Percent of total Billed charges,77% of total billed charges,1307.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,384.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,384.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.9,1307.3,
BONE LTD AREA,T990480015,CDM,341,RC,78300,HCPCS,Outpatient,,,1385.5,692.75,,1066.84,77,,,Percent of Total Billed Charges,77% of total billed charges,353.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1025.27,74,,,Percent of Total Billed Charges,74% of total billed charges,956,69,,,Percent of Total Billed Charges,69% of total billed charges,956,69,,,Percent of Total Billed Charges,69% of total billed charges,346.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,956,69,,,Percent of Total Billed Charges,69% of total billed charges,956,69,,,Percent of Total Billed Charges,69% of total billed charges,1163.82,84,,,Percent of Total Billed Charges,84% of total billed charges,1136.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,610.16,400,,,fee schedule,400% of healthlink fee schedule,572.03,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,610.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,169.82,120,,,Fee Schedule,120% of MO Medicaid Rate,169.82,120,,,Fee Schedule,120% of MO Medicaid Rate,169.82,120,,,Fee Schedule,120% of MO of Medicaid Rate,346.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1066.84,77,,,Percent of total Billed charges,77% of total billed charges,1177.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,398.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,169.82,120,,,Fee Schedule,120% of MO Medicaid Rate,346.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,346.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.82,1177.68,
BONE SCAN,T990480016,CDM,341,RC,78306,HCPCS,Outpatient,,,1437,718.5,,1106.49,77,,,Percent of Total Billed Charges,77% of total billed charges,366.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,449.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1063.38,74,,,Percent of Total Billed Charges,74% of total billed charges,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,991.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1207.08,84,,,Percent of Total Billed Charges,84% of total billed charges,1178.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,874.48,400,,,fee schedule,400% of healthlink fee schedule,819.83,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,874.48,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,219.06,120,,,Fee Schedule,120% of MO Medicaid Rate,219.06,120,,,Fee Schedule,120% of MO Medicaid Rate,219.06,120,,,Fee Schedule,120% of MO of Medicaid Rate,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1106.49,77,,,Percent of total Billed charges,77% of total billed charges,1221.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,413.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,219.06,120,,,Fee Schedule,120% of MO Medicaid Rate,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,359.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.06,1221.45,
3 PH BONE SCAN,T990480017,CDM,341,RC,78315,HCPCS,Outpatient,,,1604.5,802.25,,1235.47,77,,,Percent of Total Billed Charges,77% of total billed charges,409.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,409.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,501.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1187.33,74,,,Percent of Total Billed Charges,74% of total billed charges,1107.11,69,,,Percent of Total Billed Charges,69% of total billed charges,1107.11,69,,,Percent of Total Billed Charges,69% of total billed charges,401.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1107.11,69,,,Percent of Total Billed Charges,69% of total billed charges,1107.11,69,,,Percent of Total Billed Charges,69% of total billed charges,1347.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1315.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1200.36,400,,,fee schedule,400% of healthlink fee schedule,1125.34,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1200.36,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,254.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,401.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1235.47,77,,,Percent of total Billed charges,77% of total billed charges,1363.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,461.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,254.9,120,,,Fee Schedule,120% of MO Medicaid Rate,401.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,401.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.9,1363.83,
MYO INFARCT AVID PLANAR,T990480018,CDM,341,RC,78466,HCPCS,Outpatient,,,1392,696,,1071.84,77,,,Percent of Total Billed Charges,77% of total billed charges,354.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,435,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1030.08,74,,,Percent of Total Billed Charges,74% of total billed charges,960.48,69,,,Percent of Total Billed Charges,69% of total billed charges,960.48,69,,,Percent of Total Billed Charges,69% of total billed charges,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,960.48,69,,,Percent of Total Billed Charges,69% of total billed charges,960.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1169.28,84,,,Percent of Total Billed Charges,84% of total billed charges,1141.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,649.88,400,,,fee schedule,400% of healthlink fee schedule,609.26,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,649.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,137.59,120,,,Fee Schedule,120% of MO Medicaid Rate,137.59,120,,,Fee Schedule,120% of MO Medicaid Rate,137.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.84,77,,,Percent of total Billed charges,77% of total billed charges,1183.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,400.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,137.59,120,,,Fee Schedule,120% of MO Medicaid Rate,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,348,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.59,1183.2,
HEART INFARCT IMAGE (3D),T990480019,CDM,341,RC,78469,HCPCS,Outpatient,,,1462.5,731.25,,1126.13,77,,,Percent of Total Billed Charges,77% of total billed charges,372.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,372.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,457.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1082.25,74,,,Percent of Total Billed Charges,74% of total billed charges,1009.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1009.13,69,,,Percent of Total Billed Charges,69% of total billed charges,365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1009.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1009.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1228.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1199.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,880.84,400,,,fee schedule,400% of healthlink fee schedule,825.79,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,880.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,263.8,120,,,Fee Schedule,120% of MO Medicaid Rate,263.8,120,,,Fee Schedule,120% of MO Medicaid Rate,263.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1126.13,77,,,Percent of total Billed charges,77% of total billed charges,1243.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,420.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,263.8,120,,,Fee Schedule,120% of MO Medicaid Rate,365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,365.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,263.8,1243.13,
REST RADIO VENT RVG,T990480021,CDM,341,RC,78472,HCPCS,Outpatient,,,2366,1183,,1821.82,77,,,Percent of Total Billed Charges,77% of total billed charges,603.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,603.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,739.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1750.84,74,,,Percent of Total Billed Charges,74% of total billed charges,1632.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1632.54,69,,,Percent of Total Billed Charges,69% of total billed charges,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1632.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1632.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1987.44,84,,,Percent of Total Billed Charges,84% of total billed charges,1940.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,887.88,400,,,fee schedule,400% of healthlink fee schedule,832.39,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,887.88,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,188.89,120,,,Fee Schedule,120% of MO Medicaid Rate,188.89,120,,,Fee Schedule,120% of MO Medicaid Rate,188.89,120,,,Fee Schedule,120% of MO of Medicaid Rate,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1821.82,77,,,Percent of total Billed charges,77% of total billed charges,2011.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,680.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,188.89,120,,,Fee Schedule,120% of MO Medicaid Rate,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,591.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.89,2011.1,
LUNG PERF PARTICULATE,T990480022,CDM,341,RC,78580,HCPCS,Outpatient,,,1338,669,,1030.26,77,,,Percent of Total Billed Charges,77% of total billed charges,341.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,341.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,418.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,990.12,74,,,Percent of Total Billed Charges,74% of total billed charges,923.22,69,,,Percent of Total Billed Charges,69% of total billed charges,923.22,69,,,Percent of Total Billed Charges,69% of total billed charges,334.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,923.22,69,,,Percent of Total Billed Charges,69% of total billed charges,923.22,69,,,Percent of Total Billed Charges,69% of total billed charges,1123.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1097.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,738.64,400,,,fee schedule,400% of healthlink fee schedule,692.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,738.64,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,172.25,120,,,Fee Schedule,120% of MO Medicaid Rate,172.25,120,,,Fee Schedule,120% of MO Medicaid Rate,172.25,120,,,Fee Schedule,120% of MO of Medicaid Rate,334.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1030.26,77,,,Percent of total Billed charges,77% of total billed charges,1137.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,172.25,120,,,Fee Schedule,120% of MO Medicaid Rate,334.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,334.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.25,1137.3,
AEROSOL VENT/PERF MUL/PRO,T990480023,CDM,341,RC,78582,HCPCS,Outpatient,,,1975,987.5,,1520.75,77,,,Percent of Total Billed Charges,77% of total billed charges,503.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,503.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,617.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1461.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1362.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1362.75,69,,,Percent of Total Billed Charges,69% of total billed charges,493.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1362.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1362.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1659,84,,,Percent of Total Billed Charges,84% of total billed charges,1619.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,241.22,120,,,Fee Schedule,120% of MO Medicaid Rate,241.22,120,,,Fee Schedule,120% of MO Medicaid Rate,241.22,120,,,Fee Schedule,120% of MO of Medicaid Rate,493.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1520.75,77,,,Percent of total Billed charges,77% of total billed charges,1678.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,567.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,241.22,120,,,Fee Schedule,120% of MO Medicaid Rate,493.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,493.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.22,1678.75,
RENAL IMAGING STATIC,T990480024,CDM,341,RC,78700,HCPCS,Outpatient,,,1149.5,574.75,,885.12,77,,,Percent of Total Billed Charges,77% of total billed charges,293.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,359.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,850.63,74,,,Percent of Total Billed Charges,74% of total billed charges,793.16,69,,,Percent of Total Billed Charges,69% of total billed charges,793.16,69,,,Percent of Total Billed Charges,69% of total billed charges,287.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,793.16,69,,,Percent of Total Billed Charges,69% of total billed charges,793.16,69,,,Percent of Total Billed Charges,69% of total billed charges,965.58,84,,,Percent of Total Billed Charges,84% of total billed charges,942.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,604.84,400,,,fee schedule,400% of healthlink fee schedule,567.04,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,604.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,128.47,120,,,Fee Schedule,120% of MO Medicaid Rate,128.47,120,,,Fee Schedule,120% of MO Medicaid Rate,128.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,287.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,885.12,77,,,Percent of total Billed charges,77% of total billed charges,977.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,330.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,128.47,120,,,Fee Schedule,120% of MO Medicaid Rate,287.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,287.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.47,977.08,
KIDNEY W/O LASIX,T990480025,CDM,341,RC,78707,HCPCS,Outpatient,,,1728.5,864.25,,1330.95,77,,,Percent of Total Billed Charges,77% of total billed charges,440.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,440.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,540.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1279.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1192.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1192.67,69,,,Percent of Total Billed Charges,69% of total billed charges,432.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1192.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1192.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1451.94,84,,,Percent of Total Billed Charges,84% of total billed charges,1417.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,825.2,400,,,fee schedule,400% of healthlink fee schedule,773.63,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,825.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,160.4,120,,,Fee Schedule,120% of MO Medicaid Rate,160.4,120,,,Fee Schedule,120% of MO Medicaid Rate,160.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,432.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1330.95,77,,,Percent of total Billed charges,77% of total billed charges,1469.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,496.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,160.4,120,,,Fee Schedule,120% of MO Medicaid Rate,432.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,432.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.4,1469.23,
K FLOW/FUNCT IMAGE W/DRUG,T990480026,CDM,341,RC,78708,HCPCS,Outpatient,,,1748.5,874.25,,1346.35,77,,,Percent of Total Billed Charges,77% of total billed charges,445.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,445.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,546.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1293.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1206.47,69,,,Percent of Total Billed Charges,69% of total billed charges,1206.47,69,,,Percent of Total Billed Charges,69% of total billed charges,437.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1206.47,69,,,Percent of Total Billed Charges,69% of total billed charges,1206.47,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.74,84,,,Percent of Total Billed Charges,84% of total billed charges,1433.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,628.2,400,,,fee schedule,400% of healthlink fee schedule,588.94,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,628.2,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,111.12,120,,,Fee Schedule,120% of MO Medicaid Rate,111.12,120,,,Fee Schedule,120% of MO Medicaid Rate,111.12,120,,,Fee Schedule,120% of MO of Medicaid Rate,437.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1346.35,77,,,Percent of total Billed charges,77% of total billed charges,1486.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,502.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,111.12,120,,,Fee Schedule,120% of MO Medicaid Rate,437.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,437.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.12,1486.23,
RENAL SCAN W/LASIX,T990480028,CDM,341,RC,78709,HCPCS,Outpatient,,,2094.5,1047.25,,1612.77,77,,,Percent of Total Billed Charges,77% of total billed charges,534.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,534.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,654.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1549.93,74,,,Percent of Total Billed Charges,74% of total billed charges,1445.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1445.21,69,,,Percent of Total Billed Charges,69% of total billed charges,523.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1445.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1445.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1759.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1717.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,1294.52,400,,,fee schedule,400% of healthlink fee schedule,1213.61,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1294.52,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,259.16,120,,,Fee Schedule,120% of MO Medicaid Rate,259.16,120,,,Fee Schedule,120% of MO Medicaid Rate,259.16,120,,,Fee Schedule,120% of MO of Medicaid Rate,523.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1612.77,77,,,Percent of total Billed charges,77% of total billed charges,1780.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,602.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,259.16,120,,,Fee Schedule,120% of MO Medicaid Rate,523.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,523.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.16,1780.33,
"WBC SCAN/LIMITED, SINGLE DAY",T990480029,CDM,341,RC,78800,HCPCS,Outpatient,,,3547,1773.5,,2731.19,77,,,Percent of Total Billed Charges,77% of total billed charges,904.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,904.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1108.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2624.78,74,,,Percent of Total Billed Charges,74% of total billed charges,2447.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2447.43,69,,,Percent of Total Billed Charges,69% of total billed charges,886.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2447.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2447.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2979.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2908.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,636.16,400,,,fee schedule,400% of healthlink fee schedule,596.4,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,636.16,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,190.79,120,,,Fee Schedule,120% of MO Medicaid Rate,190.79,120,,,Fee Schedule,120% of MO Medicaid Rate,190.79,120,,,Fee Schedule,120% of MO of Medicaid Rate,886.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2731.19,77,,,Percent of total Billed charges,77% of total billed charges,3014.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1019.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,190.79,120,,,Fee Schedule,120% of MO Medicaid Rate,886.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,886.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.79,3014.95,
"WBC SCAN/LIMIT BODY, MULTI DAY",T990480030,CDM,341,RC,78801,HCPCS,Outpatient,,,742.5,371.25,,571.73,77,,,Percent of Total Billed Charges,77% of total billed charges,189.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,189.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,549.45,74,,,Percent of Total Billed Charges,74% of total billed charges,512.33,69,,,Percent of Total Billed Charges,69% of total billed charges,512.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,512.33,69,,,Percent of Total Billed Charges,69% of total billed charges,512.33,69,,,Percent of Total Billed Charges,69% of total billed charges,623.7,84,,,Percent of Total Billed Charges,84% of total billed charges,608.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,863.44,400,,,fee schedule,400% of healthlink fee schedule,809.48,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,863.44,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,206.59,120,,,Fee Schedule,120% of MO Medicaid Rate,206.59,120,,,Fee Schedule,120% of MO Medicaid Rate,206.59,120,,,Fee Schedule,120% of MO of Medicaid Rate,185.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,571.73,77,,,Percent of total Billed charges,77% of total billed charges,631.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,213.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,206.59,120,,,Fee Schedule,120% of MO Medicaid Rate,185.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,185.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.63,863.44,
"WBC SCAN/WHOLE BODY, SINGLE DA",T990480031,CDM,341,RC,78802,HCPCS,Outpatient,,,1529,764.5,,1177.33,77,,,Percent of Total Billed Charges,77% of total billed charges,389.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,389.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1131.46,74,,,Percent of Total Billed Charges,74% of total billed charges,1055.01,69,,,Percent of Total Billed Charges,69% of total billed charges,1055.01,69,,,Percent of Total Billed Charges,69% of total billed charges,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.01,69,,,Percent of Total Billed Charges,69% of total billed charges,1055.01,69,,,Percent of Total Billed Charges,69% of total billed charges,1284.36,84,,,Percent of Total Billed Charges,84% of total billed charges,1253.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1134.72,400,,,fee schedule,400% of healthlink fee schedule,1063.8,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1134.72,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,233.65,120,,,Fee Schedule,120% of MO Medicaid Rate,233.65,120,,,Fee Schedule,120% of MO Medicaid Rate,233.65,120,,,Fee Schedule,120% of MO of Medicaid Rate,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1177.33,77,,,Percent of total Billed charges,77% of total billed charges,1299.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,439.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,233.65,120,,,Fee Schedule,120% of MO Medicaid Rate,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,382.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.65,1299.65,
BONE TOMO-SPECT,T990480032,CDM,341,RC,78803,HCPCS,Outpatient,,,1566.5,783.25,,1206.21,77,,,Percent of Total Billed Charges,77% of total billed charges,399.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,399.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,489.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1159.21,74,,,Percent of Total Billed Charges,74% of total billed charges,1080.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1080.89,69,,,Percent of Total Billed Charges,69% of total billed charges,391.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1080.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1080.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.86,84,,,Percent of Total Billed Charges,84% of total billed charges,1284.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1231,400,,,fee schedule,400% of healthlink fee schedule,1154.06,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1231,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,391.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1206.21,77,,,Percent of total Billed charges,77% of total billed charges,1331.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,450.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,391.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,391.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.39,1331.53,
LIVER SPECT,T990480033,CDM,341,RC,78803,HCPCS,Outpatient,,,1675,837.5,,1289.75,77,,,Percent of Total Billed Charges,77% of total billed charges,427.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,523.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1239.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1155.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1155.75,69,,,Percent of Total Billed Charges,69% of total billed charges,418.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1155.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1155.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1407,84,,,Percent of Total Billed Charges,84% of total billed charges,1373.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,1231,400,,,fee schedule,400% of healthlink fee schedule,1154.06,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1231,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,418.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1289.75,77,,,Percent of total Billed charges,77% of total billed charges,1423.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,481.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,418.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,418.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.39,1423.75,
LIVER SPECT W/FLO,T990480034,CDM,341,RC,78803,HCPCS,Outpatient,,,1656,828,,1275.12,77,,,Percent of Total Billed Charges,77% of total billed charges,422.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.44,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.64,69,,,Percent of Total Billed Charges,69% of total billed charges,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.04,84,,,Percent of Total Billed Charges,84% of total billed charges,1357.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1231,400,,,fee schedule,400% of healthlink fee schedule,1154.06,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1231,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,305.39,120,,,Fee Schedule,120% of MO of Medicaid Rate,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.12,77,,,Percent of total Billed charges,77% of total billed charges,1407.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,305.39,120,,,Fee Schedule,120% of MO Medicaid Rate,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,414,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.39,1407.6,
"WBC SCAN/WHOLE BODY, MULTI DAY",T990480035,CDM,341,RC,78804,HCPCS,Outpatient,,,1722.5,861.25,,1326.33,77,,,Percent of Total Billed Charges,77% of total billed charges,439.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,439.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,538.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1274.65,74,,,Percent of Total Billed Charges,74% of total billed charges,1188.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1188.53,69,,,Percent of Total Billed Charges,69% of total billed charges,430.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1188.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1446.9,84,,,Percent of Total Billed Charges,84% of total billed charges,1412.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,1953.84,400,,,fee schedule,400% of healthlink fee schedule,1831.73,375,,,Fee Schedule,375% of Healthlink HMO Fee Schedule,1953.84,400,,,Fee Schedule,400% of Healthlink PPO Fee Schedule,519.86,120,,,Fee Schedule,120% of MO Medicaid Rate,519.86,120,,,Fee Schedule,120% of MO Medicaid Rate,519.86,120,,,Fee Schedule,120% of MO of Medicaid Rate,430.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1326.33,77,,,Percent of total Billed charges,77% of total billed charges,1464.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,495.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,519.86,120,,,Fee Schedule,120% of MO Medicaid Rate,430.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,430.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,430.63,1953.84,
ADDITIONAL SLICE,T990480036,CDM,340,RC,,,Outpatient,,,108.5,54.25,,83.55,77,,,Percent of Total Billed Charges,77% of total billed charges,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.29,74,,,Percent of Total Billed Charges,74% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,69,,,Percent of Total Billed Charges,69% of total billed charges,91.14,84,,,Percent of Total Billed Charges,84% of total billed charges,88.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,44.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.55,77,,,Percent of total Billed charges,77% of total billed charges,92.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,44.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,27.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.13,847,
EMER FEE/SCAN,T990480037,CDM,340,RC,,,Outpatient,,,675,337.5,,519.75,77,,,Percent of Total Billed Charges,77% of total billed charges,172.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,172.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,499.5,74,,,Percent of Total Billed Charges,74% of total billed charges,465.75,69,,,Percent of Total Billed Charges,69% of total billed charges,465.75,69,,,Percent of Total Billed Charges,69% of total billed charges,168.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,465.75,69,,,Percent of Total Billed Charges,69% of total billed charges,465.75,69,,,Percent of Total Billed Charges,69% of total billed charges,567,84,,,Percent of Total Billed Charges,84% of total billed charges,553.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,275.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,275.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.75,77,,,Percent of total Billed charges,77% of total billed charges,573.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,194.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,275.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,168.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,168.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.75,847,
CARDIOLITE,T990480038,CDM,434,RC,A9500,HCPCS,Outpatient,,,288,144,,221.76,77,,,Percent of Total Billed Charges,77% of total billed charges,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,236.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.76,77,,,Percent of total Billed charges,77% of total billed charges,244.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,117.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72,244.8,
I123 CAPSULES,T990480039,CDM,343,RC,A9509,HCPCS,Outpatient,,,401.5,200.75,,309.16,77,,,Percent of Total Billed Charges,77% of total billed charges,102.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,297.11,74,,,Percent of Total Billed Charges,74% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,337.26,84,,,Percent of Total Billed Charges,84% of total billed charges,329.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,163.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.16,77,,,Percent of total Billed charges,77% of total billed charges,341.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.38,357.34,
I123 CAPSULES,T990480039,CDM,343,RC,A9516,HCPCS,Outpatient,,,401.5,200.75,,309.16,77,,,Percent of Total Billed Charges,77% of total billed charges,102.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,297.11,74,,,Percent of Total Billed Charges,74% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,277.04,69,,,Percent of Total Billed Charges,69% of total billed charges,337.26,84,,,Percent of Total Billed Charges,84% of total billed charges,329.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,163.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.16,77,,,Percent of total Billed charges,77% of total billed charges,341.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.38,357.34,
PYP VIAL- PYROPHOSPHATE,T990480040,CDM,343,RC,A9538,HCPCS,Outpatient,,,765.5,382.75,,589.44,77,,,Percent of Total Billed Charges,77% of total billed charges,195.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,566.47,74,,,Percent of Total Billed Charges,74% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,528.2,69,,,Percent of Total Billed Charges,69% of total billed charges,643.02,84,,,Percent of Total Billed Charges,84% of total billed charges,627.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,312.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,312.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,589.44,77,,,Percent of total Billed charges,77% of total billed charges,650.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,220.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,382.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,312.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,681.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.38,681.3,
FILTERED SULFER COLLIOD,T990480041,CDM,343,RC,A9541,HCPCS,Outpatient,,,475.5,237.75,,366.14,77,,,Percent of Total Billed Charges,77% of total billed charges,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.87,74,,,Percent of Total Billed Charges,74% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,399.42,84,,,Percent of Total Billed Charges,84% of total billed charges,389.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.14,77,,,Percent of total Billed charges,77% of total billed charges,404.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,237.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,423.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.88,423.2,
GALLIUM GA (PER MCI),T990480042,CDM,343,RC,A9556,HCPCS,Outpatient,,,175.5,87.75,,135.14,77,,,Percent of Total Billed Charges,77% of total billed charges,44.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.87,74,,,Percent of Total Billed Charges,74% of total billed charges,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,121.1,69,,,Percent of Total Billed Charges,69% of total billed charges,147.42,84,,,Percent of Total Billed Charges,84% of total billed charges,143.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,71.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.14,77,,,Percent of total Billed charges,77% of total billed charges,149.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.88,156.2,
Flu Vaccine Administration,T990550001,CDM,771,RC,G0008,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.14,74,,,Percent of Total Billed Charges,74% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,51.24,84,,,Percent of Total Billed Charges,84% of total billed charges,50.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,69,
Flu Vaccine Administration,T990550001,CDM,771,RC,90471,HCPCS,Outpatient,,,61,30.5,,46.97,77,,,Percent of Total Billed Charges,77% of total billed charges,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.14,74,,,Percent of Total Billed Charges,74% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,69,,,Percent of Total Billed Charges,69% of total billed charges,51.24,84,,,Percent of Total Billed Charges,84% of total billed charges,50.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.97,77,,,Percent of total Billed charges,77% of total billed charges,51.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,24.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,15.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.25,69,
R.T. ARTIERAL PUNCTURE,T990600001,CDM,920,RC,36600,HCPCS,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.62,74,,,Percent of Total Billed Charges,74% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,43.47,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,84,,,Percent of Total Billed Charges,84% of total billed charges,51.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,119,
BREATH ALCOHOL TEST,T990600002,CDM,301,RC,82075,HCPCS,Outpatient,,,81.5,40.75,,62.76,77,,,Percent of Total Billed Charges,77% of total billed charges,20.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.31,74,,,Percent of Total Billed Charges,74% of total billed charges,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,56.24,69,,,Percent of Total Billed Charges,69% of total billed charges,68.46,84,,,Percent of Total Billed Charges,84% of total billed charges,66.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.76,77,,,Percent of total Billed charges,77% of total billed charges,69.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,20.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.38,88,
REPEAT BREATH ALCOHOL TST,T990600003,CDM,301,RC,82075,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,117.66,74,,,Percent of Total Billed Charges,74% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,133.56,84,,,Percent of Total Billed Charges,84% of total billed charges,130.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,88,500,,,fee schedule,500% of healthlink,88,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,88,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,28.8,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,28.8,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.8,135.15,
ARC THAW FROZEN BLODD EA UNIT,T990600004,CDM,390,RC,86931,HCPCS,Outpatient,,,281.5,140.75,,216.76,77,,,Percent of Total Billed Charges,77% of total billed charges,71.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.31,74,,,Percent of Total Billed Charges,74% of total billed charges,194.24,69,,,Percent of Total Billed Charges,69% of total billed charges,194.24,69,,,Percent of Total Billed Charges,69% of total billed charges,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.24,69,,,Percent of Total Billed Charges,69% of total billed charges,194.24,69,,,Percent of Total Billed Charges,69% of total billed charges,236.46,84,,,Percent of Total Billed Charges,84% of total billed charges,230.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,279.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.76,77,,,Percent of total Billed charges,77% of total billed charges,239.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,279.6,120,,,Fee Schedule,120% of MO Medicaid Rate,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,70.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,279.6,
VENT FIRST DAY,T990600005,CDM,410,RC,94002,HCPCS,Outpatient,,,1145.5,572.75,,882.04,77,,,Percent of Total Billed Charges,77% of total billed charges,292.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,847.67,74,,,Percent of Total Billed Charges,74% of total billed charges,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,962.22,84,,,Percent of Total Billed Charges,84% of total billed charges,939.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,467.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,882.04,77,,,Percent of total Billed charges,77% of total billed charges,973.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,329.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,467.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,973.68,
VENT MGMT INPAT SUBQ DAY,T990600006,CDM,410,RC,94003,HCPCS,Outpatient,,,272.5,136.25,,209.83,77,,,Percent of Total Billed Charges,77% of total billed charges,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,201.65,74,,,Percent of Total Billed Charges,74% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,188.03,69,,,Percent of Total Billed Charges,69% of total billed charges,228.9,84,,,Percent of Total Billed Charges,84% of total billed charges,223.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,111.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.83,77,,,Percent of total Billed charges,77% of total billed charges,231.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,111.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,68.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.13,231.63,
PULM FUNC SPIROMETRY,T990600008,CDM,460,RC,94010,HCPCS,Outpatient,,,556.5,278.25,,428.51,77,,,Percent of Total Billed Charges,77% of total billed charges,141.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.81,74,,,Percent of Total Billed Charges,74% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,383.99,69,,,Percent of Total Billed Charges,69% of total billed charges,467.46,84,,,Percent of Total Billed Charges,84% of total billed charges,456.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.51,77,,,Percent of total Billed charges,77% of total billed charges,473.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,159.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,139.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,650,
"SPIROMETRY-VC,FVC,MVV",T990600009,CDM,460,RC,94010,HCPCS,Outpatient,,,248.5,124.25,,191.35,77,,,Percent of Total Billed Charges,77% of total billed charges,63.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,183.89,74,,,Percent of Total Billed Charges,74% of total billed charges,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,208.74,84,,,Percent of Total Billed Charges,84% of total billed charges,203.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,221.17,89,,,Percent of total Billed Charges,89% of total Billed charges,221.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,18.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.35,77,,,Percent of total Billed charges,77% of total billed charges,211.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,18.9,120,,,Fee Schedule,120% of MO Medicaid Rate,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,650,
NIOSH-Spirometry,T990600010,CDM,460,RC,94060,HCPCS,Outpatient,,,107,53.5,,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.18,74,,,Percent of Total Billed Charges,74% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,73.83,69,,,Percent of Total Billed Charges,69% of total billed charges,89.88,84,,,Percent of Total Billed Charges,84% of total billed charges,87.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.23,89,,,Percent of total Billed Charges,89% of total Billed charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,650,
PUL FUNC SP B&A BRON,T990600011,CDM,460,RC,94060,HCPCS,Outpatient,,,794.5,397.25,,611.77,77,,,Percent of Total Billed Charges,77% of total billed charges,202.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,587.93,74,,,Percent of Total Billed Charges,74% of total billed charges,548.21,69,,,Percent of Total Billed Charges,69% of total billed charges,548.21,69,,,Percent of Total Billed Charges,69% of total billed charges,198.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,548.21,69,,,Percent of Total Billed Charges,69% of total billed charges,548.21,69,,,Percent of Total Billed Charges,69% of total billed charges,667.38,84,,,Percent of Total Billed Charges,84% of total billed charges,651.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,707.11,89,,,Percent of total Billed Charges,89% of total Billed charges,707.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,707.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,198.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.77,77,,,Percent of total Billed charges,77% of total billed charges,675.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,228.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,198.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,198.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.57,707.11,
SPIROMETRY P & P,T990600012,CDM,460,RC,94060,HCPCS,Outpatient,,,491,245.5,,378.07,77,,,Percent of Total Billed Charges,77% of total billed charges,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,363.34,74,,,Percent of Total Billed Charges,74% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,338.79,69,,,Percent of Total Billed Charges,69% of total billed charges,412.44,84,,,Percent of Total Billed Charges,84% of total billed charges,402.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.99,89,,,Percent of total Billed Charges,89% of total Billed charges,436.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,32.57,120,,,Fee Schedule,120% of MO of Medicaid Rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.07,77,,,Percent of total Billed charges,77% of total billed charges,417.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,32.57,120,,,Fee Schedule,120% of MO Medicaid Rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.57,650,
PEAK FLOW SUBS,T990600013,CDM,460,RC,94150,HCPCS,Outpatient,,,37,18.5,,28.49,77,,,Percent of Total Billed Charges,77% of total billed charges,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.38,74,,,Percent of Total Billed Charges,74% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.53,69,,,Percent of Total Billed Charges,69% of total billed charges,31.08,84,,,Percent of Total Billed Charges,84% of total billed charges,30.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.93,89,,,Percent of total Billed Charges,89% of total Billed charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,2.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.49,77,,,Percent of total Billed charges,77% of total billed charges,31.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,9.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,650,
"PEAK FLOW, INITIAL",T990600014,CDM,460,RC,94150,HCPCS,Outpatient,,,159,79.5,,122.43,77,,,Percent of Total Billed Charges,77% of total billed charges,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,117.66,74,,,Percent of Total Billed Charges,74% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,109.71,69,,,Percent of Total Billed Charges,69% of total billed charges,133.56,84,,,Percent of Total Billed Charges,84% of total billed charges,130.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,141.51,89,,,Percent of total Billed Charges,89% of total Billed charges,141.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,2.47,120,,,Fee Schedule,120% of MO of Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.43,77,,,Percent of total Billed charges,77% of total billed charges,135.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,2.47,120,,,Fee Schedule,120% of MO Medicaid Rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,39.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,650,
FEV 1.0,T990600015,CDM,460,RC,94375,HCPCS,Outpatient,,,70.5,35.25,,54.29,77,,,Percent of Total Billed Charges,77% of total billed charges,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.17,74,,,Percent of Total Billed Charges,74% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,69,,,Percent of Total Billed Charges,69% of total billed charges,59.22,84,,,Percent of Total Billed Charges,84% of total billed charges,57.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.75,89,,,Percent of total Billed Charges,89% of total Billed charges,62.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.29,77,,,Percent of total Billed charges,77% of total billed charges,59.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,17.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.63,650,
PULM STRESS PRE/POST BRONCH,T990600016,CDM,460,RC,94618,HCPCS,Outpatient,,,874,437,,672.98,77,,,Percent of Total Billed Charges,77% of total billed charges,222.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,273.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,646.76,74,,,Percent of Total Billed Charges,74% of total billed charges,603.06,69,,,Percent of Total Billed Charges,69% of total billed charges,603.06,69,,,Percent of Total Billed Charges,69% of total billed charges,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,603.06,69,,,Percent of Total Billed Charges,69% of total billed charges,603.06,69,,,Percent of Total Billed Charges,69% of total billed charges,734.16,84,,,Percent of Total Billed Charges,84% of total billed charges,716.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,777.86,89,,,Percent of total Billed Charges,89% of total Billed charges,777.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,47.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,672.98,77,,,Percent of total Billed charges,77% of total billed charges,742.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,251.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,218.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.03,777.86,
PULMONARY STRESS TESTING,T990600017,CDM,460,RC,94618,HCPCS,Outpatient,,,505.5,252.75,,389.24,77,,,Percent of Total Billed Charges,77% of total billed charges,128.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,374.07,74,,,Percent of Total Billed Charges,74% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,348.8,69,,,Percent of Total Billed Charges,69% of total billed charges,424.62,84,,,Percent of Total Billed Charges,84% of total billed charges,414.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,449.9,89,,,Percent of total Billed Charges,89% of total Billed charges,449.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,449.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,47.03,120,,,Fee Schedule,120% of MO of Medicaid Rate,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,389.24,77,,,Percent of total Billed charges,77% of total billed charges,429.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,47.03,120,,,Fee Schedule,120% of MO Medicaid Rate,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,126.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.03,650,
SPUTUM SPEC INDUCTION,T990600018,CDM,410,RC,94640,HCPCS,Outpatient,,,80.5,40.25,,61.99,77,,,Percent of Total Billed Charges,77% of total billed charges,20.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.57,74,,,Percent of Total Billed Charges,74% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,55.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.62,84,,,Percent of Total Billed Charges,84% of total billed charges,66.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.65,89,,,Percent of total Billed Charges,89% of total Billed charges,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.99,77,,,Percent of total Billed charges,77% of total billed charges,68.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,20.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.02,163,
MDI TREATMENT,T990600019,CDM,410,RC,94640,HCPCS,Outpatient,,,31.5,15.75,,24.26,77,,,Percent of Total Billed Charges,77% of total billed charges,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.31,74,,,Percent of Total Billed Charges,74% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21.74,69,,,Percent of Total Billed Charges,69% of total billed charges,26.46,84,,,Percent of Total Billed Charges,84% of total billed charges,25.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.04,89,,,Percent of total Billed Charges,89% of total Billed charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.26,77,,,Percent of total Billed charges,77% of total billed charges,26.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,7.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,163,
"NEB TX, INITIAL",T990600020,CDM,410,RC,94640,HCPCS,Outpatient,,,256,128,,197.12,77,,,Percent of Total Billed Charges,77% of total billed charges,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,189.44,74,,,Percent of Total Billed Charges,74% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.64,69,,,Percent of Total Billed Charges,69% of total billed charges,215.04,84,,,Percent of Total Billed Charges,84% of total billed charges,209.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,227.84,89,,,Percent of total Billed Charges,89% of total Billed charges,227.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.12,77,,,Percent of total Billed charges,77% of total billed charges,217.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.02,227.84,
"NEB TX, SUB",T990600021,CDM,410,RC,94640,HCPCS,Outpatient,,,187,93.5,,143.99,77,,,Percent of Total Billed Charges,77% of total billed charges,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,138.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,129.03,69,,,Percent of Total Billed Charges,69% of total billed charges,157.08,84,,,Percent of Total Billed Charges,84% of total billed charges,153.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,166.43,89,,,Percent of total Billed Charges,89% of total Billed charges,166.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,166.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,10.02,120,,,Fee Schedule,120% of MO of Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.99,77,,,Percent of total Billed charges,77% of total billed charges,158.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,10.02,120,,,Fee Schedule,120% of MO Medicaid Rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,46.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.02,166.43,
CONT NEB INITIAL HOUR,T990600023,CDM,410,RC,94644,HCPCS,Outpatient,,,341,170.5,,262.57,77,,,Percent of Total Billed Charges,77% of total billed charges,86.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,252.34,74,,,Percent of Total Billed Charges,74% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,235.29,69,,,Percent of Total Billed Charges,69% of total billed charges,286.44,84,,,Percent of Total Billed Charges,84% of total billed charges,279.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,303.49,89,,,Percent of total Billed Charges,89% of total Billed charges,303.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.57,77,,,Percent of total Billed charges,77% of total billed charges,289.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,139.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,85.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.25,303.49,
CONT NEB SUB HOUR,T990600024,CDM,410,RC,94645,HCPCS,Outpatient,,,179.5,89.75,,138.22,77,,,Percent of Total Billed Charges,77% of total billed charges,45.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.83,74,,,Percent of Total Billed Charges,74% of total billed charges,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,123.86,69,,,Percent of Total Billed Charges,69% of total billed charges,150.78,84,,,Percent of Total Billed Charges,84% of total billed charges,147.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.76,89,,,Percent of total Billed Charges,89% of total Billed charges,159.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.22,77,,,Percent of total Billed charges,77% of total billed charges,152.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,73.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,44.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.88,163,
BI PAP 1ST DAY,T990600025,CDM,410,RC,94660,HCPCS,Outpatient,,,1145.5,572.75,,882.04,77,,,Percent of Total Billed Charges,77% of total billed charges,292.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,292.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,357.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,847.67,74,,,Percent of Total Billed Charges,74% of total billed charges,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,790.4,69,,,Percent of Total Billed Charges,69% of total billed charges,962.22,84,,,Percent of Total Billed Charges,84% of total billed charges,939.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,1019.5,89,,,Percent of total Billed Charges,89% of total Billed charges,1019.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1019.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,882.04,77,,,Percent of total Billed charges,77% of total billed charges,973.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,329.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,286.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,1019.5,
"FLUTTER TX, INITIAL",T990600026,CDM,410,RC,94667,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.96,89,,,Percent of total Billed Charges,89% of total Billed charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66,234.96,
"POST DRAIN & PERC, INITIAL",T990600027,CDM,410,RC,94667,HCPCS,Outpatient,,,264,132,,203.28,77,,,Percent of Total Billed Charges,77% of total billed charges,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.36,74,,,Percent of Total Billed Charges,74% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,182.16,69,,,Percent of Total Billed Charges,69% of total billed charges,221.76,84,,,Percent of Total Billed Charges,84% of total billed charges,216.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.96,89,,,Percent of total Billed Charges,89% of total Billed charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.28,77,,,Percent of total Billed charges,77% of total billed charges,224.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66,234.96,
"FLUTTER TX, SUB",T990600028,CDM,410,RC,94668,HCPCS,Outpatient,,,83,41.5,,63.91,77,,,Percent of Total Billed Charges,77% of total billed charges,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.42,74,,,Percent of Total Billed Charges,74% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,69.72,84,,,Percent of Total Billed Charges,84% of total billed charges,68.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.87,89,,,Percent of total Billed Charges,89% of total Billed charges,73.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.91,77,,,Percent of total Billed charges,77% of total billed charges,70.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.75,163,
"POST DRAIN & PERC, SUBS",T990600029,CDM,410,RC,94668,HCPCS,Outpatient,,,83,41.5,,63.91,77,,,Percent of Total Billed Charges,77% of total billed charges,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.42,74,,,Percent of Total Billed Charges,74% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,57.27,69,,,Percent of Total Billed Charges,69% of total billed charges,69.72,84,,,Percent of Total Billed Charges,84% of total billed charges,68.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.87,89,,,Percent of total Billed Charges,89% of total Billed charges,73.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.91,77,,,Percent of total Billed charges,77% of total billed charges,70.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,20.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.75,163,
RAW,T990600030,CDM,460,RC,94726,HCPCS,Outpatient,,,248.5,124.25,,191.35,77,,,Percent of Total Billed Charges,77% of total billed charges,63.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,183.89,74,,,Percent of Total Billed Charges,74% of total billed charges,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,171.47,69,,,Percent of Total Billed Charges,69% of total billed charges,208.74,84,,,Percent of Total Billed Charges,84% of total billed charges,203.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,221.17,89,,,Percent of total Billed Charges,89% of total Billed charges,221.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.26,120,,,Fee Schedule,120% of MO Medicaid Rate,38.26,120,,,Fee Schedule,120% of MO Medicaid Rate,38.26,120,,,Fee Schedule,120% of MO of Medicaid Rate,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.35,77,,,Percent of total Billed charges,77% of total billed charges,211.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,71.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,38.26,120,,,Fee Schedule,120% of MO Medicaid Rate,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,62.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.26,650,
PULM FUNCTION TEST BY GAS,T990600032,CDM,460,RC,94727,HCPCS,Outpatient,,,410.5,205.25,,316.09,77,,,Percent of Total Billed Charges,77% of total billed charges,104.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,303.77,74,,,Percent of Total Billed Charges,74% of total billed charges,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,344.82,84,,,Percent of Total Billed Charges,84% of total billed charges,336.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,365.35,89,,,Percent of total Billed Charges,89% of total Billed charges,365.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,365.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,28.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.09,77,,,Percent of total Billed charges,77% of total billed charges,348.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,28.55,120,,,Fee Schedule,120% of MO Medicaid Rate,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.55,650,
DLCO,T990600035,CDM,460,RC,94729,HCPCS,Outpatient,,,410.5,205.25,,316.09,77,,,Percent of Total Billed Charges,77% of total billed charges,104.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,303.77,74,,,Percent of Total Billed Charges,74% of total billed charges,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,283.25,69,,,Percent of Total Billed Charges,69% of total billed charges,344.82,84,,,Percent of Total Billed Charges,84% of total billed charges,336.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,365.35,89,,,Percent of total Billed Charges,89% of total Billed charges,365.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,365.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.66,120,,,Fee Schedule,120% of MO Medicaid Rate,44.66,120,,,Fee Schedule,120% of MO Medicaid Rate,44.66,120,,,Fee Schedule,120% of MO of Medicaid Rate,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,316.09,77,,,Percent of total Billed charges,77% of total billed charges,348.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,44.66,120,,,Fee Schedule,120% of MO Medicaid Rate,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,102.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,650,
AMBULATORY OXIMETRY W/O O2,T990600037,CDM,460,RC,94760,HCPCS,Outpatient,,,79.5,39.75,,61.22,77,,,Percent of Total Billed Charges,77% of total billed charges,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.83,74,,,Percent of Total Billed Charges,74% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,66.78,84,,,Percent of Total Billed Charges,84% of total billed charges,65.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.76,89,,,Percent of total Billed Charges,89% of total Billed charges,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,3.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,77,,,Percent of total Billed charges,77% of total billed charges,67.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.11,650,
"OXYGEN SAT, SINGLE",T990600038,CDM,460,RC,94760,HCPCS,Outpatient,,,79.5,39.75,,61.22,77,,,Percent of Total Billed Charges,77% of total billed charges,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.83,74,,,Percent of Total Billed Charges,74% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,69,,,Percent of Total Billed Charges,69% of total billed charges,66.78,84,,,Percent of Total Billed Charges,84% of total billed charges,65.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.76,89,,,Percent of total Billed Charges,89% of total Billed charges,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,3.11,120,,,Fee Schedule,120% of MO of Medicaid Rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,77,,,Percent of total Billed charges,77% of total billed charges,67.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,3.11,120,,,Fee Schedule,120% of MO Medicaid Rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,19.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.11,650,
AMBULATION W/O2,T990600039,CDM,460,RC,94761,HCPCS,Outpatient,,,98.5,49.25,,75.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.89,74,,,Percent of Total Billed Charges,74% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,67.97,69,,,Percent of Total Billed Charges,69% of total billed charges,82.74,84,,,Percent of Total Billed Charges,84% of total billed charges,80.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.67,89,,,Percent of total Billed Charges,89% of total Billed charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,77,,,Percent of total Billed charges,77% of total billed charges,83.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.23,650,
"OXYGEN SAT, MULTIPLE (per day)",T990600040,CDM,460,RC,94761,HCPCS,Outpatient,,,290,145,,223.3,77,,,Percent of Total Billed Charges,77% of total billed charges,73.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.6,74,,,Percent of Total Billed Charges,74% of total billed charges,200.1,69,,,Percent of Total Billed Charges,69% of total billed charges,200.1,69,,,Percent of Total Billed Charges,69% of total billed charges,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.1,69,,,Percent of Total Billed Charges,69% of total billed charges,200.1,69,,,Percent of Total Billed Charges,69% of total billed charges,243.6,84,,,Percent of Total Billed Charges,84% of total billed charges,237.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.1,89,,,Percent of total Billed Charges,89% of total Billed charges,258.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,6.23,120,,,Fee Schedule,120% of MO of Medicaid Rate,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.3,77,,,Percent of total Billed charges,77% of total billed charges,246.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,6.23,120,,,Fee Schedule,120% of MO Medicaid Rate,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.23,650,
OVERNIGHT SLEEP OXIMETRY,T990600041,CDM,460,RC,94762,HCPCS,Outpatient,,,371.5,185.75,,286.06,77,,,Percent of Total Billed Charges,77% of total billed charges,94.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.91,74,,,Percent of Total Billed Charges,74% of total billed charges,256.34,69,,,Percent of Total Billed Charges,69% of total billed charges,256.34,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.34,69,,,Percent of Total Billed Charges,69% of total billed charges,256.34,69,,,Percent of Total Billed Charges,69% of total billed charges,312.06,84,,,Percent of Total Billed Charges,84% of total billed charges,304.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.64,89,,,Percent of total Billed Charges,89% of total Billed charges,330.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,23.68,120,,,Fee Schedule,120% of MO of Medicaid Rate,92.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,286.06,77,,,Percent of total Billed charges,77% of total billed charges,315.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,23.68,120,,,Fee Schedule,120% of MO Medicaid Rate,92.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,92.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.68,650,
MULTIPLE SLEEP LATENCY TEST,T990600043,CDM,920,RC,95805,HCPCS,Outpatient,,,3215,1607.5,,2475.55,77,,,Percent of Total Billed Charges,77% of total billed charges,819.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,819.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1004.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1433,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,100,,,case rate,pays based on per visit,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,803.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1475,84,,,Percent of Total Billed Charges,84% of total billed charges,2636.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,2861.35,89,,,Percent of total Billed Charges,89% of total Billed charges,2861.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2861.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.2,120,,,Fee Schedule,120% of MO Medicaid Rate,344.2,120,,,Fee Schedule,120% of MO Medicaid Rate,344.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,803.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2475.55,77,,,Percent of total Billed charges,77% of total billed charges,2732.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2369,100,,,Case Rate,Pays based on per visit rate,344.2,120,,,Fee Schedule,120% of MO Medicaid Rate,803.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2050,100,,,Case Rate,Pays based on per visit rate,803.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.2,2861.35,
FEV 1X3,T990600045,CDM,460,RC,94375,HCPCS,Outpatient,,,110,55,,84.7,77,,,Percent of Total Billed Charges,77% of total billed charges,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.4,74,,,Percent of Total Billed Charges,74% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,75.9,69,,,Percent of Total Billed Charges,69% of total billed charges,92.4,84,,,Percent of Total Billed Charges,84% of total billed charges,90.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,97.9,89,,,Percent of total Billed Charges,89% of total Billed charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,21.55,120,,,Fee Schedule,120% of MO of Medicaid Rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.7,77,,,Percent of total Billed charges,77% of total billed charges,93.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650,100,,,Case Rate,Pays based on per visit rate,21.55,120,,,Fee Schedule,120% of MO Medicaid Rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,562,100,,,Case Rate,Pays based on per visit rate,27.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.55,650,
AEROSOL SETUP,T990600046,CDM,270,RC,,,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.24,74,,,Percent of Total Billed Charges,74% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,86.94,69,,,Percent of Total Billed Charges,69% of total billed charges,105.84,84,,,Percent of Total Billed Charges,84% of total billed charges,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,112.14,
BI-PAP,T990600047,CDM,410,RC,,,Outpatient,,,1008.5,504.25,,776.55,77,,,Percent of Total Billed Charges,77% of total billed charges,257.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,315.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,695.87,69,,,Percent of Total Billed Charges,69% of total billed charges,695.87,69,,,Percent of Total Billed Charges,69% of total billed charges,252.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,695.87,69,,,Percent of Total Billed Charges,69% of total billed charges,695.87,69,,,Percent of Total Billed Charges,69% of total billed charges,847.14,84,,,Percent of Total Billed Charges,84% of total billed charges,826.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,897.57,89,,,Percent of total Billed Charges,89% of total Billed charges,897.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,897.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,411.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,411.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,411.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,252.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.55,77,,,Percent of total Billed charges,77% of total billed charges,857.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,289.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,411.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,252.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,252.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,897.57,
DELEE SUCTION,T990600048,CDM,410,RC,,,Outpatient,,,35,17.5,,26.95,77,,,Percent of Total Billed Charges,77% of total billed charges,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.9,74,,,Percent of Total Billed Charges,74% of total billed charges,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.15,69,,,Percent of Total Billed Charges,69% of total billed charges,29.4,84,,,Percent of Total Billed Charges,84% of total billed charges,28.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.15,89,,,Percent of total Billed Charges,89% of total Billed charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.95,77,,,Percent of total Billed charges,77% of total billed charges,29.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,14.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,8.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.75,163,
DELIVERY,T990600049,CDM,410,RC,,,Outpatient,,,112,56,,86.24,77,,,Percent of Total Billed Charges,77% of total billed charges,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.88,74,,,Percent of Total Billed Charges,74% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,77.28,69,,,Percent of Total Billed Charges,69% of total billed charges,94.08,84,,,Percent of Total Billed Charges,84% of total billed charges,91.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.68,89,,,Percent of total Billed Charges,89% of total Billed charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.24,77,,,Percent of total Billed charges,77% of total billed charges,95.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,45.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28,163,
ASSIST W/AMBU BAG PER 15 MIN,T990600050,CDM,410,RC,G0238,HCPCS,Outpatient,,,119.5,59.75,,92.02,77,,,Percent of Total Billed Charges,77% of total billed charges,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.43,74,,,Percent of Total Billed Charges,74% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,82.46,69,,,Percent of Total Billed Charges,69% of total billed charges,100.38,84,,,Percent of Total Billed Charges,84% of total billed charges,97.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.36,89,,,Percent of total Billed Charges,89% of total Billed charges,106.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.02,77,,,Percent of total Billed charges,77% of total billed charges,101.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,48.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,29.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.88,163,
EKG FACILITY,T990610001,CDM,730,RC,93005,HCPCS,Outpatient,,,178,89,,137.06,77,,,Percent of Total Billed Charges,77% of total billed charges,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160,100,,,Case rate,pays based on per visit rate,155,100,,,case rate,pays based on per visit,155,100,,,case rate,pays based on per visit,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155,100,,,case rate,pays based on per visit,155,100,,,case rate,pays based on per day rate,164,100,,,case rate,pays based on per day rate,145.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.42,89,,,Percent of total Billed Charges,89% of total Billed charges,158.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.06,77,,,Percent of total Billed charges,77% of total billed charges,151.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.43,296,
EKG,T990610002,CDM,730,RC,93010,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.92,74,,,Percent of Total Billed Charges,74% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,258.72,84,,,Percent of Total Billed Charges,84% of total billed charges,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,274.12,89,,,Percent of total Billed Charges,89% of total Billed charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,125.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,296,
EKG,T990610002,CDM,730,RC,93005,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160,100,,,Case rate,pays based on per visit rate,155,100,,,case rate,pays based on per visit,155,100,,,case rate,pays based on per visit,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155,100,,,case rate,pays based on per visit,155,100,,,case rate,pays based on per day rate,164,100,,,case rate,pays based on per day rate,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,274.12,89,,,Percent of total Billed Charges,89% of total Billed charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,12.43,120,,,Fee Schedule,120% of MO of Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,12.43,120,,,Fee Schedule,120% of MO Medicaid Rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.43,296,
EKG PF,T990610003,CDM,985,RC,93010,HCPCS,Outpatient,,,119,59.5,,11.56,175,,,fee schedule,175% of aetna fee schedule,8.81,115,,,fee schedule,115% of cms physician fee schedule,8.99,117.3,,,fee schedule,117.3% of cms physician fee schedule,11.01,143.75,,,fee schedule,143.75% of cms fee schedule ,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,8.81,115,,,fee schedule,115% of cms fee schedule,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,9.73,100,,,fee schedule,100% of cigna fee schedule,12.15,100,,,fee schedule,100% of healthlink fee schedule,11.32,100,,,Fee Schedule,100% of Healthlink HMO Fee Schedule,12.15,100,,,Fee Schedule,100% of Healthlink PPO Fee Schedule,107.1,90,,,Percent of Total Billed Charges,90% of Total Billed Charges,107.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,115,,,fee schedule,115% of cms fee schedule,11.56,135,,,Fee Schedule,135% of CMS Fee Schedule ,13.65,178.25,,,Fee Schedule,178.25% of Multiplan Fee Schedule,10.13,132.25,,,Fee Schedule,132.25% CMS OPPS Rate,11.33,100,,,Fee Schedule,100% of UHC Fee Schedule,107.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,115,,,Fee Schedule,115% of CMS OPPS Rate,10.44,100,,,Fee Schedule,100% of UMR Fee Schedule,8.81,115,,,Fee Schedule,115% of CMS OPPS Rate,8.81,107.1,
EKG RHYTHM STRIP,T990610004,CDM,730,RC,93041,HCPCS,Outpatient,,,51,25.5,,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.74,74,,,Percent of Total Billed Charges,74% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,84,,,Percent of Total Billed Charges,84% of total billed charges,41.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.39,89,,,Percent of total Billed Charges,89% of total Billed charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.14,120,,,Fee Schedule,120% of MO Medicaid Rate,5.14,120,,,Fee Schedule,120% of MO Medicaid Rate,5.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,5.14,120,,,Fee Schedule,120% of MO Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.14,296,
"2 NIGHT SLEEP STUDY, UNATTENDE",T990620001,CDM,920,RC,95806,HCPCS,Outpatient,,,1631.5,815.75,,1256.26,77,,,Percent of Total Billed Charges,77% of total billed charges,416.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1125.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.74,100,,,case rate,pays based on per visit,1125.74,69,,,Percent of Total Billed Charges,69% of total billed charges,407.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,1452.04,89,,,Percent of total Billed Charges,89% of total Billed charges,1452.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1452.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,407.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.26,77,,,Percent of total Billed charges,77% of total billed charges,1386.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2110,100,,,Case Rate,Pays based on per visit rate,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,407.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1827,100,,,Case Rate,Pays based on per visit rate,407.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.93,2110,
"3 NIGHT SLEEP STUDY, UNATTENDE",T990620002,CDM,920,RC,95806,HCPCS,Outpatient,,,2446.5,1223.25,,1883.81,77,,,Percent of Total Billed Charges,77% of total billed charges,623.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,623.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,764.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1433,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,100,,,case rate,pays based on per visit,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,611.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1475,84,,,Percent of Total Billed Charges,84% of total billed charges,2006.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,2177.39,89,,,Percent of total Billed Charges,89% of total Billed charges,2177.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2177.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,52.93,120,,,Fee Schedule,120% of MO of Medicaid Rate,611.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1883.81,77,,,Percent of total Billed charges,77% of total billed charges,2079.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,703.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2110,100,,,Case Rate,Pays based on per visit rate,52.93,120,,,Fee Schedule,120% of MO Medicaid Rate,611.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1827,100,,,Case Rate,Pays based on per visit rate,611.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.93,2177.39,
SLEEP STUDY,T990620003,CDM,920,RC,95810,HCPCS,Outpatient,,,4131,2065.5,,3180.87,77,,,Percent of Total Billed Charges,77% of total billed charges,1053.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1053.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1290.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1433,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,100,,,case rate,pays based on per visit,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1032.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1475,84,,,Percent of Total Billed Charges,84% of total billed charges,3387.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,3676.59,89,,,Percent of total Billed Charges,89% of total Billed charges,3676.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3676.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.96,120,,,Fee Schedule,120% of MO Medicaid Rate,464.96,120,,,Fee Schedule,120% of MO Medicaid Rate,464.96,120,,,Fee Schedule,120% of MO of Medicaid Rate,1032.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3180.87,77,,,Percent of total Billed charges,77% of total billed charges,3511.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1187.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2369,100,,,Case Rate,Pays based on per visit rate,464.96,120,,,Fee Schedule,120% of MO Medicaid Rate,1032.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2050,100,,,Case Rate,Pays based on per visit rate,1032.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,464.96,3676.59,
SLEEP STUDY W/CPAP,T990620004,CDM,920,RC,95811,HCPCS,Outpatient,,,5058,2529,,3894.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1289.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1289.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1580.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1433,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,100,,,case rate,pays based on per visit,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1264.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1389,69,,,Percent of Total Billed Charges,69% of total billed charges,1475,84,,,Percent of Total Billed Charges,84% of total billed charges,4147.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4501.62,89,,,Percent of total Billed Charges,89% of total Billed charges,4501.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4501.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,521.62,120,,,Fee Schedule,120% of MO Medicaid Rate,521.62,120,,,Fee Schedule,120% of MO Medicaid Rate,521.62,120,,,Fee Schedule,120% of MO of Medicaid Rate,1264.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3894.66,77,,,Percent of total Billed charges,77% of total billed charges,4299.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1454.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2369,100,,,Case Rate,Pays based on per visit rate,521.62,120,,,Fee Schedule,120% of MO Medicaid Rate,1264.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2050,100,,,Case Rate,Pays based on per visit rate,1264.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.62,4501.62,
ROUTINE EEG,T990620005,CDM,740,RC,95816,HCPCS,Outpatient,,,1050,525,,808.5,77,,,Percent of Total Billed Charges,77% of total billed charges,267.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777,74,,,Percent of Total Billed Charges,74% of total billed charges,724.5,69,,,Percent of Total Billed Charges,69% of total billed charges,724.5,69,,,Percent of Total Billed Charges,69% of total billed charges,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.5,69,,,Percent of Total Billed Charges,69% of total billed charges,724.5,69,,,Percent of Total Billed Charges,69% of total billed charges,882,84,,,Percent of Total Billed Charges,84% of total billed charges,861,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.5,89,,,Percent of total Billed Charges,89% of total Billed charges,934.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,294.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.5,77,,,Percent of total Billed charges,77% of total billed charges,892.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,617,100,,,Case Rate,Pays based on per visit rate,294.14,120,,,Fee Schedule,120% of MO Medicaid Rate,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,534,100,,,Case Rate,Pays based on per visit rate,262.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.5,934.5,
STRESS TEST SINGLE NUCLEAR,T990650001,CDM,341,RC,78451,HCPCS,Outpatient,,,1387.5,693.75,,1068.38,77,,,Percent of Total Billed Charges,77% of total billed charges,353.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,353.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,433.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1026.75,74,,,Percent of Total Billed Charges,74% of total billed charges,957.38,69,,,Percent of Total Billed Charges,69% of total billed charges,957.38,69,,,Percent of Total Billed Charges,69% of total billed charges,346.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,957.38,69,,,Percent of Total Billed Charges,69% of total billed charges,957.38,69,,,Percent of Total Billed Charges,69% of total billed charges,1165.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1137.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,1234.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1234.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.85,120,,,Fee Schedule,120% of MO Medicaid Rate,234.85,120,,,Fee Schedule,120% of MO Medicaid Rate,234.85,120,,,Fee Schedule,120% of MO of Medicaid Rate,346.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.38,77,,,Percent of total Billed charges,77% of total billed charges,1179.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,398.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,234.85,120,,,Fee Schedule,120% of MO Medicaid Rate,346.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,346.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.85,1234.88,
DOBUTAMINE NUCLEAR STRESS TEST,T990650002,CDM,340,RC,78452,HCPCS,Outpatient,,,3596.5,1798.25,,2769.31,77,,,Percent of Total Billed Charges,77% of total billed charges,917.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,917.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2661.41,74,,,Percent of Total Billed Charges,74% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3021.06,84,,,Percent of Total Billed Charges,84% of total billed charges,2949.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,3200.89,89,,,Percent of total Billed Charges,89% of total Billed charges,3200.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3200.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2769.31,77,,,Percent of total Billed charges,77% of total billed charges,3057.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1033.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.32,3200.89,
MYOCARDIAL SPECT MULTI STUDIES,T990650003,CDM,341,RC,78452,HCPCS,Outpatient,,,3596.5,1798.25,,2769.31,77,,,Percent of Total Billed Charges,77% of total billed charges,917.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,917.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2661.41,74,,,Percent of Total Billed Charges,74% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3021.06,84,,,Percent of Total Billed Charges,84% of total billed charges,2949.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,3200.89,89,,,Percent of total Billed Charges,89% of total Billed charges,3200.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3200.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2769.31,77,,,Percent of total Billed charges,77% of total billed charges,3057.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1033.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.32,3200.89,
LEXISCAN NUC STRESS TEST,T990650004,CDM,341,RC,78452,HCPCS,Outpatient,,,3596.5,1798.25,,2769.31,77,,,Percent of Total Billed Charges,77% of total billed charges,917.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,917.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2661.41,74,,,Percent of Total Billed Charges,74% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2481.59,69,,,Percent of Total Billed Charges,69% of total billed charges,3021.06,84,,,Percent of Total Billed Charges,84% of total billed charges,2949.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,3200.89,89,,,Percent of total Billed Charges,89% of total Billed charges,3200.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3200.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,339.32,120,,,Fee Schedule,120% of MO of Medicaid Rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2769.31,77,,,Percent of total Billed charges,77% of total billed charges,3057.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1033.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,847,100,,,Case Rate,Pays based on per visit rate,339.32,120,,,Fee Schedule,120% of MO Medicaid Rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733,100,,,Case Rate,Pays based on per visit rate,899.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.32,3200.89,
STRESS TEST,T990650005,CDM,482,RC,93017,HCPCS,Outpatient,,,775.5,387.75,,597.14,77,,,Percent of Total Billed Charges,77% of total billed charges,197.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,197.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,242.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,291,100,,,Case rate,pays based on per visit rate,284,100,,,case rate,pays based on per visit,284,100,,,case rate,pays based on per visit,193.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284,100,,,case rate,pays based on per visit,284,100,,,case rate,pays based on per day rate,312,100,,,case rate,pays based on per day rate,635.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,690.2,89,,,Percent of total Billed Charges,89% of total Billed charges,690.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,690.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,120,,,Fee Schedule,120% of MO Medicaid Rate,62.29,120,,,Fee Schedule,120% of MO Medicaid Rate,62.29,120,,,Fee Schedule,120% of MO of Medicaid Rate,193.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,597.14,77,,,Percent of total Billed charges,77% of total billed charges,659.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,222.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,446,100,,,Case Rate,Pays based on per visit rate,62.29,120,,,Fee Schedule,120% of MO Medicaid Rate,193.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386,100,,,Case Rate,Pays based on per visit rate,193.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,690.2,
CARDIAC RHYTHM MONITORING,T990650007,CDM,730,RC,93041,HCPCS,Outpatient,,,51,25.5,,39.27,77,,,Percent of Total Billed Charges,77% of total billed charges,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.74,74,,,Percent of Total Billed Charges,74% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,35.19,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,84,,,Percent of Total Billed Charges,84% of total billed charges,41.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.39,89,,,Percent of total Billed Charges,89% of total Billed charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.14,120,,,Fee Schedule,120% of MO Medicaid Rate,5.14,120,,,Fee Schedule,120% of MO Medicaid Rate,5.14,120,,,Fee Schedule,120% of MO of Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.27,77,,,Percent of total Billed charges,77% of total billed charges,43.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296,100,,,Case Rate,Pays based on per visit rate,5.14,120,,,Fee Schedule,120% of MO Medicaid Rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256,100,,,Case Rate,Pays based on per visit rate,12.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.14,296,
"HOLTER, 3 TO 7 DAYS",T990650011,CDM,731,RC,93242,HCPCS,Outpatient,,,711.5,355.75,,547.86,77,,,Percent of Total Billed Charges,77% of total billed charges,181.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.51,74,,,Percent of Total Billed Charges,74% of total billed charges,490.94,69,,,Percent of Total Billed Charges,69% of total billed charges,490.94,69,,,Percent of Total Billed Charges,69% of total billed charges,177.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.94,69,,,Percent of Total Billed Charges,69% of total billed charges,490.94,69,,,Percent of Total Billed Charges,69% of total billed charges,597.66,84,,,Percent of Total Billed Charges,84% of total billed charges,583.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,633.24,89,,,Percent of total Billed Charges,89% of total Billed charges,633.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,633.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.74,120,,,Fee Schedule,120% of MO Medicaid Rate,12.74,120,,,Fee Schedule,120% of MO Medicaid Rate,12.74,120,,,Fee Schedule,120% of MO of Medicaid Rate,177.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.86,77,,,Percent of total Billed charges,77% of total billed charges,604.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,508,100,,,Case Rate,Pays based on per visit rate,12.74,120,,,Fee Schedule,120% of MO Medicaid Rate,177.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439,100,,,Case Rate,Pays based on per visit rate,177.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.74,633.24,
CARDIAC 30-DAY EVENT MONITOR,T990650012,CDM,731,RC,93270,HCPCS,Outpatient,,,804.5,402.25,,619.47,77,,,Percent of Total Billed Charges,77% of total billed charges,205.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,205.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,595.33,74,,,Percent of Total Billed Charges,74% of total billed charges,555.11,69,,,Percent of Total Billed Charges,69% of total billed charges,555.11,69,,,Percent of Total Billed Charges,69% of total billed charges,201.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.11,69,,,Percent of Total Billed Charges,69% of total billed charges,555.11,69,,,Percent of Total Billed Charges,69% of total billed charges,675.78,84,,,Percent of Total Billed Charges,84% of total billed charges,659.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,716.01,89,,,Percent of total Billed Charges,89% of total Billed charges,716.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,716.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.87,120,,,Fee Schedule,120% of MO Medicaid Rate,22.87,120,,,Fee Schedule,120% of MO Medicaid Rate,22.87,120,,,Fee Schedule,120% of MO of Medicaid Rate,201.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,619.47,77,,,Percent of total Billed charges,77% of total billed charges,683.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,231.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,508,100,,,Case Rate,Pays based on per visit rate,22.87,120,,,Fee Schedule,120% of MO Medicaid Rate,201.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,439,100,,,Case Rate,Pays based on per visit rate,201.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,716.01,
STRESS ECHO-TREADMILL,T990650013,CDM,480,RC,93351,HCPCS,Outpatient,,,4273.5,2136.75,,3290.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3162.39,74,,,Percent of Total Billed Charges,74% of total billed charges,2948.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2948.72,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2948.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2948.72,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3504.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,3803.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3803.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3803.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.9,120,,,Fee Schedule,120% of MO Medicaid Rate,137.9,120,,,Fee Schedule,120% of MO Medicaid Rate,137.9,120,,,Fee Schedule,120% of MO of Medicaid Rate,1068.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3290.6,77,,,Percent of total Billed charges,77% of total billed charges,3632.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,898,100,,,Case Rate,Pays based on per visit rate,137.9,120,,,Fee Schedule,120% of MO Medicaid Rate,1068.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777,100,,,Case Rate,Pays based on per visit rate,1068.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.9,3803.42,
PAD REHAB,T990650014,CDM,489,RC,93668,HCPCS,Outpatient,,,308,154,,237.16,77,,,Percent of Total Billed Charges,77% of total billed charges,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,227.92,74,,,Percent of Total Billed Charges,74% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,212.52,69,,,Percent of Total Billed Charges,69% of total billed charges,258.72,84,,,Percent of Total Billed Charges,84% of total billed charges,252.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,274.12,89,,,Percent of total Billed Charges,89% of total Billed charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,274.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.16,77,,,Percent of total Billed charges,77% of total billed charges,261.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,898,100,,,Case Rate,Pays based on per visit rate,125.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777,100,,,Case Rate,Pays based on per visit rate,77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77,898,
THORACIC BIOIMPEDANCE,T990650015,CDM,480,RC,93701,HCPCS,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.9,74,,,Percent of Total Billed Charges,74% of total billed charges,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,93.15,69,,,Percent of Total Billed Charges,69% of total billed charges,113.4,84,,,Percent of Total Billed Charges,84% of total billed charges,110.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.15,89,,,Percent of total Billed Charges,89% of total Billed charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,24.6,120,,,Fee Schedule,120% of MO of Medicaid Rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,898,100,,,Case Rate,Pays based on per visit rate,24.6,120,,,Fee Schedule,120% of MO Medicaid Rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777,100,,,Case Rate,Pays based on per visit rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.6,898,
AMBULATORY BP MONITOR 24H,T990650016,CDM,920,RC,93786,HCPCS,Outpatient,,,428,214,,329.56,77,,,Percent of Total Billed Charges,77% of total billed charges,109.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,316.72,74,,,Percent of Total Billed Charges,74% of total billed charges,295.32,69,,,Percent of Total Billed Charges,69% of total billed charges,295.32,69,,,Percent of Total Billed Charges,69% of total billed charges,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.32,69,,,Percent of Total Billed Charges,69% of total billed charges,295.32,69,,,Percent of Total Billed Charges,69% of total billed charges,359.52,84,,,Percent of Total Billed Charges,84% of total billed charges,350.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,380.92,89,,,Percent of total Billed Charges,89% of total Billed charges,380.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,120,,,Fee Schedule,120% of MO Medicaid Rate,24.17,120,,,Fee Schedule,120% of MO Medicaid Rate,24.17,120,,,Fee Schedule,120% of MO of Medicaid Rate,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.56,77,,,Percent of total Billed charges,77% of total billed charges,363.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119,100,,,Case Rate,Pays based on per visit rate,24.17,120,,,Fee Schedule,120% of MO Medicaid Rate,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103,100,,,Case Rate,Pays based on per visit rate,107,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.17,380.92,
CARDIAC ED VISIT-NON MONITOR,T990650017,CDM,941,RC,93797,HCPCS,Outpatient,,,333.5,166.75,,256.8,77,,,Percent of Total Billed Charges,77% of total billed charges,85.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,246.79,74,,,Percent of Total Billed Charges,74% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,280.14,84,,,Percent of Total Billed Charges,84% of total billed charges,273.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,296.82,89,,,Percent of total Billed Charges,89% of total Billed charges,296.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.8,77,,,Percent of total Billed charges,77% of total billed charges,283.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,,,,,Other,Not Seperately Reimbusable,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,296.82,
CARDIAC REHAB UNMONITORED,T990650018,CDM,943,RC,93797,HCPCS,Outpatient,,,333.5,166.75,,256.8,77,,,Percent of Total Billed Charges,77% of total billed charges,85.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,246.79,74,,,Percent of Total Billed Charges,74% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,230.12,69,,,Percent of Total Billed Charges,69% of total billed charges,280.14,84,,,Percent of Total Billed Charges,84% of total billed charges,273.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,296.82,89,,,Percent of total Billed Charges,89% of total Billed charges,296.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.8,77,,,Percent of total Billed charges,77% of total billed charges,283.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,162,100,,,Case Rate,Pays based on per visit rate,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140,100,,,Case Rate,Pays based on per visit rate,83.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,296.82,
CARDIAC REHAB 1ST VISIT,T990650019,CDM,943,RC,93797,HCPCS,Outpatient,,,446.5,223.25,,343.81,77,,,Percent of Total Billed Charges,77% of total billed charges,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.41,74,,,Percent of Total Billed Charges,74% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,375.06,84,,,Percent of Total Billed Charges,84% of total billed charges,366.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.39,89,,,Percent of total Billed Charges,89% of total Billed charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,18.88,120,,,Fee Schedule,120% of MO of Medicaid Rate,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.81,77,,,Percent of total Billed charges,77% of total billed charges,379.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,162,100,,,Case Rate,Pays based on per visit rate,18.88,120,,,Fee Schedule,120% of MO Medicaid Rate,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140,100,,,Case Rate,Pays based on per visit rate,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,397.39,
CARDIAC REHAB 1ST VISIT,T990650019,CDM,943,RC,93798,HCPCS,Outpatient,,,446.5,223.25,,343.81,77,,,Percent of Total Billed Charges,77% of total billed charges,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.41,74,,,Percent of Total Billed Charges,74% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,375.06,84,,,Percent of Total Billed Charges,84% of total billed charges,366.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.39,89,,,Percent of total Billed Charges,89% of total Billed charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.81,77,,,Percent of total Billed charges,77% of total billed charges,379.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,162,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140,100,,,Case Rate,Pays based on per visit rate,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.63,397.39,
CARDIAC REHAB MONITORED,T990650020,CDM,943,RC,93798,HCPCS,Outpatient,,,369.5,184.75,,284.52,77,,,Percent of Total Billed Charges,77% of total billed charges,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.43,74,,,Percent of Total Billed Charges,74% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,254.96,69,,,Percent of Total Billed Charges,69% of total billed charges,310.38,84,,,Percent of Total Billed Charges,84% of total billed charges,302.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.86,89,,,Percent of total Billed Charges,89% of total Billed charges,328.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.52,77,,,Percent of total Billed charges,77% of total billed charges,314.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,162,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140,100,,,Case Rate,Pays based on per visit rate,92.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.38,328.86,
Pul Rehab COPD/COV w/o pulse,T990650021,CDM,948,RC,94625,HCPCS,Outpatient,,,429,214.5,,330.33,77,,,Percent of Total Billed Charges,77% of total billed charges,109.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,317.46,74,,,Percent of Total Billed Charges,74% of total billed charges,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,360.36,84,,,Percent of Total Billed Charges,84% of total billed charges,351.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,381.81,89,,,Percent of total Billed Charges,89% of total Billed charges,381.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,381.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.33,77,,,Percent of total Billed charges,77% of total billed charges,364.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227,100,,,Case Rate,Pays based on per visit rate,175.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196,100,,,Case Rate,Pays based on per visit rate,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.25,381.81,
Pul Rehab COPD/COV w/pulse ox,T990650023,CDM,948,RC,94626,HCPCS,Outpatient,,,429,214.5,,330.33,77,,,Percent of Total Billed Charges,77% of total billed charges,109.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,317.46,74,,,Percent of Total Billed Charges,74% of total billed charges,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,296.01,69,,,Percent of Total Billed Charges,69% of total billed charges,360.36,84,,,Percent of Total Billed Charges,84% of total billed charges,351.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,381.81,89,,,Percent of total Billed Charges,89% of total Billed charges,381.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,381.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.33,77,,,Percent of total Billed charges,77% of total billed charges,364.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,123.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227,100,,,Case Rate,Pays based on per visit rate,175.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196,100,,,Case Rate,Pays based on per visit rate,107.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.25,381.81,
SMOKING CESSATION UP TO 10 MIN,T990650028,CDM,942,RC,99406,HCPCS,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.34,74,,,Percent of Total Billed Charges,74% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,76.44,84,,,Percent of Total Billed Charges,84% of total billed charges,74.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.99,89,,,Percent of total Billed Charges,89% of total Billed charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,37.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,92,
SMOKING CESSATION UP TO 10 MIN,T990650028,CDM,942,RC,99406,HCPCS,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.34,74,,,Percent of Total Billed Charges,74% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,76.44,84,,,Percent of Total Billed Charges,84% of total billed charges,74.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.99,89,,,Percent of total Billed Charges,89% of total Billed charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,37.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,92,
SMOKING CESSATION OVER 10 MIN,T990650029,CDM,942,RC,99407,HCPCS,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.34,74,,,Percent of Total Billed Charges,74% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,76.44,84,,,Percent of Total Billed Charges,84% of total billed charges,74.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.99,89,,,Percent of total Billed Charges,89% of total Billed charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,37.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,92,
SMOKING CESSATION OVER 10 MIN,T990650029,CDM,942,RC,99407,HCPCS,Outpatient,,,91,45.5,,70.07,77,,,Percent of Total Billed Charges,77% of total billed charges,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.34,74,,,Percent of Total Billed Charges,74% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.79,69,,,Percent of Total Billed Charges,69% of total billed charges,76.44,84,,,Percent of Total Billed Charges,84% of total billed charges,74.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.99,89,,,Percent of total Billed Charges,89% of total Billed charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.07,77,,,Percent of total Billed charges,77% of total billed charges,77.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,37.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,92,
ADULT FITNESS WEEKLY CHG,T990650030,CDM,943,RC,,,Outpatient,,,8.5,4.25,,6.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.29,74,,,Percent of Total Billed Charges,74% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,69,,,Percent of Total Billed Charges,69% of total billed charges,7.14,84,,,Percent of Total Billed Charges,84% of total billed charges,6.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.57,89,,,Percent of total Billed Charges,89% of total Billed charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.55,77,,,Percent of total Billed charges,77% of total billed charges,7.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,162,100,,,Case Rate,Pays based on per visit rate,3.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140,100,,,Case Rate,Pays based on per visit rate,2.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.13,162,
NO CHARGE STRESS TEST,T990650037,CDM,482,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,291,100,,,Case rate,pays based on per visit rate,284,100,,,case rate,pays based on per visit,284,100,,,case rate,pays based on per visit,,,,,other,not seperately reimbusable,284,100,,,case rate,pays based on per visit,284,100,,,case rate,pays based on per day rate,312,100,,,case rate,pays based on per day rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,446,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,386,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,284,446,
RESP SRV Pul Rehab NonCOPD 1st,T990650048,CDM,419,RC,G0237,HCPCS,Outpatient,,,115.5,57.75,,88.94,77,,,Percent of Total Billed Charges,77% of total billed charges,29.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,85.47,74,,,Percent of Total Billed Charges,74% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,79.7,69,,,Percent of Total Billed Charges,69% of total billed charges,97.02,84,,,Percent of Total Billed Charges,84% of total billed charges,94.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.8,89,,,Percent of total Billed Charges,89% of total Billed charges,102.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.94,77,,,Percent of total Billed charges,77% of total billed charges,98.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,47.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,28.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.88,163,
RESP SRV Pul Rehab NONCOPD GRP,T990650049,CDM,419,RC,G0239,HCPCS,Outpatient,,,446.5,223.25,,343.81,77,,,Percent of Total Billed Charges,77% of total billed charges,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.41,74,,,Percent of Total Billed Charges,74% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,308.09,69,,,Percent of Total Billed Charges,69% of total billed charges,375.06,84,,,Percent of Total Billed Charges,84% of total billed charges,366.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.39,89,,,Percent of total Billed Charges,89% of total Billed charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.81,77,,,Percent of total Billed charges,77% of total billed charges,379.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163,100,,,Case Rate,Pays based on per visit rate,182.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141,100,,,Case Rate,Pays based on per visit rate,111.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.63,397.39,
Mobile Cardiac Telemetry,T990650050,CDM,731,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,508,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,439,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,439,508,
DRESSING CHANGE,T990700001,CDM,510,RC,16030,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,112.14,
BIOFEEDBACK TRAINING,T990700002,CDM,420,RC,90901,HCPCS,Outpatient,,,134,67,,103.18,77,,,Percent of Total Billed Charges,77% of total billed charges,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,109.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.26,89,,,Percent of total Billed Charges,89% of total Billed charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.18,77,,,Percent of total Billed charges,77% of total billed charges,113.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,54.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,33.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,222,
Biofeedback (Peri/Uro) Initial,T990700003,CDM,420,RC,90912,HCPCS,Outpatient,,,197.5,98.75,,152.08,77,,,Percent of Total Billed Charges,77% of total billed charges,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,161.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.78,89,,,Percent of total Billed Charges,89% of total Billed charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,77,,,Percent of total Billed charges,77% of total billed charges,167.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,80.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,49.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.38,222,
BIOFEEDBACK ADD'L 15,T990700004,CDM,420,RC,90913,HCPCS,Outpatient,,,113,56.5,,87.01,77,,,Percent of Total Billed Charges,77% of total billed charges,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,92.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,100.57,89,,,Percent of total Billed Charges,89% of total Billed charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.01,77,,,Percent of total Billed charges,77% of total billed charges,96.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,46.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,28.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,222,
1 MUSCLE EMG,T990700005,CDM,922,RC,95870,HCPCS,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163,100,,,Case rate,pays based on per visit rate,158,100,,,case rate,pays based on per visit,158,100,,,case rate,pays based on per visit,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158,100,,,case rate,pays based on per visit,158,100,,,case rate,pays based on per day rate,170,100,,,case rate,pays based on per day rate,32.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.6,89,,,Percent of total Billed Charges,89% of total Billed charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.77,120,,,Fee Schedule,120% of MO Medicaid Rate,60.77,120,,,Fee Schedule,120% of MO Medicaid Rate,60.77,120,,,Fee Schedule,120% of MO of Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,60.77,120,,,Fee Schedule,120% of MO Medicaid Rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166,100,,,Case Rate,Pays based on per visit rate,10,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10,192,
HEAT THERAPY/COLD THERAPY,T990700006,CDM,420,RC,97010,HCPCS,Outpatient,,,49.5,24.75,,38.12,77,,,Percent of Total Billed Charges,77% of total billed charges,12.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,40.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.06,89,,,Percent of total Billed Charges,89% of total Billed charges,44.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.12,77,,,Percent of total Billed charges,77% of total billed charges,42.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,20.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.38,222,
PT/OT 0.00 charge for coding,T990700007,CDM,420,RC,97010,HCPCS,Outpatient,,,49.5,24.75,,38.12,77,,,Percent of Total Billed Charges,77% of total billed charges,12.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,40.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.06,89,,,Percent of total Billed Charges,89% of total Billed charges,44.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.12,77,,,Percent of total Billed charges,77% of total billed charges,42.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,20.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.38,222,
PT/OT 0.00 charge for coding,T990700007,CDM,420,RC,97010,HCPCS,Outpatient,,,49.5,24.75,GP,38.12,77,,,Percent of Total Billed Charges,77% of total billed charges,12.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,40.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.06,89,,,Percent of total Billed Charges,89% of total Billed charges,44.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.12,77,,,Percent of total Billed charges,77% of total billed charges,42.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,20.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,12.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.38,222,
MACHANICAL TRACTION,T990700008,CDM,420,RC,97012,HCPCS,Outpatient,,,98.5,49.25,,75.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,80.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.67,89,,,Percent of total Billed Charges,89% of total Billed charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,77,,,Percent of total Billed charges,77% of total billed charges,83.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,40.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.63,222,
ELECTRICAL STIMULATION,T990700009,CDM,420,RC,G0283,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.41,89,,,Percent of total Billed Charges,89% of total Billed charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,28.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,222,
ELECTRICAL STIMULATION,T990700009,CDM,420,RC,97014,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.41,89,,,Percent of total Billed Charges,89% of total Billed charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,28.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,222,
TENS APPLICATION,T990700010,CDM,420,RC,G0283,HCPCS,Outpatient,,,129.5,64.75,,99.72,77,,,Percent of Total Billed Charges,77% of total billed charges,33.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,106.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.26,89,,,Percent of total Billed Charges,89% of total Billed charges,115.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.72,77,,,Percent of total Billed charges,77% of total billed charges,110.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,52.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.38,222,
VASOPNEUMATIC PUMP,T990700011,CDM,420,RC,97016,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,60.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.86,89,,,Percent of total Billed Charges,89% of total Billed charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,30.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,222,
PARRAFIN BATH,T990700012,CDM,420,RC,97018,HCPCS,Outpatient,,,65,32.5,,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,53.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,222,
PARRAFIN BATH,T990700012,CDM,420,RC,97018,HCPCS,Outpatient,,,65,32.5,GP,50.05,77,,,Percent of Total Billed Charges,77% of total billed charges,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,53.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.85,89,,,Percent of total Billed Charges,89% of total Billed charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,77,,,Percent of total Billed charges,77% of total billed charges,55.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,26.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,16.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.25,222,
WHIRLPOOL,T990700013,CDM,420,RC,97022,HCPCS,Outpatient,,,98,49,,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,80.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.22,89,,,Percent of total Billed Charges,89% of total Billed charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,39.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,222,
WHIRLPOOL,T990700013,CDM,420,RC,97022,HCPCS,Outpatient,,,98,49,GP,75.46,77,,,Percent of Total Billed Charges,77% of total billed charges,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,80.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.22,89,,,Percent of total Billed Charges,89% of total Billed charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.46,77,,,Percent of total Billed charges,77% of total billed charges,83.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,39.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,24.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.5,222,
"UV LIGHT THERAPY, 1+ AREAS",T990700014,CDM,420,RC,97028,HCPCS,Outpatient,,,83.5,41.75,,64.3,77,,,Percent of Total Billed Charges,77% of total billed charges,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,68.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.32,89,,,Percent of total Billed Charges,89% of total Billed charges,74.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.3,77,,,Percent of total Billed charges,77% of total billed charges,70.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,34.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,20.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.88,222,
MANUAL STIM - 15 MINUTES,T990700015,CDM,420,RC,97032,HCPCS,Outpatient,,,76,38,,58.52,77,,,Percent of Total Billed Charges,77% of total billed charges,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,62.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.64,89,,,Percent of total Billed Charges,89% of total Billed charges,67.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.52,77,,,Percent of total Billed charges,77% of total billed charges,64.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,31.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19,222,
IONTOPHORESIS,T990700016,CDM,420,RC,97033,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,124.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.28,89,,,Percent of total Billed Charges,89% of total Billed charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,62.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38,222,
ULTRASOUND,T990700018,CDM,420,RC,97035,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,60.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.86,89,,,Percent of total Billed Charges,89% of total Billed charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,30.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,222,
FLUIDOTHERAPY,T990700019,CDM,420,RC,97036,HCPCS,Outpatient,,,72,36,,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,59.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.08,89,,,Percent of total Billed Charges,89% of total Billed charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,29.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,222,
THERAPEUTIC EXERCISE,T990700020,CDM,420,RC,97110,HCPCS,Outpatient,,,100.5,50.25,,77.39,77,,,Percent of Total Billed Charges,77% of total billed charges,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,82.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.45,89,,,Percent of total Billed Charges,89% of total Billed charges,89.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.39,77,,,Percent of total Billed charges,77% of total billed charges,85.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,25.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.13,222,
NEUROMUSCULAR RE-EDUCATION,T990700021,CDM,420,RC,97112,HCPCS,Outpatient,,,110.5,55.25,,85.09,77,,,Percent of Total Billed Charges,77% of total billed charges,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,90.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.35,89,,,Percent of total Billed Charges,89% of total Billed charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.09,77,,,Percent of total Billed charges,77% of total billed charges,93.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,45.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,27.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.63,222,
AQUATIC THERAPY 15 MIN,T990700022,CDM,420,RC,97113,HCPCS,Outpatient,,,157.5,78.75,,121.28,77,,,Percent of Total Billed Charges,77% of total billed charges,40.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,39.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,129.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.18,89,,,Percent of total Billed Charges,89% of total Billed charges,140.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.28,77,,,Percent of total Billed charges,77% of total billed charges,133.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,64.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,39.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.38,222,
GAIT TRAINING,T990700023,CDM,420,RC,97116,HCPCS,Outpatient,,,119,59.5,,91.63,77,,,Percent of Total Billed Charges,77% of total billed charges,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,97.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.91,89,,,Percent of total Billed Charges,89% of total Billed charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.63,77,,,Percent of total Billed charges,77% of total billed charges,101.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,48.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,222,
COGNITIVE TRAINING,T990700024,CDM,420,RC,97129,HCPCS,Outpatient,,,127,63.5,,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,104.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.03,89,,,Percent of total Billed Charges,89% of total Billed charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,51.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,222,
MANUAL THERAPY - 15 MINUTES,T990700025,CDM,420,RC,97140,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,100.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.47,89,,,Percent of total Billed Charges,89% of total Billed charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,50.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.75,222,
GROUP THERAPEUTIC PROCEDURES,T990700026,CDM,420,RC,97150,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.77,89,,,Percent of total Billed Charges,89% of total Billed charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,36.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,222,
"PT EVAL, Low Complexity 20 min",T990700028,CDM,424,RC,97161,HCPCS,Outpatient,,,116.5,58.25,,89.71,77,,,Percent of Total Billed Charges,77% of total billed charges,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,95.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,103.69,89,,,Percent of total Billed Charges,89% of total Billed charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.71,77,,,Percent of total Billed charges,77% of total billed charges,99.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,47.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,29.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.13,222,
"PT EVAL, Moderate Comp 30 min",T990700029,CDM,424,RC,97162,HCPCS,Outpatient,,,174,87,,133.98,77,,,Percent of Total Billed Charges,77% of total billed charges,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,142.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.86,89,,,Percent of total Billed Charges,89% of total Billed charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.98,77,,,Percent of total Billed charges,77% of total billed charges,147.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,70.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,43.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.5,222,
"PT EVAL, High Complex 45 min",T990700030,CDM,424,RC,97163,HCPCS,Outpatient,,,261,130.5,,200.97,77,,,Percent of Total Billed Charges,77% of total billed charges,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,214.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,232.29,89,,,Percent of total Billed Charges,89% of total Billed charges,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.97,77,,,Percent of total Billed charges,77% of total billed charges,221.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,106.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,65.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,232.29,
RE-EVALUATION EST PATIENT,T990700031,CDM,424,RC,97164,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,222,
THERAPEUTIC ACTIVITIES,T990700033,CDM,420,RC,97530,HCPCS,Outpatient,,,119,59.5,,91.63,77,,,Percent of Total Billed Charges,77% of total billed charges,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,97.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.91,89,,,Percent of total Billed Charges,89% of total Billed charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.63,77,,,Percent of total Billed charges,77% of total billed charges,101.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,48.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,222,
ACTIVITIES of DAILY LIVING,T990700034,CDM,420,RC,97535,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,222,
COMMUNITY REINTERGRATION,T990700035,CDM,420,RC,97537,HCPCS,Outpatient,,,98.5,49.25,,75.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,80.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.67,89,,,Percent of total Billed Charges,89% of total Billed charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,77,,,Percent of total Billed charges,77% of total billed charges,83.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,40.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,24.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.63,222,
WORK HARD/COND INITIAL 2 HRS,T990700036,CDM,420,RC,97545,HCPCS,Outpatient,,,255,127.5,,196.35,77,,,Percent of Total Billed Charges,77% of total billed charges,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,209.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.95,89,,,Percent of total Billed Charges,89% of total Billed charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.35,77,,,Percent of total Billed charges,77% of total billed charges,216.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,104.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,63.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.75,226.95,
WORK HARD/COND EA ADD'L HR,T990700037,CDM,420,RC,97546,HCPCS,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.88,89,,,Percent of total Billed Charges,89% of total Billed charges,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,35.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.88,222,
DEBRIDEMENT SELECTIVE,T990700038,CDM,420,RC,97597,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,222,
SELECT DEBRID > THAN 20 CM,T990700039,CDM,420,RC,97597,HCPCS,Outpatient,,,188,94,,144.76,77,,,Percent of Total Billed Charges,77% of total billed charges,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,154.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.32,89,,,Percent of total Billed Charges,89% of total Billed charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.76,77,,,Percent of total Billed charges,77% of total billed charges,159.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,76.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47,222,
DEBRIDEMENT GENERAL,T990700040,CDM,420,RC,97602,HCPCS,Outpatient,,,105.5,52.75,,81.24,77,,,Percent of Total Billed Charges,77% of total billed charges,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,86.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.9,89,,,Percent of total Billed Charges,89% of total Billed charges,93.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.24,77,,,Percent of total Billed charges,77% of total billed charges,89.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,43.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,26.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.38,222,
PHYSICAL PREFORMANCE TEST,T990700041,CDM,420,RC,97750,HCPCS,Outpatient,,,135,67.5,,103.95,77,,,Percent of Total Billed Charges,77% of total billed charges,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,110.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.15,89,,,Percent of total Billed Charges,89% of total Billed charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.95,77,,,Percent of total Billed charges,77% of total billed charges,114.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,55.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,33.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.75,222,
ORTHOOTIC FIT,T990700042,CDM,420,RC,97760,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,222,
SPLINT FABRICATION,T990700043,CDM,420,RC,97760,HCPCS,Outpatient,,,131.5,65.75,GP,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,222,
SPLINT FABRICATION,T990700043,CDM,420,RC,97760,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,222,
SUPPORT/POSTURAL TAPING,T990700044,CDM,420,RC,97760,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,222,
PROSTHETIC TRAINING,T990700045,CDM,420,RC,97761,HCPCS,Outpatient,,,119,59.5,,91.63,77,,,Percent of Total Billed Charges,77% of total billed charges,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,97.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.91,89,,,Percent of total Billed Charges,89% of total Billed charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.63,77,,,Percent of total Billed charges,77% of total billed charges,101.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,48.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,222,
ORTHOTIC/PROSTHETIC CHECK,T990700046,CDM,420,RC,97763,HCPCS,Outpatient,,,72.5,36.25,,55.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,59.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.53,89,,,Percent of total Billed Charges,89% of total Billed charges,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.83,77,,,Percent of total Billed charges,77% of total billed charges,61.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,18.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.13,222,
PT FUNCTIONALITY CHG/CODE,T990700047,CDM,420,RC,,,Outpatient,,,2.5,1.25,,1.93,77,,,Percent of Total Billed Charges,77% of total billed charges,0.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,0.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,2.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,77,,,Percent of total Billed charges,77% of total billed charges,2.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,1.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,0.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.63,222,
SELF-PAY PT SG,T990700048,CDM,420,RC,,,Outpatient,,,60,30,,46.2,77,,,Percent of Total Billed Charges,77% of total billed charges,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,49.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.4,89,,,Percent of total Billed Charges,89% of total Billed charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.2,77,,,Percent of total Billed charges,77% of total billed charges,51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,24.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15,222,
CPM TREATMENT,T990700049,CDM,420,RC,,,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,222,
Biofeedback Add'L 30 min,T990700050,CDM,420,RC,90913,HCPCS,Outpatient,,,226,113,,174.02,77,,,Percent of Total Billed Charges,77% of total billed charges,57.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,185.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.14,89,,,Percent of total Billed Charges,89% of total Billed charges,201.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.02,77,,,Percent of total Billed charges,77% of total billed charges,192.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,92.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,56.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.5,222,
Biofeedback Add'L 45 min,T990700051,CDM,420,RC,90913,HCPCS,Outpatient,,,339,169.5,,261.03,77,,,Percent of Total Billed Charges,77% of total billed charges,86.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,277.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,301.71,89,,,Percent of total Billed Charges,89% of total Billed charges,301.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,138.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.03,77,,,Percent of total Billed charges,77% of total billed charges,288.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,97.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,138.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,84.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.75,301.71,
Biofeedback Add'L hour,T990700052,CDM,420,RC,90913,HCPCS,Outpatient,,,452,226,,348.04,77,,,Percent of Total Billed Charges,77% of total billed charges,115.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,370.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,402.28,89,,,Percent of total Billed Charges,89% of total Billed charges,402.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,402.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,184.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.04,77,,,Percent of total Billed charges,77% of total billed charges,384.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,184.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,113,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113,402.28,
Manual Stim - 30 Minutes,T990700053,CDM,420,RC,97032,HCPCS,Outpatient,,,152,76,,117.04,77,,,Percent of Total Billed Charges,77% of total billed charges,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,124.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.28,89,,,Percent of total Billed Charges,89% of total Billed charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.04,77,,,Percent of total Billed charges,77% of total billed charges,129.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,62.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38,222,
Manual Stim - 45 Minutes,T990700054,CDM,420,RC,97032,HCPCS,Outpatient,,,228,114,,175.56,77,,,Percent of Total Billed Charges,77% of total billed charges,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,186.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.92,89,,,Percent of total Billed Charges,89% of total Billed charges,202.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.56,77,,,Percent of total Billed charges,77% of total billed charges,193.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,93.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57,222,
Manual Stim - 60 Minutes,T990700055,CDM,420,RC,97032,HCPCS,Outpatient,,,304,152,,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,249.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,124.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76,270.56,
Iontophoresis 30 Min,T990700056,CDM,420,RC,97033,HCPCS,Outpatient,,,304,152,,234.08,77,,,Percent of Total Billed Charges,77% of total billed charges,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,249.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.56,89,,,Percent of total Billed Charges,89% of total Billed charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.08,77,,,Percent of total Billed charges,77% of total billed charges,258.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,124.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76,270.56,
Iontophoresis 45 Min,T990700057,CDM,420,RC,97033,HCPCS,Outpatient,,,456,228,,351.12,77,,,Percent of Total Billed Charges,77% of total billed charges,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,116.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,373.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,405.84,89,,,Percent of total Billed Charges,89% of total Billed charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,351.12,77,,,Percent of total Billed charges,77% of total billed charges,387.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,131.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,186.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,114,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114,405.84,
Iontophoresis 60 Min,T990700058,CDM,420,RC,97033,HCPCS,Outpatient,,,608,304,,468.16,77,,,Percent of Total Billed Charges,77% of total billed charges,155.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,152,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,498.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,541.12,89,,,Percent of total Billed Charges,89% of total Billed charges,541.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.16,77,,,Percent of total Billed charges,77% of total billed charges,516.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,174.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,248.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,152,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,152,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,541.12,
Iontophoresis (2 Areas) 30 Min,T990700059,CDM,420,RC,97033,HCPCS,Outpatient,,,419,209.5,,322.63,77,,,Percent of Total Billed Charges,77% of total billed charges,106.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,343.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,372.91,89,,,Percent of total Billed Charges,89% of total Billed charges,372.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,170.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,170.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.63,77,,,Percent of total Billed charges,77% of total billed charges,356.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,170.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,104.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.75,372.91,
Iontophoresis (2 Areas) 45 Min,T990700060,CDM,420,RC,97033,HCPCS,Outpatient,,,628,314,,483.56,77,,,Percent of Total Billed Charges,77% of total billed charges,160.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,514.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,558.92,89,,,Percent of total Billed Charges,89% of total Billed charges,558.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,483.56,77,,,Percent of total Billed charges,77% of total billed charges,533.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,256.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,157,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,558.92,
Iontophoresis (2 Areas) 60 Min,T990700061,CDM,420,RC,97033,HCPCS,Outpatient,,,837,418.5,,644.49,77,,,Percent of Total Billed Charges,77% of total billed charges,213.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,686.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,744.93,89,,,Percent of total Billed Charges,89% of total Billed charges,744.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,744.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.49,77,,,Percent of total Billed charges,77% of total billed charges,711.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,341.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,209.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,744.93,
Ultrasound 30 min,T990700062,CDM,420,RC,97035,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.72,89,,,Percent of total Billed Charges,89% of total Billed charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,60.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37,222,
Ultrasound 45 min,T990700063,CDM,420,RC,97035,HCPCS,Outpatient,,,222,111,,170.94,77,,,Percent of Total Billed Charges,77% of total billed charges,56.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,182.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,197.58,89,,,Percent of total Billed Charges,89% of total Billed charges,197.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,197.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.94,77,,,Percent of total Billed charges,77% of total billed charges,188.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,90.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.5,222,
Ultrasound 60 min,T990700064,CDM,420,RC,97035,HCPCS,Outpatient,,,296,148,,227.92,77,,,Percent of Total Billed Charges,77% of total billed charges,75.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,242.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,263.44,89,,,Percent of total Billed Charges,89% of total Billed charges,263.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.92,77,,,Percent of total Billed charges,77% of total billed charges,251.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,120.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74,263.44,
Fluidotherapy 30 min,T990700065,CDM,420,RC,97036,HCPCS,Outpatient,,,144,72,,110.88,77,,,Percent of Total Billed Charges,77% of total billed charges,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,118.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.16,89,,,Percent of total Billed Charges,89% of total Billed charges,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.88,77,,,Percent of total Billed charges,77% of total billed charges,122.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,58.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36,222,
Fluidotherapy 45 min,T990700066,CDM,420,RC,97036,HCPCS,Outpatient,,,216,108,,166.32,77,,,Percent of Total Billed Charges,77% of total billed charges,55.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,177.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,192.24,89,,,Percent of total Billed Charges,89% of total Billed charges,192.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.32,77,,,Percent of total Billed charges,77% of total billed charges,183.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,88.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,222,
Fluidotherapy 60 min,T990700067,CDM,420,RC,97036,HCPCS,Outpatient,,,288,144,,221.76,77,,,Percent of Total Billed Charges,77% of total billed charges,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,236.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.32,89,,,Percent of total Billed Charges,89% of total Billed charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.76,77,,,Percent of total Billed charges,77% of total billed charges,244.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,117.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72,256.32,
Therapeutic Exercise 30 min,T990700068,CDM,420,RC,97110,HCPCS,Outpatient,,,201,100.5,,154.77,77,,,Percent of Total Billed Charges,77% of total billed charges,51.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,164.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.89,89,,,Percent of total Billed Charges,89% of total Billed charges,178.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.77,77,,,Percent of total Billed charges,77% of total billed charges,170.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,82.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,50.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.25,222,
Therapeutic Exercise 45 min,T990700069,CDM,420,RC,97110,HCPCS,Outpatient,,,302,151,,232.54,77,,,Percent of Total Billed Charges,77% of total billed charges,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,247.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.78,89,,,Percent of total Billed Charges,89% of total Billed charges,268.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.54,77,,,Percent of total Billed charges,77% of total billed charges,256.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,123.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,75.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.5,268.78,
Therapeutic Exercise 60 min,T990700070,CDM,420,RC,97110,HCPCS,Outpatient,,,402,201,,309.54,77,,,Percent of Total Billed Charges,77% of total billed charges,102.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,329.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,357.78,89,,,Percent of total Billed Charges,89% of total Billed charges,357.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,357.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,164.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.54,77,,,Percent of total Billed charges,77% of total billed charges,341.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,164.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,100.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.5,357.78,
Neuromuscular Re-Edu 30 min,T990700071,CDM,420,RC,97112,HCPCS,Outpatient,,,221,110.5,,170.17,77,,,Percent of Total Billed Charges,77% of total billed charges,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,181.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.69,89,,,Percent of total Billed Charges,89% of total Billed charges,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.17,77,,,Percent of total Billed charges,77% of total billed charges,187.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,90.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,55.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,222,
Neuromuscular Re-Edu 45 min,T990700072,CDM,420,RC,97112,HCPCS,Outpatient,,,331,165.5,,254.87,77,,,Percent of Total Billed Charges,77% of total billed charges,84.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,271.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,294.59,89,,,Percent of total Billed Charges,89% of total Billed charges,294.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,294.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.87,77,,,Percent of total Billed charges,77% of total billed charges,281.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,135.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,82.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.75,294.59,
Neuromuscular Re-Edu 60 min,T990700073,CDM,420,RC,97112,HCPCS,Outpatient,,,441,220.5,,339.57,77,,,Percent of Total Billed Charges,77% of total billed charges,112.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,110.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,361.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,392.49,89,,,Percent of total Billed Charges,89% of total Billed charges,392.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,339.57,77,,,Percent of total Billed charges,77% of total billed charges,374.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,179.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,110.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.25,392.49,
Aquatic Therapy 2 units,T990700074,CDM,420,RC,97113,HCPCS,Outpatient,,,315,157.5,,242.55,77,,,Percent of Total Billed Charges,77% of total billed charges,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,258.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.35,89,,,Percent of total Billed Charges,89% of total Billed charges,280.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.55,77,,,Percent of total Billed charges,77% of total billed charges,267.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,128.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,78.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.75,280.35,
Aquatic Therapy 3 units,T990700075,CDM,420,RC,97113,HCPCS,Outpatient,,,472,236,,363.44,77,,,Percent of Total Billed Charges,77% of total billed charges,120.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,387.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.08,89,,,Percent of total Billed Charges,89% of total Billed charges,420.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,363.44,77,,,Percent of total Billed charges,77% of total billed charges,401.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,192.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,118,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118,420.08,
Aquatic Therapy 4 units,T990700076,CDM,420,RC,97113,HCPCS,Outpatient,,,629,314.5,,484.33,77,,,Percent of Total Billed Charges,77% of total billed charges,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,160.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,515.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,559.81,89,,,Percent of total Billed Charges,89% of total Billed charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,559.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,256.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,484.33,77,,,Percent of total Billed charges,77% of total billed charges,534.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,180.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,256.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,157.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,559.81,
Gait Training 30 Min,T990700077,CDM,420,RC,97116,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,222,
Gait Training 45 Min,T990700078,CDM,420,RC,97116,HCPCS,Outpatient,,,356,178,,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,316.84,89,,,Percent of total Billed Charges,89% of total Billed charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,145.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,316.84,
Gait Training 60 Min,T990700079,CDM,420,RC,97116,HCPCS,Outpatient,,,475,237.5,,365.75,77,,,Percent of Total Billed Charges,77% of total billed charges,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,389.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,422.75,89,,,Percent of total Billed Charges,89% of total Billed charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.75,77,,,Percent of total Billed charges,77% of total billed charges,403.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,193.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,422.75,
Cognitive Training add'tl 30,T990700080,CDM,420,RC,97130,HCPCS,Outpatient,,,254,127,,195.58,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,208.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.06,89,,,Percent of total Billed Charges,89% of total Billed charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.58,77,,,Percent of total Billed charges,77% of total billed charges,215.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.06,
Cognitive Training add'tl 45,T990700081,CDM,420,RC,97130,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,312.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
Cognitive Training add'tl hour,T990700082,CDM,420,RC,97130,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127,452.12,
Manual Therapy - 30 Minutes,T990700083,CDM,420,RC,97140,HCPCS,Outpatient,,,246,123,,189.42,77,,,Percent of Total Billed Charges,77% of total billed charges,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,201.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.94,89,,,Percent of total Billed Charges,89% of total Billed charges,218.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.42,77,,,Percent of total Billed charges,77% of total billed charges,209.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,100.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,61.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.5,222,
Manual Therapy - 45 Minutes,T990700084,CDM,420,RC,97140,HCPCS,Outpatient,,,369,184.5,,284.13,77,,,Percent of Total Billed Charges,77% of total billed charges,94.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,302.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.41,89,,,Percent of total Billed Charges,89% of total Billed charges,328.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.13,77,,,Percent of total Billed charges,77% of total billed charges,313.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,150.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,92.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.25,328.41,
Manual Therapy - 60 Minutes,T990700085,CDM,420,RC,97140,HCPCS,Outpatient,,,491,245.5,,378.07,77,,,Percent of Total Billed Charges,77% of total billed charges,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,402.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.99,89,,,Percent of total Billed Charges,89% of total Billed charges,436.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.07,77,,,Percent of total Billed charges,77% of total billed charges,417.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,200.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,122.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.75,436.99,
Therapeutic Activities 30 min,T990700086,CDM,420,RC,97530,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,222,
Therapeutic Activities 45 min,T990700087,CDM,420,RC,97530,HCPCS,Outpatient,,,356,178,,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,316.84,89,,,Percent of total Billed Charges,89% of total Billed charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,145.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,316.84,
Therapeutic Activities 60 min,T990700088,CDM,420,RC,97530,HCPCS,Outpatient,,,475,237.5,,365.75,77,,,Percent of Total Billed Charges,77% of total billed charges,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,389.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,422.75,89,,,Percent of total Billed Charges,89% of total Billed charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.75,77,,,Percent of total Billed charges,77% of total billed charges,403.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,193.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,422.75,
Activity Of Daily Living x2,T990700089,CDM,420,RC,97535,HCPCS,Outpatient,,,252,126,,194.04,77,,,Percent of Total Billed Charges,77% of total billed charges,64.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,206.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.28,89,,,Percent of total Billed Charges,89% of total Billed charges,224.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.04,77,,,Percent of total Billed charges,77% of total billed charges,214.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,102.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63,224.28,
Activity Of Daily Living x3,T990700090,CDM,420,RC,97535,HCPCS,Outpatient,,,378,189,,291.06,77,,,Percent of Total Billed Charges,77% of total billed charges,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,309.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,336.42,89,,,Percent of total Billed Charges,89% of total Billed charges,336.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.06,77,,,Percent of total Billed charges,77% of total billed charges,321.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,154.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,94.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.5,336.42,
Activity Of Daily Living x4,T990700091,CDM,420,RC,97535,HCPCS,Outpatient,,,504,252,,388.08,77,,,Percent of Total Billed Charges,77% of total billed charges,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,413.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,448.56,89,,,Percent of total Billed Charges,89% of total Billed charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,448.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,205.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.08,77,,,Percent of total Billed charges,77% of total billed charges,428.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,205.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,126,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126,448.56,
Community Reintergration 30min,T990700092,CDM,420,RC,97537,HCPCS,Outpatient,,,197,98.5,,151.69,77,,,Percent of Total Billed Charges,77% of total billed charges,50.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,161.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.33,89,,,Percent of total Billed Charges,89% of total Billed charges,175.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.69,77,,,Percent of total Billed charges,77% of total billed charges,167.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,80.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,49.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.25,222,
Community Reintergration 45min,T990700093,CDM,420,RC,97537,HCPCS,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,241.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,120.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.75,262.55,
Community Reintergration 60min,T990700094,CDM,420,RC,97537,HCPCS,Outpatient,,,394,197,,303.38,77,,,Percent of Total Billed Charges,77% of total billed charges,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,323.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,350.66,89,,,Percent of total Billed Charges,89% of total Billed charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.38,77,,,Percent of total Billed charges,77% of total billed charges,334.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,160.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.5,350.66,
Physical Preform Test 30 min,T990700095,CDM,420,RC,97750,HCPCS,Outpatient,,,270,135,,207.9,77,,,Percent of Total Billed Charges,77% of total billed charges,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,221.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.3,89,,,Percent of total Billed Charges,89% of total Billed charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.9,77,,,Percent of total Billed charges,77% of total billed charges,229.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,110.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,67.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.5,240.3,
Physical Preform Test 45 min,T990700096,CDM,420,RC,97750,HCPCS,Outpatient,,,405,202.5,,311.85,77,,,Percent of Total Billed Charges,77% of total billed charges,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,332.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,360.45,89,,,Percent of total Billed Charges,89% of total Billed charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.85,77,,,Percent of total Billed charges,77% of total billed charges,344.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,165.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.25,360.45,
Physical Preform Test 60 min,T990700097,CDM,420,RC,97750,HCPCS,Outpatient,,,539,269.5,,415.03,77,,,Percent of Total Billed Charges,77% of total billed charges,137.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,168.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,441.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,479.71,89,,,Percent of total Billed Charges,89% of total Billed charges,479.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,479.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.03,77,,,Percent of total Billed charges,77% of total billed charges,458.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,154.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,134.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,479.71,
Orthootic Fit 30 Min,T990700098,CDM,420,RC,97760,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,107.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.75,234.07,
Orthootic Fit 45 Min,T990700099,CDM,420,RC,97760,HCPCS,Outpatient,,,394,197,,303.38,77,,,Percent of Total Billed Charges,77% of total billed charges,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,323.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,350.66,89,,,Percent of total Billed Charges,89% of total Billed charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.38,77,,,Percent of total Billed charges,77% of total billed charges,334.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,160.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.5,350.66,
Orthootic Fit 60 Min,T990700100,CDM,420,RC,97760,HCPCS,Outpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,430.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,467.25,89,,,Percent of total Billed Charges,89% of total Billed charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,214.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.25,467.25,
Splint Fabrication 30 min,T990700101,CDM,420,RC,97760,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,107.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.75,234.07,
Splint Fabrication 45 min,T990700102,CDM,420,RC,97760,HCPCS,Outpatient,,,394,197,,303.38,77,,,Percent of Total Billed Charges,77% of total billed charges,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,323.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,350.66,89,,,Percent of total Billed Charges,89% of total Billed charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.38,77,,,Percent of total Billed charges,77% of total billed charges,334.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,160.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.5,350.66,
Splint Fabrication 60 min,T990700103,CDM,420,RC,97760,HCPCS,Outpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,430.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,467.25,89,,,Percent of total Billed Charges,89% of total Billed charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,214.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.25,467.25,
Support/Postural Taping 30 min,T990700104,CDM,420,RC,97760,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,107.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.75,234.07,
Support/Postural Taping 45 min,T990700105,CDM,420,RC,97760,HCPCS,Outpatient,,,394,197,,303.38,77,,,Percent of Total Billed Charges,77% of total billed charges,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,323.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,350.66,89,,,Percent of total Billed Charges,89% of total Billed charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.38,77,,,Percent of total Billed charges,77% of total billed charges,334.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,160.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.5,350.66,
Support/Postural Taping 60 min,T990700106,CDM,420,RC,97760,HCPCS,Outpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,430.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,467.25,89,,,Percent of total Billed Charges,89% of total Billed charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,214.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.25,467.25,
Prosthetic Training 30 Min,T990700107,CDM,420,RC,97761,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,222,
Prosthetic Training 45 Min,T990700108,CDM,420,RC,97761,HCPCS,Outpatient,,,356,178,,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,316.84,89,,,Percent of total Billed Charges,89% of total Billed charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,145.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,316.84,
Prosthetic Training 15 Min,T990700109,CDM,420,RC,97761,HCPCS,Outpatient,,,475,237.5,,365.75,77,,,Percent of Total Billed Charges,77% of total billed charges,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,389.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,422.75,89,,,Percent of total Billed Charges,89% of total Billed charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.75,77,,,Percent of total Billed charges,77% of total billed charges,403.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,193.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,422.75,
Orthotic/Prosthetic Ck 30 min,T990700110,CDM,420,RC,97763,HCPCS,Outpatient,,,145,72.5,,111.65,77,,,Percent of Total Billed Charges,77% of total billed charges,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,118.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.05,89,,,Percent of total Billed Charges,89% of total Billed charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.65,77,,,Percent of total Billed charges,77% of total billed charges,123.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,59.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,36.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.25,222,
Orthotic/Prosthetic Ck 45 min,T990700111,CDM,420,RC,97763,HCPCS,Outpatient,,,217,108.5,,167.09,77,,,Percent of Total Billed Charges,77% of total billed charges,55.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,54.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,177.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.13,89,,,Percent of total Billed Charges,89% of total Billed charges,193.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.09,77,,,Percent of total Billed charges,77% of total billed charges,184.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,88.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,54.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.25,222,
Orthotic/Prosthetic Ck 60 min,T990700112,CDM,420,RC,97763,HCPCS,Outpatient,,,290,145,,223.3,77,,,Percent of Total Billed Charges,77% of total billed charges,73.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155,100,,,Case rate,pays based on per visit rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per visit,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146,100,,,case rate,pays based on per visit,146,100,,,case rate,pays based on per day rate,160,100,,,case rate,pays based on per day rate,237.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.1,89,,,Percent of total Billed Charges,89% of total Billed charges,258.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.3,77,,,Percent of total Billed charges,77% of total billed charges,246.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,118.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,72.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.5,258.1,
DRESSING CHANGE,T990710001,CDM,510,RC,16030,HCPCS,Outpatient,,,122,61,,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.5,108.58,
BIOFEEDBACK TRAINING,T990710002,CDM,430,RC,90901,HCPCS,Outpatient,,,130,65,,100.1,77,,,Percent of Total Billed Charges,77% of total billed charges,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,106.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.7,89,,,Percent of total Billed Charges,89% of total Billed charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.1,77,,,Percent of total Billed charges,77% of total billed charges,110.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,32.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.5,222,
MECHANICAL TRACTION,T990710004,CDM,430,RC,97012,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.55,89,,,Percent of total Billed Charges,89% of total Billed charges,84.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,38.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.75,222,
ELECTRICAL STIMULATION,T990710005,CDM,430,RC,97014,HCPCS,Outpatient,,,69,34.5,,53.13,77,,,Percent of Total Billed Charges,77% of total billed charges,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,56.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.41,89,,,Percent of total Billed Charges,89% of total Billed charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.13,77,,,Percent of total Billed charges,77% of total billed charges,58.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,28.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,17.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,222,
VASOPNEUMATIC PUMP,T990710006,CDM,430,RC,97016,HCPCS,Outpatient,,,72,36,,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,59.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.08,89,,,Percent of total Billed Charges,89% of total Billed charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,29.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,222,
PARRAFIN BATH,T990710007,CDM,430,RC,97018,HCPCS,Outpatient,,,63,31.5,,48.51,77,,,Percent of Total Billed Charges,77% of total billed charges,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,51.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.07,89,,,Percent of total Billed Charges,89% of total Billed charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.51,77,,,Percent of total Billed charges,77% of total billed charges,53.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,25.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,15.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,222,
WHIRLPOOL,T990710008,CDM,430,RC,97022,HCPCS,Outpatient,,,94.5,47.25,,72.77,77,,,Percent of Total Billed Charges,77% of total billed charges,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,77.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.11,89,,,Percent of total Billed Charges,89% of total Billed charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.77,77,,,Percent of total Billed charges,77% of total billed charges,80.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,38.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,23.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.63,222,
MANUAL STIM - 15 MINUTES,T990710009,CDM,430,RC,97032,HCPCS,Outpatient,,,74,37,,56.98,77,,,Percent of Total Billed Charges,77% of total billed charges,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,60.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.86,89,,,Percent of total Billed Charges,89% of total Billed charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,77,,,Percent of total Billed charges,77% of total billed charges,62.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,30.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,18.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.5,222,
IONTOPHORESIS,T990710010,CDM,430,RC,97033,HCPCS,Outpatient,,,147.5,73.75,,113.58,77,,,Percent of Total Billed Charges,77% of total billed charges,37.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,120.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.28,89,,,Percent of total Billed Charges,89% of total Billed charges,131.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.58,77,,,Percent of total Billed charges,77% of total billed charges,125.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,60.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,36.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.88,222,
ULTRASOUND,T990710012,CDM,430,RC,97035,HCPCS,Outpatient,,,72,36,,55.44,77,,,Percent of Total Billed Charges,77% of total billed charges,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,59.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.08,89,,,Percent of total Billed Charges,89% of total Billed charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.44,77,,,Percent of total Billed charges,77% of total billed charges,61.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,29.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18,222,
FLUIDOTHERAPY,T990710013,CDM,430,RC,97036,HCPCS,Outpatient,,,69.5,34.75,,53.52,77,,,Percent of Total Billed Charges,77% of total billed charges,17.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,17.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,56.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.86,89,,,Percent of total Billed Charges,89% of total Billed charges,61.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.52,77,,,Percent of total Billed charges,77% of total billed charges,59.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,28.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,17.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.38,222,
THERAPEUTIC EXERCISE,T990710014,CDM,430,RC,97110,HCPCS,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,222,
NEURO-MUSCULAR RE-EDUCATION,T990710015,CDM,430,RC,97112,HCPCS,Outpatient,,,107,53.5,,82.39,77,,,Percent of Total Billed Charges,77% of total billed charges,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,87.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.23,89,,,Percent of total Billed Charges,89% of total Billed charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.39,77,,,Percent of total Billed charges,77% of total billed charges,90.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,43.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,26.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,222,
GAIT TRAINING,T990710016,CDM,430,RC,97116,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,94.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.35,89,,,Percent of total Billed Charges,89% of total Billed charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,46.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.75,222,
MASSAGE,T990710017,CDM,430,RC,97124,HCPCS,Outpatient,,,87.5,43.75,,67.38,77,,,Percent of Total Billed Charges,77% of total billed charges,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,71.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.88,89,,,Percent of total Billed Charges,89% of total Billed charges,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.38,77,,,Percent of total Billed charges,77% of total billed charges,74.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,35.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,21.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.88,222,
COGNITIVE TRAINING,T990710018,CDM,430,RC,97129,HCPCS,Outpatient,,,123.5,61.75,,95.1,77,,,Percent of Total Billed Charges,77% of total billed charges,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,101.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.92,89,,,Percent of total Billed Charges,89% of total Billed charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.1,77,,,Percent of total Billed charges,77% of total billed charges,104.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,50.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,30.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,222,
CPM TREATMENT,T990710019,CDM,430,RC,97139,HCPCS,Outpatient,,,124,62,,95.48,77,,,Percent of Total Billed Charges,77% of total billed charges,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,101.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.36,89,,,Percent of total Billed Charges,89% of total Billed charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.48,77,,,Percent of total Billed charges,77% of total billed charges,105.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,50.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31,222,
MANUAL THERAPY,T990710020,CDM,430,RC,97140,HCPCS,Outpatient,,,123,61.5,,94.71,77,,,Percent of Total Billed Charges,77% of total billed charges,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,100.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,109.47,89,,,Percent of total Billed Charges,89% of total Billed charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.71,77,,,Percent of total Billed charges,77% of total billed charges,104.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,50.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,30.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.75,222,
GROUP THERAPEUTIC PROCEDURES,T990710021,CDM,430,RC,97150,HCPCS,Outpatient,,,88.5,44.25,,68.15,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,72.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.77,89,,,Percent of total Billed Charges,89% of total Billed charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.15,77,,,Percent of total Billed charges,77% of total billed charges,75.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,36.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,222,
"OT EVAL, Low Complex 30 min",T990710022,CDM,434,RC,97166,HCPCS,Outpatient,,,168.5,84.25,,129.75,77,,,Percent of Total Billed Charges,77% of total billed charges,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,138.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.97,89,,,Percent of total Billed Charges,89% of total Billed charges,149.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.75,77,,,Percent of total Billed charges,77% of total billed charges,143.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,68.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.13,222,
"OT EVAL, Moderate Comp 45 min",T990710023,CDM,430,RC,97166,HCPCS,Outpatient,,,252.5,126.25,,194.43,77,,,Percent of Total Billed Charges,77% of total billed charges,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,207.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.73,89,,,Percent of total Billed Charges,89% of total Billed charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.43,77,,,Percent of total Billed charges,77% of total billed charges,214.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,103.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.13,224.73,
"OT EVAL, High Compl 60 min",T990710024,CDM,434,RC,97167,HCPCS,Outpatient,,,335.5,167.75,,258.34,77,,,Percent of Total Billed Charges,77% of total billed charges,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,275.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,298.6,89,,,Percent of total Billed Charges,89% of total Billed charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.34,77,,,Percent of total Billed charges,77% of total billed charges,285.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,136.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.88,298.6,
"OT EVAL, High Compl 60 min",T990710024,CDM,434,RC,97167,HCPCS,Outpatient,,,335.5,167.75,GO,258.34,77,,,Percent of Total Billed Charges,77% of total billed charges,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,275.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,298.6,89,,,Percent of total Billed Charges,89% of total Billed charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.34,77,,,Percent of total Billed charges,77% of total billed charges,285.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,136.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,83.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.88,298.6,
"RE EVAL, EST PATIENT",T990710025,CDM,434,RC,97168,HCPCS,Outpatient,,,168.5,84.25,,129.75,77,,,Percent of Total Billed Charges,77% of total billed charges,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,138.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.97,89,,,Percent of total Billed Charges,89% of total Billed charges,149.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.75,77,,,Percent of total Billed charges,77% of total billed charges,143.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,68.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.13,222,
THERAPEUTIC ACTIVITIES,T990710027,CDM,430,RC,97530,HCPCS,Outpatient,,,119,59.5,,91.63,77,,,Percent of Total Billed Charges,77% of total billed charges,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,97.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,105.91,89,,,Percent of total Billed Charges,89% of total Billed charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.63,77,,,Percent of total Billed charges,77% of total billed charges,101.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,48.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,29.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,222,
ACTIVITIES DAILY LIVING,T990710028,CDM,430,RC,97535,HCPCS,Outpatient,,,122,61,,93.94,77,,,Percent of Total Billed Charges,77% of total billed charges,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,100.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.58,89,,,Percent of total Billed Charges,89% of total Billed charges,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.94,77,,,Percent of total Billed charges,77% of total billed charges,103.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,49.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,30.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.5,222,
COMM/WORK REINTEGRATION,T990710029,CDM,430,RC,97537,HCPCS,Outpatient,,,95,47.5,,73.15,77,,,Percent of Total Billed Charges,77% of total billed charges,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,77.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,84.55,89,,,Percent of total Billed Charges,89% of total Billed charges,84.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.15,77,,,Percent of total Billed charges,77% of total billed charges,80.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,38.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,23.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.75,222,
DEBRIDEMENT SELECTIVE,T990710030,CDM,430,RC,97597,HCPCS,Outpatient,,,126,63,,97.02,77,,,Percent of Total Billed Charges,77% of total billed charges,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,103.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,112.14,89,,,Percent of total Billed Charges,89% of total Billed charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.02,77,,,Percent of total Billed charges,77% of total billed charges,107.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,51.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,31.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.5,222,
DEBRIDEMENT NON-SELECTIVE,T990710031,CDM,430,RC,97602,HCPCS,Outpatient,,,102,51,,78.54,77,,,Percent of Total Billed Charges,77% of total billed charges,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,83.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.78,89,,,Percent of total Billed Charges,89% of total Billed charges,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.54,77,,,Percent of total Billed charges,77% of total billed charges,86.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,41.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,25.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.5,222,
PHYSICAL PERFORMANCE TEST,T990710032,CDM,430,RC,97750,HCPCS,Outpatient,,,131.5,65.75,,101.26,77,,,Percent of Total Billed Charges,77% of total billed charges,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,107.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.04,89,,,Percent of total Billed Charges,89% of total Billed charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.26,77,,,Percent of total Billed charges,77% of total billed charges,111.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,53.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,32.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.88,222,
ORTHOTICS FIT/TRAINING,T990710033,CDM,430,RC,97760,HCPCS,Outpatient,,,127,63.5,,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,104.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.03,89,,,Percent of total Billed Charges,89% of total Billed charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,51.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,222,
SPLINT FABRICATION,T990710034,CDM,430,RC,97760,HCPCS,Outpatient,,,127,63.5,,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,104.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.03,89,,,Percent of total Billed Charges,89% of total Billed charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,51.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,222,
SUPPORT/POSTURAL TAPING,T990710035,CDM,430,RC,97760,HCPCS,Outpatient,,,127,63.5,,97.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,104.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.03,89,,,Percent of total Billed Charges,89% of total Billed charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.79,77,,,Percent of total Billed charges,77% of total billed charges,107.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,51.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,31.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.75,222,
PROSTHETIC TRAINING,T990710036,CDM,430,RC,97761,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,94.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.35,89,,,Percent of total Billed Charges,89% of total Billed charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,46.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.75,222,
ORTHOTICS/PROSTETHIC CHECK,T990710037,CDM,430,RC,97763,HCPCS,Outpatient,,,70,35,,53.9,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,57.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.3,89,,,Percent of total Billed Charges,89% of total Billed charges,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,77,,,Percent of total Billed charges,77% of total billed charges,59.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,222,
OT FUNCTIONALITY CHG/CODE,T990710038,CDM,430,RC,,,Outpatient,,,4,2,,3.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,3.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3.56,89,,,Percent of total Billed Charges,89% of total Billed charges,3.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,77,,,Percent of total Billed charges,77% of total billed charges,3.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,1.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1,222,
SELF-PAY OT SG,T990710039,CDM,430,RC,,,Outpatient,,,62.5,31.25,,48.13,77,,,Percent of Total Billed Charges,77% of total billed charges,15.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,51.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.63,89,,,Percent of total Billed Charges,89% of total Billed charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.13,77,,,Percent of total Billed charges,77% of total billed charges,53.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,25.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,15.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.63,222,
Activities Daily Living 30 min,T990710040,CDM,430,RC,97535,HCPCS,Outpatient,,,244,122,,187.88,77,,,Percent of Total Billed Charges,77% of total billed charges,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,200.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.16,89,,,Percent of total Billed Charges,89% of total Billed charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.88,77,,,Percent of total Billed charges,77% of total billed charges,207.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,99.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,222,
Activities Daily Living 45 min,T990710041,CDM,430,RC,97535,HCPCS,Outpatient,,,366,183,,281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,93.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,91.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,300.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,325.74,89,,,Percent of total Billed Charges,89% of total Billed charges,325.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,149.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.82,77,,,Percent of total Billed charges,77% of total billed charges,311.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,105.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,149.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,91.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.5,325.74,
Activities Daily Living 60 min,T990710042,CDM,430,RC,97535,HCPCS,Outpatient,,,487,243.5,,374.99,77,,,Percent of Total Billed Charges,77% of total billed charges,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,399.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,433.43,89,,,Percent of total Billed Charges,89% of total Billed charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.99,77,,,Percent of total Billed charges,77% of total billed charges,413.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,198.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,433.43,
Cognitive Training add'tl 30,T990710043,CDM,430,RC,97130,HCPCS,Outpatient,,,254,127,,195.58,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,208.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.06,89,,,Percent of total Billed Charges,89% of total Billed charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.58,77,,,Percent of total Billed charges,77% of total billed charges,215.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.06,
Cognitive Training add'tl  45,T990710044,CDM,430,RC,97130,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,312.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
Cognitive Training add'tl  60,T990710045,CDM,430,RC,97130,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,452.12,
Comm/Work Reintegration 30 min,T990710046,CDM,430,RC,97537,HCPCS,Outpatient,,,190,95,,146.3,77,,,Percent of Total Billed Charges,77% of total billed charges,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,155.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.1,89,,,Percent of total Billed Charges,89% of total Billed charges,169.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.3,77,,,Percent of total Billed charges,77% of total billed charges,161.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,77.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,47.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.5,222,
Comm/Work Reintegration 45 min,T990710047,CDM,430,RC,97537,HCPCS,Outpatient,,,284,142,,218.68,77,,,Percent of Total Billed Charges,77% of total billed charges,72.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,232.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,252.76,89,,,Percent of total Billed Charges,89% of total Billed charges,252.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,252.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.68,77,,,Percent of total Billed charges,77% of total billed charges,241.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,115.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71,252.76,
Comm/Work Reintegration 60 min,T990710048,CDM,430,RC,97537,HCPCS,Outpatient,,,379,189.5,,291.83,77,,,Percent of Total Billed Charges,77% of total billed charges,96.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,94.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,310.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.31,89,,,Percent of total Billed Charges,89% of total Billed charges,337.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.83,77,,,Percent of total Billed charges,77% of total billed charges,322.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,154.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,94.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.75,337.31,
Fluidotherapy 30 min,T990710049,CDM,430,RC,97036,HCPCS,Outpatient,,,139,69.5,,107.03,77,,,Percent of Total Billed Charges,77% of total billed charges,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,113.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.71,89,,,Percent of total Billed Charges,89% of total Billed charges,123.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.03,77,,,Percent of total Billed charges,77% of total billed charges,118.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,56.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,34.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.75,222,
Fluidotherapy 45 min,T990710050,CDM,430,RC,97036,HCPCS,Outpatient,,,208,104,,160.16,77,,,Percent of Total Billed Charges,77% of total billed charges,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,170.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,185.12,89,,,Percent of total Billed Charges,89% of total Billed charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.16,77,,,Percent of total Billed charges,77% of total billed charges,176.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,84.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52,222,
Fluidotherapy 60 min,T990710051,CDM,430,RC,97036,HCPCS,Outpatient,,,277,138.5,,213.29,77,,,Percent of Total Billed Charges,77% of total billed charges,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,227.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,246.53,89,,,Percent of total Billed Charges,89% of total Billed charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.29,77,,,Percent of total Billed charges,77% of total billed charges,235.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,113.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,69.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.25,246.53,
Gait Training 30 Min,T990710052,CDM,430,RC,97116,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,188.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,204.7,89,,,Percent of total Billed Charges,89% of total Billed charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,93.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,222,
Gait Training 45 Min,T990710053,CDM,430,RC,97116,HCPCS,Outpatient,,,345,172.5,,265.65,77,,,Percent of Total Billed Charges,77% of total billed charges,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,282.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,307.05,89,,,Percent of total Billed Charges,89% of total Billed charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,77,,,Percent of total Billed charges,77% of total billed charges,293.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,140.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,307.05,
Gait Training 60 Min,T990710054,CDM,430,RC,97116,HCPCS,Outpatient,,,460,230,,354.2,77,,,Percent of Total Billed Charges,77% of total billed charges,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,377.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,409.4,89,,,Percent of total Billed Charges,89% of total Billed charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.2,77,,,Percent of total Billed charges,77% of total billed charges,391,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,187.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,409.4,
Iontophoresis 30 Min,T990710055,CDM,430,RC,97033,HCPCS,Outpatient,,,295,147.5,,227.15,77,,,Percent of Total Billed Charges,77% of total billed charges,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,241.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,262.55,89,,,Percent of total Billed Charges,89% of total Billed charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.15,77,,,Percent of total Billed charges,77% of total billed charges,250.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,120.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,73.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.75,262.55,
Iontophoresis 45 Min,T990710056,CDM,430,RC,97033,HCPCS,Outpatient,,,442,221,,340.34,77,,,Percent of Total Billed Charges,77% of total billed charges,112.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,362.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.38,89,,,Percent of total Billed Charges,89% of total Billed charges,393.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.34,77,,,Percent of total Billed charges,77% of total billed charges,375.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,180.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,110.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,393.38,
Iontophoresis 60 Min,T990710057,CDM,430,RC,97033,HCPCS,Outpatient,,,589,294.5,,453.53,77,,,Percent of Total Billed Charges,77% of total billed charges,150.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,482.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.21,89,,,Percent of total Billed Charges,89% of total Billed charges,524.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.53,77,,,Percent of total Billed charges,77% of total billed charges,500.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,240.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,147.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,524.21,
Iontophoresis (2 Areas) 30 Min,T990710058,CDM,430,RC,97033,HCPCS,Outpatient,,,406,203,,312.62,77,,,Percent of Total Billed Charges,77% of total billed charges,103.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,332.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,361.34,89,,,Percent of total Billed Charges,89% of total Billed charges,361.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,312.62,77,,,Percent of total Billed charges,77% of total billed charges,345.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,165.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,101.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,361.34,
Iontophoresis (2 Areas) 45 Min,T990710059,CDM,430,RC,97033,HCPCS,Outpatient,,,609,304.5,,468.93,77,,,Percent of Total Billed Charges,77% of total billed charges,155.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,499.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,542.01,89,,,Percent of total Billed Charges,89% of total Billed charges,542.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,542.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.93,77,,,Percent of total Billed charges,77% of total billed charges,517.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,248.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,152.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,542.01,
Iontophoresis (2 Areas) 60 Min,T990710060,CDM,430,RC,97033,HCPCS,Outpatient,,,812,406,,625.24,77,,,Percent of Total Billed Charges,77% of total billed charges,207.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,203,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,665.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,722.68,89,,,Percent of total Billed Charges,89% of total Billed charges,722.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,722.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,331.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,331.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,331.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,625.24,77,,,Percent of total Billed charges,77% of total billed charges,690.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,233.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,331.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,203,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,203,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,722.68,
Manual Stim - 30 Minutes,T990710061,CDM,430,RC,97032,HCPCS,Outpatient,,,148,74,,113.96,77,,,Percent of Total Billed Charges,77% of total billed charges,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,121.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.72,89,,,Percent of total Billed Charges,89% of total Billed charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.96,77,,,Percent of total Billed charges,77% of total billed charges,125.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,60.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37,222,
Manual Stim - 45 Minutes,T990710062,CDM,430,RC,97032,HCPCS,Outpatient,,,222,111,,170.94,77,,,Percent of Total Billed Charges,77% of total billed charges,56.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,182.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,197.58,89,,,Percent of total Billed Charges,89% of total Billed charges,197.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,197.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,170.94,77,,,Percent of total Billed charges,77% of total billed charges,188.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,90.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,55.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.5,222,
Manual Stim - 60 Minutes,T990710063,CDM,430,RC,97032,HCPCS,Outpatient,,,296,148,,227.92,77,,,Percent of Total Billed Charges,77% of total billed charges,75.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,242.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,263.44,89,,,Percent of total Billed Charges,89% of total Billed charges,263.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,120.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.92,77,,,Percent of total Billed charges,77% of total billed charges,251.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,120.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74,263.44,
Manual Therapy - 30 Minutes,T990710064,CDM,430,RC,97140,HCPCS,Outpatient,,,238,119,,183.26,77,,,Percent of Total Billed Charges,77% of total billed charges,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,195.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.82,89,,,Percent of total Billed Charges,89% of total Billed charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.26,77,,,Percent of total Billed charges,77% of total billed charges,202.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,97.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,59.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.5,222,
Manual Therapy - 45 Minutes,T990710065,CDM,430,RC,97140,HCPCS,Outpatient,,,356,178,,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,316.84,89,,,Percent of total Billed Charges,89% of total Billed charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,145.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,316.84,
Manual Therapy - 60 Minutes,T990710066,CDM,430,RC,97140,HCPCS,Outpatient,,,475,237.5,,365.75,77,,,Percent of Total Billed Charges,77% of total billed charges,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,389.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,422.75,89,,,Percent of total Billed Charges,89% of total Billed charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,193.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,365.75,77,,,Percent of total Billed charges,77% of total billed charges,403.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,193.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,118.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,422.75,
Massage 30 min,T990710067,CDM,430,RC,97124,HCPCS,Outpatient,,,175,87.5,,134.75,77,,,Percent of Total Billed Charges,77% of total billed charges,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,143.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.75,89,,,Percent of total Billed Charges,89% of total Billed charges,155.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.75,77,,,Percent of total Billed charges,77% of total billed charges,148.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,71.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,43.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.75,222,
Massage 45 min,T990710068,CDM,430,RC,97124,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,107.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.75,234.07,
Massage 60 min,T990710069,CDM,430,RC,97124,HCPCS,Outpatient,,,350,175,,269.5,77,,,Percent of Total Billed Charges,77% of total billed charges,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,287,82,,,Percent of Total Billed Charges,82% of total billed charges ,311.5,89,,,Percent of total Billed Charges,89% of total Billed charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.5,77,,,Percent of total Billed charges,77% of total billed charges,297.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,142.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,87.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.5,311.5,
Neuro-Muscular Re-Ed 30 min,T990710070,CDM,430,RC,97112,HCPCS,Outpatient,,,214,107,,164.78,77,,,Percent of Total Billed Charges,77% of total billed charges,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,175.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.46,89,,,Percent of total Billed Charges,89% of total Billed charges,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.78,77,,,Percent of total Billed charges,77% of total billed charges,181.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,87.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,53.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.5,222,
Neuro-Muscular Re-Ed 45 min,T990710071,CDM,430,RC,97112,HCPCS,Outpatient,,,320,160,,246.4,77,,,Percent of Total Billed Charges,77% of total billed charges,81.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,262.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.8,89,,,Percent of total Billed Charges,89% of total Billed charges,284.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.4,77,,,Percent of total Billed charges,77% of total billed charges,272,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,130.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,80,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,284.8,
Neuro-Muscular Re-Ed 60 min,T990710072,CDM,430,RC,97112,HCPCS,Outpatient,,,427,213.5,,328.79,77,,,Percent of Total Billed Charges,77% of total billed charges,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,350.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,380.03,89,,,Percent of total Billed Charges,89% of total Billed charges,380.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,174.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.79,77,,,Percent of total Billed charges,77% of total billed charges,362.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,174.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,106.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,380.03,
Orthotics Fit/Training 30 min,T990710073,CDM,430,RC,97760,HCPCS,Outpatient,,,254,127,,195.58,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,208.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.06,89,,,Percent of total Billed Charges,89% of total Billed charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.58,77,,,Percent of total Billed charges,77% of total billed charges,215.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.06,
Orthotics Fit/Training 45 min,T990710074,CDM,430,RC,97760,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,312.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
Orthotics Fit/Training 60 min,T990710075,CDM,430,RC,97760,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,452.12,
Orthotics/Prostethic Ck 30 min,T990710076,CDM,430,RC,97763,HCPCS,Outpatient,,,140,70,,107.8,77,,,Percent of Total Billed Charges,77% of total billed charges,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,114.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,124.6,89,,,Percent of total Billed Charges,89% of total Billed charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.8,77,,,Percent of total Billed charges,77% of total billed charges,119,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,57.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35,222,
Orthotics/Prostethic Ck 45 min,T990710077,CDM,430,RC,97763,HCPCS,Outpatient,,,210,105,,161.7,77,,,Percent of Total Billed Charges,77% of total billed charges,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,172.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.9,89,,,Percent of total Billed Charges,89% of total Billed charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.7,77,,,Percent of total Billed charges,77% of total billed charges,178.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,85.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,52.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.5,222,
Orthotics/Prostethic Ck 60 min,T990710078,CDM,430,RC,97763,HCPCS,Outpatient,,,279,139.5,,214.83,77,,,Percent of Total Billed Charges,77% of total billed charges,71.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,228.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,248.31,89,,,Percent of total Billed Charges,89% of total Billed charges,248.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.83,77,,,Percent of total Billed charges,77% of total billed charges,237.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,113.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,69.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.75,248.31,
Physical Perform Test 30 min,T990710079,CDM,430,RC,97750,HCPCS,Outpatient,,,263,131.5,,202.51,77,,,Percent of Total Billed Charges,77% of total billed charges,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,215.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.07,89,,,Percent of total Billed Charges,89% of total Billed charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.51,77,,,Percent of total Billed charges,77% of total billed charges,223.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,107.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,65.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.75,234.07,
Physical Perform Test 45 min,T990710080,CDM,430,RC,97750,HCPCS,Outpatient,,,394,197,,303.38,77,,,Percent of Total Billed Charges,77% of total billed charges,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,100.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,323.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,350.66,89,,,Percent of total Billed Charges,89% of total Billed charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.38,77,,,Percent of total Billed charges,77% of total billed charges,334.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,113.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,160.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,98.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,350.66,
Physical Perform Test 60 min,T990710081,CDM,430,RC,97750,HCPCS,Outpatient,,,525,262.5,,404.25,77,,,Percent of Total Billed Charges,77% of total billed charges,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,430.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,467.25,89,,,Percent of total Billed Charges,89% of total Billed charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,214.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.25,77,,,Percent of total Billed charges,77% of total billed charges,446.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,214.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,131.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,467.25,
Prosthetic Training 30 Min,T990710082,CDM,430,RC,97761,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,188.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,204.7,89,,,Percent of total Billed Charges,89% of total Billed charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,93.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,222,
Prosthetic Training 45 Min,T990710083,CDM,430,RC,97761,HCPCS,Outpatient,,,345,172.5,,265.65,77,,,Percent of Total Billed Charges,77% of total billed charges,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,282.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,307.05,89,,,Percent of total Billed Charges,89% of total Billed charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,77,,,Percent of total Billed charges,77% of total billed charges,293.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,140.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,307.05,
Prosthetic Training 60 Min,T990710084,CDM,430,RC,97761,HCPCS,Outpatient,,,460,230,,354.2,77,,,Percent of Total Billed Charges,77% of total billed charges,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,377.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,409.4,89,,,Percent of total Billed Charges,89% of total Billed charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.2,77,,,Percent of total Billed charges,77% of total billed charges,391,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,187.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,409.4,
Splint Fabrication 30 min,T990710085,CDM,430,RC,97760,HCPCS,Outpatient,,,254,127,,195.58,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,208.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.06,89,,,Percent of total Billed Charges,89% of total Billed charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.58,77,,,Percent of total Billed charges,77% of total billed charges,215.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.06,
Splint Fabrication 45 min,T990710086,CDM,430,RC,97760,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,312.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
Splint Fabrication 60 min,T990710087,CDM,430,RC,97760,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,452.12,
Support/Postural Taping 30 min,T990710088,CDM,430,RC,97760,HCPCS,Outpatient,,,254,127,,195.58,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,208.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.06,89,,,Percent of total Billed Charges,89% of total Billed charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.58,77,,,Percent of total Billed charges,77% of total billed charges,215.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.06,
Support/Postural Taping 45 min,T990710089,CDM,430,RC,97760,HCPCS,Outpatient,,,381,190.5,,293.37,77,,,Percent of Total Billed Charges,77% of total billed charges,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,312.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,339.09,89,,,Percent of total Billed Charges,89% of total Billed charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,339.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,155.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.37,77,,,Percent of total Billed charges,77% of total billed charges,323.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,109.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,155.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,95.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.25,339.09,
Support/Postural Taping 60 min,T990710090,CDM,430,RC,97760,HCPCS,Outpatient,,,508,254,,391.16,77,,,Percent of Total Billed Charges,77% of total billed charges,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,416.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.12,89,,,Percent of total Billed Charges,89% of total Billed charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.16,77,,,Percent of total Billed charges,77% of total billed charges,431.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,207.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,127,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,452.12,
Therapeutic Activities 30 min,T990710091,CDM,430,RC,97530,HCPCS,Outpatient,,,230,115,,177.1,77,,,Percent of Total Billed Charges,77% of total billed charges,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,188.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,204.7,89,,,Percent of total Billed Charges,89% of total Billed charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.1,77,,,Percent of total Billed charges,77% of total billed charges,195.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,93.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,57.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,222,
Therapeutic Activities 45 min,T990710092,CDM,430,RC,97530,HCPCS,Outpatient,,,345,172.5,,265.65,77,,,Percent of Total Billed Charges,77% of total billed charges,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,282.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,307.05,89,,,Percent of total Billed Charges,89% of total Billed charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.65,77,,,Percent of total Billed charges,77% of total billed charges,293.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,140.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,86.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.25,307.05,
Therapeutic Activities 60 min,T990710093,CDM,430,RC,97530,HCPCS,Outpatient,,,460,230,,354.2,77,,,Percent of Total Billed Charges,77% of total billed charges,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,143.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,377.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,409.4,89,,,Percent of total Billed Charges,89% of total Billed charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,409.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,187.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.2,77,,,Percent of total Billed charges,77% of total billed charges,391,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,187.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,115,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,409.4,
Therapeutic Exercise 30 min,T990710094,CDM,430,RC,97110,HCPCS,Outpatient,,,194,97,,149.38,77,,,Percent of Total Billed Charges,77% of total billed charges,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,159.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,172.66,89,,,Percent of total Billed Charges,89% of total Billed charges,172.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.38,77,,,Percent of total Billed charges,77% of total billed charges,164.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,79.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,48.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.5,222,
Therapeutic Exercise 45 min,T990710095,CDM,430,RC,97110,HCPCS,Outpatient,,,291,145.5,,224.07,77,,,Percent of Total Billed Charges,77% of total billed charges,74.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,72.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,238.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.99,89,,,Percent of total Billed Charges,89% of total Billed charges,258.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.07,77,,,Percent of total Billed charges,77% of total billed charges,247.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,118.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,72.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.75,258.99,
Therapeutic Exercise 60 min,T990710096,CDM,430,RC,97110,HCPCS,Outpatient,,,387,193.5,,297.99,77,,,Percent of Total Billed Charges,77% of total billed charges,98.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,96.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,317.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,344.43,89,,,Percent of total Billed Charges,89% of total Billed charges,344.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.99,77,,,Percent of total Billed charges,77% of total billed charges,328.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,157.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,96.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,344.43,
Ultrasound 30 min,T990710097,CDM,430,RC,97035,HCPCS,Outpatient,,,144,72,,110.88,77,,,Percent of Total Billed Charges,77% of total billed charges,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,118.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.16,89,,,Percent of total Billed Charges,89% of total Billed charges,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.88,77,,,Percent of total Billed charges,77% of total billed charges,122.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,58.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36,222,
Ultrasound 45 min,T990710098,CDM,430,RC,97035,HCPCS,Outpatient,,,216,108,,166.32,77,,,Percent of Total Billed Charges,77% of total billed charges,55.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,177.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,192.24,89,,,Percent of total Billed Charges,89% of total Billed charges,192.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.32,77,,,Percent of total Billed charges,77% of total billed charges,183.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,88.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,222,
Ultrasound 60 min,T990710099,CDM,430,RC,97035,HCPCS,Outpatient,,,288,144,,221.76,77,,,Percent of Total Billed Charges,77% of total billed charges,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,236.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,256.32,89,,,Percent of total Billed Charges,89% of total Billed charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,256.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.76,77,,,Percent of total Billed charges,77% of total billed charges,244.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,117.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200,100,,,Case Rate,Pays based on per visit rate,72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72,256.32,
SPEECH/HEAR THPY,T990720001,CDM,440,RC,92507,HCPCS,Outpatient,,,490,245,,377.3,77,,,Percent of Total Billed Charges,77% of total billed charges,124.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,401.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.1,89,,,Percent of total Billed Charges,89% of total Billed charges,436.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.3,77,,,Percent of total Billed charges,77% of total billed charges,416.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,199.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,436.1,
SPEECH/HEAR THPY,T990720001,CDM,440,RC,92507,HCPCS,Outpatient,,,490,245,GN,377.3,77,,,Percent of Total Billed Charges,77% of total billed charges,124.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,401.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.1,89,,,Percent of total Billed Charges,89% of total Billed charges,436.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.3,77,,,Percent of total Billed charges,77% of total billed charges,416.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,199.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,122.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,436.1,
SPEECH/HEAR THPY GRP,T990720002,CDM,440,RC,92508,HCPCS,Outpatient,,,242,121,,186.34,77,,,Percent of Total Billed Charges,77% of total billed charges,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,198.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,215.38,89,,,Percent of total Billed Charges,89% of total Billed charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.34,77,,,Percent of total Billed charges,77% of total billed charges,205.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,98.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,222,
SPEECH/HEAR THPY GRP,T990720002,CDM,440,RC,92508,HCPCS,Outpatient,,,242,121,GN,186.34,77,,,Percent of Total Billed Charges,77% of total billed charges,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,198.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,215.38,89,,,Percent of total Billed Charges,89% of total Billed charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.34,77,,,Percent of total Billed charges,77% of total billed charges,205.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,98.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,60.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,222,
"SPEECH,LANG,AURAL REHAB EVAL",T990720003,CDM,444,RC,92523,HCPCS,Outpatient,,,261.5,130.75,GN,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,232.74,89,,,Percent of total Billed Charges,89% of total Billed charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,106.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.38,232.74,
"SPEECH,LANG,AURAL REHAB EVAL",T990720003,CDM,444,RC,92523,HCPCS,Outpatient,,,261.5,130.75,,201.36,77,,,Percent of Total Billed Charges,77% of total billed charges,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,214.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,232.74,89,,,Percent of total Billed Charges,89% of total Billed charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.36,77,,,Percent of total Billed charges,77% of total billed charges,222.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,106.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,65.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.38,232.74,
SWALLOWING TX,T990720004,CDM,440,RC,92526,HCPCS,Outpatient,,,207.5,103.75,,159.78,77,,,Percent of Total Billed Charges,77% of total billed charges,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,170.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.68,89,,,Percent of total Billed Charges,89% of total Billed charges,184.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.78,77,,,Percent of total Billed charges,77% of total billed charges,176.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,84.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.88,222,
SWALLOWING TX,T990720004,CDM,440,RC,92526,HCPCS,Outpatient,,,207.5,103.75,GN,159.78,77,,,Percent of Total Billed Charges,77% of total billed charges,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,170.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.68,89,,,Percent of total Billed Charges,89% of total Billed charges,184.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.78,77,,,Percent of total Billed charges,77% of total billed charges,176.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,84.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,51.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.88,222,
CLINICAL DYSPHASIA EVAL,T990720005,CDM,444,RC,92610,HCPCS,Outpatient,,,326,163,,251.02,77,,,Percent of Total Billed Charges,77% of total billed charges,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,267.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,290.14,89,,,Percent of total Billed Charges,89% of total Billed charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.02,77,,,Percent of total Billed charges,77% of total billed charges,277.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,133.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.5,290.14,
CLINICAL DYSPHASIA EVAL,T990720005,CDM,444,RC,92610,HCPCS,Outpatient,,,326,163,GN,251.02,77,,,Percent of Total Billed Charges,77% of total billed charges,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,267.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,290.14,89,,,Percent of total Billed Charges,89% of total Billed charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.02,77,,,Percent of total Billed charges,77% of total billed charges,277.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,133.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,81.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.5,290.14,
MODIFIED BARIUM SWALLOW,T990720006,CDM,444,RC,92611,HCPCS,Outpatient,,,204,102,,157.08,77,,,Percent of Total Billed Charges,77% of total billed charges,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,167.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.56,89,,,Percent of total Billed Charges,89% of total Billed charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.08,77,,,Percent of total Billed charges,77% of total billed charges,173.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,83.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51,222,
MODIFIED BARIUM SWALLOW,T990720006,CDM,444,RC,92611,HCPCS,Outpatient,,,204,102,GN,157.08,77,,,Percent of Total Billed Charges,77% of total billed charges,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,167.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.56,89,,,Percent of total Billed Charges,89% of total Billed charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.08,77,,,Percent of total Billed charges,77% of total billed charges,173.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,83.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51,222,
ASESS OF APHASIA 1 HR,T990720008,CDM,444,RC,96105,HCPCS,Outpatient,,,183,91.5,,140.91,77,,,Percent of Total Billed Charges,77% of total billed charges,46.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,150.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,162.87,89,,,Percent of total Billed Charges,89% of total Billed charges,162.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.91,77,,,Percent of total Billed charges,77% of total billed charges,155.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,74.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.75,222,
ASESS OF APHASIA 1 HR,T990720008,CDM,444,RC,96105,HCPCS,Outpatient,,,183,91.5,GN,140.91,77,,,Percent of Total Billed Charges,77% of total billed charges,46.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,150.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,162.87,89,,,Percent of total Billed Charges,89% of total Billed charges,162.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.91,77,,,Percent of total Billed charges,77% of total billed charges,155.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,74.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,45.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.75,222,
ST FUNCTIONALITY CHG/CODE,T990720009,CDM,440,RC,,,Outpatient,,,4.5,2.25,,3.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,1.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,3.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.47,77,,,Percent of total Billed charges,77% of total billed charges,3.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,1.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,1.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.13,222,
Evaluation Of Speech Fluency,T990720010,CDM,440,RC,92521,HCPCS,Outpatient,,,337,168.5,,259.49,77,,,Percent of Total Billed Charges,77% of total billed charges,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,276.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.93,89,,,Percent of total Billed Charges,89% of total Billed charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.49,77,,,Percent of total Billed charges,77% of total billed charges,286.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,137.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,84.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.25,299.93,
Eval Of Speech Sound Produc,T990720011,CDM,440,RC,92522,HCPCS,Outpatient,,,567,283.5,,436.59,77,,,Percent of Total Billed Charges,77% of total billed charges,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,464.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,504.63,89,,,Percent of total Billed Charges,89% of total Billed charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.59,77,,,Percent of total Billed charges,77% of total billed charges,481.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,231.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,504.63,
BH/Qual Analysis Of Voice Res,T990720012,CDM,440,RC,92524,HCPCS,Outpatient,,,585,292.5,,450.45,77,,,Percent of Total Billed Charges,77% of total billed charges,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,182.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,479.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,520.65,89,,,Percent of total Billed Charges,89% of total Billed charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,238.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.45,77,,,Percent of total Billed charges,77% of total billed charges,497.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,168.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,238.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,146.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,520.65,
"Cognitive testing, 1 hour",T990720013,CDM,440,RC,96125,HCPCS,Outpatient,,,385,192.5,,296.45,77,,,Percent of Total Billed Charges,77% of total billed charges,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,315.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,342.65,89,,,Percent of total Billed Charges,89% of total Billed charges,342.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.45,77,,,Percent of total Billed charges,77% of total billed charges,327.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,110.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,157.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,96.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,342.65,
"Cognitive therapy, initial 15",T990720014,CDM,440,RC,97129,HCPCS,Outpatient,,,93,46.5,,71.61,77,,,Percent of Total Billed Charges,77% of total billed charges,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,76.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.77,89,,,Percent of total Billed Charges,89% of total Billed charges,82.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.61,77,,,Percent of total Billed charges,77% of total billed charges,79.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,37.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,23.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.25,222,
Cognitive therapy addt'l 15,T990720015,CDM,440,RC,97130,HCPCS,Outpatient,,,89,44.5,,68.53,77,,,Percent of Total Billed Charges,77% of total billed charges,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,72.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.21,89,,,Percent of total Billed Charges,89% of total Billed charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.53,77,,,Percent of total Billed charges,77% of total billed charges,75.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,36.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,22.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,222,
Cognitive therapy addt'l 30,T990720016,CDM,440,RC,97130,HCPCS,Outpatient,,,178,89,,137.06,77,,,Percent of Total Billed Charges,77% of total billed charges,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,145.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.42,89,,,Percent of total Billed Charges,89% of total Billed charges,158.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.06,77,,,Percent of total Billed charges,77% of total billed charges,151.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,72.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,44.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.5,222,
Cognitive therapy addt'l 45,T990720017,CDM,440,RC,97130,HCPCS,Outpatient,,,267,133.5,,205.59,77,,,Percent of Total Billed Charges,77% of total billed charges,68.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,218.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.63,89,,,Percent of total Billed Charges,89% of total Billed charges,237.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.59,77,,,Percent of total Billed charges,77% of total billed charges,226.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,108.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,66.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.75,237.63,
Cognitive therapy addt'l hour,T990720018,CDM,440,RC,97130,HCPCS,Outpatient,,,356,178,,274.12,77,,,Percent of Total Billed Charges,77% of total billed charges,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102,100,,,Case rate,pays based on per visit rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per visit,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96,100,,,case rate,pays based on per visit,96,100,,,case rate,pays based on per day rate,114,100,,,case rate,pays based on per day rate,291.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,316.84,89,,,Percent of total Billed Charges,89% of total Billed charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,316.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,145.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,274.12,77,,,Percent of total Billed charges,77% of total billed charges,302.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,102.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222,100,,,Case Rate,Pays based on per visit rate,145.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192,100,,,Case Rate,Pays based on per visit rate,89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89,316.84,
BLOOD TRANS ADM 1ST HOUR,T990750002,CDM,391,RC,36430,HCPCS,Outpatient,,,520,260,,400.4,77,,,Percent of Total Billed Charges,77% of total billed charges,132.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,162.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,384.8,74,,,Percent of Total Billed Charges,74% of total billed charges,358.8,69,,,Percent of Total Billed Charges,69% of total billed charges,358.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.8,69,,,Percent of Total Billed Charges,69% of total billed charges,358.8,69,,,Percent of Total Billed Charges,69% of total billed charges,436.8,84,,,Percent of Total Billed Charges,84% of total billed charges,426.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,462.8,89,,,Percent of total Billed Charges,89% of total Billed charges,462.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,462.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.4,77,,,Percent of total Billed charges,77% of total billed charges,442,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,212.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,130,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130,462.8,
BLOOD TRANS ADM EA ADDL HOUR,T990750003,CDM,391,RC,36430,HCPCS,Outpatient,,,260,130,,200.2,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.4,74,,,Percent of Total Billed Charges,74% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,179.4,69,,,Percent of Total Billed Charges,69% of total billed charges,218.4,84,,,Percent of Total Billed Charges,84% of total billed charges,213.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.4,89,,,Percent of total Billed Charges,89% of total Billed charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.2,77,,,Percent of total Billed charges,77% of total billed charges,221,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,260,100,,,Case Rate,Pays based on per visit rate,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,260,
PICC LINE INSERTION,T990750006,CDM,761,RC,36569,HCPCS,Outpatient,,,1907.5,953.75,,1468.78,77,,,Percent of Total Billed Charges,77% of total billed charges,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,596.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1411.55,74,,,Percent of Total Billed Charges,74% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1316.18,69,,,Percent of Total Billed Charges,69% of total billed charges,1602.3,84,,,Percent of Total Billed Charges,84% of total billed charges,1564.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,1697.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.78,77,,,Percent of total Billed charges,77% of total billed charges,1621.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,548.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,953.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,778.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1697.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.88,1697.68,
BLOOD DRAW-IMPLANTED ACC DEVIC,T990750007,CDM,300,RC,36591,HCPCS,Outpatient,,,64.5,32.25,,49.67,77,,,Percent of Total Billed Charges,77% of total billed charges,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.73,74,,,Percent of Total Billed Charges,74% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,69,,,Percent of Total Billed Charges,69% of total billed charges,54.18,84,,,Percent of Total Billed Charges,84% of total billed charges,52.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.41,89,,,Percent of total Billed Charges,89% of total Billed charges,57.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.67,77,,,Percent of total Billed charges,77% of total billed charges,54.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,26.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.13,64,
BLD COLL EST CENT/PERI CATH,T990750008,CDM,300,RC,36592,HCPCS,Outpatient,,,56,28,,43.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.44,74,,,Percent of Total Billed Charges,74% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,38.64,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,84,,,Percent of Total Billed Charges,84% of total billed charges,45.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.84,89,,,Percent of total Billed Charges,89% of total Billed charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.12,77,,,Percent of total Billed charges,77% of total billed charges,47.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,22.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14,64,
DECLOT IMPLNT VAS ACCESS DEVIC,T990750009,CDM,761,RC,36593,HCPCS,Outpatient,,,796.5,398.25,,613.31,77,,,Percent of Total Billed Charges,77% of total billed charges,203.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,248.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.41,74,,,Percent of Total Billed Charges,74% of total billed charges,549.59,69,,,Percent of Total Billed Charges,69% of total billed charges,549.59,69,,,Percent of Total Billed Charges,69% of total billed charges,199.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.59,69,,,Percent of Total Billed Charges,69% of total billed charges,549.59,69,,,Percent of Total Billed Charges,69% of total billed charges,669.06,84,,,Percent of Total Billed Charges,84% of total billed charges,653.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,708.89,89,,,Percent of total Billed Charges,89% of total Billed charges,708.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,708.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,324.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.31,77,,,Percent of total Billed charges,77% of total billed charges,677.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,228.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,324.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,708.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.13,708.89,
SUBSQ DECLOT IMPLNT VAS DEVICE,T990750010,CDM,761,RC,36593,HCPCS,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296,74,,,Percent of Total Billed Charges,74% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,336,84,,,Percent of Total Billed Charges,84% of total billed charges,328,82,,,Percent of Total Billed Charges,82% of total billed charges ,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
"BLADDER IRRIG,SIMPLE,LAVAGE",T990750011,CDM,761,RC,51700,HCPCS,Outpatient,,,487,243.5,,374.99,77,,,Percent of Total Billed Charges,77% of total billed charges,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,360.38,74,,,Percent of Total Billed Charges,74% of total billed charges,336.03,69,,,Percent of Total Billed Charges,69% of total billed charges,336.03,69,,,Percent of Total Billed Charges,69% of total billed charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.03,69,,,Percent of Total Billed Charges,69% of total billed charges,336.03,69,,,Percent of Total Billed Charges,69% of total billed charges,409.08,84,,,Percent of Total Billed Charges,84% of total billed charges,399.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,433.43,89,,,Percent of total Billed Charges,89% of total Billed charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.99,77,,,Percent of total Billed charges,77% of total billed charges,413.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,243.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,198.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,433.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.75,433.43,
BLADDER INSTALLATION (BCG),T990750013,CDM,361,RC,51720,HCPCS,Outpatient,,,840.5,420.25,,647.19,77,,,Percent of Total Billed Charges,77% of total billed charges,214.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,214.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,262.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,495.9,59,,,Percent of Total Billed Charges,59% of total billed charges,495.9,100,,,case rate,pays based on per visit,495.9,59,,,case rate,pays based on per visit,210.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.9,59,,,Percent of Total Billed Charges,59% of total billed charges,495.9,59,,,Percent of Total Billed Charges,59% of total billed charges,706.02,84,,,Percent of Total Billed Charges,84% of total billed charges,689.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,748.05,89,,,Percent of total Billed Charges,89% of total Billed charges,748.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,748.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,210.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.19,77,,,Percent of total Billed charges,77% of total billed charges,714.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,241.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,342.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,210.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,210.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.13,748.05,
STOOL/EMESIS GUIAC PROCEDURE,T990750014,CDM,300,RC,82270,HCPCS,Outpatient,,,67,33.5,,51.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.58,74,,,Percent of Total Billed Charges,74% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,46.23,69,,,Percent of Total Billed Charges,69% of total billed charges,56.28,84,,,Percent of Total Billed Charges,84% of total billed charges,54.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.75,500,,,fee schedule,500% of healthlink,23.75,500,,,Fee Schedule,500% of Healthlink HMO Fee Schedule,23.75,500,,,Fee Schedule,500% of Healthlink PPO Fee Schedule,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,4.2,120,,,Fee Schedule,120% of MO of Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.59,77,,,Percent of total Billed charges,77% of total billed charges,56.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,4.2,120,,,Fee Schedule,120% of MO Medicaid Rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.2,64,
PPD WITH ADMINISTRATION,T990750016,CDM,300,RC,86580,HCPCS,Outpatient,,,162.5,81.25,,125.13,77,,,Percent of Total Billed Charges,77% of total billed charges,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.25,74,,,Percent of Total Billed Charges,74% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,112.13,69,,,Percent of Total Billed Charges,69% of total billed charges,136.5,84,,,Percent of Total Billed Charges,84% of total billed charges,133.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.63,89,,,Percent of total Billed Charges,89% of total Billed charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.4,120,,,Fee Schedule,120% of MO Medicaid Rate,9.4,120,,,Fee Schedule,120% of MO Medicaid Rate,9.4,120,,,Fee Schedule,120% of MO of Medicaid Rate,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.13,77,,,Percent of total Billed charges,77% of total billed charges,138.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64,100,,,Case Rate,Pays based on per visit rate,9.4,120,,,Fee Schedule,120% of MO Medicaid Rate,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,100,,,Case Rate,Pays based on per visit rate,40.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.4,144.63,
ALLERGY INJECTION X1,T990750018,CDM,940,RC,95115,HCPCS,Outpatient,,,330,165,,254.1,77,,,Percent of Total Billed Charges,77% of total billed charges,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,244.2,74,,,Percent of Total Billed Charges,74% of total billed charges,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,227.7,69,,,Percent of Total Billed Charges,69% of total billed charges,277.2,84,,,Percent of Total Billed Charges,84% of total billed charges,270.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,293.7,89,,,Percent of total Billed Charges,89% of total Billed charges,293.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.1,77,,,Percent of total Billed charges,77% of total billed charges,280.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,134.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,82.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.5,293.7,
ALLERGY INJECTION X2,T990750019,CDM,940,RC,95117,HCPCS,Outpatient,,,376.5,188.25,,289.91,77,,,Percent of Total Billed Charges,77% of total billed charges,96.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,278.61,74,,,Percent of Total Billed Charges,74% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,259.79,69,,,Percent of Total Billed Charges,69% of total billed charges,316.26,84,,,Percent of Total Billed Charges,84% of total billed charges,308.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.09,89,,,Percent of total Billed Charges,89% of total Billed charges,335.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,289.91,77,,,Percent of total Billed charges,77% of total billed charges,320.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,153.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,94.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.13,335.09,
INF-TPD CONCURRENT DRUG,T990750025,CDM,450,RC,96368,HCPCS,Outpatient,,,229.5,114.75,,176.72,77,,,Percent of Total Billed Charges,77% of total billed charges,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.41,59,,,Percent of Total Billed Charges,59% of total billed charges,135.41,100,,,case rate,pays based on per visit,135.41,59,,,case rate,pays based on per visit,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.41,59,,,Percent of Total Billed Charges,59% of total billed charges,135.41,59,,,Percent of Total Billed Charges,59% of total billed charges,192.78,84,,,Percent of Total Billed Charges,84% of total billed charges,188.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,204.26,89,,,Percent of total Billed Charges,89% of total Billed charges,192.78,84,,,Percent of Total Billed Charges,84% of Total Billed charges,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.72,77,,,Percent of total Billed charges,77% of total billed charges,195.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,114.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,93.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.38,204.26,
APPL ON-BODY INJ,T990750030,CDM,940,RC,96377,HCPCS,Outpatient,,,222.5,111.25,,171.33,77,,,Percent of Total Billed Charges,77% of total billed charges,56.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,164.65,74,,,Percent of Total Billed Charges,74% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,153.53,69,,,Percent of Total Billed Charges,69% of total billed charges,186.9,84,,,Percent of Total Billed Charges,84% of total billed charges,182.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.03,89,,,Percent of total Billed Charges,89% of total Billed charges,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,90.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.33,77,,,Percent of total Billed charges,77% of total billed charges,189.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,90.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,55.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.63,198.03,
PROLONG CHEMO INFUSION,T990750031,CDM,940,RC,G0498,HCPCS,Outpatient,,,995,497.5,,766.15,77,,,Percent of Total Billed Charges,77% of total billed charges,253.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,736.3,74,,,Percent of Total Billed Charges,74% of total billed charges,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,835.8,84,,,Percent of Total Billed Charges,84% of total billed charges,815.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,885.55,89,,,Percent of total Billed Charges,89% of total Billed charges,885.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,885.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.15,77,,,Percent of total Billed charges,77% of total billed charges,845.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,405.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,885.55,
PROLONG CHEMO INFUSION,T990750031,CDM,940,RC,96379,HCPCS,Outpatient,,,995,497.5,,766.15,77,,,Percent of Total Billed Charges,77% of total billed charges,253.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,253.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,310.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,736.3,74,,,Percent of Total Billed Charges,74% of total billed charges,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,686.55,69,,,Percent of Total Billed Charges,69% of total billed charges,835.8,84,,,Percent of Total Billed Charges,84% of total billed charges,815.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,885.55,89,,,Percent of total Billed Charges,89% of total Billed charges,885.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,885.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,405.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.15,77,,,Percent of total Billed charges,77% of total billed charges,845.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,286.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,405.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,248.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,885.55,
INJ IM/SQ NON HORM,T990750032,CDM,331,RC,96401,HCPCS,Outpatient,,,475.5,237.75,,366.14,77,,,Percent of Total Billed Charges,77% of total billed charges,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.87,74,,,Percent of Total Billed Charges,74% of total billed charges,328.1,100,,,case rate,pays based on per visit,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,399.42,84,,,Percent of Total Billed Charges,84% of total billed charges,389.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,423.2,89,,,Percent of total Billed Charges,89% of total Billed charges,423.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,423.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.14,77,,,Percent of total Billed charges,77% of total billed charges,404.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,194,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.88,423.2,
INJ IM/SQ NON HORM ANTI NEO,T990750033,CDM,331,RC,96401,HCPCS,Outpatient,,,238.5,119.25,,183.65,77,,,Percent of Total Billed Charges,77% of total billed charges,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.49,74,,,Percent of Total Billed Charges,74% of total billed charges,164.57,100,,,case rate,pays based on per visit,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,200.34,84,,,Percent of Total Billed Charges,84% of total billed charges,195.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.27,89,,,Percent of total Billed Charges,89% of total Billed charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.65,77,,,Percent of total Billed charges,77% of total billed charges,202.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,97.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.63,212.27,
INJ IM/SQ HORM ANTI NEO,T990750034,CDM,331,RC,96402,HCPCS,Outpatient,,,238.5,119.25,,183.65,77,,,Percent of Total Billed Charges,77% of total billed charges,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.49,74,,,Percent of Total Billed Charges,74% of total billed charges,164.57,100,,,case rate,pays based on per visit,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,164.57,69,,,Percent of Total Billed Charges,69% of total billed charges,200.34,84,,,Percent of Total Billed Charges,84% of total billed charges,195.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.27,89,,,Percent of total Billed Charges,89% of total Billed charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.65,77,,,Percent of total Billed charges,77% of total billed charges,202.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,97.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,59.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.63,212.27,
INJ IM/SQ HORM ANTI NEO,T990750035,CDM,331,RC,96402,HCPCS,Outpatient,,,475.5,237.75,,366.14,77,,,Percent of Total Billed Charges,77% of total billed charges,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,121.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,148.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,351.87,74,,,Percent of Total Billed Charges,74% of total billed charges,328.1,100,,,case rate,pays based on per visit,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,328.1,69,,,Percent of Total Billed Charges,69% of total billed charges,399.42,84,,,Percent of Total Billed Charges,84% of total billed charges,389.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,423.2,89,,,Percent of total Billed Charges,89% of total Billed charges,423.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,423.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.14,77,,,Percent of total Billed charges,77% of total billed charges,404.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,136.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,194,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,118.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.88,423.2,
IV PUSH CHEMO INITIAL/SINGLE,T990750036,CDM,335,RC,96409,HCPCS,Outpatient,,,837.5,418.75,,644.88,77,,,Percent of Total Billed Charges,77% of total billed charges,213.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,619.75,74,,,Percent of Total Billed Charges,74% of total billed charges,577.88,100,,,case rate,pays based on per visit,577.88,69,,,Percent of Total Billed Charges,69% of total billed charges,209.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,577.88,69,,,Percent of Total Billed Charges,69% of total billed charges,577.88,69,,,Percent of Total Billed Charges,69% of total billed charges,703.5,84,,,Percent of Total Billed Charges,84% of total billed charges,686.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,745.38,89,,,Percent of total Billed Charges,89% of total Billed charges,745.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,745.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,341.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,341.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,209.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.88,77,,,Percent of total Billed charges,77% of total billed charges,711.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,341.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,209.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,209.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,745.38,
IV PUSH CHEMO EA ADD SEQ DRUG,T990750037,CDM,335,RC,96411,HCPCS,Outpatient,,,128,64,,98.56,77,,,Percent of Total Billed Charges,77% of total billed charges,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.72,74,,,Percent of Total Billed Charges,74% of total billed charges,88.32,100,,,case rate,pays based on per visit,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,88.32,69,,,Percent of Total Billed Charges,69% of total billed charges,107.52,84,,,Percent of Total Billed Charges,84% of total billed charges,104.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,113.92,89,,,Percent of total Billed Charges,89% of total Billed charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.56,77,,,Percent of total Billed charges,77% of total billed charges,108.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,52.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,210,
CHEMO IV INFUSION 1 HR,T990750038,CDM,335,RC,96413,HCPCS,Outpatient,,,1035.5,517.75,,797.34,77,,,Percent of Total Billed Charges,77% of total billed charges,264.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,264.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,323.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,766.27,74,,,Percent of Total Billed Charges,74% of total billed charges,714.5,100,,,case rate,pays based on per visit,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,714.5,69,,,Percent of Total Billed Charges,69% of total billed charges,869.82,84,,,Percent of Total Billed Charges,84% of total billed charges,849.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,921.6,89,,,Percent of total Billed Charges,89% of total Billed charges,921.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,921.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,797.34,77,,,Percent of total Billed charges,77% of total billed charges,880.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,297.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,422.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,258.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,921.6,
INF CHEMO EA ADD HR UP TO 8,T990750040,CDM,335,RC,96415,HCPCS,Outpatient,,,168.5,84.25,,129.75,77,,,Percent of Total Billed Charges,77% of total billed charges,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.69,74,,,Percent of Total Billed Charges,74% of total billed charges,116.27,100,,,case rate,pays based on per visit,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.27,69,,,Percent of Total Billed Charges,69% of total billed charges,141.54,84,,,Percent of Total Billed Charges,84% of total billed charges,138.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.97,89,,,Percent of total Billed Charges,89% of total Billed charges,149.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.75,77,,,Percent of total Billed charges,77% of total billed charges,143.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,68.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,42.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.13,210,
INF CHEMO ADD SEQUENT DRUG 1H,T990750041,CDM,335,RC,96417,HCPCS,Outpatient,,,343.5,171.75,,264.5,77,,,Percent of Total Billed Charges,77% of total billed charges,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.19,74,,,Percent of Total Billed Charges,74% of total billed charges,237.02,100,,,case rate,pays based on per visit,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,237.02,69,,,Percent of Total Billed Charges,69% of total billed charges,288.54,84,,,Percent of Total Billed Charges,84% of total billed charges,281.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,305.72,89,,,Percent of total Billed Charges,89% of total Billed charges,305.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.5,77,,,Percent of total Billed charges,77% of total billed charges,291.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210,100,,,Case Rate,Pays based on per visit rate,140.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182,100,,,Case Rate,Pays based on per visit rate,85.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.88,305.72,
REFILL & MAINT PORTABLE PUMP,T990750042,CDM,940,RC,96521,HCPCS,Outpatient,,,146,73,,112.42,77,,,Percent of Total Billed Charges,77% of total billed charges,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.04,74,,,Percent of Total Billed Charges,74% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,100.74,69,,,Percent of Total Billed Charges,69% of total billed charges,122.64,84,,,Percent of Total Billed Charges,84% of total billed charges,119.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,129.94,89,,,Percent of total Billed Charges,89% of total Billed charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.42,77,,,Percent of total Billed charges,77% of total billed charges,124.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,59.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,36.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,136,
IRRIG IMPLANT VENOUS DEVICE,T990750043,CDM,940,RC,96523,HCPCS,Outpatient,,,505,252.5,,388.85,77,,,Percent of Total Billed Charges,77% of total billed charges,128.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,373.7,74,,,Percent of Total Billed Charges,74% of total billed charges,348.45,69,,,Percent of Total Billed Charges,69% of total billed charges,348.45,69,,,Percent of Total Billed Charges,69% of total billed charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.45,69,,,Percent of Total Billed Charges,69% of total billed charges,348.45,69,,,Percent of Total Billed Charges,69% of total billed charges,424.2,84,,,Percent of Total Billed Charges,84% of total billed charges,414.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,449.45,89,,,Percent of total Billed Charges,89% of total Billed charges,449.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,449.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.85,77,,,Percent of total Billed charges,77% of total billed charges,429.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,145.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,206.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,126.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,449.45,
PHLEBOTOMY THERAPEUTIC,T990750044,CDM,940,RC,99195,HCPCS,Outpatient,,,450.5,225.25,,346.89,77,,,Percent of Total Billed Charges,77% of total billed charges,114.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.37,74,,,Percent of Total Billed Charges,74% of total billed charges,310.85,69,,,Percent of Total Billed Charges,69% of total billed charges,310.85,69,,,Percent of Total Billed Charges,69% of total billed charges,112.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.85,69,,,Percent of Total Billed Charges,69% of total billed charges,310.85,69,,,Percent of Total Billed Charges,69% of total billed charges,378.42,84,,,Percent of Total Billed Charges,84% of total billed charges,369.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.95,89,,,Percent of total Billed Charges,89% of total Billed charges,400.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.89,77,,,Percent of total Billed charges,77% of total billed charges,382.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,183.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,112.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.63,400.95,
"INJ, BEBTELOVIMAB, PRE/POST",T990750048,CDM,771,RC,M0222,HCPCS,Outpatient,,,1517,758.5,,1168.09,77,,,Percent of Total Billed Charges,77% of total billed charges,386.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,386.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,474.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1122.58,74,,,Percent of Total Billed Charges,74% of total billed charges,1046.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1046.73,69,,,Percent of Total Billed Charges,69% of total billed charges,379.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1046.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1046.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1274.28,84,,,Percent of Total Billed Charges,84% of total billed charges,1243.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1350.13,89,,,Percent of total Billed Charges,89% of total Billed charges,1350.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1350.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,618.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,618.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,618.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,379.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1168.09,77,,,Percent of total Billed charges,77% of total billed charges,1289.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,436.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,618.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,379.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,379.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,1350.13,
"INF, CASIRIVAMAB/IMDEVIMAB",T990750049,CDM,771,RC,M0243,HCPCS,Outpatient,,,2001,1000.5,,1540.77,77,,,Percent of Total Billed Charges,77% of total billed charges,510.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,510.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,625.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1480.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.84,84,,,Percent of Total Billed Charges,84% of total billed charges,1640.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1780.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1780.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1780.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1540.77,77,,,Percent of total Billed charges,77% of total billed charges,1700.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,575.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,816.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,1780.89,
"INF ADM, Bamlanivimab Pre/Post",T990750050,CDM,771,RC,M0245,HCPCS,Outpatient,,,1396,698,,1074.92,77,,,Percent of Total Billed Charges,77% of total billed charges,355.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1033.04,74,,,Percent of Total Billed Charges,74% of total billed charges,963.24,69,,,Percent of Total Billed Charges,69% of total billed charges,963.24,69,,,Percent of Total Billed Charges,69% of total billed charges,349,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.24,69,,,Percent of Total Billed Charges,69% of total billed charges,963.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.64,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.92,77,,,Percent of total Billed charges,77% of total billed charges,1186.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,569.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,349,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,1242.44,
"Infusion, BAMLANIVI/ETESEVI",T990750051,CDM,771,RC,M0245,HCPCS,Outpatient,,,2001,1000.5,,1540.77,77,,,Percent of Total Billed Charges,77% of total billed charges,510.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,510.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,625.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1480.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.84,84,,,Percent of Total Billed Charges,84% of total billed charges,1640.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1780.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1780.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1780.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1540.77,77,,,Percent of total Billed charges,77% of total billed charges,1700.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,575.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,816.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,1780.89,
"INF, SOTROVIMAB, PRE/POST",T990750052,CDM,771,RC,M0247,HCPCS,Outpatient,,,2001,1000.5,,1540.77,77,,,Percent of Total Billed Charges,77% of total billed charges,510.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,510.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,625.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1480.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1680.84,84,,,Percent of Total Billed Charges,84% of total billed charges,1640.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1780.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1780.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1780.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,816.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1540.77,77,,,Percent of total Billed charges,77% of total billed charges,1700.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,575.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69,100,,,Case Rate,Pays based on per visit rate,816.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,Other,Not Seperately Reimbusable,500.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69,1780.89,
I & D ABSCESS (SIMPLE),T990760001,CDM,361,RC,10060,HCPCS,Outpatient,,,560.5,280.25,,431.59,77,,,Percent of Total Billed Charges,77% of total billed charges,142.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,142.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,175.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.7,59,,,Percent of Total Billed Charges,59% of total billed charges,330.7,100,,,case rate,pays based on per visit,330.7,59,,,case rate,pays based on per visit,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.7,59,,,Percent of Total Billed Charges,59% of total billed charges,330.7,59,,,Percent of Total Billed Charges,59% of total billed charges,470.82,84,,,Percent of Total Billed Charges,84% of total billed charges,459.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,498.85,89,,,Percent of total Billed Charges,89% of total Billed charges,498.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,498.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.59,77,,,Percent of total Billed charges,77% of total billed charges,476.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,161.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,228.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,140.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.13,498.85,
I&D HEMATOMA SEROMA R FLD COLL,T990760002,CDM,361,RC,10140,HCPCS,Outpatient,,,1607,803.5,,1237.39,77,,,Percent of Total Billed Charges,77% of total billed charges,409.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,409.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,502.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,948.13,59,,,Percent of Total Billed Charges,59% of total billed charges,948.13,100,,,case rate,pays based on per visit,948.13,59,,,case rate,pays based on per visit,401.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,948.13,59,,,Percent of Total Billed Charges,59% of total billed charges,948.13,59,,,Percent of Total Billed Charges,59% of total billed charges,1349.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1317.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1430.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1430.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1430.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,655.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,655.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,655.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,401.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.39,77,,,Percent of total Billed charges,77% of total billed charges,1365.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,462.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2350,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,655.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,401.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2034,100,,,Fee Schedule,100% of UMR Fee Schedule,401.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,401.75,2350,
DEBRID/REMOVE ECZEMATUS TISSUE,T990760003,CDM,761,RC,11000,HCPCS,Outpatient,,,252.5,126.25,,194.43,77,,,Percent of Total Billed Charges,77% of total billed charges,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.85,74,,,Percent of Total Billed Charges,74% of total billed charges,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,174.23,69,,,Percent of Total Billed Charges,69% of total billed charges,212.1,84,,,Percent of Total Billed Charges,84% of total billed charges,207.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.73,89,,,Percent of total Billed Charges,89% of total Billed charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.43,77,,,Percent of total Billed charges,77% of total billed charges,214.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,126.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.13,224.73,
DBRD/REM ECZMATUS TIS/INF SKIN,T990760004,CDM,761,RC,11001,HCPCS,Outpatient,,,245,122.5,,188.65,77,,,Percent of Total Billed Charges,77% of total billed charges,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.3,74,,,Percent of Total Billed Charges,74% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,169.05,69,,,Percent of Total Billed Charges,69% of total billed charges,205.8,84,,,Percent of Total Billed Charges,84% of total billed charges,200.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.05,89,,,Percent of total Billed Charges,89% of total Billed charges,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.65,77,,,Percent of total Billed charges,77% of total billed charges,208.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.05,
DEBRIDE SUBQ TISSUE 1ST 20 CM,T990760005,CDM,761,RC,11042,HCPCS,Outpatient,,,1904.5,952.25,,1466.47,77,,,Percent of Total Billed Charges,77% of total billed charges,485.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1409.33,74,,,Percent of Total Billed Charges,74% of total billed charges,1314.11,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.11,69,,,Percent of Total Billed Charges,69% of total billed charges,476.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1314.11,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.11,69,,,Percent of Total Billed Charges,69% of total billed charges,1599.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1561.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1695.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1695.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1695.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1466.47,77,,,Percent of total Billed charges,77% of total billed charges,1618.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1695.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.13,1695.01,
DEBRIDE MUSCLE/FASCIA 1ST 20CM,T990760006,CDM,761,RC,11043,HCPCS,Outpatient,,,2342,1171,,1803.34,77,,,Percent of Total Billed Charges,77% of total billed charges,597.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,597.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,731.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1733.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1615.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1615.98,69,,,Percent of Total Billed Charges,69% of total billed charges,585.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1615.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1615.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1967.28,84,,,Percent of Total Billed Charges,84% of total billed charges,1920.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,2084.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2084.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2084.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,955.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,955.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,955.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1803.34,77,,,Percent of total Billed charges,77% of total billed charges,1990.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,673.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1171,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,955.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,585.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2084.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.5,2084.38,
DEBRIDE BONE FIRST 20 CM,T990760007,CDM,761,RC,11044,HCPCS,Outpatient,,,5059.5,2529.75,,3895.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1290.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1290.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1581.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3744.03,74,,,Percent of Total Billed Charges,74% of total billed charges,3491.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3491.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1264.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3491.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3491.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4249.98,84,,,Percent of Total Billed Charges,84% of total billed charges,4148.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,4502.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4502.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4502.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2064.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2064.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2064.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1264.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3895.82,77,,,Percent of total Billed charges,77% of total billed charges,4300.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1454.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2529.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2064.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1264.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4502.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1264.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1264.88,4502.96,
DEBRIDE SUBQ TIS EA ADD 20 CM,T990760008,CDM,761,RC,11045,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
DEBRD MUSCL/FASCIA EA ADD 20CM,T990760009,CDM,761,RC,11046,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
DEBRIDE BONE EA ADD 20 CM,T990760010,CDM,761,RC,11047,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
"PAIRING/CUTTING, SINGLE LESION",T990760011,CDM,761,RC,11055,HCPCS,Outpatient,,,183.5,91.75,,141.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.79,74,,,Percent of Total Billed Charges,74% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,126.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.14,84,,,Percent of Total Billed Charges,84% of total billed charges,150.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.32,89,,,Percent of total Billed Charges,89% of total Billed charges,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.3,77,,,Percent of total Billed charges,77% of total billed charges,155.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.88,163.32,
PAIRING/CUTTING 2-4 LESIONS,T990760012,CDM,761,RC,11056,HCPCS,Outpatient,,,190.5,95.25,,146.69,77,,,Percent of Total Billed Charges,77% of total billed charges,48.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.97,74,,,Percent of Total Billed Charges,74% of total billed charges,131.45,69,,,Percent of Total Billed Charges,69% of total billed charges,131.45,69,,,Percent of Total Billed Charges,69% of total billed charges,47.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.45,69,,,Percent of Total Billed Charges,69% of total billed charges,131.45,69,,,Percent of Total Billed Charges,69% of total billed charges,160.02,84,,,Percent of Total Billed Charges,84% of total billed charges,156.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.55,89,,,Percent of total Billed Charges,89% of total Billed charges,169.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.69,77,,,Percent of total Billed charges,77% of total billed charges,161.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.63,169.55,
PAIRING/CUTTING OVER 4 LESIONS,T990760013,CDM,761,RC,11057,HCPCS,Outpatient,,,218.5,109.25,,168.25,77,,,Percent of Total Billed Charges,77% of total billed charges,55.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.69,74,,,Percent of Total Billed Charges,74% of total billed charges,150.77,69,,,Percent of Total Billed Charges,69% of total billed charges,150.77,69,,,Percent of Total Billed Charges,69% of total billed charges,54.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.77,69,,,Percent of Total Billed Charges,69% of total billed charges,150.77,69,,,Percent of Total Billed Charges,69% of total billed charges,183.54,84,,,Percent of Total Billed Charges,84% of total billed charges,179.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.47,89,,,Percent of total Billed Charges,89% of total Billed charges,194.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.25,77,,,Percent of total Billed charges,77% of total billed charges,185.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,194.47,
"BIOPSY (SKIN, SUBCUTANEOUS)",T990760014,CDM,761,RC,11102,HCPCS,Outpatient,,,740,370,,569.8,77,,,Percent of Total Billed Charges,77% of total billed charges,188.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,231.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,547.6,74,,,Percent of Total Billed Charges,74% of total billed charges,510.6,69,,,Percent of Total Billed Charges,69% of total billed charges,510.6,69,,,Percent of Total Billed Charges,69% of total billed charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.6,69,,,Percent of Total Billed Charges,69% of total billed charges,510.6,69,,,Percent of Total Billed Charges,69% of total billed charges,621.6,84,,,Percent of Total Billed Charges,84% of total billed charges,606.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,658.6,89,,,Percent of total Billed Charges,89% of total Billed charges,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.8,77,,,Percent of total Billed charges,77% of total billed charges,629,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,212.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,370,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,301.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,658.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185,658.6,
"APP SKINSUB TRUNK,EXREMITY25cm",T990760015,CDM,761,RC,15271,HCPCS,Outpatient,,,3483,1741.5,,2681.91,77,,,Percent of Total Billed Charges,77% of total billed charges,888.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,888.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1088.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2577.42,74,,,Percent of Total Billed Charges,74% of total billed charges,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2403.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2925.72,84,,,Percent of Total Billed Charges,84% of total billed charges,2856.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3099.87,89,,,Percent of total Billed Charges,89% of total Billed charges,3099.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3099.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1421.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1421.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1421.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2681.91,77,,,Percent of total Billed charges,77% of total billed charges,2960.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1001.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1741.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1421.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3099.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,870.75,3099.87,
APP SKIN SUB EA ADD 25 SQ CM >,T990760016,CDM,761,RC,15272,HCPCS,Outpatient,,,860,430,,662.2,77,,,Percent of Total Billed Charges,77% of total billed charges,219.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,636.4,74,,,Percent of Total Billed Charges,74% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,722.4,84,,,Percent of Total Billed Charges,84% of total billed charges,705.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,765.4,89,,,Percent of total Billed Charges,89% of total Billed charges,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.2,77,,,Percent of total Billed charges,77% of total billed charges,731,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,430,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215,765.4,
APP SKIN SUB +/= 100 SQ CM,T990760017,CDM,761,RC,15273,HCPCS,Outpatient,,,8484.5,4242.25,,6533.07,77,,,Percent of Total Billed Charges,77% of total billed charges,2163.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2163.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2651.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6278.53,74,,,Percent of Total Billed Charges,74% of total billed charges,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,7126.98,84,,,Percent of Total Billed Charges,84% of total billed charges,6957.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,7551.21,89,,,Percent of total Billed Charges,89% of total Billed charges,7551.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7551.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6533.07,77,,,Percent of total Billed charges,77% of total billed charges,7211.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2439.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4242.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7551.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2121.13,7551.21,
APP SKIN SUB EA ADD 100 SQ CM,T990760018,CDM,761,RC,15274,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
"APP SKINSUB HEAD/HAND,FEET25cm",T990760019,CDM,761,RC,15275,HCPCS,Outpatient,,,3485,1742.5,,2683.45,77,,,Percent of Total Billed Charges,77% of total billed charges,888.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,888.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2578.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2404.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2404.65,69,,,Percent of Total Billed Charges,69% of total billed charges,871.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2404.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2404.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2927.4,84,,,Percent of Total Billed Charges,84% of total billed charges,2857.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,3101.65,89,,,Percent of total Billed Charges,89% of total Billed charges,3101.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3101.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1421.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1421.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1421.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,871.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2683.45,77,,,Percent of total Billed charges,77% of total billed charges,2962.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1001.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1742.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1421.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,871.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3101.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,871.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,871.25,3101.65,
APP SKIN SUB EA ADD 25 SQ CM >,T990760020,CDM,761,RC,15276,HCPCS,Outpatient,,,860,430,,662.2,77,,,Percent of Total Billed Charges,77% of total billed charges,219.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,219.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,268.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,636.4,74,,,Percent of Total Billed Charges,74% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,593.4,69,,,Percent of Total Billed Charges,69% of total billed charges,722.4,84,,,Percent of Total Billed Charges,84% of total billed charges,705.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,765.4,89,,,Percent of total Billed Charges,89% of total Billed charges,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.2,77,,,Percent of total Billed charges,77% of total billed charges,731,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,247.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,430,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,350.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215,765.4,
APP SKIN SUB +/= 100 SQ CM,T990760021,CDM,761,RC,15277,HCPCS,Outpatient,,,8484.5,4242.25,,6533.07,77,,,Percent of Total Billed Charges,77% of total billed charges,2163.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2163.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2651.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6278.53,74,,,Percent of Total Billed Charges,74% of total billed charges,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,5854.31,69,,,Percent of Total Billed Charges,69% of total billed charges,7126.98,84,,,Percent of Total Billed Charges,84% of total billed charges,6957.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,7551.21,89,,,Percent of total Billed Charges,89% of total Billed charges,7551.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7551.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6533.07,77,,,Percent of total Billed charges,77% of total billed charges,7211.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2439.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4242.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3461.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7551.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2121.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2121.13,7551.21,
APP SKIN SUB EA ADD 100 SQ CM,T990760022,CDM,761,RC,15278,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
INITIAL TRTMT 1ST DEGREE BURNS,T990760023,CDM,361,RC,16000,HCPCS,Outpatient,,,143,71.5,,110.11,77,,,Percent of Total Billed Charges,77% of total billed charges,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,84.37,100,,,case rate,pays based on per visit,84.37,59,,,case rate,pays based on per visit,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,84.37,59,,,Percent of Total Billed Charges,59% of total billed charges,120.12,84,,,Percent of Total Billed Charges,84% of total billed charges,117.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.27,89,,,Percent of total Billed Charges,89% of total Billed charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.11,77,,,Percent of total Billed charges,77% of total billed charges,121.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,58.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,35.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.75,436,
DSG/DBRD PRT THICK BURN(S)-SM,T990760024,CDM,940,RC,16020,HCPCS,Outpatient,,,352,176,,271.04,77,,,Percent of Total Billed Charges,77% of total billed charges,89.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.48,74,,,Percent of Total Billed Charges,74% of total billed charges,242.88,69,,,Percent of Total Billed Charges,69% of total billed charges,242.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.88,69,,,Percent of Total Billed Charges,69% of total billed charges,242.88,69,,,Percent of Total Billed Charges,69% of total billed charges,295.68,84,,,Percent of Total Billed Charges,84% of total billed charges,288.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.28,89,,,Percent of total Billed Charges,89% of total Billed charges,313.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.04,77,,,Percent of total Billed charges,77% of total billed charges,299.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,143.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88,313.28,
DSG/DBRD PRT THICK BURN(S)-MED,T990760025,CDM,361,RC,16025,HCPCS,Outpatient,,,251.5,125.75,,193.66,77,,,Percent of Total Billed Charges,77% of total billed charges,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,148.39,100,,,case rate,pays based on per visit,148.39,59,,,case rate,pays based on per visit,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,148.39,59,,,Percent of Total Billed Charges,59% of total billed charges,211.26,84,,,Percent of Total Billed Charges,84% of total billed charges,206.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.84,89,,,Percent of total Billed Charges,89% of total Billed charges,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.66,77,,,Percent of total Billed charges,77% of total billed charges,213.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436,100,,,Fee Schedule,100% of UHC Asc Tier Groupings,102.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377,100,,,Fee Schedule,100% of UMR Fee Schedule,62.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.88,436,
DSG/DBRD PRT THICK BURN(S)-LG,T990760026,CDM,940,RC,16030,HCPCS,Outpatient,,,289,144.5,,222.53,77,,,Percent of Total Billed Charges,77% of total billed charges,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,213.86,74,,,Percent of Total Billed Charges,74% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,199.41,69,,,Percent of Total Billed Charges,69% of total billed charges,242.76,84,,,Percent of Total Billed Charges,84% of total billed charges,236.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,257.21,89,,,Percent of total Billed Charges,89% of total Billed charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,257.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,117.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.53,77,,,Percent of total Billed charges,77% of total billed charges,245.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,117.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,72.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.25,257.21,
CHEM CAUTERIZATION OF GRAN TIS,T990760027,CDM,761,RC,17250,HCPCS,Outpatient,,,983.5,491.75,,757.3,77,,,Percent of Total Billed Charges,77% of total billed charges,250.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,250.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,727.79,74,,,Percent of Total Billed Charges,74% of total billed charges,678.62,69,,,Percent of Total Billed Charges,69% of total billed charges,678.62,69,,,Percent of Total Billed Charges,69% of total billed charges,245.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,678.62,69,,,Percent of Total Billed Charges,69% of total billed charges,678.62,69,,,Percent of Total Billed Charges,69% of total billed charges,826.14,84,,,Percent of Total Billed Charges,84% of total billed charges,806.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,875.32,89,,,Percent of total Billed Charges,89% of total Billed charges,875.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,875.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,401.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,401.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,401.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,757.3,77,,,Percent of total Billed charges,77% of total billed charges,835.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,282.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,491.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,401.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,245.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,875.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.88,875.32,
APPL OF UNNA BOOT-LEFT,T990760028,CDM,761,RC,29580,HCPCS,Outpatient,,,2155.5,1077.75,LT,1659.74,77,,,Percent of Total Billed Charges,77% of total billed charges,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,673.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1595.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1810.62,84,,,Percent of Total Billed Charges,84% of total billed charges,1767.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1918.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1659.74,77,,,Percent of total Billed charges,77% of total billed charges,1832.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,619.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1077.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,538.88,1918.4,
APPL OF UNNA BOOT-RIGHT,T990760029,CDM,761,RC,29580,HCPCS,Outpatient,,,2155.5,1077.75,RT,1659.74,77,,,Percent of Total Billed Charges,77% of total billed charges,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,673.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1595.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1810.62,84,,,Percent of Total Billed Charges,84% of total billed charges,1767.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1918.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1659.74,77,,,Percent of total Billed charges,77% of total billed charges,1832.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,619.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1077.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,538.88,1918.4,
APPL MULTI VENOUS WND COMP-LT,T990760030,CDM,761,RC,29581,HCPCS,Outpatient,,,2155.5,1077.75,LT,1659.74,77,,,Percent of Total Billed Charges,77% of total billed charges,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,673.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1595.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1810.62,84,,,Percent of Total Billed Charges,84% of total billed charges,1767.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1918.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1659.74,77,,,Percent of total Billed charges,77% of total billed charges,1832.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,619.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1077.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,538.88,1918.4,
APPL MULTI VENOUS WND COMP-RT,T990760031,CDM,761,RC,29581,HCPCS,Outpatient,,,2155.5,1077.75,RT,1659.74,77,,,Percent of Total Billed Charges,77% of total billed charges,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,549.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,673.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1595.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1487.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1810.62,84,,,Percent of Total Billed Charges,84% of total billed charges,1767.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1918.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1659.74,77,,,Percent of total Billed charges,77% of total billed charges,1832.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,619.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1077.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,879.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1918.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,538.88,1918.4,
DEBRD DEVIATAL DERM/EMID 1ST20,T990760032,CDM,761,RC,97597,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
DEBRD DEVIATAL EA ADD 20CM,T990760033,CDM,761,RC,97598,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
ACTIVE WND MGMT(NON-SEL DEBRD),T990760034,CDM,940,RC,97602,HCPCS,Outpatient,,,359,179.5,,276.43,77,,,Percent of Total Billed Charges,77% of total billed charges,91.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,265.66,74,,,Percent of Total Billed Charges,74% of total billed charges,247.71,69,,,Percent of Total Billed Charges,69% of total billed charges,247.71,69,,,Percent of Total Billed Charges,69% of total billed charges,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,247.71,69,,,Percent of Total Billed Charges,69% of total billed charges,247.71,69,,,Percent of Total Billed Charges,69% of total billed charges,301.56,84,,,Percent of Total Billed Charges,84% of total billed charges,294.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,319.51,89,,,Percent of total Billed Charges,89% of total Billed charges,319.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,319.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,146.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276.43,77,,,Percent of total Billed charges,77% of total billed charges,305.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,103.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,136,100,,,Case Rate,Pays based on per visit rate,146.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117,100,,,Case Rate,Pays based on per visit rate,89.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.75,319.51,
WOUND VAC DME <50 SQ CM,T990760035,CDM,761,RC,97605,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
WOUND VAC DME >50 SQ CM,T990760036,CDM,761,RC,97606,HCPCS,Outpatient,,,1874,937,,1442.98,77,,,Percent of Total Billed Charges,77% of total billed charges,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,477.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1386.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1293.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1574.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1536.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1667.86,89,,,Percent of total Billed Charges,89% of total Billed charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1442.98,77,,,Percent of total Billed charges,77% of total billed charges,1592.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,538.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,764.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1667.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.5,1667.86,
WOUND VAC DISPOS <50 CM,T990760037,CDM,361,RC,97607,HCPCS,Outpatient,,,753.5,376.75,,580.2,77,,,Percent of Total Billed Charges,77% of total billed charges,192.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,444.57,59,,,Percent of Total Billed Charges,59% of total billed charges,444.57,100,,,case rate,pays based on per visit,444.57,59,,,case rate,pays based on per visit,188.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.57,59,,,Percent of Total Billed Charges,59% of total billed charges,444.57,59,,,Percent of Total Billed Charges,59% of total billed charges,632.94,84,,,Percent of Total Billed Charges,84% of total billed charges,617.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,670.62,89,,,Percent of total Billed Charges,89% of total Billed charges,670.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,670.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.2,77,,,Percent of total Billed charges,77% of total billed charges,640.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,670.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,670.62,
WOUND VAC DISPOS >50 CM,T990760038,CDM,361,RC,97608,HCPCS,Outpatient,,,985.5,492.75,,758.84,77,,,Percent of Total Billed Charges,77% of total billed charges,251.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,251.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,307.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,581.45,59,,,Percent of Total Billed Charges,59% of total billed charges,581.45,100,,,case rate,pays based on per visit,581.45,59,,,case rate,pays based on per visit,246.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.45,59,,,Percent of Total Billed Charges,59% of total billed charges,581.45,59,,,Percent of Total Billed Charges,59% of total billed charges,827.82,84,,,Percent of Total Billed Charges,84% of total billed charges,808.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,877.1,89,,,Percent of total Billed Charges,89% of total Billed charges,877.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,877.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,402.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,402.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,402.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,246.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.84,77,,,Percent of total Billed charges,77% of total billed charges,837.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,283.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,492.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,402.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,246.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,246.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,246.38,877.1,
EST OP VISIT - RN VISIT,T990760039,CDM,761,RC,G0463,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,307.84,74,,,Percent of Total Billed Charges,74% of total billed charges,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
EST OP VISIT - RN VISIT,T990760039,CDM,761,RC,99211,HCPCS,Outpatient,,,416,208,,320.32,77,,,Percent of Total Billed Charges,77% of total billed charges,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,106.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,307.84,74,,,Percent of Total Billed Charges,74% of total billed charges,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,287.04,69,,,Percent of Total Billed Charges,69% of total billed charges,349.44,84,,,Percent of Total Billed Charges,84% of total billed charges,341.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,370.24,89,,,Percent of total Billed Charges,89% of total Billed charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,320.32,77,,,Percent of total Billed charges,77% of total billed charges,353.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,119.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,208,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,169.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104,370.24,
EST OP VISIT 10-19 MINUTES,T990760040,CDM,761,RC,99212,HCPCS,Outpatient,,,531.5,265.75,,409.26,77,,,Percent of Total Billed Charges,77% of total billed charges,135.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,393.31,74,,,Percent of Total Billed Charges,74% of total billed charges,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,446.46,84,,,Percent of Total Billed Charges,84% of total billed charges,435.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,473.04,89,,,Percent of total Billed Charges,89% of total Billed charges,473.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,409.26,77,,,Percent of total Billed charges,77% of total billed charges,451.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,265.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.88,473.04,
EST OP VISIT 10-19 MINUTES,T990760040,CDM,761,RC,G0463,HCPCS,Outpatient,,,531.5,265.75,,409.26,77,,,Percent of Total Billed Charges,77% of total billed charges,135.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,393.31,74,,,Percent of Total Billed Charges,74% of total billed charges,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,366.74,69,,,Percent of Total Billed Charges,69% of total billed charges,446.46,84,,,Percent of Total Billed Charges,84% of total billed charges,435.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,473.04,89,,,Percent of total Billed Charges,89% of total Billed charges,473.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,473.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,409.26,77,,,Percent of total Billed charges,77% of total billed charges,451.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,152.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,265.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,216.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,473.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.88,473.04,
EST OP VISIT 20-29 MINUTES,T990760041,CDM,761,RC,99213,HCPCS,Outpatient,,,610,305,,469.7,77,,,Percent of Total Billed Charges,77% of total billed charges,155.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,451.4,74,,,Percent of Total Billed Charges,74% of total billed charges,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,512.4,84,,,Percent of Total Billed Charges,84% of total billed charges,500.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,542.9,89,,,Percent of total Billed Charges,89% of total Billed charges,542.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,542.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,469.7,77,,,Percent of total Billed charges,77% of total billed charges,518.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,305,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.5,542.9,
EST OP VISIT 20-29 MINUTES,T990760041,CDM,761,RC,G0463,HCPCS,Outpatient,,,610,305,,469.7,77,,,Percent of Total Billed Charges,77% of total billed charges,155.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,451.4,74,,,Percent of Total Billed Charges,74% of total billed charges,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,420.9,69,,,Percent of Total Billed Charges,69% of total billed charges,512.4,84,,,Percent of Total Billed Charges,84% of total billed charges,500.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,542.9,89,,,Percent of total Billed Charges,89% of total Billed charges,542.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,542.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,469.7,77,,,Percent of total Billed charges,77% of total billed charges,518.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,175.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,305,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,248.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,542.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.5,542.9,
EST OP VISIT 30-39 MINUTES,T990760042,CDM,761,RC,99214,HCPCS,Outpatient,,,886,443,,682.22,77,,,Percent of Total Billed Charges,77% of total billed charges,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.64,74,,,Percent of Total Billed Charges,74% of total billed charges,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,744.24,84,,,Percent of Total Billed Charges,84% of total billed charges,726.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.54,89,,,Percent of total Billed Charges,89% of total Billed charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.22,77,,,Percent of total Billed charges,77% of total billed charges,753.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.5,788.54,
EST OP VISIT 40-54 MINUTES,T990760043,CDM,761,RC,99215,HCPCS,Outpatient,,,886,443,,682.22,77,,,Percent of Total Billed Charges,77% of total billed charges,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.64,74,,,Percent of Total Billed Charges,74% of total billed charges,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,611.34,69,,,Percent of Total Billed Charges,69% of total billed charges,744.24,84,,,Percent of Total Billed Charges,84% of total billed charges,726.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.54,89,,,Percent of total Billed Charges,89% of total Billed charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.22,77,,,Percent of total Billed charges,77% of total billed charges,753.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.5,788.54,
MNT INPT Initial 15 min,T990800001,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
"MNT OP INITIAL, EA 15 MIN",T990800002,CDM,942,RC,97802,HCPCS,Outpatient,,,81,40.5,,62.37,77,,,Percent of Total Billed Charges,77% of total billed charges,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.94,74,,,Percent of Total Billed Charges,74% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,68.04,84,,,Percent of Total Billed Charges,84% of total billed charges,66.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.09,89,,,Percent of total Billed Charges,89% of total Billed charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.37,77,,,Percent of total Billed charges,77% of total billed charges,68.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,33.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,92,
MNT FOLLOW-UP ASSESSMENT-15MIN,T990800003,CDM,942,RC,G0270,HCPCS,Outpatient,,,81,40.5,,62.37,77,,,Percent of Total Billed Charges,77% of total billed charges,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.94,74,,,Percent of Total Billed Charges,74% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,68.04,84,,,Percent of Total Billed Charges,84% of total billed charges,66.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.09,89,,,Percent of total Billed Charges,89% of total Billed charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.37,77,,,Percent of total Billed charges,77% of total billed charges,68.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,33.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,92,
MNT FOLLOW-UP ASSESSMENT-15MIN,T990800003,CDM,942,RC,97803,HCPCS,Outpatient,,,81,40.5,,62.37,77,,,Percent of Total Billed Charges,77% of total billed charges,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.94,74,,,Percent of Total Billed Charges,74% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,68.04,84,,,Percent of Total Billed Charges,84% of total billed charges,66.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.09,89,,,Percent of total Billed Charges,89% of total Billed charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.37,77,,,Percent of total Billed charges,77% of total billed charges,68.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,33.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,92,
MNT GROUP,T990800005,CDM,942,RC,97804,HCPCS,Outpatient,,,86,43,,66.22,77,,,Percent of Total Billed Charges,77% of total billed charges,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.64,74,,,Percent of Total Billed Charges,74% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,59.34,69,,,Percent of Total Billed Charges,69% of total billed charges,72.24,84,,,Percent of Total Billed Charges,84% of total billed charges,70.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.54,89,,,Percent of total Billed Charges,89% of total Billed charges,76.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.22,77,,,Percent of total Billed charges,77% of total billed charges,73.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,35.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,21.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.5,92,
EDUCATION TRAINING; 30 MIN,T990800006,CDM,942,RC,98960,HCPCS,Outpatient,,,137,68.5,,105.49,77,,,Percent of Total Billed Charges,77% of total billed charges,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.38,74,,,Percent of Total Billed Charges,74% of total billed charges,94.53,69,,,Percent of Total Billed Charges,69% of total billed charges,94.53,69,,,Percent of Total Billed Charges,69% of total billed charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.53,69,,,Percent of Total Billed Charges,69% of total billed charges,94.53,69,,,Percent of Total Billed Charges,69% of total billed charges,115.08,84,,,Percent of Total Billed Charges,84% of total billed charges,112.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.93,89,,,Percent of total Billed Charges,89% of total Billed charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.49,77,,,Percent of total Billed charges,77% of total billed charges,116.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,55.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,34.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.25,121.93,
PREVENT MED COUNSEL; 15 MIN,T990800007,CDM,510,RC,99401,HCPCS,Outpatient,,,115,57.5,,88.55,77,,,Percent of Total Billed Charges,77% of total billed charges,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.55,77,,,Percent of total Billed charges,77% of total billed charges,97.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.75,102.35,
PREVENT MED COUNSEL; 30 MIN,T990800008,CDM,510,RC,99402,HCPCS,Outpatient,,,191,95.5,,147.07,77,,,Percent of Total Billed Charges,77% of total billed charges,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.07,77,,,Percent of total Billed charges,77% of total billed charges,162.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.75,169.99,
PREVENT MED COUNCIL; 45 MIN,T990800009,CDM,510,RC,99403,HCPCS,Outpatient,,,267.5,133.75,,205.98,77,,,Percent of Total Billed Charges,77% of total billed charges,68.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,66.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,109.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.98,77,,,Percent of total Billed charges,77% of total billed charges,227.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,238.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.88,238.08,
PREVENT MED COUNSEL; 60 MIN,T990800010,CDM,510,RC,99404,HCPCS,Outpatient,,,282.5,141.25,,217.53,77,,,Percent of Total Billed Charges,77% of total billed charges,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,115.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,77,,,Percent of total Billed charges,77% of total billed charges,240.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.63,251.43,
MNT IP REASSESSMENT EA ADD 15M,T990800011,CDM,942,RC,,,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
"NUTRITIONAL COUNSEL, VISIT",T990800012,CDM,942,RC,S9470,HCPCS,Outpatient,,,324.5,162.25,,249.87,77,,,Percent of Total Billed Charges,77% of total billed charges,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,240.13,74,,,Percent of Total Billed Charges,74% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,272.58,84,,,Percent of Total Billed Charges,84% of total billed charges,266.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,288.81,89,,,Percent of total Billed Charges,89% of total Billed charges,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.87,77,,,Percent of total Billed charges,77% of total billed charges,275.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,132.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,288.81,
"NUTRITIONAL COUNSEL, VISIT",T990800012,CDM,942,RC,S9470,HCPCS,Outpatient,,,324.5,162.25,U1,249.87,77,,,Percent of Total Billed Charges,77% of total billed charges,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,240.13,74,,,Percent of Total Billed Charges,74% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,223.91,69,,,Percent of Total Billed Charges,69% of total billed charges,272.58,84,,,Percent of Total Billed Charges,84% of total billed charges,266.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,288.81,89,,,Percent of total Billed Charges,89% of total Billed charges,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.87,77,,,Percent of total Billed charges,77% of total billed charges,275.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,132.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,81.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,288.81,
Education Training 1.5 hr,T990800014,CDM,942,RC,98960,HCPCS,Outpatient,,,410,205,,315.7,77,,,Percent of Total Billed Charges,77% of total billed charges,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,104.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,303.4,74,,,Percent of Total Billed Charges,74% of total billed charges,282.9,69,,,Percent of Total Billed Charges,69% of total billed charges,282.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.9,69,,,Percent of Total Billed Charges,69% of total billed charges,282.9,69,,,Percent of Total Billed Charges,69% of total billed charges,344.4,84,,,Percent of Total Billed Charges,84% of total billed charges,336.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,364.9,89,,,Percent of total Billed Charges,89% of total Billed charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,167.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.7,77,,,Percent of total Billed charges,77% of total billed charges,348.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,117.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,167.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,102.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,364.9,
Education Training 2 hr,T990800015,CDM,942,RC,98960,HCPCS,Outpatient,,,547,273.5,,421.19,77,,,Percent of Total Billed Charges,77% of total billed charges,139.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,170.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,404.78,74,,,Percent of Total Billed Charges,74% of total billed charges,377.43,69,,,Percent of Total Billed Charges,69% of total billed charges,377.43,69,,,Percent of Total Billed Charges,69% of total billed charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.43,69,,,Percent of Total Billed Charges,69% of total billed charges,377.43,69,,,Percent of Total Billed Charges,69% of total billed charges,459.48,84,,,Percent of Total Billed Charges,84% of total billed charges,448.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,486.83,89,,,Percent of total Billed Charges,89% of total Billed charges,486.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,421.19,77,,,Percent of total Billed charges,77% of total billed charges,464.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,157.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,223.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,136.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,486.83,
MNT OP Follow Up 30 Min,T990800016,CDM,942,RC,97803,HCPCS,Outpatient,,,162,81,,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.88,74,,,Percent of Total Billed Charges,74% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,136.08,84,,,Percent of Total Billed Charges,84% of total billed charges,132.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.18,89,,,Percent of total Billed Charges,89% of total Billed charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,66.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,144.18,
MNT OP Follow Up 45 Min,T990800017,CDM,942,RC,97803,HCPCS,Outpatient,,,243,121.5,,187.11,77,,,Percent of Total Billed Charges,77% of total billed charges,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.82,74,,,Percent of Total Billed Charges,74% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,204.12,84,,,Percent of Total Billed Charges,84% of total billed charges,199.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.27,89,,,Percent of total Billed Charges,89% of total Billed charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.11,77,,,Percent of total Billed charges,77% of total billed charges,206.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,99.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.75,216.27,
MNT OP Assessment 60 Min,T990800018,CDM,942,RC,97803,HCPCS,Outpatient,,,324,162,,249.48,77,,,Percent of Total Billed Charges,77% of total billed charges,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.76,74,,,Percent of Total Billed Charges,74% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,272.16,84,,,Percent of Total Billed Charges,84% of total billed charges,265.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,288.36,89,,,Percent of total Billed Charges,89% of total Billed charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.48,77,,,Percent of total Billed charges,77% of total billed charges,275.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,132.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,288.36,
MNT Group 60 min,T990800019,CDM,942,RC,97804,HCPCS,Outpatient,,,172,86,,132.44,77,,,Percent of Total Billed Charges,77% of total billed charges,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.28,74,,,Percent of Total Billed Charges,74% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,118.68,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,84,,,Percent of Total Billed Charges,84% of total billed charges,141.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.08,89,,,Percent of total Billed Charges,89% of total Billed charges,153.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.44,77,,,Percent of total Billed charges,77% of total billed charges,146.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,70.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43,153.08,
MNT Group 1.5 hr,T990800020,CDM,942,RC,97804,HCPCS,Outpatient,,,257,128.5,,197.89,77,,,Percent of Total Billed Charges,77% of total billed charges,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,190.18,74,,,Percent of Total Billed Charges,74% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,177.33,69,,,Percent of Total Billed Charges,69% of total billed charges,215.88,84,,,Percent of Total Billed Charges,84% of total billed charges,210.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,228.73,89,,,Percent of total Billed Charges,89% of total Billed charges,228.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,104.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.89,77,,,Percent of total Billed charges,77% of total billed charges,218.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,104.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,64.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.25,228.73,
MNT Group 2 Hr,T990800021,CDM,942,RC,97804,HCPCS,Outpatient,,,343,171.5,,264.11,77,,,Percent of Total Billed Charges,77% of total billed charges,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,253.82,74,,,Percent of Total Billed Charges,74% of total billed charges,236.67,69,,,Percent of Total Billed Charges,69% of total billed charges,236.67,69,,,Percent of Total Billed Charges,69% of total billed charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.67,69,,,Percent of Total Billed Charges,69% of total billed charges,236.67,69,,,Percent of Total Billed Charges,69% of total billed charges,288.12,84,,,Percent of Total Billed Charges,84% of total billed charges,281.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,305.27,89,,,Percent of total Billed Charges,89% of total Billed charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.11,77,,,Percent of total Billed charges,77% of total billed charges,291.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,98.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,139.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,85.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,305.27,
MNT Inpatient Initial 30 min,T990800022,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Inpatient Initial 45 min,T990800023,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Inpatient Initial 60 min,T990800024,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT IP Reassessment 30 min,T990800025,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT IP Reassessment 45 min,T990800026,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT IP Reassessment 60 min,T990800027,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT OP Initial 30 minutes,T990800028,CDM,942,RC,97802,HCPCS,Outpatient,,,162,81,,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.88,74,,,Percent of Total Billed Charges,74% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,136.08,84,,,Percent of Total Billed Charges,84% of total billed charges,132.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.18,89,,,Percent of total Billed Charges,89% of total Billed charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,66.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,144.18,
MNT OP Initial 45 minutes,T990800029,CDM,942,RC,97802,HCPCS,Outpatient,,,243,121.5,,187.11,77,,,Percent of Total Billed Charges,77% of total billed charges,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.82,74,,,Percent of Total Billed Charges,74% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,204.12,84,,,Percent of Total Billed Charges,84% of total billed charges,199.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.27,89,,,Percent of total Billed Charges,89% of total Billed charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.11,77,,,Percent of total Billed charges,77% of total billed charges,206.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,99.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.75,216.27,
MNT OP 60 Initial minutes,T990800030,CDM,942,RC,97802,HCPCS,Outpatient,,,324,162,,249.48,77,,,Percent of Total Billed Charges,77% of total billed charges,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.76,74,,,Percent of Total Billed Charges,74% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,272.16,84,,,Percent of Total Billed Charges,84% of total billed charges,265.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,288.36,89,,,Percent of total Billed Charges,89% of total Billed charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.48,77,,,Percent of total Billed charges,77% of total billed charges,275.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,132.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,288.36,
MNT OP Follow Up 1.25 hr,T990800031,CDM,942,RC,97803,HCPCS,Outpatient,,,405,202.5,,311.85,77,,,Percent of Total Billed Charges,77% of total billed charges,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,299.7,74,,,Percent of Total Billed Charges,74% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,340.2,84,,,Percent of Total Billed Charges,84% of total billed charges,332.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,360.45,89,,,Percent of total Billed Charges,89% of total Billed charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.85,77,,,Percent of total Billed charges,77% of total billed charges,344.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,165.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,360.45,
MNT OP Follow Up 1.5 hr,T990800032,CDM,942,RC,97803,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,359.64,74,,,Percent of Total Billed Charges,74% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,408.24,84,,,Percent of Total Billed Charges,84% of total billed charges,398.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,432.54,89,,,Percent of total Billed Charges,89% of total Billed charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,198.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,432.54,
MNT OP Follow Up 1.75 hr,T990800033,CDM,942,RC,97803,HCPCS,Outpatient,,,567,283.5,,436.59,77,,,Percent of Total Billed Charges,77% of total billed charges,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,419.58,74,,,Percent of Total Billed Charges,74% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,476.28,84,,,Percent of Total Billed Charges,84% of total billed charges,464.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,504.63,89,,,Percent of total Billed Charges,89% of total Billed charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.59,77,,,Percent of total Billed charges,77% of total billed charges,481.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,231.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,504.63,
MNT OP Follow Up 2 hrs,T990800034,CDM,942,RC,97803,HCPCS,Outpatient,,,648,324,,498.96,77,,,Percent of Total Billed Charges,77% of total billed charges,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,479.52,74,,,Percent of Total Billed Charges,74% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,544.32,84,,,Percent of Total Billed Charges,84% of total billed charges,531.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,576.72,89,,,Percent of total Billed Charges,89% of total Billed charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.96,77,,,Percent of total Billed charges,77% of total billed charges,550.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,264.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,576.72,
MNT IP Reassessment 1.25 hr,T990800035,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT IP Reassessment 1.5 hr,T990800036,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT IP Reassessment 1.75 hr,T990800037,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT IP Reassessment 2 hr,T990800038,CDM,942,RC,97803,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Inpatient Initial 1.25 hr,T990800039,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Inpatient Initial 1.5 hr,T990800040,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Inpatient Initial 1.75 hr,T990800041,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Inpatient Initial 2 hr,T990800042,CDM,942,RC,97802,HCPCS,Outpatient,,,,,,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,other,not seperately reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,92,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,80,100,,,Case Rate,Pays based on per visit rate,,,,,Other,Not Seperately Reimbusable,80,92,
MNT Outpatient Initial 1.25 hr,T990800043,CDM,942,RC,97802,HCPCS,Outpatient,,,405,202.5,,311.85,77,,,Percent of Total Billed Charges,77% of total billed charges,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,299.7,74,,,Percent of Total Billed Charges,74% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,340.2,84,,,Percent of Total Billed Charges,84% of total billed charges,332.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,360.45,89,,,Percent of total Billed Charges,89% of total Billed charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.85,77,,,Percent of total Billed charges,77% of total billed charges,344.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,165.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,360.45,
MNT Outpatient Initial 1.5 hr,T990800044,CDM,942,RC,97802,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,359.64,74,,,Percent of Total Billed Charges,74% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,408.24,84,,,Percent of Total Billed Charges,84% of total billed charges,398.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,432.54,89,,,Percent of total Billed Charges,89% of total Billed charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,198.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,432.54,
MNT Outpatient Initial 1.75 hr,T990800045,CDM,942,RC,97802,HCPCS,Outpatient,,,567,283.5,,436.59,77,,,Percent of Total Billed Charges,77% of total billed charges,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,419.58,74,,,Percent of Total Billed Charges,74% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,476.28,84,,,Percent of Total Billed Charges,84% of total billed charges,464.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,504.63,89,,,Percent of total Billed Charges,89% of total Billed charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.59,77,,,Percent of total Billed charges,77% of total billed charges,481.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,231.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,504.63,
MNT Outpatient Initial 2 hr,T990800046,CDM,942,RC,97802,HCPCS,Outpatient,,,648,324,,498.96,77,,,Percent of Total Billed Charges,77% of total billed charges,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,479.52,74,,,Percent of Total Billed Charges,74% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,544.32,84,,,Percent of Total Billed Charges,84% of total billed charges,531.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,576.72,89,,,Percent of total Billed Charges,89% of total Billed charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.96,77,,,Percent of total Billed charges,77% of total billed charges,550.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,264.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,576.72,
G0270 MNT OP Subsq Visit 15min,T990800047,CDM,942,RC,G0270,HCPCS,Outpatient,,,81,40.5,,62.37,77,,,Percent of Total Billed Charges,77% of total billed charges,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.94,74,,,Percent of Total Billed Charges,74% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,55.89,69,,,Percent of Total Billed Charges,69% of total billed charges,68.04,84,,,Percent of Total Billed Charges,84% of total billed charges,66.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.09,89,,,Percent of total Billed Charges,89% of total Billed charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.37,77,,,Percent of total Billed charges,77% of total billed charges,68.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,33.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,20.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,92,
G0270 MNT OP Subsq Visit 30min,T990800048,CDM,942,RC,G0270,HCPCS,Outpatient,,,162,81,,124.74,77,,,Percent of Total Billed Charges,77% of total billed charges,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.88,74,,,Percent of Total Billed Charges,74% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,111.78,69,,,Percent of Total Billed Charges,69% of total billed charges,136.08,84,,,Percent of Total Billed Charges,84% of total billed charges,132.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.18,89,,,Percent of total Billed Charges,89% of total Billed charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.74,77,,,Percent of total Billed charges,77% of total billed charges,137.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,66.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,40.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,144.18,
G0270 MNT OP Subsq Visit 45min,T990800049,CDM,942,RC,G0270,HCPCS,Outpatient,,,243,121.5,,187.11,77,,,Percent of Total Billed Charges,77% of total billed charges,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.82,74,,,Percent of Total Billed Charges,74% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,167.67,69,,,Percent of Total Billed Charges,69% of total billed charges,204.12,84,,,Percent of Total Billed Charges,84% of total billed charges,199.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.27,89,,,Percent of total Billed Charges,89% of total Billed charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.11,77,,,Percent of total Billed charges,77% of total billed charges,206.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,99.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,60.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.75,216.27,
G0270 MNT OP Subsq Visit 60min,T990800050,CDM,942,RC,G0270,HCPCS,Outpatient,,,324,162,,249.48,77,,,Percent of Total Billed Charges,77% of total billed charges,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.76,74,,,Percent of Total Billed Charges,74% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,223.56,69,,,Percent of Total Billed Charges,69% of total billed charges,272.16,84,,,Percent of Total Billed Charges,84% of total billed charges,265.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,288.36,89,,,Percent of total Billed Charges,89% of total Billed charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,288.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.48,77,,,Percent of total Billed charges,77% of total billed charges,275.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,93.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,132.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,288.36,
G0270 MNT OP Subsq Visit 1.25h,T990800051,CDM,942,RC,G0270,HCPCS,Outpatient,,,405,202.5,,311.85,77,,,Percent of Total Billed Charges,77% of total billed charges,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,299.7,74,,,Percent of Total Billed Charges,74% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,279.45,69,,,Percent of Total Billed Charges,69% of total billed charges,340.2,84,,,Percent of Total Billed Charges,84% of total billed charges,332.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,360.45,89,,,Percent of total Billed Charges,89% of total Billed charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,360.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,311.85,77,,,Percent of total Billed charges,77% of total billed charges,344.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,116.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,165.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,101.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,360.45,
G0270 MNT OP Subsq Visit 1.5hr,T990800052,CDM,942,RC,G0270,HCPCS,Outpatient,,,486,243,,374.22,77,,,Percent of Total Billed Charges,77% of total billed charges,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,123.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,359.64,74,,,Percent of Total Billed Charges,74% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,335.34,69,,,Percent of Total Billed Charges,69% of total billed charges,408.24,84,,,Percent of Total Billed Charges,84% of total billed charges,398.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,432.54,89,,,Percent of total Billed Charges,89% of total Billed charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,432.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,198.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.22,77,,,Percent of total Billed charges,77% of total billed charges,413.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,139.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,198.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,121.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,432.54,
G0270 MNT OP Subsq Visit 1.75h,T990800053,CDM,942,RC,G0270,HCPCS,Outpatient,,,567,283.5,,436.59,77,,,Percent of Total Billed Charges,77% of total billed charges,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,177.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,419.58,74,,,Percent of Total Billed Charges,74% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,391.23,69,,,Percent of Total Billed Charges,69% of total billed charges,476.28,84,,,Percent of Total Billed Charges,84% of total billed charges,464.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,504.63,89,,,Percent of total Billed Charges,89% of total Billed charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,504.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,231.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.59,77,,,Percent of total Billed charges,77% of total billed charges,481.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,163.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,231.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,141.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,504.63,
G0270 MNT OP Subsq Visit 2 hrs,T990800054,CDM,942,RC,G0270,HCPCS,Outpatient,,,648,324,,498.96,77,,,Percent of Total Billed Charges,77% of total billed charges,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,202.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,479.52,74,,,Percent of Total Billed Charges,74% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,447.12,69,,,Percent of Total Billed Charges,69% of total billed charges,544.32,84,,,Percent of Total Billed Charges,84% of total billed charges,531.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,576.72,89,,,Percent of total Billed Charges,89% of total Billed charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,576.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,264.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,498.96,77,,,Percent of total Billed charges,77% of total billed charges,550.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,186.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92,100,,,Case Rate,Pays based on per visit rate,264.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,100,,,Case Rate,Pays based on per visit rate,162,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80,576.72,
Annual Lifeline,T990990001,CDM,990,RC,,,Outpatient,,,325,162.5,,250.25,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,240.5,74,,,Percent of Total Billed Charges,74% of total billed charges,224.25,69,,,Percent of Total Billed Charges,69% of total billed charges,224.25,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,224.25,69,,,Percent of Total Billed Charges,69% of total billed charges,224.25,69,,,Percent of Total Billed Charges,69% of total billed charges,273,84,,,Percent of Total Billed Charges,84% of total billed charges,266.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,289.25,89,,,Percent of total Billed Charges,89% of total Billed charges,289.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,250.25,77,,,Percent of total Billed charges,77% of total billed charges,276.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,132.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,132.6,289.25,
Lifeline Installation,T990990002,CDM,990,RC,,,Outpatient,,,50,25,,38.5,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,37,74,,,Percent of Total Billed Charges,74% of total billed charges,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,34.5,69,,,Percent of Total Billed Charges,69% of total billed charges,42,84,,,Percent of Total Billed Charges,84% of total billed charges,41,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.5,89,,,Percent of total Billed Charges,89% of total Billed charges,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,38.5,77,,,Percent of total Billed charges,77% of total billed charges,42.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.4,44.5,
Lifeline Auto Alert,T990990003,CDM,990,RC,,,Outpatient,,,40,20,,30.8,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,29.6,74,,,Percent of Total Billed Charges,74% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,27.6,69,,,Percent of Total Billed Charges,69% of total billed charges,33.6,84,,,Percent of Total Billed Charges,84% of total billed charges,32.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.6,89,,,Percent of total Billed Charges,89% of total Billed charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,30.8,77,,,Percent of total Billed charges,77% of total billed charges,34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,16.32,35.6,
Monthly Lifeline,T990990004,CDM,990,RC,,,Outpatient,,,30,15,,23.1,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,22.2,74,,,Percent of Total Billed Charges,74% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,69,,,Percent of Total Billed Charges,69% of total billed charges,25.2,84,,,Percent of Total Billed Charges,84% of total billed charges,24.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.7,89,,,Percent of total Billed Charges,89% of total Billed charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,23.1,77,,,Percent of total Billed charges,77% of total billed charges,25.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,12.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,12.24,26.7,
LFLN AUTO BUTTON SUBSQNT-2 SUB,T990990009,CDM,270,RC,,,Outpatient,,,541,270.5,,416.57,77,,,Percent of Total Billed Charges,77% of total billed charges,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,400.34,74,,,Percent of Total Billed Charges,74% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,373.29,69,,,Percent of Total Billed Charges,69% of total billed charges,454.44,84,,,Percent of Total Billed Charges,84% of total billed charges,443.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,481.49,89,,,Percent of total Billed Charges,89% of total Billed charges,481.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,481.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,416.57,77,,,Percent of total Billed charges,77% of total billed charges,459.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,155.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,270.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,220.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.25,481.49,
Lifeline Auto Alert - Annual,T990990010,CDM,270,RC,,,Outpatient,,,400,200,,308,77,,,Percent of Total Billed Charges,77% of total billed charges,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,296,74,,,Percent of Total Billed Charges,74% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,276,69,,,Percent of Total Billed Charges,69% of total billed charges,276,69,,,Percent of Total Billed Charges,69% of total billed charges,336,84,,,Percent of Total Billed Charges,84% of total billed charges,328,82,,,Percent of Total Billed Charges,82% of total billed charges ,356,89,,,Percent of total Billed Charges,89% of total Billed charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308,77,,,Percent of total Billed charges,77% of total billed charges,340,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,115,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,200,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,163.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,356,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,100,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100,356,
Lifeline Auto Alert Install,T990990018,CDM,990,RC,,,Outpatient,,,80,40,,61.6,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,59.2,74,,,Percent of Total Billed Charges,74% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,55.2,69,,,Percent of Total Billed Charges,69% of total billed charges,67.2,84,,,Percent of Total Billed Charges,84% of total billed charges,65.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.2,89,,,Percent of total Billed Charges,89% of total Billed charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,61.6,77,,,Percent of total Billed charges,77% of total billed charges,68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,32.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,32.64,71.2,
Mobile-on-the-Go unit,T990990019,CDM,990,RC,,,Outpatient,,,99,49.5,,76.23,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,73.26,74,,,Percent of Total Billed Charges,74% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,68.31,69,,,Percent of Total Billed Charges,69% of total billed charges,83.16,84,,,Percent of Total Billed Charges,84% of total billed charges,81.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.11,89,,,Percent of total Billed Charges,89% of total Billed charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,76.23,77,,,Percent of total Billed charges,77% of total billed charges,84.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,40.39,88.11,
Mobile-on-the-Go Monthly fee,T990990020,CDM,990,RC,,,Outpatient,,,49.95,24.98,,38.46,77,,,Percent of Total Billed Charges,77% of total billed charges,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,,,,,other,not seperately reimbusable,36.96,74,,,Percent of Total Billed Charges,74% of total billed charges,34.47,69,,,Percent of Total Billed Charges,69% of total billed charges,34.47,69,,,Percent of Total Billed Charges,69% of total billed charges,,,,,other,not seperately reimbusable,34.47,69,,,Percent of Total Billed Charges,69% of total billed charges,34.47,69,,,Percent of Total Billed Charges,69% of total billed charges,41.96,84,,,Percent of Total Billed Charges,84% of total billed charges,40.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.46,89,,,Percent of total Billed Charges,89% of total Billed charges,44.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,,,,,other,not seperately reimbusable,38.46,77,,,Percent of total Billed charges,77% of total billed charges,42.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,,,,,Other,Not Seperately Reimbusable,20.38,44.46,
Sodium Chloride 0.9% 1000ml IV Bag,338004904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 1000ml IV Bag,338004904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 1000ml IV Bag,338004904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 1000ml IV Bag,338004904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 1000ml IV Bag,338004904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 1000ml IV Bag,338004904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 100ml IV Bag,990798423,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 100ml Bag,338055318,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride PF 0.9% 10ml SDV,63323018610,CDM,250,RC,,,Outpatient,,,48.39,24.2,,37.26,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.81,74,,,Percent of Total Billed Charges,74% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,33.39,69,,,Percent of Total Billed Charges,69% of total billed charges,40.65,84,,,Percent of Total Billed Charges,84% of total billed charges,39.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.07,89,,,Percent of total Billed Charges,89% of total Billed charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.26,77,,,Percent of total Billed charges,77% of total billed charges,41.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.07,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 150ml IV Bag,990798361,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride PF 0.9% 20ml SDV,63323018620,CDM,250,RC,,,Outpatient,,,57.19,28.6,,44.04,77,,,Percent of Total Billed Charges,77% of total billed charges,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.32,74,,,Percent of Total Billed Charges,74% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,39.46,69,,,Percent of Total Billed Charges,69% of total billed charges,48.04,84,,,Percent of Total Billed Charges,84% of total billed charges,46.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.9,89,,,Percent of total Billed Charges,89% of total Billed charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.04,77,,,Percent of total Billed charges,77% of total billed charges,48.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.3,50.9,
Sodium Chloride 0.9% 250ml IV Bag,338004902,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 250ml IV Bag,338004902,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 250ml IV Bag,338004902,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 250ml IV Bag,338004902,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 250ml IV Bag,338004902,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 250ml IV Bag,338004902,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 250ml IV Bag,338954302,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Non-DEHP 500ml IV Bag,990798355,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 500ml IV Bag,338004903,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 500ml IV Bag,338004903,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 500ml IV Bag,338004903,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 500ml IV Bag,338004903,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 500ml IV Bag,338004903,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 500ml IV Bag,338004903,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% 50ml IV Bag,990798413,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9% Minibag+ 50ml Bag,338055311,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
Sodium Chloride PF 0.9% 50ml SDV,409488806,CDM,250,RC,,,Outpatient,,,66.4,33.2,,51.13,77,,,Percent of Total Billed Charges,77% of total billed charges,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.14,74,,,Percent of Total Billed Charges,74% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,45.82,69,,,Percent of Total Billed Charges,69% of total billed charges,55.78,84,,,Percent of Total Billed Charges,84% of total billed charges,54.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.1,89,,,Percent of total Billed Charges,89% of total Billed charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.13,77,,,Percent of total Billed charges,77% of total billed charges,56.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.6,59.1,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 4.25/5% IV 2,000ml Bag-PERIPHERAL LINE",338111504,CDM,250,RC,,,Outpatient,,,651.57,325.79,,501.71,77,,,Percent of Total Billed Charges,77% of total billed charges,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,166.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,482.16,74,,,Percent of Total Billed Charges,74% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,449.58,69,,,Percent of Total Billed Charges,69% of total billed charges,547.32,84,,,Percent of Total Billed Charges,84% of total billed charges,534.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,579.9,89,,,Percent of total Billed Charges,89% of total Billed charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,501.71,77,,,Percent of total Billed charges,77% of total billed charges,553.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,187.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,325.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,265.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,162.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.89,579.9,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
"Clinimix-E 5/20% IV 2,000ml Bag-CENTRAL LINE",338112504,CDM,250,RC,,,Outpatient,,,488.06,244.03,,375.81,77,,,Percent of Total Billed Charges,77% of total billed charges,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,124.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,361.16,74,,,Percent of Total Billed Charges,74% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,336.76,69,,,Percent of Total Billed Charges,69% of total billed charges,409.97,84,,,Percent of Total Billed Charges,84% of total billed charges,400.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,434.37,89,,,Percent of total Billed Charges,89% of total Billed charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,375.81,77,,,Percent of total Billed charges,77% of total billed charges,414.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,140.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,244.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,199.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,434.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.02,434.37,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10510.54,5255.27,,8093.12,77,,,Percent of Total Billed Charges,77% of total billed charges,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3284.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7777.8,74,,,Percent of Total Billed Charges,74% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,8828.85,84,,,Percent of Total Billed Charges,84% of total billed charges,8618.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,9354.38,89,,,Percent of total Billed Charges,89% of total Billed charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8093.12,77,,,Percent of total Billed charges,77% of total billed charges,8933.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3021.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5255.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.64,9354.38,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10243.35,5121.68,,7887.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3201.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7580.08,74,,,Percent of Total Billed Charges,74% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8604.41,84,,,Percent of Total Billed Charges,84% of total billed charges,8399.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,9116.58,89,,,Percent of total Billed Charges,89% of total Billed charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7887.38,77,,,Percent of total Billed charges,77% of total billed charges,8706.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2944.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5121.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.84,9116.58,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10510.54,5255.27,,8093.12,77,,,Percent of Total Billed Charges,77% of total billed charges,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3284.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7777.8,74,,,Percent of Total Billed Charges,74% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,8828.85,84,,,Percent of Total Billed Charges,84% of total billed charges,8618.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,9354.38,89,,,Percent of total Billed Charges,89% of total Billed charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8093.12,77,,,Percent of total Billed charges,77% of total billed charges,8933.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3021.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5255.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.64,9354.38,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10243.35,5121.68,,7887.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3201.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7580.08,74,,,Percent of Total Billed Charges,74% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8604.41,84,,,Percent of Total Billed Charges,84% of total billed charges,8399.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,9116.58,89,,,Percent of total Billed Charges,89% of total Billed charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7887.38,77,,,Percent of total Billed charges,77% of total billed charges,8706.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2944.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5121.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.84,9116.58,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10510.54,5255.27,,8093.12,77,,,Percent of Total Billed Charges,77% of total billed charges,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3284.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7777.8,74,,,Percent of Total Billed Charges,74% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,8828.85,84,,,Percent of Total Billed Charges,84% of total billed charges,8618.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,9354.38,89,,,Percent of total Billed Charges,89% of total Billed charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8093.12,77,,,Percent of total Billed charges,77% of total billed charges,8933.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3021.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5255.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.64,9354.38,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10243.35,5121.68,,7887.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3201.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7580.08,74,,,Percent of Total Billed Charges,74% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8604.41,84,,,Percent of Total Billed Charges,84% of total billed charges,8399.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,9116.58,89,,,Percent of total Billed Charges,89% of total Billed charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7887.38,77,,,Percent of total Billed charges,77% of total billed charges,8706.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2944.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5121.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.84,9116.58,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10510.54,5255.27,,8093.12,77,,,Percent of Total Billed Charges,77% of total billed charges,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3284.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7777.8,74,,,Percent of Total Billed Charges,74% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,8828.85,84,,,Percent of Total Billed Charges,84% of total billed charges,8618.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,9354.38,89,,,Percent of total Billed Charges,89% of total Billed charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8093.12,77,,,Percent of total Billed charges,77% of total billed charges,8933.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3021.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5255.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.64,9354.38,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10243.35,5121.68,,7887.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3201.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7580.08,74,,,Percent of Total Billed Charges,74% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8604.41,84,,,Percent of Total Billed Charges,84% of total billed charges,8399.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,9116.58,89,,,Percent of total Billed Charges,89% of total Billed charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7887.38,77,,,Percent of total Billed charges,77% of total billed charges,8706.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2944.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5121.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.84,9116.58,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10510.54,5255.27,,8093.12,77,,,Percent of Total Billed Charges,77% of total billed charges,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3284.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7777.8,74,,,Percent of Total Billed Charges,74% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,8828.85,84,,,Percent of Total Billed Charges,84% of total billed charges,8618.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,9354.38,89,,,Percent of total Billed Charges,89% of total Billed charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8093.12,77,,,Percent of total Billed charges,77% of total billed charges,8933.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3021.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5255.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.64,9354.38,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10243.35,5121.68,,7887.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3201.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7580.08,74,,,Percent of Total Billed Charges,74% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8604.41,84,,,Percent of Total Billed Charges,84% of total billed charges,8399.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,9116.58,89,,,Percent of total Billed Charges,89% of total Billed charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7887.38,77,,,Percent of total Billed charges,77% of total billed charges,8706.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2944.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5121.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.84,9116.58,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10510.54,5255.27,,8093.12,77,,,Percent of Total Billed Charges,77% of total billed charges,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2680.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3284.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7777.8,74,,,Percent of Total Billed Charges,74% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7252.27,69,,,Percent of Total Billed Charges,69% of total billed charges,8828.85,84,,,Percent of Total Billed Charges,84% of total billed charges,8618.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,9354.38,89,,,Percent of total Billed Charges,89% of total Billed charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8093.12,77,,,Percent of total Billed charges,77% of total billed charges,8933.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3021.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5255.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4288.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9354.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.64,9354.38,
Abatacept (Orencia) 250mg/10ml Powder SDV,3218713,CDM,250,RC,,,Outpatient,,,10243.35,5121.68,,7887.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2612.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3201.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7580.08,74,,,Percent of Total Billed Charges,74% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7067.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8604.41,84,,,Percent of Total Billed Charges,84% of total billed charges,8399.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,9116.58,89,,,Percent of total Billed Charges,89% of total Billed charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7887.38,77,,,Percent of total Billed charges,77% of total billed charges,8706.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2944.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5121.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4179.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9116.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2560.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.84,9116.58,
Acamprosate DR 333mg Tablet,68462043518,CDM,250,RC,,,Outpatient,,,21.52,10.76,,16.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.92,74,,,Percent of Total Billed Charges,74% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,84,,,Percent of Total Billed Charges,84% of total billed charges,17.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.15,89,,,Percent of total Billed Charges,89% of total Billed charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,77,,,Percent of total Billed charges,77% of total billed charges,18.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,19.15,
Acamprosate DR 333mg Tablet,68462043518,CDM,250,RC,,,Outpatient,,,21.52,10.76,,16.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.92,74,,,Percent of Total Billed Charges,74% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,84,,,Percent of Total Billed Charges,84% of total billed charges,17.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.15,89,,,Percent of total Billed Charges,89% of total Billed charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,77,,,Percent of total Billed charges,77% of total billed charges,18.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,19.15,
Acamprosate DR 333mg Tablet,68462043518,CDM,250,RC,,,Outpatient,,,21.52,10.76,,16.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.92,74,,,Percent of Total Billed Charges,74% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,84,,,Percent of Total Billed Charges,84% of total billed charges,17.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.15,89,,,Percent of total Billed Charges,89% of total Billed charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,77,,,Percent of total Billed charges,77% of total billed charges,18.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,19.15,
Acamprosate DR 333mg Tablet,68462043518,CDM,250,RC,,,Outpatient,,,21.52,10.76,,16.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.92,74,,,Percent of Total Billed Charges,74% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,84,,,Percent of Total Billed Charges,84% of total billed charges,17.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.15,89,,,Percent of total Billed Charges,89% of total Billed charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,77,,,Percent of total Billed charges,77% of total billed charges,18.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,19.15,
Acamprosate DR 333mg Tablet,68462043518,CDM,250,RC,,,Outpatient,,,21.52,10.76,,16.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.92,74,,,Percent of Total Billed Charges,74% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,84,,,Percent of Total Billed Charges,84% of total billed charges,17.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.15,89,,,Percent of total Billed Charges,89% of total Billed charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,77,,,Percent of total Billed charges,77% of total billed charges,18.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,19.15,
Acamprosate DR 333mg Tablet,68462043518,CDM,250,RC,,,Outpatient,,,21.52,10.76,,16.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.92,74,,,Percent of Total Billed Charges,74% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14.85,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,84,,,Percent of Total Billed Charges,84% of total billed charges,17.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.15,89,,,Percent of total Billed Charges,89% of total Billed charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.57,77,,,Percent of total Billed charges,77% of total billed charges,18.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.38,19.15,
Acebutolol 200mg Capsule,53746066901,CDM,250,RC,,,Outpatient,,,18.23,9.12,,14.04,77,,,Percent of Total Billed Charges,77% of total billed charges,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.49,74,,,Percent of Total Billed Charges,74% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.31,84,,,Percent of Total Billed Charges,84% of total billed charges,14.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.22,89,,,Percent of total Billed Charges,89% of total Billed charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.04,77,,,Percent of total Billed charges,77% of total billed charges,15.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,16.22,
Acebutolol 200mg Capsule,53746066901,CDM,250,RC,,,Outpatient,,,18.23,9.12,,14.04,77,,,Percent of Total Billed Charges,77% of total billed charges,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.49,74,,,Percent of Total Billed Charges,74% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.31,84,,,Percent of Total Billed Charges,84% of total billed charges,14.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.22,89,,,Percent of total Billed Charges,89% of total Billed charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.04,77,,,Percent of total Billed charges,77% of total billed charges,15.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,16.22,
Acebutolol 200mg Capsule,53746066901,CDM,250,RC,,,Outpatient,,,18.23,9.12,,14.04,77,,,Percent of Total Billed Charges,77% of total billed charges,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.49,74,,,Percent of Total Billed Charges,74% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.31,84,,,Percent of Total Billed Charges,84% of total billed charges,14.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.22,89,,,Percent of total Billed Charges,89% of total Billed charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.04,77,,,Percent of total Billed charges,77% of total billed charges,15.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,16.22,
Acebutolol 200mg Capsule,53746066901,CDM,250,RC,,,Outpatient,,,18.23,9.12,,14.04,77,,,Percent of Total Billed Charges,77% of total billed charges,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.49,74,,,Percent of Total Billed Charges,74% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.31,84,,,Percent of Total Billed Charges,84% of total billed charges,14.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.22,89,,,Percent of total Billed Charges,89% of total Billed charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.04,77,,,Percent of total Billed charges,77% of total billed charges,15.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,16.22,
Acebutolol 200mg Capsule,53746066901,CDM,250,RC,,,Outpatient,,,18.23,9.12,,14.04,77,,,Percent of Total Billed Charges,77% of total billed charges,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.49,74,,,Percent of Total Billed Charges,74% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.31,84,,,Percent of Total Billed Charges,84% of total billed charges,14.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.22,89,,,Percent of total Billed Charges,89% of total Billed charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.04,77,,,Percent of total Billed charges,77% of total billed charges,15.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,16.22,
Acebutolol 200mg Capsule,53746066901,CDM,250,RC,,,Outpatient,,,18.23,9.12,,14.04,77,,,Percent of Total Billed Charges,77% of total billed charges,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.49,74,,,Percent of Total Billed Charges,74% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,12.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.31,84,,,Percent of Total Billed Charges,84% of total billed charges,14.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.22,89,,,Percent of total Billed Charges,89% of total Billed charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.04,77,,,Percent of total Billed charges,77% of total billed charges,15.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.56,16.22,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 1000mg/100ml IV Bag,63323043400,CDM,250,RC,,,Outpatient,,,179.11,89.56,,137.91,77,,,Percent of Total Billed Charges,77% of total billed charges,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.54,74,,,Percent of Total Billed Charges,74% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,123.59,69,,,Percent of Total Billed Charges,69% of total billed charges,150.45,84,,,Percent of Total Billed Charges,84% of total billed charges,146.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.41,89,,,Percent of total Billed Charges,89% of total Billed charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.91,77,,,Percent of total Billed charges,77% of total billed charges,152.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.78,159.41,
Acetaminophen 120mg Suppository,45802073230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 120mg Suppository,45802073230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 120mg Suppository,45802073230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 120mg Suppository,45802073230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 120mg Suppository,45802073230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 120mg Suppository,45802073230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 160mg/5ml Oral UDC,121065705,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 160mg/5ml Oral UDC,121065705,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 160mg/5ml Oral UDC,121065705,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 160mg/5ml Oral UDC,121065705,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 160mg/5ml Oral UDC,121065705,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 160mg/5ml Oral UDC,121065705,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen Chewable Tablet,904664524,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Acetaminophen Chewable Tablet,904664524,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Acetaminophen Chewable Tablet,904664524,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Acetaminophen Chewable Tablet,904664524,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Acetaminophen Chewable Tablet,904664524,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Acetaminophen Chewable Tablet,904664524,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Acetaminophen/Codeine 300/30mg Tablet,406048401,CDM,250,RC,,,Outpatient,,,18.42,9.21,,14.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.63,74,,,Percent of Total Billed Charges,74% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,15.47,84,,,Percent of Total Billed Charges,84% of total billed charges,15.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.39,89,,,Percent of total Billed Charges,89% of total Billed charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,77,,,Percent of total Billed charges,77% of total billed charges,15.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,16.39,
Acetaminophen/Codeine 300/30mg Tablet,406048401,CDM,250,RC,,,Outpatient,,,18.42,9.21,,14.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.63,74,,,Percent of Total Billed Charges,74% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,15.47,84,,,Percent of Total Billed Charges,84% of total billed charges,15.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.39,89,,,Percent of total Billed Charges,89% of total Billed charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,77,,,Percent of total Billed charges,77% of total billed charges,15.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,16.39,
Acetaminophen/Codeine 300/30mg Tablet,406048401,CDM,250,RC,,,Outpatient,,,18.42,9.21,,14.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.63,74,,,Percent of Total Billed Charges,74% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,15.47,84,,,Percent of Total Billed Charges,84% of total billed charges,15.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.39,89,,,Percent of total Billed Charges,89% of total Billed charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,77,,,Percent of total Billed charges,77% of total billed charges,15.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,16.39,
Acetaminophen/Codeine 300/30mg Tablet,406048401,CDM,250,RC,,,Outpatient,,,18.42,9.21,,14.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.63,74,,,Percent of Total Billed Charges,74% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,15.47,84,,,Percent of Total Billed Charges,84% of total billed charges,15.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.39,89,,,Percent of total Billed Charges,89% of total Billed charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,77,,,Percent of total Billed charges,77% of total billed charges,15.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,16.39,
Acetaminophen/Codeine 300/30mg Tablet,406048401,CDM,250,RC,,,Outpatient,,,18.42,9.21,,14.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.63,74,,,Percent of Total Billed Charges,74% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,15.47,84,,,Percent of Total Billed Charges,84% of total billed charges,15.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.39,89,,,Percent of total Billed Charges,89% of total Billed charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,77,,,Percent of total Billed charges,77% of total billed charges,15.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,16.39,
Acetaminophen/Codeine 300/30mg Tablet,406048401,CDM,250,RC,,,Outpatient,,,18.42,9.21,,14.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.63,74,,,Percent of Total Billed Charges,74% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12.71,69,,,Percent of Total Billed Charges,69% of total billed charges,15.47,84,,,Percent of Total Billed Charges,84% of total billed charges,15.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.39,89,,,Percent of total Billed Charges,89% of total Billed charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.18,77,,,Percent of total Billed charges,77% of total billed charges,15.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.61,16.39,
Acetylcysteine 20% 6000mg/30ml Neb Vial (PO Use),409330803,CDM,250,RC,,,Outpatient,,,120.39,60.2,,92.7,77,,,Percent of Total Billed Charges,77% of total billed charges,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.09,74,,,Percent of Total Billed Charges,74% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,101.13,84,,,Percent of Total Billed Charges,84% of total billed charges,98.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.15,89,,,Percent of total Billed Charges,89% of total Billed charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.7,77,,,Percent of total Billed charges,77% of total billed charges,102.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,107.15,
Acetylcysteine 20% 6000mg/30ml Neb Vial (PO Use),409330803,CDM,250,RC,,,Outpatient,,,120.39,60.2,,92.7,77,,,Percent of Total Billed Charges,77% of total billed charges,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.09,74,,,Percent of Total Billed Charges,74% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,101.13,84,,,Percent of Total Billed Charges,84% of total billed charges,98.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.15,89,,,Percent of total Billed Charges,89% of total Billed charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.7,77,,,Percent of total Billed charges,77% of total billed charges,102.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,107.15,
Acetylcysteine 20% 6000mg/30ml Neb Vial (PO Use),409330803,CDM,250,RC,,,Outpatient,,,120.39,60.2,,92.7,77,,,Percent of Total Billed Charges,77% of total billed charges,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.09,74,,,Percent of Total Billed Charges,74% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,101.13,84,,,Percent of Total Billed Charges,84% of total billed charges,98.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.15,89,,,Percent of total Billed Charges,89% of total Billed charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.7,77,,,Percent of total Billed charges,77% of total billed charges,102.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,107.15,
Acetylcysteine 20% 6000mg/30ml Neb Vial (PO Use),409330803,CDM,250,RC,,,Outpatient,,,120.39,60.2,,92.7,77,,,Percent of Total Billed Charges,77% of total billed charges,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.09,74,,,Percent of Total Billed Charges,74% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,101.13,84,,,Percent of Total Billed Charges,84% of total billed charges,98.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.15,89,,,Percent of total Billed Charges,89% of total Billed charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.7,77,,,Percent of total Billed charges,77% of total billed charges,102.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,107.15,
Acetylcysteine 20% 6000mg/30ml Neb Vial (PO Use),409330803,CDM,250,RC,,,Outpatient,,,120.39,60.2,,92.7,77,,,Percent of Total Billed Charges,77% of total billed charges,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.09,74,,,Percent of Total Billed Charges,74% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,101.13,84,,,Percent of Total Billed Charges,84% of total billed charges,98.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.15,89,,,Percent of total Billed Charges,89% of total Billed charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.7,77,,,Percent of total Billed charges,77% of total billed charges,102.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,107.15,
Acetylcysteine 20% 6000mg/30ml Neb Vial (PO Use),409330803,CDM,250,RC,,,Outpatient,,,120.39,60.2,,92.7,77,,,Percent of Total Billed Charges,77% of total billed charges,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.09,74,,,Percent of Total Billed Charges,74% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,69,,,Percent of Total Billed Charges,69% of total billed charges,101.13,84,,,Percent of Total Billed Charges,84% of total billed charges,98.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.15,89,,,Percent of total Billed Charges,89% of total Billed charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.7,77,,,Percent of total Billed charges,77% of total billed charges,102.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.1,107.15,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,962.02,481.01,,740.76,77,,,Percent of Total Billed Charges,77% of total billed charges,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,711.89,74,,,Percent of Total Billed Charges,74% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,808.1,84,,,Percent of Total Billed Charges,84% of total billed charges,788.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,856.2,89,,,Percent of total Billed Charges,89% of total Billed charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,740.76,77,,,Percent of total Billed charges,77% of total billed charges,817.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,481.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.51,856.2,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,1000.43,500.22,,770.33,77,,,Percent of Total Billed Charges,77% of total billed charges,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740.32,74,,,Percent of Total Billed Charges,74% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,840.36,84,,,Percent of Total Billed Charges,84% of total billed charges,820.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,890.38,89,,,Percent of total Billed Charges,89% of total Billed charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.33,77,,,Percent of total Billed charges,77% of total billed charges,850.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.11,890.38,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,962.02,481.01,,740.76,77,,,Percent of Total Billed Charges,77% of total billed charges,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,711.89,74,,,Percent of Total Billed Charges,74% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,808.1,84,,,Percent of Total Billed Charges,84% of total billed charges,788.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,856.2,89,,,Percent of total Billed Charges,89% of total Billed charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,740.76,77,,,Percent of total Billed charges,77% of total billed charges,817.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,481.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.51,856.2,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,1000.43,500.22,,770.33,77,,,Percent of Total Billed Charges,77% of total billed charges,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740.32,74,,,Percent of Total Billed Charges,74% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,840.36,84,,,Percent of Total Billed Charges,84% of total billed charges,820.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,890.38,89,,,Percent of total Billed Charges,89% of total Billed charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.33,77,,,Percent of total Billed charges,77% of total billed charges,850.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.11,890.38,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,962.02,481.01,,740.76,77,,,Percent of Total Billed Charges,77% of total billed charges,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,711.89,74,,,Percent of Total Billed Charges,74% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,808.1,84,,,Percent of Total Billed Charges,84% of total billed charges,788.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,856.2,89,,,Percent of total Billed Charges,89% of total Billed charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,740.76,77,,,Percent of total Billed charges,77% of total billed charges,817.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,481.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.51,856.2,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,1000.43,500.22,,770.33,77,,,Percent of Total Billed Charges,77% of total billed charges,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740.32,74,,,Percent of Total Billed Charges,74% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,840.36,84,,,Percent of Total Billed Charges,84% of total billed charges,820.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,890.38,89,,,Percent of total Billed Charges,89% of total Billed charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.33,77,,,Percent of total Billed charges,77% of total billed charges,850.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.11,890.38,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,962.02,481.01,,740.76,77,,,Percent of Total Billed Charges,77% of total billed charges,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,711.89,74,,,Percent of Total Billed Charges,74% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,808.1,84,,,Percent of Total Billed Charges,84% of total billed charges,788.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,856.2,89,,,Percent of total Billed Charges,89% of total Billed charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,740.76,77,,,Percent of total Billed charges,77% of total billed charges,817.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,481.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.51,856.2,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,1000.43,500.22,,770.33,77,,,Percent of Total Billed Charges,77% of total billed charges,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740.32,74,,,Percent of Total Billed Charges,74% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,840.36,84,,,Percent of Total Billed Charges,84% of total billed charges,820.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,890.38,89,,,Percent of total Billed Charges,89% of total Billed charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.33,77,,,Percent of total Billed charges,77% of total billed charges,850.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.11,890.38,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,962.02,481.01,,740.76,77,,,Percent of Total Billed Charges,77% of total billed charges,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,711.89,74,,,Percent of Total Billed Charges,74% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,808.1,84,,,Percent of Total Billed Charges,84% of total billed charges,788.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,856.2,89,,,Percent of total Billed Charges,89% of total Billed charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,740.76,77,,,Percent of total Billed charges,77% of total billed charges,817.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,481.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.51,856.2,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,1000.43,500.22,,770.33,77,,,Percent of Total Billed Charges,77% of total billed charges,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740.32,74,,,Percent of Total Billed Charges,74% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,840.36,84,,,Percent of Total Billed Charges,84% of total billed charges,820.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,890.38,89,,,Percent of total Billed Charges,89% of total Billed charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.33,77,,,Percent of total Billed charges,77% of total billed charges,850.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.11,890.38,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,962.02,481.01,,740.76,77,,,Percent of Total Billed Charges,77% of total billed charges,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,245.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,300.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,711.89,74,,,Percent of Total Billed Charges,74% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,663.79,69,,,Percent of Total Billed Charges,69% of total billed charges,808.1,84,,,Percent of Total Billed Charges,84% of total billed charges,788.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,856.2,89,,,Percent of total Billed Charges,89% of total Billed charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,740.76,77,,,Percent of total Billed charges,77% of total billed charges,817.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,276.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,481.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,392.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,856.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.51,856.2,
Acetylcysteine IV 6000mg/30ml SDV,66220020730,CDM,250,RC,,,Outpatient,,,1000.43,500.22,,770.33,77,,,Percent of Total Billed Charges,77% of total billed charges,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,255.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,312.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,740.32,74,,,Percent of Total Billed Charges,74% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,690.3,69,,,Percent of Total Billed Charges,69% of total billed charges,840.36,84,,,Percent of Total Billed Charges,84% of total billed charges,820.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,890.38,89,,,Percent of total Billed Charges,89% of total Billed charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,770.33,77,,,Percent of total Billed charges,77% of total billed charges,850.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,287.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,500.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,408.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,890.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.11,890.38,
acetaZOLAMIDE 250mg Tablet,51672402301,CDM,250,RC,,,Outpatient,,,32.03,16.02,,24.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.7,74,,,Percent of Total Billed Charges,74% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,84,,,Percent of Total Billed Charges,84% of total billed charges,26.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.51,89,,,Percent of total Billed Charges,89% of total Billed charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.66,77,,,Percent of total Billed charges,77% of total billed charges,27.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,28.51,
acetaZOLAMIDE 250mg Tablet,51672402301,CDM,250,RC,,,Outpatient,,,32.03,16.02,,24.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.7,74,,,Percent of Total Billed Charges,74% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,84,,,Percent of Total Billed Charges,84% of total billed charges,26.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.51,89,,,Percent of total Billed Charges,89% of total Billed charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.66,77,,,Percent of total Billed charges,77% of total billed charges,27.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,28.51,
acetaZOLAMIDE 250mg Tablet,51672402301,CDM,250,RC,,,Outpatient,,,32.03,16.02,,24.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.7,74,,,Percent of Total Billed Charges,74% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,84,,,Percent of Total Billed Charges,84% of total billed charges,26.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.51,89,,,Percent of total Billed Charges,89% of total Billed charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.66,77,,,Percent of total Billed charges,77% of total billed charges,27.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,28.51,
acetaZOLAMIDE 250mg Tablet,51672402301,CDM,250,RC,,,Outpatient,,,32.03,16.02,,24.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.7,74,,,Percent of Total Billed Charges,74% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,84,,,Percent of Total Billed Charges,84% of total billed charges,26.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.51,89,,,Percent of total Billed Charges,89% of total Billed charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.66,77,,,Percent of total Billed charges,77% of total billed charges,27.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,28.51,
acetaZOLAMIDE 250mg Tablet,51672402301,CDM,250,RC,,,Outpatient,,,32.03,16.02,,24.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.7,74,,,Percent of Total Billed Charges,74% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,84,,,Percent of Total Billed Charges,84% of total billed charges,26.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.51,89,,,Percent of total Billed Charges,89% of total Billed charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.66,77,,,Percent of total Billed charges,77% of total billed charges,27.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,28.51,
acetaZOLAMIDE 250mg Tablet,51672402301,CDM,250,RC,,,Outpatient,,,32.03,16.02,,24.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.7,74,,,Percent of Total Billed Charges,74% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,22.1,69,,,Percent of Total Billed Charges,69% of total billed charges,26.91,84,,,Percent of Total Billed Charges,84% of total billed charges,26.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,28.51,89,,,Percent of total Billed Charges,89% of total Billed charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.66,77,,,Percent of total Billed charges,77% of total billed charges,27.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.01,28.51,
Acetaminophen 325mg Suppository,51672211602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Suppository,51672211602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Suppository,51672211602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Suppository,51672211602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Suppository,51672211602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Suppository,51672211602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Tablet,10135012357,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Tablet,10135012357,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Tablet,10135012357,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Tablet,10135012357,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Tablet,10135012357,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 325mg Tablet,10135012357,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
acetaZOLAMIDE 500mg SDV,39822019001,CDM,250,RC,,,Outpatient,,,244.26,122.13,,188.08,77,,,Percent of Total Billed Charges,77% of total billed charges,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.75,74,,,Percent of Total Billed Charges,74% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,205.18,84,,,Percent of Total Billed Charges,84% of total billed charges,200.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.39,89,,,Percent of total Billed Charges,89% of total Billed charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.08,77,,,Percent of total Billed charges,77% of total billed charges,207.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,217.39,
acetaZOLAMIDE 500mg SDV,39822019001,CDM,250,RC,,,Outpatient,,,244.26,122.13,,188.08,77,,,Percent of Total Billed Charges,77% of total billed charges,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.75,74,,,Percent of Total Billed Charges,74% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,205.18,84,,,Percent of Total Billed Charges,84% of total billed charges,200.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.39,89,,,Percent of total Billed Charges,89% of total Billed charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.08,77,,,Percent of total Billed charges,77% of total billed charges,207.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,217.39,
acetaZOLAMIDE 500mg SDV,39822019001,CDM,250,RC,,,Outpatient,,,244.26,122.13,,188.08,77,,,Percent of Total Billed Charges,77% of total billed charges,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.75,74,,,Percent of Total Billed Charges,74% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,205.18,84,,,Percent of Total Billed Charges,84% of total billed charges,200.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.39,89,,,Percent of total Billed Charges,89% of total Billed charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.08,77,,,Percent of total Billed charges,77% of total billed charges,207.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,217.39,
acetaZOLAMIDE 500mg SDV,39822019001,CDM,250,RC,,,Outpatient,,,244.26,122.13,,188.08,77,,,Percent of Total Billed Charges,77% of total billed charges,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.75,74,,,Percent of Total Billed Charges,74% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,205.18,84,,,Percent of Total Billed Charges,84% of total billed charges,200.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.39,89,,,Percent of total Billed Charges,89% of total Billed charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.08,77,,,Percent of total Billed charges,77% of total billed charges,207.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,217.39,
acetaZOLAMIDE 500mg SDV,39822019001,CDM,250,RC,,,Outpatient,,,244.26,122.13,,188.08,77,,,Percent of Total Billed Charges,77% of total billed charges,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.75,74,,,Percent of Total Billed Charges,74% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,205.18,84,,,Percent of Total Billed Charges,84% of total billed charges,200.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.39,89,,,Percent of total Billed Charges,89% of total Billed charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.08,77,,,Percent of total Billed charges,77% of total billed charges,207.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,217.39,
acetaZOLAMIDE 500mg SDV,39822019001,CDM,250,RC,,,Outpatient,,,244.26,122.13,,188.08,77,,,Percent of Total Billed Charges,77% of total billed charges,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,180.75,74,,,Percent of Total Billed Charges,74% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,168.54,69,,,Percent of Total Billed Charges,69% of total billed charges,205.18,84,,,Percent of Total Billed Charges,84% of total billed charges,200.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,217.39,89,,,Percent of total Billed Charges,89% of total Billed charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.08,77,,,Percent of total Billed charges,77% of total billed charges,207.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.07,217.39,
Acetaminophen 650mg Suppository,45802073030,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 650mg Suppository,45802073030,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 650mg Suppository,45802073030,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 650mg Suppository,45802073030,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 650mg Suppository,45802073030,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 650mg Suppository,45802073030,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Activated Charcoal Pediatric 25gm/120ml Tube,,,250,RC,,,Outpatient,,,142.35,71.18,,109.61,77,,,Percent of Total Billed Charges,77% of total billed charges,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.34,74,,,Percent of Total Billed Charges,74% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,119.57,84,,,Percent of Total Billed Charges,84% of total billed charges,116.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.69,89,,,Percent of total Billed Charges,89% of total Billed charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.61,77,,,Percent of total Billed charges,77% of total billed charges,121,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,126.69,
Activated Charcoal Pediatric 25gm/120ml Tube,,,250,RC,,,Outpatient,,,142.35,71.18,,109.61,77,,,Percent of Total Billed Charges,77% of total billed charges,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.34,74,,,Percent of Total Billed Charges,74% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,119.57,84,,,Percent of Total Billed Charges,84% of total billed charges,116.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.69,89,,,Percent of total Billed Charges,89% of total Billed charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.61,77,,,Percent of total Billed charges,77% of total billed charges,121,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,126.69,
Activated Charcoal Pediatric 25gm/120ml Tube,,,250,RC,,,Outpatient,,,142.35,71.18,,109.61,77,,,Percent of Total Billed Charges,77% of total billed charges,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.34,74,,,Percent of Total Billed Charges,74% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,119.57,84,,,Percent of Total Billed Charges,84% of total billed charges,116.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.69,89,,,Percent of total Billed Charges,89% of total Billed charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.61,77,,,Percent of total Billed charges,77% of total billed charges,121,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,126.69,
Activated Charcoal Pediatric 25gm/120ml Tube,,,250,RC,,,Outpatient,,,142.35,71.18,,109.61,77,,,Percent of Total Billed Charges,77% of total billed charges,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.34,74,,,Percent of Total Billed Charges,74% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,119.57,84,,,Percent of Total Billed Charges,84% of total billed charges,116.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.69,89,,,Percent of total Billed Charges,89% of total Billed charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.61,77,,,Percent of total Billed charges,77% of total billed charges,121,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,126.69,
Activated Charcoal Pediatric 25gm/120ml Tube,,,250,RC,,,Outpatient,,,142.35,71.18,,109.61,77,,,Percent of Total Billed Charges,77% of total billed charges,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.34,74,,,Percent of Total Billed Charges,74% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,119.57,84,,,Percent of Total Billed Charges,84% of total billed charges,116.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.69,89,,,Percent of total Billed Charges,89% of total Billed charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.61,77,,,Percent of total Billed charges,77% of total billed charges,121,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,126.69,
Activated Charcoal Pediatric 25gm/120ml Tube,,,250,RC,,,Outpatient,,,142.35,71.18,,109.61,77,,,Percent of Total Billed Charges,77% of total billed charges,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.34,74,,,Percent of Total Billed Charges,74% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,98.22,69,,,Percent of Total Billed Charges,69% of total billed charges,119.57,84,,,Percent of Total Billed Charges,84% of total billed charges,116.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.69,89,,,Percent of total Billed Charges,89% of total Billed charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.61,77,,,Percent of total Billed charges,77% of total billed charges,121,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,126.69,
Acyclovir 5% Ointment 15gm,378870006,CDM,250,RC,,,Outpatient,,,1378.95,689.48,,1061.79,77,,,Percent of Total Billed Charges,77% of total billed charges,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1020.42,74,,,Percent of Total Billed Charges,74% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1130.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1227.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.79,77,,,Percent of total Billed charges,77% of total billed charges,1172.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,689.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.74,1227.27,
Acyclovir 5% Ointment 15gm,378870006,CDM,250,RC,,,Outpatient,,,1378.95,689.48,,1061.79,77,,,Percent of Total Billed Charges,77% of total billed charges,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1020.42,74,,,Percent of Total Billed Charges,74% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1130.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1227.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.79,77,,,Percent of total Billed charges,77% of total billed charges,1172.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,689.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.74,1227.27,
Acyclovir 5% Ointment 15gm,378870006,CDM,250,RC,,,Outpatient,,,1378.95,689.48,,1061.79,77,,,Percent of Total Billed Charges,77% of total billed charges,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1020.42,74,,,Percent of Total Billed Charges,74% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1130.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1227.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.79,77,,,Percent of total Billed charges,77% of total billed charges,1172.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,689.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.74,1227.27,
Acyclovir 5% Ointment 15gm,378870006,CDM,250,RC,,,Outpatient,,,1378.95,689.48,,1061.79,77,,,Percent of Total Billed Charges,77% of total billed charges,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1020.42,74,,,Percent of Total Billed Charges,74% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1130.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1227.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.79,77,,,Percent of total Billed charges,77% of total billed charges,1172.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,689.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.74,1227.27,
Acyclovir 5% Ointment 15gm,378870006,CDM,250,RC,,,Outpatient,,,1378.95,689.48,,1061.79,77,,,Percent of Total Billed Charges,77% of total billed charges,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1020.42,74,,,Percent of Total Billed Charges,74% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1130.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1227.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.79,77,,,Percent of total Billed charges,77% of total billed charges,1172.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,689.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.74,1227.27,
Acyclovir 5% Ointment 15gm,378870006,CDM,250,RC,,,Outpatient,,,1378.95,689.48,,1061.79,77,,,Percent of Total Billed Charges,77% of total billed charges,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,351.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,430.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1020.42,74,,,Percent of Total Billed Charges,74% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,951.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.32,84,,,Percent of Total Billed Charges,84% of total billed charges,1130.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1227.27,89,,,Percent of total Billed Charges,89% of total Billed charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.79,77,,,Percent of total Billed charges,77% of total billed charges,1172.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,396.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,689.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,562.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1227.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,344.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.74,1227.27,
Acyclovir 200mg/5ml Oral UDC,472008216,CDM,250,RC,,,Outpatient,,,46.47,23.24,,35.78,77,,,Percent of Total Billed Charges,77% of total billed charges,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.39,74,,,Percent of Total Billed Charges,74% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,39.03,84,,,Percent of Total Billed Charges,84% of total billed charges,38.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.36,89,,,Percent of total Billed Charges,89% of total Billed charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.78,77,,,Percent of total Billed charges,77% of total billed charges,39.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,41.36,
Acyclovir 200mg/5ml Oral UDC,472008216,CDM,250,RC,,,Outpatient,,,46.47,23.24,,35.78,77,,,Percent of Total Billed Charges,77% of total billed charges,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.39,74,,,Percent of Total Billed Charges,74% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,39.03,84,,,Percent of Total Billed Charges,84% of total billed charges,38.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.36,89,,,Percent of total Billed Charges,89% of total Billed charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.78,77,,,Percent of total Billed charges,77% of total billed charges,39.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,41.36,
Acyclovir 200mg/5ml Oral UDC,472008216,CDM,250,RC,,,Outpatient,,,46.47,23.24,,35.78,77,,,Percent of Total Billed Charges,77% of total billed charges,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.39,74,,,Percent of Total Billed Charges,74% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,39.03,84,,,Percent of Total Billed Charges,84% of total billed charges,38.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.36,89,,,Percent of total Billed Charges,89% of total Billed charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.78,77,,,Percent of total Billed charges,77% of total billed charges,39.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,41.36,
Acyclovir 200mg/5ml Oral UDC,472008216,CDM,250,RC,,,Outpatient,,,46.47,23.24,,35.78,77,,,Percent of Total Billed Charges,77% of total billed charges,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.39,74,,,Percent of Total Billed Charges,74% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,39.03,84,,,Percent of Total Billed Charges,84% of total billed charges,38.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.36,89,,,Percent of total Billed Charges,89% of total Billed charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.78,77,,,Percent of total Billed charges,77% of total billed charges,39.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,41.36,
Acyclovir 200mg/5ml Oral UDC,472008216,CDM,250,RC,,,Outpatient,,,46.47,23.24,,35.78,77,,,Percent of Total Billed Charges,77% of total billed charges,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.39,74,,,Percent of Total Billed Charges,74% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,39.03,84,,,Percent of Total Billed Charges,84% of total billed charges,38.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.36,89,,,Percent of total Billed Charges,89% of total Billed charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.78,77,,,Percent of total Billed charges,77% of total billed charges,39.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,41.36,
Acyclovir 200mg/5ml Oral UDC,472008216,CDM,250,RC,,,Outpatient,,,46.47,23.24,,35.78,77,,,Percent of Total Billed Charges,77% of total billed charges,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.39,74,,,Percent of Total Billed Charges,74% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,32.06,69,,,Percent of Total Billed Charges,69% of total billed charges,39.03,84,,,Percent of Total Billed Charges,84% of total billed charges,38.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.36,89,,,Percent of total Billed Charges,89% of total Billed charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.78,77,,,Percent of total Billed charges,77% of total billed charges,39.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.62,41.36,
Acyclovir 400mg Tablet,50268006115,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Acyclovir 400mg Tablet,50268006115,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Acyclovir 400mg Tablet,50268006115,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Acyclovir 400mg Tablet,50268006115,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Acyclovir 400mg Tablet,50268006115,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Acyclovir 400mg Tablet,50268006115,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Acyclovir 500mg/10ml SDV,63323032510,CDM,250,RC,,,Outpatient,,,161.91,80.96,,124.67,77,,,Percent of Total Billed Charges,77% of total billed charges,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.81,74,,,Percent of Total Billed Charges,74% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,111.72,69,,,Percent of Total Billed Charges,69% of total billed charges,136,84,,,Percent of Total Billed Charges,84% of total billed charges,132.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.1,89,,,Percent of total Billed Charges,89% of total Billed charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.67,77,,,Percent of total Billed charges,77% of total billed charges,137.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.48,144.1,
Adenosine 6mg/2ml SDV,72078003300,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Adenosine 6mg/2ml SDV,72078003300,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Adenosine 6mg/2ml SDV,72078003300,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Adenosine 6mg/2ml SDV,72078003300,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Adenosine 6mg/2ml SDV,72078003300,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Adenosine 6mg/2ml SDV,72078003300,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25667.04,12833.52,,19763.62,77,,,Percent of Total Billed Charges,77% of total billed charges,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8020.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18993.61,74,,,Percent of Total Billed Charges,74% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,21560.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22843.67,89,,,Percent of total Billed Charges,89% of total Billed charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19763.62,77,,,Percent of total Billed charges,77% of total billed charges,21816.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7379.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12833.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6416.76,22843.67,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25007.86,12503.93,,19256.05,77,,,Percent of Total Billed Charges,77% of total billed charges,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7814.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18505.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,21006.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22257,89,,,Percent of total Billed Charges,89% of total Billed charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19256.05,77,,,Percent of total Billed charges,77% of total billed charges,21256.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7189.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12503.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6251.97,22257,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25667.04,12833.52,,19763.62,77,,,Percent of Total Billed Charges,77% of total billed charges,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8020.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18993.61,74,,,Percent of Total Billed Charges,74% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,21560.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22843.67,89,,,Percent of total Billed Charges,89% of total Billed charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19763.62,77,,,Percent of total Billed charges,77% of total billed charges,21816.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7379.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12833.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6416.76,22843.67,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25007.86,12503.93,,19256.05,77,,,Percent of Total Billed Charges,77% of total billed charges,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7814.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18505.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,21006.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22257,89,,,Percent of total Billed Charges,89% of total Billed charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19256.05,77,,,Percent of total Billed charges,77% of total billed charges,21256.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7189.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12503.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6251.97,22257,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25667.04,12833.52,,19763.62,77,,,Percent of Total Billed Charges,77% of total billed charges,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8020.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18993.61,74,,,Percent of Total Billed Charges,74% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,21560.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22843.67,89,,,Percent of total Billed Charges,89% of total Billed charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19763.62,77,,,Percent of total Billed charges,77% of total billed charges,21816.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7379.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12833.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6416.76,22843.67,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25007.86,12503.93,,19256.05,77,,,Percent of Total Billed Charges,77% of total billed charges,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7814.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18505.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,21006.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22257,89,,,Percent of total Billed Charges,89% of total Billed charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19256.05,77,,,Percent of total Billed charges,77% of total billed charges,21256.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7189.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12503.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6251.97,22257,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25667.04,12833.52,,19763.62,77,,,Percent of Total Billed Charges,77% of total billed charges,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8020.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18993.61,74,,,Percent of Total Billed Charges,74% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,21560.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22843.67,89,,,Percent of total Billed Charges,89% of total Billed charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19763.62,77,,,Percent of total Billed charges,77% of total billed charges,21816.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7379.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12833.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6416.76,22843.67,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25007.86,12503.93,,19256.05,77,,,Percent of Total Billed Charges,77% of total billed charges,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7814.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18505.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,21006.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22257,89,,,Percent of total Billed Charges,89% of total Billed charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19256.05,77,,,Percent of total Billed charges,77% of total billed charges,21256.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7189.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12503.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6251.97,22257,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25667.04,12833.52,,19763.62,77,,,Percent of Total Billed Charges,77% of total billed charges,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8020.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18993.61,74,,,Percent of Total Billed Charges,74% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,21560.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22843.67,89,,,Percent of total Billed Charges,89% of total Billed charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19763.62,77,,,Percent of total Billed charges,77% of total billed charges,21816.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7379.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12833.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6416.76,22843.67,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25007.86,12503.93,,19256.05,77,,,Percent of Total Billed Charges,77% of total billed charges,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7814.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18505.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,21006.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22257,89,,,Percent of total Billed Charges,89% of total Billed charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19256.05,77,,,Percent of total Billed charges,77% of total billed charges,21256.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7189.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12503.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6251.97,22257,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25667.04,12833.52,,19763.62,77,,,Percent of Total Billed Charges,77% of total billed charges,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6545.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8020.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18993.61,74,,,Percent of Total Billed Charges,74% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,17710.26,69,,,Percent of Total Billed Charges,69% of total billed charges,21560.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22843.67,89,,,Percent of total Billed Charges,89% of total Billed charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19763.62,77,,,Percent of total Billed charges,77% of total billed charges,21816.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7379.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12833.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10472.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22843.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6416.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6416.76,22843.67,
ADO-Trastuzumab (Kadcyla) 100mg/5ml Powder SDV,50242008801,CDM,250,RC,,,Outpatient,,,25007.86,12503.93,,19256.05,77,,,Percent of Total Billed Charges,77% of total billed charges,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6377,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7814.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18505.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,17255.42,69,,,Percent of Total Billed Charges,69% of total billed charges,21006.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22257,89,,,Percent of total Billed Charges,89% of total Billed charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19256.05,77,,,Percent of total Billed charges,77% of total billed charges,21256.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7189.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12503.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10203.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22257,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6251.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6251.97,22257,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,30016.82,15008.41,,23112.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9380.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22212.45,74,,,Percent of Total Billed Charges,74% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,25214.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26714.97,89,,,Percent of total Billed Charges,89% of total Billed charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23112.95,77,,,Percent of total Billed charges,77% of total billed charges,25514.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8629.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15008.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7504.21,26714.97,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,29245.15,14622.58,,22518.77,77,,,Percent of Total Billed Charges,77% of total billed charges,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9139.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21641.41,74,,,Percent of Total Billed Charges,74% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24565.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26028.18,89,,,Percent of total Billed Charges,89% of total Billed charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22518.77,77,,,Percent of total Billed charges,77% of total billed charges,24858.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8407.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14622.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.29,26028.18,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,30016.82,15008.41,,23112.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9380.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22212.45,74,,,Percent of Total Billed Charges,74% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,25214.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26714.97,89,,,Percent of total Billed Charges,89% of total Billed charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23112.95,77,,,Percent of total Billed charges,77% of total billed charges,25514.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8629.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15008.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7504.21,26714.97,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,29245.15,14622.58,,22518.77,77,,,Percent of Total Billed Charges,77% of total billed charges,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9139.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21641.41,74,,,Percent of Total Billed Charges,74% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24565.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26028.18,89,,,Percent of total Billed Charges,89% of total Billed charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22518.77,77,,,Percent of total Billed charges,77% of total billed charges,24858.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8407.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14622.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.29,26028.18,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,30016.82,15008.41,,23112.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9380.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22212.45,74,,,Percent of Total Billed Charges,74% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,25214.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26714.97,89,,,Percent of total Billed Charges,89% of total Billed charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23112.95,77,,,Percent of total Billed charges,77% of total billed charges,25514.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8629.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15008.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7504.21,26714.97,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,29245.15,14622.58,,22518.77,77,,,Percent of Total Billed Charges,77% of total billed charges,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9139.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21641.41,74,,,Percent of Total Billed Charges,74% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24565.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26028.18,89,,,Percent of total Billed Charges,89% of total Billed charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22518.77,77,,,Percent of total Billed charges,77% of total billed charges,24858.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8407.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14622.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.29,26028.18,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,30016.82,15008.41,,23112.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9380.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22212.45,74,,,Percent of Total Billed Charges,74% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,25214.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26714.97,89,,,Percent of total Billed Charges,89% of total Billed charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23112.95,77,,,Percent of total Billed charges,77% of total billed charges,25514.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8629.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15008.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7504.21,26714.97,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,29245.15,14622.58,,22518.77,77,,,Percent of Total Billed Charges,77% of total billed charges,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9139.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21641.41,74,,,Percent of Total Billed Charges,74% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24565.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26028.18,89,,,Percent of total Billed Charges,89% of total Billed charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22518.77,77,,,Percent of total Billed charges,77% of total billed charges,24858.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8407.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14622.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.29,26028.18,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,30016.82,15008.41,,23112.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9380.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22212.45,74,,,Percent of Total Billed Charges,74% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,25214.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26714.97,89,,,Percent of total Billed Charges,89% of total Billed charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23112.95,77,,,Percent of total Billed charges,77% of total billed charges,25514.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8629.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15008.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7504.21,26714.97,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,29245.15,14622.58,,22518.77,77,,,Percent of Total Billed Charges,77% of total billed charges,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9139.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21641.41,74,,,Percent of Total Billed Charges,74% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24565.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26028.18,89,,,Percent of total Billed Charges,89% of total Billed charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22518.77,77,,,Percent of total Billed charges,77% of total billed charges,24858.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8407.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14622.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.29,26028.18,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,30016.82,15008.41,,23112.95,77,,,Percent of Total Billed Charges,77% of total billed charges,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7654.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9380.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22212.45,74,,,Percent of Total Billed Charges,74% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,20711.61,69,,,Percent of Total Billed Charges,69% of total billed charges,25214.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26714.97,89,,,Percent of total Billed Charges,89% of total Billed charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23112.95,77,,,Percent of total Billed charges,77% of total billed charges,25514.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8629.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15008.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12246.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26714.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7504.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7504.21,26714.97,
ADO-Trastuzumab (Kadcyla) 160mg/8ml Powder SDV,50242008701,CDM,250,RC,,,Outpatient,,,29245.15,14622.58,,22518.77,77,,,Percent of Total Billed Charges,77% of total billed charges,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7457.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9139.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21641.41,74,,,Percent of Total Billed Charges,74% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20179.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24565.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26028.18,89,,,Percent of total Billed Charges,89% of total Billed charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22518.77,77,,,Percent of total Billed charges,77% of total billed charges,24858.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8407.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14622.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11932.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26028.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.29,26028.18,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,35517.72,17758.86,,27348.64,77,,,Percent of Total Billed Charges,77% of total billed charges,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11099.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26283.11,74,,,Percent of Total Billed Charges,74% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,29834.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31610.77,89,,,Percent of total Billed Charges,89% of total Billed charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27348.64,77,,,Percent of total Billed charges,77% of total billed charges,30190.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10211.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17758.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8879.43,31610.77,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,34603.03,17301.52,,26644.33,77,,,Percent of Total Billed Charges,77% of total billed charges,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10813.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25606.24,74,,,Percent of Total Billed Charges,74% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,29066.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30796.7,89,,,Percent of total Billed Charges,89% of total Billed charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26644.33,77,,,Percent of total Billed charges,77% of total billed charges,29412.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9948.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17301.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8650.76,30796.7,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,35517.72,17758.86,,27348.64,77,,,Percent of Total Billed Charges,77% of total billed charges,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11099.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26283.11,74,,,Percent of Total Billed Charges,74% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,29834.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31610.77,89,,,Percent of total Billed Charges,89% of total Billed charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27348.64,77,,,Percent of total Billed charges,77% of total billed charges,30190.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10211.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17758.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8879.43,31610.77,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,34603.03,17301.52,,26644.33,77,,,Percent of Total Billed Charges,77% of total billed charges,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10813.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25606.24,74,,,Percent of Total Billed Charges,74% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,29066.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30796.7,89,,,Percent of total Billed Charges,89% of total Billed charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26644.33,77,,,Percent of total Billed charges,77% of total billed charges,29412.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9948.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17301.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8650.76,30796.7,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,35517.72,17758.86,,27348.64,77,,,Percent of Total Billed Charges,77% of total billed charges,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11099.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26283.11,74,,,Percent of Total Billed Charges,74% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,29834.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31610.77,89,,,Percent of total Billed Charges,89% of total Billed charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27348.64,77,,,Percent of total Billed charges,77% of total billed charges,30190.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10211.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17758.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8879.43,31610.77,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,34603.03,17301.52,,26644.33,77,,,Percent of Total Billed Charges,77% of total billed charges,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10813.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25606.24,74,,,Percent of Total Billed Charges,74% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,29066.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30796.7,89,,,Percent of total Billed Charges,89% of total Billed charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26644.33,77,,,Percent of total Billed charges,77% of total billed charges,29412.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9948.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17301.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8650.76,30796.7,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,35517.72,17758.86,,27348.64,77,,,Percent of Total Billed Charges,77% of total billed charges,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11099.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26283.11,74,,,Percent of Total Billed Charges,74% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,29834.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31610.77,89,,,Percent of total Billed Charges,89% of total Billed charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27348.64,77,,,Percent of total Billed charges,77% of total billed charges,30190.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10211.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17758.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8879.43,31610.77,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,34603.03,17301.52,,26644.33,77,,,Percent of Total Billed Charges,77% of total billed charges,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10813.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25606.24,74,,,Percent of Total Billed Charges,74% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,29066.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30796.7,89,,,Percent of total Billed Charges,89% of total Billed charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26644.33,77,,,Percent of total Billed charges,77% of total billed charges,29412.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9948.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17301.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8650.76,30796.7,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,35517.72,17758.86,,27348.64,77,,,Percent of Total Billed Charges,77% of total billed charges,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11099.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26283.11,74,,,Percent of Total Billed Charges,74% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,29834.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31610.77,89,,,Percent of total Billed Charges,89% of total Billed charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27348.64,77,,,Percent of total Billed charges,77% of total billed charges,30190.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10211.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17758.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8879.43,31610.77,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,34603.03,17301.52,,26644.33,77,,,Percent of Total Billed Charges,77% of total billed charges,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10813.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25606.24,74,,,Percent of Total Billed Charges,74% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,29066.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30796.7,89,,,Percent of total Billed Charges,89% of total Billed charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26644.33,77,,,Percent of total Billed charges,77% of total billed charges,29412.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9948.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17301.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8650.76,30796.7,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,35517.72,17758.86,,27348.64,77,,,Percent of Total Billed Charges,77% of total billed charges,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9057.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11099.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26283.11,74,,,Percent of Total Billed Charges,74% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,24507.23,69,,,Percent of Total Billed Charges,69% of total billed charges,29834.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31610.77,89,,,Percent of total Billed Charges,89% of total Billed charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27348.64,77,,,Percent of total Billed charges,77% of total billed charges,30190.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10211.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17758.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14491.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31610.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8879.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8879.43,31610.77,
Agalsidase Beta (Fabrazyme) 35mg/7ml Powder SDV,58468004001,CDM,250,RC,,,Outpatient,,,34603.03,17301.52,,26644.33,77,,,Percent of Total Billed Charges,77% of total billed charges,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8823.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10813.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25606.24,74,,,Percent of Total Billed Charges,74% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,23876.09,69,,,Percent of Total Billed Charges,69% of total billed charges,29066.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30796.7,89,,,Percent of total Billed Charges,89% of total Billed charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26644.33,77,,,Percent of total Billed charges,77% of total billed charges,29412.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9948.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17301.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14118.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30796.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8650.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8650.76,30796.7,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5201.24,2600.62,,4004.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3848.92,74,,,Percent of Total Billed Charges,74% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,4369.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4265.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4629.1,89,,,Percent of total Billed Charges,89% of total Billed charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4004.95,77,,,Percent of total Billed charges,77% of total billed charges,4421.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2600.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.31,4629.1,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5070.59,2535.3,,3904.35,77,,,Percent of Total Billed Charges,77% of total billed charges,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3752.24,74,,,Percent of Total Billed Charges,74% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4259.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4157.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4512.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3904.35,77,,,Percent of total Billed charges,77% of total billed charges,4310,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.65,4512.83,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5201.24,2600.62,,4004.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3848.92,74,,,Percent of Total Billed Charges,74% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,4369.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4265.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4629.1,89,,,Percent of total Billed Charges,89% of total Billed charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4004.95,77,,,Percent of total Billed charges,77% of total billed charges,4421.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2600.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.31,4629.1,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5070.59,2535.3,,3904.35,77,,,Percent of Total Billed Charges,77% of total billed charges,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3752.24,74,,,Percent of Total Billed Charges,74% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4259.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4157.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4512.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3904.35,77,,,Percent of total Billed charges,77% of total billed charges,4310,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.65,4512.83,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5201.24,2600.62,,4004.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3848.92,74,,,Percent of Total Billed Charges,74% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,4369.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4265.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4629.1,89,,,Percent of total Billed Charges,89% of total Billed charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4004.95,77,,,Percent of total Billed charges,77% of total billed charges,4421.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2600.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.31,4629.1,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5070.59,2535.3,,3904.35,77,,,Percent of Total Billed Charges,77% of total billed charges,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3752.24,74,,,Percent of Total Billed Charges,74% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4259.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4157.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4512.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3904.35,77,,,Percent of total Billed charges,77% of total billed charges,4310,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.65,4512.83,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5201.24,2600.62,,4004.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3848.92,74,,,Percent of Total Billed Charges,74% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,4369.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4265.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4629.1,89,,,Percent of total Billed Charges,89% of total Billed charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4004.95,77,,,Percent of total Billed charges,77% of total billed charges,4421.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2600.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.31,4629.1,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5070.59,2535.3,,3904.35,77,,,Percent of Total Billed Charges,77% of total billed charges,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3752.24,74,,,Percent of Total Billed Charges,74% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4259.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4157.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4512.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3904.35,77,,,Percent of total Billed charges,77% of total billed charges,4310,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.65,4512.83,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5201.24,2600.62,,4004.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3848.92,74,,,Percent of Total Billed Charges,74% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,4369.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4265.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4629.1,89,,,Percent of total Billed Charges,89% of total Billed charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4004.95,77,,,Percent of total Billed charges,77% of total billed charges,4421.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2600.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.31,4629.1,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5070.59,2535.3,,3904.35,77,,,Percent of Total Billed Charges,77% of total billed charges,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3752.24,74,,,Percent of Total Billed Charges,74% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4259.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4157.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4512.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3904.35,77,,,Percent of total Billed charges,77% of total billed charges,4310,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.65,4512.83,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5201.24,2600.62,,4004.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3848.92,74,,,Percent of Total Billed Charges,74% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.86,69,,,Percent of Total Billed Charges,69% of total billed charges,4369.04,84,,,Percent of Total Billed Charges,84% of total billed charges,4265.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4629.1,89,,,Percent of total Billed Charges,89% of total Billed charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4004.95,77,,,Percent of total Billed charges,77% of total billed charges,4421.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2600.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4629.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.31,4629.1,
Agalsidase Beta (Fabrazyme) 5mg/ml Powder SDV,58468004101,CDM,250,RC,,,Outpatient,,,5070.59,2535.3,,3904.35,77,,,Percent of Total Billed Charges,77% of total billed charges,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1293,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1584.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3752.24,74,,,Percent of Total Billed Charges,74% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3498.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4259.3,84,,,Percent of Total Billed Charges,84% of total billed charges,4157.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4512.83,89,,,Percent of total Billed Charges,89% of total Billed charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3904.35,77,,,Percent of total Billed charges,77% of total billed charges,4310,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1457.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2535.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2068.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4512.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1267.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1267.65,4512.83,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albumin-25% 12.5gm/50ml IV Bag,944049301,CDM,250,RC,,,Outpatient,,,497.65,248.83,,383.19,77,,,Percent of Total Billed Charges,77% of total billed charges,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,126.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,155.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,368.26,74,,,Percent of Total Billed Charges,74% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,343.38,69,,,Percent of Total Billed Charges,69% of total billed charges,418.03,84,,,Percent of Total Billed Charges,84% of total billed charges,408.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,442.91,89,,,Percent of total Billed Charges,89% of total Billed charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.19,77,,,Percent of total Billed charges,77% of total billed charges,423,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,143.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,248.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,203.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,442.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.41,442.91,
Albuterol HFA 8.5gm Inhaler,68180096301,CDM,250,RC,,,Outpatient,,,260.01,130.01,,200.21,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.41,74,,,Percent of Total Billed Charges,74% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,218.41,84,,,Percent of Total Billed Charges,84% of total billed charges,213.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.41,89,,,Percent of total Billed Charges,89% of total Billed charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.21,77,,,Percent of total Billed charges,77% of total billed charges,221.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.41,
Albuterol HFA 8.5gm Inhaler,68180096301,CDM,250,RC,,,Outpatient,,,260.01,130.01,,200.21,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.41,74,,,Percent of Total Billed Charges,74% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,218.41,84,,,Percent of Total Billed Charges,84% of total billed charges,213.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.41,89,,,Percent of total Billed Charges,89% of total Billed charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.21,77,,,Percent of total Billed charges,77% of total billed charges,221.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.41,
Albuterol HFA 8.5gm Inhaler,68180096301,CDM,250,RC,,,Outpatient,,,260.01,130.01,,200.21,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.41,74,,,Percent of Total Billed Charges,74% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,218.41,84,,,Percent of Total Billed Charges,84% of total billed charges,213.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.41,89,,,Percent of total Billed Charges,89% of total Billed charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.21,77,,,Percent of total Billed charges,77% of total billed charges,221.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.41,
Albuterol HFA 8.5gm Inhaler,68180096301,CDM,250,RC,,,Outpatient,,,260.01,130.01,,200.21,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.41,74,,,Percent of Total Billed Charges,74% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,218.41,84,,,Percent of Total Billed Charges,84% of total billed charges,213.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.41,89,,,Percent of total Billed Charges,89% of total Billed charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.21,77,,,Percent of total Billed charges,77% of total billed charges,221.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.41,
Albuterol HFA 8.5gm Inhaler,68180096301,CDM,250,RC,,,Outpatient,,,260.01,130.01,,200.21,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.41,74,,,Percent of Total Billed Charges,74% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,218.41,84,,,Percent of Total Billed Charges,84% of total billed charges,213.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.41,89,,,Percent of total Billed Charges,89% of total Billed charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.21,77,,,Percent of total Billed charges,77% of total billed charges,221.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.41,
Albuterol HFA 8.5gm Inhaler,68180096301,CDM,250,RC,,,Outpatient,,,260.01,130.01,,200.21,77,,,Percent of Total Billed Charges,77% of total billed charges,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,192.41,74,,,Percent of Total Billed Charges,74% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,179.41,69,,,Percent of Total Billed Charges,69% of total billed charges,218.41,84,,,Percent of Total Billed Charges,84% of total billed charges,213.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,231.41,89,,,Percent of total Billed Charges,89% of total Billed charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.21,77,,,Percent of total Billed charges,77% of total billed charges,221.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,130.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,106.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,231.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65,231.41,
Albuterol HFA Per Gram Inhaler,,,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Albuterol HFA Per Gram Inhaler,,,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Albuterol HFA Per Gram Inhaler,,,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Albuterol HFA Per Gram Inhaler,,,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Albuterol HFA Per Gram Inhaler,,,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Albuterol HFA Per Gram Inhaler,,,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Alcohol 95% PO Liquid 100ml Bottle,1.00E+12,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Alcohol 95% PO Liquid 100ml Bottle,1.00E+12,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Alcohol 95% PO Liquid 100ml Bottle,1.00E+12,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Alcohol 95% PO Liquid 100ml Bottle,1.00E+12,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Alcohol 95% PO Liquid 100ml Bottle,1.00E+12,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Alcohol 95% PO Liquid 100ml Bottle,1.00E+12,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Allopurinol 100mg Tablet,378013701,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Allopurinol 100mg Tablet,378013701,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Allopurinol 100mg Tablet,378013701,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Allopurinol 100mg Tablet,378013701,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Allopurinol 100mg Tablet,378013701,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Allopurinol 100mg Tablet,378013701,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Allopurinol 300mg Tablet,51079020620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Allopurinol 300mg Tablet,51079020620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Allopurinol 300mg Tablet,51079020620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Allopurinol 300mg Tablet,51079020620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Allopurinol 300mg Tablet,51079020620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Allopurinol 300mg Tablet,51079020620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
ALPRAZolam 0.25mg Tablet,51079078820,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
ALPRAZolam 0.25mg Tablet,51079078820,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
ALPRAZolam 0.25mg Tablet,51079078820,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
ALPRAZolam 0.25mg Tablet,51079078820,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
ALPRAZolam 0.25mg Tablet,51079078820,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
ALPRAZolam 0.25mg Tablet,51079078820,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
ALPRAZolam 0.5mg Tablet,,,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
ALPRAZolam 0.5mg Tablet,,,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
ALPRAZolam 0.5mg Tablet,,,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
ALPRAZolam 0.5mg Tablet,,,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
ALPRAZolam 0.5mg Tablet,,,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
ALPRAZolam 0.5mg Tablet,,,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,724.2,362.1,,557.63,77,,,Percent of Total Billed Charges,77% of total billed charges,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.91,74,,,Percent of Total Billed Charges,74% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,608.33,84,,,Percent of Total Billed Charges,84% of total billed charges,593.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,644.54,89,,,Percent of total Billed Charges,89% of total Billed charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.63,77,,,Percent of total Billed charges,77% of total billed charges,615.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,362.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.05,644.54,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,752.7,376.35,,579.58,77,,,Percent of Total Billed Charges,77% of total billed charges,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557,74,,,Percent of Total Billed Charges,74% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,632.27,84,,,Percent of Total Billed Charges,84% of total billed charges,617.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,669.9,89,,,Percent of total Billed Charges,89% of total Billed charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.58,77,,,Percent of total Billed charges,77% of total billed charges,639.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.18,669.9,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,724.2,362.1,,557.63,77,,,Percent of Total Billed Charges,77% of total billed charges,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.91,74,,,Percent of Total Billed Charges,74% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,608.33,84,,,Percent of Total Billed Charges,84% of total billed charges,593.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,644.54,89,,,Percent of total Billed Charges,89% of total Billed charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.63,77,,,Percent of total Billed charges,77% of total billed charges,615.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,362.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.05,644.54,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,752.7,376.35,,579.58,77,,,Percent of Total Billed Charges,77% of total billed charges,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557,74,,,Percent of Total Billed Charges,74% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,632.27,84,,,Percent of Total Billed Charges,84% of total billed charges,617.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,669.9,89,,,Percent of total Billed Charges,89% of total Billed charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.58,77,,,Percent of total Billed charges,77% of total billed charges,639.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.18,669.9,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,724.2,362.1,,557.63,77,,,Percent of Total Billed Charges,77% of total billed charges,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.91,74,,,Percent of Total Billed Charges,74% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,608.33,84,,,Percent of Total Billed Charges,84% of total billed charges,593.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,644.54,89,,,Percent of total Billed Charges,89% of total Billed charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.63,77,,,Percent of total Billed charges,77% of total billed charges,615.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,362.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.05,644.54,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,752.7,376.35,,579.58,77,,,Percent of Total Billed Charges,77% of total billed charges,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557,74,,,Percent of Total Billed Charges,74% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,632.27,84,,,Percent of Total Billed Charges,84% of total billed charges,617.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,669.9,89,,,Percent of total Billed Charges,89% of total Billed charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.58,77,,,Percent of total Billed charges,77% of total billed charges,639.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.18,669.9,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,724.2,362.1,,557.63,77,,,Percent of Total Billed Charges,77% of total billed charges,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.91,74,,,Percent of Total Billed Charges,74% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,608.33,84,,,Percent of Total Billed Charges,84% of total billed charges,593.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,644.54,89,,,Percent of total Billed Charges,89% of total Billed charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.63,77,,,Percent of total Billed charges,77% of total billed charges,615.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,362.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.05,644.54,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,752.7,376.35,,579.58,77,,,Percent of Total Billed Charges,77% of total billed charges,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557,74,,,Percent of Total Billed Charges,74% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,632.27,84,,,Percent of Total Billed Charges,84% of total billed charges,617.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,669.9,89,,,Percent of total Billed Charges,89% of total Billed charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.58,77,,,Percent of total Billed charges,77% of total billed charges,639.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.18,669.9,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,724.2,362.1,,557.63,77,,,Percent of Total Billed Charges,77% of total billed charges,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.91,74,,,Percent of Total Billed Charges,74% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,608.33,84,,,Percent of Total Billed Charges,84% of total billed charges,593.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,644.54,89,,,Percent of total Billed Charges,89% of total Billed charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.63,77,,,Percent of total Billed charges,77% of total billed charges,615.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,362.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.05,644.54,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,752.7,376.35,,579.58,77,,,Percent of Total Billed Charges,77% of total billed charges,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557,74,,,Percent of Total Billed Charges,74% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,632.27,84,,,Percent of Total Billed Charges,84% of total billed charges,617.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,669.9,89,,,Percent of total Billed Charges,89% of total Billed charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.58,77,,,Percent of total Billed charges,77% of total billed charges,639.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.18,669.9,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,724.2,362.1,,557.63,77,,,Percent of Total Billed Charges,77% of total billed charges,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,535.91,74,,,Percent of Total Billed Charges,74% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,499.7,69,,,Percent of Total Billed Charges,69% of total billed charges,608.33,84,,,Percent of Total Billed Charges,84% of total billed charges,593.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,644.54,89,,,Percent of total Billed Charges,89% of total Billed charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,557.63,77,,,Percent of total Billed charges,77% of total billed charges,615.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,208.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,362.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,295.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,644.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.05,644.54,
Alprostadil IV (Prostin VR) 500mcg/ml Ampule,9021505,CDM,250,RC,,,Outpatient,,,752.7,376.35,,579.58,77,,,Percent of Total Billed Charges,77% of total billed charges,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,191.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,557,74,,,Percent of Total Billed Charges,74% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,519.36,69,,,Percent of Total Billed Charges,69% of total billed charges,632.27,84,,,Percent of Total Billed Charges,84% of total billed charges,617.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,669.9,89,,,Percent of total Billed Charges,89% of total Billed charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,579.58,77,,,Percent of total Billed charges,77% of total billed charges,639.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,376.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.18,669.9,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,39240.32,19620.16,,30215.05,77,,,Percent of Total Billed Charges,77% of total billed charges,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12262.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29037.84,74,,,Percent of Total Billed Charges,74% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32961.87,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34923.88,89,,,Percent of total Billed Charges,89% of total Billed charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30215.05,77,,,Percent of total Billed charges,77% of total billed charges,33354.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11281.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19620.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9810.08,34923.88,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,37784.81,18892.41,,29094.3,77,,,Percent of Total Billed Charges,77% of total billed charges,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11807.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27960.76,74,,,Percent of Total Billed Charges,74% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,31739.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,33628.48,89,,,Percent of total Billed Charges,89% of total Billed charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29094.3,77,,,Percent of total Billed charges,77% of total billed charges,32117.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10863.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18892.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9446.2,33628.48,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,39240.32,19620.16,,30215.05,77,,,Percent of Total Billed Charges,77% of total billed charges,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12262.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29037.84,74,,,Percent of Total Billed Charges,74% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32961.87,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34923.88,89,,,Percent of total Billed Charges,89% of total Billed charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30215.05,77,,,Percent of total Billed charges,77% of total billed charges,33354.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11281.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19620.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9810.08,34923.88,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,37784.81,18892.41,,29094.3,77,,,Percent of Total Billed Charges,77% of total billed charges,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11807.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27960.76,74,,,Percent of Total Billed Charges,74% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,31739.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,33628.48,89,,,Percent of total Billed Charges,89% of total Billed charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29094.3,77,,,Percent of total Billed charges,77% of total billed charges,32117.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10863.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18892.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9446.2,33628.48,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,39240.32,19620.16,,30215.05,77,,,Percent of Total Billed Charges,77% of total billed charges,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12262.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29037.84,74,,,Percent of Total Billed Charges,74% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32961.87,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34923.88,89,,,Percent of total Billed Charges,89% of total Billed charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30215.05,77,,,Percent of total Billed charges,77% of total billed charges,33354.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11281.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19620.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9810.08,34923.88,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,37784.81,18892.41,,29094.3,77,,,Percent of Total Billed Charges,77% of total billed charges,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11807.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27960.76,74,,,Percent of Total Billed Charges,74% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,31739.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,33628.48,89,,,Percent of total Billed Charges,89% of total Billed charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29094.3,77,,,Percent of total Billed charges,77% of total billed charges,32117.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10863.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18892.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9446.2,33628.48,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,39240.32,19620.16,,30215.05,77,,,Percent of Total Billed Charges,77% of total billed charges,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12262.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29037.84,74,,,Percent of Total Billed Charges,74% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32961.87,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34923.88,89,,,Percent of total Billed Charges,89% of total Billed charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30215.05,77,,,Percent of total Billed charges,77% of total billed charges,33354.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11281.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19620.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9810.08,34923.88,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,37784.81,18892.41,,29094.3,77,,,Percent of Total Billed Charges,77% of total billed charges,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11807.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27960.76,74,,,Percent of Total Billed Charges,74% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,31739.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,33628.48,89,,,Percent of total Billed Charges,89% of total Billed charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29094.3,77,,,Percent of total Billed charges,77% of total billed charges,32117.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10863.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18892.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9446.2,33628.48,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,39240.32,19620.16,,30215.05,77,,,Percent of Total Billed Charges,77% of total billed charges,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12262.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29037.84,74,,,Percent of Total Billed Charges,74% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32961.87,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34923.88,89,,,Percent of total Billed Charges,89% of total Billed charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30215.05,77,,,Percent of total Billed charges,77% of total billed charges,33354.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11281.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19620.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9810.08,34923.88,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,37784.81,18892.41,,29094.3,77,,,Percent of Total Billed Charges,77% of total billed charges,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11807.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27960.76,74,,,Percent of Total Billed Charges,74% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,31739.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,33628.48,89,,,Percent of total Billed Charges,89% of total Billed charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29094.3,77,,,Percent of total Billed charges,77% of total billed charges,32117.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10863.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18892.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9446.2,33628.48,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,39240.32,19620.16,,30215.05,77,,,Percent of Total Billed Charges,77% of total billed charges,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10006.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12262.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29037.84,74,,,Percent of Total Billed Charges,74% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,27075.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32961.87,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34923.88,89,,,Percent of total Billed Charges,89% of total Billed charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30215.05,77,,,Percent of total Billed charges,77% of total billed charges,33354.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11281.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19620.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16010.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34923.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9810.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9810.08,34923.88,
Alteplase (Activase) 100mg/100ml SDV,50242008527,CDM,250,RC,,,Outpatient,,,37784.81,18892.41,,29094.3,77,,,Percent of Total Billed Charges,77% of total billed charges,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9635.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11807.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27960.76,74,,,Percent of Total Billed Charges,74% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,26071.52,69,,,Percent of Total Billed Charges,69% of total billed charges,31739.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,33628.48,89,,,Percent of total Billed Charges,89% of total Billed charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29094.3,77,,,Percent of total Billed charges,77% of total billed charges,32117.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10863.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18892.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15416.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33628.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9446.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9446.2,33628.48,
Alteplase (Cathflo) 2mg SDV,50242004164,CDM,250,RC,,,Outpatient,,,825.53,412.77,,635.66,77,,,Percent of Total Billed Charges,77% of total billed charges,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.89,74,,,Percent of Total Billed Charges,74% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,693.45,84,,,Percent of Total Billed Charges,84% of total billed charges,676.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,734.72,89,,,Percent of total Billed Charges,89% of total Billed charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.66,77,,,Percent of total Billed charges,77% of total billed charges,701.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,412.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.38,734.72,
Alteplase (Cathflo) 2mg SDV,50242004164,CDM,250,RC,,,Outpatient,,,825.53,412.77,,635.66,77,,,Percent of Total Billed Charges,77% of total billed charges,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.89,74,,,Percent of Total Billed Charges,74% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,693.45,84,,,Percent of Total Billed Charges,84% of total billed charges,676.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,734.72,89,,,Percent of total Billed Charges,89% of total Billed charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.66,77,,,Percent of total Billed charges,77% of total billed charges,701.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,412.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.38,734.72,
Alteplase (Cathflo) 2mg SDV,50242004164,CDM,250,RC,,,Outpatient,,,825.53,412.77,,635.66,77,,,Percent of Total Billed Charges,77% of total billed charges,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.89,74,,,Percent of Total Billed Charges,74% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,693.45,84,,,Percent of Total Billed Charges,84% of total billed charges,676.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,734.72,89,,,Percent of total Billed Charges,89% of total Billed charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.66,77,,,Percent of total Billed charges,77% of total billed charges,701.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,412.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.38,734.72,
Alteplase (Cathflo) 2mg SDV,50242004164,CDM,250,RC,,,Outpatient,,,825.53,412.77,,635.66,77,,,Percent of Total Billed Charges,77% of total billed charges,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.89,74,,,Percent of Total Billed Charges,74% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,693.45,84,,,Percent of Total Billed Charges,84% of total billed charges,676.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,734.72,89,,,Percent of total Billed Charges,89% of total Billed charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.66,77,,,Percent of total Billed charges,77% of total billed charges,701.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,412.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.38,734.72,
Alteplase (Cathflo) 2mg SDV,50242004164,CDM,250,RC,,,Outpatient,,,825.53,412.77,,635.66,77,,,Percent of Total Billed Charges,77% of total billed charges,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.89,74,,,Percent of Total Billed Charges,74% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,693.45,84,,,Percent of Total Billed Charges,84% of total billed charges,676.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,734.72,89,,,Percent of total Billed Charges,89% of total Billed charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.66,77,,,Percent of total Billed charges,77% of total billed charges,701.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,412.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.38,734.72,
Alteplase (Cathflo) 2mg SDV,50242004164,CDM,250,RC,,,Outpatient,,,825.53,412.77,,635.66,77,,,Percent of Total Billed Charges,77% of total billed charges,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,210.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,257.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,610.89,74,,,Percent of Total Billed Charges,74% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,569.62,69,,,Percent of Total Billed Charges,69% of total billed charges,693.45,84,,,Percent of Total Billed Charges,84% of total billed charges,676.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,734.72,89,,,Percent of total Billed Charges,89% of total Billed charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.66,77,,,Percent of total Billed charges,77% of total billed charges,701.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,237.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,412.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,336.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,734.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,206.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.38,734.72,
Amantadine 100mg Capsule,904704206,CDM,250,RC,,,Outpatient,,,18.14,9.07,,13.97,77,,,Percent of Total Billed Charges,77% of total billed charges,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.42,74,,,Percent of Total Billed Charges,74% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,15.24,84,,,Percent of Total Billed Charges,84% of total billed charges,14.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.14,89,,,Percent of total Billed Charges,89% of total Billed charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,77,,,Percent of total Billed charges,77% of total billed charges,15.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,16.14,
Amantadine 100mg Capsule,904704206,CDM,250,RC,,,Outpatient,,,18.14,9.07,,13.97,77,,,Percent of Total Billed Charges,77% of total billed charges,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.42,74,,,Percent of Total Billed Charges,74% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,15.24,84,,,Percent of Total Billed Charges,84% of total billed charges,14.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.14,89,,,Percent of total Billed Charges,89% of total Billed charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,77,,,Percent of total Billed charges,77% of total billed charges,15.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,16.14,
Amantadine 100mg Capsule,904704206,CDM,250,RC,,,Outpatient,,,18.14,9.07,,13.97,77,,,Percent of Total Billed Charges,77% of total billed charges,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.42,74,,,Percent of Total Billed Charges,74% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,15.24,84,,,Percent of Total Billed Charges,84% of total billed charges,14.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.14,89,,,Percent of total Billed Charges,89% of total Billed charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,77,,,Percent of total Billed charges,77% of total billed charges,15.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,16.14,
Amantadine 100mg Capsule,904704206,CDM,250,RC,,,Outpatient,,,18.14,9.07,,13.97,77,,,Percent of Total Billed Charges,77% of total billed charges,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.42,74,,,Percent of Total Billed Charges,74% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,15.24,84,,,Percent of Total Billed Charges,84% of total billed charges,14.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.14,89,,,Percent of total Billed Charges,89% of total Billed charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,77,,,Percent of total Billed charges,77% of total billed charges,15.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,16.14,
Amantadine 100mg Capsule,904704206,CDM,250,RC,,,Outpatient,,,18.14,9.07,,13.97,77,,,Percent of Total Billed Charges,77% of total billed charges,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.42,74,,,Percent of Total Billed Charges,74% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,15.24,84,,,Percent of Total Billed Charges,84% of total billed charges,14.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.14,89,,,Percent of total Billed Charges,89% of total Billed charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,77,,,Percent of total Billed charges,77% of total billed charges,15.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,16.14,
Amantadine 100mg Capsule,904704206,CDM,250,RC,,,Outpatient,,,18.14,9.07,,13.97,77,,,Percent of Total Billed Charges,77% of total billed charges,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.42,74,,,Percent of Total Billed Charges,74% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,12.52,69,,,Percent of Total Billed Charges,69% of total billed charges,15.24,84,,,Percent of Total Billed Charges,84% of total billed charges,14.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.14,89,,,Percent of total Billed Charges,89% of total Billed charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.97,77,,,Percent of total Billed charges,77% of total billed charges,15.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.54,16.14,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminocaproic Acid 5000mg/20ml MDV,409434673,CDM,250,RC,,,Outpatient,,,99.87,49.94,,76.9,77,,,Percent of Total Billed Charges,77% of total billed charges,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.9,74,,,Percent of Total Billed Charges,74% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,68.91,69,,,Percent of Total Billed Charges,69% of total billed charges,83.89,84,,,Percent of Total Billed Charges,84% of total billed charges,81.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.88,89,,,Percent of total Billed Charges,89% of total Billed charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.9,77,,,Percent of total Billed charges,77% of total billed charges,84.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.97,88.88,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Aminophylline IV 250mg/10ml SDV,409592101,CDM,250,RC,,,Outpatient,,,175.87,87.94,,135.42,77,,,Percent of Total Billed Charges,77% of total billed charges,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,130.14,74,,,Percent of Total Billed Charges,74% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,121.35,69,,,Percent of Total Billed Charges,69% of total billed charges,147.73,84,,,Percent of Total Billed Charges,84% of total billed charges,144.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,156.52,89,,,Percent of total Billed Charges,89% of total Billed charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.42,77,,,Percent of total Billed charges,77% of total billed charges,149.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.97,156.52,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 150mg/100ml IV Bag,43066015010,CDM,250,RC,,,Outpatient,,,344.72,172.36,,265.43,77,,,Percent of Total Billed Charges,77% of total billed charges,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,255.09,74,,,Percent of Total Billed Charges,74% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,237.86,69,,,Percent of Total Billed Charges,69% of total billed charges,289.56,84,,,Percent of Total Billed Charges,84% of total billed charges,282.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.8,89,,,Percent of total Billed Charges,89% of total Billed charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.43,77,,,Percent of total Billed charges,77% of total billed charges,293.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.18,306.8,
Amiodarone 200mg Tablet,245014701,CDM,250,RC,,,Outpatient,,,61.09,30.55,,47.04,77,,,Percent of Total Billed Charges,77% of total billed charges,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.21,74,,,Percent of Total Billed Charges,74% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,51.32,84,,,Percent of Total Billed Charges,84% of total billed charges,50.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.37,89,,,Percent of total Billed Charges,89% of total Billed charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,77,,,Percent of total Billed charges,77% of total billed charges,51.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,54.37,
Amiodarone 200mg Tablet,245014701,CDM,250,RC,,,Outpatient,,,61.09,30.55,,47.04,77,,,Percent of Total Billed Charges,77% of total billed charges,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.21,74,,,Percent of Total Billed Charges,74% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,51.32,84,,,Percent of Total Billed Charges,84% of total billed charges,50.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.37,89,,,Percent of total Billed Charges,89% of total Billed charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,77,,,Percent of total Billed charges,77% of total billed charges,51.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,54.37,
Amiodarone 200mg Tablet,245014701,CDM,250,RC,,,Outpatient,,,61.09,30.55,,47.04,77,,,Percent of Total Billed Charges,77% of total billed charges,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.21,74,,,Percent of Total Billed Charges,74% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,51.32,84,,,Percent of Total Billed Charges,84% of total billed charges,50.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.37,89,,,Percent of total Billed Charges,89% of total Billed charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,77,,,Percent of total Billed charges,77% of total billed charges,51.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,54.37,
Amiodarone 200mg Tablet,245014701,CDM,250,RC,,,Outpatient,,,61.09,30.55,,47.04,77,,,Percent of Total Billed Charges,77% of total billed charges,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.21,74,,,Percent of Total Billed Charges,74% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,51.32,84,,,Percent of Total Billed Charges,84% of total billed charges,50.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.37,89,,,Percent of total Billed Charges,89% of total Billed charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,77,,,Percent of total Billed charges,77% of total billed charges,51.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,54.37,
Amiodarone 200mg Tablet,245014701,CDM,250,RC,,,Outpatient,,,61.09,30.55,,47.04,77,,,Percent of Total Billed Charges,77% of total billed charges,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.21,74,,,Percent of Total Billed Charges,74% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,51.32,84,,,Percent of Total Billed Charges,84% of total billed charges,50.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.37,89,,,Percent of total Billed Charges,89% of total Billed charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,77,,,Percent of total Billed charges,77% of total billed charges,51.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,54.37,
Amiodarone 200mg Tablet,245014701,CDM,250,RC,,,Outpatient,,,61.09,30.55,,47.04,77,,,Percent of Total Billed Charges,77% of total billed charges,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.21,74,,,Percent of Total Billed Charges,74% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.15,69,,,Percent of Total Billed Charges,69% of total billed charges,51.32,84,,,Percent of Total Billed Charges,84% of total billed charges,50.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.37,89,,,Percent of total Billed Charges,89% of total Billed charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,77,,,Percent of total Billed charges,77% of total billed charges,51.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,54.37,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 360mg/200ml IV Bag,43066036020,CDM,250,RC,,,Outpatient,,,420.29,210.15,,323.62,77,,,Percent of Total Billed Charges,77% of total billed charges,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,131.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,311.01,74,,,Percent of Total Billed Charges,74% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290,69,,,Percent of Total Billed Charges,69% of total billed charges,290,69,,,Percent of Total Billed Charges,69% of total billed charges,353.04,84,,,Percent of Total Billed Charges,84% of total billed charges,344.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,374.06,89,,,Percent of total Billed Charges,89% of total Billed charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,323.62,77,,,Percent of total Billed charges,77% of total billed charges,357.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,120.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,210.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,171.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,374.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.07,374.06,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amiodarone 450mg/9ml SDV,67457015309,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Amisulpride 5mg/2ml SDV,,,250,RC,,,Outpatient,,,305.7,152.85,,235.39,77,,,Percent of Total Billed Charges,77% of total billed charges,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.22,74,,,Percent of Total Billed Charges,74% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,256.79,84,,,Percent of Total Billed Charges,84% of total billed charges,250.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.07,89,,,Percent of total Billed Charges,89% of total Billed charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.39,77,,,Percent of total Billed charges,77% of total billed charges,259.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.43,272.07,
Amisulpride 5mg/2ml SDV,,,250,RC,,,Outpatient,,,305.7,152.85,,235.39,77,,,Percent of Total Billed Charges,77% of total billed charges,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.22,74,,,Percent of Total Billed Charges,74% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,256.79,84,,,Percent of Total Billed Charges,84% of total billed charges,250.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.07,89,,,Percent of total Billed Charges,89% of total Billed charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.39,77,,,Percent of total Billed charges,77% of total billed charges,259.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.43,272.07,
Amisulpride 5mg/2ml SDV,,,250,RC,,,Outpatient,,,305.7,152.85,,235.39,77,,,Percent of Total Billed Charges,77% of total billed charges,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.22,74,,,Percent of Total Billed Charges,74% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,256.79,84,,,Percent of Total Billed Charges,84% of total billed charges,250.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.07,89,,,Percent of total Billed Charges,89% of total Billed charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.39,77,,,Percent of total Billed charges,77% of total billed charges,259.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.43,272.07,
Amisulpride 5mg/2ml SDV,,,250,RC,,,Outpatient,,,305.7,152.85,,235.39,77,,,Percent of Total Billed Charges,77% of total billed charges,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.22,74,,,Percent of Total Billed Charges,74% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,256.79,84,,,Percent of Total Billed Charges,84% of total billed charges,250.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.07,89,,,Percent of total Billed Charges,89% of total Billed charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.39,77,,,Percent of total Billed charges,77% of total billed charges,259.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.43,272.07,
Amisulpride 5mg/2ml SDV,,,250,RC,,,Outpatient,,,305.7,152.85,,235.39,77,,,Percent of Total Billed Charges,77% of total billed charges,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.22,74,,,Percent of Total Billed Charges,74% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,256.79,84,,,Percent of Total Billed Charges,84% of total billed charges,250.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.07,89,,,Percent of total Billed Charges,89% of total Billed charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.39,77,,,Percent of total Billed charges,77% of total billed charges,259.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.43,272.07,
Amisulpride 5mg/2ml SDV,,,250,RC,,,Outpatient,,,305.7,152.85,,235.39,77,,,Percent of Total Billed Charges,77% of total billed charges,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.22,74,,,Percent of Total Billed Charges,74% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,210.93,69,,,Percent of Total Billed Charges,69% of total billed charges,256.79,84,,,Percent of Total Billed Charges,84% of total billed charges,250.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.07,89,,,Percent of total Billed Charges,89% of total Billed charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,235.39,77,,,Percent of total Billed charges,77% of total billed charges,259.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.43,272.07,
Amitriptyline 10mg Tablet,781148601,CDM,250,RC,,,Outpatient,,,6.69,3.35,,5.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.95,74,,,Percent of Total Billed Charges,74% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,5.62,84,,,Percent of Total Billed Charges,84% of total billed charges,5.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.95,89,,,Percent of total Billed Charges,89% of total Billed charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.15,77,,,Percent of total Billed charges,77% of total billed charges,5.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.67,5.95,
Amitriptyline 10mg Tablet,781148601,CDM,250,RC,,,Outpatient,,,6.69,3.35,,5.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.95,74,,,Percent of Total Billed Charges,74% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,5.62,84,,,Percent of Total Billed Charges,84% of total billed charges,5.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.95,89,,,Percent of total Billed Charges,89% of total Billed charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.15,77,,,Percent of total Billed charges,77% of total billed charges,5.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.67,5.95,
Amitriptyline 10mg Tablet,781148601,CDM,250,RC,,,Outpatient,,,6.69,3.35,,5.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.95,74,,,Percent of Total Billed Charges,74% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,5.62,84,,,Percent of Total Billed Charges,84% of total billed charges,5.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.95,89,,,Percent of total Billed Charges,89% of total Billed charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.15,77,,,Percent of total Billed charges,77% of total billed charges,5.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.67,5.95,
Amitriptyline 10mg Tablet,781148601,CDM,250,RC,,,Outpatient,,,6.69,3.35,,5.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.95,74,,,Percent of Total Billed Charges,74% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,5.62,84,,,Percent of Total Billed Charges,84% of total billed charges,5.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.95,89,,,Percent of total Billed Charges,89% of total Billed charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.15,77,,,Percent of total Billed charges,77% of total billed charges,5.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.67,5.95,
Amitriptyline 10mg Tablet,781148601,CDM,250,RC,,,Outpatient,,,6.69,3.35,,5.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.95,74,,,Percent of Total Billed Charges,74% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,5.62,84,,,Percent of Total Billed Charges,84% of total billed charges,5.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.95,89,,,Percent of total Billed Charges,89% of total Billed charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.15,77,,,Percent of total Billed charges,77% of total billed charges,5.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.67,5.95,
Amitriptyline 10mg Tablet,781148601,CDM,250,RC,,,Outpatient,,,6.69,3.35,,5.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.95,74,,,Percent of Total Billed Charges,74% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,4.62,69,,,Percent of Total Billed Charges,69% of total billed charges,5.62,84,,,Percent of Total Billed Charges,84% of total billed charges,5.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.95,89,,,Percent of total Billed Charges,89% of total Billed charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.15,77,,,Percent of total Billed charges,77% of total billed charges,5.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.67,5.95,
Amitriptyline 25mg Tablet,16729017201,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
Amitriptyline 25mg Tablet,16729017201,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
Amitriptyline 25mg Tablet,16729017201,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
Amitriptyline 25mg Tablet,16729017201,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
Amitriptyline 25mg Tablet,16729017201,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
Amitriptyline 25mg Tablet,16729017201,CDM,250,RC,,,Outpatient,,,11.01,5.51,,8.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.15,74,,,Percent of Total Billed Charges,74% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,7.6,69,,,Percent of Total Billed Charges,69% of total billed charges,9.25,84,,,Percent of Total Billed Charges,84% of total billed charges,9.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.8,89,,,Percent of total Billed Charges,89% of total Billed charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.48,77,,,Percent of total Billed charges,77% of total billed charges,9.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.75,9.8,
Amitriptyline 50mg Tablet,,,250,RC,,,Outpatient,,,16.92,8.46,,13.03,77,,,Percent of Total Billed Charges,77% of total billed charges,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.52,74,,,Percent of Total Billed Charges,74% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,14.21,84,,,Percent of Total Billed Charges,84% of total billed charges,13.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.06,89,,,Percent of total Billed Charges,89% of total Billed charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.03,77,,,Percent of total Billed charges,77% of total billed charges,14.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,15.06,
Amitriptyline 50mg Tablet,,,250,RC,,,Outpatient,,,16.92,8.46,,13.03,77,,,Percent of Total Billed Charges,77% of total billed charges,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.52,74,,,Percent of Total Billed Charges,74% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,14.21,84,,,Percent of Total Billed Charges,84% of total billed charges,13.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.06,89,,,Percent of total Billed Charges,89% of total Billed charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.03,77,,,Percent of total Billed charges,77% of total billed charges,14.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,15.06,
Amitriptyline 50mg Tablet,,,250,RC,,,Outpatient,,,16.92,8.46,,13.03,77,,,Percent of Total Billed Charges,77% of total billed charges,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.52,74,,,Percent of Total Billed Charges,74% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,14.21,84,,,Percent of Total Billed Charges,84% of total billed charges,13.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.06,89,,,Percent of total Billed Charges,89% of total Billed charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.03,77,,,Percent of total Billed charges,77% of total billed charges,14.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,15.06,
Amitriptyline 50mg Tablet,,,250,RC,,,Outpatient,,,16.92,8.46,,13.03,77,,,Percent of Total Billed Charges,77% of total billed charges,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.52,74,,,Percent of Total Billed Charges,74% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,14.21,84,,,Percent of Total Billed Charges,84% of total billed charges,13.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.06,89,,,Percent of total Billed Charges,89% of total Billed charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.03,77,,,Percent of total Billed charges,77% of total billed charges,14.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,15.06,
Amitriptyline 50mg Tablet,,,250,RC,,,Outpatient,,,16.92,8.46,,13.03,77,,,Percent of Total Billed Charges,77% of total billed charges,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.52,74,,,Percent of Total Billed Charges,74% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,14.21,84,,,Percent of Total Billed Charges,84% of total billed charges,13.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.06,89,,,Percent of total Billed Charges,89% of total Billed charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.03,77,,,Percent of total Billed charges,77% of total billed charges,14.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,15.06,
Amitriptyline 50mg Tablet,,,250,RC,,,Outpatient,,,16.92,8.46,,13.03,77,,,Percent of Total Billed Charges,77% of total billed charges,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.52,74,,,Percent of Total Billed Charges,74% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,11.67,69,,,Percent of Total Billed Charges,69% of total billed charges,14.21,84,,,Percent of Total Billed Charges,84% of total billed charges,13.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.06,89,,,Percent of total Billed Charges,89% of total Billed charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.03,77,,,Percent of total Billed charges,77% of total billed charges,14.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,15.06,
amLODIPine 5mg Tablet,51079045120,CDM,250,RC,,,Outpatient,,,21.24,10.62,,16.35,77,,,Percent of Total Billed Charges,77% of total billed charges,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.72,74,,,Percent of Total Billed Charges,74% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,17.84,84,,,Percent of Total Billed Charges,84% of total billed charges,17.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.9,89,,,Percent of total Billed Charges,89% of total Billed charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.35,77,,,Percent of total Billed charges,77% of total billed charges,18.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.31,18.9,
amLODIPine 5mg Tablet,51079045120,CDM,250,RC,,,Outpatient,,,21.24,10.62,,16.35,77,,,Percent of Total Billed Charges,77% of total billed charges,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.72,74,,,Percent of Total Billed Charges,74% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,17.84,84,,,Percent of Total Billed Charges,84% of total billed charges,17.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.9,89,,,Percent of total Billed Charges,89% of total Billed charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.35,77,,,Percent of total Billed charges,77% of total billed charges,18.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.31,18.9,
amLODIPine 5mg Tablet,51079045120,CDM,250,RC,,,Outpatient,,,21.24,10.62,,16.35,77,,,Percent of Total Billed Charges,77% of total billed charges,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.72,74,,,Percent of Total Billed Charges,74% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,17.84,84,,,Percent of Total Billed Charges,84% of total billed charges,17.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.9,89,,,Percent of total Billed Charges,89% of total Billed charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.35,77,,,Percent of total Billed charges,77% of total billed charges,18.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.31,18.9,
amLODIPine 5mg Tablet,51079045120,CDM,250,RC,,,Outpatient,,,21.24,10.62,,16.35,77,,,Percent of Total Billed Charges,77% of total billed charges,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.72,74,,,Percent of Total Billed Charges,74% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,17.84,84,,,Percent of Total Billed Charges,84% of total billed charges,17.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.9,89,,,Percent of total Billed Charges,89% of total Billed charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.35,77,,,Percent of total Billed charges,77% of total billed charges,18.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.31,18.9,
amLODIPine 5mg Tablet,51079045120,CDM,250,RC,,,Outpatient,,,21.24,10.62,,16.35,77,,,Percent of Total Billed Charges,77% of total billed charges,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.72,74,,,Percent of Total Billed Charges,74% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,17.84,84,,,Percent of Total Billed Charges,84% of total billed charges,17.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.9,89,,,Percent of total Billed Charges,89% of total Billed charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.35,77,,,Percent of total Billed charges,77% of total billed charges,18.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.31,18.9,
amLODIPine 5mg Tablet,51079045120,CDM,250,RC,,,Outpatient,,,21.24,10.62,,16.35,77,,,Percent of Total Billed Charges,77% of total billed charges,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.72,74,,,Percent of Total Billed Charges,74% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,14.66,69,,,Percent of Total Billed Charges,69% of total billed charges,17.84,84,,,Percent of Total Billed Charges,84% of total billed charges,17.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.9,89,,,Percent of total Billed Charges,89% of total Billed charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.35,77,,,Percent of total Billed charges,77% of total billed charges,18.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.31,18.9,
Ammonium Lactate 12% Cream 140gm,51672130104,CDM,250,RC,,,Outpatient,,,189.56,94.78,,145.96,77,,,Percent of Total Billed Charges,77% of total billed charges,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.27,74,,,Percent of Total Billed Charges,74% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,159.23,84,,,Percent of Total Billed Charges,84% of total billed charges,155.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.71,89,,,Percent of total Billed Charges,89% of total Billed charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,77,,,Percent of total Billed charges,77% of total billed charges,161.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.39,168.71,
Ammonium Lactate 12% Cream 140gm,51672130104,CDM,250,RC,,,Outpatient,,,189.56,94.78,,145.96,77,,,Percent of Total Billed Charges,77% of total billed charges,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.27,74,,,Percent of Total Billed Charges,74% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,159.23,84,,,Percent of Total Billed Charges,84% of total billed charges,155.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.71,89,,,Percent of total Billed Charges,89% of total Billed charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,77,,,Percent of total Billed charges,77% of total billed charges,161.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.39,168.71,
Ammonium Lactate 12% Cream 140gm,51672130104,CDM,250,RC,,,Outpatient,,,189.56,94.78,,145.96,77,,,Percent of Total Billed Charges,77% of total billed charges,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.27,74,,,Percent of Total Billed Charges,74% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,159.23,84,,,Percent of Total Billed Charges,84% of total billed charges,155.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.71,89,,,Percent of total Billed Charges,89% of total Billed charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,77,,,Percent of total Billed charges,77% of total billed charges,161.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.39,168.71,
Ammonium Lactate 12% Cream 140gm,51672130104,CDM,250,RC,,,Outpatient,,,189.56,94.78,,145.96,77,,,Percent of Total Billed Charges,77% of total billed charges,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.27,74,,,Percent of Total Billed Charges,74% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,159.23,84,,,Percent of Total Billed Charges,84% of total billed charges,155.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.71,89,,,Percent of total Billed Charges,89% of total Billed charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,77,,,Percent of total Billed charges,77% of total billed charges,161.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.39,168.71,
Ammonium Lactate 12% Cream 140gm,51672130104,CDM,250,RC,,,Outpatient,,,189.56,94.78,,145.96,77,,,Percent of Total Billed Charges,77% of total billed charges,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.27,74,,,Percent of Total Billed Charges,74% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,159.23,84,,,Percent of Total Billed Charges,84% of total billed charges,155.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.71,89,,,Percent of total Billed Charges,89% of total Billed charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,77,,,Percent of total Billed charges,77% of total billed charges,161.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.39,168.71,
Ammonium Lactate 12% Cream 140gm,51672130104,CDM,250,RC,,,Outpatient,,,189.56,94.78,,145.96,77,,,Percent of Total Billed Charges,77% of total billed charges,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.27,74,,,Percent of Total Billed Charges,74% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,130.8,69,,,Percent of Total Billed Charges,69% of total billed charges,159.23,84,,,Percent of Total Billed Charges,84% of total billed charges,155.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,168.71,89,,,Percent of total Billed Charges,89% of total Billed charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.96,77,,,Percent of total Billed charges,77% of total billed charges,161.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.39,168.71,
Amoxicillin Susp 125mg/5ml 100ml,781603946,CDM,250,RC,,,Outpatient,,,38.41,19.21,,29.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.42,74,,,Percent of Total Billed Charges,74% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,32.26,84,,,Percent of Total Billed Charges,84% of total billed charges,31.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.18,89,,,Percent of total Billed Charges,89% of total Billed charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.58,77,,,Percent of total Billed charges,77% of total billed charges,32.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.6,34.18,
Amoxicillin Susp 125mg/5ml 100ml,781603946,CDM,250,RC,,,Outpatient,,,38.41,19.21,,29.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.42,74,,,Percent of Total Billed Charges,74% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,32.26,84,,,Percent of Total Billed Charges,84% of total billed charges,31.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.18,89,,,Percent of total Billed Charges,89% of total Billed charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.58,77,,,Percent of total Billed charges,77% of total billed charges,32.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.6,34.18,
Amoxicillin Susp 125mg/5ml 100ml,781603946,CDM,250,RC,,,Outpatient,,,38.41,19.21,,29.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.42,74,,,Percent of Total Billed Charges,74% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,32.26,84,,,Percent of Total Billed Charges,84% of total billed charges,31.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.18,89,,,Percent of total Billed Charges,89% of total Billed charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.58,77,,,Percent of total Billed charges,77% of total billed charges,32.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.6,34.18,
Amoxicillin Susp 125mg/5ml 100ml,781603946,CDM,250,RC,,,Outpatient,,,38.41,19.21,,29.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.42,74,,,Percent of Total Billed Charges,74% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,32.26,84,,,Percent of Total Billed Charges,84% of total billed charges,31.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.18,89,,,Percent of total Billed Charges,89% of total Billed charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.58,77,,,Percent of total Billed charges,77% of total billed charges,32.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.6,34.18,
Amoxicillin Susp 125mg/5ml 100ml,781603946,CDM,250,RC,,,Outpatient,,,38.41,19.21,,29.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.42,74,,,Percent of Total Billed Charges,74% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,32.26,84,,,Percent of Total Billed Charges,84% of total billed charges,31.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.18,89,,,Percent of total Billed Charges,89% of total Billed charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.58,77,,,Percent of total Billed charges,77% of total billed charges,32.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.6,34.18,
Amoxicillin Susp 125mg/5ml 100ml,781603946,CDM,250,RC,,,Outpatient,,,38.41,19.21,,29.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.42,74,,,Percent of Total Billed Charges,74% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,26.5,69,,,Percent of Total Billed Charges,69% of total billed charges,32.26,84,,,Percent of Total Billed Charges,84% of total billed charges,31.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.18,89,,,Percent of total Billed Charges,89% of total Billed charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.58,77,,,Percent of total Billed charges,77% of total billed charges,32.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.6,34.18,
Amoxicillin & Pot Clav 500mg Tablet,93227434,CDM,250,RC,,,Outpatient,,,40.47,20.24,,31.16,77,,,Percent of Total Billed Charges,77% of total billed charges,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.95,74,,,Percent of Total Billed Charges,74% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,33.99,84,,,Percent of Total Billed Charges,84% of total billed charges,33.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.02,89,,,Percent of total Billed Charges,89% of total Billed charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.16,77,,,Percent of total Billed charges,77% of total billed charges,34.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,36.02,
Amoxicillin & Pot Clav 500mg Tablet,93227434,CDM,250,RC,,,Outpatient,,,40.47,20.24,,31.16,77,,,Percent of Total Billed Charges,77% of total billed charges,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.95,74,,,Percent of Total Billed Charges,74% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,33.99,84,,,Percent of Total Billed Charges,84% of total billed charges,33.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.02,89,,,Percent of total Billed Charges,89% of total Billed charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.16,77,,,Percent of total Billed charges,77% of total billed charges,34.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,36.02,
Amoxicillin & Pot Clav 500mg Tablet,93227434,CDM,250,RC,,,Outpatient,,,40.47,20.24,,31.16,77,,,Percent of Total Billed Charges,77% of total billed charges,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.95,74,,,Percent of Total Billed Charges,74% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,33.99,84,,,Percent of Total Billed Charges,84% of total billed charges,33.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.02,89,,,Percent of total Billed Charges,89% of total Billed charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.16,77,,,Percent of total Billed charges,77% of total billed charges,34.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,36.02,
Amoxicillin & Pot Clav 500mg Tablet,93227434,CDM,250,RC,,,Outpatient,,,40.47,20.24,,31.16,77,,,Percent of Total Billed Charges,77% of total billed charges,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.95,74,,,Percent of Total Billed Charges,74% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,33.99,84,,,Percent of Total Billed Charges,84% of total billed charges,33.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.02,89,,,Percent of total Billed Charges,89% of total Billed charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.16,77,,,Percent of total Billed charges,77% of total billed charges,34.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,36.02,
Amoxicillin & Pot Clav 500mg Tablet,93227434,CDM,250,RC,,,Outpatient,,,40.47,20.24,,31.16,77,,,Percent of Total Billed Charges,77% of total billed charges,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.95,74,,,Percent of Total Billed Charges,74% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,33.99,84,,,Percent of Total Billed Charges,84% of total billed charges,33.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.02,89,,,Percent of total Billed Charges,89% of total Billed charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.16,77,,,Percent of total Billed charges,77% of total billed charges,34.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,36.02,
Amoxicillin & Pot Clav 500mg Tablet,93227434,CDM,250,RC,,,Outpatient,,,40.47,20.24,,31.16,77,,,Percent of Total Billed Charges,77% of total billed charges,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.95,74,,,Percent of Total Billed Charges,74% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,27.92,69,,,Percent of Total Billed Charges,69% of total billed charges,33.99,84,,,Percent of Total Billed Charges,84% of total billed charges,33.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.02,89,,,Percent of total Billed Charges,89% of total Billed charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.16,77,,,Percent of total Billed charges,77% of total billed charges,34.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,36.02,
Amoxicillin & Pot Clav 875mg Tablet,93227534,CDM,250,RC,,,Outpatient,,,49.46,24.73,,38.08,77,,,Percent of Total Billed Charges,77% of total billed charges,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.6,74,,,Percent of Total Billed Charges,74% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,41.55,84,,,Percent of Total Billed Charges,84% of total billed charges,40.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.02,89,,,Percent of total Billed Charges,89% of total Billed charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.08,77,,,Percent of total Billed charges,77% of total billed charges,42.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.37,44.02,
Amoxicillin & Pot Clav 875mg Tablet,93227534,CDM,250,RC,,,Outpatient,,,49.46,24.73,,38.08,77,,,Percent of Total Billed Charges,77% of total billed charges,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.6,74,,,Percent of Total Billed Charges,74% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,41.55,84,,,Percent of Total Billed Charges,84% of total billed charges,40.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.02,89,,,Percent of total Billed Charges,89% of total Billed charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.08,77,,,Percent of total Billed charges,77% of total billed charges,42.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.37,44.02,
Amoxicillin & Pot Clav 875mg Tablet,93227534,CDM,250,RC,,,Outpatient,,,49.46,24.73,,38.08,77,,,Percent of Total Billed Charges,77% of total billed charges,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.6,74,,,Percent of Total Billed Charges,74% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,41.55,84,,,Percent of Total Billed Charges,84% of total billed charges,40.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.02,89,,,Percent of total Billed Charges,89% of total Billed charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.08,77,,,Percent of total Billed charges,77% of total billed charges,42.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.37,44.02,
Amoxicillin & Pot Clav 875mg Tablet,93227534,CDM,250,RC,,,Outpatient,,,49.46,24.73,,38.08,77,,,Percent of Total Billed Charges,77% of total billed charges,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.6,74,,,Percent of Total Billed Charges,74% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,41.55,84,,,Percent of Total Billed Charges,84% of total billed charges,40.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.02,89,,,Percent of total Billed Charges,89% of total Billed charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.08,77,,,Percent of total Billed charges,77% of total billed charges,42.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.37,44.02,
Amoxicillin & Pot Clav 875mg Tablet,93227534,CDM,250,RC,,,Outpatient,,,49.46,24.73,,38.08,77,,,Percent of Total Billed Charges,77% of total billed charges,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.6,74,,,Percent of Total Billed Charges,74% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,41.55,84,,,Percent of Total Billed Charges,84% of total billed charges,40.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.02,89,,,Percent of total Billed Charges,89% of total Billed charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.08,77,,,Percent of total Billed charges,77% of total billed charges,42.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.37,44.02,
Amoxicillin & Pot Clav 875mg Tablet,93227534,CDM,250,RC,,,Outpatient,,,49.46,24.73,,38.08,77,,,Percent of Total Billed Charges,77% of total billed charges,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.6,74,,,Percent of Total Billed Charges,74% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,34.13,69,,,Percent of Total Billed Charges,69% of total billed charges,41.55,84,,,Percent of Total Billed Charges,84% of total billed charges,40.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.02,89,,,Percent of total Billed Charges,89% of total Billed charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.08,77,,,Percent of total Billed charges,77% of total billed charges,42.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.37,44.02,
Amoxicillin & Pot Clav Susp 200mg/5ml 100ml,143998101,CDM,250,RC,,,Outpatient,,,93.82,46.91,,72.24,77,,,Percent of Total Billed Charges,77% of total billed charges,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.43,74,,,Percent of Total Billed Charges,74% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,78.81,84,,,Percent of Total Billed Charges,84% of total billed charges,76.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.5,89,,,Percent of total Billed Charges,89% of total Billed charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.24,77,,,Percent of total Billed charges,77% of total billed charges,79.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,83.5,
Amoxicillin & Pot Clav Susp 200mg/5ml 100ml,143998101,CDM,250,RC,,,Outpatient,,,93.82,46.91,,72.24,77,,,Percent of Total Billed Charges,77% of total billed charges,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.43,74,,,Percent of Total Billed Charges,74% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,78.81,84,,,Percent of Total Billed Charges,84% of total billed charges,76.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.5,89,,,Percent of total Billed Charges,89% of total Billed charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.24,77,,,Percent of total Billed charges,77% of total billed charges,79.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,83.5,
Amoxicillin & Pot Clav Susp 200mg/5ml 100ml,143998101,CDM,250,RC,,,Outpatient,,,93.82,46.91,,72.24,77,,,Percent of Total Billed Charges,77% of total billed charges,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.43,74,,,Percent of Total Billed Charges,74% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,78.81,84,,,Percent of Total Billed Charges,84% of total billed charges,76.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.5,89,,,Percent of total Billed Charges,89% of total Billed charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.24,77,,,Percent of total Billed charges,77% of total billed charges,79.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,83.5,
Amoxicillin & Pot Clav Susp 200mg/5ml 100ml,143998101,CDM,250,RC,,,Outpatient,,,93.82,46.91,,72.24,77,,,Percent of Total Billed Charges,77% of total billed charges,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.43,74,,,Percent of Total Billed Charges,74% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,78.81,84,,,Percent of Total Billed Charges,84% of total billed charges,76.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.5,89,,,Percent of total Billed Charges,89% of total Billed charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.24,77,,,Percent of total Billed charges,77% of total billed charges,79.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,83.5,
Amoxicillin & Pot Clav Susp 200mg/5ml 100ml,143998101,CDM,250,RC,,,Outpatient,,,93.82,46.91,,72.24,77,,,Percent of Total Billed Charges,77% of total billed charges,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.43,74,,,Percent of Total Billed Charges,74% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,78.81,84,,,Percent of Total Billed Charges,84% of total billed charges,76.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.5,89,,,Percent of total Billed Charges,89% of total Billed charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.24,77,,,Percent of total Billed charges,77% of total billed charges,79.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,83.5,
Amoxicillin & Pot Clav Susp 200mg/5ml 100ml,143998101,CDM,250,RC,,,Outpatient,,,93.82,46.91,,72.24,77,,,Percent of Total Billed Charges,77% of total billed charges,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.43,74,,,Percent of Total Billed Charges,74% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,64.74,69,,,Percent of Total Billed Charges,69% of total billed charges,78.81,84,,,Percent of Total Billed Charges,84% of total billed charges,76.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.5,89,,,Percent of total Billed Charges,89% of total Billed charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.24,77,,,Percent of total Billed charges,77% of total billed charges,79.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.46,83.5,
Amoxicillin 250mg Capsule,65862001601,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Amoxicillin 250mg Capsule,65862001601,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Amoxicillin 250mg Capsule,65862001601,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Amoxicillin 250mg Capsule,65862001601,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Amoxicillin 250mg Capsule,65862001601,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Amoxicillin 250mg Capsule,65862001601,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Amoxicillin Susp 250mg/5ml 150ml,143988915,CDM,250,RC,,,Outpatient,,,48.64,24.32,,37.45,77,,,Percent of Total Billed Charges,77% of total billed charges,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.99,74,,,Percent of Total Billed Charges,74% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,40.86,84,,,Percent of Total Billed Charges,84% of total billed charges,39.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.29,89,,,Percent of total Billed Charges,89% of total Billed charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.45,77,,,Percent of total Billed charges,77% of total billed charges,41.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.16,43.29,
Amoxicillin Susp 250mg/5ml 150ml,143988915,CDM,250,RC,,,Outpatient,,,48.64,24.32,,37.45,77,,,Percent of Total Billed Charges,77% of total billed charges,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.99,74,,,Percent of Total Billed Charges,74% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,40.86,84,,,Percent of Total Billed Charges,84% of total billed charges,39.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.29,89,,,Percent of total Billed Charges,89% of total Billed charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.45,77,,,Percent of total Billed charges,77% of total billed charges,41.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.16,43.29,
Amoxicillin Susp 250mg/5ml 150ml,143988915,CDM,250,RC,,,Outpatient,,,48.64,24.32,,37.45,77,,,Percent of Total Billed Charges,77% of total billed charges,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.99,74,,,Percent of Total Billed Charges,74% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,40.86,84,,,Percent of Total Billed Charges,84% of total billed charges,39.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.29,89,,,Percent of total Billed Charges,89% of total Billed charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.45,77,,,Percent of total Billed charges,77% of total billed charges,41.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.16,43.29,
Amoxicillin Susp 250mg/5ml 150ml,143988915,CDM,250,RC,,,Outpatient,,,48.64,24.32,,37.45,77,,,Percent of Total Billed Charges,77% of total billed charges,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.99,74,,,Percent of Total Billed Charges,74% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,40.86,84,,,Percent of Total Billed Charges,84% of total billed charges,39.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.29,89,,,Percent of total Billed Charges,89% of total Billed charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.45,77,,,Percent of total Billed charges,77% of total billed charges,41.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.16,43.29,
Amoxicillin Susp 250mg/5ml 150ml,143988915,CDM,250,RC,,,Outpatient,,,48.64,24.32,,37.45,77,,,Percent of Total Billed Charges,77% of total billed charges,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.99,74,,,Percent of Total Billed Charges,74% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,40.86,84,,,Percent of Total Billed Charges,84% of total billed charges,39.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.29,89,,,Percent of total Billed Charges,89% of total Billed charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.45,77,,,Percent of total Billed charges,77% of total billed charges,41.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.16,43.29,
Amoxicillin Susp 250mg/5ml 150ml,143988915,CDM,250,RC,,,Outpatient,,,48.64,24.32,,37.45,77,,,Percent of Total Billed Charges,77% of total billed charges,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.99,74,,,Percent of Total Billed Charges,74% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,33.56,69,,,Percent of Total Billed Charges,69% of total billed charges,40.86,84,,,Percent of Total Billed Charges,84% of total billed charges,39.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.29,89,,,Percent of total Billed Charges,89% of total Billed charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.45,77,,,Percent of total Billed charges,77% of total billed charges,41.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.16,43.29,
Amoxicillin 500mg Capsule,781261301,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Amoxicillin 500mg Capsule,781261301,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Amoxicillin 500mg Capsule,781261301,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Amoxicillin 500mg Capsule,781261301,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Amoxicillin 500mg Capsule,781261301,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Amoxicillin 500mg Capsule,781261301,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Amoxicillin & Clav Pot ES Susp 600mg/5ml 200ml,143985324,CDM,250,RC,,,Outpatient,,,194.78,97.39,,149.98,77,,,Percent of Total Billed Charges,77% of total billed charges,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.14,74,,,Percent of Total Billed Charges,74% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,163.62,84,,,Percent of Total Billed Charges,84% of total billed charges,159.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.35,89,,,Percent of total Billed Charges,89% of total Billed charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.98,77,,,Percent of total Billed charges,77% of total billed charges,165.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.7,173.35,
Amoxicillin & Clav Pot ES Susp 600mg/5ml 200ml,143985324,CDM,250,RC,,,Outpatient,,,194.78,97.39,,149.98,77,,,Percent of Total Billed Charges,77% of total billed charges,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.14,74,,,Percent of Total Billed Charges,74% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,163.62,84,,,Percent of Total Billed Charges,84% of total billed charges,159.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.35,89,,,Percent of total Billed Charges,89% of total Billed charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.98,77,,,Percent of total Billed charges,77% of total billed charges,165.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.7,173.35,
Amoxicillin & Clav Pot ES Susp 600mg/5ml 200ml,143985324,CDM,250,RC,,,Outpatient,,,194.78,97.39,,149.98,77,,,Percent of Total Billed Charges,77% of total billed charges,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.14,74,,,Percent of Total Billed Charges,74% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,163.62,84,,,Percent of Total Billed Charges,84% of total billed charges,159.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.35,89,,,Percent of total Billed Charges,89% of total Billed charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.98,77,,,Percent of total Billed charges,77% of total billed charges,165.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.7,173.35,
Amoxicillin & Clav Pot ES Susp 600mg/5ml 200ml,143985324,CDM,250,RC,,,Outpatient,,,194.78,97.39,,149.98,77,,,Percent of Total Billed Charges,77% of total billed charges,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.14,74,,,Percent of Total Billed Charges,74% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,163.62,84,,,Percent of Total Billed Charges,84% of total billed charges,159.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.35,89,,,Percent of total Billed Charges,89% of total Billed charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.98,77,,,Percent of total Billed charges,77% of total billed charges,165.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.7,173.35,
Amoxicillin & Clav Pot ES Susp 600mg/5ml 200ml,143985324,CDM,250,RC,,,Outpatient,,,194.78,97.39,,149.98,77,,,Percent of Total Billed Charges,77% of total billed charges,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.14,74,,,Percent of Total Billed Charges,74% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,163.62,84,,,Percent of Total Billed Charges,84% of total billed charges,159.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.35,89,,,Percent of total Billed Charges,89% of total Billed charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.98,77,,,Percent of total Billed charges,77% of total billed charges,165.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.7,173.35,
Amoxicillin & Clav Pot ES Susp 600mg/5ml 200ml,143985324,CDM,250,RC,,,Outpatient,,,194.78,97.39,,149.98,77,,,Percent of Total Billed Charges,77% of total billed charges,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.14,74,,,Percent of Total Billed Charges,74% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,134.4,69,,,Percent of Total Billed Charges,69% of total billed charges,163.62,84,,,Percent of Total Billed Charges,84% of total billed charges,159.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.35,89,,,Percent of total Billed Charges,89% of total Billed charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.98,77,,,Percent of total Billed charges,77% of total billed charges,165.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.7,173.35,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin 1000mg SDV,,,250,RC,,,Outpatient,,,111.06,55.53,,85.52,77,,,Percent of Total Billed Charges,77% of total billed charges,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.18,74,,,Percent of Total Billed Charges,74% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,69,,,Percent of Total Billed Charges,69% of total billed charges,93.29,84,,,Percent of Total Billed Charges,84% of total billed charges,91.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.84,89,,,Percent of total Billed Charges,89% of total Billed charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.52,77,,,Percent of total Billed charges,77% of total billed charges,94.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,98.84,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin-Sulbactam 1.5gram SDV,55150011620,CDM,250,RC,,,Outpatient,,,103.66,51.83,,79.82,77,,,Percent of Total Billed Charges,77% of total billed charges,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.71,74,,,Percent of Total Billed Charges,74% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,71.53,69,,,Percent of Total Billed Charges,69% of total billed charges,87.07,84,,,Percent of Total Billed Charges,84% of total billed charges,85,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.26,89,,,Percent of total Billed Charges,89% of total Billed charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.82,77,,,Percent of total Billed charges,77% of total billed charges,88.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,92.26,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin 2000mg SDV,781340895,CDM,250,RC,,,Outpatient,,,177.76,88.88,,136.88,77,,,Percent of Total Billed Charges,77% of total billed charges,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.54,74,,,Percent of Total Billed Charges,74% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,122.65,69,,,Percent of Total Billed Charges,69% of total billed charges,149.32,84,,,Percent of Total Billed Charges,84% of total billed charges,145.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.21,89,,,Percent of total Billed Charges,89% of total Billed charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.88,77,,,Percent of total Billed charges,77% of total billed charges,151.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.44,158.21,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin-Sulbactam 3gm SDV,55150011720,CDM,250,RC,,,Outpatient,,,160.08,80.04,,123.26,77,,,Percent of Total Billed Charges,77% of total billed charges,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.46,74,,,Percent of Total Billed Charges,74% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,110.46,69,,,Percent of Total Billed Charges,69% of total billed charges,134.47,84,,,Percent of Total Billed Charges,84% of total billed charges,131.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.47,89,,,Percent of total Billed Charges,89% of total Billed charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.26,77,,,Percent of total Billed charges,77% of total billed charges,136.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,142.47,
Ampicillin 500mg Capsule,781214501,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Ampicillin 500mg Capsule,781214501,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Ampicillin 500mg Capsule,781214501,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Ampicillin 500mg Capsule,781214501,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Ampicillin 500mg Capsule,781214501,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Ampicillin 500mg Capsule,781214501,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg SDV,781340795,CDM,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
Ampicillin 500mg/5ml SDV - Neonatal Use,,,250,RC,,,Outpatient,,,76.27,38.14,,58.73,77,,,Percent of Total Billed Charges,77% of total billed charges,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.44,74,,,Percent of Total Billed Charges,74% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,52.63,69,,,Percent of Total Billed Charges,69% of total billed charges,64.07,84,,,Percent of Total Billed Charges,84% of total billed charges,62.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.88,89,,,Percent of total Billed Charges,89% of total Billed charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.73,77,,,Percent of total Billed charges,77% of total billed charges,64.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.07,67.88,
ANAStrozole 1mg Tablet,60687011221,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
ANAStrozole 1mg Tablet,60687011221,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
ANAStrozole 1mg Tablet,60687011221,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
ANAStrozole 1mg Tablet,60687011221,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
ANAStrozole 1mg Tablet,60687011221,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
ANAStrozole 1mg Tablet,60687011221,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24959.72,12479.86,,19218.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7799.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18470.19,74,,,Percent of Total Billed Charges,74% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20966.16,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22214.15,89,,,Percent of total Billed Charges,89% of total Billed charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19218.98,77,,,Percent of total Billed charges,77% of total billed charges,21215.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7175.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12479.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6239.93,22214.15,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24318.08,12159.04,,18724.92,77,,,Percent of Total Billed Charges,77% of total billed charges,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7599.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17995.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,20427.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21643.09,89,,,Percent of total Billed Charges,89% of total Billed charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18724.92,77,,,Percent of total Billed charges,77% of total billed charges,20670.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6991.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12159.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6079.52,21643.09,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24959.72,12479.86,,19218.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7799.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18470.19,74,,,Percent of Total Billed Charges,74% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20966.16,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22214.15,89,,,Percent of total Billed Charges,89% of total Billed charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19218.98,77,,,Percent of total Billed charges,77% of total billed charges,21215.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7175.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12479.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6239.93,22214.15,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24318.08,12159.04,,18724.92,77,,,Percent of Total Billed Charges,77% of total billed charges,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7599.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17995.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,20427.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21643.09,89,,,Percent of total Billed Charges,89% of total Billed charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18724.92,77,,,Percent of total Billed charges,77% of total billed charges,20670.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6991.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12159.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6079.52,21643.09,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24959.72,12479.86,,19218.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7799.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18470.19,74,,,Percent of Total Billed Charges,74% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20966.16,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22214.15,89,,,Percent of total Billed Charges,89% of total Billed charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19218.98,77,,,Percent of total Billed charges,77% of total billed charges,21215.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7175.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12479.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6239.93,22214.15,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24318.08,12159.04,,18724.92,77,,,Percent of Total Billed Charges,77% of total billed charges,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7599.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17995.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,20427.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21643.09,89,,,Percent of total Billed Charges,89% of total Billed charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18724.92,77,,,Percent of total Billed charges,77% of total billed charges,20670.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6991.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12159.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6079.52,21643.09,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24959.72,12479.86,,19218.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7799.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18470.19,74,,,Percent of Total Billed Charges,74% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20966.16,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22214.15,89,,,Percent of total Billed Charges,89% of total Billed charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19218.98,77,,,Percent of total Billed charges,77% of total billed charges,21215.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7175.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12479.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6239.93,22214.15,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24318.08,12159.04,,18724.92,77,,,Percent of Total Billed Charges,77% of total billed charges,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7599.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17995.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,20427.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21643.09,89,,,Percent of total Billed Charges,89% of total Billed charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18724.92,77,,,Percent of total Billed charges,77% of total billed charges,20670.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6991.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12159.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6079.52,21643.09,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24959.72,12479.86,,19218.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7799.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18470.19,74,,,Percent of Total Billed Charges,74% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20966.16,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22214.15,89,,,Percent of total Billed Charges,89% of total Billed charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19218.98,77,,,Percent of total Billed charges,77% of total billed charges,21215.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7175.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12479.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6239.93,22214.15,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24318.08,12159.04,,18724.92,77,,,Percent of Total Billed Charges,77% of total billed charges,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7599.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17995.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,20427.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21643.09,89,,,Percent of total Billed Charges,89% of total Billed charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18724.92,77,,,Percent of total Billed charges,77% of total billed charges,20670.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6991.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12159.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6079.52,21643.09,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24959.72,12479.86,,19218.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6364.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7799.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18470.19,74,,,Percent of Total Billed Charges,74% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,17222.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20966.16,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22214.15,89,,,Percent of total Billed Charges,89% of total Billed charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19218.98,77,,,Percent of total Billed charges,77% of total billed charges,21215.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7175.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12479.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10183.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22214.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6239.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6239.93,22214.15,
Anifrolumab-FNIA (Saphnelo) 300mg/2ml Liquid SDV,310304000,CDM,250,RC,,,Outpatient,,,24318.08,12159.04,,18724.92,77,,,Percent of Total Billed Charges,77% of total billed charges,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6201.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7599.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17995.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,16779.48,69,,,Percent of Total Billed Charges,69% of total billed charges,20427.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21643.09,89,,,Percent of total Billed Charges,89% of total Billed charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18724.92,77,,,Percent of total Billed charges,77% of total billed charges,20670.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6991.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12159.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9921.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21643.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6079.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6079.52,21643.09,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14285.17,7142.59,,10999.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4464.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10571.03,74,,,Percent of Total Billed Charges,74% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11999.54,84,,,Percent of Total Billed Charges,84% of total billed charges,11713.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,12713.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10999.58,77,,,Percent of total Billed charges,77% of total billed charges,12142.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4106.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7142.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3571.29,12713.8,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14878.72,7439.36,,11456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4649.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11010.25,74,,,Percent of Total Billed Charges,74% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12498.12,84,,,Percent of Total Billed Charges,84% of total billed charges,12200.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,13242.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11456.61,77,,,Percent of total Billed charges,77% of total billed charges,12646.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4277.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7439.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3719.68,13242.06,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14285.17,7142.59,,10999.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4464.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10571.03,74,,,Percent of Total Billed Charges,74% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11999.54,84,,,Percent of Total Billed Charges,84% of total billed charges,11713.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,12713.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10999.58,77,,,Percent of total Billed charges,77% of total billed charges,12142.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4106.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7142.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3571.29,12713.8,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14878.72,7439.36,,11456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4649.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11010.25,74,,,Percent of Total Billed Charges,74% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12498.12,84,,,Percent of Total Billed Charges,84% of total billed charges,12200.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,13242.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11456.61,77,,,Percent of total Billed charges,77% of total billed charges,12646.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4277.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7439.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3719.68,13242.06,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14285.17,7142.59,,10999.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4464.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10571.03,74,,,Percent of Total Billed Charges,74% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11999.54,84,,,Percent of Total Billed Charges,84% of total billed charges,11713.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,12713.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10999.58,77,,,Percent of total Billed charges,77% of total billed charges,12142.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4106.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7142.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3571.29,12713.8,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14878.72,7439.36,,11456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4649.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11010.25,74,,,Percent of Total Billed Charges,74% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12498.12,84,,,Percent of Total Billed Charges,84% of total billed charges,12200.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,13242.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11456.61,77,,,Percent of total Billed charges,77% of total billed charges,12646.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4277.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7439.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3719.68,13242.06,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14285.17,7142.59,,10999.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4464.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10571.03,74,,,Percent of Total Billed Charges,74% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11999.54,84,,,Percent of Total Billed Charges,84% of total billed charges,11713.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,12713.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10999.58,77,,,Percent of total Billed charges,77% of total billed charges,12142.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4106.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7142.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3571.29,12713.8,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14878.72,7439.36,,11456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4649.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11010.25,74,,,Percent of Total Billed Charges,74% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12498.12,84,,,Percent of Total Billed Charges,84% of total billed charges,12200.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,13242.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11456.61,77,,,Percent of total Billed charges,77% of total billed charges,12646.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4277.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7439.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3719.68,13242.06,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14285.17,7142.59,,10999.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4464.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10571.03,74,,,Percent of Total Billed Charges,74% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11999.54,84,,,Percent of Total Billed Charges,84% of total billed charges,11713.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,12713.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10999.58,77,,,Percent of total Billed charges,77% of total billed charges,12142.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4106.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7142.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3571.29,12713.8,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14878.72,7439.36,,11456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4649.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11010.25,74,,,Percent of Total Billed Charges,74% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12498.12,84,,,Percent of Total Billed Charges,84% of total billed charges,12200.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,13242.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11456.61,77,,,Percent of total Billed charges,77% of total billed charges,12646.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4277.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7439.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3719.68,13242.06,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14285.17,7142.59,,10999.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3642.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4464.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10571.03,74,,,Percent of Total Billed Charges,74% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,9856.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11999.54,84,,,Percent of Total Billed Charges,84% of total billed charges,11713.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,12713.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10999.58,77,,,Percent of total Billed charges,77% of total billed charges,12142.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4106.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7142.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5828.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12713.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3571.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3571.29,12713.8,
Crofab 1gm SDV,50633011012,CDM,250,RC,,,Outpatient,,,14878.72,7439.36,,11456.61,77,,,Percent of Total Billed Charges,77% of total billed charges,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3794.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4649.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11010.25,74,,,Percent of Total Billed Charges,74% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,10266.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12498.12,84,,,Percent of Total Billed Charges,84% of total billed charges,12200.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,13242.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11456.61,77,,,Percent of total Billed charges,77% of total billed charges,12646.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4277.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7439.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6070.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13242.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3719.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3719.68,13242.06,
Apixaban 2.5mg Tablet,3089321,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 2.5mg Tablet,3089321,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 2.5mg Tablet,3089321,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 2.5mg Tablet,3089321,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 2.5mg Tablet,3089321,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 2.5mg Tablet,3089321,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 5mg Tablet,3089421,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 5mg Tablet,3089421,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 5mg Tablet,3089421,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 5mg Tablet,3089421,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 5mg Tablet,3089421,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apixaban 5mg Tablet,3089421,CDM,250,RC,,,Outpatient,,,75.01,37.51,,57.76,77,,,Percent of Total Billed Charges,77% of total billed charges,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.51,74,,,Percent of Total Billed Charges,74% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,51.76,69,,,Percent of Total Billed Charges,69% of total billed charges,63.01,84,,,Percent of Total Billed Charges,84% of total billed charges,61.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.76,89,,,Percent of total Billed Charges,89% of total Billed charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.76,77,,,Percent of total Billed charges,77% of total billed charges,63.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.75,66.76,
Apraclonidine 0.5% OPHTH (Iopidine) 5ml,61314066505,CDM,250,RC,,,Outpatient,,,303.94,151.97,,234.03,77,,,Percent of Total Billed Charges,77% of total billed charges,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.92,74,,,Percent of Total Billed Charges,74% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,255.31,84,,,Percent of Total Billed Charges,84% of total billed charges,249.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.51,89,,,Percent of total Billed Charges,89% of total Billed charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.03,77,,,Percent of total Billed charges,77% of total billed charges,258.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.99,270.51,
Apraclonidine 0.5% OPHTH (Iopidine) 5ml,61314066505,CDM,250,RC,,,Outpatient,,,303.94,151.97,,234.03,77,,,Percent of Total Billed Charges,77% of total billed charges,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.92,74,,,Percent of Total Billed Charges,74% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,255.31,84,,,Percent of Total Billed Charges,84% of total billed charges,249.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.51,89,,,Percent of total Billed Charges,89% of total Billed charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.03,77,,,Percent of total Billed charges,77% of total billed charges,258.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.99,270.51,
Apraclonidine 0.5% OPHTH (Iopidine) 5ml,61314066505,CDM,250,RC,,,Outpatient,,,303.94,151.97,,234.03,77,,,Percent of Total Billed Charges,77% of total billed charges,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.92,74,,,Percent of Total Billed Charges,74% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,255.31,84,,,Percent of Total Billed Charges,84% of total billed charges,249.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.51,89,,,Percent of total Billed Charges,89% of total Billed charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.03,77,,,Percent of total Billed charges,77% of total billed charges,258.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.99,270.51,
Apraclonidine 0.5% OPHTH (Iopidine) 5ml,61314066505,CDM,250,RC,,,Outpatient,,,303.94,151.97,,234.03,77,,,Percent of Total Billed Charges,77% of total billed charges,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.92,74,,,Percent of Total Billed Charges,74% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,255.31,84,,,Percent of Total Billed Charges,84% of total billed charges,249.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.51,89,,,Percent of total Billed Charges,89% of total Billed charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.03,77,,,Percent of total Billed charges,77% of total billed charges,258.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.99,270.51,
Apraclonidine 0.5% OPHTH (Iopidine) 5ml,61314066505,CDM,250,RC,,,Outpatient,,,303.94,151.97,,234.03,77,,,Percent of Total Billed Charges,77% of total billed charges,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.92,74,,,Percent of Total Billed Charges,74% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,255.31,84,,,Percent of Total Billed Charges,84% of total billed charges,249.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.51,89,,,Percent of total Billed Charges,89% of total Billed charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.03,77,,,Percent of total Billed charges,77% of total billed charges,258.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.99,270.51,
Apraclonidine 0.5% OPHTH (Iopidine) 5ml,61314066505,CDM,250,RC,,,Outpatient,,,303.94,151.97,,234.03,77,,,Percent of Total Billed Charges,77% of total billed charges,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.92,74,,,Percent of Total Billed Charges,74% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,209.72,69,,,Percent of Total Billed Charges,69% of total billed charges,255.31,84,,,Percent of Total Billed Charges,84% of total billed charges,249.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.51,89,,,Percent of total Billed Charges,89% of total Billed charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.03,77,,,Percent of total Billed charges,77% of total billed charges,258.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.99,270.51,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,2122.97,1061.49,,1634.69,77,,,Percent of Total Billed Charges,77% of total billed charges,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1571,74,,,Percent of Total Billed Charges,74% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1783.29,84,,,Percent of Total Billed Charges,84% of total billed charges,1740.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1889.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1634.69,77,,,Percent of total Billed charges,77% of total billed charges,1804.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,610.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1061.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.74,1889.44,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,3156.32,1578.16,,2430.37,77,,,Percent of Total Billed Charges,77% of total billed charges,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,986.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2335.68,74,,,Percent of Total Billed Charges,74% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2651.31,84,,,Percent of Total Billed Charges,84% of total billed charges,2588.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2809.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.37,77,,,Percent of total Billed charges,77% of total billed charges,2682.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,907.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1578.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.08,2809.12,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,2122.97,1061.49,,1634.69,77,,,Percent of Total Billed Charges,77% of total billed charges,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1571,74,,,Percent of Total Billed Charges,74% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1783.29,84,,,Percent of Total Billed Charges,84% of total billed charges,1740.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1889.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1634.69,77,,,Percent of total Billed charges,77% of total billed charges,1804.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,610.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1061.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.74,1889.44,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,3156.32,1578.16,,2430.37,77,,,Percent of Total Billed Charges,77% of total billed charges,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,986.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2335.68,74,,,Percent of Total Billed Charges,74% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2651.31,84,,,Percent of Total Billed Charges,84% of total billed charges,2588.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2809.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.37,77,,,Percent of total Billed charges,77% of total billed charges,2682.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,907.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1578.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.08,2809.12,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,2122.97,1061.49,,1634.69,77,,,Percent of Total Billed Charges,77% of total billed charges,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1571,74,,,Percent of Total Billed Charges,74% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1783.29,84,,,Percent of Total Billed Charges,84% of total billed charges,1740.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1889.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1634.69,77,,,Percent of total Billed charges,77% of total billed charges,1804.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,610.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1061.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.74,1889.44,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,3156.32,1578.16,,2430.37,77,,,Percent of Total Billed Charges,77% of total billed charges,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,986.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2335.68,74,,,Percent of Total Billed Charges,74% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2651.31,84,,,Percent of Total Billed Charges,84% of total billed charges,2588.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2809.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.37,77,,,Percent of total Billed charges,77% of total billed charges,2682.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,907.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1578.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.08,2809.12,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,2122.97,1061.49,,1634.69,77,,,Percent of Total Billed Charges,77% of total billed charges,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1571,74,,,Percent of Total Billed Charges,74% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1783.29,84,,,Percent of Total Billed Charges,84% of total billed charges,1740.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1889.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1634.69,77,,,Percent of total Billed charges,77% of total billed charges,1804.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,610.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1061.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.74,1889.44,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,3156.32,1578.16,,2430.37,77,,,Percent of Total Billed Charges,77% of total billed charges,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,986.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2335.68,74,,,Percent of Total Billed Charges,74% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2651.31,84,,,Percent of Total Billed Charges,84% of total billed charges,2588.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2809.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.37,77,,,Percent of total Billed charges,77% of total billed charges,2682.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,907.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1578.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.08,2809.12,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,2122.97,1061.49,,1634.69,77,,,Percent of Total Billed Charges,77% of total billed charges,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1571,74,,,Percent of Total Billed Charges,74% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1783.29,84,,,Percent of Total Billed Charges,84% of total billed charges,1740.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1889.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1634.69,77,,,Percent of total Billed charges,77% of total billed charges,1804.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,610.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1061.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.74,1889.44,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,3156.32,1578.16,,2430.37,77,,,Percent of Total Billed Charges,77% of total billed charges,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,986.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2335.68,74,,,Percent of Total Billed Charges,74% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2651.31,84,,,Percent of Total Billed Charges,84% of total billed charges,2588.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2809.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.37,77,,,Percent of total Billed charges,77% of total billed charges,2682.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,907.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1578.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.08,2809.12,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,2122.97,1061.49,,1634.69,77,,,Percent of Total Billed Charges,77% of total billed charges,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,541.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,663.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1571,74,,,Percent of Total Billed Charges,74% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1464.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1783.29,84,,,Percent of Total Billed Charges,84% of total billed charges,1740.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,1889.44,89,,,Percent of total Billed Charges,89% of total Billed charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1634.69,77,,,Percent of total Billed charges,77% of total billed charges,1804.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,610.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1061.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,866.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1889.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.74,1889.44,
Aprepitant (Cinvanti) 130mg/18ml Liquid SDV,47426020101,CDM,250,RC,,,Outpatient,,,3156.32,1578.16,,2430.37,77,,,Percent of Total Billed Charges,77% of total billed charges,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,804.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,986.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2335.68,74,,,Percent of Total Billed Charges,74% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2177.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2651.31,84,,,Percent of Total Billed Charges,84% of total billed charges,2588.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2809.12,89,,,Percent of total Billed Charges,89% of total Billed charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.37,77,,,Percent of total Billed charges,77% of total billed charges,2682.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,907.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1578.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1287.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2809.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,789.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,789.08,2809.12,
Juven 28.8gm Packet,59781066684,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Juven 28.8gm Packet,59781066684,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Juven 28.8gm Packet,59781066684,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Juven 28.8gm Packet,59781066684,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Juven 28.8gm Packet,59781066684,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Juven 28.8gm Packet,59781066684,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
ARIPiprazole 10mg Tablet,59148000813,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 10mg Tablet,59148000813,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 10mg Tablet,59148000813,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 10mg Tablet,59148000813,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 10mg Tablet,59148000813,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 10mg Tablet,59148000813,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 2mg Tablet,59148000613,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 2mg Tablet,59148000613,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 2mg Tablet,59148000613,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 2mg Tablet,59148000613,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 2mg Tablet,59148000613,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
ARIPiprazole 2mg Tablet,59148000613,CDM,250,RC,,,Outpatient,,,142.47,71.24,,109.7,77,,,Percent of Total Billed Charges,77% of total billed charges,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.43,74,,,Percent of Total Billed Charges,74% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,98.3,69,,,Percent of Total Billed Charges,69% of total billed charges,119.67,84,,,Percent of Total Billed Charges,84% of total billed charges,116.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.8,89,,,Percent of total Billed Charges,89% of total Billed charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.7,77,,,Percent of total Billed charges,77% of total billed charges,121.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.62,126.8,
Ascorbic Acid (Vitamin C) 500mg Tablet,904052361,CDM,250,RC,,,Outpatient,,,5.28,2.64,,4.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.91,74,,,Percent of Total Billed Charges,74% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,4.44,84,,,Percent of Total Billed Charges,84% of total billed charges,4.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,77,,,Percent of total Billed charges,77% of total billed charges,4.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.32,4.7,
Ascorbic Acid (Vitamin C) 500mg Tablet,904052361,CDM,250,RC,,,Outpatient,,,5.28,2.64,,4.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.91,74,,,Percent of Total Billed Charges,74% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,4.44,84,,,Percent of Total Billed Charges,84% of total billed charges,4.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,77,,,Percent of total Billed charges,77% of total billed charges,4.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.32,4.7,
Ascorbic Acid (Vitamin C) 500mg Tablet,904052361,CDM,250,RC,,,Outpatient,,,5.28,2.64,,4.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.91,74,,,Percent of Total Billed Charges,74% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,4.44,84,,,Percent of Total Billed Charges,84% of total billed charges,4.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,77,,,Percent of total Billed charges,77% of total billed charges,4.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.32,4.7,
Ascorbic Acid (Vitamin C) 500mg Tablet,904052361,CDM,250,RC,,,Outpatient,,,5.28,2.64,,4.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.91,74,,,Percent of Total Billed Charges,74% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,4.44,84,,,Percent of Total Billed Charges,84% of total billed charges,4.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,77,,,Percent of total Billed charges,77% of total billed charges,4.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.32,4.7,
Ascorbic Acid (Vitamin C) 500mg Tablet,904052361,CDM,250,RC,,,Outpatient,,,5.28,2.64,,4.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.91,74,,,Percent of Total Billed Charges,74% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,4.44,84,,,Percent of Total Billed Charges,84% of total billed charges,4.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,77,,,Percent of total Billed charges,77% of total billed charges,4.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.32,4.7,
Ascorbic Acid (Vitamin C) 500mg Tablet,904052361,CDM,250,RC,,,Outpatient,,,5.28,2.64,,4.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.91,74,,,Percent of Total Billed Charges,74% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.64,69,,,Percent of Total Billed Charges,69% of total billed charges,4.44,84,,,Percent of Total Billed Charges,84% of total billed charges,4.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,77,,,Percent of total Billed charges,77% of total billed charges,4.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.32,4.7,
Aspirin Enteric Coated 325mg Tablet,57896092101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 325mg Tablet,57896092101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 325mg Tablet,57896092101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 325mg Tablet,57896092101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 325mg Tablet,57896092101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 325mg Tablet,57896092101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 81mg Tablet,63739021202,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 81mg Tablet,63739021202,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 81mg Tablet,63739021202,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 81mg Tablet,63739021202,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 81mg Tablet,63739021202,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Enteric Coated 81mg Tablet,63739021202,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 325mg Tablet,66553000101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 325mg Tablet,66553000101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 325mg Tablet,66553000101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 325mg Tablet,66553000101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 325mg Tablet,66553000101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 325mg Tablet,66553000101,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dipyridamole/ASA 200/25mg Capsule,70436009205,CDM,250,RC,,,Outpatient,,,64.48,32.24,,49.65,77,,,Percent of Total Billed Charges,77% of total billed charges,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.72,74,,,Percent of Total Billed Charges,74% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,54.16,84,,,Percent of Total Billed Charges,84% of total billed charges,52.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.39,89,,,Percent of total Billed Charges,89% of total Billed charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.65,77,,,Percent of total Billed charges,77% of total billed charges,54.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.12,57.39,
Dipyridamole/ASA 200/25mg Capsule,70436009205,CDM,250,RC,,,Outpatient,,,64.48,32.24,,49.65,77,,,Percent of Total Billed Charges,77% of total billed charges,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.72,74,,,Percent of Total Billed Charges,74% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,54.16,84,,,Percent of Total Billed Charges,84% of total billed charges,52.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.39,89,,,Percent of total Billed Charges,89% of total Billed charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.65,77,,,Percent of total Billed charges,77% of total billed charges,54.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.12,57.39,
Dipyridamole/ASA 200/25mg Capsule,70436009205,CDM,250,RC,,,Outpatient,,,64.48,32.24,,49.65,77,,,Percent of Total Billed Charges,77% of total billed charges,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.72,74,,,Percent of Total Billed Charges,74% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,54.16,84,,,Percent of Total Billed Charges,84% of total billed charges,52.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.39,89,,,Percent of total Billed Charges,89% of total Billed charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.65,77,,,Percent of total Billed charges,77% of total billed charges,54.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.12,57.39,
Dipyridamole/ASA 200/25mg Capsule,70436009205,CDM,250,RC,,,Outpatient,,,64.48,32.24,,49.65,77,,,Percent of Total Billed Charges,77% of total billed charges,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.72,74,,,Percent of Total Billed Charges,74% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,54.16,84,,,Percent of Total Billed Charges,84% of total billed charges,52.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.39,89,,,Percent of total Billed Charges,89% of total Billed charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.65,77,,,Percent of total Billed charges,77% of total billed charges,54.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.12,57.39,
Dipyridamole/ASA 200/25mg Capsule,70436009205,CDM,250,RC,,,Outpatient,,,64.48,32.24,,49.65,77,,,Percent of Total Billed Charges,77% of total billed charges,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.72,74,,,Percent of Total Billed Charges,74% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,54.16,84,,,Percent of Total Billed Charges,84% of total billed charges,52.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.39,89,,,Percent of total Billed Charges,89% of total Billed charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.65,77,,,Percent of total Billed charges,77% of total billed charges,54.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.12,57.39,
Dipyridamole/ASA 200/25mg Capsule,70436009205,CDM,250,RC,,,Outpatient,,,64.48,32.24,,49.65,77,,,Percent of Total Billed Charges,77% of total billed charges,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.72,74,,,Percent of Total Billed Charges,74% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,44.49,69,,,Percent of Total Billed Charges,69% of total billed charges,54.16,84,,,Percent of Total Billed Charges,84% of total billed charges,52.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.39,89,,,Percent of total Billed Charges,89% of total Billed charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.65,77,,,Percent of total Billed charges,77% of total billed charges,54.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.12,57.39,
Alka Seltzer (ASA 325mg) Tablet,16500004011,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Alka Seltzer (ASA 325mg) Tablet,16500004011,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Alka Seltzer (ASA 325mg) Tablet,16500004011,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Alka Seltzer (ASA 325mg) Tablet,16500004011,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Alka Seltzer (ASA 325mg) Tablet,16500004011,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Alka Seltzer (ASA 325mg) Tablet,16500004011,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 300mg Suppository,574703412,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 300mg Suppository,574703412,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 300mg Suppository,574703412,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 300mg Suppository,574703412,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 300mg Suppository,574703412,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin 300mg Suppository,574703412,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Chewable 81mg Tablet,904404073,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Chewable 81mg Tablet,904404073,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Chewable 81mg Tablet,904404073,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Chewable 81mg Tablet,904404073,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Chewable 81mg Tablet,904404073,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Aspirin Chewable 81mg Tablet,904404073,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Atenolol 25mg Tablet,51079075920,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
Atenolol 25mg Tablet,51079075920,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
Atenolol 25mg Tablet,51079075920,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
Atenolol 25mg Tablet,51079075920,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
Atenolol 25mg Tablet,51079075920,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
Atenolol 25mg Tablet,51079075920,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
Atenolol 50mg Tablet,51079068420,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
Atenolol 50mg Tablet,51079068420,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
Atenolol 50mg Tablet,51079068420,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
Atenolol 50mg Tablet,51079068420,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
Atenolol 50mg Tablet,51079068420,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
Atenolol 50mg Tablet,51079068420,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,51977.75,25988.88,,40022.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16243.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38463.54,74,,,Percent of Total Billed Charges,74% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,43661.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,46260.2,89,,,Percent of total Billed Charges,89% of total Billed charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40022.87,77,,,Percent of total Billed charges,77% of total billed charges,44181.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14943.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25988.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12994.44,46260.2,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,50637.37,25318.69,,38990.77,77,,,Percent of Total Billed Charges,77% of total billed charges,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15824.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37471.65,74,,,Percent of Total Billed Charges,74% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,42535.39,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,45067.26,89,,,Percent of total Billed Charges,89% of total Billed charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38990.77,77,,,Percent of total Billed charges,77% of total billed charges,43041.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14558.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25318.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12659.34,45067.26,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,51977.75,25988.88,,40022.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16243.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38463.54,74,,,Percent of Total Billed Charges,74% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,43661.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,46260.2,89,,,Percent of total Billed Charges,89% of total Billed charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40022.87,77,,,Percent of total Billed charges,77% of total billed charges,44181.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14943.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25988.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12994.44,46260.2,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,50637.37,25318.69,,38990.77,77,,,Percent of Total Billed Charges,77% of total billed charges,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15824.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37471.65,74,,,Percent of Total Billed Charges,74% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,42535.39,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,45067.26,89,,,Percent of total Billed Charges,89% of total Billed charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38990.77,77,,,Percent of total Billed charges,77% of total billed charges,43041.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14558.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25318.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12659.34,45067.26,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,51977.75,25988.88,,40022.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16243.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38463.54,74,,,Percent of Total Billed Charges,74% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,43661.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,46260.2,89,,,Percent of total Billed Charges,89% of total Billed charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40022.87,77,,,Percent of total Billed charges,77% of total billed charges,44181.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14943.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25988.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12994.44,46260.2,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,50637.37,25318.69,,38990.77,77,,,Percent of Total Billed Charges,77% of total billed charges,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15824.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37471.65,74,,,Percent of Total Billed Charges,74% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,42535.39,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,45067.26,89,,,Percent of total Billed Charges,89% of total Billed charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38990.77,77,,,Percent of total Billed charges,77% of total billed charges,43041.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14558.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25318.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12659.34,45067.26,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,51977.75,25988.88,,40022.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16243.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38463.54,74,,,Percent of Total Billed Charges,74% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,43661.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,46260.2,89,,,Percent of total Billed Charges,89% of total Billed charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40022.87,77,,,Percent of total Billed charges,77% of total billed charges,44181.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14943.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25988.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12994.44,46260.2,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,50637.37,25318.69,,38990.77,77,,,Percent of Total Billed Charges,77% of total billed charges,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15824.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37471.65,74,,,Percent of Total Billed Charges,74% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,42535.39,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,45067.26,89,,,Percent of total Billed Charges,89% of total Billed charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38990.77,77,,,Percent of total Billed charges,77% of total billed charges,43041.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14558.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25318.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12659.34,45067.26,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,51977.75,25988.88,,40022.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16243.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38463.54,74,,,Percent of Total Billed Charges,74% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,43661.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,46260.2,89,,,Percent of total Billed Charges,89% of total Billed charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40022.87,77,,,Percent of total Billed charges,77% of total billed charges,44181.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14943.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25988.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12994.44,46260.2,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,50637.37,25318.69,,38990.77,77,,,Percent of Total Billed Charges,77% of total billed charges,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15824.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37471.65,74,,,Percent of Total Billed Charges,74% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,42535.39,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,45067.26,89,,,Percent of total Billed Charges,89% of total Billed charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38990.77,77,,,Percent of total Billed charges,77% of total billed charges,43041.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14558.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25318.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12659.34,45067.26,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,51977.75,25988.88,,40022.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13254.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16243.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38463.54,74,,,Percent of Total Billed Charges,74% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,35864.65,69,,,Percent of Total Billed Charges,69% of total billed charges,43661.31,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,46260.2,89,,,Percent of total Billed Charges,89% of total Billed charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40022.87,77,,,Percent of total Billed charges,77% of total billed charges,44181.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14943.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25988.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21206.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46260.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12994.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12994.44,46260.2,
Atezolizumab (Tecentriq) 1200mg/20ml Liquid SDV,50242091701,CDM,250,RC,,,Outpatient,,,50637.37,25318.69,,38990.77,77,,,Percent of Total Billed Charges,77% of total billed charges,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12912.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15824.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37471.65,74,,,Percent of Total Billed Charges,74% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,34939.79,69,,,Percent of Total Billed Charges,69% of total billed charges,42535.39,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,45067.26,89,,,Percent of total Billed Charges,89% of total Billed charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38990.77,77,,,Percent of total Billed charges,77% of total billed charges,43041.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14558.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25318.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20660.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45067.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12659.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12659.34,45067.26,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,36429.26,18214.63,,28050.53,77,,,Percent of Total Billed Charges,77% of total billed charges,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11384.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26957.65,74,,,Percent of Total Billed Charges,74% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30600.58,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32422.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28050.53,77,,,Percent of total Billed charges,77% of total billed charges,30964.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10473.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18214.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9107.32,32422.04,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,35490.99,17745.5,,27328.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11090.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26263.33,74,,,Percent of Total Billed Charges,74% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,29812.43,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31586.98,89,,,Percent of total Billed Charges,89% of total Billed charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27328.06,77,,,Percent of total Billed charges,77% of total billed charges,30167.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10203.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17745.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8872.75,31586.98,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,36429.26,18214.63,,28050.53,77,,,Percent of Total Billed Charges,77% of total billed charges,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11384.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26957.65,74,,,Percent of Total Billed Charges,74% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30600.58,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32422.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28050.53,77,,,Percent of total Billed charges,77% of total billed charges,30964.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10473.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18214.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9107.32,32422.04,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,35490.99,17745.5,,27328.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11090.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26263.33,74,,,Percent of Total Billed Charges,74% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,29812.43,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31586.98,89,,,Percent of total Billed Charges,89% of total Billed charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27328.06,77,,,Percent of total Billed charges,77% of total billed charges,30167.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10203.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17745.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8872.75,31586.98,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,36429.26,18214.63,,28050.53,77,,,Percent of Total Billed Charges,77% of total billed charges,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11384.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26957.65,74,,,Percent of Total Billed Charges,74% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30600.58,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32422.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28050.53,77,,,Percent of total Billed charges,77% of total billed charges,30964.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10473.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18214.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9107.32,32422.04,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,35490.99,17745.5,,27328.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11090.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26263.33,74,,,Percent of Total Billed Charges,74% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,29812.43,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31586.98,89,,,Percent of total Billed Charges,89% of total Billed charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27328.06,77,,,Percent of total Billed charges,77% of total billed charges,30167.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10203.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17745.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8872.75,31586.98,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,36429.26,18214.63,,28050.53,77,,,Percent of Total Billed Charges,77% of total billed charges,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11384.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26957.65,74,,,Percent of Total Billed Charges,74% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30600.58,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32422.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28050.53,77,,,Percent of total Billed charges,77% of total billed charges,30964.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10473.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18214.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9107.32,32422.04,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,35490.99,17745.5,,27328.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11090.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26263.33,74,,,Percent of Total Billed Charges,74% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,29812.43,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31586.98,89,,,Percent of total Billed Charges,89% of total Billed charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27328.06,77,,,Percent of total Billed charges,77% of total billed charges,30167.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10203.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17745.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8872.75,31586.98,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,36429.26,18214.63,,28050.53,77,,,Percent of Total Billed Charges,77% of total billed charges,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11384.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26957.65,74,,,Percent of Total Billed Charges,74% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30600.58,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32422.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28050.53,77,,,Percent of total Billed charges,77% of total billed charges,30964.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10473.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18214.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9107.32,32422.04,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,35490.99,17745.5,,27328.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11090.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26263.33,74,,,Percent of Total Billed Charges,74% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,29812.43,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31586.98,89,,,Percent of total Billed Charges,89% of total Billed charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27328.06,77,,,Percent of total Billed charges,77% of total billed charges,30167.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10203.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17745.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8872.75,31586.98,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,36429.26,18214.63,,28050.53,77,,,Percent of Total Billed Charges,77% of total billed charges,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9289.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11384.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26957.65,74,,,Percent of Total Billed Charges,74% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25136.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30600.58,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32422.04,89,,,Percent of total Billed Charges,89% of total Billed charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28050.53,77,,,Percent of total Billed charges,77% of total billed charges,30964.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10473.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18214.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14863.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32422.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9107.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9107.32,32422.04,
Atezolizumab (Tecentriq) 840mg/14ml Liquid SDV,50242091801,CDM,250,RC,,,Outpatient,,,35490.99,17745.5,,27328.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9050.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11090.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26263.33,74,,,Percent of Total Billed Charges,74% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,24488.78,69,,,Percent of Total Billed Charges,69% of total billed charges,29812.43,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31586.98,89,,,Percent of total Billed Charges,89% of total Billed charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27328.06,77,,,Percent of total Billed charges,77% of total billed charges,30167.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10203.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17745.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14480.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31586.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8872.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8872.75,31586.98,
Atorvastatin 10mg Tablet,904629061,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Atorvastatin 10mg Tablet,904629061,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Atorvastatin 10mg Tablet,904629061,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Atorvastatin 10mg Tablet,904629061,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Atorvastatin 10mg Tablet,904629061,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Atorvastatin 10mg Tablet,904629061,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Atorvastatin 20mg Tablet,904629161,CDM,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Atorvastatin 20mg Tablet,904629161,CDM,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Atorvastatin 20mg Tablet,904629161,CDM,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Atorvastatin 20mg Tablet,904629161,CDM,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Atorvastatin 20mg Tablet,904629161,CDM,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Atorvastatin 20mg Tablet,904629161,CDM,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Atropine 1mg/10ml Prefilled IV Syringe,76329334001,CDM,250,RC,,,Outpatient,,,134.17,67.09,,103.31,77,,,Percent of Total Billed Charges,77% of total billed charges,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.29,74,,,Percent of Total Billed Charges,74% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,112.7,84,,,Percent of Total Billed Charges,84% of total billed charges,110.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.41,89,,,Percent of total Billed Charges,89% of total Billed charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.31,77,,,Percent of total Billed charges,77% of total billed charges,114.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.54,119.41,
Atropine 1mg/10ml Prefilled IV Syringe,76329334001,CDM,250,RC,,,Outpatient,,,134.17,67.09,,103.31,77,,,Percent of Total Billed Charges,77% of total billed charges,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.29,74,,,Percent of Total Billed Charges,74% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,112.7,84,,,Percent of Total Billed Charges,84% of total billed charges,110.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.41,89,,,Percent of total Billed Charges,89% of total Billed charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.31,77,,,Percent of total Billed charges,77% of total billed charges,114.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.54,119.41,
Atropine 1mg/10ml Prefilled IV Syringe,76329334001,CDM,250,RC,,,Outpatient,,,134.17,67.09,,103.31,77,,,Percent of Total Billed Charges,77% of total billed charges,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.29,74,,,Percent of Total Billed Charges,74% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,112.7,84,,,Percent of Total Billed Charges,84% of total billed charges,110.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.41,89,,,Percent of total Billed Charges,89% of total Billed charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.31,77,,,Percent of total Billed charges,77% of total billed charges,114.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.54,119.41,
Atropine 1mg/10ml Prefilled IV Syringe,76329334001,CDM,250,RC,,,Outpatient,,,134.17,67.09,,103.31,77,,,Percent of Total Billed Charges,77% of total billed charges,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.29,74,,,Percent of Total Billed Charges,74% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,112.7,84,,,Percent of Total Billed Charges,84% of total billed charges,110.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.41,89,,,Percent of total Billed Charges,89% of total Billed charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.31,77,,,Percent of total Billed charges,77% of total billed charges,114.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.54,119.41,
Atropine 1mg/10ml Prefilled IV Syringe,76329334001,CDM,250,RC,,,Outpatient,,,134.17,67.09,,103.31,77,,,Percent of Total Billed Charges,77% of total billed charges,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.29,74,,,Percent of Total Billed Charges,74% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,112.7,84,,,Percent of Total Billed Charges,84% of total billed charges,110.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.41,89,,,Percent of total Billed Charges,89% of total Billed charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.31,77,,,Percent of total Billed charges,77% of total billed charges,114.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.54,119.41,
Atropine 1mg/10ml Prefilled IV Syringe,76329334001,CDM,250,RC,,,Outpatient,,,134.17,67.09,,103.31,77,,,Percent of Total Billed Charges,77% of total billed charges,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.29,74,,,Percent of Total Billed Charges,74% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,92.58,69,,,Percent of Total Billed Charges,69% of total billed charges,112.7,84,,,Percent of Total Billed Charges,84% of total billed charges,110.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.41,89,,,Percent of total Billed Charges,89% of total Billed charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.31,77,,,Percent of total Billed charges,77% of total billed charges,114.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.54,119.41,
Atropine 0.4mg/ml SDV,,,250,RC,,,Outpatient,,,132.36,66.18,,101.92,77,,,Percent of Total Billed Charges,77% of total billed charges,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.95,74,,,Percent of Total Billed Charges,74% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,111.18,84,,,Percent of Total Billed Charges,84% of total billed charges,108.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.8,89,,,Percent of total Billed Charges,89% of total Billed charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.92,77,,,Percent of total Billed charges,77% of total billed charges,112.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.09,117.8,
Atropine 0.4mg/ml SDV,,,250,RC,,,Outpatient,,,132.36,66.18,,101.92,77,,,Percent of Total Billed Charges,77% of total billed charges,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.95,74,,,Percent of Total Billed Charges,74% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,111.18,84,,,Percent of Total Billed Charges,84% of total billed charges,108.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.8,89,,,Percent of total Billed Charges,89% of total Billed charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.92,77,,,Percent of total Billed charges,77% of total billed charges,112.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.09,117.8,
Atropine 0.4mg/ml SDV,,,250,RC,,,Outpatient,,,132.36,66.18,,101.92,77,,,Percent of Total Billed Charges,77% of total billed charges,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.95,74,,,Percent of Total Billed Charges,74% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,111.18,84,,,Percent of Total Billed Charges,84% of total billed charges,108.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.8,89,,,Percent of total Billed Charges,89% of total Billed charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.92,77,,,Percent of total Billed charges,77% of total billed charges,112.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.09,117.8,
Atropine 0.4mg/ml SDV,,,250,RC,,,Outpatient,,,132.36,66.18,,101.92,77,,,Percent of Total Billed Charges,77% of total billed charges,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.95,74,,,Percent of Total Billed Charges,74% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,111.18,84,,,Percent of Total Billed Charges,84% of total billed charges,108.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.8,89,,,Percent of total Billed Charges,89% of total Billed charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.92,77,,,Percent of total Billed charges,77% of total billed charges,112.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.09,117.8,
Atropine 0.4mg/ml SDV,,,250,RC,,,Outpatient,,,132.36,66.18,,101.92,77,,,Percent of Total Billed Charges,77% of total billed charges,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.95,74,,,Percent of Total Billed Charges,74% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,111.18,84,,,Percent of Total Billed Charges,84% of total billed charges,108.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.8,89,,,Percent of total Billed Charges,89% of total Billed charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.92,77,,,Percent of total Billed charges,77% of total billed charges,112.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.09,117.8,
Atropine 0.4mg/ml SDV,,,250,RC,,,Outpatient,,,132.36,66.18,,101.92,77,,,Percent of Total Billed Charges,77% of total billed charges,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.95,74,,,Percent of Total Billed Charges,74% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,91.33,69,,,Percent of Total Billed Charges,69% of total billed charges,111.18,84,,,Percent of Total Billed Charges,84% of total billed charges,108.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.8,89,,,Percent of total Billed Charges,89% of total Billed charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.92,77,,,Percent of total Billed charges,77% of total billed charges,112.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.09,117.8,
Atropine 8mg/20ml MDV,,,250,RC,,,Outpatient,,,68.79,34.4,,52.97,77,,,Percent of Total Billed Charges,77% of total billed charges,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.9,74,,,Percent of Total Billed Charges,74% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,57.78,84,,,Percent of Total Billed Charges,84% of total billed charges,56.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.22,89,,,Percent of total Billed Charges,89% of total Billed charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.97,77,,,Percent of total Billed charges,77% of total billed charges,58.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,61.22,
Atropine 8mg/20ml MDV,,,250,RC,,,Outpatient,,,68.79,34.4,,52.97,77,,,Percent of Total Billed Charges,77% of total billed charges,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.9,74,,,Percent of Total Billed Charges,74% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,57.78,84,,,Percent of Total Billed Charges,84% of total billed charges,56.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.22,89,,,Percent of total Billed Charges,89% of total Billed charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.97,77,,,Percent of total Billed charges,77% of total billed charges,58.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,61.22,
Atropine 8mg/20ml MDV,,,250,RC,,,Outpatient,,,68.79,34.4,,52.97,77,,,Percent of Total Billed Charges,77% of total billed charges,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.9,74,,,Percent of Total Billed Charges,74% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,57.78,84,,,Percent of Total Billed Charges,84% of total billed charges,56.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.22,89,,,Percent of total Billed Charges,89% of total Billed charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.97,77,,,Percent of total Billed charges,77% of total billed charges,58.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,61.22,
Atropine 8mg/20ml MDV,,,250,RC,,,Outpatient,,,68.79,34.4,,52.97,77,,,Percent of Total Billed Charges,77% of total billed charges,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.9,74,,,Percent of Total Billed Charges,74% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,57.78,84,,,Percent of Total Billed Charges,84% of total billed charges,56.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.22,89,,,Percent of total Billed Charges,89% of total Billed charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.97,77,,,Percent of total Billed charges,77% of total billed charges,58.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,61.22,
Atropine 8mg/20ml MDV,,,250,RC,,,Outpatient,,,68.79,34.4,,52.97,77,,,Percent of Total Billed Charges,77% of total billed charges,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.9,74,,,Percent of Total Billed Charges,74% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,57.78,84,,,Percent of Total Billed Charges,84% of total billed charges,56.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.22,89,,,Percent of total Billed Charges,89% of total Billed charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.97,77,,,Percent of total Billed charges,77% of total billed charges,58.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,61.22,
Atropine 8mg/20ml MDV,,,250,RC,,,Outpatient,,,68.79,34.4,,52.97,77,,,Percent of Total Billed Charges,77% of total billed charges,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.9,74,,,Percent of Total Billed Charges,74% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,47.47,69,,,Percent of Total Billed Charges,69% of total billed charges,57.78,84,,,Percent of Total Billed Charges,84% of total billed charges,56.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.22,89,,,Percent of total Billed Charges,89% of total Billed charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.97,77,,,Percent of total Billed charges,77% of total billed charges,58.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.2,61.22,
Atropine OPHTH Soln 1% 5ml,60219174903,CDM,250,RC,,,Outpatient,,,206.13,103.07,,158.72,77,,,Percent of Total Billed Charges,77% of total billed charges,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.54,74,,,Percent of Total Billed Charges,74% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,173.15,84,,,Percent of Total Billed Charges,84% of total billed charges,169.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.46,89,,,Percent of total Billed Charges,89% of total Billed charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.72,77,,,Percent of total Billed charges,77% of total billed charges,175.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.53,183.46,
Atropine OPHTH Soln 1% 5ml,60219174903,CDM,250,RC,,,Outpatient,,,206.13,103.07,,158.72,77,,,Percent of Total Billed Charges,77% of total billed charges,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.54,74,,,Percent of Total Billed Charges,74% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,173.15,84,,,Percent of Total Billed Charges,84% of total billed charges,169.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.46,89,,,Percent of total Billed Charges,89% of total Billed charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.72,77,,,Percent of total Billed charges,77% of total billed charges,175.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.53,183.46,
Atropine OPHTH Soln 1% 5ml,60219174903,CDM,250,RC,,,Outpatient,,,206.13,103.07,,158.72,77,,,Percent of Total Billed Charges,77% of total billed charges,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.54,74,,,Percent of Total Billed Charges,74% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,173.15,84,,,Percent of Total Billed Charges,84% of total billed charges,169.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.46,89,,,Percent of total Billed Charges,89% of total Billed charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.72,77,,,Percent of total Billed charges,77% of total billed charges,175.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.53,183.46,
Atropine OPHTH Soln 1% 5ml,60219174903,CDM,250,RC,,,Outpatient,,,206.13,103.07,,158.72,77,,,Percent of Total Billed Charges,77% of total billed charges,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.54,74,,,Percent of Total Billed Charges,74% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,173.15,84,,,Percent of Total Billed Charges,84% of total billed charges,169.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.46,89,,,Percent of total Billed Charges,89% of total Billed charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.72,77,,,Percent of total Billed charges,77% of total billed charges,175.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.53,183.46,
Atropine OPHTH Soln 1% 5ml,60219174903,CDM,250,RC,,,Outpatient,,,206.13,103.07,,158.72,77,,,Percent of Total Billed Charges,77% of total billed charges,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.54,74,,,Percent of Total Billed Charges,74% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,173.15,84,,,Percent of Total Billed Charges,84% of total billed charges,169.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.46,89,,,Percent of total Billed Charges,89% of total Billed charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.72,77,,,Percent of total Billed charges,77% of total billed charges,175.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.53,183.46,
Atropine OPHTH Soln 1% 5ml,60219174903,CDM,250,RC,,,Outpatient,,,206.13,103.07,,158.72,77,,,Percent of Total Billed Charges,77% of total billed charges,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,152.54,74,,,Percent of Total Billed Charges,74% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,142.23,69,,,Percent of Total Billed Charges,69% of total billed charges,173.15,84,,,Percent of Total Billed Charges,84% of total billed charges,169.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,183.46,89,,,Percent of total Billed Charges,89% of total Billed charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.72,77,,,Percent of total Billed charges,77% of total billed charges,175.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.53,183.46,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13826.46,6913.23,,10646.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4320.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10231.58,74,,,Percent of Total Billed Charges,74% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11614.23,84,,,Percent of Total Billed Charges,84% of total billed charges,11337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,12305.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10646.37,77,,,Percent of total Billed charges,77% of total billed charges,11752.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3975.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6913.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3456.62,12305.55,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13472.75,6736.38,,10374.02,77,,,Percent of Total Billed Charges,77% of total billed charges,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4210.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9969.84,74,,,Percent of Total Billed Charges,74% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,11317.11,84,,,Percent of Total Billed Charges,84% of total billed charges,11047.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11990.75,89,,,Percent of total Billed Charges,89% of total Billed charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10374.02,77,,,Percent of total Billed charges,77% of total billed charges,11451.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3873.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6736.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3368.19,11990.75,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13826.46,6913.23,,10646.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4320.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10231.58,74,,,Percent of Total Billed Charges,74% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11614.23,84,,,Percent of Total Billed Charges,84% of total billed charges,11337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,12305.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10646.37,77,,,Percent of total Billed charges,77% of total billed charges,11752.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3975.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6913.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3456.62,12305.55,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13472.75,6736.38,,10374.02,77,,,Percent of Total Billed Charges,77% of total billed charges,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4210.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9969.84,74,,,Percent of Total Billed Charges,74% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,11317.11,84,,,Percent of Total Billed Charges,84% of total billed charges,11047.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11990.75,89,,,Percent of total Billed Charges,89% of total Billed charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10374.02,77,,,Percent of total Billed charges,77% of total billed charges,11451.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3873.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6736.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3368.19,11990.75,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13826.46,6913.23,,10646.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4320.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10231.58,74,,,Percent of Total Billed Charges,74% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11614.23,84,,,Percent of Total Billed Charges,84% of total billed charges,11337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,12305.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10646.37,77,,,Percent of total Billed charges,77% of total billed charges,11752.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3975.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6913.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3456.62,12305.55,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13472.75,6736.38,,10374.02,77,,,Percent of Total Billed Charges,77% of total billed charges,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4210.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9969.84,74,,,Percent of Total Billed Charges,74% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,11317.11,84,,,Percent of Total Billed Charges,84% of total billed charges,11047.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11990.75,89,,,Percent of total Billed Charges,89% of total Billed charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10374.02,77,,,Percent of total Billed charges,77% of total billed charges,11451.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3873.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6736.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3368.19,11990.75,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13826.46,6913.23,,10646.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4320.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10231.58,74,,,Percent of Total Billed Charges,74% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11614.23,84,,,Percent of Total Billed Charges,84% of total billed charges,11337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,12305.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10646.37,77,,,Percent of total Billed charges,77% of total billed charges,11752.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3975.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6913.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3456.62,12305.55,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13472.75,6736.38,,10374.02,77,,,Percent of Total Billed Charges,77% of total billed charges,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4210.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9969.84,74,,,Percent of Total Billed Charges,74% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,11317.11,84,,,Percent of Total Billed Charges,84% of total billed charges,11047.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11990.75,89,,,Percent of total Billed Charges,89% of total Billed charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10374.02,77,,,Percent of total Billed charges,77% of total billed charges,11451.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3873.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6736.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3368.19,11990.75,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13826.46,6913.23,,10646.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4320.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10231.58,74,,,Percent of Total Billed Charges,74% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11614.23,84,,,Percent of Total Billed Charges,84% of total billed charges,11337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,12305.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10646.37,77,,,Percent of total Billed charges,77% of total billed charges,11752.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3975.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6913.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3456.62,12305.55,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13472.75,6736.38,,10374.02,77,,,Percent of Total Billed Charges,77% of total billed charges,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4210.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9969.84,74,,,Percent of Total Billed Charges,74% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,11317.11,84,,,Percent of Total Billed Charges,84% of total billed charges,11047.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11990.75,89,,,Percent of total Billed Charges,89% of total Billed charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10374.02,77,,,Percent of total Billed charges,77% of total billed charges,11451.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3873.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6736.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3368.19,11990.75,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13826.46,6913.23,,10646.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3525.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4320.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10231.58,74,,,Percent of Total Billed Charges,74% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,9540.26,69,,,Percent of Total Billed Charges,69% of total billed charges,11614.23,84,,,Percent of Total Billed Charges,84% of total billed charges,11337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,12305.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10646.37,77,,,Percent of total Billed charges,77% of total billed charges,11752.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3975.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6913.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5641.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12305.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3456.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3456.62,12305.55,
Avelumab (Bavencio) 200mg/10ml Liquid SDV,44087353501,CDM,250,RC,,,Outpatient,,,13472.75,6736.38,,10374.02,77,,,Percent of Total Billed Charges,77% of total billed charges,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3435.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4210.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9969.84,74,,,Percent of Total Billed Charges,74% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,9296.2,69,,,Percent of Total Billed Charges,69% of total billed charges,11317.11,84,,,Percent of Total Billed Charges,84% of total billed charges,11047.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,11990.75,89,,,Percent of total Billed Charges,89% of total Billed charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10374.02,77,,,Percent of total Billed charges,77% of total billed charges,11451.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3873.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6736.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5496.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11990.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3368.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3368.19,11990.75,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3109.24,1554.62,,2394.11,77,,,Percent of Total Billed Charges,77% of total billed charges,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2300.84,74,,,Percent of Total Billed Charges,74% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.76,84,,,Percent of Total Billed Charges,84% of total billed charges,2549.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2767.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2394.11,77,,,Percent of total Billed charges,77% of total billed charges,2642.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1554.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.31,2767.22,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3033.45,1516.73,,2335.76,77,,,Percent of Total Billed Charges,77% of total billed charges,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,947.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2244.75,74,,,Percent of Total Billed Charges,74% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2548.1,84,,,Percent of Total Billed Charges,84% of total billed charges,2487.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,2699.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2335.76,77,,,Percent of total Billed charges,77% of total billed charges,2578.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,872.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1516.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.36,2699.77,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3109.24,1554.62,,2394.11,77,,,Percent of Total Billed Charges,77% of total billed charges,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2300.84,74,,,Percent of Total Billed Charges,74% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.76,84,,,Percent of Total Billed Charges,84% of total billed charges,2549.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2767.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2394.11,77,,,Percent of total Billed charges,77% of total billed charges,2642.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1554.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.31,2767.22,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3033.45,1516.73,,2335.76,77,,,Percent of Total Billed Charges,77% of total billed charges,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,947.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2244.75,74,,,Percent of Total Billed Charges,74% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2548.1,84,,,Percent of Total Billed Charges,84% of total billed charges,2487.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,2699.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2335.76,77,,,Percent of total Billed charges,77% of total billed charges,2578.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,872.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1516.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.36,2699.77,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3109.24,1554.62,,2394.11,77,,,Percent of Total Billed Charges,77% of total billed charges,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2300.84,74,,,Percent of Total Billed Charges,74% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.76,84,,,Percent of Total Billed Charges,84% of total billed charges,2549.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2767.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2394.11,77,,,Percent of total Billed charges,77% of total billed charges,2642.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1554.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.31,2767.22,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3033.45,1516.73,,2335.76,77,,,Percent of Total Billed Charges,77% of total billed charges,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,947.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2244.75,74,,,Percent of Total Billed Charges,74% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2548.1,84,,,Percent of Total Billed Charges,84% of total billed charges,2487.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,2699.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2335.76,77,,,Percent of total Billed charges,77% of total billed charges,2578.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,872.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1516.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.36,2699.77,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3109.24,1554.62,,2394.11,77,,,Percent of Total Billed Charges,77% of total billed charges,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2300.84,74,,,Percent of Total Billed Charges,74% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.76,84,,,Percent of Total Billed Charges,84% of total billed charges,2549.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2767.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2394.11,77,,,Percent of total Billed charges,77% of total billed charges,2642.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1554.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.31,2767.22,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3033.45,1516.73,,2335.76,77,,,Percent of Total Billed Charges,77% of total billed charges,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,947.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2244.75,74,,,Percent of Total Billed Charges,74% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2548.1,84,,,Percent of Total Billed Charges,84% of total billed charges,2487.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,2699.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2335.76,77,,,Percent of total Billed charges,77% of total billed charges,2578.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,872.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1516.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.36,2699.77,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3109.24,1554.62,,2394.11,77,,,Percent of Total Billed Charges,77% of total billed charges,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2300.84,74,,,Percent of Total Billed Charges,74% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.76,84,,,Percent of Total Billed Charges,84% of total billed charges,2549.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2767.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2394.11,77,,,Percent of total Billed charges,77% of total billed charges,2642.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1554.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.31,2767.22,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3033.45,1516.73,,2335.76,77,,,Percent of Total Billed Charges,77% of total billed charges,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,947.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2244.75,74,,,Percent of Total Billed Charges,74% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2548.1,84,,,Percent of Total Billed Charges,84% of total billed charges,2487.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,2699.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2335.76,77,,,Percent of total Billed charges,77% of total billed charges,2578.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,872.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1516.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.36,2699.77,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3109.24,1554.62,,2394.11,77,,,Percent of Total Billed Charges,77% of total billed charges,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,792.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,971.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2300.84,74,,,Percent of Total Billed Charges,74% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2145.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.76,84,,,Percent of Total Billed Charges,84% of total billed charges,2549.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2767.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2394.11,77,,,Percent of total Billed charges,77% of total billed charges,2642.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,893.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1554.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1268.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2767.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.31,2767.22,
azaCITIDine 100mg Powder SDV,16729030610,CDM,250,RC,,,Outpatient,,,3033.45,1516.73,,2335.76,77,,,Percent of Total Billed Charges,77% of total billed charges,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,773.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,947.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2244.75,74,,,Percent of Total Billed Charges,74% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2093.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2548.1,84,,,Percent of Total Billed Charges,84% of total billed charges,2487.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,2699.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2335.76,77,,,Percent of total Billed charges,77% of total billed charges,2578.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,872.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1516.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1237.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2699.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.36,2699.77,
azaTHIOprine 50mg Tablet,68382000301,CDM,250,RC,,,Outpatient,,,24.8,12.4,,19.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.35,74,,,Percent of Total Billed Charges,74% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20.83,84,,,Percent of Total Billed Charges,84% of total billed charges,20.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.07,89,,,Percent of total Billed Charges,89% of total Billed charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.1,77,,,Percent of total Billed charges,77% of total billed charges,21.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,22.07,
azaTHIOprine 50mg Tablet,68382000301,CDM,250,RC,,,Outpatient,,,24.8,12.4,,19.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.35,74,,,Percent of Total Billed Charges,74% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20.83,84,,,Percent of Total Billed Charges,84% of total billed charges,20.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.07,89,,,Percent of total Billed Charges,89% of total Billed charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.1,77,,,Percent of total Billed charges,77% of total billed charges,21.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,22.07,
azaTHIOprine 50mg Tablet,68382000301,CDM,250,RC,,,Outpatient,,,24.8,12.4,,19.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.35,74,,,Percent of Total Billed Charges,74% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20.83,84,,,Percent of Total Billed Charges,84% of total billed charges,20.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.07,89,,,Percent of total Billed Charges,89% of total Billed charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.1,77,,,Percent of total Billed charges,77% of total billed charges,21.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,22.07,
azaTHIOprine 50mg Tablet,68382000301,CDM,250,RC,,,Outpatient,,,24.8,12.4,,19.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.35,74,,,Percent of Total Billed Charges,74% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20.83,84,,,Percent of Total Billed Charges,84% of total billed charges,20.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.07,89,,,Percent of total Billed Charges,89% of total Billed charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.1,77,,,Percent of total Billed charges,77% of total billed charges,21.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,22.07,
azaTHIOprine 50mg Tablet,68382000301,CDM,250,RC,,,Outpatient,,,24.8,12.4,,19.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.35,74,,,Percent of Total Billed Charges,74% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20.83,84,,,Percent of Total Billed Charges,84% of total billed charges,20.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.07,89,,,Percent of total Billed Charges,89% of total Billed charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.1,77,,,Percent of total Billed charges,77% of total billed charges,21.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,22.07,
azaTHIOprine 50mg Tablet,68382000301,CDM,250,RC,,,Outpatient,,,24.8,12.4,,19.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.35,74,,,Percent of Total Billed Charges,74% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,17.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20.83,84,,,Percent of Total Billed Charges,84% of total billed charges,20.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.07,89,,,Percent of total Billed Charges,89% of total Billed charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.1,77,,,Percent of total Billed charges,77% of total billed charges,21.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,22.07,
Azithromycin Oral Susp 200mg/5ml 15ml,59762311001,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Azithromycin Oral Susp 200mg/5ml 15ml,59762311001,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Azithromycin Oral Susp 200mg/5ml 15ml,59762311001,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Azithromycin Oral Susp 200mg/5ml 15ml,59762311001,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Azithromycin Oral Susp 200mg/5ml 15ml,59762311001,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Azithromycin Oral Susp 200mg/5ml 15ml,59762311001,CDM,250,RC,,,Outpatient,,,169.49,84.75,,130.51,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,116.95,69,,,Percent of Total Billed Charges,69% of total billed charges,142.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.85,89,,,Percent of total Billed Charges,89% of total Billed charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.51,77,,,Percent of total Billed charges,77% of total billed charges,144.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.85,
Azithromycin 250mg Tablet,59762306003,CDM,250,RC,,,Outpatient,,,36.91,18.46,,28.42,77,,,Percent of Total Billed Charges,77% of total billed charges,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.31,74,,,Percent of Total Billed Charges,74% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,31,84,,,Percent of Total Billed Charges,84% of total billed charges,30.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,89,,,Percent of total Billed Charges,89% of total Billed charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,77,,,Percent of total Billed charges,77% of total billed charges,31.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.23,32.85,
Azithromycin 250mg Tablet,59762306003,CDM,250,RC,,,Outpatient,,,36.91,18.46,,28.42,77,,,Percent of Total Billed Charges,77% of total billed charges,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.31,74,,,Percent of Total Billed Charges,74% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,31,84,,,Percent of Total Billed Charges,84% of total billed charges,30.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,89,,,Percent of total Billed Charges,89% of total Billed charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,77,,,Percent of total Billed charges,77% of total billed charges,31.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.23,32.85,
Azithromycin 250mg Tablet,59762306003,CDM,250,RC,,,Outpatient,,,36.91,18.46,,28.42,77,,,Percent of Total Billed Charges,77% of total billed charges,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.31,74,,,Percent of Total Billed Charges,74% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,31,84,,,Percent of Total Billed Charges,84% of total billed charges,30.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,89,,,Percent of total Billed Charges,89% of total Billed charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,77,,,Percent of total Billed charges,77% of total billed charges,31.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.23,32.85,
Azithromycin 250mg Tablet,59762306003,CDM,250,RC,,,Outpatient,,,36.91,18.46,,28.42,77,,,Percent of Total Billed Charges,77% of total billed charges,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.31,74,,,Percent of Total Billed Charges,74% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,31,84,,,Percent of Total Billed Charges,84% of total billed charges,30.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,89,,,Percent of total Billed Charges,89% of total Billed charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,77,,,Percent of total Billed charges,77% of total billed charges,31.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.23,32.85,
Azithromycin 250mg Tablet,59762306003,CDM,250,RC,,,Outpatient,,,36.91,18.46,,28.42,77,,,Percent of Total Billed Charges,77% of total billed charges,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.31,74,,,Percent of Total Billed Charges,74% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,31,84,,,Percent of Total Billed Charges,84% of total billed charges,30.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,89,,,Percent of total Billed Charges,89% of total Billed charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,77,,,Percent of total Billed charges,77% of total billed charges,31.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.23,32.85,
Azithromycin 250mg Tablet,59762306003,CDM,250,RC,,,Outpatient,,,36.91,18.46,,28.42,77,,,Percent of Total Billed Charges,77% of total billed charges,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.31,74,,,Percent of Total Billed Charges,74% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,25.47,69,,,Percent of Total Billed Charges,69% of total billed charges,31,84,,,Percent of Total Billed Charges,84% of total billed charges,30.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.85,89,,,Percent of total Billed Charges,89% of total Billed charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.42,77,,,Percent of total Billed charges,77% of total billed charges,31.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.23,32.85,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Azithromycin 500mg SDV,63323039812,CDM,250,RC,,,Outpatient,,,234.21,117.11,,180.34,77,,,Percent of Total Billed Charges,77% of total billed charges,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.32,74,,,Percent of Total Billed Charges,74% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,161.6,69,,,Percent of Total Billed Charges,69% of total billed charges,196.74,84,,,Percent of Total Billed Charges,84% of total billed charges,192.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.45,89,,,Percent of total Billed Charges,89% of total Billed charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.34,77,,,Percent of total Billed charges,77% of total billed charges,199.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.55,208.45,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 1gm SDV,3256016,CDM,250,RC,,,Outpatient,,,232.78,116.39,,179.24,77,,,Percent of Total Billed Charges,77% of total billed charges,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,172.26,74,,,Percent of Total Billed Charges,74% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,160.62,69,,,Percent of Total Billed Charges,69% of total billed charges,195.54,84,,,Percent of Total Billed Charges,84% of total billed charges,190.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,207.17,89,,,Percent of total Billed Charges,89% of total Billed charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.24,77,,,Percent of total Billed charges,77% of total billed charges,197.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,66.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,116.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,94.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,207.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.2,207.17,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Aztreonam 2gm SDV,63323040220,CDM,250,RC,,,Outpatient,,,472.85,236.43,,364.09,77,,,Percent of Total Billed Charges,77% of total billed charges,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,349.91,74,,,Percent of Total Billed Charges,74% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,326.27,69,,,Percent of Total Billed Charges,69% of total billed charges,397.19,84,,,Percent of Total Billed Charges,84% of total billed charges,387.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,420.84,89,,,Percent of total Billed Charges,89% of total Billed charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.09,77,,,Percent of total Billed charges,77% of total billed charges,401.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,135.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,236.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,192.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,420.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.21,420.84,
Bacitracin/Polymixin Oint 14.2gm,81079888,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Bacitracin/Polymixin Oint 14.2gm,81079888,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Bacitracin/Polymixin Oint 14.2gm,81079888,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Bacitracin/Polymixin Oint 14.2gm,81079888,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Bacitracin/Polymixin Oint 14.2gm,81079888,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Bacitracin/Polymixin Oint 14.2gm,81079888,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Bacitracin EXT Oint 0.9 gm UD Packet,45802006070,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bacitracin EXT Oint 0.9 gm UD Packet,45802006070,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bacitracin EXT Oint 0.9 gm UD Packet,45802006070,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bacitracin EXT Oint 0.9 gm UD Packet,45802006070,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bacitracin EXT Oint 0.9 gm UD Packet,45802006070,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bacitracin EXT Oint 0.9 gm UD Packet,45802006070,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bacitracin/Polymix OPHTH Oint 3.5gm,574402135,CDM,250,RC,,,Outpatient,,,184.05,92.03,,141.72,77,,,Percent of Total Billed Charges,77% of total billed charges,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.2,74,,,Percent of Total Billed Charges,74% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,154.6,84,,,Percent of Total Billed Charges,84% of total billed charges,150.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.8,89,,,Percent of total Billed Charges,89% of total Billed charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.72,77,,,Percent of total Billed charges,77% of total billed charges,156.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.01,163.8,
Bacitracin/Polymix OPHTH Oint 3.5gm,574402135,CDM,250,RC,,,Outpatient,,,184.05,92.03,,141.72,77,,,Percent of Total Billed Charges,77% of total billed charges,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.2,74,,,Percent of Total Billed Charges,74% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,154.6,84,,,Percent of Total Billed Charges,84% of total billed charges,150.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.8,89,,,Percent of total Billed Charges,89% of total Billed charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.72,77,,,Percent of total Billed charges,77% of total billed charges,156.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.01,163.8,
Bacitracin/Polymix OPHTH Oint 3.5gm,574402135,CDM,250,RC,,,Outpatient,,,184.05,92.03,,141.72,77,,,Percent of Total Billed Charges,77% of total billed charges,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.2,74,,,Percent of Total Billed Charges,74% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,154.6,84,,,Percent of Total Billed Charges,84% of total billed charges,150.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.8,89,,,Percent of total Billed Charges,89% of total Billed charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.72,77,,,Percent of total Billed charges,77% of total billed charges,156.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.01,163.8,
Bacitracin/Polymix OPHTH Oint 3.5gm,574402135,CDM,250,RC,,,Outpatient,,,184.05,92.03,,141.72,77,,,Percent of Total Billed Charges,77% of total billed charges,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.2,74,,,Percent of Total Billed Charges,74% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,154.6,84,,,Percent of Total Billed Charges,84% of total billed charges,150.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.8,89,,,Percent of total Billed Charges,89% of total Billed charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.72,77,,,Percent of total Billed charges,77% of total billed charges,156.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.01,163.8,
Bacitracin/Polymix OPHTH Oint 3.5gm,574402135,CDM,250,RC,,,Outpatient,,,184.05,92.03,,141.72,77,,,Percent of Total Billed Charges,77% of total billed charges,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.2,74,,,Percent of Total Billed Charges,74% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,154.6,84,,,Percent of Total Billed Charges,84% of total billed charges,150.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.8,89,,,Percent of total Billed Charges,89% of total Billed charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.72,77,,,Percent of total Billed charges,77% of total billed charges,156.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.01,163.8,
Bacitracin/Polymix OPHTH Oint 3.5gm,574402135,CDM,250,RC,,,Outpatient,,,184.05,92.03,,141.72,77,,,Percent of Total Billed Charges,77% of total billed charges,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.2,74,,,Percent of Total Billed Charges,74% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,126.99,69,,,Percent of Total Billed Charges,69% of total billed charges,154.6,84,,,Percent of Total Billed Charges,84% of total billed charges,150.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.8,89,,,Percent of total Billed Charges,89% of total Billed charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.72,77,,,Percent of total Billed charges,77% of total billed charges,156.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.01,163.8,
Bacitracin OPHTH Oint 3.5gm,574402235,CDM,250,RC,,,Outpatient,,,377.36,188.68,,290.57,77,,,Percent of Total Billed Charges,77% of total billed charges,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.25,74,,,Percent of Total Billed Charges,74% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,316.98,84,,,Percent of Total Billed Charges,84% of total billed charges,309.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.85,89,,,Percent of total Billed Charges,89% of total Billed charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.57,77,,,Percent of total Billed charges,77% of total billed charges,320.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.34,335.85,
Bacitracin OPHTH Oint 3.5gm,574402235,CDM,250,RC,,,Outpatient,,,377.36,188.68,,290.57,77,,,Percent of Total Billed Charges,77% of total billed charges,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.25,74,,,Percent of Total Billed Charges,74% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,316.98,84,,,Percent of Total Billed Charges,84% of total billed charges,309.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.85,89,,,Percent of total Billed Charges,89% of total Billed charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.57,77,,,Percent of total Billed charges,77% of total billed charges,320.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.34,335.85,
Bacitracin OPHTH Oint 3.5gm,574402235,CDM,250,RC,,,Outpatient,,,377.36,188.68,,290.57,77,,,Percent of Total Billed Charges,77% of total billed charges,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.25,74,,,Percent of Total Billed Charges,74% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,316.98,84,,,Percent of Total Billed Charges,84% of total billed charges,309.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.85,89,,,Percent of total Billed Charges,89% of total Billed charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.57,77,,,Percent of total Billed charges,77% of total billed charges,320.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.34,335.85,
Bacitracin OPHTH Oint 3.5gm,574402235,CDM,250,RC,,,Outpatient,,,377.36,188.68,,290.57,77,,,Percent of Total Billed Charges,77% of total billed charges,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.25,74,,,Percent of Total Billed Charges,74% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,316.98,84,,,Percent of Total Billed Charges,84% of total billed charges,309.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.85,89,,,Percent of total Billed Charges,89% of total Billed charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.57,77,,,Percent of total Billed charges,77% of total billed charges,320.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.34,335.85,
Bacitracin OPHTH Oint 3.5gm,574402235,CDM,250,RC,,,Outpatient,,,377.36,188.68,,290.57,77,,,Percent of Total Billed Charges,77% of total billed charges,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.25,74,,,Percent of Total Billed Charges,74% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,316.98,84,,,Percent of Total Billed Charges,84% of total billed charges,309.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.85,89,,,Percent of total Billed Charges,89% of total Billed charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.57,77,,,Percent of total Billed charges,77% of total billed charges,320.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.34,335.85,
Bacitracin OPHTH Oint 3.5gm,574402235,CDM,250,RC,,,Outpatient,,,377.36,188.68,,290.57,77,,,Percent of Total Billed Charges,77% of total billed charges,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,279.25,74,,,Percent of Total Billed Charges,74% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,260.38,69,,,Percent of Total Billed Charges,69% of total billed charges,316.98,84,,,Percent of Total Billed Charges,84% of total billed charges,309.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,335.85,89,,,Percent of total Billed Charges,89% of total Billed charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,290.57,77,,,Percent of total Billed charges,77% of total billed charges,320.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,188.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,335.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.34,335.85,
Baclofen 10mg Tablet,172409660,CDM,250,RC,,,Outpatient,,,28.18,14.09,,21.7,77,,,Percent of Total Billed Charges,77% of total billed charges,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.85,74,,,Percent of Total Billed Charges,74% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,23.67,84,,,Percent of Total Billed Charges,84% of total billed charges,23.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.08,89,,,Percent of total Billed Charges,89% of total Billed charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77,,,Percent of total Billed charges,77% of total billed charges,23.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.05,25.08,
Baclofen 10mg Tablet,172409660,CDM,250,RC,,,Outpatient,,,28.18,14.09,,21.7,77,,,Percent of Total Billed Charges,77% of total billed charges,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.85,74,,,Percent of Total Billed Charges,74% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,23.67,84,,,Percent of Total Billed Charges,84% of total billed charges,23.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.08,89,,,Percent of total Billed Charges,89% of total Billed charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77,,,Percent of total Billed charges,77% of total billed charges,23.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.05,25.08,
Baclofen 10mg Tablet,172409660,CDM,250,RC,,,Outpatient,,,28.18,14.09,,21.7,77,,,Percent of Total Billed Charges,77% of total billed charges,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.85,74,,,Percent of Total Billed Charges,74% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,23.67,84,,,Percent of Total Billed Charges,84% of total billed charges,23.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.08,89,,,Percent of total Billed Charges,89% of total Billed charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77,,,Percent of total Billed charges,77% of total billed charges,23.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.05,25.08,
Baclofen 10mg Tablet,172409660,CDM,250,RC,,,Outpatient,,,28.18,14.09,,21.7,77,,,Percent of Total Billed Charges,77% of total billed charges,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.85,74,,,Percent of Total Billed Charges,74% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,23.67,84,,,Percent of Total Billed Charges,84% of total billed charges,23.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.08,89,,,Percent of total Billed Charges,89% of total Billed charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77,,,Percent of total Billed charges,77% of total billed charges,23.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.05,25.08,
Baclofen 10mg Tablet,172409660,CDM,250,RC,,,Outpatient,,,28.18,14.09,,21.7,77,,,Percent of Total Billed Charges,77% of total billed charges,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.85,74,,,Percent of Total Billed Charges,74% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,23.67,84,,,Percent of Total Billed Charges,84% of total billed charges,23.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.08,89,,,Percent of total Billed Charges,89% of total Billed charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77,,,Percent of total Billed charges,77% of total billed charges,23.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.05,25.08,
Baclofen 10mg Tablet,172409660,CDM,250,RC,,,Outpatient,,,28.18,14.09,,21.7,77,,,Percent of Total Billed Charges,77% of total billed charges,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.85,74,,,Percent of Total Billed Charges,74% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,19.44,69,,,Percent of Total Billed Charges,69% of total billed charges,23.67,84,,,Percent of Total Billed Charges,84% of total billed charges,23.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.08,89,,,Percent of total Billed Charges,89% of total Billed charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77,,,Percent of total Billed charges,77% of total billed charges,23.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.05,25.08,
BSS OPHTH Irrigation Soln 15ml,65079515,CDM,250,RC,,,Outpatient,,,105.01,52.51,,80.86,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.71,74,,,Percent of Total Billed Charges,74% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,88.21,84,,,Percent of Total Billed Charges,84% of total billed charges,86.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.46,89,,,Percent of total Billed Charges,89% of total Billed charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.86,77,,,Percent of total Billed charges,77% of total billed charges,89.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.46,
BSS OPHTH Irrigation Soln 15ml,65079515,CDM,250,RC,,,Outpatient,,,105.01,52.51,,80.86,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.71,74,,,Percent of Total Billed Charges,74% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,88.21,84,,,Percent of Total Billed Charges,84% of total billed charges,86.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.46,89,,,Percent of total Billed Charges,89% of total Billed charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.86,77,,,Percent of total Billed charges,77% of total billed charges,89.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.46,
BSS OPHTH Irrigation Soln 15ml,65079515,CDM,250,RC,,,Outpatient,,,105.01,52.51,,80.86,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.71,74,,,Percent of Total Billed Charges,74% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,88.21,84,,,Percent of Total Billed Charges,84% of total billed charges,86.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.46,89,,,Percent of total Billed Charges,89% of total Billed charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.86,77,,,Percent of total Billed charges,77% of total billed charges,89.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.46,
BSS OPHTH Irrigation Soln 15ml,65079515,CDM,250,RC,,,Outpatient,,,105.01,52.51,,80.86,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.71,74,,,Percent of Total Billed Charges,74% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,88.21,84,,,Percent of Total Billed Charges,84% of total billed charges,86.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.46,89,,,Percent of total Billed Charges,89% of total Billed charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.86,77,,,Percent of total Billed charges,77% of total billed charges,89.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.46,
BSS OPHTH Irrigation Soln 15ml,65079515,CDM,250,RC,,,Outpatient,,,105.01,52.51,,80.86,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.71,74,,,Percent of Total Billed Charges,74% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,88.21,84,,,Percent of Total Billed Charges,84% of total billed charges,86.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.46,89,,,Percent of total Billed Charges,89% of total Billed charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.86,77,,,Percent of total Billed charges,77% of total billed charges,89.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.46,
BSS OPHTH Irrigation Soln 15ml,65079515,CDM,250,RC,,,Outpatient,,,105.01,52.51,,80.86,77,,,Percent of Total Billed Charges,77% of total billed charges,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,77.71,74,,,Percent of Total Billed Charges,74% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,72.46,69,,,Percent of Total Billed Charges,69% of total billed charges,88.21,84,,,Percent of Total Billed Charges,84% of total billed charges,86.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,93.46,89,,,Percent of total Billed Charges,89% of total Billed charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.86,77,,,Percent of total Billed charges,77% of total billed charges,89.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.25,93.46,
Baloxavir Marboxil 40mg Tablet,50242086001,CDM,250,RC,,,Outpatient,,,592.52,296.26,,456.24,77,,,Percent of Total Billed Charges,77% of total billed charges,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.46,74,,,Percent of Total Billed Charges,74% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,497.72,84,,,Percent of Total Billed Charges,84% of total billed charges,485.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,527.34,89,,,Percent of total Billed Charges,89% of total Billed charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.24,77,,,Percent of total Billed charges,77% of total billed charges,503.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.13,527.34,
Baloxavir Marboxil 40mg Tablet,50242086001,CDM,250,RC,,,Outpatient,,,592.52,296.26,,456.24,77,,,Percent of Total Billed Charges,77% of total billed charges,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.46,74,,,Percent of Total Billed Charges,74% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,497.72,84,,,Percent of Total Billed Charges,84% of total billed charges,485.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,527.34,89,,,Percent of total Billed Charges,89% of total Billed charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.24,77,,,Percent of total Billed charges,77% of total billed charges,503.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.13,527.34,
Baloxavir Marboxil 40mg Tablet,50242086001,CDM,250,RC,,,Outpatient,,,592.52,296.26,,456.24,77,,,Percent of Total Billed Charges,77% of total billed charges,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.46,74,,,Percent of Total Billed Charges,74% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,497.72,84,,,Percent of Total Billed Charges,84% of total billed charges,485.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,527.34,89,,,Percent of total Billed Charges,89% of total Billed charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.24,77,,,Percent of total Billed charges,77% of total billed charges,503.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.13,527.34,
Baloxavir Marboxil 40mg Tablet,50242086001,CDM,250,RC,,,Outpatient,,,592.52,296.26,,456.24,77,,,Percent of Total Billed Charges,77% of total billed charges,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.46,74,,,Percent of Total Billed Charges,74% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,497.72,84,,,Percent of Total Billed Charges,84% of total billed charges,485.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,527.34,89,,,Percent of total Billed Charges,89% of total Billed charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.24,77,,,Percent of total Billed charges,77% of total billed charges,503.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.13,527.34,
Baloxavir Marboxil 40mg Tablet,50242086001,CDM,250,RC,,,Outpatient,,,592.52,296.26,,456.24,77,,,Percent of Total Billed Charges,77% of total billed charges,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.46,74,,,Percent of Total Billed Charges,74% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,497.72,84,,,Percent of Total Billed Charges,84% of total billed charges,485.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,527.34,89,,,Percent of total Billed Charges,89% of total Billed charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.24,77,,,Percent of total Billed charges,77% of total billed charges,503.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.13,527.34,
Baloxavir Marboxil 40mg Tablet,50242086001,CDM,250,RC,,,Outpatient,,,592.52,296.26,,456.24,77,,,Percent of Total Billed Charges,77% of total billed charges,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,185.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,438.46,74,,,Percent of Total Billed Charges,74% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,408.84,69,,,Percent of Total Billed Charges,69% of total billed charges,497.72,84,,,Percent of Total Billed Charges,84% of total billed charges,485.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,527.34,89,,,Percent of total Billed Charges,89% of total Billed charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,456.24,77,,,Percent of total Billed charges,77% of total billed charges,503.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,170.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,296.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,241.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.13,527.34,
Balsam Peru/Castor Oil Oint 30gm,58980078011,CDM,250,RC,,,Outpatient,,,154.35,77.18,,118.85,77,,,Percent of Total Billed Charges,77% of total billed charges,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.22,74,,,Percent of Total Billed Charges,74% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,129.65,84,,,Percent of Total Billed Charges,84% of total billed charges,126.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.37,89,,,Percent of total Billed Charges,89% of total Billed charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.85,77,,,Percent of total Billed charges,77% of total billed charges,131.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.59,137.37,
Balsam Peru/Castor Oil Oint 30gm,58980078011,CDM,250,RC,,,Outpatient,,,154.35,77.18,,118.85,77,,,Percent of Total Billed Charges,77% of total billed charges,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.22,74,,,Percent of Total Billed Charges,74% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,129.65,84,,,Percent of Total Billed Charges,84% of total billed charges,126.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.37,89,,,Percent of total Billed Charges,89% of total Billed charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.85,77,,,Percent of total Billed charges,77% of total billed charges,131.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.59,137.37,
Balsam Peru/Castor Oil Oint 30gm,58980078011,CDM,250,RC,,,Outpatient,,,154.35,77.18,,118.85,77,,,Percent of Total Billed Charges,77% of total billed charges,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.22,74,,,Percent of Total Billed Charges,74% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,129.65,84,,,Percent of Total Billed Charges,84% of total billed charges,126.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.37,89,,,Percent of total Billed Charges,89% of total Billed charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.85,77,,,Percent of total Billed charges,77% of total billed charges,131.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.59,137.37,
Balsam Peru/Castor Oil Oint 30gm,58980078011,CDM,250,RC,,,Outpatient,,,154.35,77.18,,118.85,77,,,Percent of Total Billed Charges,77% of total billed charges,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.22,74,,,Percent of Total Billed Charges,74% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,129.65,84,,,Percent of Total Billed Charges,84% of total billed charges,126.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.37,89,,,Percent of total Billed Charges,89% of total Billed charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.85,77,,,Percent of total Billed charges,77% of total billed charges,131.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.59,137.37,
Balsam Peru/Castor Oil Oint 30gm,58980078011,CDM,250,RC,,,Outpatient,,,154.35,77.18,,118.85,77,,,Percent of Total Billed Charges,77% of total billed charges,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.22,74,,,Percent of Total Billed Charges,74% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,129.65,84,,,Percent of Total Billed Charges,84% of total billed charges,126.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.37,89,,,Percent of total Billed Charges,89% of total Billed charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.85,77,,,Percent of total Billed charges,77% of total billed charges,131.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.59,137.37,
Balsam Peru/Castor Oil Oint 30gm,58980078011,CDM,250,RC,,,Outpatient,,,154.35,77.18,,118.85,77,,,Percent of Total Billed Charges,77% of total billed charges,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.22,74,,,Percent of Total Billed Charges,74% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,106.5,69,,,Percent of Total Billed Charges,69% of total billed charges,129.65,84,,,Percent of Total Billed Charges,84% of total billed charges,126.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.37,89,,,Percent of total Billed Charges,89% of total Billed charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.85,77,,,Percent of total Billed charges,77% of total billed charges,131.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.59,137.37,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3101.94,1550.97,,2388.49,77,,,Percent of Total Billed Charges,77% of total billed charges,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,969.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2295.44,74,,,Percent of Total Billed Charges,74% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2605.63,84,,,Percent of Total Billed Charges,84% of total billed charges,2543.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2760.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2388.49,77,,,Percent of total Billed charges,77% of total billed charges,2636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1550.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.49,2760.73,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3025.58,1512.79,,2329.7,77,,,Percent of Total Billed Charges,77% of total billed charges,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.93,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2480.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.7,77,,,Percent of total Billed charges,77% of total billed charges,2571.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.4,2692.77,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3101.94,1550.97,,2388.49,77,,,Percent of Total Billed Charges,77% of total billed charges,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,969.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2295.44,74,,,Percent of Total Billed Charges,74% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2605.63,84,,,Percent of Total Billed Charges,84% of total billed charges,2543.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2760.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2388.49,77,,,Percent of total Billed charges,77% of total billed charges,2636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1550.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.49,2760.73,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3025.58,1512.79,,2329.7,77,,,Percent of Total Billed Charges,77% of total billed charges,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.93,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2480.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.7,77,,,Percent of total Billed charges,77% of total billed charges,2571.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.4,2692.77,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3101.94,1550.97,,2388.49,77,,,Percent of Total Billed Charges,77% of total billed charges,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,969.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2295.44,74,,,Percent of Total Billed Charges,74% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2605.63,84,,,Percent of Total Billed Charges,84% of total billed charges,2543.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2760.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2388.49,77,,,Percent of total Billed charges,77% of total billed charges,2636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1550.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.49,2760.73,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3025.58,1512.79,,2329.7,77,,,Percent of Total Billed Charges,77% of total billed charges,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.93,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2480.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.7,77,,,Percent of total Billed charges,77% of total billed charges,2571.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.4,2692.77,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3101.94,1550.97,,2388.49,77,,,Percent of Total Billed Charges,77% of total billed charges,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,969.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2295.44,74,,,Percent of Total Billed Charges,74% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2605.63,84,,,Percent of Total Billed Charges,84% of total billed charges,2543.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2760.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2388.49,77,,,Percent of total Billed charges,77% of total billed charges,2636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1550.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.49,2760.73,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3025.58,1512.79,,2329.7,77,,,Percent of Total Billed Charges,77% of total billed charges,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.93,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2480.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.7,77,,,Percent of total Billed charges,77% of total billed charges,2571.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.4,2692.77,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3101.94,1550.97,,2388.49,77,,,Percent of Total Billed Charges,77% of total billed charges,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,969.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2295.44,74,,,Percent of Total Billed Charges,74% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2605.63,84,,,Percent of Total Billed Charges,84% of total billed charges,2543.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2760.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2388.49,77,,,Percent of total Billed charges,77% of total billed charges,2636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1550.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.49,2760.73,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3025.58,1512.79,,2329.7,77,,,Percent of Total Billed Charges,77% of total billed charges,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.93,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2480.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.7,77,,,Percent of total Billed charges,77% of total billed charges,2571.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.4,2692.77,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3101.94,1550.97,,2388.49,77,,,Percent of Total Billed Charges,77% of total billed charges,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,790.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,969.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2295.44,74,,,Percent of Total Billed Charges,74% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2140.34,69,,,Percent of Total Billed Charges,69% of total billed charges,2605.63,84,,,Percent of Total Billed Charges,84% of total billed charges,2543.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2760.73,89,,,Percent of total Billed Charges,89% of total Billed charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2388.49,77,,,Percent of total Billed charges,77% of total billed charges,2636.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,891.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1550.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1265.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2760.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.49,2760.73,
Belimumab (Benlysta) 120mg/1.5ml Powder SDV,49401010101,CDM,250,RC,,,Outpatient,,,3025.58,1512.79,,2329.7,77,,,Percent of Total Billed Charges,77% of total billed charges,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.93,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2480.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.7,77,,,Percent of total Billed charges,77% of total billed charges,2571.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.4,2692.77,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9990.43,4995.22,,7692.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3122.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7392.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,8391.96,84,,,Percent of Total Billed Charges,84% of total billed charges,8192.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,8891.48,89,,,Percent of total Billed Charges,89% of total Billed charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7692.63,77,,,Percent of total Billed charges,77% of total billed charges,8491.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2872.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4995.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.61,8891.48,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9735.92,4867.96,,7496.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3042.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7204.58,74,,,Percent of Total Billed Charges,74% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8178.17,84,,,Percent of Total Billed Charges,84% of total billed charges,7983.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8664.97,89,,,Percent of total Billed Charges,89% of total Billed charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7496.66,77,,,Percent of total Billed charges,77% of total billed charges,8275.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2799.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4867.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2433.98,8664.97,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9990.43,4995.22,,7692.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3122.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7392.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,8391.96,84,,,Percent of Total Billed Charges,84% of total billed charges,8192.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,8891.48,89,,,Percent of total Billed Charges,89% of total Billed charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7692.63,77,,,Percent of total Billed charges,77% of total billed charges,8491.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2872.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4995.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.61,8891.48,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9735.92,4867.96,,7496.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3042.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7204.58,74,,,Percent of Total Billed Charges,74% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8178.17,84,,,Percent of Total Billed Charges,84% of total billed charges,7983.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8664.97,89,,,Percent of total Billed Charges,89% of total Billed charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7496.66,77,,,Percent of total Billed charges,77% of total billed charges,8275.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2799.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4867.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2433.98,8664.97,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9990.43,4995.22,,7692.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3122.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7392.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,8391.96,84,,,Percent of Total Billed Charges,84% of total billed charges,8192.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,8891.48,89,,,Percent of total Billed Charges,89% of total Billed charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7692.63,77,,,Percent of total Billed charges,77% of total billed charges,8491.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2872.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4995.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.61,8891.48,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9735.92,4867.96,,7496.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3042.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7204.58,74,,,Percent of Total Billed Charges,74% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8178.17,84,,,Percent of Total Billed Charges,84% of total billed charges,7983.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8664.97,89,,,Percent of total Billed Charges,89% of total Billed charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7496.66,77,,,Percent of total Billed charges,77% of total billed charges,8275.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2799.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4867.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2433.98,8664.97,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9990.43,4995.22,,7692.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3122.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7392.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,8391.96,84,,,Percent of Total Billed Charges,84% of total billed charges,8192.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,8891.48,89,,,Percent of total Billed Charges,89% of total Billed charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7692.63,77,,,Percent of total Billed charges,77% of total billed charges,8491.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2872.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4995.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.61,8891.48,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9735.92,4867.96,,7496.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3042.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7204.58,74,,,Percent of Total Billed Charges,74% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8178.17,84,,,Percent of Total Billed Charges,84% of total billed charges,7983.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8664.97,89,,,Percent of total Billed Charges,89% of total Billed charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7496.66,77,,,Percent of total Billed charges,77% of total billed charges,8275.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2799.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4867.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2433.98,8664.97,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9990.43,4995.22,,7692.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3122.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7392.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,8391.96,84,,,Percent of Total Billed Charges,84% of total billed charges,8192.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,8891.48,89,,,Percent of total Billed Charges,89% of total Billed charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7692.63,77,,,Percent of total Billed charges,77% of total billed charges,8491.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2872.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4995.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.61,8891.48,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9735.92,4867.96,,7496.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3042.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7204.58,74,,,Percent of Total Billed Charges,74% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8178.17,84,,,Percent of Total Billed Charges,84% of total billed charges,7983.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8664.97,89,,,Percent of total Billed Charges,89% of total Billed charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7496.66,77,,,Percent of total Billed charges,77% of total billed charges,8275.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2799.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4867.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2433.98,8664.97,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9990.43,4995.22,,7692.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2547.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3122.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7392.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6893.4,69,,,Percent of Total Billed Charges,69% of total billed charges,8391.96,84,,,Percent of Total Billed Charges,84% of total billed charges,8192.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,8891.48,89,,,Percent of total Billed Charges,89% of total Billed charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7692.63,77,,,Percent of total Billed charges,77% of total billed charges,8491.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2872.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4995.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4076.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8891.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2497.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.61,8891.48,
Belimumab (Benlysta) 400mg/5ml Powder SDV,49401010201,CDM,250,RC,,,Outpatient,,,9735.92,4867.96,,7496.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2482.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3042.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7204.58,74,,,Percent of Total Billed Charges,74% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6717.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8178.17,84,,,Percent of Total Billed Charges,84% of total billed charges,7983.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8664.97,89,,,Percent of total Billed Charges,89% of total Billed charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7496.66,77,,,Percent of total Billed charges,77% of total billed charges,8275.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2799.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4867.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3972.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8664.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2433.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2433.98,8664.97,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2651.54,1325.77,,2041.69,77,,,Percent of Total Billed Charges,77% of total billed charges,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.29,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.87,89,,,Percent of total Billed Charges,89% of total Billed charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2041.69,77,,,Percent of total Billed charges,77% of total billed charges,2253.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1325.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.89,2359.87,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2587.6,1293.8,,1992.45,77,,,Percent of Total Billed Charges,77% of total billed charges,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1914.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2173.58,84,,,Percent of Total Billed Charges,84% of total billed charges,2121.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1992.45,77,,,Percent of total Billed charges,77% of total billed charges,2199.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,743.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1293.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.9,2302.96,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2651.54,1325.77,,2041.69,77,,,Percent of Total Billed Charges,77% of total billed charges,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.29,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.87,89,,,Percent of total Billed Charges,89% of total Billed charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2041.69,77,,,Percent of total Billed charges,77% of total billed charges,2253.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1325.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.89,2359.87,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2587.6,1293.8,,1992.45,77,,,Percent of Total Billed Charges,77% of total billed charges,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1914.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2173.58,84,,,Percent of Total Billed Charges,84% of total billed charges,2121.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1992.45,77,,,Percent of total Billed charges,77% of total billed charges,2199.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,743.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1293.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.9,2302.96,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2651.54,1325.77,,2041.69,77,,,Percent of Total Billed Charges,77% of total billed charges,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.29,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.87,89,,,Percent of total Billed Charges,89% of total Billed charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2041.69,77,,,Percent of total Billed charges,77% of total billed charges,2253.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1325.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.89,2359.87,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2587.6,1293.8,,1992.45,77,,,Percent of Total Billed Charges,77% of total billed charges,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1914.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2173.58,84,,,Percent of Total Billed Charges,84% of total billed charges,2121.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1992.45,77,,,Percent of total Billed charges,77% of total billed charges,2199.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,743.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1293.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.9,2302.96,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2651.54,1325.77,,2041.69,77,,,Percent of Total Billed Charges,77% of total billed charges,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.29,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.87,89,,,Percent of total Billed Charges,89% of total Billed charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2041.69,77,,,Percent of total Billed charges,77% of total billed charges,2253.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1325.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.89,2359.87,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2587.6,1293.8,,1992.45,77,,,Percent of Total Billed Charges,77% of total billed charges,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1914.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2173.58,84,,,Percent of Total Billed Charges,84% of total billed charges,2121.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1992.45,77,,,Percent of total Billed charges,77% of total billed charges,2199.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,743.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1293.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.9,2302.96,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2651.54,1325.77,,2041.69,77,,,Percent of Total Billed Charges,77% of total billed charges,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.29,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.87,89,,,Percent of total Billed Charges,89% of total Billed charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2041.69,77,,,Percent of total Billed charges,77% of total billed charges,2253.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1325.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.89,2359.87,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2587.6,1293.8,,1992.45,77,,,Percent of Total Billed Charges,77% of total billed charges,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1914.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2173.58,84,,,Percent of Total Billed Charges,84% of total billed charges,2121.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1992.45,77,,,Percent of total Billed charges,77% of total billed charges,2199.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,743.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1293.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.9,2302.96,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2651.54,1325.77,,2041.69,77,,,Percent of Total Billed Charges,77% of total billed charges,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,676.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,828.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1962.14,74,,,Percent of Total Billed Charges,74% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2227.29,84,,,Percent of Total Billed Charges,84% of total billed charges,2174.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2359.87,89,,,Percent of total Billed Charges,89% of total Billed charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2041.69,77,,,Percent of total Billed charges,77% of total billed charges,2253.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,762.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1325.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1081.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2359.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,662.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,662.89,2359.87,
Bendamustine 100mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,2587.6,1293.8,,1992.45,77,,,Percent of Total Billed Charges,77% of total billed charges,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,659.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,808.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1914.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1785.44,69,,,Percent of Total Billed Charges,69% of total billed charges,2173.58,84,,,Percent of Total Billed Charges,84% of total billed charges,2121.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2302.96,89,,,Percent of total Billed Charges,89% of total Billed charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1992.45,77,,,Percent of total Billed charges,77% of total billed charges,2199.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,743.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1293.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1055.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2302.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,646.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,646.9,2302.96,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,797.14,398.57,,613.8,77,,,Percent of Total Billed Charges,77% of total billed charges,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.88,74,,,Percent of Total Billed Charges,74% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,669.6,84,,,Percent of Total Billed Charges,84% of total billed charges,653.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,709.45,89,,,Percent of total Billed Charges,89% of total Billed charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.8,77,,,Percent of total Billed charges,77% of total billed charges,677.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.29,709.45,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,5230.52,2615.26,,4027.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1634.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3870.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4393.64,84,,,Percent of Total Billed Charges,84% of total billed charges,4289.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,4655.16,89,,,Percent of total Billed Charges,89% of total Billed charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4027.5,77,,,Percent of total Billed charges,77% of total billed charges,4445.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1503.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2615.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1307.63,4655.16,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,797.14,398.57,,613.8,77,,,Percent of Total Billed Charges,77% of total billed charges,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.88,74,,,Percent of Total Billed Charges,74% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,669.6,84,,,Percent of Total Billed Charges,84% of total billed charges,653.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,709.45,89,,,Percent of total Billed Charges,89% of total Billed charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.8,77,,,Percent of total Billed charges,77% of total billed charges,677.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.29,709.45,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,5230.52,2615.26,,4027.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1634.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3870.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4393.64,84,,,Percent of Total Billed Charges,84% of total billed charges,4289.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,4655.16,89,,,Percent of total Billed Charges,89% of total Billed charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4027.5,77,,,Percent of total Billed charges,77% of total billed charges,4445.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1503.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2615.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1307.63,4655.16,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,797.14,398.57,,613.8,77,,,Percent of Total Billed Charges,77% of total billed charges,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.88,74,,,Percent of Total Billed Charges,74% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,669.6,84,,,Percent of Total Billed Charges,84% of total billed charges,653.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,709.45,89,,,Percent of total Billed Charges,89% of total Billed charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.8,77,,,Percent of total Billed charges,77% of total billed charges,677.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.29,709.45,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,5230.52,2615.26,,4027.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1634.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3870.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4393.64,84,,,Percent of Total Billed Charges,84% of total billed charges,4289.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,4655.16,89,,,Percent of total Billed Charges,89% of total Billed charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4027.5,77,,,Percent of total Billed charges,77% of total billed charges,4445.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1503.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2615.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1307.63,4655.16,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,797.14,398.57,,613.8,77,,,Percent of Total Billed Charges,77% of total billed charges,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.88,74,,,Percent of Total Billed Charges,74% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,669.6,84,,,Percent of Total Billed Charges,84% of total billed charges,653.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,709.45,89,,,Percent of total Billed Charges,89% of total Billed charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.8,77,,,Percent of total Billed charges,77% of total billed charges,677.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.29,709.45,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,5230.52,2615.26,,4027.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1634.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3870.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4393.64,84,,,Percent of Total Billed Charges,84% of total billed charges,4289.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,4655.16,89,,,Percent of total Billed Charges,89% of total Billed charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4027.5,77,,,Percent of total Billed charges,77% of total billed charges,4445.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1503.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2615.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1307.63,4655.16,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,797.14,398.57,,613.8,77,,,Percent of Total Billed Charges,77% of total billed charges,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.88,74,,,Percent of Total Billed Charges,74% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,669.6,84,,,Percent of Total Billed Charges,84% of total billed charges,653.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,709.45,89,,,Percent of total Billed Charges,89% of total Billed charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.8,77,,,Percent of total Billed charges,77% of total billed charges,677.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.29,709.45,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,5230.52,2615.26,,4027.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1634.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3870.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4393.64,84,,,Percent of Total Billed Charges,84% of total billed charges,4289.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,4655.16,89,,,Percent of total Billed Charges,89% of total Billed charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4027.5,77,,,Percent of total Billed charges,77% of total billed charges,4445.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1503.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2615.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1307.63,4655.16,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,797.14,398.57,,613.8,77,,,Percent of Total Billed Charges,77% of total billed charges,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,203.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,249.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,589.88,74,,,Percent of Total Billed Charges,74% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,550.03,69,,,Percent of Total Billed Charges,69% of total billed charges,669.6,84,,,Percent of Total Billed Charges,84% of total billed charges,653.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,709.45,89,,,Percent of total Billed Charges,89% of total Billed charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,613.8,77,,,Percent of total Billed charges,77% of total billed charges,677.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,229.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,398.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,325.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.29,709.45,
Bendamustine 25mg/5ml Powder SDV,,,250,RC,,,Outpatient,,,5230.52,2615.26,,4027.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1333.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1634.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3870.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3609.06,69,,,Percent of Total Billed Charges,69% of total billed charges,4393.64,84,,,Percent of Total Billed Charges,84% of total billed charges,4289.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,4655.16,89,,,Percent of total Billed Charges,89% of total Billed charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4027.5,77,,,Percent of total Billed charges,77% of total billed charges,4445.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1503.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2615.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2134.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4655.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1307.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1307.63,4655.16,
Benralizumab (Fasenra) 30mg/ml Syringe,310173030,CDM,250,RC,,,Outpatient,,,27082.27,13541.14,,20853.35,77,,,Percent of Total Billed Charges,77% of total billed charges,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8463.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20040.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22749.11,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24103.22,89,,,Percent of total Billed Charges,89% of total Billed charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20853.35,77,,,Percent of total Billed charges,77% of total billed charges,23019.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7786.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13541.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6770.57,24103.22,
Benralizumab (Fasenra) 30mg/ml Syringe,310173030,CDM,250,RC,,,Outpatient,,,27082.27,13541.14,,20853.35,77,,,Percent of Total Billed Charges,77% of total billed charges,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8463.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20040.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22749.11,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24103.22,89,,,Percent of total Billed Charges,89% of total Billed charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20853.35,77,,,Percent of total Billed charges,77% of total billed charges,23019.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7786.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13541.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6770.57,24103.22,
Benralizumab (Fasenra) 30mg/ml Syringe,310173030,CDM,250,RC,,,Outpatient,,,27082.27,13541.14,,20853.35,77,,,Percent of Total Billed Charges,77% of total billed charges,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8463.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20040.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22749.11,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24103.22,89,,,Percent of total Billed Charges,89% of total Billed charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20853.35,77,,,Percent of total Billed charges,77% of total billed charges,23019.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7786.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13541.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6770.57,24103.22,
Benralizumab (Fasenra) 30mg/ml Syringe,310173030,CDM,250,RC,,,Outpatient,,,27082.27,13541.14,,20853.35,77,,,Percent of Total Billed Charges,77% of total billed charges,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8463.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20040.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22749.11,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24103.22,89,,,Percent of total Billed Charges,89% of total Billed charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20853.35,77,,,Percent of total Billed charges,77% of total billed charges,23019.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7786.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13541.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6770.57,24103.22,
Benralizumab (Fasenra) 30mg/ml Syringe,310173030,CDM,250,RC,,,Outpatient,,,27082.27,13541.14,,20853.35,77,,,Percent of Total Billed Charges,77% of total billed charges,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8463.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20040.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22749.11,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24103.22,89,,,Percent of total Billed Charges,89% of total Billed charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20853.35,77,,,Percent of total Billed charges,77% of total billed charges,23019.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7786.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13541.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6770.57,24103.22,
Benralizumab (Fasenra) 30mg/ml Syringe,310173030,CDM,250,RC,,,Outpatient,,,27082.27,13541.14,,20853.35,77,,,Percent of Total Billed Charges,77% of total billed charges,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6905.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8463.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20040.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,18686.77,69,,,Percent of Total Billed Charges,69% of total billed charges,22749.11,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24103.22,89,,,Percent of total Billed Charges,89% of total Billed charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20853.35,77,,,Percent of total Billed charges,77% of total billed charges,23019.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7786.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13541.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11049.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24103.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6770.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6770.57,24103.22,
Benztropine 0.5mg Tablet,69315013601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Benztropine 0.5mg Tablet,69315013601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Benztropine 0.5mg Tablet,69315013601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Benztropine 0.5mg Tablet,69315013601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Benztropine 0.5mg Tablet,69315013601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Benztropine 0.5mg Tablet,69315013601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Benzonatate 100mg Capsule,42806071401,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Benzonatate 100mg Capsule,42806071401,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Benzonatate 100mg Capsule,42806071401,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Benzonatate 100mg Capsule,42806071401,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Benzonatate 100mg Capsule,42806071401,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Benzonatate 100mg Capsule,42806071401,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Throat Lozenges (8pk),63824073216,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Throat Lozenges (8pk),63824073216,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Throat Lozenges (8pk),63824073216,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Throat Lozenges (8pk),63824073216,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Throat Lozenges (8pk),63824073216,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Throat Lozenges (8pk),63824073216,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Benzocaine Oral Spray UD,283061026,CDM,250,RC,,,Outpatient,,,114.38,57.19,,88.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.64,74,,,Percent of Total Billed Charges,74% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,96.08,84,,,Percent of Total Billed Charges,84% of total billed charges,93.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.8,89,,,Percent of total Billed Charges,89% of total Billed charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.07,77,,,Percent of total Billed charges,77% of total billed charges,97.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.6,101.8,
Benzocaine Oral Spray UD,283061026,CDM,250,RC,,,Outpatient,,,114.38,57.19,,88.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.64,74,,,Percent of Total Billed Charges,74% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,96.08,84,,,Percent of Total Billed Charges,84% of total billed charges,93.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.8,89,,,Percent of total Billed Charges,89% of total Billed charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.07,77,,,Percent of total Billed charges,77% of total billed charges,97.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.6,101.8,
Benzocaine Oral Spray UD,283061026,CDM,250,RC,,,Outpatient,,,114.38,57.19,,88.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.64,74,,,Percent of Total Billed Charges,74% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,96.08,84,,,Percent of Total Billed Charges,84% of total billed charges,93.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.8,89,,,Percent of total Billed Charges,89% of total Billed charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.07,77,,,Percent of total Billed charges,77% of total billed charges,97.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.6,101.8,
Benzocaine Oral Spray UD,283061026,CDM,250,RC,,,Outpatient,,,114.38,57.19,,88.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.64,74,,,Percent of Total Billed Charges,74% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,96.08,84,,,Percent of Total Billed Charges,84% of total billed charges,93.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.8,89,,,Percent of total Billed Charges,89% of total Billed charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.07,77,,,Percent of total Billed charges,77% of total billed charges,97.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.6,101.8,
Benzocaine Oral Spray UD,283061026,CDM,250,RC,,,Outpatient,,,114.38,57.19,,88.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.64,74,,,Percent of Total Billed Charges,74% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,96.08,84,,,Percent of Total Billed Charges,84% of total billed charges,93.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.8,89,,,Percent of total Billed Charges,89% of total Billed charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.07,77,,,Percent of total Billed charges,77% of total billed charges,97.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.6,101.8,
Benzocaine Oral Spray UD,283061026,CDM,250,RC,,,Outpatient,,,114.38,57.19,,88.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.64,74,,,Percent of Total Billed Charges,74% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,78.92,69,,,Percent of Total Billed Charges,69% of total billed charges,96.08,84,,,Percent of Total Billed Charges,84% of total billed charges,93.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.8,89,,,Percent of total Billed Charges,89% of total Billed charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.07,77,,,Percent of total Billed charges,77% of total billed charges,97.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.6,101.8,
Benztropine 2mg Tablet,68084038901,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Benztropine 2mg Tablet,68084038901,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Benztropine 2mg Tablet,68084038901,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Benztropine 2mg Tablet,68084038901,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Benztropine 2mg Tablet,68084038901,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Benztropine 2mg Tablet,68084038901,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Benzocaine/Menthol Topical Spray 78gm,16864068002,CDM,250,RC,,,Outpatient,,,64.22,32.11,,49.45,77,,,Percent of Total Billed Charges,77% of total billed charges,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.52,74,,,Percent of Total Billed Charges,74% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,53.94,84,,,Percent of Total Billed Charges,84% of total billed charges,52.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.16,89,,,Percent of total Billed Charges,89% of total Billed charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.45,77,,,Percent of total Billed charges,77% of total billed charges,54.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,57.16,
Benzocaine/Menthol Topical Spray 78gm,16864068002,CDM,250,RC,,,Outpatient,,,64.22,32.11,,49.45,77,,,Percent of Total Billed Charges,77% of total billed charges,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.52,74,,,Percent of Total Billed Charges,74% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,53.94,84,,,Percent of Total Billed Charges,84% of total billed charges,52.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.16,89,,,Percent of total Billed Charges,89% of total Billed charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.45,77,,,Percent of total Billed charges,77% of total billed charges,54.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,57.16,
Benzocaine/Menthol Topical Spray 78gm,16864068002,CDM,250,RC,,,Outpatient,,,64.22,32.11,,49.45,77,,,Percent of Total Billed Charges,77% of total billed charges,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.52,74,,,Percent of Total Billed Charges,74% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,53.94,84,,,Percent of Total Billed Charges,84% of total billed charges,52.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.16,89,,,Percent of total Billed Charges,89% of total Billed charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.45,77,,,Percent of total Billed charges,77% of total billed charges,54.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,57.16,
Benzocaine/Menthol Topical Spray 78gm,16864068002,CDM,250,RC,,,Outpatient,,,64.22,32.11,,49.45,77,,,Percent of Total Billed Charges,77% of total billed charges,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.52,74,,,Percent of Total Billed Charges,74% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,53.94,84,,,Percent of Total Billed Charges,84% of total billed charges,52.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.16,89,,,Percent of total Billed Charges,89% of total Billed charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.45,77,,,Percent of total Billed charges,77% of total billed charges,54.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,57.16,
Benzocaine/Menthol Topical Spray 78gm,16864068002,CDM,250,RC,,,Outpatient,,,64.22,32.11,,49.45,77,,,Percent of Total Billed Charges,77% of total billed charges,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.52,74,,,Percent of Total Billed Charges,74% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,53.94,84,,,Percent of Total Billed Charges,84% of total billed charges,52.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.16,89,,,Percent of total Billed Charges,89% of total Billed charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.45,77,,,Percent of total Billed charges,77% of total billed charges,54.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,57.16,
Benzocaine/Menthol Topical Spray 78gm,16864068002,CDM,250,RC,,,Outpatient,,,64.22,32.11,,49.45,77,,,Percent of Total Billed Charges,77% of total billed charges,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.52,74,,,Percent of Total Billed Charges,74% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.31,69,,,Percent of Total Billed Charges,69% of total billed charges,53.94,84,,,Percent of Total Billed Charges,84% of total billed charges,52.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.16,89,,,Percent of total Billed Charges,89% of total Billed charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.45,77,,,Percent of total Billed charges,77% of total billed charges,54.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,57.16,
Benzocaine 20% Oral Gel 9gm,50024043203,CDM,250,RC,,,Outpatient,,,49.29,24.65,,37.95,77,,,Percent of Total Billed Charges,77% of total billed charges,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.47,74,,,Percent of Total Billed Charges,74% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,84,,,Percent of Total Billed Charges,84% of total billed charges,40.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.87,89,,,Percent of total Billed Charges,89% of total Billed charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.95,77,,,Percent of total Billed charges,77% of total billed charges,41.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,43.87,
Benzocaine 20% Oral Gel 9gm,50024043203,CDM,250,RC,,,Outpatient,,,49.29,24.65,,37.95,77,,,Percent of Total Billed Charges,77% of total billed charges,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.47,74,,,Percent of Total Billed Charges,74% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,84,,,Percent of Total Billed Charges,84% of total billed charges,40.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.87,89,,,Percent of total Billed Charges,89% of total Billed charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.95,77,,,Percent of total Billed charges,77% of total billed charges,41.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,43.87,
Benzocaine 20% Oral Gel 9gm,50024043203,CDM,250,RC,,,Outpatient,,,49.29,24.65,,37.95,77,,,Percent of Total Billed Charges,77% of total billed charges,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.47,74,,,Percent of Total Billed Charges,74% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,84,,,Percent of Total Billed Charges,84% of total billed charges,40.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.87,89,,,Percent of total Billed Charges,89% of total Billed charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.95,77,,,Percent of total Billed charges,77% of total billed charges,41.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,43.87,
Benzocaine 20% Oral Gel 9gm,50024043203,CDM,250,RC,,,Outpatient,,,49.29,24.65,,37.95,77,,,Percent of Total Billed Charges,77% of total billed charges,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.47,74,,,Percent of Total Billed Charges,74% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,84,,,Percent of Total Billed Charges,84% of total billed charges,40.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.87,89,,,Percent of total Billed Charges,89% of total Billed charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.95,77,,,Percent of total Billed charges,77% of total billed charges,41.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,43.87,
Benzocaine 20% Oral Gel 9gm,50024043203,CDM,250,RC,,,Outpatient,,,49.29,24.65,,37.95,77,,,Percent of Total Billed Charges,77% of total billed charges,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.47,74,,,Percent of Total Billed Charges,74% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,84,,,Percent of Total Billed Charges,84% of total billed charges,40.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.87,89,,,Percent of total Billed Charges,89% of total Billed charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.95,77,,,Percent of total Billed charges,77% of total billed charges,41.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,43.87,
Benzocaine 20% Oral Gel 9gm,50024043203,CDM,250,RC,,,Outpatient,,,49.29,24.65,,37.95,77,,,Percent of Total Billed Charges,77% of total billed charges,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.47,74,,,Percent of Total Billed Charges,74% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.01,69,,,Percent of Total Billed Charges,69% of total billed charges,41.4,84,,,Percent of Total Billed Charges,84% of total billed charges,40.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.87,89,,,Percent of total Billed Charges,89% of total Billed charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.95,77,,,Percent of total Billed charges,77% of total billed charges,41.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,43.87,
Betamethasone Dip 0.05% Cream 15gm,51672127401,CDM,250,RC,,,Outpatient,,,156.69,78.35,,120.65,77,,,Percent of Total Billed Charges,77% of total billed charges,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.95,74,,,Percent of Total Billed Charges,74% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,131.62,84,,,Percent of Total Billed Charges,84% of total billed charges,128.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.45,89,,,Percent of total Billed Charges,89% of total Billed charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.65,77,,,Percent of total Billed charges,77% of total billed charges,133.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.17,139.45,
Betamethasone Dip 0.05% Cream 15gm,51672127401,CDM,250,RC,,,Outpatient,,,156.69,78.35,,120.65,77,,,Percent of Total Billed Charges,77% of total billed charges,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.95,74,,,Percent of Total Billed Charges,74% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,131.62,84,,,Percent of Total Billed Charges,84% of total billed charges,128.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.45,89,,,Percent of total Billed Charges,89% of total Billed charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.65,77,,,Percent of total Billed charges,77% of total billed charges,133.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.17,139.45,
Betamethasone Dip 0.05% Cream 15gm,51672127401,CDM,250,RC,,,Outpatient,,,156.69,78.35,,120.65,77,,,Percent of Total Billed Charges,77% of total billed charges,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.95,74,,,Percent of Total Billed Charges,74% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,131.62,84,,,Percent of Total Billed Charges,84% of total billed charges,128.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.45,89,,,Percent of total Billed Charges,89% of total Billed charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.65,77,,,Percent of total Billed charges,77% of total billed charges,133.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.17,139.45,
Betamethasone Dip 0.05% Cream 15gm,51672127401,CDM,250,RC,,,Outpatient,,,156.69,78.35,,120.65,77,,,Percent of Total Billed Charges,77% of total billed charges,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.95,74,,,Percent of Total Billed Charges,74% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,131.62,84,,,Percent of Total Billed Charges,84% of total billed charges,128.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.45,89,,,Percent of total Billed Charges,89% of total Billed charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.65,77,,,Percent of total Billed charges,77% of total billed charges,133.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.17,139.45,
Betamethasone Dip 0.05% Cream 15gm,51672127401,CDM,250,RC,,,Outpatient,,,156.69,78.35,,120.65,77,,,Percent of Total Billed Charges,77% of total billed charges,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.95,74,,,Percent of Total Billed Charges,74% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,131.62,84,,,Percent of Total Billed Charges,84% of total billed charges,128.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.45,89,,,Percent of total Billed Charges,89% of total Billed charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.65,77,,,Percent of total Billed charges,77% of total billed charges,133.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.17,139.45,
Betamethasone Dip 0.05% Cream 15gm,51672127401,CDM,250,RC,,,Outpatient,,,156.69,78.35,,120.65,77,,,Percent of Total Billed Charges,77% of total billed charges,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.95,74,,,Percent of Total Billed Charges,74% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,108.12,69,,,Percent of Total Billed Charges,69% of total billed charges,131.62,84,,,Percent of Total Billed Charges,84% of total billed charges,128.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.45,89,,,Percent of total Billed Charges,89% of total Billed charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.65,77,,,Percent of total Billed charges,77% of total billed charges,133.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.17,139.45,
Celestone 6mg/ml Vial MDV,517072001,CDM,250,RC,,,Outpatient,,,364.92,182.46,,280.99,77,,,Percent of Total Billed Charges,77% of total billed charges,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.04,74,,,Percent of Total Billed Charges,74% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,306.53,84,,,Percent of Total Billed Charges,84% of total billed charges,299.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.78,89,,,Percent of total Billed Charges,89% of total Billed charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.99,77,,,Percent of total Billed charges,77% of total billed charges,310.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,182.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,324.78,
Celestone 6mg/ml Vial MDV,517072001,CDM,250,RC,,,Outpatient,,,364.92,182.46,,280.99,77,,,Percent of Total Billed Charges,77% of total billed charges,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.04,74,,,Percent of Total Billed Charges,74% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,306.53,84,,,Percent of Total Billed Charges,84% of total billed charges,299.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.78,89,,,Percent of total Billed Charges,89% of total Billed charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.99,77,,,Percent of total Billed charges,77% of total billed charges,310.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,182.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,324.78,
Celestone 6mg/ml Vial MDV,517072001,CDM,250,RC,,,Outpatient,,,364.92,182.46,,280.99,77,,,Percent of Total Billed Charges,77% of total billed charges,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.04,74,,,Percent of Total Billed Charges,74% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,306.53,84,,,Percent of Total Billed Charges,84% of total billed charges,299.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.78,89,,,Percent of total Billed Charges,89% of total Billed charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.99,77,,,Percent of total Billed charges,77% of total billed charges,310.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,182.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,324.78,
Celestone 6mg/ml Vial MDV,517072001,CDM,250,RC,,,Outpatient,,,364.92,182.46,,280.99,77,,,Percent of Total Billed Charges,77% of total billed charges,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.04,74,,,Percent of Total Billed Charges,74% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,306.53,84,,,Percent of Total Billed Charges,84% of total billed charges,299.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.78,89,,,Percent of total Billed Charges,89% of total Billed charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.99,77,,,Percent of total Billed charges,77% of total billed charges,310.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,182.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,324.78,
Celestone 6mg/ml Vial MDV,517072001,CDM,250,RC,,,Outpatient,,,364.92,182.46,,280.99,77,,,Percent of Total Billed Charges,77% of total billed charges,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.04,74,,,Percent of Total Billed Charges,74% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,306.53,84,,,Percent of Total Billed Charges,84% of total billed charges,299.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.78,89,,,Percent of total Billed Charges,89% of total Billed charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.99,77,,,Percent of total Billed charges,77% of total billed charges,310.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,182.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,324.78,
Celestone 6mg/ml Vial MDV,517072001,CDM,250,RC,,,Outpatient,,,364.92,182.46,,280.99,77,,,Percent of Total Billed Charges,77% of total billed charges,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,270.04,74,,,Percent of Total Billed Charges,74% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,251.79,69,,,Percent of Total Billed Charges,69% of total billed charges,306.53,84,,,Percent of Total Billed Charges,84% of total billed charges,299.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,324.78,89,,,Percent of total Billed Charges,89% of total Billed charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.99,77,,,Percent of total Billed charges,77% of total billed charges,310.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,104.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,182.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,148.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,324.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.23,324.78,
Bethanechol 25mg Tablet,832051201,CDM,250,RC,,,Outpatient,,,30.06,15.03,,23.15,77,,,Percent of Total Billed Charges,77% of total billed charges,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.24,74,,,Percent of Total Billed Charges,74% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,25.25,84,,,Percent of Total Billed Charges,84% of total billed charges,24.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,89,,,Percent of total Billed Charges,89% of total Billed charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.15,77,,,Percent of total Billed charges,77% of total billed charges,25.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.52,26.75,
Bethanechol 25mg Tablet,832051201,CDM,250,RC,,,Outpatient,,,30.06,15.03,,23.15,77,,,Percent of Total Billed Charges,77% of total billed charges,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.24,74,,,Percent of Total Billed Charges,74% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,25.25,84,,,Percent of Total Billed Charges,84% of total billed charges,24.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,89,,,Percent of total Billed Charges,89% of total Billed charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.15,77,,,Percent of total Billed charges,77% of total billed charges,25.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.52,26.75,
Bethanechol 25mg Tablet,832051201,CDM,250,RC,,,Outpatient,,,30.06,15.03,,23.15,77,,,Percent of Total Billed Charges,77% of total billed charges,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.24,74,,,Percent of Total Billed Charges,74% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,25.25,84,,,Percent of Total Billed Charges,84% of total billed charges,24.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,89,,,Percent of total Billed Charges,89% of total Billed charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.15,77,,,Percent of total Billed charges,77% of total billed charges,25.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.52,26.75,
Bethanechol 25mg Tablet,832051201,CDM,250,RC,,,Outpatient,,,30.06,15.03,,23.15,77,,,Percent of Total Billed Charges,77% of total billed charges,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.24,74,,,Percent of Total Billed Charges,74% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,25.25,84,,,Percent of Total Billed Charges,84% of total billed charges,24.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,89,,,Percent of total Billed Charges,89% of total Billed charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.15,77,,,Percent of total Billed charges,77% of total billed charges,25.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.52,26.75,
Bethanechol 25mg Tablet,832051201,CDM,250,RC,,,Outpatient,,,30.06,15.03,,23.15,77,,,Percent of Total Billed Charges,77% of total billed charges,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.24,74,,,Percent of Total Billed Charges,74% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,25.25,84,,,Percent of Total Billed Charges,84% of total billed charges,24.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,89,,,Percent of total Billed Charges,89% of total Billed charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.15,77,,,Percent of total Billed charges,77% of total billed charges,25.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.52,26.75,
Bethanechol 25mg Tablet,832051201,CDM,250,RC,,,Outpatient,,,30.06,15.03,,23.15,77,,,Percent of Total Billed Charges,77% of total billed charges,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.24,74,,,Percent of Total Billed Charges,74% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,20.74,69,,,Percent of Total Billed Charges,69% of total billed charges,25.25,84,,,Percent of Total Billed Charges,84% of total billed charges,24.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.75,89,,,Percent of total Billed Charges,89% of total Billed charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.15,77,,,Percent of total Billed charges,77% of total billed charges,25.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.52,26.75,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5779.4,2889.7,,4450.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1806.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4854.7,84,,,Percent of Total Billed Charges,84% of total billed charges,4739.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,5143.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4450.14,77,,,Percent of total Billed charges,77% of total billed charges,4912.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1661.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2889.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.85,5143.67,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5633.8,2816.9,,4338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1760.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4169.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4732.39,84,,,Percent of Total Billed Charges,84% of total billed charges,4619.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5014.08,89,,,Percent of total Billed Charges,89% of total Billed charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4338.03,77,,,Percent of total Billed charges,77% of total billed charges,4788.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1619.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2816.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1408.45,5014.08,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5779.4,2889.7,,4450.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1806.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4854.7,84,,,Percent of Total Billed Charges,84% of total billed charges,4739.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,5143.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4450.14,77,,,Percent of total Billed charges,77% of total billed charges,4912.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1661.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2889.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.85,5143.67,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5633.8,2816.9,,4338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1760.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4169.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4732.39,84,,,Percent of Total Billed Charges,84% of total billed charges,4619.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5014.08,89,,,Percent of total Billed Charges,89% of total Billed charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4338.03,77,,,Percent of total Billed charges,77% of total billed charges,4788.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1619.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2816.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1408.45,5014.08,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5779.4,2889.7,,4450.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1806.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4854.7,84,,,Percent of Total Billed Charges,84% of total billed charges,4739.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,5143.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4450.14,77,,,Percent of total Billed charges,77% of total billed charges,4912.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1661.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2889.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.85,5143.67,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5633.8,2816.9,,4338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1760.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4169.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4732.39,84,,,Percent of Total Billed Charges,84% of total billed charges,4619.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5014.08,89,,,Percent of total Billed Charges,89% of total Billed charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4338.03,77,,,Percent of total Billed charges,77% of total billed charges,4788.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1619.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2816.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1408.45,5014.08,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5779.4,2889.7,,4450.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1806.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4854.7,84,,,Percent of Total Billed Charges,84% of total billed charges,4739.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,5143.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4450.14,77,,,Percent of total Billed charges,77% of total billed charges,4912.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1661.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2889.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.85,5143.67,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5633.8,2816.9,,4338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1760.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4169.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4732.39,84,,,Percent of Total Billed Charges,84% of total billed charges,4619.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5014.08,89,,,Percent of total Billed Charges,89% of total Billed charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4338.03,77,,,Percent of total Billed charges,77% of total billed charges,4788.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1619.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2816.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1408.45,5014.08,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5779.4,2889.7,,4450.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1806.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4854.7,84,,,Percent of Total Billed Charges,84% of total billed charges,4739.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,5143.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4450.14,77,,,Percent of total Billed charges,77% of total billed charges,4912.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1661.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2889.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.85,5143.67,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5633.8,2816.9,,4338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1760.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4169.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4732.39,84,,,Percent of Total Billed Charges,84% of total billed charges,4619.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5014.08,89,,,Percent of total Billed Charges,89% of total Billed charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4338.03,77,,,Percent of total Billed charges,77% of total billed charges,4788.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1619.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2816.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1408.45,5014.08,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5779.4,2889.7,,4450.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1473.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1806.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4276.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3987.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4854.7,84,,,Percent of Total Billed Charges,84% of total billed charges,4739.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,5143.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4450.14,77,,,Percent of total Billed charges,77% of total billed charges,4912.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1661.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2889.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2358,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5143.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1444.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.85,5143.67,
Bevacizumab (Avastin) 100mg/4ml Liquid SDV,50242006001,CDM,250,RC,,,Outpatient,,,5633.8,2816.9,,4338.03,77,,,Percent of Total Billed Charges,77% of total billed charges,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1436.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1760.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4169.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4732.39,84,,,Percent of Total Billed Charges,84% of total billed charges,4619.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5014.08,89,,,Percent of total Billed Charges,89% of total Billed charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4338.03,77,,,Percent of total Billed charges,77% of total billed charges,4788.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1619.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2816.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2298.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5014.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1408.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1408.45,5014.08,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20820.21,10410.11,,16031.56,77,,,Percent of Total Billed Charges,77% of total billed charges,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15406.96,74,,,Percent of Total Billed Charges,74% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17488.98,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18529.99,89,,,Percent of total Billed Charges,89% of total Billed charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16031.56,77,,,Percent of total Billed charges,77% of total billed charges,17697.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5985.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10410.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5205.05,18529.99,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20285.62,10142.81,,15619.93,77,,,Percent of Total Billed Charges,77% of total billed charges,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6339.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15011.36,74,,,Percent of Total Billed Charges,74% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,17039.92,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18054.2,89,,,Percent of total Billed Charges,89% of total Billed charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15619.93,77,,,Percent of total Billed charges,77% of total billed charges,17242.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5832.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10142.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.41,18054.2,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20820.21,10410.11,,16031.56,77,,,Percent of Total Billed Charges,77% of total billed charges,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15406.96,74,,,Percent of Total Billed Charges,74% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17488.98,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18529.99,89,,,Percent of total Billed Charges,89% of total Billed charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16031.56,77,,,Percent of total Billed charges,77% of total billed charges,17697.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5985.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10410.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5205.05,18529.99,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20285.62,10142.81,,15619.93,77,,,Percent of Total Billed Charges,77% of total billed charges,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6339.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15011.36,74,,,Percent of Total Billed Charges,74% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,17039.92,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18054.2,89,,,Percent of total Billed Charges,89% of total Billed charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15619.93,77,,,Percent of total Billed charges,77% of total billed charges,17242.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5832.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10142.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.41,18054.2,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20820.21,10410.11,,16031.56,77,,,Percent of Total Billed Charges,77% of total billed charges,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15406.96,74,,,Percent of Total Billed Charges,74% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17488.98,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18529.99,89,,,Percent of total Billed Charges,89% of total Billed charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16031.56,77,,,Percent of total Billed charges,77% of total billed charges,17697.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5985.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10410.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5205.05,18529.99,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20285.62,10142.81,,15619.93,77,,,Percent of Total Billed Charges,77% of total billed charges,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6339.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15011.36,74,,,Percent of Total Billed Charges,74% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,17039.92,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18054.2,89,,,Percent of total Billed Charges,89% of total Billed charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15619.93,77,,,Percent of total Billed charges,77% of total billed charges,17242.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5832.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10142.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.41,18054.2,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20820.21,10410.11,,16031.56,77,,,Percent of Total Billed Charges,77% of total billed charges,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15406.96,74,,,Percent of Total Billed Charges,74% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17488.98,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18529.99,89,,,Percent of total Billed Charges,89% of total Billed charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16031.56,77,,,Percent of total Billed charges,77% of total billed charges,17697.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5985.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10410.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5205.05,18529.99,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20285.62,10142.81,,15619.93,77,,,Percent of Total Billed Charges,77% of total billed charges,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6339.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15011.36,74,,,Percent of Total Billed Charges,74% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,17039.92,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18054.2,89,,,Percent of total Billed Charges,89% of total Billed charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15619.93,77,,,Percent of total Billed charges,77% of total billed charges,17242.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5832.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10142.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.41,18054.2,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20820.21,10410.11,,16031.56,77,,,Percent of Total Billed Charges,77% of total billed charges,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15406.96,74,,,Percent of Total Billed Charges,74% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17488.98,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18529.99,89,,,Percent of total Billed Charges,89% of total Billed charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16031.56,77,,,Percent of total Billed charges,77% of total billed charges,17697.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5985.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10410.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5205.05,18529.99,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20285.62,10142.81,,15619.93,77,,,Percent of Total Billed Charges,77% of total billed charges,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6339.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15011.36,74,,,Percent of Total Billed Charges,74% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,17039.92,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18054.2,89,,,Percent of total Billed Charges,89% of total Billed charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15619.93,77,,,Percent of total Billed charges,77% of total billed charges,17242.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5832.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10142.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.41,18054.2,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20820.21,10410.11,,16031.56,77,,,Percent of Total Billed Charges,77% of total billed charges,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5309.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15406.96,74,,,Percent of Total Billed Charges,74% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,14365.94,69,,,Percent of Total Billed Charges,69% of total billed charges,17488.98,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18529.99,89,,,Percent of total Billed Charges,89% of total Billed charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16031.56,77,,,Percent of total Billed charges,77% of total billed charges,17697.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5985.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10410.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8494.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18529.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5205.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5205.05,18529.99,
Bevacizumab (Avastin) 400mg/16ml Liquid SDV,50242006101,CDM,250,RC,,,Outpatient,,,20285.62,10142.81,,15619.93,77,,,Percent of Total Billed Charges,77% of total billed charges,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5172.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6339.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15011.36,74,,,Percent of Total Billed Charges,74% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,13997.08,69,,,Percent of Total Billed Charges,69% of total billed charges,17039.92,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18054.2,89,,,Percent of total Billed Charges,89% of total Billed charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15619.93,77,,,Percent of total Billed charges,77% of total billed charges,17242.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5832.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10142.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8276.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18054.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5071.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.41,18054.2,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,5078.54,2539.27,,3910.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1587.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3758.12,74,,,Percent of Total Billed Charges,74% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4265.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4164.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,4519.9,89,,,Percent of total Billed Charges,89% of total Billed charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3910.48,77,,,Percent of total Billed charges,77% of total billed charges,4316.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1460.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2539.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.64,4519.9,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,4951.07,2475.54,,3812.32,77,,,Percent of Total Billed Charges,77% of total billed charges,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1547.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3663.79,74,,,Percent of Total Billed Charges,74% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,4158.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4059.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4406.45,89,,,Percent of total Billed Charges,89% of total Billed charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3812.32,77,,,Percent of total Billed charges,77% of total billed charges,4208.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1423.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2475.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.77,4406.45,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,5078.54,2539.27,,3910.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1587.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3758.12,74,,,Percent of Total Billed Charges,74% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4265.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4164.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,4519.9,89,,,Percent of total Billed Charges,89% of total Billed charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3910.48,77,,,Percent of total Billed charges,77% of total billed charges,4316.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1460.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2539.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.64,4519.9,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,4951.07,2475.54,,3812.32,77,,,Percent of Total Billed Charges,77% of total billed charges,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1547.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3663.79,74,,,Percent of Total Billed Charges,74% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,4158.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4059.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4406.45,89,,,Percent of total Billed Charges,89% of total Billed charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3812.32,77,,,Percent of total Billed charges,77% of total billed charges,4208.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1423.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2475.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.77,4406.45,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,5078.54,2539.27,,3910.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1587.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3758.12,74,,,Percent of Total Billed Charges,74% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4265.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4164.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,4519.9,89,,,Percent of total Billed Charges,89% of total Billed charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3910.48,77,,,Percent of total Billed charges,77% of total billed charges,4316.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1460.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2539.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.64,4519.9,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,4951.07,2475.54,,3812.32,77,,,Percent of Total Billed Charges,77% of total billed charges,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1547.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3663.79,74,,,Percent of Total Billed Charges,74% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,4158.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4059.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4406.45,89,,,Percent of total Billed Charges,89% of total Billed charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3812.32,77,,,Percent of total Billed charges,77% of total billed charges,4208.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1423.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2475.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.77,4406.45,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,5078.54,2539.27,,3910.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1587.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3758.12,74,,,Percent of Total Billed Charges,74% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4265.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4164.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,4519.9,89,,,Percent of total Billed Charges,89% of total Billed charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3910.48,77,,,Percent of total Billed charges,77% of total billed charges,4316.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1460.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2539.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.64,4519.9,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,4951.07,2475.54,,3812.32,77,,,Percent of Total Billed Charges,77% of total billed charges,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1547.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3663.79,74,,,Percent of Total Billed Charges,74% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,4158.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4059.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4406.45,89,,,Percent of total Billed Charges,89% of total Billed charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3812.32,77,,,Percent of total Billed charges,77% of total billed charges,4208.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1423.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2475.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.77,4406.45,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,5078.54,2539.27,,3910.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1587.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3758.12,74,,,Percent of Total Billed Charges,74% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4265.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4164.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,4519.9,89,,,Percent of total Billed Charges,89% of total Billed charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3910.48,77,,,Percent of total Billed charges,77% of total billed charges,4316.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1460.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2539.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.64,4519.9,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,4951.07,2475.54,,3812.32,77,,,Percent of Total Billed Charges,77% of total billed charges,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1547.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3663.79,74,,,Percent of Total Billed Charges,74% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,4158.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4059.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4406.45,89,,,Percent of total Billed Charges,89% of total Billed charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3812.32,77,,,Percent of total Billed charges,77% of total billed charges,4208.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1423.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2475.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.77,4406.45,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,5078.54,2539.27,,3910.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1295.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1587.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3758.12,74,,,Percent of Total Billed Charges,74% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,3504.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4265.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4164.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,4519.9,89,,,Percent of total Billed Charges,89% of total Billed charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3910.48,77,,,Percent of total Billed charges,77% of total billed charges,4316.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1460.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2539.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2072.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4519.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1269.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1269.64,4519.9,
Bevacizumab-AWWB (Mvasi) 100mg/4ml Liquid SDV,55513020601,CDM,250,RC,,,Outpatient,,,4951.07,2475.54,,3812.32,77,,,Percent of Total Billed Charges,77% of total billed charges,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1262.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1547.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3663.79,74,,,Percent of Total Billed Charges,74% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,3416.24,69,,,Percent of Total Billed Charges,69% of total billed charges,4158.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4059.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,4406.45,89,,,Percent of total Billed Charges,89% of total Billed charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3812.32,77,,,Percent of total Billed charges,77% of total billed charges,4208.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1423.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2475.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2020.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4406.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1237.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1237.77,4406.45,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,18246.75,9123.38,,14050,77,,,Percent of Total Billed Charges,77% of total billed charges,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5702.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13502.6,74,,,Percent of Total Billed Charges,74% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,15327.27,84,,,Percent of Total Billed Charges,84% of total billed charges,14962.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,16239.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14050,77,,,Percent of total Billed charges,77% of total billed charges,15509.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5245.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9123.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4561.69,16239.61,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,17778.71,8889.36,,13689.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5555.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13156.25,74,,,Percent of Total Billed Charges,74% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14934.12,84,,,Percent of Total Billed Charges,84% of total billed charges,14578.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,15823.05,89,,,Percent of total Billed Charges,89% of total Billed charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13689.61,77,,,Percent of total Billed charges,77% of total billed charges,15111.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5111.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8889.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4444.68,15823.05,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,18246.75,9123.38,,14050,77,,,Percent of Total Billed Charges,77% of total billed charges,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5702.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13502.6,74,,,Percent of Total Billed Charges,74% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,15327.27,84,,,Percent of Total Billed Charges,84% of total billed charges,14962.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,16239.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14050,77,,,Percent of total Billed charges,77% of total billed charges,15509.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5245.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9123.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4561.69,16239.61,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,17778.71,8889.36,,13689.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5555.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13156.25,74,,,Percent of Total Billed Charges,74% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14934.12,84,,,Percent of Total Billed Charges,84% of total billed charges,14578.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,15823.05,89,,,Percent of total Billed Charges,89% of total Billed charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13689.61,77,,,Percent of total Billed charges,77% of total billed charges,15111.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5111.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8889.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4444.68,15823.05,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,18246.75,9123.38,,14050,77,,,Percent of Total Billed Charges,77% of total billed charges,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5702.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13502.6,74,,,Percent of Total Billed Charges,74% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,15327.27,84,,,Percent of Total Billed Charges,84% of total billed charges,14962.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,16239.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14050,77,,,Percent of total Billed charges,77% of total billed charges,15509.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5245.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9123.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4561.69,16239.61,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,17778.71,8889.36,,13689.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5555.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13156.25,74,,,Percent of Total Billed Charges,74% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14934.12,84,,,Percent of Total Billed Charges,84% of total billed charges,14578.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,15823.05,89,,,Percent of total Billed Charges,89% of total Billed charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13689.61,77,,,Percent of total Billed charges,77% of total billed charges,15111.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5111.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8889.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4444.68,15823.05,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,18246.75,9123.38,,14050,77,,,Percent of Total Billed Charges,77% of total billed charges,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5702.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13502.6,74,,,Percent of Total Billed Charges,74% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,15327.27,84,,,Percent of Total Billed Charges,84% of total billed charges,14962.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,16239.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14050,77,,,Percent of total Billed charges,77% of total billed charges,15509.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5245.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9123.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4561.69,16239.61,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,17778.71,8889.36,,13689.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5555.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13156.25,74,,,Percent of Total Billed Charges,74% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14934.12,84,,,Percent of Total Billed Charges,84% of total billed charges,14578.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,15823.05,89,,,Percent of total Billed Charges,89% of total Billed charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13689.61,77,,,Percent of total Billed charges,77% of total billed charges,15111.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5111.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8889.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4444.68,15823.05,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,18246.75,9123.38,,14050,77,,,Percent of Total Billed Charges,77% of total billed charges,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5702.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13502.6,74,,,Percent of Total Billed Charges,74% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,15327.27,84,,,Percent of Total Billed Charges,84% of total billed charges,14962.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,16239.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14050,77,,,Percent of total Billed charges,77% of total billed charges,15509.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5245.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9123.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4561.69,16239.61,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,17778.71,8889.36,,13689.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5555.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13156.25,74,,,Percent of Total Billed Charges,74% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14934.12,84,,,Percent of Total Billed Charges,84% of total billed charges,14578.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,15823.05,89,,,Percent of total Billed Charges,89% of total Billed charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13689.61,77,,,Percent of total Billed charges,77% of total billed charges,15111.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5111.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8889.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4444.68,15823.05,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,18246.75,9123.38,,14050,77,,,Percent of Total Billed Charges,77% of total billed charges,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4652.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5702.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13502.6,74,,,Percent of Total Billed Charges,74% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,12590.26,69,,,Percent of Total Billed Charges,69% of total billed charges,15327.27,84,,,Percent of Total Billed Charges,84% of total billed charges,14962.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,16239.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14050,77,,,Percent of total Billed charges,77% of total billed charges,15509.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5245.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9123.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7444.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16239.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4561.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4561.69,16239.61,
Bevacizumab-AWWB (Mvasi) 400mg/16ml Liquid SDV,55513020701,CDM,250,RC,,,Outpatient,,,17778.71,8889.36,,13689.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4533.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5555.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13156.25,74,,,Percent of Total Billed Charges,74% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,12267.31,69,,,Percent of Total Billed Charges,69% of total billed charges,14934.12,84,,,Percent of Total Billed Charges,84% of total billed charges,14578.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,15823.05,89,,,Percent of total Billed Charges,89% of total Billed charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13689.61,77,,,Percent of total Billed charges,77% of total billed charges,15111.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5111.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8889.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7253.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15823.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4444.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4444.68,15823.05,
Bicalutamide 50mg Tablet,16729002310,CDM,250,RC,,,Outpatient,,,134.63,67.32,,103.67,77,,,Percent of Total Billed Charges,77% of total billed charges,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.63,74,,,Percent of Total Billed Charges,74% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,113.09,84,,,Percent of Total Billed Charges,84% of total billed charges,110.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.82,89,,,Percent of total Billed Charges,89% of total Billed charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.67,77,,,Percent of total Billed charges,77% of total billed charges,114.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.66,119.82,
Bicalutamide 50mg Tablet,16729002310,CDM,250,RC,,,Outpatient,,,134.63,67.32,,103.67,77,,,Percent of Total Billed Charges,77% of total billed charges,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.63,74,,,Percent of Total Billed Charges,74% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,113.09,84,,,Percent of Total Billed Charges,84% of total billed charges,110.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.82,89,,,Percent of total Billed Charges,89% of total Billed charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.67,77,,,Percent of total Billed charges,77% of total billed charges,114.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.66,119.82,
Bicalutamide 50mg Tablet,16729002310,CDM,250,RC,,,Outpatient,,,134.63,67.32,,103.67,77,,,Percent of Total Billed Charges,77% of total billed charges,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.63,74,,,Percent of Total Billed Charges,74% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,113.09,84,,,Percent of Total Billed Charges,84% of total billed charges,110.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.82,89,,,Percent of total Billed Charges,89% of total Billed charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.67,77,,,Percent of total Billed charges,77% of total billed charges,114.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.66,119.82,
Bicalutamide 50mg Tablet,16729002310,CDM,250,RC,,,Outpatient,,,134.63,67.32,,103.67,77,,,Percent of Total Billed Charges,77% of total billed charges,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.63,74,,,Percent of Total Billed Charges,74% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,113.09,84,,,Percent of Total Billed Charges,84% of total billed charges,110.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.82,89,,,Percent of total Billed Charges,89% of total Billed charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.67,77,,,Percent of total Billed charges,77% of total billed charges,114.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.66,119.82,
Bicalutamide 50mg Tablet,16729002310,CDM,250,RC,,,Outpatient,,,134.63,67.32,,103.67,77,,,Percent of Total Billed Charges,77% of total billed charges,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.63,74,,,Percent of Total Billed Charges,74% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,113.09,84,,,Percent of Total Billed Charges,84% of total billed charges,110.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.82,89,,,Percent of total Billed Charges,89% of total Billed charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.67,77,,,Percent of total Billed charges,77% of total billed charges,114.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.66,119.82,
Bicalutamide 50mg Tablet,16729002310,CDM,250,RC,,,Outpatient,,,134.63,67.32,,103.67,77,,,Percent of Total Billed Charges,77% of total billed charges,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.63,74,,,Percent of Total Billed Charges,74% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,92.89,69,,,Percent of Total Billed Charges,69% of total billed charges,113.09,84,,,Percent of Total Billed Charges,84% of total billed charges,110.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.82,89,,,Percent of total Billed Charges,89% of total Billed charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.67,77,,,Percent of total Billed charges,77% of total billed charges,114.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.66,119.82,
Bisacodyl 10mg Suppository,574705050,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 10mg Suppository,574705050,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 10mg Suppository,574705050,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 10mg Suppository,574705050,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 10mg Suppository,574705050,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 10mg Suppository,574705050,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 5mg Tablet,904640761,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 5mg Tablet,904640761,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 5mg Tablet,904640761,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 5mg Tablet,904640761,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 5mg Tablet,904640761,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bisacodyl 5mg Tablet,904640761,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 524mg/30ml UDC,37000003201,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 524mg/30ml UDC,37000003201,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 524mg/30ml UDC,37000003201,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 524mg/30ml UDC,37000003201,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 524mg/30ml UDC,37000003201,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 524mg/30ml UDC,37000003201,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 262mg Tablet,37000047602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 262mg Tablet,37000047602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 262mg Tablet,37000047602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 262mg Tablet,37000047602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 262mg Tablet,37000047602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bismuth Subsalicylate 262mg Tablet,37000047602,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4518.93,2259.47,,3479.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1412.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3344.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3795.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3705.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,4021.85,89,,,Percent of total Billed Charges,89% of total Billed charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3479.58,77,,,Percent of total Billed charges,77% of total billed charges,3841.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1299.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2259.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.73,4021.85,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4406.69,2203.35,,3393.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3260.95,74,,,Percent of Total Billed Charges,74% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3701.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3613.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,3921.95,89,,,Percent of total Billed Charges,89% of total Billed charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3393.15,77,,,Percent of total Billed charges,77% of total billed charges,3745.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1266.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2203.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.67,3921.95,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4518.93,2259.47,,3479.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1412.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3344.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3795.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3705.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,4021.85,89,,,Percent of total Billed Charges,89% of total Billed charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3479.58,77,,,Percent of total Billed charges,77% of total billed charges,3841.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1299.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2259.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.73,4021.85,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4406.69,2203.35,,3393.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3260.95,74,,,Percent of Total Billed Charges,74% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3701.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3613.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,3921.95,89,,,Percent of total Billed Charges,89% of total Billed charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3393.15,77,,,Percent of total Billed charges,77% of total billed charges,3745.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1266.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2203.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.67,3921.95,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4518.93,2259.47,,3479.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1412.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3344.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3795.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3705.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,4021.85,89,,,Percent of total Billed Charges,89% of total Billed charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3479.58,77,,,Percent of total Billed charges,77% of total billed charges,3841.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1299.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2259.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.73,4021.85,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4406.69,2203.35,,3393.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3260.95,74,,,Percent of Total Billed Charges,74% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3701.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3613.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,3921.95,89,,,Percent of total Billed Charges,89% of total Billed charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3393.15,77,,,Percent of total Billed charges,77% of total billed charges,3745.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1266.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2203.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.67,3921.95,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4518.93,2259.47,,3479.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1412.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3344.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3795.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3705.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,4021.85,89,,,Percent of total Billed Charges,89% of total Billed charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3479.58,77,,,Percent of total Billed charges,77% of total billed charges,3841.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1299.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2259.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.73,4021.85,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4406.69,2203.35,,3393.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3260.95,74,,,Percent of Total Billed Charges,74% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3701.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3613.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,3921.95,89,,,Percent of total Billed Charges,89% of total Billed charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3393.15,77,,,Percent of total Billed charges,77% of total billed charges,3745.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1266.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2203.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.67,3921.95,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4518.93,2259.47,,3479.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1412.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3344.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3795.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3705.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,4021.85,89,,,Percent of total Billed Charges,89% of total Billed charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3479.58,77,,,Percent of total Billed charges,77% of total billed charges,3841.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1299.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2259.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.73,4021.85,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4406.69,2203.35,,3393.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3260.95,74,,,Percent of Total Billed Charges,74% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3701.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3613.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,3921.95,89,,,Percent of total Billed Charges,89% of total Billed charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3393.15,77,,,Percent of total Billed charges,77% of total billed charges,3745.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1266.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2203.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.67,3921.95,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4518.93,2259.47,,3479.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1152.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1412.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3344.01,74,,,Percent of Total Billed Charges,74% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3118.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3795.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3705.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,4021.85,89,,,Percent of total Billed Charges,89% of total Billed charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3479.58,77,,,Percent of total Billed charges,77% of total billed charges,3841.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1299.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2259.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1843.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4021.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1129.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1129.73,4021.85,
Bleomycin 30unit/10ml Powder SDV,63323013720,CDM,250,RC,,,Outpatient,,,4406.69,2203.35,,3393.15,77,,,Percent of Total Billed Charges,77% of total billed charges,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1123.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1377.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3260.95,74,,,Percent of Total Billed Charges,74% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.62,69,,,Percent of Total Billed Charges,69% of total billed charges,3701.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3613.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,3921.95,89,,,Percent of total Billed Charges,89% of total Billed charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3393.15,77,,,Percent of total Billed charges,77% of total billed charges,3745.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1266.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2203.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1797.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3921.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1101.67,3921.95,
Bortezomib 3.5mg Powder SDV,43598042660,CDM,250,RC,,,Outpatient,,,1945.1,972.55,,1497.73,77,,,Percent of Total Billed Charges,77% of total billed charges,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1594.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1731.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.73,77,,,Percent of total Billed charges,77% of total billed charges,1653.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,559.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,972.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.28,1731.14,
Bortezomib 3.5mg Powder SDV,43598042660,CDM,250,RC,,,Outpatient,,,1945.1,972.55,,1497.73,77,,,Percent of Total Billed Charges,77% of total billed charges,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1594.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1731.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.73,77,,,Percent of total Billed charges,77% of total billed charges,1653.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,559.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,972.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.28,1731.14,
Bortezomib 3.5mg Powder SDV,43598042660,CDM,250,RC,,,Outpatient,,,1945.1,972.55,,1497.73,77,,,Percent of Total Billed Charges,77% of total billed charges,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1594.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1731.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.73,77,,,Percent of total Billed charges,77% of total billed charges,1653.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,559.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,972.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.28,1731.14,
Bortezomib 3.5mg Powder SDV,43598042660,CDM,250,RC,,,Outpatient,,,1945.1,972.55,,1497.73,77,,,Percent of Total Billed Charges,77% of total billed charges,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1594.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1731.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.73,77,,,Percent of total Billed charges,77% of total billed charges,1653.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,559.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,972.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.28,1731.14,
Bortezomib 3.5mg Powder SDV,43598042660,CDM,250,RC,,,Outpatient,,,1945.1,972.55,,1497.73,77,,,Percent of Total Billed Charges,77% of total billed charges,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1594.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1731.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.73,77,,,Percent of total Billed charges,77% of total billed charges,1653.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,559.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,972.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.28,1731.14,
Bortezomib 3.5mg Powder SDV,43598042660,CDM,250,RC,,,Outpatient,,,1945.1,972.55,,1497.73,77,,,Percent of Total Billed Charges,77% of total billed charges,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,496,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,607.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1439.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1342.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1633.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1594.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1731.14,89,,,Percent of total Billed Charges,89% of total Billed charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.73,77,,,Percent of total Billed charges,77% of total billed charges,1653.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,559.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,972.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,793.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1731.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,486.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,486.28,1731.14,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,55887.74,27943.87,,43033.56,77,,,Percent of Total Billed Charges,77% of total billed charges,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17464.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41356.93,74,,,Percent of Total Billed Charges,74% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,46945.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,49740.09,89,,,Percent of total Billed Charges,89% of total Billed charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43033.56,77,,,Percent of total Billed charges,77% of total billed charges,47504.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16067.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27943.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13971.94,49740.09,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,54447,27223.5,,41924.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17014.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40290.78,74,,,Percent of Total Billed Charges,74% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,45735.48,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,48457.83,89,,,Percent of total Billed Charges,89% of total Billed charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41924.19,77,,,Percent of total Billed charges,77% of total billed charges,46279.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15653.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27223.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13611.75,48457.83,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,55887.74,27943.87,,43033.56,77,,,Percent of Total Billed Charges,77% of total billed charges,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17464.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41356.93,74,,,Percent of Total Billed Charges,74% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,46945.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,49740.09,89,,,Percent of total Billed Charges,89% of total Billed charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43033.56,77,,,Percent of total Billed charges,77% of total billed charges,47504.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16067.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27943.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13971.94,49740.09,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,54447,27223.5,,41924.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17014.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40290.78,74,,,Percent of Total Billed Charges,74% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,45735.48,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,48457.83,89,,,Percent of total Billed Charges,89% of total Billed charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41924.19,77,,,Percent of total Billed charges,77% of total billed charges,46279.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15653.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27223.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13611.75,48457.83,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,55887.74,27943.87,,43033.56,77,,,Percent of Total Billed Charges,77% of total billed charges,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17464.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41356.93,74,,,Percent of Total Billed Charges,74% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,46945.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,49740.09,89,,,Percent of total Billed Charges,89% of total Billed charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43033.56,77,,,Percent of total Billed charges,77% of total billed charges,47504.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16067.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27943.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13971.94,49740.09,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,54447,27223.5,,41924.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17014.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40290.78,74,,,Percent of Total Billed Charges,74% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,45735.48,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,48457.83,89,,,Percent of total Billed Charges,89% of total Billed charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41924.19,77,,,Percent of total Billed charges,77% of total billed charges,46279.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15653.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27223.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13611.75,48457.83,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,55887.74,27943.87,,43033.56,77,,,Percent of Total Billed Charges,77% of total billed charges,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17464.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41356.93,74,,,Percent of Total Billed Charges,74% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,46945.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,49740.09,89,,,Percent of total Billed Charges,89% of total Billed charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43033.56,77,,,Percent of total Billed charges,77% of total billed charges,47504.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16067.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27943.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13971.94,49740.09,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,54447,27223.5,,41924.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17014.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40290.78,74,,,Percent of Total Billed Charges,74% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,45735.48,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,48457.83,89,,,Percent of total Billed Charges,89% of total Billed charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41924.19,77,,,Percent of total Billed charges,77% of total billed charges,46279.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15653.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27223.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13611.75,48457.83,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,55887.74,27943.87,,43033.56,77,,,Percent of Total Billed Charges,77% of total billed charges,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17464.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41356.93,74,,,Percent of Total Billed Charges,74% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,46945.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,49740.09,89,,,Percent of total Billed Charges,89% of total Billed charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43033.56,77,,,Percent of total Billed charges,77% of total billed charges,47504.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16067.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27943.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13971.94,49740.09,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,54447,27223.5,,41924.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17014.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40290.78,74,,,Percent of Total Billed Charges,74% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,45735.48,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,48457.83,89,,,Percent of total Billed Charges,89% of total Billed charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41924.19,77,,,Percent of total Billed charges,77% of total billed charges,46279.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15653.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27223.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13611.75,48457.83,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,55887.74,27943.87,,43033.56,77,,,Percent of Total Billed Charges,77% of total billed charges,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14251.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17464.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41356.93,74,,,Percent of Total Billed Charges,74% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38562.54,69,,,Percent of Total Billed Charges,69% of total billed charges,46945.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,49740.09,89,,,Percent of total Billed Charges,89% of total Billed charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43033.56,77,,,Percent of total Billed charges,77% of total billed charges,47504.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16067.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27943.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22802.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49740.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13971.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13971.94,49740.09,
Brentuximab (Adcetris) 50mg/10ml Powder SDV,51144005001,CDM,250,RC,,,Outpatient,,,54447,27223.5,,41924.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13883.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17014.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40290.78,74,,,Percent of Total Billed Charges,74% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,37568.43,69,,,Percent of Total Billed Charges,69% of total billed charges,45735.48,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,48457.83,89,,,Percent of total Billed Charges,89% of total Billed charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41924.19,77,,,Percent of total Billed charges,77% of total billed charges,46279.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15653.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27223.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22214.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48457.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13611.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13611.75,48457.83,
Brimonidine 0.15% OPHTH Soln 5ml,23917705,CDM,250,RC,,,Outpatient,,,719.16,359.58,,553.75,77,,,Percent of Total Billed Charges,77% of total billed charges,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.18,74,,,Percent of Total Billed Charges,74% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,604.09,84,,,Percent of Total Billed Charges,84% of total billed charges,589.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.05,89,,,Percent of total Billed Charges,89% of total Billed charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.75,77,,,Percent of total Billed charges,77% of total billed charges,611.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.79,640.05,
Brimonidine 0.15% OPHTH Soln 5ml,23917705,CDM,250,RC,,,Outpatient,,,719.16,359.58,,553.75,77,,,Percent of Total Billed Charges,77% of total billed charges,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.18,74,,,Percent of Total Billed Charges,74% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,604.09,84,,,Percent of Total Billed Charges,84% of total billed charges,589.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.05,89,,,Percent of total Billed Charges,89% of total Billed charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.75,77,,,Percent of total Billed charges,77% of total billed charges,611.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.79,640.05,
Brimonidine 0.15% OPHTH Soln 5ml,23917705,CDM,250,RC,,,Outpatient,,,719.16,359.58,,553.75,77,,,Percent of Total Billed Charges,77% of total billed charges,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.18,74,,,Percent of Total Billed Charges,74% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,604.09,84,,,Percent of Total Billed Charges,84% of total billed charges,589.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.05,89,,,Percent of total Billed Charges,89% of total Billed charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.75,77,,,Percent of total Billed charges,77% of total billed charges,611.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.79,640.05,
Brimonidine 0.15% OPHTH Soln 5ml,23917705,CDM,250,RC,,,Outpatient,,,719.16,359.58,,553.75,77,,,Percent of Total Billed Charges,77% of total billed charges,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.18,74,,,Percent of Total Billed Charges,74% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,604.09,84,,,Percent of Total Billed Charges,84% of total billed charges,589.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.05,89,,,Percent of total Billed Charges,89% of total Billed charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.75,77,,,Percent of total Billed charges,77% of total billed charges,611.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.79,640.05,
Brimonidine 0.15% OPHTH Soln 5ml,23917705,CDM,250,RC,,,Outpatient,,,719.16,359.58,,553.75,77,,,Percent of Total Billed Charges,77% of total billed charges,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.18,74,,,Percent of Total Billed Charges,74% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,604.09,84,,,Percent of Total Billed Charges,84% of total billed charges,589.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.05,89,,,Percent of total Billed Charges,89% of total Billed charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.75,77,,,Percent of total Billed charges,77% of total billed charges,611.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.79,640.05,
Brimonidine 0.15% OPHTH Soln 5ml,23917705,CDM,250,RC,,,Outpatient,,,719.16,359.58,,553.75,77,,,Percent of Total Billed Charges,77% of total billed charges,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.18,74,,,Percent of Total Billed Charges,74% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,496.22,69,,,Percent of Total Billed Charges,69% of total billed charges,604.09,84,,,Percent of Total Billed Charges,84% of total billed charges,589.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.05,89,,,Percent of total Billed Charges,89% of total Billed charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,553.75,77,,,Percent of total Billed charges,77% of total billed charges,611.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.79,640.05,
Brinzolamide OPHTH Soln (Azopt) 10ml,,,250,RC,,,Outpatient,,,1271.46,635.73,,979.02,77,,,Percent of Total Billed Charges,77% of total billed charges,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.88,74,,,Percent of Total Billed Charges,74% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1042.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1131.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.02,77,,,Percent of total Billed charges,77% of total billed charges,1080.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,635.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.87,1131.6,
Brinzolamide OPHTH Soln (Azopt) 10ml,,,250,RC,,,Outpatient,,,1271.46,635.73,,979.02,77,,,Percent of Total Billed Charges,77% of total billed charges,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.88,74,,,Percent of Total Billed Charges,74% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1042.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1131.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.02,77,,,Percent of total Billed charges,77% of total billed charges,1080.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,635.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.87,1131.6,
Brinzolamide OPHTH Soln (Azopt) 10ml,,,250,RC,,,Outpatient,,,1271.46,635.73,,979.02,77,,,Percent of Total Billed Charges,77% of total billed charges,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.88,74,,,Percent of Total Billed Charges,74% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1042.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1131.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.02,77,,,Percent of total Billed charges,77% of total billed charges,1080.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,635.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.87,1131.6,
Brinzolamide OPHTH Soln (Azopt) 10ml,,,250,RC,,,Outpatient,,,1271.46,635.73,,979.02,77,,,Percent of Total Billed Charges,77% of total billed charges,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.88,74,,,Percent of Total Billed Charges,74% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1042.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1131.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.02,77,,,Percent of total Billed charges,77% of total billed charges,1080.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,635.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.87,1131.6,
Brinzolamide OPHTH Soln (Azopt) 10ml,,,250,RC,,,Outpatient,,,1271.46,635.73,,979.02,77,,,Percent of Total Billed Charges,77% of total billed charges,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.88,74,,,Percent of Total Billed Charges,74% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1042.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1131.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.02,77,,,Percent of total Billed charges,77% of total billed charges,1080.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,635.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.87,1131.6,
Brinzolamide OPHTH Soln (Azopt) 10ml,,,250,RC,,,Outpatient,,,1271.46,635.73,,979.02,77,,,Percent of Total Billed Charges,77% of total billed charges,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,397.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,940.88,74,,,Percent of Total Billed Charges,74% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,877.31,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1042.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,1131.6,89,,,Percent of total Billed Charges,89% of total Billed charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,979.02,77,,,Percent of total Billed charges,77% of total billed charges,1080.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,365.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,635.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,518.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1131.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.87,1131.6,
Bromocriptine 2.5mg Tablet,,,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Bromocriptine 2.5mg Tablet,,,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Bromocriptine 2.5mg Tablet,,,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Bromocriptine 2.5mg Tablet,,,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Bromocriptine 2.5mg Tablet,,,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Bromocriptine 2.5mg Tablet,,,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Budesonide Ext Release 9mg Tablet,68682030930,CDM,250,RC,,,Outpatient,,,197.59,98.8,,152.14,77,,,Percent of Total Billed Charges,77% of total billed charges,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.22,74,,,Percent of Total Billed Charges,74% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,165.98,84,,,Percent of Total Billed Charges,84% of total billed charges,162.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.86,89,,,Percent of total Billed Charges,89% of total Billed charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.14,77,,,Percent of total Billed charges,77% of total billed charges,167.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,175.86,
Budesonide Ext Release 9mg Tablet,68682030930,CDM,250,RC,,,Outpatient,,,197.59,98.8,,152.14,77,,,Percent of Total Billed Charges,77% of total billed charges,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.22,74,,,Percent of Total Billed Charges,74% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,165.98,84,,,Percent of Total Billed Charges,84% of total billed charges,162.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.86,89,,,Percent of total Billed Charges,89% of total Billed charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.14,77,,,Percent of total Billed charges,77% of total billed charges,167.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,175.86,
Budesonide Ext Release 9mg Tablet,68682030930,CDM,250,RC,,,Outpatient,,,197.59,98.8,,152.14,77,,,Percent of Total Billed Charges,77% of total billed charges,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.22,74,,,Percent of Total Billed Charges,74% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,165.98,84,,,Percent of Total Billed Charges,84% of total billed charges,162.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.86,89,,,Percent of total Billed Charges,89% of total Billed charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.14,77,,,Percent of total Billed charges,77% of total billed charges,167.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,175.86,
Budesonide Ext Release 9mg Tablet,68682030930,CDM,250,RC,,,Outpatient,,,197.59,98.8,,152.14,77,,,Percent of Total Billed Charges,77% of total billed charges,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.22,74,,,Percent of Total Billed Charges,74% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,165.98,84,,,Percent of Total Billed Charges,84% of total billed charges,162.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.86,89,,,Percent of total Billed Charges,89% of total Billed charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.14,77,,,Percent of total Billed charges,77% of total billed charges,167.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,175.86,
Budesonide Ext Release 9mg Tablet,68682030930,CDM,250,RC,,,Outpatient,,,197.59,98.8,,152.14,77,,,Percent of Total Billed Charges,77% of total billed charges,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.22,74,,,Percent of Total Billed Charges,74% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,165.98,84,,,Percent of Total Billed Charges,84% of total billed charges,162.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.86,89,,,Percent of total Billed Charges,89% of total Billed charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.14,77,,,Percent of total Billed charges,77% of total billed charges,167.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,175.86,
Budesonide Ext Release 9mg Tablet,68682030930,CDM,250,RC,,,Outpatient,,,197.59,98.8,,152.14,77,,,Percent of Total Billed Charges,77% of total billed charges,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.22,74,,,Percent of Total Billed Charges,74% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,136.34,69,,,Percent of Total Billed Charges,69% of total billed charges,165.98,84,,,Percent of Total Billed Charges,84% of total billed charges,162.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.86,89,,,Percent of total Billed Charges,89% of total Billed charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.14,77,,,Percent of total Billed charges,77% of total billed charges,167.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.4,175.86,
Bumetanide 1mg/4ml SDV,72205010101,CDM,250,RC,,,Outpatient,,,58.75,29.38,,45.24,77,,,Percent of Total Billed Charges,77% of total billed charges,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.48,74,,,Percent of Total Billed Charges,74% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,49.35,84,,,Percent of Total Billed Charges,84% of total billed charges,48.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.29,89,,,Percent of total Billed Charges,89% of total Billed charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.24,77,,,Percent of total Billed charges,77% of total billed charges,49.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,52.29,
Bumetanide 1mg/4ml SDV,72205010101,CDM,250,RC,,,Outpatient,,,58.75,29.38,,45.24,77,,,Percent of Total Billed Charges,77% of total billed charges,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.48,74,,,Percent of Total Billed Charges,74% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,49.35,84,,,Percent of Total Billed Charges,84% of total billed charges,48.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.29,89,,,Percent of total Billed Charges,89% of total Billed charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.24,77,,,Percent of total Billed charges,77% of total billed charges,49.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,52.29,
Bumetanide 1mg/4ml SDV,72205010101,CDM,250,RC,,,Outpatient,,,58.75,29.38,,45.24,77,,,Percent of Total Billed Charges,77% of total billed charges,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.48,74,,,Percent of Total Billed Charges,74% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,49.35,84,,,Percent of Total Billed Charges,84% of total billed charges,48.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.29,89,,,Percent of total Billed Charges,89% of total Billed charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.24,77,,,Percent of total Billed charges,77% of total billed charges,49.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,52.29,
Bumetanide 1mg/4ml SDV,72205010101,CDM,250,RC,,,Outpatient,,,58.75,29.38,,45.24,77,,,Percent of Total Billed Charges,77% of total billed charges,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.48,74,,,Percent of Total Billed Charges,74% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,49.35,84,,,Percent of Total Billed Charges,84% of total billed charges,48.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.29,89,,,Percent of total Billed Charges,89% of total Billed charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.24,77,,,Percent of total Billed charges,77% of total billed charges,49.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,52.29,
Bumetanide 1mg/4ml SDV,72205010101,CDM,250,RC,,,Outpatient,,,58.75,29.38,,45.24,77,,,Percent of Total Billed Charges,77% of total billed charges,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.48,74,,,Percent of Total Billed Charges,74% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,49.35,84,,,Percent of Total Billed Charges,84% of total billed charges,48.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.29,89,,,Percent of total Billed Charges,89% of total Billed charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.24,77,,,Percent of total Billed charges,77% of total billed charges,49.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,52.29,
Bumetanide 1mg/4ml SDV,72205010101,CDM,250,RC,,,Outpatient,,,58.75,29.38,,45.24,77,,,Percent of Total Billed Charges,77% of total billed charges,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.48,74,,,Percent of Total Billed Charges,74% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.54,69,,,Percent of Total Billed Charges,69% of total billed charges,49.35,84,,,Percent of Total Billed Charges,84% of total billed charges,48.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.29,89,,,Percent of total Billed Charges,89% of total Billed charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.24,77,,,Percent of total Billed charges,77% of total billed charges,49.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,52.29,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 2.5mg/10ml MDV,641600710,CDM,250,RC,,,Outpatient,,,66.98,33.49,,51.57,77,,,Percent of Total Billed Charges,77% of total billed charges,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.57,74,,,Percent of Total Billed Charges,74% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,46.22,69,,,Percent of Total Billed Charges,69% of total billed charges,56.26,84,,,Percent of Total Billed Charges,84% of total billed charges,54.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.61,89,,,Percent of total Billed Charges,89% of total Billed charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.57,77,,,Percent of total Billed charges,77% of total billed charges,56.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.75,59.61,
Bumetanide 1mg Tablet,185012901,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Bumetanide 1mg Tablet,185012901,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Bumetanide 1mg Tablet,185012901,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Bumetanide 1mg Tablet,185012901,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Bumetanide 1mg Tablet,185012901,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Bumetanide 1mg Tablet,185012901,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Bupivacaine PF+EPI 0.5% 1:200000 10ml SDV,409174910,CDM,250,RC,,,Outpatient,,,81.2,40.6,,62.52,77,,,Percent of Total Billed Charges,77% of total billed charges,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.09,74,,,Percent of Total Billed Charges,74% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.21,84,,,Percent of Total Billed Charges,84% of total billed charges,66.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.27,89,,,Percent of total Billed Charges,89% of total Billed charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.52,77,,,Percent of total Billed charges,77% of total billed charges,69.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.3,72.27,
Bupivacaine PF+EPI 0.5% 1:200000 10ml SDV,409174910,CDM,250,RC,,,Outpatient,,,81.2,40.6,,62.52,77,,,Percent of Total Billed Charges,77% of total billed charges,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.09,74,,,Percent of Total Billed Charges,74% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.21,84,,,Percent of Total Billed Charges,84% of total billed charges,66.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.27,89,,,Percent of total Billed Charges,89% of total Billed charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.52,77,,,Percent of total Billed charges,77% of total billed charges,69.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.3,72.27,
Bupivacaine PF+EPI 0.5% 1:200000 10ml SDV,409174910,CDM,250,RC,,,Outpatient,,,81.2,40.6,,62.52,77,,,Percent of Total Billed Charges,77% of total billed charges,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.09,74,,,Percent of Total Billed Charges,74% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.21,84,,,Percent of Total Billed Charges,84% of total billed charges,66.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.27,89,,,Percent of total Billed Charges,89% of total Billed charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.52,77,,,Percent of total Billed charges,77% of total billed charges,69.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.3,72.27,
Bupivacaine PF+EPI 0.5% 1:200000 10ml SDV,409174910,CDM,250,RC,,,Outpatient,,,81.2,40.6,,62.52,77,,,Percent of Total Billed Charges,77% of total billed charges,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.09,74,,,Percent of Total Billed Charges,74% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.21,84,,,Percent of Total Billed Charges,84% of total billed charges,66.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.27,89,,,Percent of total Billed Charges,89% of total Billed charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.52,77,,,Percent of total Billed charges,77% of total billed charges,69.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.3,72.27,
Bupivacaine PF+EPI 0.5% 1:200000 10ml SDV,409174910,CDM,250,RC,,,Outpatient,,,81.2,40.6,,62.52,77,,,Percent of Total Billed Charges,77% of total billed charges,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.09,74,,,Percent of Total Billed Charges,74% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.21,84,,,Percent of Total Billed Charges,84% of total billed charges,66.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.27,89,,,Percent of total Billed Charges,89% of total Billed charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.52,77,,,Percent of total Billed charges,77% of total billed charges,69.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.3,72.27,
Bupivacaine PF+EPI 0.5% 1:200000 10ml SDV,409174910,CDM,250,RC,,,Outpatient,,,81.2,40.6,,62.52,77,,,Percent of Total Billed Charges,77% of total billed charges,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.09,74,,,Percent of Total Billed Charges,74% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,56.03,69,,,Percent of Total Billed Charges,69% of total billed charges,68.21,84,,,Percent of Total Billed Charges,84% of total billed charges,66.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.27,89,,,Percent of total Billed Charges,89% of total Billed charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.52,77,,,Percent of total Billed charges,77% of total billed charges,69.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.3,72.27,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,197.69,98.85,,152.22,77,,,Percent of Total Billed Charges,77% of total billed charges,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.29,74,,,Percent of Total Billed Charges,74% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,166.06,84,,,Percent of Total Billed Charges,84% of total billed charges,162.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.94,89,,,Percent of total Billed Charges,89% of total Billed charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.22,77,,,Percent of total Billed charges,77% of total billed charges,168.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,175.94,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,197.69,98.85,,152.22,77,,,Percent of Total Billed Charges,77% of total billed charges,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.29,74,,,Percent of Total Billed Charges,74% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,166.06,84,,,Percent of Total Billed Charges,84% of total billed charges,162.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.94,89,,,Percent of total Billed Charges,89% of total Billed charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.22,77,,,Percent of total Billed charges,77% of total billed charges,168.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,175.94,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,197.69,98.85,,152.22,77,,,Percent of Total Billed Charges,77% of total billed charges,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.29,74,,,Percent of Total Billed Charges,74% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,166.06,84,,,Percent of Total Billed Charges,84% of total billed charges,162.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.94,89,,,Percent of total Billed Charges,89% of total Billed charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.22,77,,,Percent of total Billed charges,77% of total billed charges,168.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,175.94,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,197.69,98.85,,152.22,77,,,Percent of Total Billed Charges,77% of total billed charges,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.29,74,,,Percent of Total Billed Charges,74% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,166.06,84,,,Percent of Total Billed Charges,84% of total billed charges,162.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.94,89,,,Percent of total Billed Charges,89% of total Billed charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.22,77,,,Percent of total Billed charges,77% of total billed charges,168.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,175.94,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,197.69,98.85,,152.22,77,,,Percent of Total Billed Charges,77% of total billed charges,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.29,74,,,Percent of Total Billed Charges,74% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,166.06,84,,,Percent of Total Billed Charges,84% of total billed charges,162.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.94,89,,,Percent of total Billed Charges,89% of total Billed charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.22,77,,,Percent of total Billed charges,77% of total billed charges,168.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,175.94,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Bupivacaine PF+EPI 0.25% 1:200000 10ml SDV,409904201,CDM,250,RC,,,Outpatient,,,197.69,98.85,,152.22,77,,,Percent of Total Billed Charges,77% of total billed charges,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.29,74,,,Percent of Total Billed Charges,74% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,136.41,69,,,Percent of Total Billed Charges,69% of total billed charges,166.06,84,,,Percent of Total Billed Charges,84% of total billed charges,162.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.94,89,,,Percent of total Billed Charges,89% of total Billed charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.22,77,,,Percent of total Billed charges,77% of total billed charges,168.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,175.94,
Bupivacaine/Meloxicam 400-12 mg/14ml Soler.Vial,,,250,RC,,,Outpatient,,,1353.65,676.83,,1042.31,77,,,Percent of Total Billed Charges,77% of total billed charges,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.7,74,,,Percent of Total Billed Charges,74% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.31,77,,,Percent of total Billed charges,77% of total billed charges,1150.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.41,1204.75,
Bupivacaine/Meloxicam 400-12 mg/14ml Soler.Vial,,,250,RC,,,Outpatient,,,1353.65,676.83,,1042.31,77,,,Percent of Total Billed Charges,77% of total billed charges,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.7,74,,,Percent of Total Billed Charges,74% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.31,77,,,Percent of total Billed charges,77% of total billed charges,1150.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.41,1204.75,
Bupivacaine/Meloxicam 400-12 mg/14ml Soler.Vial,,,250,RC,,,Outpatient,,,1353.65,676.83,,1042.31,77,,,Percent of Total Billed Charges,77% of total billed charges,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.7,74,,,Percent of Total Billed Charges,74% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.31,77,,,Percent of total Billed charges,77% of total billed charges,1150.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.41,1204.75,
Bupivacaine/Meloxicam 400-12 mg/14ml Soler.Vial,,,250,RC,,,Outpatient,,,1353.65,676.83,,1042.31,77,,,Percent of Total Billed Charges,77% of total billed charges,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.7,74,,,Percent of Total Billed Charges,74% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.31,77,,,Percent of total Billed charges,77% of total billed charges,1150.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.41,1204.75,
Bupivacaine/Meloxicam 400-12 mg/14ml Soler.Vial,,,250,RC,,,Outpatient,,,1353.65,676.83,,1042.31,77,,,Percent of Total Billed Charges,77% of total billed charges,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.7,74,,,Percent of Total Billed Charges,74% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.31,77,,,Percent of total Billed charges,77% of total billed charges,1150.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.41,1204.75,
Bupivacaine/Meloxicam 400-12 mg/14ml Soler.Vial,,,250,RC,,,Outpatient,,,1353.65,676.83,,1042.31,77,,,Percent of Total Billed Charges,77% of total billed charges,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1001.7,74,,,Percent of Total Billed Charges,74% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,934.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1109.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1204.75,89,,,Percent of total Billed Charges,89% of total Billed charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.31,77,,,Percent of total Billed charges,77% of total billed charges,1150.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,676.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.41,1204.75,
Bupivacaine PF 0.25% 30ml SDV,409115910,CDM,250,RC,,,Outpatient,,,54.23,27.12,,41.76,77,,,Percent of Total Billed Charges,77% of total billed charges,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.13,74,,,Percent of Total Billed Charges,74% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,45.55,84,,,Percent of Total Billed Charges,84% of total billed charges,44.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.26,89,,,Percent of total Billed Charges,89% of total Billed charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.76,77,,,Percent of total Billed charges,77% of total billed charges,46.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.56,48.26,
Bupivacaine PF 0.25% 30ml SDV,409115910,CDM,250,RC,,,Outpatient,,,54.23,27.12,,41.76,77,,,Percent of Total Billed Charges,77% of total billed charges,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.13,74,,,Percent of Total Billed Charges,74% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,45.55,84,,,Percent of Total Billed Charges,84% of total billed charges,44.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.26,89,,,Percent of total Billed Charges,89% of total Billed charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.76,77,,,Percent of total Billed charges,77% of total billed charges,46.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.56,48.26,
Bupivacaine PF 0.25% 30ml SDV,409115910,CDM,250,RC,,,Outpatient,,,54.23,27.12,,41.76,77,,,Percent of Total Billed Charges,77% of total billed charges,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.13,74,,,Percent of Total Billed Charges,74% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,45.55,84,,,Percent of Total Billed Charges,84% of total billed charges,44.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.26,89,,,Percent of total Billed Charges,89% of total Billed charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.76,77,,,Percent of total Billed charges,77% of total billed charges,46.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.56,48.26,
Bupivacaine PF 0.25% 30ml SDV,409115910,CDM,250,RC,,,Outpatient,,,54.23,27.12,,41.76,77,,,Percent of Total Billed Charges,77% of total billed charges,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.13,74,,,Percent of Total Billed Charges,74% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,45.55,84,,,Percent of Total Billed Charges,84% of total billed charges,44.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.26,89,,,Percent of total Billed Charges,89% of total Billed charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.76,77,,,Percent of total Billed charges,77% of total billed charges,46.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.56,48.26,
Bupivacaine PF 0.25% 30ml SDV,409115910,CDM,250,RC,,,Outpatient,,,54.23,27.12,,41.76,77,,,Percent of Total Billed Charges,77% of total billed charges,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.13,74,,,Percent of Total Billed Charges,74% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,45.55,84,,,Percent of Total Billed Charges,84% of total billed charges,44.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.26,89,,,Percent of total Billed Charges,89% of total Billed charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.76,77,,,Percent of total Billed charges,77% of total billed charges,46.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.56,48.26,
Bupivacaine PF 0.25% 30ml SDV,409115910,CDM,250,RC,,,Outpatient,,,54.23,27.12,,41.76,77,,,Percent of Total Billed Charges,77% of total billed charges,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.13,74,,,Percent of Total Billed Charges,74% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,37.42,69,,,Percent of Total Billed Charges,69% of total billed charges,45.55,84,,,Percent of Total Billed Charges,84% of total billed charges,44.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.26,89,,,Percent of total Billed Charges,89% of total Billed charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.76,77,,,Percent of total Billed charges,77% of total billed charges,46.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.56,48.26,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,85.07,42.54,,65.5,77,,,Percent of Total Billed Charges,77% of total billed charges,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.95,74,,,Percent of Total Billed Charges,74% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,71.46,84,,,Percent of Total Billed Charges,84% of total billed charges,69.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.71,89,,,Percent of total Billed Charges,89% of total Billed charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,77,,,Percent of total Billed charges,77% of total billed charges,72.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.27,75.71,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,204.71,102.36,,157.63,77,,,Percent of Total Billed Charges,77% of total billed charges,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.49,74,,,Percent of Total Billed Charges,74% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,171.96,84,,,Percent of Total Billed Charges,84% of total billed charges,167.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.19,89,,,Percent of total Billed Charges,89% of total Billed charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.63,77,,,Percent of total Billed charges,77% of total billed charges,174,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,102.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.18,182.19,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,85.07,42.54,,65.5,77,,,Percent of Total Billed Charges,77% of total billed charges,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.95,74,,,Percent of Total Billed Charges,74% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,71.46,84,,,Percent of Total Billed Charges,84% of total billed charges,69.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.71,89,,,Percent of total Billed Charges,89% of total Billed charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,77,,,Percent of total Billed charges,77% of total billed charges,72.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.27,75.71,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,204.71,102.36,,157.63,77,,,Percent of Total Billed Charges,77% of total billed charges,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.49,74,,,Percent of Total Billed Charges,74% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,171.96,84,,,Percent of Total Billed Charges,84% of total billed charges,167.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.19,89,,,Percent of total Billed Charges,89% of total Billed charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.63,77,,,Percent of total Billed charges,77% of total billed charges,174,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,102.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.18,182.19,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,85.07,42.54,,65.5,77,,,Percent of Total Billed Charges,77% of total billed charges,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.95,74,,,Percent of Total Billed Charges,74% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,71.46,84,,,Percent of Total Billed Charges,84% of total billed charges,69.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.71,89,,,Percent of total Billed Charges,89% of total Billed charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,77,,,Percent of total Billed charges,77% of total billed charges,72.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.27,75.71,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,204.71,102.36,,157.63,77,,,Percent of Total Billed Charges,77% of total billed charges,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.49,74,,,Percent of Total Billed Charges,74% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,171.96,84,,,Percent of Total Billed Charges,84% of total billed charges,167.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.19,89,,,Percent of total Billed Charges,89% of total Billed charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.63,77,,,Percent of total Billed charges,77% of total billed charges,174,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,102.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.18,182.19,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,85.07,42.54,,65.5,77,,,Percent of Total Billed Charges,77% of total billed charges,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.95,74,,,Percent of Total Billed Charges,74% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,71.46,84,,,Percent of Total Billed Charges,84% of total billed charges,69.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.71,89,,,Percent of total Billed Charges,89% of total Billed charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,77,,,Percent of total Billed charges,77% of total billed charges,72.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.27,75.71,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,204.71,102.36,,157.63,77,,,Percent of Total Billed Charges,77% of total billed charges,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.49,74,,,Percent of Total Billed Charges,74% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,171.96,84,,,Percent of Total Billed Charges,84% of total billed charges,167.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.19,89,,,Percent of total Billed Charges,89% of total Billed charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.63,77,,,Percent of total Billed charges,77% of total billed charges,174,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,102.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.18,182.19,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,85.07,42.54,,65.5,77,,,Percent of Total Billed Charges,77% of total billed charges,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.95,74,,,Percent of Total Billed Charges,74% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,71.46,84,,,Percent of Total Billed Charges,84% of total billed charges,69.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.71,89,,,Percent of total Billed Charges,89% of total Billed charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,77,,,Percent of total Billed charges,77% of total billed charges,72.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.27,75.71,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,204.71,102.36,,157.63,77,,,Percent of Total Billed Charges,77% of total billed charges,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.49,74,,,Percent of Total Billed Charges,74% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,171.96,84,,,Percent of Total Billed Charges,84% of total billed charges,167.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.19,89,,,Percent of total Billed Charges,89% of total Billed charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.63,77,,,Percent of total Billed charges,77% of total billed charges,174,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,102.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.18,182.19,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,85.07,42.54,,65.5,77,,,Percent of Total Billed Charges,77% of total billed charges,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.95,74,,,Percent of Total Billed Charges,74% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,58.7,69,,,Percent of Total Billed Charges,69% of total billed charges,71.46,84,,,Percent of Total Billed Charges,84% of total billed charges,69.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.71,89,,,Percent of total Billed Charges,89% of total Billed charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.5,77,,,Percent of total Billed charges,77% of total billed charges,72.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.27,75.71,
Bupivacaine PF SPINAL 0.75% 15mg/2ml Ampule,409176110,CDM,250,RC,,,Outpatient,,,204.71,102.36,,157.63,77,,,Percent of Total Billed Charges,77% of total billed charges,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,151.49,74,,,Percent of Total Billed Charges,74% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,141.25,69,,,Percent of Total Billed Charges,69% of total billed charges,171.96,84,,,Percent of Total Billed Charges,84% of total billed charges,167.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,182.19,89,,,Percent of total Billed Charges,89% of total Billed charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.63,77,,,Percent of total Billed charges,77% of total billed charges,174,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,102.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.18,182.19,
Bupivacaine PF+EPI 0.25% 1:200000 30ml SDV,63323046802,CDM,250,RC,,,Outpatient,,,136.06,68.03,,104.77,77,,,Percent of Total Billed Charges,77% of total billed charges,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.68,74,,,Percent of Total Billed Charges,74% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.29,84,,,Percent of Total Billed Charges,84% of total billed charges,111.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.09,89,,,Percent of total Billed Charges,89% of total Billed charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.77,77,,,Percent of total Billed charges,77% of total billed charges,115.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,121.09,
Bupivacaine PF+EPI 0.25% 1:200000 30ml SDV,63323046802,CDM,250,RC,,,Outpatient,,,136.06,68.03,,104.77,77,,,Percent of Total Billed Charges,77% of total billed charges,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.68,74,,,Percent of Total Billed Charges,74% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.29,84,,,Percent of Total Billed Charges,84% of total billed charges,111.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.09,89,,,Percent of total Billed Charges,89% of total Billed charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.77,77,,,Percent of total Billed charges,77% of total billed charges,115.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,121.09,
Bupivacaine PF+EPI 0.25% 1:200000 30ml SDV,63323046802,CDM,250,RC,,,Outpatient,,,136.06,68.03,,104.77,77,,,Percent of Total Billed Charges,77% of total billed charges,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.68,74,,,Percent of Total Billed Charges,74% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.29,84,,,Percent of Total Billed Charges,84% of total billed charges,111.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.09,89,,,Percent of total Billed Charges,89% of total Billed charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.77,77,,,Percent of total Billed charges,77% of total billed charges,115.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,121.09,
Bupivacaine PF+EPI 0.25% 1:200000 30ml SDV,63323046802,CDM,250,RC,,,Outpatient,,,136.06,68.03,,104.77,77,,,Percent of Total Billed Charges,77% of total billed charges,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.68,74,,,Percent of Total Billed Charges,74% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.29,84,,,Percent of Total Billed Charges,84% of total billed charges,111.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.09,89,,,Percent of total Billed Charges,89% of total Billed charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.77,77,,,Percent of total Billed charges,77% of total billed charges,115.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,121.09,
Bupivacaine PF+EPI 0.25% 1:200000 30ml SDV,63323046802,CDM,250,RC,,,Outpatient,,,136.06,68.03,,104.77,77,,,Percent of Total Billed Charges,77% of total billed charges,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.68,74,,,Percent of Total Billed Charges,74% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.29,84,,,Percent of Total Billed Charges,84% of total billed charges,111.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.09,89,,,Percent of total Billed Charges,89% of total Billed charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.77,77,,,Percent of total Billed charges,77% of total billed charges,115.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,121.09,
Bupivacaine PF+EPI 0.25% 1:200000 30ml SDV,63323046802,CDM,250,RC,,,Outpatient,,,136.06,68.03,,104.77,77,,,Percent of Total Billed Charges,77% of total billed charges,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,100.68,74,,,Percent of Total Billed Charges,74% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,93.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.29,84,,,Percent of Total Billed Charges,84% of total billed charges,111.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,121.09,89,,,Percent of total Billed Charges,89% of total Billed charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.77,77,,,Percent of total Billed charges,77% of total billed charges,115.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.02,121.09,
Bupivacaine PF+EPI 0.5% 1:200000 30ml SDV,409174929,CDM,250,RC,,,Outpatient,,,88.61,44.31,,68.23,77,,,Percent of Total Billed Charges,77% of total billed charges,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.57,74,,,Percent of Total Billed Charges,74% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,74.43,84,,,Percent of Total Billed Charges,84% of total billed charges,72.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.86,89,,,Percent of total Billed Charges,89% of total Billed charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.23,77,,,Percent of total Billed charges,77% of total billed charges,75.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.15,78.86,
Bupivacaine PF+EPI 0.5% 1:200000 30ml SDV,409174929,CDM,250,RC,,,Outpatient,,,88.61,44.31,,68.23,77,,,Percent of Total Billed Charges,77% of total billed charges,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.57,74,,,Percent of Total Billed Charges,74% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,74.43,84,,,Percent of Total Billed Charges,84% of total billed charges,72.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.86,89,,,Percent of total Billed Charges,89% of total Billed charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.23,77,,,Percent of total Billed charges,77% of total billed charges,75.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.15,78.86,
Bupivacaine PF+EPI 0.5% 1:200000 30ml SDV,409174929,CDM,250,RC,,,Outpatient,,,88.61,44.31,,68.23,77,,,Percent of Total Billed Charges,77% of total billed charges,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.57,74,,,Percent of Total Billed Charges,74% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,74.43,84,,,Percent of Total Billed Charges,84% of total billed charges,72.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.86,89,,,Percent of total Billed Charges,89% of total Billed charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.23,77,,,Percent of total Billed charges,77% of total billed charges,75.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.15,78.86,
Bupivacaine PF+EPI 0.5% 1:200000 30ml SDV,409174929,CDM,250,RC,,,Outpatient,,,88.61,44.31,,68.23,77,,,Percent of Total Billed Charges,77% of total billed charges,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.57,74,,,Percent of Total Billed Charges,74% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,74.43,84,,,Percent of Total Billed Charges,84% of total billed charges,72.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.86,89,,,Percent of total Billed Charges,89% of total Billed charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.23,77,,,Percent of total Billed charges,77% of total billed charges,75.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.15,78.86,
Bupivacaine PF+EPI 0.5% 1:200000 30ml SDV,409174929,CDM,250,RC,,,Outpatient,,,88.61,44.31,,68.23,77,,,Percent of Total Billed Charges,77% of total billed charges,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.57,74,,,Percent of Total Billed Charges,74% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,74.43,84,,,Percent of Total Billed Charges,84% of total billed charges,72.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.86,89,,,Percent of total Billed Charges,89% of total Billed charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.23,77,,,Percent of total Billed charges,77% of total billed charges,75.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.15,78.86,
Bupivacaine PF+EPI 0.5% 1:200000 30ml SDV,409174929,CDM,250,RC,,,Outpatient,,,88.61,44.31,,68.23,77,,,Percent of Total Billed Charges,77% of total billed charges,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.57,74,,,Percent of Total Billed Charges,74% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,61.14,69,,,Percent of Total Billed Charges,69% of total billed charges,74.43,84,,,Percent of Total Billed Charges,84% of total billed charges,72.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.86,89,,,Percent of total Billed Charges,89% of total Billed charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.23,77,,,Percent of total Billed charges,77% of total billed charges,75.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.15,78.86,
Bupivacaine+EPI 0.5% 1:200000 50ml MDV,409175550,CDM,250,RC,,,Outpatient,,,174.39,87.2,,134.28,77,,,Percent of Total Billed Charges,77% of total billed charges,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.05,74,,,Percent of Total Billed Charges,74% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,146.49,84,,,Percent of Total Billed Charges,84% of total billed charges,143,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.21,89,,,Percent of total Billed Charges,89% of total Billed charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.28,77,,,Percent of total Billed charges,77% of total billed charges,148.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.6,155.21,
Bupivacaine+EPI 0.5% 1:200000 50ml MDV,409175550,CDM,250,RC,,,Outpatient,,,174.39,87.2,,134.28,77,,,Percent of Total Billed Charges,77% of total billed charges,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.05,74,,,Percent of Total Billed Charges,74% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,146.49,84,,,Percent of Total Billed Charges,84% of total billed charges,143,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.21,89,,,Percent of total Billed Charges,89% of total Billed charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.28,77,,,Percent of total Billed charges,77% of total billed charges,148.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.6,155.21,
Bupivacaine+EPI 0.5% 1:200000 50ml MDV,409175550,CDM,250,RC,,,Outpatient,,,174.39,87.2,,134.28,77,,,Percent of Total Billed Charges,77% of total billed charges,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.05,74,,,Percent of Total Billed Charges,74% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,146.49,84,,,Percent of Total Billed Charges,84% of total billed charges,143,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.21,89,,,Percent of total Billed Charges,89% of total Billed charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.28,77,,,Percent of total Billed charges,77% of total billed charges,148.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.6,155.21,
Bupivacaine+EPI 0.5% 1:200000 50ml MDV,409175550,CDM,250,RC,,,Outpatient,,,174.39,87.2,,134.28,77,,,Percent of Total Billed Charges,77% of total billed charges,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.05,74,,,Percent of Total Billed Charges,74% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,146.49,84,,,Percent of Total Billed Charges,84% of total billed charges,143,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.21,89,,,Percent of total Billed Charges,89% of total Billed charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.28,77,,,Percent of total Billed charges,77% of total billed charges,148.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.6,155.21,
Bupivacaine+EPI 0.5% 1:200000 50ml MDV,409175550,CDM,250,RC,,,Outpatient,,,174.39,87.2,,134.28,77,,,Percent of Total Billed Charges,77% of total billed charges,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.05,74,,,Percent of Total Billed Charges,74% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,146.49,84,,,Percent of Total Billed Charges,84% of total billed charges,143,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.21,89,,,Percent of total Billed Charges,89% of total Billed charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.28,77,,,Percent of total Billed charges,77% of total billed charges,148.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.6,155.21,
Bupivacaine+EPI 0.5% 1:200000 50ml MDV,409175550,CDM,250,RC,,,Outpatient,,,174.39,87.2,,134.28,77,,,Percent of Total Billed Charges,77% of total billed charges,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,129.05,74,,,Percent of Total Billed Charges,74% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,120.33,69,,,Percent of Total Billed Charges,69% of total billed charges,146.49,84,,,Percent of Total Billed Charges,84% of total billed charges,143,82,,,Percent of Total Billed Charges,82% of total billed charges ,155.21,89,,,Percent of total Billed Charges,89% of total Billed charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.28,77,,,Percent of total Billed charges,77% of total billed charges,148.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.6,155.21,
Bupivacaine PF 0.5% 30ml SDV,63323046637,CDM,250,RC,,,Outpatient,,,99.63,49.82,,76.72,77,,,Percent of Total Billed Charges,77% of total billed charges,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.73,74,,,Percent of Total Billed Charges,74% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,83.69,84,,,Percent of Total Billed Charges,84% of total billed charges,81.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.67,89,,,Percent of total Billed Charges,89% of total Billed charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.72,77,,,Percent of total Billed charges,77% of total billed charges,84.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.91,88.67,
Bupivacaine PF 0.5% 30ml SDV,63323046637,CDM,250,RC,,,Outpatient,,,99.63,49.82,,76.72,77,,,Percent of Total Billed Charges,77% of total billed charges,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.73,74,,,Percent of Total Billed Charges,74% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,83.69,84,,,Percent of Total Billed Charges,84% of total billed charges,81.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.67,89,,,Percent of total Billed Charges,89% of total Billed charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.72,77,,,Percent of total Billed charges,77% of total billed charges,84.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.91,88.67,
Bupivacaine PF 0.5% 30ml SDV,63323046637,CDM,250,RC,,,Outpatient,,,99.63,49.82,,76.72,77,,,Percent of Total Billed Charges,77% of total billed charges,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.73,74,,,Percent of Total Billed Charges,74% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,83.69,84,,,Percent of Total Billed Charges,84% of total billed charges,81.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.67,89,,,Percent of total Billed Charges,89% of total Billed charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.72,77,,,Percent of total Billed charges,77% of total billed charges,84.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.91,88.67,
Bupivacaine PF 0.5% 30ml SDV,63323046637,CDM,250,RC,,,Outpatient,,,99.63,49.82,,76.72,77,,,Percent of Total Billed Charges,77% of total billed charges,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.73,74,,,Percent of Total Billed Charges,74% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,83.69,84,,,Percent of Total Billed Charges,84% of total billed charges,81.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.67,89,,,Percent of total Billed Charges,89% of total Billed charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.72,77,,,Percent of total Billed charges,77% of total billed charges,84.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.91,88.67,
Bupivacaine PF 0.5% 30ml SDV,63323046637,CDM,250,RC,,,Outpatient,,,99.63,49.82,,76.72,77,,,Percent of Total Billed Charges,77% of total billed charges,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.73,74,,,Percent of Total Billed Charges,74% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,83.69,84,,,Percent of Total Billed Charges,84% of total billed charges,81.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.67,89,,,Percent of total Billed Charges,89% of total Billed charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.72,77,,,Percent of total Billed charges,77% of total billed charges,84.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.91,88.67,
Bupivacaine PF 0.5% 30ml SDV,63323046637,CDM,250,RC,,,Outpatient,,,99.63,49.82,,76.72,77,,,Percent of Total Billed Charges,77% of total billed charges,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.73,74,,,Percent of Total Billed Charges,74% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,68.74,69,,,Percent of Total Billed Charges,69% of total billed charges,83.69,84,,,Percent of Total Billed Charges,84% of total billed charges,81.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.67,89,,,Percent of total Billed Charges,89% of total Billed charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.72,77,,,Percent of total Billed charges,77% of total billed charges,84.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.91,88.67,
Bupivacaine PF 0.5% 10ml SDV,409116201,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Bupivacaine PF 0.5% 10ml SDV,409116201,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Bupivacaine PF 0.5% 10ml SDV,409116201,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Bupivacaine PF 0.5% 10ml SDV,409116201,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Bupivacaine PF 0.5% 10ml SDV,409116201,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Bupivacaine PF 0.5% 10ml SDV,409116201,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Bupivacaine PF 0.75% 10ml SDV,55150017110,CDM,250,RC,,,Outpatient,,,69.44,34.72,,53.47,77,,,Percent of Total Billed Charges,77% of total billed charges,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.39,74,,,Percent of Total Billed Charges,74% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,58.33,84,,,Percent of Total Billed Charges,84% of total billed charges,56.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,89,,,Percent of total Billed Charges,89% of total Billed charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.47,77,,,Percent of total Billed charges,77% of total billed charges,59.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,61.8,
Bupivacaine PF 0.75% 10ml SDV,55150017110,CDM,250,RC,,,Outpatient,,,69.44,34.72,,53.47,77,,,Percent of Total Billed Charges,77% of total billed charges,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.39,74,,,Percent of Total Billed Charges,74% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,58.33,84,,,Percent of Total Billed Charges,84% of total billed charges,56.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,89,,,Percent of total Billed Charges,89% of total Billed charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.47,77,,,Percent of total Billed charges,77% of total billed charges,59.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,61.8,
Bupivacaine PF 0.75% 10ml SDV,55150017110,CDM,250,RC,,,Outpatient,,,69.44,34.72,,53.47,77,,,Percent of Total Billed Charges,77% of total billed charges,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.39,74,,,Percent of Total Billed Charges,74% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,58.33,84,,,Percent of Total Billed Charges,84% of total billed charges,56.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,89,,,Percent of total Billed Charges,89% of total Billed charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.47,77,,,Percent of total Billed charges,77% of total billed charges,59.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,61.8,
Bupivacaine PF 0.75% 10ml SDV,55150017110,CDM,250,RC,,,Outpatient,,,69.44,34.72,,53.47,77,,,Percent of Total Billed Charges,77% of total billed charges,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.39,74,,,Percent of Total Billed Charges,74% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,58.33,84,,,Percent of Total Billed Charges,84% of total billed charges,56.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,89,,,Percent of total Billed Charges,89% of total Billed charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.47,77,,,Percent of total Billed charges,77% of total billed charges,59.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,61.8,
Bupivacaine PF 0.75% 10ml SDV,55150017110,CDM,250,RC,,,Outpatient,,,69.44,34.72,,53.47,77,,,Percent of Total Billed Charges,77% of total billed charges,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.39,74,,,Percent of Total Billed Charges,74% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,58.33,84,,,Percent of Total Billed Charges,84% of total billed charges,56.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,89,,,Percent of total Billed Charges,89% of total Billed charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.47,77,,,Percent of total Billed charges,77% of total billed charges,59.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,61.8,
Bupivacaine PF 0.75% 10ml SDV,55150017110,CDM,250,RC,,,Outpatient,,,69.44,34.72,,53.47,77,,,Percent of Total Billed Charges,77% of total billed charges,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.39,74,,,Percent of Total Billed Charges,74% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,47.91,69,,,Percent of Total Billed Charges,69% of total billed charges,58.33,84,,,Percent of Total Billed Charges,84% of total billed charges,56.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.8,89,,,Percent of total Billed Charges,89% of total Billed charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.47,77,,,Percent of total Billed charges,77% of total billed charges,59.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,61.8,
buPROPion SR 150mg Tablet 12-Hr,173013555,CDM,250,RC,,,Outpatient,,,60.6,30.3,,46.66,77,,,Percent of Total Billed Charges,77% of total billed charges,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.84,74,,,Percent of Total Billed Charges,74% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,50.9,84,,,Percent of Total Billed Charges,84% of total billed charges,49.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.93,89,,,Percent of total Billed Charges,89% of total Billed charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.66,77,,,Percent of total Billed charges,77% of total billed charges,51.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.15,53.93,
buPROPion SR 150mg Tablet 12-Hr,173013555,CDM,250,RC,,,Outpatient,,,60.6,30.3,,46.66,77,,,Percent of Total Billed Charges,77% of total billed charges,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.84,74,,,Percent of Total Billed Charges,74% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,50.9,84,,,Percent of Total Billed Charges,84% of total billed charges,49.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.93,89,,,Percent of total Billed Charges,89% of total Billed charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.66,77,,,Percent of total Billed charges,77% of total billed charges,51.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.15,53.93,
buPROPion SR 150mg Tablet 12-Hr,173013555,CDM,250,RC,,,Outpatient,,,60.6,30.3,,46.66,77,,,Percent of Total Billed Charges,77% of total billed charges,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.84,74,,,Percent of Total Billed Charges,74% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,50.9,84,,,Percent of Total Billed Charges,84% of total billed charges,49.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.93,89,,,Percent of total Billed Charges,89% of total Billed charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.66,77,,,Percent of total Billed charges,77% of total billed charges,51.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.15,53.93,
buPROPion SR 150mg Tablet 12-Hr,173013555,CDM,250,RC,,,Outpatient,,,60.6,30.3,,46.66,77,,,Percent of Total Billed Charges,77% of total billed charges,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.84,74,,,Percent of Total Billed Charges,74% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,50.9,84,,,Percent of Total Billed Charges,84% of total billed charges,49.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.93,89,,,Percent of total Billed Charges,89% of total Billed charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.66,77,,,Percent of total Billed charges,77% of total billed charges,51.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.15,53.93,
buPROPion SR 150mg Tablet 12-Hr,173013555,CDM,250,RC,,,Outpatient,,,60.6,30.3,,46.66,77,,,Percent of Total Billed Charges,77% of total billed charges,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.84,74,,,Percent of Total Billed Charges,74% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,50.9,84,,,Percent of Total Billed Charges,84% of total billed charges,49.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.93,89,,,Percent of total Billed Charges,89% of total Billed charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.66,77,,,Percent of total Billed charges,77% of total billed charges,51.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.15,53.93,
buPROPion SR 150mg Tablet 12-Hr,173013555,CDM,250,RC,,,Outpatient,,,60.6,30.3,,46.66,77,,,Percent of Total Billed Charges,77% of total billed charges,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.84,74,,,Percent of Total Billed Charges,74% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,41.81,69,,,Percent of Total Billed Charges,69% of total billed charges,50.9,84,,,Percent of Total Billed Charges,84% of total billed charges,49.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.93,89,,,Percent of total Billed Charges,89% of total Billed charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.66,77,,,Percent of total Billed charges,77% of total billed charges,51.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.15,53.93,
buPROPion XL 150mg Tablet 24-Hr,10370010103,CDM,250,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
buPROPion XL 150mg Tablet 24-Hr,10370010103,CDM,250,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
buPROPion XL 150mg Tablet 24-Hr,10370010103,CDM,250,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
buPROPion XL 150mg Tablet 24-Hr,10370010103,CDM,250,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
buPROPion XL 150mg Tablet 24-Hr,10370010103,CDM,250,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
buPROPion XL 150mg Tablet 24-Hr,10370010103,CDM,250,RC,,,Outpatient,,,47,23.5,,36.19,77,,,Percent of Total Billed Charges,77% of total billed charges,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.78,74,,,Percent of Total Billed Charges,74% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.43,69,,,Percent of Total Billed Charges,69% of total billed charges,39.48,84,,,Percent of Total Billed Charges,84% of total billed charges,38.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.83,89,,,Percent of total Billed Charges,89% of total Billed charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.19,77,,,Percent of total Billed charges,77% of total billed charges,39.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.75,41.83,
Buprenorphine Sublingual 2mg Tablet,54017613,CDM,250,RC,,,Outpatient,,,43.85,21.93,,33.76,77,,,Percent of Total Billed Charges,77% of total billed charges,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.45,74,,,Percent of Total Billed Charges,74% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,36.83,84,,,Percent of Total Billed Charges,84% of total billed charges,35.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.03,89,,,Percent of total Billed Charges,89% of total Billed charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.76,77,,,Percent of total Billed charges,77% of total billed charges,37.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,39.03,
Buprenorphine Sublingual 2mg Tablet,54017613,CDM,250,RC,,,Outpatient,,,43.85,21.93,,33.76,77,,,Percent of Total Billed Charges,77% of total billed charges,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.45,74,,,Percent of Total Billed Charges,74% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,36.83,84,,,Percent of Total Billed Charges,84% of total billed charges,35.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.03,89,,,Percent of total Billed Charges,89% of total Billed charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.76,77,,,Percent of total Billed charges,77% of total billed charges,37.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,39.03,
Buprenorphine Sublingual 2mg Tablet,54017613,CDM,250,RC,,,Outpatient,,,43.85,21.93,,33.76,77,,,Percent of Total Billed Charges,77% of total billed charges,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.45,74,,,Percent of Total Billed Charges,74% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,36.83,84,,,Percent of Total Billed Charges,84% of total billed charges,35.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.03,89,,,Percent of total Billed Charges,89% of total Billed charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.76,77,,,Percent of total Billed charges,77% of total billed charges,37.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,39.03,
Buprenorphine Sublingual 2mg Tablet,54017613,CDM,250,RC,,,Outpatient,,,43.85,21.93,,33.76,77,,,Percent of Total Billed Charges,77% of total billed charges,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.45,74,,,Percent of Total Billed Charges,74% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,36.83,84,,,Percent of Total Billed Charges,84% of total billed charges,35.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.03,89,,,Percent of total Billed Charges,89% of total Billed charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.76,77,,,Percent of total Billed charges,77% of total billed charges,37.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,39.03,
Buprenorphine Sublingual 2mg Tablet,54017613,CDM,250,RC,,,Outpatient,,,43.85,21.93,,33.76,77,,,Percent of Total Billed Charges,77% of total billed charges,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.45,74,,,Percent of Total Billed Charges,74% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,36.83,84,,,Percent of Total Billed Charges,84% of total billed charges,35.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.03,89,,,Percent of total Billed Charges,89% of total Billed charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.76,77,,,Percent of total Billed charges,77% of total billed charges,37.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,39.03,
Buprenorphine Sublingual 2mg Tablet,54017613,CDM,250,RC,,,Outpatient,,,43.85,21.93,,33.76,77,,,Percent of Total Billed Charges,77% of total billed charges,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.45,74,,,Percent of Total Billed Charges,74% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,30.26,69,,,Percent of Total Billed Charges,69% of total billed charges,36.83,84,,,Percent of Total Billed Charges,84% of total billed charges,35.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.03,89,,,Percent of total Billed Charges,89% of total Billed charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.76,77,,,Percent of total Billed charges,77% of total billed charges,37.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,39.03,
buPROPion 75mg Tablet,60505015801,CDM,250,RC,,,Outpatient,,,12.41,6.21,,9.56,77,,,Percent of Total Billed Charges,77% of total billed charges,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,10.42,84,,,Percent of Total Billed Charges,84% of total billed charges,10.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.04,89,,,Percent of total Billed Charges,89% of total Billed charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.56,77,,,Percent of total Billed charges,77% of total billed charges,10.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.1,11.04,
buPROPion 75mg Tablet,60505015801,CDM,250,RC,,,Outpatient,,,12.41,6.21,,9.56,77,,,Percent of Total Billed Charges,77% of total billed charges,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,10.42,84,,,Percent of Total Billed Charges,84% of total billed charges,10.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.04,89,,,Percent of total Billed Charges,89% of total Billed charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.56,77,,,Percent of total Billed charges,77% of total billed charges,10.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.1,11.04,
buPROPion 75mg Tablet,60505015801,CDM,250,RC,,,Outpatient,,,12.41,6.21,,9.56,77,,,Percent of Total Billed Charges,77% of total billed charges,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,10.42,84,,,Percent of Total Billed Charges,84% of total billed charges,10.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.04,89,,,Percent of total Billed Charges,89% of total Billed charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.56,77,,,Percent of total Billed charges,77% of total billed charges,10.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.1,11.04,
buPROPion 75mg Tablet,60505015801,CDM,250,RC,,,Outpatient,,,12.41,6.21,,9.56,77,,,Percent of Total Billed Charges,77% of total billed charges,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,10.42,84,,,Percent of Total Billed Charges,84% of total billed charges,10.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.04,89,,,Percent of total Billed Charges,89% of total Billed charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.56,77,,,Percent of total Billed charges,77% of total billed charges,10.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.1,11.04,
buPROPion 75mg Tablet,60505015801,CDM,250,RC,,,Outpatient,,,12.41,6.21,,9.56,77,,,Percent of Total Billed Charges,77% of total billed charges,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,10.42,84,,,Percent of Total Billed Charges,84% of total billed charges,10.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.04,89,,,Percent of total Billed Charges,89% of total Billed charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.56,77,,,Percent of total Billed charges,77% of total billed charges,10.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.1,11.04,
buPROPion 75mg Tablet,60505015801,CDM,250,RC,,,Outpatient,,,12.41,6.21,,9.56,77,,,Percent of Total Billed Charges,77% of total billed charges,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,8.56,69,,,Percent of Total Billed Charges,69% of total billed charges,10.42,84,,,Percent of Total Billed Charges,84% of total billed charges,10.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.04,89,,,Percent of total Billed Charges,89% of total Billed charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.56,77,,,Percent of total Billed charges,77% of total billed charges,10.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.1,11.04,
Buprenorphine Sublingual 8mg Tablet,54017713,CDM,250,RC,,,Outpatient,,,73.15,36.58,,56.33,77,,,Percent of Total Billed Charges,77% of total billed charges,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.13,74,,,Percent of Total Billed Charges,74% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,61.45,84,,,Percent of Total Billed Charges,84% of total billed charges,59.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.1,89,,,Percent of total Billed Charges,89% of total Billed charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.33,77,,,Percent of total Billed charges,77% of total billed charges,62.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.29,65.1,
Buprenorphine Sublingual 8mg Tablet,54017713,CDM,250,RC,,,Outpatient,,,73.15,36.58,,56.33,77,,,Percent of Total Billed Charges,77% of total billed charges,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.13,74,,,Percent of Total Billed Charges,74% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,61.45,84,,,Percent of Total Billed Charges,84% of total billed charges,59.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.1,89,,,Percent of total Billed Charges,89% of total Billed charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.33,77,,,Percent of total Billed charges,77% of total billed charges,62.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.29,65.1,
Buprenorphine Sublingual 8mg Tablet,54017713,CDM,250,RC,,,Outpatient,,,73.15,36.58,,56.33,77,,,Percent of Total Billed Charges,77% of total billed charges,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.13,74,,,Percent of Total Billed Charges,74% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,61.45,84,,,Percent of Total Billed Charges,84% of total billed charges,59.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.1,89,,,Percent of total Billed Charges,89% of total Billed charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.33,77,,,Percent of total Billed charges,77% of total billed charges,62.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.29,65.1,
Buprenorphine Sublingual 8mg Tablet,54017713,CDM,250,RC,,,Outpatient,,,73.15,36.58,,56.33,77,,,Percent of Total Billed Charges,77% of total billed charges,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.13,74,,,Percent of Total Billed Charges,74% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,61.45,84,,,Percent of Total Billed Charges,84% of total billed charges,59.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.1,89,,,Percent of total Billed Charges,89% of total Billed charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.33,77,,,Percent of total Billed charges,77% of total billed charges,62.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.29,65.1,
Buprenorphine Sublingual 8mg Tablet,54017713,CDM,250,RC,,,Outpatient,,,73.15,36.58,,56.33,77,,,Percent of Total Billed Charges,77% of total billed charges,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.13,74,,,Percent of Total Billed Charges,74% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,61.45,84,,,Percent of Total Billed Charges,84% of total billed charges,59.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.1,89,,,Percent of total Billed Charges,89% of total Billed charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.33,77,,,Percent of total Billed charges,77% of total billed charges,62.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.29,65.1,
Buprenorphine Sublingual 8mg Tablet,54017713,CDM,250,RC,,,Outpatient,,,73.15,36.58,,56.33,77,,,Percent of Total Billed Charges,77% of total billed charges,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.13,74,,,Percent of Total Billed Charges,74% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,50.47,69,,,Percent of Total Billed Charges,69% of total billed charges,61.45,84,,,Percent of Total Billed Charges,84% of total billed charges,59.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.1,89,,,Percent of total Billed Charges,89% of total Billed charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.33,77,,,Percent of total Billed charges,77% of total billed charges,62.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.29,65.1,
busPIRone 10mg Tablet,378115001,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
busPIRone 10mg Tablet,378115001,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
busPIRone 10mg Tablet,378115001,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
busPIRone 10mg Tablet,378115001,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
busPIRone 10mg Tablet,378115001,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
busPIRone 10mg Tablet,378115001,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Butalbital/APAP/Caffeine 50/325/40mg Tablet,527169501,CDM,250,RC,,,Outpatient,,,20.86,10.43,,16.06,77,,,Percent of Total Billed Charges,77% of total billed charges,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.44,74,,,Percent of Total Billed Charges,74% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,17.52,84,,,Percent of Total Billed Charges,84% of total billed charges,17.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.57,89,,,Percent of total Billed Charges,89% of total Billed charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,77,,,Percent of total Billed charges,77% of total billed charges,17.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,18.57,
Butalbital/APAP/Caffeine 50/325/40mg Tablet,527169501,CDM,250,RC,,,Outpatient,,,20.86,10.43,,16.06,77,,,Percent of Total Billed Charges,77% of total billed charges,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.44,74,,,Percent of Total Billed Charges,74% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,17.52,84,,,Percent of Total Billed Charges,84% of total billed charges,17.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.57,89,,,Percent of total Billed Charges,89% of total Billed charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,77,,,Percent of total Billed charges,77% of total billed charges,17.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,18.57,
Butalbital/APAP/Caffeine 50/325/40mg Tablet,527169501,CDM,250,RC,,,Outpatient,,,20.86,10.43,,16.06,77,,,Percent of Total Billed Charges,77% of total billed charges,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.44,74,,,Percent of Total Billed Charges,74% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,17.52,84,,,Percent of Total Billed Charges,84% of total billed charges,17.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.57,89,,,Percent of total Billed Charges,89% of total Billed charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,77,,,Percent of total Billed charges,77% of total billed charges,17.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,18.57,
Butalbital/APAP/Caffeine 50/325/40mg Tablet,527169501,CDM,250,RC,,,Outpatient,,,20.86,10.43,,16.06,77,,,Percent of Total Billed Charges,77% of total billed charges,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.44,74,,,Percent of Total Billed Charges,74% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,17.52,84,,,Percent of Total Billed Charges,84% of total billed charges,17.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.57,89,,,Percent of total Billed Charges,89% of total Billed charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,77,,,Percent of total Billed charges,77% of total billed charges,17.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,18.57,
Butalbital/APAP/Caffeine 50/325/40mg Tablet,527169501,CDM,250,RC,,,Outpatient,,,20.86,10.43,,16.06,77,,,Percent of Total Billed Charges,77% of total billed charges,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.44,74,,,Percent of Total Billed Charges,74% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,17.52,84,,,Percent of Total Billed Charges,84% of total billed charges,17.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.57,89,,,Percent of total Billed Charges,89% of total Billed charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,77,,,Percent of total Billed charges,77% of total billed charges,17.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,18.57,
Butalbital/APAP/Caffeine 50/325/40mg Tablet,527169501,CDM,250,RC,,,Outpatient,,,20.86,10.43,,16.06,77,,,Percent of Total Billed Charges,77% of total billed charges,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.44,74,,,Percent of Total Billed Charges,74% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,14.39,69,,,Percent of Total Billed Charges,69% of total billed charges,17.52,84,,,Percent of Total Billed Charges,84% of total billed charges,17.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.57,89,,,Percent of total Billed Charges,89% of total Billed charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.06,77,,,Percent of total Billed charges,77% of total billed charges,17.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,18.57,
Butorphanol 2mg/ml SDV,409162621,CDM,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
Butorphanol 2mg/ml SDV,409162621,CDM,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
Butorphanol 2mg/ml SDV,409162621,CDM,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
Butorphanol 2mg/ml SDV,409162621,CDM,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
Butorphanol 2mg/ml SDV,409162621,CDM,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
Butorphanol 2mg/ml SDV,409162621,CDM,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
Cadexomer Iodine Gel 10gm Tube,40565012256,CDM,250,RC,,,Outpatient,,,202.22,101.11,,155.71,77,,,Percent of Total Billed Charges,77% of total billed charges,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.64,74,,,Percent of Total Billed Charges,74% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,169.86,84,,,Percent of Total Billed Charges,84% of total billed charges,165.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.98,89,,,Percent of total Billed Charges,89% of total Billed charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.71,77,,,Percent of total Billed charges,77% of total billed charges,171.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.56,179.98,
Cadexomer Iodine Gel 10gm Tube,40565012256,CDM,250,RC,,,Outpatient,,,202.22,101.11,,155.71,77,,,Percent of Total Billed Charges,77% of total billed charges,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.64,74,,,Percent of Total Billed Charges,74% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,169.86,84,,,Percent of Total Billed Charges,84% of total billed charges,165.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.98,89,,,Percent of total Billed Charges,89% of total Billed charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.71,77,,,Percent of total Billed charges,77% of total billed charges,171.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.56,179.98,
Cadexomer Iodine Gel 10gm Tube,40565012256,CDM,250,RC,,,Outpatient,,,202.22,101.11,,155.71,77,,,Percent of Total Billed Charges,77% of total billed charges,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.64,74,,,Percent of Total Billed Charges,74% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,169.86,84,,,Percent of Total Billed Charges,84% of total billed charges,165.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.98,89,,,Percent of total Billed Charges,89% of total Billed charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.71,77,,,Percent of total Billed charges,77% of total billed charges,171.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.56,179.98,
Cadexomer Iodine Gel 10gm Tube,40565012256,CDM,250,RC,,,Outpatient,,,202.22,101.11,,155.71,77,,,Percent of Total Billed Charges,77% of total billed charges,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.64,74,,,Percent of Total Billed Charges,74% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,169.86,84,,,Percent of Total Billed Charges,84% of total billed charges,165.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.98,89,,,Percent of total Billed Charges,89% of total Billed charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.71,77,,,Percent of total Billed charges,77% of total billed charges,171.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.56,179.98,
Cadexomer Iodine Gel 10gm Tube,40565012256,CDM,250,RC,,,Outpatient,,,202.22,101.11,,155.71,77,,,Percent of Total Billed Charges,77% of total billed charges,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.64,74,,,Percent of Total Billed Charges,74% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,169.86,84,,,Percent of Total Billed Charges,84% of total billed charges,165.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.98,89,,,Percent of total Billed Charges,89% of total Billed charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.71,77,,,Percent of total Billed charges,77% of total billed charges,171.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.56,179.98,
Cadexomer Iodine Gel 10gm Tube,40565012256,CDM,250,RC,,,Outpatient,,,202.22,101.11,,155.71,77,,,Percent of Total Billed Charges,77% of total billed charges,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.64,74,,,Percent of Total Billed Charges,74% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,139.53,69,,,Percent of Total Billed Charges,69% of total billed charges,169.86,84,,,Percent of Total Billed Charges,84% of total billed charges,165.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.98,89,,,Percent of total Billed Charges,89% of total Billed charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.71,77,,,Percent of total Billed charges,77% of total billed charges,171.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.56,179.98,
Caffeine 200mg Tablet,46017001816,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Caffeine 200mg Tablet,46017001816,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Caffeine 200mg Tablet,46017001816,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Caffeine 200mg Tablet,46017001816,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Caffeine 200mg Tablet,46017001816,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Caffeine 200mg Tablet,46017001816,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Caffeine Citrate ORAL Solution 60mg/3ml UDC,25021060203,CDM,250,RC,,,Outpatient,,,146.29,73.15,,112.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.25,74,,,Percent of Total Billed Charges,74% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,122.88,84,,,Percent of Total Billed Charges,84% of total billed charges,119.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,89,,,Percent of total Billed Charges,89% of total Billed charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.64,77,,,Percent of total Billed charges,77% of total billed charges,124.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,130.2,
Caffeine Citrate ORAL Solution 60mg/3ml UDC,25021060203,CDM,250,RC,,,Outpatient,,,146.29,73.15,,112.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.25,74,,,Percent of Total Billed Charges,74% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,122.88,84,,,Percent of Total Billed Charges,84% of total billed charges,119.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,89,,,Percent of total Billed Charges,89% of total Billed charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.64,77,,,Percent of total Billed charges,77% of total billed charges,124.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,130.2,
Caffeine Citrate ORAL Solution 60mg/3ml UDC,25021060203,CDM,250,RC,,,Outpatient,,,146.29,73.15,,112.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.25,74,,,Percent of Total Billed Charges,74% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,122.88,84,,,Percent of Total Billed Charges,84% of total billed charges,119.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,89,,,Percent of total Billed Charges,89% of total Billed charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.64,77,,,Percent of total Billed charges,77% of total billed charges,124.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,130.2,
Caffeine Citrate ORAL Solution 60mg/3ml UDC,25021060203,CDM,250,RC,,,Outpatient,,,146.29,73.15,,112.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.25,74,,,Percent of Total Billed Charges,74% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,122.88,84,,,Percent of Total Billed Charges,84% of total billed charges,119.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,89,,,Percent of total Billed Charges,89% of total Billed charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.64,77,,,Percent of total Billed charges,77% of total billed charges,124.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,130.2,
Caffeine Citrate ORAL Solution 60mg/3ml UDC,25021060203,CDM,250,RC,,,Outpatient,,,146.29,73.15,,112.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.25,74,,,Percent of Total Billed Charges,74% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,122.88,84,,,Percent of Total Billed Charges,84% of total billed charges,119.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,89,,,Percent of total Billed Charges,89% of total Billed charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.64,77,,,Percent of total Billed charges,77% of total billed charges,124.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,130.2,
Caffeine Citrate ORAL Solution 60mg/3ml UDC,25021060203,CDM,250,RC,,,Outpatient,,,146.29,73.15,,112.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.25,74,,,Percent of Total Billed Charges,74% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,100.94,69,,,Percent of Total Billed Charges,69% of total billed charges,122.88,84,,,Percent of Total Billed Charges,84% of total billed charges,119.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.2,89,,,Percent of total Billed Charges,89% of total Billed charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.64,77,,,Percent of total Billed charges,77% of total billed charges,124.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.57,130.2,
Calamine Lotion 180ml Bottle,395041396,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Calamine Lotion 180ml Bottle,395041396,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Calamine Lotion 180ml Bottle,395041396,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Calamine Lotion 180ml Bottle,395041396,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Calamine Lotion 180ml Bottle,395041396,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Calamine Lotion 180ml Bottle,395041396,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Calcitriol 0.25mcg Capsule,54000725,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Calcitriol 0.25mcg Capsule,54000725,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Calcitriol 0.25mcg Capsule,54000725,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Calcitriol 0.25mcg Capsule,54000725,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Calcitriol 0.25mcg Capsule,54000725,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Calcitriol 0.25mcg Capsule,54000725,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml Syringe,409492834,CDM,250,RC,,,Outpatient,,,180.64,90.32,,139.09,77,,,Percent of Total Billed Charges,77% of total billed charges,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.67,74,,,Percent of Total Billed Charges,74% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,124.64,69,,,Percent of Total Billed Charges,69% of total billed charges,151.74,84,,,Percent of Total Billed Charges,84% of total billed charges,148.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.77,89,,,Percent of total Billed Charges,89% of total Billed charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.09,77,,,Percent of total Billed charges,77% of total billed charges,153.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.16,160.77,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Chloride 10% 1000mg/10ml SDV,517671001,CDM,250,RC,,,Outpatient,,,171.11,85.56,,131.75,77,,,Percent of Total Billed Charges,77% of total billed charges,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.62,74,,,Percent of Total Billed Charges,74% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,118.07,69,,,Percent of Total Billed Charges,69% of total billed charges,143.73,84,,,Percent of Total Billed Charges,84% of total billed charges,140.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.29,89,,,Percent of total Billed Charges,89% of total Billed charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.75,77,,,Percent of total Billed charges,77% of total billed charges,145.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.78,152.29,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Calcium Gluconate 10% 1000mg/10ml SDV,63323036019,CDM,250,RC,,,Outpatient,,,122.41,61.21,,94.26,77,,,Percent of Total Billed Charges,77% of total billed charges,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.58,74,,,Percent of Total Billed Charges,74% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,84.46,69,,,Percent of Total Billed Charges,69% of total billed charges,102.82,84,,,Percent of Total Billed Charges,84% of total billed charges,100.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.94,89,,,Percent of total Billed Charges,89% of total Billed charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.26,77,,,Percent of total Billed charges,77% of total billed charges,104.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.6,108.94,
Domeboro Topical Packets (12 per Box),16500002324,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Domeboro Topical Packets (12 per Box),16500002324,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Domeboro Topical Packets (12 per Box),16500002324,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Domeboro Topical Packets (12 per Box),16500002324,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Domeboro Topical Packets (12 per Box),16500002324,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Domeboro Topical Packets (12 per Box),16500002324,CDM,250,RC,,,Outpatient,,,11.29,5.65,,8.69,77,,,Percent of Total Billed Charges,77% of total billed charges,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.35,74,,,Percent of Total Billed Charges,74% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,7.79,69,,,Percent of Total Billed Charges,69% of total billed charges,9.48,84,,,Percent of Total Billed Charges,84% of total billed charges,9.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.05,89,,,Percent of total Billed Charges,89% of total Billed charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,77,,,Percent of total Billed charges,77% of total billed charges,9.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.82,10.05,
Calcium+Vit D 500mg/200IU Tablet,904546052,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium+Vit D 500mg/200IU Tablet,904546052,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium+Vit D 500mg/200IU Tablet,904546052,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium+Vit D 500mg/200IU Tablet,904546052,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium+Vit D 500mg/200IU Tablet,904546052,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium+Vit D 500mg/200IU Tablet,904546052,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Chewable 500mg Tablet,536100715,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Chewable 500mg Tablet,536100715,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Chewable 500mg Tablet,536100715,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Chewable 500mg Tablet,536100715,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Chewable 500mg Tablet,536100715,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Chewable 500mg Tablet,536100715,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcitonin Nasal 200units/Spray 30 Sprays 3.7ml,49884016111,CDM,250,RC,,,Outpatient,,,157.01,78.51,,120.9,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.19,74,,,Percent of Total Billed Charges,74% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,131.89,84,,,Percent of Total Billed Charges,84% of total billed charges,128.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.74,89,,,Percent of total Billed Charges,89% of total Billed charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.9,77,,,Percent of total Billed charges,77% of total billed charges,133.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.74,
Calcitonin Nasal 200units/Spray 30 Sprays 3.7ml,49884016111,CDM,250,RC,,,Outpatient,,,157.01,78.51,,120.9,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.19,74,,,Percent of Total Billed Charges,74% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,131.89,84,,,Percent of Total Billed Charges,84% of total billed charges,128.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.74,89,,,Percent of total Billed Charges,89% of total Billed charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.9,77,,,Percent of total Billed charges,77% of total billed charges,133.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.74,
Calcitonin Nasal 200units/Spray 30 Sprays 3.7ml,49884016111,CDM,250,RC,,,Outpatient,,,157.01,78.51,,120.9,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.19,74,,,Percent of Total Billed Charges,74% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,131.89,84,,,Percent of Total Billed Charges,84% of total billed charges,128.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.74,89,,,Percent of total Billed Charges,89% of total Billed charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.9,77,,,Percent of total Billed charges,77% of total billed charges,133.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.74,
Calcitonin Nasal 200units/Spray 30 Sprays 3.7ml,49884016111,CDM,250,RC,,,Outpatient,,,157.01,78.51,,120.9,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.19,74,,,Percent of Total Billed Charges,74% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,131.89,84,,,Percent of Total Billed Charges,84% of total billed charges,128.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.74,89,,,Percent of total Billed Charges,89% of total Billed charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.9,77,,,Percent of total Billed charges,77% of total billed charges,133.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.74,
Calcitonin Nasal 200units/Spray 30 Sprays 3.7ml,49884016111,CDM,250,RC,,,Outpatient,,,157.01,78.51,,120.9,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.19,74,,,Percent of Total Billed Charges,74% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,131.89,84,,,Percent of Total Billed Charges,84% of total billed charges,128.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.74,89,,,Percent of total Billed Charges,89% of total Billed charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.9,77,,,Percent of total Billed charges,77% of total billed charges,133.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.74,
Calcitonin Nasal 200units/Spray 30 Sprays 3.7ml,49884016111,CDM,250,RC,,,Outpatient,,,157.01,78.51,,120.9,77,,,Percent of Total Billed Charges,77% of total billed charges,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.19,74,,,Percent of Total Billed Charges,74% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,108.34,69,,,Percent of Total Billed Charges,69% of total billed charges,131.89,84,,,Percent of Total Billed Charges,84% of total billed charges,128.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.74,89,,,Percent of total Billed Charges,89% of total Billed charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.9,77,,,Percent of total Billed charges,77% of total billed charges,133.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.25,139.74,
Calcium Carbonate 500mg Tablet,904188361,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Carbonate 500mg Tablet,904188361,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Carbonate 500mg Tablet,904188361,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Carbonate 500mg Tablet,904188361,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Carbonate 500mg Tablet,904188361,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Carbonate 500mg Tablet,904188361,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Calcium Acetate 667mg Capsule,54008826,CDM,250,RC,,,Outpatient,,,14.67,7.34,,11.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.86,74,,,Percent of Total Billed Charges,74% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,84,,,Percent of Total Billed Charges,84% of total billed charges,12.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,77,,,Percent of total Billed charges,77% of total billed charges,12.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,13.06,
Calcium Acetate 667mg Capsule,54008826,CDM,250,RC,,,Outpatient,,,14.67,7.34,,11.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.86,74,,,Percent of Total Billed Charges,74% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,84,,,Percent of Total Billed Charges,84% of total billed charges,12.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,77,,,Percent of total Billed charges,77% of total billed charges,12.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,13.06,
Calcium Acetate 667mg Capsule,54008826,CDM,250,RC,,,Outpatient,,,14.67,7.34,,11.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.86,74,,,Percent of Total Billed Charges,74% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,84,,,Percent of Total Billed Charges,84% of total billed charges,12.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,77,,,Percent of total Billed charges,77% of total billed charges,12.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,13.06,
Calcium Acetate 667mg Capsule,54008826,CDM,250,RC,,,Outpatient,,,14.67,7.34,,11.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.86,74,,,Percent of Total Billed Charges,74% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,84,,,Percent of Total Billed Charges,84% of total billed charges,12.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,77,,,Percent of total Billed charges,77% of total billed charges,12.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,13.06,
Calcium Acetate 667mg Capsule,54008826,CDM,250,RC,,,Outpatient,,,14.67,7.34,,11.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.86,74,,,Percent of Total Billed Charges,74% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,84,,,Percent of Total Billed Charges,84% of total billed charges,12.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,77,,,Percent of total Billed charges,77% of total billed charges,12.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,13.06,
Calcium Acetate 667mg Capsule,54008826,CDM,250,RC,,,Outpatient,,,14.67,7.34,,11.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.86,74,,,Percent of Total Billed Charges,74% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.12,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,84,,,Percent of Total Billed Charges,84% of total billed charges,12.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.06,89,,,Percent of total Billed Charges,89% of total Billed charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,77,,,Percent of total Billed charges,77% of total billed charges,12.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.67,13.06,
Calcium Gluconate 2.5% Gel,35181730332,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Calcium Gluconate 2.5% Gel,35181730332,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Calcium Gluconate 2.5% Gel,35181730332,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Calcium Gluconate 2.5% Gel,35181730332,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Calcium Gluconate 2.5% Gel,35181730332,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Calcium Gluconate 2.5% Gel,35181730332,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Captopril 25mg Tablet,51079086420,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Captopril 25mg Tablet,51079086420,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Captopril 25mg Tablet,51079086420,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Captopril 25mg Tablet,51079086420,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Captopril 25mg Tablet,51079086420,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Captopril 25mg Tablet,51079086420,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Carbidopa/Levodopa 10-100mg Tablet,62756051788,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Carbidopa/Levodopa 10-100mg Tablet,62756051788,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Carbidopa/Levodopa 10-100mg Tablet,62756051788,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Carbidopa/Levodopa 10-100mg Tablet,62756051788,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Carbidopa/Levodopa 10-100mg Tablet,62756051788,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Carbidopa/Levodopa 10-100mg Tablet,62756051788,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Carbidopa/Levodopa 50-200mg CR Tablet,68084028211,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Carbidopa/Levodopa 50-200mg CR Tablet,68084028211,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Carbidopa/Levodopa 50-200mg CR Tablet,68084028211,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Carbidopa/Levodopa 50-200mg CR Tablet,68084028211,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Carbidopa/Levodopa 50-200mg CR Tablet,68084028211,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Carbidopa/Levodopa 50-200mg CR Tablet,68084028211,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Carbachol Intraocular Soln 1.5ml SDV,65002315,CDM,250,RC,,,Outpatient,,,303.81,151.91,,233.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.82,74,,,Percent of Total Billed Charges,74% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,255.2,84,,,Percent of Total Billed Charges,84% of total billed charges,249.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.39,89,,,Percent of total Billed Charges,89% of total Billed charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.93,77,,,Percent of total Billed charges,77% of total billed charges,258.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.95,270.39,
Carbachol Intraocular Soln 1.5ml SDV,65002315,CDM,250,RC,,,Outpatient,,,303.81,151.91,,233.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.82,74,,,Percent of Total Billed Charges,74% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,255.2,84,,,Percent of Total Billed Charges,84% of total billed charges,249.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.39,89,,,Percent of total Billed Charges,89% of total Billed charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.93,77,,,Percent of total Billed charges,77% of total billed charges,258.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.95,270.39,
Carbachol Intraocular Soln 1.5ml SDV,65002315,CDM,250,RC,,,Outpatient,,,303.81,151.91,,233.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.82,74,,,Percent of Total Billed Charges,74% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,255.2,84,,,Percent of Total Billed Charges,84% of total billed charges,249.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.39,89,,,Percent of total Billed Charges,89% of total Billed charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.93,77,,,Percent of total Billed charges,77% of total billed charges,258.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.95,270.39,
Carbachol Intraocular Soln 1.5ml SDV,65002315,CDM,250,RC,,,Outpatient,,,303.81,151.91,,233.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.82,74,,,Percent of Total Billed Charges,74% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,255.2,84,,,Percent of Total Billed Charges,84% of total billed charges,249.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.39,89,,,Percent of total Billed Charges,89% of total Billed charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.93,77,,,Percent of total Billed charges,77% of total billed charges,258.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.95,270.39,
Carbachol Intraocular Soln 1.5ml SDV,65002315,CDM,250,RC,,,Outpatient,,,303.81,151.91,,233.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.82,74,,,Percent of Total Billed Charges,74% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,255.2,84,,,Percent of Total Billed Charges,84% of total billed charges,249.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.39,89,,,Percent of total Billed Charges,89% of total Billed charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.93,77,,,Percent of total Billed charges,77% of total billed charges,258.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.95,270.39,
Carbachol Intraocular Soln 1.5ml SDV,65002315,CDM,250,RC,,,Outpatient,,,303.81,151.91,,233.93,77,,,Percent of Total Billed Charges,77% of total billed charges,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.82,74,,,Percent of Total Billed Charges,74% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,209.63,69,,,Percent of Total Billed Charges,69% of total billed charges,255.2,84,,,Percent of Total Billed Charges,84% of total billed charges,249.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.39,89,,,Percent of total Billed Charges,89% of total Billed charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.93,77,,,Percent of total Billed charges,77% of total billed charges,258.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.95,270.39,
carBAMazepine XR 100mg Tablet,78051005,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
carBAMazepine XR 100mg Tablet,78051005,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
carBAMazepine XR 100mg Tablet,78051005,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
carBAMazepine XR 100mg Tablet,78051005,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
carBAMazepine XR 100mg Tablet,78051005,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
carBAMazepine XR 100mg Tablet,78051005,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1195.58,597.79,,920.6,77,,,Percent of Total Billed Charges,77% of total billed charges,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,884.73,74,,,Percent of Total Billed Charges,74% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1004.29,84,,,Percent of Total Billed Charges,84% of total billed charges,980.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1064.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.6,77,,,Percent of total Billed charges,77% of total billed charges,1016.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.9,1064.07,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1168.52,584.26,,899.76,77,,,Percent of Total Billed Charges,77% of total billed charges,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,864.7,74,,,Percent of Total Billed Charges,74% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,981.56,84,,,Percent of Total Billed Charges,84% of total billed charges,958.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1039.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,899.76,77,,,Percent of total Billed charges,77% of total billed charges,993.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,584.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.13,1039.98,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1195.58,597.79,,920.6,77,,,Percent of Total Billed Charges,77% of total billed charges,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,884.73,74,,,Percent of Total Billed Charges,74% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1004.29,84,,,Percent of Total Billed Charges,84% of total billed charges,980.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1064.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.6,77,,,Percent of total Billed charges,77% of total billed charges,1016.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.9,1064.07,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1168.52,584.26,,899.76,77,,,Percent of Total Billed Charges,77% of total billed charges,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,864.7,74,,,Percent of Total Billed Charges,74% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,981.56,84,,,Percent of Total Billed Charges,84% of total billed charges,958.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1039.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,899.76,77,,,Percent of total Billed charges,77% of total billed charges,993.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,584.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.13,1039.98,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1195.58,597.79,,920.6,77,,,Percent of Total Billed Charges,77% of total billed charges,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,884.73,74,,,Percent of Total Billed Charges,74% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1004.29,84,,,Percent of Total Billed Charges,84% of total billed charges,980.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1064.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.6,77,,,Percent of total Billed charges,77% of total billed charges,1016.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.9,1064.07,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1168.52,584.26,,899.76,77,,,Percent of Total Billed Charges,77% of total billed charges,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,864.7,74,,,Percent of Total Billed Charges,74% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,981.56,84,,,Percent of Total Billed Charges,84% of total billed charges,958.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1039.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,899.76,77,,,Percent of total Billed charges,77% of total billed charges,993.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,584.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.13,1039.98,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1195.58,597.79,,920.6,77,,,Percent of Total Billed Charges,77% of total billed charges,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,884.73,74,,,Percent of Total Billed Charges,74% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1004.29,84,,,Percent of Total Billed Charges,84% of total billed charges,980.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1064.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.6,77,,,Percent of total Billed charges,77% of total billed charges,1016.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.9,1064.07,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1168.52,584.26,,899.76,77,,,Percent of Total Billed Charges,77% of total billed charges,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,864.7,74,,,Percent of Total Billed Charges,74% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,981.56,84,,,Percent of Total Billed Charges,84% of total billed charges,958.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1039.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,899.76,77,,,Percent of total Billed charges,77% of total billed charges,993.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,584.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.13,1039.98,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1195.58,597.79,,920.6,77,,,Percent of Total Billed Charges,77% of total billed charges,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,884.73,74,,,Percent of Total Billed Charges,74% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1004.29,84,,,Percent of Total Billed Charges,84% of total billed charges,980.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1064.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.6,77,,,Percent of total Billed charges,77% of total billed charges,1016.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.9,1064.07,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1168.52,584.26,,899.76,77,,,Percent of Total Billed Charges,77% of total billed charges,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,864.7,74,,,Percent of Total Billed Charges,74% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,981.56,84,,,Percent of Total Billed Charges,84% of total billed charges,958.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1039.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,899.76,77,,,Percent of total Billed charges,77% of total billed charges,993.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,584.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.13,1039.98,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1195.58,597.79,,920.6,77,,,Percent of Total Billed Charges,77% of total billed charges,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,304.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,373.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,884.73,74,,,Percent of Total Billed Charges,74% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,824.95,69,,,Percent of Total Billed Charges,69% of total billed charges,1004.29,84,,,Percent of Total Billed Charges,84% of total billed charges,980.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,1064.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.6,77,,,Percent of total Billed charges,77% of total billed charges,1016.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,343.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,597.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,487.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,298.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.9,1064.07,
CARBOplatin 50mg/5ml Liquid MDV,703424401,CDM,250,RC,,,Outpatient,,,1168.52,584.26,,899.76,77,,,Percent of Total Billed Charges,77% of total billed charges,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,365.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,864.7,74,,,Percent of Total Billed Charges,74% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,806.28,69,,,Percent of Total Billed Charges,69% of total billed charges,981.56,84,,,Percent of Total Billed Charges,84% of total billed charges,958.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1039.98,89,,,Percent of total Billed Charges,89% of total Billed charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,899.76,77,,,Percent of total Billed charges,77% of total billed charges,993.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,584.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,476.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1039.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.13,1039.98,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,4044.46,2022.23,,3114.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1263.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2992.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3397.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3316.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,3599.57,89,,,Percent of total Billed Charges,89% of total Billed charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3114.23,77,,,Percent of total Billed charges,77% of total billed charges,3437.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1162.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2022.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1011.12,3599.57,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,3943.72,1971.86,,3036.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1232.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2918.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3312.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3233.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,3509.91,89,,,Percent of total Billed Charges,89% of total Billed charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3036.66,77,,,Percent of total Billed charges,77% of total billed charges,3352.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.93,3509.91,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,4044.46,2022.23,,3114.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1263.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2992.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3397.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3316.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,3599.57,89,,,Percent of total Billed Charges,89% of total Billed charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3114.23,77,,,Percent of total Billed charges,77% of total billed charges,3437.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1162.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2022.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1011.12,3599.57,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,3943.72,1971.86,,3036.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1232.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2918.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3312.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3233.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,3509.91,89,,,Percent of total Billed Charges,89% of total Billed charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3036.66,77,,,Percent of total Billed charges,77% of total billed charges,3352.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.93,3509.91,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,4044.46,2022.23,,3114.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1263.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2992.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3397.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3316.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,3599.57,89,,,Percent of total Billed Charges,89% of total Billed charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3114.23,77,,,Percent of total Billed charges,77% of total billed charges,3437.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1162.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2022.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1011.12,3599.57,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,3943.72,1971.86,,3036.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1232.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2918.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3312.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3233.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,3509.91,89,,,Percent of total Billed Charges,89% of total Billed charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3036.66,77,,,Percent of total Billed charges,77% of total billed charges,3352.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.93,3509.91,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,4044.46,2022.23,,3114.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1263.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2992.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3397.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3316.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,3599.57,89,,,Percent of total Billed Charges,89% of total Billed charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3114.23,77,,,Percent of total Billed charges,77% of total billed charges,3437.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1162.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2022.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1011.12,3599.57,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,3943.72,1971.86,,3036.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1232.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2918.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3312.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3233.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,3509.91,89,,,Percent of total Billed Charges,89% of total Billed charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3036.66,77,,,Percent of total Billed charges,77% of total billed charges,3352.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.93,3509.91,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,4044.46,2022.23,,3114.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1263.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2992.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3397.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3316.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,3599.57,89,,,Percent of total Billed Charges,89% of total Billed charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3114.23,77,,,Percent of total Billed charges,77% of total billed charges,3437.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1162.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2022.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1011.12,3599.57,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,3943.72,1971.86,,3036.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1232.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2918.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3312.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3233.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,3509.91,89,,,Percent of total Billed Charges,89% of total Billed charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3036.66,77,,,Percent of total Billed charges,77% of total billed charges,3352.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.93,3509.91,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,4044.46,2022.23,,3114.23,77,,,Percent of Total Billed Charges,77% of total billed charges,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1031.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1263.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2992.9,74,,,Percent of Total Billed Charges,74% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2790.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3397.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3316.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,3599.57,89,,,Percent of total Billed Charges,89% of total Billed charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3114.23,77,,,Percent of total Billed charges,77% of total billed charges,3437.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1162.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2022.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1650.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3599.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1011.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1011.12,3599.57,
CARBOplatin 600mg/60ml Liquid MDV,63323017260,CDM,250,RC,,,Outpatient,,,3943.72,1971.86,,3036.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1232.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2918.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2721.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3312.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3233.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,3509.91,89,,,Percent of total Billed Charges,89% of total Billed charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3036.66,77,,,Percent of total Billed charges,77% of total billed charges,3352.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1133.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1971.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1609.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3509.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,985.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,985.93,3509.91,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2812.24,1406.12,,2165.42,77,,,Percent of Total Billed Charges,77% of total billed charges,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,878.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2081.06,74,,,Percent of Total Billed Charges,74% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2362.28,84,,,Percent of Total Billed Charges,84% of total billed charges,2306.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2502.89,89,,,Percent of total Billed Charges,89% of total Billed charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.42,77,,,Percent of total Billed charges,77% of total billed charges,2390.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,808.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1406.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.06,2502.89,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2743.38,1371.69,,2112.4,77,,,Percent of Total Billed Charges,77% of total billed charges,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2030.1,74,,,Percent of Total Billed Charges,74% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2304.44,84,,,Percent of Total Billed Charges,84% of total billed charges,2249.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,2441.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2112.4,77,,,Percent of total Billed charges,77% of total billed charges,2331.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,788.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1371.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.85,2441.61,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2812.24,1406.12,,2165.42,77,,,Percent of Total Billed Charges,77% of total billed charges,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,878.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2081.06,74,,,Percent of Total Billed Charges,74% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2362.28,84,,,Percent of Total Billed Charges,84% of total billed charges,2306.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2502.89,89,,,Percent of total Billed Charges,89% of total Billed charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.42,77,,,Percent of total Billed charges,77% of total billed charges,2390.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,808.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1406.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.06,2502.89,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2743.38,1371.69,,2112.4,77,,,Percent of Total Billed Charges,77% of total billed charges,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2030.1,74,,,Percent of Total Billed Charges,74% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2304.44,84,,,Percent of Total Billed Charges,84% of total billed charges,2249.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,2441.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2112.4,77,,,Percent of total Billed charges,77% of total billed charges,2331.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,788.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1371.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.85,2441.61,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2812.24,1406.12,,2165.42,77,,,Percent of Total Billed Charges,77% of total billed charges,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,878.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2081.06,74,,,Percent of Total Billed Charges,74% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2362.28,84,,,Percent of Total Billed Charges,84% of total billed charges,2306.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2502.89,89,,,Percent of total Billed Charges,89% of total Billed charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.42,77,,,Percent of total Billed charges,77% of total billed charges,2390.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,808.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1406.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.06,2502.89,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2743.38,1371.69,,2112.4,77,,,Percent of Total Billed Charges,77% of total billed charges,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2030.1,74,,,Percent of Total Billed Charges,74% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2304.44,84,,,Percent of Total Billed Charges,84% of total billed charges,2249.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,2441.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2112.4,77,,,Percent of total Billed charges,77% of total billed charges,2331.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,788.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1371.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.85,2441.61,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2812.24,1406.12,,2165.42,77,,,Percent of Total Billed Charges,77% of total billed charges,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,878.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2081.06,74,,,Percent of Total Billed Charges,74% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2362.28,84,,,Percent of Total Billed Charges,84% of total billed charges,2306.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2502.89,89,,,Percent of total Billed Charges,89% of total Billed charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.42,77,,,Percent of total Billed charges,77% of total billed charges,2390.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,808.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1406.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.06,2502.89,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2743.38,1371.69,,2112.4,77,,,Percent of Total Billed Charges,77% of total billed charges,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2030.1,74,,,Percent of Total Billed Charges,74% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2304.44,84,,,Percent of Total Billed Charges,84% of total billed charges,2249.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,2441.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2112.4,77,,,Percent of total Billed charges,77% of total billed charges,2331.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,788.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1371.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.85,2441.61,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2812.24,1406.12,,2165.42,77,,,Percent of Total Billed Charges,77% of total billed charges,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,878.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2081.06,74,,,Percent of Total Billed Charges,74% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2362.28,84,,,Percent of Total Billed Charges,84% of total billed charges,2306.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2502.89,89,,,Percent of total Billed Charges,89% of total Billed charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.42,77,,,Percent of total Billed charges,77% of total billed charges,2390.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,808.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1406.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.06,2502.89,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2743.38,1371.69,,2112.4,77,,,Percent of Total Billed Charges,77% of total billed charges,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2030.1,74,,,Percent of Total Billed Charges,74% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2304.44,84,,,Percent of Total Billed Charges,84% of total billed charges,2249.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,2441.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2112.4,77,,,Percent of total Billed charges,77% of total billed charges,2331.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,788.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1371.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.85,2441.61,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2812.24,1406.12,,2165.42,77,,,Percent of Total Billed Charges,77% of total billed charges,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,878.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2081.06,74,,,Percent of Total Billed Charges,74% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1940.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2362.28,84,,,Percent of Total Billed Charges,84% of total billed charges,2306.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,2502.89,89,,,Percent of total Billed Charges,89% of total Billed charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2165.42,77,,,Percent of total Billed charges,77% of total billed charges,2390.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,808.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1406.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1147.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2502.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,703.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.06,2502.89,
CARBOplatin 150mg/15ml Liquid MDV,703424601,CDM,250,RC,,,Outpatient,,,2743.38,1371.69,,2112.4,77,,,Percent of Total Billed Charges,77% of total billed charges,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,699.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2030.1,74,,,Percent of Total Billed Charges,74% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2304.44,84,,,Percent of Total Billed Charges,84% of total billed charges,2249.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,2441.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2112.4,77,,,Percent of total Billed charges,77% of total billed charges,2331.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,788.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1371.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1119.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2441.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.85,2441.61,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7486.52,3743.26,,5764.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2339.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5540.02,74,,,Percent of Total Billed Charges,74% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6288.68,84,,,Percent of Total Billed Charges,84% of total billed charges,6138.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6663,89,,,Percent of total Billed Charges,89% of total Billed charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.62,77,,,Percent of total Billed charges,77% of total billed charges,6363.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2152.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3743.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1871.63,6663,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7296.77,3648.39,,5618.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2280.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5399.61,74,,,Percent of Total Billed Charges,74% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6129.29,84,,,Percent of Total Billed Charges,84% of total billed charges,5983.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,6494.13,89,,,Percent of total Billed Charges,89% of total Billed charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5618.51,77,,,Percent of total Billed charges,77% of total billed charges,6202.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2097.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3648.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1824.19,6494.13,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7486.52,3743.26,,5764.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2339.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5540.02,74,,,Percent of Total Billed Charges,74% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6288.68,84,,,Percent of Total Billed Charges,84% of total billed charges,6138.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6663,89,,,Percent of total Billed Charges,89% of total Billed charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.62,77,,,Percent of total Billed charges,77% of total billed charges,6363.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2152.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3743.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1871.63,6663,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7296.77,3648.39,,5618.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2280.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5399.61,74,,,Percent of Total Billed Charges,74% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6129.29,84,,,Percent of Total Billed Charges,84% of total billed charges,5983.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,6494.13,89,,,Percent of total Billed Charges,89% of total Billed charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5618.51,77,,,Percent of total Billed charges,77% of total billed charges,6202.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2097.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3648.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1824.19,6494.13,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7486.52,3743.26,,5764.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2339.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5540.02,74,,,Percent of Total Billed Charges,74% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6288.68,84,,,Percent of Total Billed Charges,84% of total billed charges,6138.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6663,89,,,Percent of total Billed Charges,89% of total Billed charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.62,77,,,Percent of total Billed charges,77% of total billed charges,6363.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2152.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3743.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1871.63,6663,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7296.77,3648.39,,5618.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2280.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5399.61,74,,,Percent of Total Billed Charges,74% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6129.29,84,,,Percent of Total Billed Charges,84% of total billed charges,5983.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,6494.13,89,,,Percent of total Billed Charges,89% of total Billed charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5618.51,77,,,Percent of total Billed charges,77% of total billed charges,6202.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2097.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3648.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1824.19,6494.13,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7486.52,3743.26,,5764.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2339.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5540.02,74,,,Percent of Total Billed Charges,74% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6288.68,84,,,Percent of Total Billed Charges,84% of total billed charges,6138.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6663,89,,,Percent of total Billed Charges,89% of total Billed charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.62,77,,,Percent of total Billed charges,77% of total billed charges,6363.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2152.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3743.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1871.63,6663,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7296.77,3648.39,,5618.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2280.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5399.61,74,,,Percent of Total Billed Charges,74% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6129.29,84,,,Percent of Total Billed Charges,84% of total billed charges,5983.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,6494.13,89,,,Percent of total Billed Charges,89% of total Billed charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5618.51,77,,,Percent of total Billed charges,77% of total billed charges,6202.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2097.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3648.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1824.19,6494.13,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7486.52,3743.26,,5764.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2339.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5540.02,74,,,Percent of Total Billed Charges,74% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6288.68,84,,,Percent of Total Billed Charges,84% of total billed charges,6138.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6663,89,,,Percent of total Billed Charges,89% of total Billed charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.62,77,,,Percent of total Billed charges,77% of total billed charges,6363.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2152.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3743.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1871.63,6663,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7296.77,3648.39,,5618.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2280.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5399.61,74,,,Percent of Total Billed Charges,74% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6129.29,84,,,Percent of Total Billed Charges,84% of total billed charges,5983.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,6494.13,89,,,Percent of total Billed Charges,89% of total Billed charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5618.51,77,,,Percent of total Billed charges,77% of total billed charges,6202.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2097.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3648.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1824.19,6494.13,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7486.52,3743.26,,5764.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1909.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2339.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5540.02,74,,,Percent of Total Billed Charges,74% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,5165.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6288.68,84,,,Percent of Total Billed Charges,84% of total billed charges,6138.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6663,89,,,Percent of total Billed Charges,89% of total Billed charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5764.62,77,,,Percent of total Billed charges,77% of total billed charges,6363.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2152.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3743.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3054.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6663,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1871.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1871.63,6663,
CARBOplatin 450mg/45ml Liquid MDV,703424801,CDM,250,RC,,,Outpatient,,,7296.77,3648.39,,5618.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1860.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2280.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5399.61,74,,,Percent of Total Billed Charges,74% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5034.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6129.29,84,,,Percent of Total Billed Charges,84% of total billed charges,5983.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,6494.13,89,,,Percent of total Billed Charges,89% of total Billed charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5618.51,77,,,Percent of total Billed charges,77% of total billed charges,6202.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2097.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3648.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2977.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6494.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1824.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1824.19,6494.13,
Carbamide Peroxide 6.5% OTIC 15ml,42037010478,CDM,250,RC,,,Outpatient,,,78.57,39.29,,60.5,77,,,Percent of Total Billed Charges,77% of total billed charges,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.14,74,,,Percent of Total Billed Charges,74% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,66,84,,,Percent of Total Billed Charges,84% of total billed charges,64.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.93,89,,,Percent of total Billed Charges,89% of total Billed charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,77,,,Percent of total Billed charges,77% of total billed charges,66.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69.93,
Carbamide Peroxide 6.5% OTIC 15ml,42037010478,CDM,250,RC,,,Outpatient,,,78.57,39.29,,60.5,77,,,Percent of Total Billed Charges,77% of total billed charges,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.14,74,,,Percent of Total Billed Charges,74% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,66,84,,,Percent of Total Billed Charges,84% of total billed charges,64.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.93,89,,,Percent of total Billed Charges,89% of total Billed charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,77,,,Percent of total Billed charges,77% of total billed charges,66.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69.93,
Carbamide Peroxide 6.5% OTIC 15ml,42037010478,CDM,250,RC,,,Outpatient,,,78.57,39.29,,60.5,77,,,Percent of Total Billed Charges,77% of total billed charges,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.14,74,,,Percent of Total Billed Charges,74% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,66,84,,,Percent of Total Billed Charges,84% of total billed charges,64.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.93,89,,,Percent of total Billed Charges,89% of total Billed charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,77,,,Percent of total Billed charges,77% of total billed charges,66.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69.93,
Carbamide Peroxide 6.5% OTIC 15ml,42037010478,CDM,250,RC,,,Outpatient,,,78.57,39.29,,60.5,77,,,Percent of Total Billed Charges,77% of total billed charges,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.14,74,,,Percent of Total Billed Charges,74% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,66,84,,,Percent of Total Billed Charges,84% of total billed charges,64.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.93,89,,,Percent of total Billed Charges,89% of total Billed charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,77,,,Percent of total Billed charges,77% of total billed charges,66.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69.93,
Carbamide Peroxide 6.5% OTIC 15ml,42037010478,CDM,250,RC,,,Outpatient,,,78.57,39.29,,60.5,77,,,Percent of Total Billed Charges,77% of total billed charges,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.14,74,,,Percent of Total Billed Charges,74% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,66,84,,,Percent of Total Billed Charges,84% of total billed charges,64.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.93,89,,,Percent of total Billed Charges,89% of total Billed charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,77,,,Percent of total Billed charges,77% of total billed charges,66.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69.93,
Carbamide Peroxide 6.5% OTIC 15ml,42037010478,CDM,250,RC,,,Outpatient,,,78.57,39.29,,60.5,77,,,Percent of Total Billed Charges,77% of total billed charges,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.14,74,,,Percent of Total Billed Charges,74% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,54.21,69,,,Percent of Total Billed Charges,69% of total billed charges,66,84,,,Percent of Total Billed Charges,84% of total billed charges,64.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.93,89,,,Percent of total Billed Charges,89% of total Billed charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.5,77,,,Percent of total Billed charges,77% of total billed charges,66.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69.93,
Carbidopa/Levodopa 25-250mg Tablet,,,250,RC,,,Outpatient,,,9.13,4.57,,7.03,77,,,Percent of Total Billed Charges,77% of total billed charges,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.76,74,,,Percent of Total Billed Charges,74% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,7.67,84,,,Percent of Total Billed Charges,84% of total billed charges,7.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.13,89,,,Percent of total Billed Charges,89% of total Billed charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,77,,,Percent of total Billed charges,77% of total billed charges,7.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.28,8.13,
Carbidopa/Levodopa 25-250mg Tablet,,,250,RC,,,Outpatient,,,9.13,4.57,,7.03,77,,,Percent of Total Billed Charges,77% of total billed charges,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.76,74,,,Percent of Total Billed Charges,74% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,7.67,84,,,Percent of Total Billed Charges,84% of total billed charges,7.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.13,89,,,Percent of total Billed Charges,89% of total Billed charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,77,,,Percent of total Billed charges,77% of total billed charges,7.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.28,8.13,
Carbidopa/Levodopa 25-250mg Tablet,,,250,RC,,,Outpatient,,,9.13,4.57,,7.03,77,,,Percent of Total Billed Charges,77% of total billed charges,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.76,74,,,Percent of Total Billed Charges,74% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,7.67,84,,,Percent of Total Billed Charges,84% of total billed charges,7.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.13,89,,,Percent of total Billed Charges,89% of total Billed charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,77,,,Percent of total Billed charges,77% of total billed charges,7.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.28,8.13,
Carbidopa/Levodopa 25-250mg Tablet,,,250,RC,,,Outpatient,,,9.13,4.57,,7.03,77,,,Percent of Total Billed Charges,77% of total billed charges,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.76,74,,,Percent of Total Billed Charges,74% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,7.67,84,,,Percent of Total Billed Charges,84% of total billed charges,7.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.13,89,,,Percent of total Billed Charges,89% of total Billed charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,77,,,Percent of total Billed charges,77% of total billed charges,7.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.28,8.13,
Carbidopa/Levodopa 25-250mg Tablet,,,250,RC,,,Outpatient,,,9.13,4.57,,7.03,77,,,Percent of Total Billed Charges,77% of total billed charges,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.76,74,,,Percent of Total Billed Charges,74% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,7.67,84,,,Percent of Total Billed Charges,84% of total billed charges,7.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.13,89,,,Percent of total Billed Charges,89% of total Billed charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,77,,,Percent of total Billed charges,77% of total billed charges,7.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.28,8.13,
Carbidopa/Levodopa 25-250mg Tablet,,,250,RC,,,Outpatient,,,9.13,4.57,,7.03,77,,,Percent of Total Billed Charges,77% of total billed charges,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.76,74,,,Percent of Total Billed Charges,74% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.3,69,,,Percent of Total Billed Charges,69% of total billed charges,7.67,84,,,Percent of Total Billed Charges,84% of total billed charges,7.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.13,89,,,Percent of total Billed Charges,89% of total Billed charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.03,77,,,Percent of total Billed charges,77% of total billed charges,7.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.28,8.13,
Carbidopa/Levodopa 25-100mg Tablet,,,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Carbidopa/Levodopa 25-100mg Tablet,,,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Carbidopa/Levodopa 25-100mg Tablet,,,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Carbidopa/Levodopa 25-100mg Tablet,,,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Carbidopa/Levodopa 25-100mg Tablet,,,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Carbidopa/Levodopa 25-100mg Tablet,,,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
carBAMazepine 200mg Tablet,904617261,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
carBAMazepine 200mg Tablet,904617261,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
carBAMazepine 200mg Tablet,904617261,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
carBAMazepine 200mg Tablet,904617261,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
carBAMazepine 200mg Tablet,904617261,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
carBAMazepine 200mg Tablet,904617261,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Carboprost 250mcg/1ml Ampule,9085608,CDM,250,RC,,,Outpatient,,,663.62,331.81,,510.99,77,,,Percent of Total Billed Charges,77% of total billed charges,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.08,74,,,Percent of Total Billed Charges,74% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,557.44,84,,,Percent of Total Billed Charges,84% of total billed charges,544.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,590.62,89,,,Percent of total Billed Charges,89% of total Billed charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.99,77,,,Percent of total Billed charges,77% of total billed charges,564.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,331.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.91,590.62,
Carboprost 250mcg/1ml Ampule,9085608,CDM,250,RC,,,Outpatient,,,663.62,331.81,,510.99,77,,,Percent of Total Billed Charges,77% of total billed charges,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.08,74,,,Percent of Total Billed Charges,74% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,557.44,84,,,Percent of Total Billed Charges,84% of total billed charges,544.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,590.62,89,,,Percent of total Billed Charges,89% of total Billed charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.99,77,,,Percent of total Billed charges,77% of total billed charges,564.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,331.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.91,590.62,
Carboprost 250mcg/1ml Ampule,9085608,CDM,250,RC,,,Outpatient,,,663.62,331.81,,510.99,77,,,Percent of Total Billed Charges,77% of total billed charges,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.08,74,,,Percent of Total Billed Charges,74% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,557.44,84,,,Percent of Total Billed Charges,84% of total billed charges,544.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,590.62,89,,,Percent of total Billed Charges,89% of total Billed charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.99,77,,,Percent of total Billed charges,77% of total billed charges,564.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,331.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.91,590.62,
Carboprost 250mcg/1ml Ampule,9085608,CDM,250,RC,,,Outpatient,,,663.62,331.81,,510.99,77,,,Percent of Total Billed Charges,77% of total billed charges,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.08,74,,,Percent of Total Billed Charges,74% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,557.44,84,,,Percent of Total Billed Charges,84% of total billed charges,544.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,590.62,89,,,Percent of total Billed Charges,89% of total Billed charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.99,77,,,Percent of total Billed charges,77% of total billed charges,564.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,331.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.91,590.62,
Carboprost 250mcg/1ml Ampule,9085608,CDM,250,RC,,,Outpatient,,,663.62,331.81,,510.99,77,,,Percent of Total Billed Charges,77% of total billed charges,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.08,74,,,Percent of Total Billed Charges,74% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,557.44,84,,,Percent of Total Billed Charges,84% of total billed charges,544.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,590.62,89,,,Percent of total Billed Charges,89% of total Billed charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.99,77,,,Percent of total Billed charges,77% of total billed charges,564.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,331.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.91,590.62,
Carboprost 250mcg/1ml Ampule,9085608,CDM,250,RC,,,Outpatient,,,663.62,331.81,,510.99,77,,,Percent of Total Billed Charges,77% of total billed charges,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,169.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,207.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,491.08,74,,,Percent of Total Billed Charges,74% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,457.9,69,,,Percent of Total Billed Charges,69% of total billed charges,557.44,84,,,Percent of Total Billed Charges,84% of total billed charges,544.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,590.62,89,,,Percent of total Billed Charges,89% of total Billed charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,510.99,77,,,Percent of total Billed charges,77% of total billed charges,564.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,190.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,331.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,270.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,590.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.91,590.62,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,4035.17,2017.59,,3107.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2986.03,74,,,Percent of Total Billed Charges,74% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3308.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,3591.3,89,,,Percent of total Billed Charges,89% of total Billed charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3107.08,77,,,Percent of total Billed charges,77% of total billed charges,3429.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1160.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2017.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.79,3591.3,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,3935.44,1967.72,,3030.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1229.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2912.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,3305.77,84,,,Percent of Total Billed Charges,84% of total billed charges,3227.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3502.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3030.29,77,,,Percent of total Billed charges,77% of total billed charges,3345.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1131.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1967.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.86,3502.54,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,4035.17,2017.59,,3107.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2986.03,74,,,Percent of Total Billed Charges,74% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3308.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,3591.3,89,,,Percent of total Billed Charges,89% of total Billed charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3107.08,77,,,Percent of total Billed charges,77% of total billed charges,3429.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1160.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2017.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.79,3591.3,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,3935.44,1967.72,,3030.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1229.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2912.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,3305.77,84,,,Percent of Total Billed Charges,84% of total billed charges,3227.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3502.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3030.29,77,,,Percent of total Billed charges,77% of total billed charges,3345.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1131.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1967.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.86,3502.54,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,4035.17,2017.59,,3107.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2986.03,74,,,Percent of Total Billed Charges,74% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3308.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,3591.3,89,,,Percent of total Billed Charges,89% of total Billed charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3107.08,77,,,Percent of total Billed charges,77% of total billed charges,3429.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1160.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2017.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.79,3591.3,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,3935.44,1967.72,,3030.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1229.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2912.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,3305.77,84,,,Percent of Total Billed Charges,84% of total billed charges,3227.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3502.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3030.29,77,,,Percent of total Billed charges,77% of total billed charges,3345.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1131.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1967.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.86,3502.54,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,4035.17,2017.59,,3107.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2986.03,74,,,Percent of Total Billed Charges,74% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3308.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,3591.3,89,,,Percent of total Billed Charges,89% of total Billed charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3107.08,77,,,Percent of total Billed charges,77% of total billed charges,3429.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1160.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2017.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.79,3591.3,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,3935.44,1967.72,,3030.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1229.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2912.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,3305.77,84,,,Percent of Total Billed Charges,84% of total billed charges,3227.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3502.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3030.29,77,,,Percent of total Billed charges,77% of total billed charges,3345.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1131.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1967.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.86,3502.54,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,4035.17,2017.59,,3107.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2986.03,74,,,Percent of Total Billed Charges,74% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3308.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,3591.3,89,,,Percent of total Billed Charges,89% of total Billed charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3107.08,77,,,Percent of total Billed charges,77% of total billed charges,3429.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1160.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2017.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.79,3591.3,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,3935.44,1967.72,,3030.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1229.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2912.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,3305.77,84,,,Percent of Total Billed Charges,84% of total billed charges,3227.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3502.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3030.29,77,,,Percent of total Billed charges,77% of total billed charges,3345.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1131.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1967.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.86,3502.54,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,4035.17,2017.59,,3107.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1028.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1260.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2986.03,74,,,Percent of Total Billed Charges,74% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2784.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3389.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3308.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,3591.3,89,,,Percent of total Billed Charges,89% of total Billed charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3107.08,77,,,Percent of total Billed charges,77% of total billed charges,3429.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1160.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2017.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1646.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3591.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1008.79,3591.3,
Carfilzomib (Kyprolis) 10mg/5ml Powder SDV,76075010301,CDM,250,RC,,,Outpatient,,,3935.44,1967.72,,3030.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1003.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1229.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2912.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,2715.45,69,,,Percent of Total Billed Charges,69% of total billed charges,3305.77,84,,,Percent of Total Billed Charges,84% of total billed charges,3227.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,3502.54,89,,,Percent of total Billed Charges,89% of total Billed charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3030.29,77,,,Percent of total Billed charges,77% of total billed charges,3345.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1131.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1967.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1605.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,983.86,3502.54,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11747.59,5873.8,,9045.64,77,,,Percent of Total Billed Charges,77% of total billed charges,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3671.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8693.22,74,,,Percent of Total Billed Charges,74% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9867.98,84,,,Percent of Total Billed Charges,84% of total billed charges,9633.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,10455.36,89,,,Percent of total Billed Charges,89% of total Billed charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9045.64,77,,,Percent of total Billed charges,77% of total billed charges,9985.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3377.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5873.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2936.9,10455.36,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11448.4,5724.2,,8815.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3577.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8471.82,74,,,Percent of Total Billed Charges,74% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9616.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9387.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,10189.08,89,,,Percent of total Billed Charges,89% of total Billed charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8815.27,77,,,Percent of total Billed charges,77% of total billed charges,9731.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3291.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5724.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.1,10189.08,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11747.59,5873.8,,9045.64,77,,,Percent of Total Billed Charges,77% of total billed charges,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3671.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8693.22,74,,,Percent of Total Billed Charges,74% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9867.98,84,,,Percent of Total Billed Charges,84% of total billed charges,9633.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,10455.36,89,,,Percent of total Billed Charges,89% of total Billed charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9045.64,77,,,Percent of total Billed charges,77% of total billed charges,9985.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3377.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5873.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2936.9,10455.36,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11448.4,5724.2,,8815.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3577.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8471.82,74,,,Percent of Total Billed Charges,74% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9616.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9387.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,10189.08,89,,,Percent of total Billed Charges,89% of total Billed charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8815.27,77,,,Percent of total Billed charges,77% of total billed charges,9731.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3291.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5724.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.1,10189.08,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11747.59,5873.8,,9045.64,77,,,Percent of Total Billed Charges,77% of total billed charges,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3671.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8693.22,74,,,Percent of Total Billed Charges,74% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9867.98,84,,,Percent of Total Billed Charges,84% of total billed charges,9633.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,10455.36,89,,,Percent of total Billed Charges,89% of total Billed charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9045.64,77,,,Percent of total Billed charges,77% of total billed charges,9985.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3377.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5873.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2936.9,10455.36,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11448.4,5724.2,,8815.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3577.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8471.82,74,,,Percent of Total Billed Charges,74% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9616.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9387.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,10189.08,89,,,Percent of total Billed Charges,89% of total Billed charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8815.27,77,,,Percent of total Billed charges,77% of total billed charges,9731.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3291.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5724.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.1,10189.08,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11747.59,5873.8,,9045.64,77,,,Percent of Total Billed Charges,77% of total billed charges,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3671.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8693.22,74,,,Percent of Total Billed Charges,74% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9867.98,84,,,Percent of Total Billed Charges,84% of total billed charges,9633.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,10455.36,89,,,Percent of total Billed Charges,89% of total Billed charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9045.64,77,,,Percent of total Billed charges,77% of total billed charges,9985.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3377.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5873.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2936.9,10455.36,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11448.4,5724.2,,8815.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3577.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8471.82,74,,,Percent of Total Billed Charges,74% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9616.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9387.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,10189.08,89,,,Percent of total Billed Charges,89% of total Billed charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8815.27,77,,,Percent of total Billed charges,77% of total billed charges,9731.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3291.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5724.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.1,10189.08,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11747.59,5873.8,,9045.64,77,,,Percent of Total Billed Charges,77% of total billed charges,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3671.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8693.22,74,,,Percent of Total Billed Charges,74% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9867.98,84,,,Percent of Total Billed Charges,84% of total billed charges,9633.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,10455.36,89,,,Percent of total Billed Charges,89% of total Billed charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9045.64,77,,,Percent of total Billed charges,77% of total billed charges,9985.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3377.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5873.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2936.9,10455.36,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11448.4,5724.2,,8815.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3577.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8471.82,74,,,Percent of Total Billed Charges,74% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9616.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9387.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,10189.08,89,,,Percent of total Billed Charges,89% of total Billed charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8815.27,77,,,Percent of total Billed charges,77% of total billed charges,9731.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3291.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5724.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.1,10189.08,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11747.59,5873.8,,9045.64,77,,,Percent of Total Billed Charges,77% of total billed charges,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2995.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3671.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8693.22,74,,,Percent of Total Billed Charges,74% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,8105.84,69,,,Percent of Total Billed Charges,69% of total billed charges,9867.98,84,,,Percent of Total Billed Charges,84% of total billed charges,9633.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,10455.36,89,,,Percent of total Billed Charges,89% of total Billed charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9045.64,77,,,Percent of total Billed charges,77% of total billed charges,9985.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3377.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5873.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4793.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10455.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2936.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2936.9,10455.36,
Carfilzomib (Kyprolis) 30mg/15ml Powder SDV,76075010201,CDM,250,RC,,,Outpatient,,,11448.4,5724.2,,8815.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2919.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3577.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8471.82,74,,,Percent of Total Billed Charges,74% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7899.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9616.66,84,,,Percent of Total Billed Charges,84% of total billed charges,9387.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,10189.08,89,,,Percent of total Billed Charges,89% of total Billed charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8815.27,77,,,Percent of total Billed charges,77% of total billed charges,9731.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3291.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5724.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4670.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10189.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.1,10189.08,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,21416.58,10708.29,,16490.77,77,,,Percent of Total Billed Charges,77% of total billed charges,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6692.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15848.27,74,,,Percent of Total Billed Charges,74% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17989.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19060.76,89,,,Percent of total Billed Charges,89% of total Billed charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16490.77,77,,,Percent of total Billed charges,77% of total billed charges,18204.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6157.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10708.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.15,19060.76,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,20867.33,10433.67,,16067.84,77,,,Percent of Total Billed Charges,77% of total billed charges,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6521.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15441.82,74,,,Percent of Total Billed Charges,74% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,17528.56,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18571.92,89,,,Percent of total Billed Charges,89% of total Billed charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16067.84,77,,,Percent of total Billed charges,77% of total billed charges,17737.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5999.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10433.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5216.83,18571.92,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,21416.58,10708.29,,16490.77,77,,,Percent of Total Billed Charges,77% of total billed charges,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6692.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15848.27,74,,,Percent of Total Billed Charges,74% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17989.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19060.76,89,,,Percent of total Billed Charges,89% of total Billed charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16490.77,77,,,Percent of total Billed charges,77% of total billed charges,18204.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6157.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10708.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.15,19060.76,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,20867.33,10433.67,,16067.84,77,,,Percent of Total Billed Charges,77% of total billed charges,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6521.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15441.82,74,,,Percent of Total Billed Charges,74% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,17528.56,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18571.92,89,,,Percent of total Billed Charges,89% of total Billed charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16067.84,77,,,Percent of total Billed charges,77% of total billed charges,17737.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5999.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10433.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5216.83,18571.92,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,21416.58,10708.29,,16490.77,77,,,Percent of Total Billed Charges,77% of total billed charges,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6692.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15848.27,74,,,Percent of Total Billed Charges,74% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17989.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19060.76,89,,,Percent of total Billed Charges,89% of total Billed charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16490.77,77,,,Percent of total Billed charges,77% of total billed charges,18204.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6157.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10708.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.15,19060.76,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,20867.33,10433.67,,16067.84,77,,,Percent of Total Billed Charges,77% of total billed charges,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6521.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15441.82,74,,,Percent of Total Billed Charges,74% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,17528.56,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18571.92,89,,,Percent of total Billed Charges,89% of total Billed charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16067.84,77,,,Percent of total Billed charges,77% of total billed charges,17737.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5999.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10433.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5216.83,18571.92,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,21416.58,10708.29,,16490.77,77,,,Percent of Total Billed Charges,77% of total billed charges,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6692.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15848.27,74,,,Percent of Total Billed Charges,74% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17989.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19060.76,89,,,Percent of total Billed Charges,89% of total Billed charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16490.77,77,,,Percent of total Billed charges,77% of total billed charges,18204.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6157.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10708.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.15,19060.76,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,20867.33,10433.67,,16067.84,77,,,Percent of Total Billed Charges,77% of total billed charges,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6521.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15441.82,74,,,Percent of Total Billed Charges,74% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,17528.56,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18571.92,89,,,Percent of total Billed Charges,89% of total Billed charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16067.84,77,,,Percent of total Billed charges,77% of total billed charges,17737.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5999.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10433.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5216.83,18571.92,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,21416.58,10708.29,,16490.77,77,,,Percent of Total Billed Charges,77% of total billed charges,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6692.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15848.27,74,,,Percent of Total Billed Charges,74% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17989.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19060.76,89,,,Percent of total Billed Charges,89% of total Billed charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16490.77,77,,,Percent of total Billed charges,77% of total billed charges,18204.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6157.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10708.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.15,19060.76,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,20867.33,10433.67,,16067.84,77,,,Percent of Total Billed Charges,77% of total billed charges,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6521.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15441.82,74,,,Percent of Total Billed Charges,74% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,17528.56,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18571.92,89,,,Percent of total Billed Charges,89% of total Billed charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16067.84,77,,,Percent of total Billed charges,77% of total billed charges,17737.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5999.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10433.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5216.83,18571.92,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,21416.58,10708.29,,16490.77,77,,,Percent of Total Billed Charges,77% of total billed charges,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5461.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6692.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15848.27,74,,,Percent of Total Billed Charges,74% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,14777.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17989.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19060.76,89,,,Percent of total Billed Charges,89% of total Billed charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16490.77,77,,,Percent of total Billed charges,77% of total billed charges,18204.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6157.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10708.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8737.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19060.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5354.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.15,19060.76,
Carfilzomib (Kyprolis) 60mg/30ml Powder SDV,76075010101,CDM,250,RC,,,Outpatient,,,20867.33,10433.67,,16067.84,77,,,Percent of Total Billed Charges,77% of total billed charges,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5321.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6521.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15441.82,74,,,Percent of Total Billed Charges,74% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,14398.46,69,,,Percent of Total Billed Charges,69% of total billed charges,17528.56,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18571.92,89,,,Percent of total Billed Charges,89% of total Billed charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16067.84,77,,,Percent of total Billed charges,77% of total billed charges,17737.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5999.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10433.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8513.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18571.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5216.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5216.83,18571.92,
Carisoprodol 350mg Tablet,69584011110,CDM,250,RC,,,Outpatient,,,10.63,5.32,,8.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.87,74,,,Percent of Total Billed Charges,74% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,8.93,84,,,Percent of Total Billed Charges,84% of total billed charges,8.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.46,89,,,Percent of total Billed Charges,89% of total Billed charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.19,77,,,Percent of total Billed charges,77% of total billed charges,9.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.66,9.46,
Carisoprodol 350mg Tablet,69584011110,CDM,250,RC,,,Outpatient,,,10.63,5.32,,8.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.87,74,,,Percent of Total Billed Charges,74% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,8.93,84,,,Percent of Total Billed Charges,84% of total billed charges,8.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.46,89,,,Percent of total Billed Charges,89% of total Billed charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.19,77,,,Percent of total Billed charges,77% of total billed charges,9.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.66,9.46,
Carisoprodol 350mg Tablet,69584011110,CDM,250,RC,,,Outpatient,,,10.63,5.32,,8.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.87,74,,,Percent of Total Billed Charges,74% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,8.93,84,,,Percent of Total Billed Charges,84% of total billed charges,8.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.46,89,,,Percent of total Billed Charges,89% of total Billed charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.19,77,,,Percent of total Billed charges,77% of total billed charges,9.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.66,9.46,
Carisoprodol 350mg Tablet,69584011110,CDM,250,RC,,,Outpatient,,,10.63,5.32,,8.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.87,74,,,Percent of Total Billed Charges,74% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,8.93,84,,,Percent of Total Billed Charges,84% of total billed charges,8.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.46,89,,,Percent of total Billed Charges,89% of total Billed charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.19,77,,,Percent of total Billed charges,77% of total billed charges,9.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.66,9.46,
Carisoprodol 350mg Tablet,69584011110,CDM,250,RC,,,Outpatient,,,10.63,5.32,,8.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.87,74,,,Percent of Total Billed Charges,74% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,8.93,84,,,Percent of Total Billed Charges,84% of total billed charges,8.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.46,89,,,Percent of total Billed Charges,89% of total Billed charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.19,77,,,Percent of total Billed charges,77% of total billed charges,9.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.66,9.46,
Carisoprodol 350mg Tablet,69584011110,CDM,250,RC,,,Outpatient,,,10.63,5.32,,8.19,77,,,Percent of Total Billed Charges,77% of total billed charges,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.87,74,,,Percent of Total Billed Charges,74% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,69,,,Percent of Total Billed Charges,69% of total billed charges,8.93,84,,,Percent of Total Billed Charges,84% of total billed charges,8.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.46,89,,,Percent of total Billed Charges,89% of total Billed charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.19,77,,,Percent of total Billed charges,77% of total billed charges,9.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.66,9.46,
Carvedilol 12.5mg Tablet,65862014401,CDM,250,RC,,,Outpatient,,,23.3,11.65,,17.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.24,74,,,Percent of Total Billed Charges,74% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,19.57,84,,,Percent of Total Billed Charges,84% of total billed charges,19.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.74,89,,,Percent of total Billed Charges,89% of total Billed charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,77,,,Percent of total Billed charges,77% of total billed charges,19.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.83,20.74,
Carvedilol 12.5mg Tablet,65862014401,CDM,250,RC,,,Outpatient,,,23.3,11.65,,17.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.24,74,,,Percent of Total Billed Charges,74% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,19.57,84,,,Percent of Total Billed Charges,84% of total billed charges,19.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.74,89,,,Percent of total Billed Charges,89% of total Billed charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,77,,,Percent of total Billed charges,77% of total billed charges,19.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.83,20.74,
Carvedilol 12.5mg Tablet,65862014401,CDM,250,RC,,,Outpatient,,,23.3,11.65,,17.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.24,74,,,Percent of Total Billed Charges,74% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,19.57,84,,,Percent of Total Billed Charges,84% of total billed charges,19.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.74,89,,,Percent of total Billed Charges,89% of total Billed charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,77,,,Percent of total Billed charges,77% of total billed charges,19.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.83,20.74,
Carvedilol 12.5mg Tablet,65862014401,CDM,250,RC,,,Outpatient,,,23.3,11.65,,17.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.24,74,,,Percent of Total Billed Charges,74% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,19.57,84,,,Percent of Total Billed Charges,84% of total billed charges,19.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.74,89,,,Percent of total Billed Charges,89% of total Billed charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,77,,,Percent of total Billed charges,77% of total billed charges,19.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.83,20.74,
Carvedilol 12.5mg Tablet,65862014401,CDM,250,RC,,,Outpatient,,,23.3,11.65,,17.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.24,74,,,Percent of Total Billed Charges,74% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,19.57,84,,,Percent of Total Billed Charges,84% of total billed charges,19.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.74,89,,,Percent of total Billed Charges,89% of total Billed charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,77,,,Percent of total Billed charges,77% of total billed charges,19.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.83,20.74,
Carvedilol 12.5mg Tablet,65862014401,CDM,250,RC,,,Outpatient,,,23.3,11.65,,17.94,77,,,Percent of Total Billed Charges,77% of total billed charges,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.24,74,,,Percent of Total Billed Charges,74% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,16.08,69,,,Percent of Total Billed Charges,69% of total billed charges,19.57,84,,,Percent of Total Billed Charges,84% of total billed charges,19.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.74,89,,,Percent of total Billed Charges,89% of total Billed charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.94,77,,,Percent of total Billed charges,77% of total billed charges,19.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.83,20.74,
Carvedilol 3.125mg Tablet,904730561,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Carvedilol 3.125mg Tablet,904730561,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Carvedilol 3.125mg Tablet,904730561,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Carvedilol 3.125mg Tablet,904730561,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Carvedilol 3.125mg Tablet,904730561,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Carvedilol 3.125mg Tablet,904730561,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Carvedilol 6.25mg Tablet,43547025510,CDM,250,RC,,,Outpatient,,,25.08,12.54,,19.31,77,,,Percent of Total Billed Charges,77% of total billed charges,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.56,74,,,Percent of Total Billed Charges,74% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,84,,,Percent of Total Billed Charges,84% of total billed charges,20.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.32,89,,,Percent of total Billed Charges,89% of total Billed charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.31,77,,,Percent of total Billed charges,77% of total billed charges,21.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.27,22.32,
Carvedilol 6.25mg Tablet,43547025510,CDM,250,RC,,,Outpatient,,,25.08,12.54,,19.31,77,,,Percent of Total Billed Charges,77% of total billed charges,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.56,74,,,Percent of Total Billed Charges,74% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,84,,,Percent of Total Billed Charges,84% of total billed charges,20.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.32,89,,,Percent of total Billed Charges,89% of total Billed charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.31,77,,,Percent of total Billed charges,77% of total billed charges,21.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.27,22.32,
Carvedilol 6.25mg Tablet,43547025510,CDM,250,RC,,,Outpatient,,,25.08,12.54,,19.31,77,,,Percent of Total Billed Charges,77% of total billed charges,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.56,74,,,Percent of Total Billed Charges,74% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,84,,,Percent of Total Billed Charges,84% of total billed charges,20.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.32,89,,,Percent of total Billed Charges,89% of total Billed charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.31,77,,,Percent of total Billed charges,77% of total billed charges,21.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.27,22.32,
Carvedilol 6.25mg Tablet,43547025510,CDM,250,RC,,,Outpatient,,,25.08,12.54,,19.31,77,,,Percent of Total Billed Charges,77% of total billed charges,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.56,74,,,Percent of Total Billed Charges,74% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,84,,,Percent of Total Billed Charges,84% of total billed charges,20.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.32,89,,,Percent of total Billed Charges,89% of total Billed charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.31,77,,,Percent of total Billed charges,77% of total billed charges,21.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.27,22.32,
Carvedilol 6.25mg Tablet,43547025510,CDM,250,RC,,,Outpatient,,,25.08,12.54,,19.31,77,,,Percent of Total Billed Charges,77% of total billed charges,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.56,74,,,Percent of Total Billed Charges,74% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,84,,,Percent of Total Billed Charges,84% of total billed charges,20.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.32,89,,,Percent of total Billed Charges,89% of total Billed charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.31,77,,,Percent of total Billed charges,77% of total billed charges,21.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.27,22.32,
Carvedilol 6.25mg Tablet,43547025510,CDM,250,RC,,,Outpatient,,,25.08,12.54,,19.31,77,,,Percent of Total Billed Charges,77% of total billed charges,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.56,74,,,Percent of Total Billed Charges,74% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,17.31,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,84,,,Percent of Total Billed Charges,84% of total billed charges,20.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.32,89,,,Percent of total Billed Charges,89% of total Billed charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.31,77,,,Percent of total Billed charges,77% of total billed charges,21.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.27,22.32,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Cyclopentolate 1% OPHTH Sol 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tetracaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tetracaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tetracaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tetracaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tetracaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tetracaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Hypromellose 0.3% OPHTH Gel 1 Applic (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Hypromellose 0.3% OPHTH Gel 1 Applic (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Hypromellose 0.3% OPHTH Gel 1 Applic (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Hypromellose 0.3% OPHTH Gel 1 Applic (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Hypromellose 0.3% OPHTH Gel 1 Applic (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Hypromellose 0.3% OPHTH Gel 1 Applic (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Lidocaine 2% 20mg/ml Jelly Urojet 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 10% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 2.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 2.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 2.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 2.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 2.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Phenylephrine 2.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pilocarpine 1% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pilocarpine 1% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pilocarpine 1% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pilocarpine 1% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pilocarpine 1% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pilocarpine 1% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Proparacaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Proparacaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Proparacaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Proparacaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Proparacaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Proparacaine 0.5% OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tropicamide 1% OPHTH Sol 1 ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tropicamide 1% OPHTH Sol 1 ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tropicamide 1% OPHTH Sol 1 ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tropicamide 1% OPHTH Sol 1 ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tropicamide 1% OPHTH Sol 1 ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Tropicamide 1% OPHTH Sol 1 ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Gatifloxacin OPHTH Soln 1ml (CATS),,,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 1gm SDV,60505074905,CDM,250,RC,,,Outpatient,,,61.47,30.74,,47.33,77,,,Percent of Total Billed Charges,77% of total billed charges,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.49,74,,,Percent of Total Billed Charges,74% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,42.41,69,,,Percent of Total Billed Charges,69% of total billed charges,51.63,84,,,Percent of Total Billed Charges,84% of total billed charges,50.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.71,89,,,Percent of total Billed Charges,89% of total Billed charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.33,77,,,Percent of total Billed charges,77% of total billed charges,52.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.37,54.71,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 2gm SDV,60505623105,CDM,250,RC,,,Outpatient,,,100.12,50.06,,77.09,77,,,Percent of Total Billed Charges,77% of total billed charges,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.09,74,,,Percent of Total Billed Charges,74% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,69.08,69,,,Percent of Total Billed Charges,69% of total billed charges,84.1,84,,,Percent of Total Billed Charges,84% of total billed charges,82.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.11,89,,,Percent of total Billed Charges,89% of total Billed charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.09,77,,,Percent of total Billed charges,77% of total billed charges,85.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.03,89.11,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
ceFAZolin 3gm SDV,143914025,CDM,250,RC,,,Outpatient,,,112.21,56.11,,86.4,77,,,Percent of Total Billed Charges,77% of total billed charges,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.04,74,,,Percent of Total Billed Charges,74% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,77.42,69,,,Percent of Total Billed Charges,69% of total billed charges,94.26,84,,,Percent of Total Billed Charges,84% of total billed charges,92.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.87,89,,,Percent of total Billed Charges,89% of total Billed charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.4,77,,,Percent of total Billed charges,77% of total billed charges,95.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.05,99.87,
CefDINIR Oral Susp 125mg/5ml 60ml,68180072204,CDM,250,RC,,,Outpatient,,,180.71,90.36,,139.15,77,,,Percent of Total Billed Charges,77% of total billed charges,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.73,74,,,Percent of Total Billed Charges,74% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,151.8,84,,,Percent of Total Billed Charges,84% of total billed charges,148.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.83,89,,,Percent of total Billed Charges,89% of total Billed charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.15,77,,,Percent of total Billed charges,77% of total billed charges,153.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.18,160.83,
CefDINIR Oral Susp 125mg/5ml 60ml,68180072204,CDM,250,RC,,,Outpatient,,,180.71,90.36,,139.15,77,,,Percent of Total Billed Charges,77% of total billed charges,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.73,74,,,Percent of Total Billed Charges,74% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,151.8,84,,,Percent of Total Billed Charges,84% of total billed charges,148.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.83,89,,,Percent of total Billed Charges,89% of total Billed charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.15,77,,,Percent of total Billed charges,77% of total billed charges,153.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.18,160.83,
CefDINIR Oral Susp 125mg/5ml 60ml,68180072204,CDM,250,RC,,,Outpatient,,,180.71,90.36,,139.15,77,,,Percent of Total Billed Charges,77% of total billed charges,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.73,74,,,Percent of Total Billed Charges,74% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,151.8,84,,,Percent of Total Billed Charges,84% of total billed charges,148.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.83,89,,,Percent of total Billed Charges,89% of total Billed charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.15,77,,,Percent of total Billed charges,77% of total billed charges,153.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.18,160.83,
CefDINIR Oral Susp 125mg/5ml 60ml,68180072204,CDM,250,RC,,,Outpatient,,,180.71,90.36,,139.15,77,,,Percent of Total Billed Charges,77% of total billed charges,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.73,74,,,Percent of Total Billed Charges,74% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,151.8,84,,,Percent of Total Billed Charges,84% of total billed charges,148.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.83,89,,,Percent of total Billed Charges,89% of total Billed charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.15,77,,,Percent of total Billed charges,77% of total billed charges,153.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.18,160.83,
CefDINIR Oral Susp 125mg/5ml 60ml,68180072204,CDM,250,RC,,,Outpatient,,,180.71,90.36,,139.15,77,,,Percent of Total Billed Charges,77% of total billed charges,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.73,74,,,Percent of Total Billed Charges,74% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,151.8,84,,,Percent of Total Billed Charges,84% of total billed charges,148.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.83,89,,,Percent of total Billed Charges,89% of total Billed charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.15,77,,,Percent of total Billed charges,77% of total billed charges,153.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.18,160.83,
CefDINIR Oral Susp 125mg/5ml 60ml,68180072204,CDM,250,RC,,,Outpatient,,,180.71,90.36,,139.15,77,,,Percent of Total Billed Charges,77% of total billed charges,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.73,74,,,Percent of Total Billed Charges,74% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,124.69,69,,,Percent of Total Billed Charges,69% of total billed charges,151.8,84,,,Percent of Total Billed Charges,84% of total billed charges,148.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.83,89,,,Percent of total Billed Charges,89% of total Billed charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.15,77,,,Percent of total Billed charges,77% of total billed charges,153.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.18,160.83,
CefDINIR Oral Susp 250mg/5ml 60ml,65862021960,CDM,250,RC,,,Outpatient,,,347.28,173.64,,267.41,77,,,Percent of Total Billed Charges,77% of total billed charges,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.99,74,,,Percent of Total Billed Charges,74% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,291.72,84,,,Percent of Total Billed Charges,84% of total billed charges,284.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.08,89,,,Percent of total Billed Charges,89% of total Billed charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.41,77,,,Percent of total Billed charges,77% of total billed charges,295.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,173.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.82,309.08,
CefDINIR Oral Susp 250mg/5ml 60ml,65862021960,CDM,250,RC,,,Outpatient,,,347.28,173.64,,267.41,77,,,Percent of Total Billed Charges,77% of total billed charges,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.99,74,,,Percent of Total Billed Charges,74% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,291.72,84,,,Percent of Total Billed Charges,84% of total billed charges,284.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.08,89,,,Percent of total Billed Charges,89% of total Billed charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.41,77,,,Percent of total Billed charges,77% of total billed charges,295.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,173.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.82,309.08,
CefDINIR Oral Susp 250mg/5ml 60ml,65862021960,CDM,250,RC,,,Outpatient,,,347.28,173.64,,267.41,77,,,Percent of Total Billed Charges,77% of total billed charges,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.99,74,,,Percent of Total Billed Charges,74% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,291.72,84,,,Percent of Total Billed Charges,84% of total billed charges,284.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.08,89,,,Percent of total Billed Charges,89% of total Billed charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.41,77,,,Percent of total Billed charges,77% of total billed charges,295.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,173.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.82,309.08,
CefDINIR Oral Susp 250mg/5ml 60ml,65862021960,CDM,250,RC,,,Outpatient,,,347.28,173.64,,267.41,77,,,Percent of Total Billed Charges,77% of total billed charges,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.99,74,,,Percent of Total Billed Charges,74% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,291.72,84,,,Percent of Total Billed Charges,84% of total billed charges,284.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.08,89,,,Percent of total Billed Charges,89% of total Billed charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.41,77,,,Percent of total Billed charges,77% of total billed charges,295.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,173.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.82,309.08,
CefDINIR Oral Susp 250mg/5ml 60ml,65862021960,CDM,250,RC,,,Outpatient,,,347.28,173.64,,267.41,77,,,Percent of Total Billed Charges,77% of total billed charges,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.99,74,,,Percent of Total Billed Charges,74% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,291.72,84,,,Percent of Total Billed Charges,84% of total billed charges,284.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.08,89,,,Percent of total Billed Charges,89% of total Billed charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.41,77,,,Percent of total Billed charges,77% of total billed charges,295.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,173.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.82,309.08,
CefDINIR Oral Susp 250mg/5ml 60ml,65862021960,CDM,250,RC,,,Outpatient,,,347.28,173.64,,267.41,77,,,Percent of Total Billed Charges,77% of total billed charges,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,256.99,74,,,Percent of Total Billed Charges,74% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,239.62,69,,,Percent of Total Billed Charges,69% of total billed charges,291.72,84,,,Percent of Total Billed Charges,84% of total billed charges,284.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,309.08,89,,,Percent of total Billed Charges,89% of total Billed charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.41,77,,,Percent of total Billed charges,77% of total billed charges,295.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,173.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,141.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,309.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.82,309.08,
CefDINIR 300mg Capsule,65862017760,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
CefDINIR 300mg Capsule,65862017760,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
CefDINIR 300mg Capsule,65862017760,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
CefDINIR 300mg Capsule,65862017760,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
CefDINIR 300mg Capsule,65862017760,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
CefDINIR 300mg Capsule,65862017760,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 1gm SDV,44567024010,CDM,250,RC,,,Outpatient,,,96.25,48.13,,74.11,77,,,Percent of Total Billed Charges,77% of total billed charges,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.23,74,,,Percent of Total Billed Charges,74% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,66.41,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,84,,,Percent of Total Billed Charges,84% of total billed charges,78.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.66,89,,,Percent of total Billed Charges,89% of total Billed charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.11,77,,,Percent of total Billed charges,77% of total billed charges,81.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.06,85.66,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
Cefepime 2gm SDV,60505614700,CDM,250,RC,,,Outpatient,,,301.71,150.86,,232.32,77,,,Percent of Total Billed Charges,77% of total billed charges,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,223.27,74,,,Percent of Total Billed Charges,74% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,208.18,69,,,Percent of Total Billed Charges,69% of total billed charges,253.44,84,,,Percent of Total Billed Charges,84% of total billed charges,247.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,268.52,89,,,Percent of total Billed Charges,89% of total Billed charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.32,77,,,Percent of total Billed charges,77% of total billed charges,256.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,150.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,268.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.43,268.52,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 1gm SDV,44567024525,CDM,250,RC,,,Outpatient,,,138.2,69.1,,106.41,77,,,Percent of Total Billed Charges,77% of total billed charges,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.27,74,,,Percent of Total Billed Charges,74% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,95.36,69,,,Percent of Total Billed Charges,69% of total billed charges,116.09,84,,,Percent of Total Billed Charges,84% of total billed charges,113.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,123,89,,,Percent of total Billed Charges,89% of total Billed charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.41,77,,,Percent of total Billed charges,77% of total billed charges,117.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.55,123,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
ceFOXitin 2gm SDV,63323034225,CDM,250,RC,,,Outpatient,,,154.81,77.41,,119.2,77,,,Percent of Total Billed Charges,77% of total billed charges,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.56,74,,,Percent of Total Billed Charges,74% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,106.82,69,,,Percent of Total Billed Charges,69% of total billed charges,130.04,84,,,Percent of Total Billed Charges,84% of total billed charges,126.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,137.78,89,,,Percent of total Billed Charges,89% of total Billed charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.2,77,,,Percent of total Billed charges,77% of total billed charges,131.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.7,137.78,
Cefpodoxime 200mg Tablet,781543920,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
Cefpodoxime 200mg Tablet,781543920,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
Cefpodoxime 200mg Tablet,781543920,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
Cefpodoxime 200mg Tablet,781543920,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
Cefpodoxime 200mg Tablet,781543920,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
Cefpodoxime 200mg Tablet,781543920,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTRIAXone 1000mg SDV,25021010610,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime 1gm SDV,409508216,CDM,250,RC,,,Outpatient,,,75.04,37.52,,57.78,77,,,Percent of Total Billed Charges,77% of total billed charges,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.53,74,,,Percent of Total Billed Charges,74% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,51.78,69,,,Percent of Total Billed Charges,69% of total billed charges,63.03,84,,,Percent of Total Billed Charges,84% of total billed charges,61.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.79,89,,,Percent of total Billed Charges,89% of total Billed charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.78,77,,,Percent of total Billed charges,77% of total billed charges,63.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.76,66.79,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1802.12,901.06,,1387.63,77,,,Percent of Total Billed Charges,77% of total billed charges,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1333.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1477.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1603.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1387.63,77,,,Percent of total Billed charges,77% of total billed charges,1531.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,518.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,901.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.53,1603.89,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1875.54,937.77,,1444.17,77,,,Percent of Total Billed Charges,77% of total billed charges,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,586.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1387.9,74,,,Percent of Total Billed Charges,74% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1575.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1537.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1669.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.17,77,,,Percent of total Billed charges,77% of total billed charges,1594.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,539.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.89,1669.23,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1802.12,901.06,,1387.63,77,,,Percent of Total Billed Charges,77% of total billed charges,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1333.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1477.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1603.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1387.63,77,,,Percent of total Billed charges,77% of total billed charges,1531.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,518.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,901.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.53,1603.89,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1875.54,937.77,,1444.17,77,,,Percent of Total Billed Charges,77% of total billed charges,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,586.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1387.9,74,,,Percent of Total Billed Charges,74% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1575.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1537.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1669.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.17,77,,,Percent of total Billed charges,77% of total billed charges,1594.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,539.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.89,1669.23,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1802.12,901.06,,1387.63,77,,,Percent of Total Billed Charges,77% of total billed charges,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1333.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1477.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1603.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1387.63,77,,,Percent of total Billed charges,77% of total billed charges,1531.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,518.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,901.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.53,1603.89,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1875.54,937.77,,1444.17,77,,,Percent of Total Billed Charges,77% of total billed charges,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,586.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1387.9,74,,,Percent of Total Billed Charges,74% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1575.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1537.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1669.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.17,77,,,Percent of total Billed charges,77% of total billed charges,1594.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,539.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.89,1669.23,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1802.12,901.06,,1387.63,77,,,Percent of Total Billed Charges,77% of total billed charges,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1333.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1477.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1603.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1387.63,77,,,Percent of total Billed charges,77% of total billed charges,1531.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,518.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,901.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.53,1603.89,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1875.54,937.77,,1444.17,77,,,Percent of Total Billed Charges,77% of total billed charges,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,586.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1387.9,74,,,Percent of Total Billed Charges,74% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1575.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1537.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1669.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.17,77,,,Percent of total Billed charges,77% of total billed charges,1594.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,539.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.89,1669.23,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1802.12,901.06,,1387.63,77,,,Percent of Total Billed Charges,77% of total billed charges,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1333.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1477.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1603.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1387.63,77,,,Percent of total Billed charges,77% of total billed charges,1531.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,518.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,901.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.53,1603.89,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1875.54,937.77,,1444.17,77,,,Percent of Total Billed Charges,77% of total billed charges,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,586.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1387.9,74,,,Percent of Total Billed Charges,74% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1575.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1537.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1669.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.17,77,,,Percent of total Billed charges,77% of total billed charges,1594.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,539.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.89,1669.23,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1802.12,901.06,,1387.63,77,,,Percent of Total Billed Charges,77% of total billed charges,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,459.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,563.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1333.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1243.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1513.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1477.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1603.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1387.63,77,,,Percent of total Billed charges,77% of total billed charges,1531.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,518.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,901.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,735.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,450.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,450.53,1603.89,
cefTAZidime/Avibactam 2.5gm SDV,456270010,CDM,250,RC,,,Outpatient,,,1875.54,937.77,,1444.17,77,,,Percent of Total Billed Charges,77% of total billed charges,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,478.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,586.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1387.9,74,,,Percent of Total Billed Charges,74% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1294.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1575.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1537.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1669.23,89,,,Percent of total Billed Charges,89% of total Billed charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1444.17,77,,,Percent of total Billed charges,77% of total billed charges,1594.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,539.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,937.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,765.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,468.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,468.89,1669.23,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTRIAXone 250mg SDV,409733701,CDM,250,RC,,,Outpatient,,,46.25,23.13,,35.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.23,74,,,Percent of Total Billed Charges,74% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,31.91,69,,,Percent of Total Billed Charges,69% of total billed charges,38.85,84,,,Percent of Total Billed Charges,84% of total billed charges,37.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.16,89,,,Percent of total Billed Charges,89% of total Billed charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.61,77,,,Percent of total Billed charges,77% of total billed charges,39.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.56,41.16,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTAZidime 2gm SDV,25021012850,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 2000mg SDV,409733503,CDM,250,RC,,,Outpatient,,,63.77,31.89,,49.1,77,,,Percent of Total Billed Charges,77% of total billed charges,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.19,74,,,Percent of Total Billed Charges,74% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44,69,,,Percent of Total Billed Charges,69% of total billed charges,44,69,,,Percent of Total Billed Charges,69% of total billed charges,53.57,84,,,Percent of Total Billed Charges,84% of total billed charges,52.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.76,89,,,Percent of total Billed Charges,89% of total Billed charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.1,77,,,Percent of total Billed charges,77% of total billed charges,54.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.94,56.76,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
cefTRIAXone 500mg SDV,409733801,CDM,250,RC,,,Outpatient,,,47.98,23.99,,36.94,77,,,Percent of Total Billed Charges,77% of total billed charges,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.51,74,,,Percent of Total Billed Charges,74% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,33.11,69,,,Percent of Total Billed Charges,69% of total billed charges,40.3,84,,,Percent of Total Billed Charges,84% of total billed charges,39.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.7,89,,,Percent of total Billed Charges,89% of total Billed charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,77,,,Percent of total Billed charges,77% of total billed charges,40.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12,42.7,
ceFUROXime 250mg Tablet,68180030220,CDM,250,RC,,,Outpatient,,,43.74,21.87,,33.68,77,,,Percent of Total Billed Charges,77% of total billed charges,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.37,74,,,Percent of Total Billed Charges,74% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,36.74,84,,,Percent of Total Billed Charges,84% of total billed charges,35.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.93,89,,,Percent of total Billed Charges,89% of total Billed charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,77,,,Percent of total Billed charges,77% of total billed charges,37.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.94,38.93,
ceFUROXime 250mg Tablet,68180030220,CDM,250,RC,,,Outpatient,,,43.74,21.87,,33.68,77,,,Percent of Total Billed Charges,77% of total billed charges,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.37,74,,,Percent of Total Billed Charges,74% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,36.74,84,,,Percent of Total Billed Charges,84% of total billed charges,35.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.93,89,,,Percent of total Billed Charges,89% of total Billed charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,77,,,Percent of total Billed charges,77% of total billed charges,37.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.94,38.93,
ceFUROXime 250mg Tablet,68180030220,CDM,250,RC,,,Outpatient,,,43.74,21.87,,33.68,77,,,Percent of Total Billed Charges,77% of total billed charges,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.37,74,,,Percent of Total Billed Charges,74% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,36.74,84,,,Percent of Total Billed Charges,84% of total billed charges,35.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.93,89,,,Percent of total Billed Charges,89% of total Billed charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,77,,,Percent of total Billed charges,77% of total billed charges,37.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.94,38.93,
ceFUROXime 250mg Tablet,68180030220,CDM,250,RC,,,Outpatient,,,43.74,21.87,,33.68,77,,,Percent of Total Billed Charges,77% of total billed charges,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.37,74,,,Percent of Total Billed Charges,74% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,36.74,84,,,Percent of Total Billed Charges,84% of total billed charges,35.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.93,89,,,Percent of total Billed Charges,89% of total Billed charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,77,,,Percent of total Billed charges,77% of total billed charges,37.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.94,38.93,
ceFUROXime 250mg Tablet,68180030220,CDM,250,RC,,,Outpatient,,,43.74,21.87,,33.68,77,,,Percent of Total Billed Charges,77% of total billed charges,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.37,74,,,Percent of Total Billed Charges,74% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,36.74,84,,,Percent of Total Billed Charges,84% of total billed charges,35.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.93,89,,,Percent of total Billed Charges,89% of total Billed charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,77,,,Percent of total Billed charges,77% of total billed charges,37.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.94,38.93,
ceFUROXime 250mg Tablet,68180030220,CDM,250,RC,,,Outpatient,,,43.74,21.87,,33.68,77,,,Percent of Total Billed Charges,77% of total billed charges,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.37,74,,,Percent of Total Billed Charges,74% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,30.18,69,,,Percent of Total Billed Charges,69% of total billed charges,36.74,84,,,Percent of Total Billed Charges,84% of total billed charges,35.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.93,89,,,Percent of total Billed Charges,89% of total Billed charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.68,77,,,Percent of total Billed charges,77% of total billed charges,37.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.94,38.93,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
ceFUROXime 750mg SDV,143997922,CDM,250,RC,,,Outpatient,,,64.02,32.01,,49.3,77,,,Percent of Total Billed Charges,77% of total billed charges,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.37,74,,,Percent of Total Billed Charges,74% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,44.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.78,84,,,Percent of Total Billed Charges,84% of total billed charges,52.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.98,89,,,Percent of total Billed Charges,89% of total Billed charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.3,77,,,Percent of total Billed charges,77% of total billed charges,54.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,56.98,
Celecoxib 100mg Capsule,,,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Celecoxib 100mg Capsule,,,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Celecoxib 100mg Capsule,,,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Celecoxib 100mg Capsule,,,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Celecoxib 100mg Capsule,,,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Celecoxib 100mg Capsule,,,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,50472.21,25236.11,,38863.6,77,,,Percent of Total Billed Charges,77% of total billed charges,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15772.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37349.44,74,,,Percent of Total Billed Charges,74% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,42396.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,44920.27,89,,,Percent of total Billed Charges,89% of total Billed charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38863.6,77,,,Percent of total Billed charges,77% of total billed charges,42901.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14510.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25236.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12618.05,44920.27,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,49170.76,24585.38,,37861.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15365.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36386.36,74,,,Percent of Total Billed Charges,74% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,41303.44,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,43761.98,89,,,Percent of total Billed Charges,89% of total Billed charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37861.49,77,,,Percent of total Billed charges,77% of total billed charges,41795.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14136.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24585.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12292.69,43761.98,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,50472.21,25236.11,,38863.6,77,,,Percent of Total Billed Charges,77% of total billed charges,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15772.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37349.44,74,,,Percent of Total Billed Charges,74% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,42396.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,44920.27,89,,,Percent of total Billed Charges,89% of total Billed charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38863.6,77,,,Percent of total Billed charges,77% of total billed charges,42901.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14510.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25236.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12618.05,44920.27,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,49170.76,24585.38,,37861.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15365.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36386.36,74,,,Percent of Total Billed Charges,74% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,41303.44,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,43761.98,89,,,Percent of total Billed Charges,89% of total Billed charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37861.49,77,,,Percent of total Billed charges,77% of total billed charges,41795.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14136.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24585.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12292.69,43761.98,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,50472.21,25236.11,,38863.6,77,,,Percent of Total Billed Charges,77% of total billed charges,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15772.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37349.44,74,,,Percent of Total Billed Charges,74% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,42396.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,44920.27,89,,,Percent of total Billed Charges,89% of total Billed charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38863.6,77,,,Percent of total Billed charges,77% of total billed charges,42901.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14510.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25236.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12618.05,44920.27,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,49170.76,24585.38,,37861.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15365.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36386.36,74,,,Percent of Total Billed Charges,74% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,41303.44,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,43761.98,89,,,Percent of total Billed Charges,89% of total Billed charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37861.49,77,,,Percent of total Billed charges,77% of total billed charges,41795.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14136.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24585.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12292.69,43761.98,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,50472.21,25236.11,,38863.6,77,,,Percent of Total Billed Charges,77% of total billed charges,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15772.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37349.44,74,,,Percent of Total Billed Charges,74% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,42396.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,44920.27,89,,,Percent of total Billed Charges,89% of total Billed charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38863.6,77,,,Percent of total Billed charges,77% of total billed charges,42901.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14510.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25236.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12618.05,44920.27,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,49170.76,24585.38,,37861.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15365.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36386.36,74,,,Percent of Total Billed Charges,74% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,41303.44,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,43761.98,89,,,Percent of total Billed Charges,89% of total Billed charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37861.49,77,,,Percent of total Billed charges,77% of total billed charges,41795.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14136.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24585.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12292.69,43761.98,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,50472.21,25236.11,,38863.6,77,,,Percent of Total Billed Charges,77% of total billed charges,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15772.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37349.44,74,,,Percent of Total Billed Charges,74% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,42396.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,44920.27,89,,,Percent of total Billed Charges,89% of total Billed charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38863.6,77,,,Percent of total Billed charges,77% of total billed charges,42901.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14510.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25236.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12618.05,44920.27,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,49170.76,24585.38,,37861.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15365.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36386.36,74,,,Percent of Total Billed Charges,74% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,41303.44,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,43761.98,89,,,Percent of total Billed Charges,89% of total Billed charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37861.49,77,,,Percent of total Billed charges,77% of total billed charges,41795.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14136.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24585.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12292.69,43761.98,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,50472.21,25236.11,,38863.6,77,,,Percent of Total Billed Charges,77% of total billed charges,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12870.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15772.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37349.44,74,,,Percent of Total Billed Charges,74% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,34825.82,69,,,Percent of Total Billed Charges,69% of total billed charges,42396.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,44920.27,89,,,Percent of total Billed Charges,89% of total Billed charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38863.6,77,,,Percent of total Billed charges,77% of total billed charges,42901.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14510.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25236.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20592.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44920.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12618.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12618.05,44920.27,
Cemiplimab-RWLC 350mg/7ml Liquid SDV,61755000801,CDM,250,RC,,,Outpatient,,,49170.76,24585.38,,37861.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12538.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15365.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36386.36,74,,,Percent of Total Billed Charges,74% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,33927.82,69,,,Percent of Total Billed Charges,69% of total billed charges,41303.44,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,43761.98,89,,,Percent of total Billed Charges,89% of total Billed charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37861.49,77,,,Percent of total Billed charges,77% of total billed charges,41795.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14136.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24585.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20061.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43761.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12292.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12292.69,43761.98,
cephALEXin 250mg Capsule,93314501,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
cephALEXin 250mg Capsule,93314501,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
cephALEXin 250mg Capsule,93314501,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
cephALEXin 250mg Capsule,93314501,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
cephALEXin 250mg Capsule,93314501,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
cephALEXin 250mg Capsule,93314501,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
cephALEXin Susp 250mg/5ml 200ml,93417774,CDM,250,RC,,,Outpatient,,,181.57,90.79,,139.81,77,,,Percent of Total Billed Charges,77% of total billed charges,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.36,74,,,Percent of Total Billed Charges,74% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,152.52,84,,,Percent of Total Billed Charges,84% of total billed charges,148.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.6,89,,,Percent of total Billed Charges,89% of total Billed charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.81,77,,,Percent of total Billed charges,77% of total billed charges,154.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,161.6,
cephALEXin Susp 250mg/5ml 200ml,93417774,CDM,250,RC,,,Outpatient,,,181.57,90.79,,139.81,77,,,Percent of Total Billed Charges,77% of total billed charges,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.36,74,,,Percent of Total Billed Charges,74% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,152.52,84,,,Percent of Total Billed Charges,84% of total billed charges,148.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.6,89,,,Percent of total Billed Charges,89% of total Billed charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.81,77,,,Percent of total Billed charges,77% of total billed charges,154.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,161.6,
cephALEXin Susp 250mg/5ml 200ml,93417774,CDM,250,RC,,,Outpatient,,,181.57,90.79,,139.81,77,,,Percent of Total Billed Charges,77% of total billed charges,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.36,74,,,Percent of Total Billed Charges,74% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,152.52,84,,,Percent of Total Billed Charges,84% of total billed charges,148.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.6,89,,,Percent of total Billed Charges,89% of total Billed charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.81,77,,,Percent of total Billed charges,77% of total billed charges,154.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,161.6,
cephALEXin Susp 250mg/5ml 200ml,93417774,CDM,250,RC,,,Outpatient,,,181.57,90.79,,139.81,77,,,Percent of Total Billed Charges,77% of total billed charges,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.36,74,,,Percent of Total Billed Charges,74% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,152.52,84,,,Percent of Total Billed Charges,84% of total billed charges,148.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.6,89,,,Percent of total Billed Charges,89% of total Billed charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.81,77,,,Percent of total Billed charges,77% of total billed charges,154.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,161.6,
cephALEXin Susp 250mg/5ml 200ml,93417774,CDM,250,RC,,,Outpatient,,,181.57,90.79,,139.81,77,,,Percent of Total Billed Charges,77% of total billed charges,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.36,74,,,Percent of Total Billed Charges,74% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,152.52,84,,,Percent of Total Billed Charges,84% of total billed charges,148.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.6,89,,,Percent of total Billed Charges,89% of total Billed charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.81,77,,,Percent of total Billed charges,77% of total billed charges,154.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,161.6,
cephALEXin Susp 250mg/5ml 200ml,93417774,CDM,250,RC,,,Outpatient,,,181.57,90.79,,139.81,77,,,Percent of Total Billed Charges,77% of total billed charges,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,134.36,74,,,Percent of Total Billed Charges,74% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,125.28,69,,,Percent of Total Billed Charges,69% of total billed charges,152.52,84,,,Percent of Total Billed Charges,84% of total billed charges,148.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.6,89,,,Percent of total Billed Charges,89% of total Billed charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.81,77,,,Percent of total Billed charges,77% of total billed charges,154.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.39,161.6,
cephALEXin 500mg Capsule,93314701,CDM,250,RC,,,Outpatient,,,17.95,8.98,,13.82,77,,,Percent of Total Billed Charges,77% of total billed charges,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.28,74,,,Percent of Total Billed Charges,74% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,15.08,84,,,Percent of Total Billed Charges,84% of total billed charges,14.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.98,89,,,Percent of total Billed Charges,89% of total Billed charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,77,,,Percent of total Billed charges,77% of total billed charges,15.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,15.98,
cephALEXin 500mg Capsule,93314701,CDM,250,RC,,,Outpatient,,,17.95,8.98,,13.82,77,,,Percent of Total Billed Charges,77% of total billed charges,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.28,74,,,Percent of Total Billed Charges,74% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,15.08,84,,,Percent of Total Billed Charges,84% of total billed charges,14.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.98,89,,,Percent of total Billed Charges,89% of total Billed charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,77,,,Percent of total Billed charges,77% of total billed charges,15.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,15.98,
cephALEXin 500mg Capsule,93314701,CDM,250,RC,,,Outpatient,,,17.95,8.98,,13.82,77,,,Percent of Total Billed Charges,77% of total billed charges,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.28,74,,,Percent of Total Billed Charges,74% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,15.08,84,,,Percent of Total Billed Charges,84% of total billed charges,14.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.98,89,,,Percent of total Billed Charges,89% of total Billed charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,77,,,Percent of total Billed charges,77% of total billed charges,15.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,15.98,
cephALEXin 500mg Capsule,93314701,CDM,250,RC,,,Outpatient,,,17.95,8.98,,13.82,77,,,Percent of Total Billed Charges,77% of total billed charges,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.28,74,,,Percent of Total Billed Charges,74% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,15.08,84,,,Percent of Total Billed Charges,84% of total billed charges,14.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.98,89,,,Percent of total Billed Charges,89% of total Billed charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,77,,,Percent of total Billed charges,77% of total billed charges,15.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,15.98,
cephALEXin 500mg Capsule,93314701,CDM,250,RC,,,Outpatient,,,17.95,8.98,,13.82,77,,,Percent of Total Billed Charges,77% of total billed charges,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.28,74,,,Percent of Total Billed Charges,74% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,15.08,84,,,Percent of Total Billed Charges,84% of total billed charges,14.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.98,89,,,Percent of total Billed Charges,89% of total Billed charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,77,,,Percent of total Billed charges,77% of total billed charges,15.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,15.98,
cephALEXin 500mg Capsule,93314701,CDM,250,RC,,,Outpatient,,,17.95,8.98,,13.82,77,,,Percent of Total Billed Charges,77% of total billed charges,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.28,74,,,Percent of Total Billed Charges,74% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,12.39,69,,,Percent of Total Billed Charges,69% of total billed charges,15.08,84,,,Percent of Total Billed Charges,84% of total billed charges,14.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.98,89,,,Percent of total Billed Charges,89% of total Billed charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.82,77,,,Percent of total Billed charges,77% of total billed charges,15.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,15.98,
Certolizumab (Cimzia) 400mg/2ml Syringe,50474071079,CDM,250,RC,,,Outpatient,,,25515.56,12757.78,,19646.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7973.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18881.51,74,,,Percent of Total Billed Charges,74% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21433.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22708.85,89,,,Percent of total Billed Charges,89% of total Billed charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19646.98,77,,,Percent of total Billed charges,77% of total billed charges,21688.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7335.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12757.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6378.89,22708.85,
Certolizumab (Cimzia) 400mg/2ml Syringe,50474071079,CDM,250,RC,,,Outpatient,,,25515.56,12757.78,,19646.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7973.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18881.51,74,,,Percent of Total Billed Charges,74% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21433.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22708.85,89,,,Percent of total Billed Charges,89% of total Billed charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19646.98,77,,,Percent of total Billed charges,77% of total billed charges,21688.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7335.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12757.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6378.89,22708.85,
Certolizumab (Cimzia) 400mg/2ml Syringe,50474071079,CDM,250,RC,,,Outpatient,,,25515.56,12757.78,,19646.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7973.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18881.51,74,,,Percent of Total Billed Charges,74% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21433.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22708.85,89,,,Percent of total Billed Charges,89% of total Billed charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19646.98,77,,,Percent of total Billed charges,77% of total billed charges,21688.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7335.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12757.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6378.89,22708.85,
Certolizumab (Cimzia) 400mg/2ml Syringe,50474071079,CDM,250,RC,,,Outpatient,,,25515.56,12757.78,,19646.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7973.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18881.51,74,,,Percent of Total Billed Charges,74% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21433.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22708.85,89,,,Percent of total Billed Charges,89% of total Billed charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19646.98,77,,,Percent of total Billed charges,77% of total billed charges,21688.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7335.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12757.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6378.89,22708.85,
Certolizumab (Cimzia) 400mg/2ml Syringe,50474071079,CDM,250,RC,,,Outpatient,,,25515.56,12757.78,,19646.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7973.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18881.51,74,,,Percent of Total Billed Charges,74% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21433.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22708.85,89,,,Percent of total Billed Charges,89% of total Billed charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19646.98,77,,,Percent of total Billed charges,77% of total billed charges,21688.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7335.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12757.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6378.89,22708.85,
Certolizumab (Cimzia) 400mg/2ml Syringe,50474071079,CDM,250,RC,,,Outpatient,,,25515.56,12757.78,,19646.98,77,,,Percent of Total Billed Charges,77% of total billed charges,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6506.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7973.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18881.51,74,,,Percent of Total Billed Charges,74% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,17605.74,69,,,Percent of Total Billed Charges,69% of total billed charges,21433.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22708.85,89,,,Percent of total Billed Charges,89% of total Billed charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19646.98,77,,,Percent of total Billed charges,77% of total billed charges,21688.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7335.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12757.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10410.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22708.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6378.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6378.89,22708.85,
Activated Charcoal + Sorbitol 50gm/240ml Tube,,,250,RC,,,Outpatient,,,160.61,80.31,,123.67,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.85,74,,,Percent of Total Billed Charges,74% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,134.91,84,,,Percent of Total Billed Charges,84% of total billed charges,131.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.94,89,,,Percent of total Billed Charges,89% of total Billed charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.67,77,,,Percent of total Billed charges,77% of total billed charges,136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.15,142.94,
Activated Charcoal + Sorbitol 50gm/240ml Tube,,,250,RC,,,Outpatient,,,160.61,80.31,,123.67,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.85,74,,,Percent of Total Billed Charges,74% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,134.91,84,,,Percent of Total Billed Charges,84% of total billed charges,131.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.94,89,,,Percent of total Billed Charges,89% of total Billed charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.67,77,,,Percent of total Billed charges,77% of total billed charges,136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.15,142.94,
Activated Charcoal + Sorbitol 50gm/240ml Tube,,,250,RC,,,Outpatient,,,160.61,80.31,,123.67,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.85,74,,,Percent of Total Billed Charges,74% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,134.91,84,,,Percent of Total Billed Charges,84% of total billed charges,131.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.94,89,,,Percent of total Billed Charges,89% of total Billed charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.67,77,,,Percent of total Billed charges,77% of total billed charges,136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.15,142.94,
Activated Charcoal + Sorbitol 50gm/240ml Tube,,,250,RC,,,Outpatient,,,160.61,80.31,,123.67,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.85,74,,,Percent of Total Billed Charges,74% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,134.91,84,,,Percent of Total Billed Charges,84% of total billed charges,131.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.94,89,,,Percent of total Billed Charges,89% of total Billed charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.67,77,,,Percent of total Billed charges,77% of total billed charges,136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.15,142.94,
Activated Charcoal + Sorbitol 50gm/240ml Tube,,,250,RC,,,Outpatient,,,160.61,80.31,,123.67,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.85,74,,,Percent of Total Billed Charges,74% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,134.91,84,,,Percent of Total Billed Charges,84% of total billed charges,131.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.94,89,,,Percent of total Billed Charges,89% of total Billed charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.67,77,,,Percent of total Billed charges,77% of total billed charges,136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.15,142.94,
Activated Charcoal + Sorbitol 50gm/240ml Tube,,,250,RC,,,Outpatient,,,160.61,80.31,,123.67,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.85,74,,,Percent of Total Billed Charges,74% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,110.82,69,,,Percent of Total Billed Charges,69% of total billed charges,134.91,84,,,Percent of Total Billed Charges,84% of total billed charges,131.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.94,89,,,Percent of total Billed Charges,89% of total Billed charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.67,77,,,Percent of total Billed charges,77% of total billed charges,136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.15,142.94,
Cherry Syrup 10ml Bottle,395266216,CDM,250,RC,,,Outpatient,,,8.28,4.14,,6.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.13,74,,,Percent of Total Billed Charges,74% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6.96,84,,,Percent of Total Billed Charges,84% of total billed charges,6.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.37,89,,,Percent of total Billed Charges,89% of total Billed charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,77,,,Percent of total Billed charges,77% of total billed charges,7.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.07,7.37,
Cherry Syrup 10ml Bottle,395266216,CDM,250,RC,,,Outpatient,,,8.28,4.14,,6.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.13,74,,,Percent of Total Billed Charges,74% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6.96,84,,,Percent of Total Billed Charges,84% of total billed charges,6.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.37,89,,,Percent of total Billed Charges,89% of total Billed charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,77,,,Percent of total Billed charges,77% of total billed charges,7.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.07,7.37,
Cherry Syrup 10ml Bottle,395266216,CDM,250,RC,,,Outpatient,,,8.28,4.14,,6.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.13,74,,,Percent of Total Billed Charges,74% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6.96,84,,,Percent of Total Billed Charges,84% of total billed charges,6.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.37,89,,,Percent of total Billed Charges,89% of total Billed charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,77,,,Percent of total Billed charges,77% of total billed charges,7.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.07,7.37,
Cherry Syrup 10ml Bottle,395266216,CDM,250,RC,,,Outpatient,,,8.28,4.14,,6.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.13,74,,,Percent of Total Billed Charges,74% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6.96,84,,,Percent of Total Billed Charges,84% of total billed charges,6.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.37,89,,,Percent of total Billed Charges,89% of total Billed charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,77,,,Percent of total Billed charges,77% of total billed charges,7.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.07,7.37,
Cherry Syrup 10ml Bottle,395266216,CDM,250,RC,,,Outpatient,,,8.28,4.14,,6.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.13,74,,,Percent of Total Billed Charges,74% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6.96,84,,,Percent of Total Billed Charges,84% of total billed charges,6.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.37,89,,,Percent of total Billed Charges,89% of total Billed charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,77,,,Percent of total Billed charges,77% of total billed charges,7.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.07,7.37,
Cherry Syrup 10ml Bottle,395266216,CDM,250,RC,,,Outpatient,,,8.28,4.14,,6.38,77,,,Percent of Total Billed Charges,77% of total billed charges,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.13,74,,,Percent of Total Billed Charges,74% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6.96,84,,,Percent of Total Billed Charges,84% of total billed charges,6.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.37,89,,,Percent of total Billed Charges,89% of total Billed charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.38,77,,,Percent of total Billed charges,77% of total billed charges,7.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.07,7.37,
chlordiazePOXIDE 10mg Capsule,555003302,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
chlordiazePOXIDE 10mg Capsule,555003302,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
chlordiazePOXIDE 10mg Capsule,555003302,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
chlordiazePOXIDE 10mg Capsule,555003302,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
chlordiazePOXIDE 10mg Capsule,555003302,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
chlordiazePOXIDE 10mg Capsule,555003302,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
chlordiazePOXIDE 25mg Capsule,,,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
chlordiazePOXIDE 25mg Capsule,,,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
chlordiazePOXIDE 25mg Capsule,,,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
chlordiazePOXIDE 25mg Capsule,,,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
chlordiazePOXIDE 25mg Capsule,,,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
chlordiazePOXIDE 25mg Capsule,,,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Chlorthalidone 25mg Tablet,378022201,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Chlorthalidone 25mg Tablet,378022201,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Chlorthalidone 25mg Tablet,378022201,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Chlorthalidone 25mg Tablet,378022201,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Chlorthalidone 25mg Tablet,378022201,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
Chlorthalidone 25mg Tablet,378022201,CDM,250,RC,,,Outpatient,,,16.36,8.18,,12.6,77,,,Percent of Total Billed Charges,77% of total billed charges,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.11,74,,,Percent of Total Billed Charges,74% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,11.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13.74,84,,,Percent of Total Billed Charges,84% of total billed charges,13.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.56,89,,,Percent of total Billed Charges,89% of total Billed charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.6,77,,,Percent of total Billed charges,77% of total billed charges,13.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.09,14.56,
chlorproMAZINE 25mg Tablet,51079051920,CDM,250,RC,,,Outpatient,,,72.54,36.27,,55.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.68,74,,,Percent of Total Billed Charges,74% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,60.93,84,,,Percent of Total Billed Charges,84% of total billed charges,59.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.56,89,,,Percent of total Billed Charges,89% of total Billed charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,77,,,Percent of total Billed charges,77% of total billed charges,61.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.14,64.56,
chlorproMAZINE 25mg Tablet,51079051920,CDM,250,RC,,,Outpatient,,,72.54,36.27,,55.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.68,74,,,Percent of Total Billed Charges,74% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,60.93,84,,,Percent of Total Billed Charges,84% of total billed charges,59.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.56,89,,,Percent of total Billed Charges,89% of total Billed charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,77,,,Percent of total Billed charges,77% of total billed charges,61.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.14,64.56,
chlorproMAZINE 25mg Tablet,51079051920,CDM,250,RC,,,Outpatient,,,72.54,36.27,,55.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.68,74,,,Percent of Total Billed Charges,74% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,60.93,84,,,Percent of Total Billed Charges,84% of total billed charges,59.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.56,89,,,Percent of total Billed Charges,89% of total Billed charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,77,,,Percent of total Billed charges,77% of total billed charges,61.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.14,64.56,
chlorproMAZINE 25mg Tablet,51079051920,CDM,250,RC,,,Outpatient,,,72.54,36.27,,55.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.68,74,,,Percent of Total Billed Charges,74% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,60.93,84,,,Percent of Total Billed Charges,84% of total billed charges,59.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.56,89,,,Percent of total Billed Charges,89% of total Billed charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,77,,,Percent of total Billed charges,77% of total billed charges,61.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.14,64.56,
chlorproMAZINE 25mg Tablet,51079051920,CDM,250,RC,,,Outpatient,,,72.54,36.27,,55.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.68,74,,,Percent of Total Billed Charges,74% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,60.93,84,,,Percent of Total Billed Charges,84% of total billed charges,59.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.56,89,,,Percent of total Billed Charges,89% of total Billed charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,77,,,Percent of total Billed charges,77% of total billed charges,61.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.14,64.56,
chlorproMAZINE 25mg Tablet,51079051920,CDM,250,RC,,,Outpatient,,,72.54,36.27,,55.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.68,74,,,Percent of Total Billed Charges,74% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,50.05,69,,,Percent of Total Billed Charges,69% of total billed charges,60.93,84,,,Percent of Total Billed Charges,84% of total billed charges,59.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.56,89,,,Percent of total Billed Charges,89% of total Billed charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,77,,,Percent of total Billed charges,77% of total billed charges,61.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.14,64.56,
Chlorothiazide 500mg SDV,63323065827,CDM,250,RC,,,Outpatient,,,327.49,163.75,,252.17,77,,,Percent of Total Billed Charges,77% of total billed charges,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.34,74,,,Percent of Total Billed Charges,74% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,275.09,84,,,Percent of Total Billed Charges,84% of total billed charges,268.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.47,89,,,Percent of total Billed Charges,89% of total Billed charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.17,77,,,Percent of total Billed charges,77% of total billed charges,278.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.87,291.47,
Chlorothiazide 500mg SDV,63323065827,CDM,250,RC,,,Outpatient,,,327.49,163.75,,252.17,77,,,Percent of Total Billed Charges,77% of total billed charges,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.34,74,,,Percent of Total Billed Charges,74% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,275.09,84,,,Percent of Total Billed Charges,84% of total billed charges,268.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.47,89,,,Percent of total Billed Charges,89% of total Billed charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.17,77,,,Percent of total Billed charges,77% of total billed charges,278.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.87,291.47,
Chlorothiazide 500mg SDV,63323065827,CDM,250,RC,,,Outpatient,,,327.49,163.75,,252.17,77,,,Percent of Total Billed Charges,77% of total billed charges,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.34,74,,,Percent of Total Billed Charges,74% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,275.09,84,,,Percent of Total Billed Charges,84% of total billed charges,268.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.47,89,,,Percent of total Billed Charges,89% of total Billed charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.17,77,,,Percent of total Billed charges,77% of total billed charges,278.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.87,291.47,
Chlorothiazide 500mg SDV,63323065827,CDM,250,RC,,,Outpatient,,,327.49,163.75,,252.17,77,,,Percent of Total Billed Charges,77% of total billed charges,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.34,74,,,Percent of Total Billed Charges,74% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,275.09,84,,,Percent of Total Billed Charges,84% of total billed charges,268.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.47,89,,,Percent of total Billed Charges,89% of total Billed charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.17,77,,,Percent of total Billed charges,77% of total billed charges,278.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.87,291.47,
Chlorothiazide 500mg SDV,63323065827,CDM,250,RC,,,Outpatient,,,327.49,163.75,,252.17,77,,,Percent of Total Billed Charges,77% of total billed charges,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.34,74,,,Percent of Total Billed Charges,74% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,275.09,84,,,Percent of Total Billed Charges,84% of total billed charges,268.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.47,89,,,Percent of total Billed Charges,89% of total Billed charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.17,77,,,Percent of total Billed charges,77% of total billed charges,278.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.87,291.47,
Chlorothiazide 500mg SDV,63323065827,CDM,250,RC,,,Outpatient,,,327.49,163.75,,252.17,77,,,Percent of Total Billed Charges,77% of total billed charges,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,242.34,74,,,Percent of Total Billed Charges,74% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,225.97,69,,,Percent of Total Billed Charges,69% of total billed charges,275.09,84,,,Percent of Total Billed Charges,84% of total billed charges,268.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,291.47,89,,,Percent of total Billed Charges,89% of total Billed charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,252.17,77,,,Percent of total Billed charges,77% of total billed charges,278.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,163.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,133.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.87,291.47,
Cholecalciferol (Vitamin D3) 10mcg (400 Unit)Tablet,74312001140,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cholecalciferol (Vitamin D3) 10mcg (400 Unit)Tablet,74312001140,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cholecalciferol (Vitamin D3) 10mcg (400 Unit)Tablet,74312001140,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cholecalciferol (Vitamin D3) 10mcg (400 Unit)Tablet,74312001140,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cholecalciferol (Vitamin D3) 10mcg (400 Unit)Tablet,74312001140,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cholecalciferol (Vitamin D3) 10mcg (400 Unit)Tablet,74312001140,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cholecalciferol (Vit D3) 10mcg (400 Unit/Drop) Oral Liq 90 Drops (2.5ml),51228000006,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cholecalciferol (Vit D3) 10mcg (400 Unit/Drop) Oral Liq 90 Drops (2.5ml),51228000006,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cholecalciferol (Vit D3) 10mcg (400 Unit/Drop) Oral Liq 90 Drops (2.5ml),51228000006,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cholecalciferol (Vit D3) 10mcg (400 Unit/Drop) Oral Liq 90 Drops (2.5ml),51228000006,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cholecalciferol (Vit D3) 10mcg (400 Unit/Drop) Oral Liq 90 Drops (2.5ml),51228000006,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cholecalciferol (Vit D3) 10mcg (400 Unit/Drop) Oral Liq 90 Drops (2.5ml),51228000006,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cholestyramine Light 4gm Per Packet,245003660,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
Cholestyramine Light 4gm Per Packet,245003660,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
Cholestyramine Light 4gm Per Packet,245003660,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
Cholestyramine Light 4gm Per Packet,245003660,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
Cholestyramine Light 4gm Per Packet,245003660,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
Cholestyramine Light 4gm Per Packet,245003660,CDM,250,RC,,,Outpatient,,,49.99,25,,38.49,77,,,Percent of Total Billed Charges,77% of total billed charges,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.99,74,,,Percent of Total Billed Charges,74% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,34.49,69,,,Percent of Total Billed Charges,69% of total billed charges,41.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.49,89,,,Percent of total Billed Charges,89% of total Billed charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.49,77,,,Percent of total Billed charges,77% of total billed charges,42.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.5,44.49,
"Cholecalciferol (Vitamin D3) 50mcg (2,000 Unit)Tablet",50268086515,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Cholecalciferol (Vitamin D3) 50mcg (2,000 Unit)Tablet",50268086515,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Cholecalciferol (Vitamin D3) 50mcg (2,000 Unit)Tablet",50268086515,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Cholecalciferol (Vitamin D3) 50mcg (2,000 Unit)Tablet",50268086515,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Cholecalciferol (Vitamin D3) 50mcg (2,000 Unit)Tablet",50268086515,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Cholecalciferol (Vitamin D3) 50mcg (2,000 Unit)Tablet",50268086515,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cilostazol 100mg Tablet,50268017715,CDM,250,RC,,,Outpatient,,,26.11,13.06,,20.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.32,74,,,Percent of Total Billed Charges,74% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,21.93,84,,,Percent of Total Billed Charges,84% of total billed charges,21.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.24,89,,,Percent of total Billed Charges,89% of total Billed charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.1,77,,,Percent of total Billed charges,77% of total billed charges,22.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.53,23.24,
Cilostazol 100mg Tablet,50268017715,CDM,250,RC,,,Outpatient,,,26.11,13.06,,20.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.32,74,,,Percent of Total Billed Charges,74% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,21.93,84,,,Percent of Total Billed Charges,84% of total billed charges,21.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.24,89,,,Percent of total Billed Charges,89% of total Billed charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.1,77,,,Percent of total Billed charges,77% of total billed charges,22.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.53,23.24,
Cilostazol 100mg Tablet,50268017715,CDM,250,RC,,,Outpatient,,,26.11,13.06,,20.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.32,74,,,Percent of Total Billed Charges,74% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,21.93,84,,,Percent of Total Billed Charges,84% of total billed charges,21.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.24,89,,,Percent of total Billed Charges,89% of total Billed charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.1,77,,,Percent of total Billed charges,77% of total billed charges,22.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.53,23.24,
Cilostazol 100mg Tablet,50268017715,CDM,250,RC,,,Outpatient,,,26.11,13.06,,20.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.32,74,,,Percent of Total Billed Charges,74% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,21.93,84,,,Percent of Total Billed Charges,84% of total billed charges,21.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.24,89,,,Percent of total Billed Charges,89% of total Billed charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.1,77,,,Percent of total Billed charges,77% of total billed charges,22.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.53,23.24,
Cilostazol 100mg Tablet,50268017715,CDM,250,RC,,,Outpatient,,,26.11,13.06,,20.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.32,74,,,Percent of Total Billed Charges,74% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,21.93,84,,,Percent of Total Billed Charges,84% of total billed charges,21.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.24,89,,,Percent of total Billed Charges,89% of total Billed charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.1,77,,,Percent of total Billed charges,77% of total billed charges,22.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.53,23.24,
Cilostazol 100mg Tablet,50268017715,CDM,250,RC,,,Outpatient,,,26.11,13.06,,20.1,77,,,Percent of Total Billed Charges,77% of total billed charges,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.32,74,,,Percent of Total Billed Charges,74% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.02,69,,,Percent of Total Billed Charges,69% of total billed charges,21.93,84,,,Percent of Total Billed Charges,84% of total billed charges,21.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.24,89,,,Percent of total Billed Charges,89% of total Billed charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.1,77,,,Percent of total Billed charges,77% of total billed charges,22.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.53,23.24,
Ciprofloxacin 500mg Tablet,55111012705,CDM,250,RC,,,Outpatient,,,48.41,24.21,,37.28,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.82,74,,,Percent of Total Billed Charges,74% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40.66,84,,,Percent of Total Billed Charges,84% of total billed charges,39.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.08,89,,,Percent of total Billed Charges,89% of total Billed charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.28,77,,,Percent of total Billed charges,77% of total billed charges,41.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.08,
Ciprofloxacin 500mg Tablet,55111012705,CDM,250,RC,,,Outpatient,,,48.41,24.21,,37.28,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.82,74,,,Percent of Total Billed Charges,74% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40.66,84,,,Percent of Total Billed Charges,84% of total billed charges,39.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.08,89,,,Percent of total Billed Charges,89% of total Billed charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.28,77,,,Percent of total Billed charges,77% of total billed charges,41.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.08,
Ciprofloxacin 500mg Tablet,55111012705,CDM,250,RC,,,Outpatient,,,48.41,24.21,,37.28,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.82,74,,,Percent of Total Billed Charges,74% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40.66,84,,,Percent of Total Billed Charges,84% of total billed charges,39.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.08,89,,,Percent of total Billed Charges,89% of total Billed charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.28,77,,,Percent of total Billed charges,77% of total billed charges,41.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.08,
Ciprofloxacin 500mg Tablet,55111012705,CDM,250,RC,,,Outpatient,,,48.41,24.21,,37.28,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.82,74,,,Percent of Total Billed Charges,74% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40.66,84,,,Percent of Total Billed Charges,84% of total billed charges,39.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.08,89,,,Percent of total Billed Charges,89% of total Billed charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.28,77,,,Percent of total Billed charges,77% of total billed charges,41.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.08,
Ciprofloxacin 500mg Tablet,55111012705,CDM,250,RC,,,Outpatient,,,48.41,24.21,,37.28,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.82,74,,,Percent of Total Billed Charges,74% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40.66,84,,,Percent of Total Billed Charges,84% of total billed charges,39.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.08,89,,,Percent of total Billed Charges,89% of total Billed charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.28,77,,,Percent of total Billed charges,77% of total billed charges,41.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.08,
Ciprofloxacin 500mg Tablet,55111012705,CDM,250,RC,,,Outpatient,,,48.41,24.21,,37.28,77,,,Percent of Total Billed Charges,77% of total billed charges,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.82,74,,,Percent of Total Billed Charges,74% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,33.4,69,,,Percent of Total Billed Charges,69% of total billed charges,40.66,84,,,Percent of Total Billed Charges,84% of total billed charges,39.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.08,89,,,Percent of total Billed Charges,89% of total Billed charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.28,77,,,Percent of total Billed charges,77% of total billed charges,41.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.1,43.08,
Ciprofloxacin 0.3% OPHTH Soln 2.5ml,61314065625,CDM,250,RC,,,Outpatient,,,210.86,105.43,,162.36,77,,,Percent of Total Billed Charges,77% of total billed charges,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.04,74,,,Percent of Total Billed Charges,74% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,177.12,84,,,Percent of Total Billed Charges,84% of total billed charges,172.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.67,89,,,Percent of total Billed Charges,89% of total Billed charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.36,77,,,Percent of total Billed charges,77% of total billed charges,179.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.72,187.67,
Ciprofloxacin 0.3% OPHTH Soln 2.5ml,61314065625,CDM,250,RC,,,Outpatient,,,210.86,105.43,,162.36,77,,,Percent of Total Billed Charges,77% of total billed charges,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.04,74,,,Percent of Total Billed Charges,74% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,177.12,84,,,Percent of Total Billed Charges,84% of total billed charges,172.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.67,89,,,Percent of total Billed Charges,89% of total Billed charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.36,77,,,Percent of total Billed charges,77% of total billed charges,179.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.72,187.67,
Ciprofloxacin 0.3% OPHTH Soln 2.5ml,61314065625,CDM,250,RC,,,Outpatient,,,210.86,105.43,,162.36,77,,,Percent of Total Billed Charges,77% of total billed charges,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.04,74,,,Percent of Total Billed Charges,74% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,177.12,84,,,Percent of Total Billed Charges,84% of total billed charges,172.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.67,89,,,Percent of total Billed Charges,89% of total Billed charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.36,77,,,Percent of total Billed charges,77% of total billed charges,179.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.72,187.67,
Ciprofloxacin 0.3% OPHTH Soln 2.5ml,61314065625,CDM,250,RC,,,Outpatient,,,210.86,105.43,,162.36,77,,,Percent of Total Billed Charges,77% of total billed charges,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.04,74,,,Percent of Total Billed Charges,74% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,177.12,84,,,Percent of Total Billed Charges,84% of total billed charges,172.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.67,89,,,Percent of total Billed Charges,89% of total Billed charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.36,77,,,Percent of total Billed charges,77% of total billed charges,179.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.72,187.67,
Ciprofloxacin 0.3% OPHTH Soln 2.5ml,61314065625,CDM,250,RC,,,Outpatient,,,210.86,105.43,,162.36,77,,,Percent of Total Billed Charges,77% of total billed charges,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.04,74,,,Percent of Total Billed Charges,74% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,177.12,84,,,Percent of Total Billed Charges,84% of total billed charges,172.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.67,89,,,Percent of total Billed Charges,89% of total Billed charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.36,77,,,Percent of total Billed charges,77% of total billed charges,179.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.72,187.67,
Ciprofloxacin 0.3% OPHTH Soln 2.5ml,61314065625,CDM,250,RC,,,Outpatient,,,210.86,105.43,,162.36,77,,,Percent of Total Billed Charges,77% of total billed charges,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.04,74,,,Percent of Total Billed Charges,74% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,145.49,69,,,Percent of Total Billed Charges,69% of total billed charges,177.12,84,,,Percent of Total Billed Charges,84% of total billed charges,172.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.67,89,,,Percent of total Billed Charges,89% of total Billed charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.36,77,,,Percent of total Billed charges,77% of total billed charges,179.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.72,187.67,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 200mg/100ml IV Bag,,,250,RC,,,Outpatient,,,135.09,67.55,,104.02,77,,,Percent of Total Billed Charges,77% of total billed charges,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.97,74,,,Percent of Total Billed Charges,74% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,93.21,69,,,Percent of Total Billed Charges,69% of total billed charges,113.48,84,,,Percent of Total Billed Charges,84% of total billed charges,110.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,120.23,89,,,Percent of total Billed Charges,89% of total Billed charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.02,77,,,Percent of total Billed charges,77% of total billed charges,114.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,55.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.77,120.23,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin 400mg/200ml IV Bag,,,250,RC,,,Outpatient,,,138.85,69.43,,106.91,77,,,Percent of Total Billed Charges,77% of total billed charges,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.75,74,,,Percent of Total Billed Charges,74% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,95.81,69,,,Percent of Total Billed Charges,69% of total billed charges,116.63,84,,,Percent of Total Billed Charges,84% of total billed charges,113.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.58,89,,,Percent of total Billed Charges,89% of total Billed charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.91,77,,,Percent of total Billed charges,77% of total billed charges,118.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.71,123.58,
Ciprofloxacin/Dexameth OTIC 7.5ml,43598032675,CDM,250,RC,,,Outpatient,,,931.83,465.92,,717.51,77,,,Percent of Total Billed Charges,77% of total billed charges,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.55,74,,,Percent of Total Billed Charges,74% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,782.74,84,,,Percent of Total Billed Charges,84% of total billed charges,764.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.33,89,,,Percent of total Billed Charges,89% of total Billed charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.51,77,,,Percent of total Billed charges,77% of total billed charges,792.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,465.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.96,829.33,
Ciprofloxacin/Dexameth OTIC 7.5ml,43598032675,CDM,250,RC,,,Outpatient,,,931.83,465.92,,717.51,77,,,Percent of Total Billed Charges,77% of total billed charges,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.55,74,,,Percent of Total Billed Charges,74% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,782.74,84,,,Percent of Total Billed Charges,84% of total billed charges,764.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.33,89,,,Percent of total Billed Charges,89% of total Billed charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.51,77,,,Percent of total Billed charges,77% of total billed charges,792.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,465.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.96,829.33,
Ciprofloxacin/Dexameth OTIC 7.5ml,43598032675,CDM,250,RC,,,Outpatient,,,931.83,465.92,,717.51,77,,,Percent of Total Billed Charges,77% of total billed charges,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.55,74,,,Percent of Total Billed Charges,74% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,782.74,84,,,Percent of Total Billed Charges,84% of total billed charges,764.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.33,89,,,Percent of total Billed Charges,89% of total Billed charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.51,77,,,Percent of total Billed charges,77% of total billed charges,792.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,465.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.96,829.33,
Ciprofloxacin/Dexameth OTIC 7.5ml,43598032675,CDM,250,RC,,,Outpatient,,,931.83,465.92,,717.51,77,,,Percent of Total Billed Charges,77% of total billed charges,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.55,74,,,Percent of Total Billed Charges,74% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,782.74,84,,,Percent of Total Billed Charges,84% of total billed charges,764.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.33,89,,,Percent of total Billed Charges,89% of total Billed charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.51,77,,,Percent of total Billed charges,77% of total billed charges,792.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,465.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.96,829.33,
Ciprofloxacin/Dexameth OTIC 7.5ml,43598032675,CDM,250,RC,,,Outpatient,,,931.83,465.92,,717.51,77,,,Percent of Total Billed Charges,77% of total billed charges,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.55,74,,,Percent of Total Billed Charges,74% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,782.74,84,,,Percent of Total Billed Charges,84% of total billed charges,764.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.33,89,,,Percent of total Billed Charges,89% of total Billed charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.51,77,,,Percent of total Billed charges,77% of total billed charges,792.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,465.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.96,829.33,
Ciprofloxacin/Dexameth OTIC 7.5ml,43598032675,CDM,250,RC,,,Outpatient,,,931.83,465.92,,717.51,77,,,Percent of Total Billed Charges,77% of total billed charges,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,237.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,291.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,689.55,74,,,Percent of Total Billed Charges,74% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,642.96,69,,,Percent of Total Billed Charges,69% of total billed charges,782.74,84,,,Percent of Total Billed Charges,84% of total billed charges,764.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,829.33,89,,,Percent of total Billed Charges,89% of total Billed charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.51,77,,,Percent of total Billed charges,77% of total billed charges,792.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,267.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,465.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,380.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,829.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,232.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.96,829.33,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2324.07,1162.04,,1789.53,77,,,Percent of Total Billed Charges,77% of total billed charges,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,726.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1719.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1952.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1905.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,2068.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1789.53,77,,,Percent of total Billed charges,77% of total billed charges,1975.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,668.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1162.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.02,2068.42,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2267.83,1133.92,,1746.23,77,,,Percent of Total Billed Charges,77% of total billed charges,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,708.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1678.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1904.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1859.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2018.37,89,,,Percent of total Billed Charges,89% of total Billed charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1746.23,77,,,Percent of total Billed charges,77% of total billed charges,1927.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1133.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.96,2018.37,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2324.07,1162.04,,1789.53,77,,,Percent of Total Billed Charges,77% of total billed charges,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,726.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1719.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1952.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1905.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,2068.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1789.53,77,,,Percent of total Billed charges,77% of total billed charges,1975.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,668.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1162.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.02,2068.42,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2267.83,1133.92,,1746.23,77,,,Percent of Total Billed Charges,77% of total billed charges,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,708.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1678.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1904.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1859.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2018.37,89,,,Percent of total Billed Charges,89% of total Billed charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1746.23,77,,,Percent of total Billed charges,77% of total billed charges,1927.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1133.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.96,2018.37,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2324.07,1162.04,,1789.53,77,,,Percent of Total Billed Charges,77% of total billed charges,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,726.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1719.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1952.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1905.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,2068.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1789.53,77,,,Percent of total Billed charges,77% of total billed charges,1975.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,668.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1162.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.02,2068.42,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2267.83,1133.92,,1746.23,77,,,Percent of Total Billed Charges,77% of total billed charges,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,708.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1678.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1904.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1859.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2018.37,89,,,Percent of total Billed Charges,89% of total Billed charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1746.23,77,,,Percent of total Billed charges,77% of total billed charges,1927.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1133.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.96,2018.37,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2324.07,1162.04,,1789.53,77,,,Percent of Total Billed Charges,77% of total billed charges,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,726.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1719.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1952.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1905.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,2068.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1789.53,77,,,Percent of total Billed charges,77% of total billed charges,1975.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,668.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1162.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.02,2068.42,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2267.83,1133.92,,1746.23,77,,,Percent of Total Billed Charges,77% of total billed charges,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,708.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1678.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1904.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1859.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2018.37,89,,,Percent of total Billed Charges,89% of total Billed charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1746.23,77,,,Percent of total Billed charges,77% of total billed charges,1927.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1133.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.96,2018.37,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2324.07,1162.04,,1789.53,77,,,Percent of Total Billed Charges,77% of total billed charges,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,726.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1719.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1952.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1905.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,2068.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1789.53,77,,,Percent of total Billed charges,77% of total billed charges,1975.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,668.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1162.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.02,2068.42,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2267.83,1133.92,,1746.23,77,,,Percent of Total Billed Charges,77% of total billed charges,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,708.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1678.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1904.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1859.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2018.37,89,,,Percent of total Billed Charges,89% of total Billed charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1746.23,77,,,Percent of total Billed charges,77% of total billed charges,1927.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1133.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.96,2018.37,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2324.07,1162.04,,1789.53,77,,,Percent of Total Billed Charges,77% of total billed charges,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,592.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,726.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1719.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1603.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1952.22,84,,,Percent of Total Billed Charges,84% of total billed charges,1905.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,2068.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1789.53,77,,,Percent of total Billed charges,77% of total billed charges,1975.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,668.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1162.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,948.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2068.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,581.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,581.02,2068.42,
CISplatin 50mg/50ml Liquid MDV,63323010351,CDM,250,RC,,,Outpatient,,,2267.83,1133.92,,1746.23,77,,,Percent of Total Billed Charges,77% of total billed charges,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,578.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,708.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1678.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1564.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1904.98,84,,,Percent of Total Billed Charges,84% of total billed charges,1859.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,2018.37,89,,,Percent of total Billed Charges,89% of total Billed charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1746.23,77,,,Percent of total Billed charges,77% of total billed charges,1927.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,652,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1133.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,925.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2018.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,566.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,566.96,2018.37,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7891.94,3945.97,,6076.79,77,,,Percent of Total Billed Charges,77% of total billed charges,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2466.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5840.04,74,,,Percent of Total Billed Charges,74% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6629.23,84,,,Percent of Total Billed Charges,84% of total billed charges,6471.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,7023.83,89,,,Percent of total Billed Charges,89% of total Billed charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6076.79,77,,,Percent of total Billed charges,77% of total billed charges,6708.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2268.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3945.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1972.99,7023.83,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7691.71,3845.86,,5922.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2403.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5691.87,74,,,Percent of Total Billed Charges,74% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,6461.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6307.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,6845.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5922.62,77,,,Percent of total Billed charges,77% of total billed charges,6537.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2211.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3845.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922.93,6845.62,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7891.94,3945.97,,6076.79,77,,,Percent of Total Billed Charges,77% of total billed charges,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2466.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5840.04,74,,,Percent of Total Billed Charges,74% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6629.23,84,,,Percent of Total Billed Charges,84% of total billed charges,6471.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,7023.83,89,,,Percent of total Billed Charges,89% of total Billed charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6076.79,77,,,Percent of total Billed charges,77% of total billed charges,6708.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2268.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3945.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1972.99,7023.83,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7691.71,3845.86,,5922.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2403.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5691.87,74,,,Percent of Total Billed Charges,74% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,6461.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6307.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,6845.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5922.62,77,,,Percent of total Billed charges,77% of total billed charges,6537.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2211.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3845.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922.93,6845.62,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7891.94,3945.97,,6076.79,77,,,Percent of Total Billed Charges,77% of total billed charges,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2466.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5840.04,74,,,Percent of Total Billed Charges,74% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6629.23,84,,,Percent of Total Billed Charges,84% of total billed charges,6471.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,7023.83,89,,,Percent of total Billed Charges,89% of total Billed charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6076.79,77,,,Percent of total Billed charges,77% of total billed charges,6708.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2268.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3945.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1972.99,7023.83,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7691.71,3845.86,,5922.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2403.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5691.87,74,,,Percent of Total Billed Charges,74% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,6461.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6307.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,6845.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5922.62,77,,,Percent of total Billed charges,77% of total billed charges,6537.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2211.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3845.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922.93,6845.62,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7891.94,3945.97,,6076.79,77,,,Percent of Total Billed Charges,77% of total billed charges,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2466.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5840.04,74,,,Percent of Total Billed Charges,74% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6629.23,84,,,Percent of Total Billed Charges,84% of total billed charges,6471.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,7023.83,89,,,Percent of total Billed Charges,89% of total Billed charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6076.79,77,,,Percent of total Billed charges,77% of total billed charges,6708.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2268.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3945.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1972.99,7023.83,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7691.71,3845.86,,5922.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2403.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5691.87,74,,,Percent of Total Billed Charges,74% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,6461.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6307.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,6845.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5922.62,77,,,Percent of total Billed charges,77% of total billed charges,6537.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2211.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3845.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922.93,6845.62,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7891.94,3945.97,,6076.79,77,,,Percent of Total Billed Charges,77% of total billed charges,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2466.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5840.04,74,,,Percent of Total Billed Charges,74% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6629.23,84,,,Percent of Total Billed Charges,84% of total billed charges,6471.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,7023.83,89,,,Percent of total Billed Charges,89% of total Billed charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6076.79,77,,,Percent of total Billed charges,77% of total billed charges,6708.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2268.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3945.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1972.99,7023.83,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7691.71,3845.86,,5922.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2403.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5691.87,74,,,Percent of Total Billed Charges,74% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,6461.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6307.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,6845.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5922.62,77,,,Percent of total Billed charges,77% of total billed charges,6537.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2211.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3845.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922.93,6845.62,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7891.94,3945.97,,6076.79,77,,,Percent of Total Billed Charges,77% of total billed charges,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2012.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2466.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5840.04,74,,,Percent of Total Billed Charges,74% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,5445.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6629.23,84,,,Percent of Total Billed Charges,84% of total billed charges,6471.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,7023.83,89,,,Percent of total Billed Charges,89% of total Billed charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6076.79,77,,,Percent of total Billed charges,77% of total billed charges,6708.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2268.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3945.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3219.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7023.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1972.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1972.99,7023.83,
CISplatin 200mg/200ml Liquid MDV,63323010364,CDM,250,RC,,,Outpatient,,,7691.71,3845.86,,5922.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1961.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2403.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5691.87,74,,,Percent of Total Billed Charges,74% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,5307.28,69,,,Percent of Total Billed Charges,69% of total billed charges,6461.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6307.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,6845.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5922.62,77,,,Percent of total Billed charges,77% of total billed charges,6537.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2211.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3845.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3138.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6845.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1922.93,6845.62,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4497.59,2248.8,,3463.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1405.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3328.22,74,,,Percent of Total Billed Charges,74% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3777.98,84,,,Percent of Total Billed Charges,84% of total billed charges,3688.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4002.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3463.14,77,,,Percent of total Billed charges,77% of total billed charges,3822.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1293.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2248.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1124.4,4002.86,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4385.14,2192.57,,3376.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1370.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3245,74,,,Percent of Total Billed Charges,74% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3683.52,84,,,Percent of Total Billed Charges,84% of total billed charges,3595.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,3902.77,89,,,Percent of total Billed Charges,89% of total Billed charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3376.56,77,,,Percent of total Billed charges,77% of total billed charges,3727.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1260.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2192.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.29,3902.77,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4497.59,2248.8,,3463.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1405.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3328.22,74,,,Percent of Total Billed Charges,74% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3777.98,84,,,Percent of Total Billed Charges,84% of total billed charges,3688.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4002.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3463.14,77,,,Percent of total Billed charges,77% of total billed charges,3822.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1293.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2248.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1124.4,4002.86,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4385.14,2192.57,,3376.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1370.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3245,74,,,Percent of Total Billed Charges,74% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3683.52,84,,,Percent of Total Billed Charges,84% of total billed charges,3595.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,3902.77,89,,,Percent of total Billed Charges,89% of total Billed charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3376.56,77,,,Percent of total Billed charges,77% of total billed charges,3727.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1260.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2192.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.29,3902.77,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4497.59,2248.8,,3463.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1405.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3328.22,74,,,Percent of Total Billed Charges,74% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3777.98,84,,,Percent of Total Billed Charges,84% of total billed charges,3688.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4002.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3463.14,77,,,Percent of total Billed charges,77% of total billed charges,3822.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1293.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2248.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1124.4,4002.86,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4385.14,2192.57,,3376.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1370.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3245,74,,,Percent of Total Billed Charges,74% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3683.52,84,,,Percent of Total Billed Charges,84% of total billed charges,3595.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,3902.77,89,,,Percent of total Billed Charges,89% of total Billed charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3376.56,77,,,Percent of total Billed charges,77% of total billed charges,3727.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1260.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2192.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.29,3902.77,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4497.59,2248.8,,3463.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1405.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3328.22,74,,,Percent of Total Billed Charges,74% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3777.98,84,,,Percent of Total Billed Charges,84% of total billed charges,3688.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4002.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3463.14,77,,,Percent of total Billed charges,77% of total billed charges,3822.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1293.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2248.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1124.4,4002.86,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4385.14,2192.57,,3376.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1370.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3245,74,,,Percent of Total Billed Charges,74% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3683.52,84,,,Percent of Total Billed Charges,84% of total billed charges,3595.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,3902.77,89,,,Percent of total Billed Charges,89% of total Billed charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3376.56,77,,,Percent of total Billed charges,77% of total billed charges,3727.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1260.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2192.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.29,3902.77,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4497.59,2248.8,,3463.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1405.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3328.22,74,,,Percent of Total Billed Charges,74% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3777.98,84,,,Percent of Total Billed Charges,84% of total billed charges,3688.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4002.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3463.14,77,,,Percent of total Billed charges,77% of total billed charges,3822.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1293.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2248.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1124.4,4002.86,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4385.14,2192.57,,3376.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1370.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3245,74,,,Percent of Total Billed Charges,74% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3683.52,84,,,Percent of Total Billed Charges,84% of total billed charges,3595.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,3902.77,89,,,Percent of total Billed Charges,89% of total Billed charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3376.56,77,,,Percent of total Billed charges,77% of total billed charges,3727.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1260.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2192.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.29,3902.77,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4497.59,2248.8,,3463.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1146.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1405.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3328.22,74,,,Percent of Total Billed Charges,74% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3103.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3777.98,84,,,Percent of Total Billed Charges,84% of total billed charges,3688.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4002.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3463.14,77,,,Percent of total Billed charges,77% of total billed charges,3822.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1293.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2248.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1835.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4002.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1124.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1124.4,4002.86,
CISplatin 100mg/100ml Liquid MDV,63323010365,CDM,250,RC,,,Outpatient,,,4385.14,2192.57,,3376.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1118.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1370.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3245,74,,,Percent of Total Billed Charges,74% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3025.75,69,,,Percent of Total Billed Charges,69% of total billed charges,3683.52,84,,,Percent of Total Billed Charges,84% of total billed charges,3595.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,3902.77,89,,,Percent of total Billed Charges,89% of total Billed charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3376.56,77,,,Percent of total Billed charges,77% of total billed charges,3727.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1260.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2192.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1789.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3902.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1096.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1096.29,3902.77,
Citalopram 20mg Tablet,904608561,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Citalopram 20mg Tablet,904608561,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Citalopram 20mg Tablet,904608561,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Citalopram 20mg Tablet,904608561,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Citalopram 20mg Tablet,904608561,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Citalopram 20mg Tablet,904608561,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Sod Citrate and  Citric Acid 30ml UDC,,,250,RC,,,Outpatient,,,60.82,30.41,,46.83,77,,,Percent of Total Billed Charges,77% of total billed charges,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.01,74,,,Percent of Total Billed Charges,74% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,51.09,84,,,Percent of Total Billed Charges,84% of total billed charges,49.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.13,89,,,Percent of total Billed Charges,89% of total Billed charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.83,77,,,Percent of total Billed charges,77% of total billed charges,51.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,54.13,
Sod Citrate and  Citric Acid 30ml UDC,,,250,RC,,,Outpatient,,,60.82,30.41,,46.83,77,,,Percent of Total Billed Charges,77% of total billed charges,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.01,74,,,Percent of Total Billed Charges,74% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,51.09,84,,,Percent of Total Billed Charges,84% of total billed charges,49.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.13,89,,,Percent of total Billed Charges,89% of total Billed charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.83,77,,,Percent of total Billed charges,77% of total billed charges,51.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,54.13,
Sod Citrate and  Citric Acid 30ml UDC,,,250,RC,,,Outpatient,,,60.82,30.41,,46.83,77,,,Percent of Total Billed Charges,77% of total billed charges,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.01,74,,,Percent of Total Billed Charges,74% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,51.09,84,,,Percent of Total Billed Charges,84% of total billed charges,49.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.13,89,,,Percent of total Billed Charges,89% of total Billed charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.83,77,,,Percent of total Billed charges,77% of total billed charges,51.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,54.13,
Sod Citrate and  Citric Acid 30ml UDC,,,250,RC,,,Outpatient,,,60.82,30.41,,46.83,77,,,Percent of Total Billed Charges,77% of total billed charges,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.01,74,,,Percent of Total Billed Charges,74% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,51.09,84,,,Percent of Total Billed Charges,84% of total billed charges,49.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.13,89,,,Percent of total Billed Charges,89% of total Billed charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.83,77,,,Percent of total Billed charges,77% of total billed charges,51.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,54.13,
Sod Citrate and  Citric Acid 30ml UDC,,,250,RC,,,Outpatient,,,60.82,30.41,,46.83,77,,,Percent of Total Billed Charges,77% of total billed charges,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.01,74,,,Percent of Total Billed Charges,74% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,51.09,84,,,Percent of Total Billed Charges,84% of total billed charges,49.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.13,89,,,Percent of total Billed Charges,89% of total Billed charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.83,77,,,Percent of total Billed charges,77% of total billed charges,51.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,54.13,
Sod Citrate and  Citric Acid 30ml UDC,,,250,RC,,,Outpatient,,,60.82,30.41,,46.83,77,,,Percent of Total Billed Charges,77% of total billed charges,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.01,74,,,Percent of Total Billed Charges,74% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,69,,,Percent of Total Billed Charges,69% of total billed charges,51.09,84,,,Percent of Total Billed Charges,84% of total billed charges,49.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.13,89,,,Percent of total Billed Charges,89% of total Billed charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.83,77,,,Percent of total Billed charges,77% of total billed charges,51.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.21,54.13,
Clarithromycin Oral Susp 250mg/5ml 100ml,781602346,CDM,250,RC,,,Outpatient,,,756.6,378.3,,582.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.88,74,,,Percent of Total Billed Charges,74% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,635.54,84,,,Percent of Total Billed Charges,84% of total billed charges,620.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.37,89,,,Percent of total Billed Charges,89% of total Billed charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.58,77,,,Percent of total Billed charges,77% of total billed charges,643.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.15,673.37,
Clarithromycin Oral Susp 250mg/5ml 100ml,781602346,CDM,250,RC,,,Outpatient,,,756.6,378.3,,582.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.88,74,,,Percent of Total Billed Charges,74% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,635.54,84,,,Percent of Total Billed Charges,84% of total billed charges,620.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.37,89,,,Percent of total Billed Charges,89% of total Billed charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.58,77,,,Percent of total Billed charges,77% of total billed charges,643.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.15,673.37,
Clarithromycin Oral Susp 250mg/5ml 100ml,781602346,CDM,250,RC,,,Outpatient,,,756.6,378.3,,582.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.88,74,,,Percent of Total Billed Charges,74% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,635.54,84,,,Percent of Total Billed Charges,84% of total billed charges,620.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.37,89,,,Percent of total Billed Charges,89% of total Billed charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.58,77,,,Percent of total Billed charges,77% of total billed charges,643.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.15,673.37,
Clarithromycin Oral Susp 250mg/5ml 100ml,781602346,CDM,250,RC,,,Outpatient,,,756.6,378.3,,582.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.88,74,,,Percent of Total Billed Charges,74% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,635.54,84,,,Percent of Total Billed Charges,84% of total billed charges,620.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.37,89,,,Percent of total Billed Charges,89% of total Billed charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.58,77,,,Percent of total Billed charges,77% of total billed charges,643.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.15,673.37,
Clarithromycin Oral Susp 250mg/5ml 100ml,781602346,CDM,250,RC,,,Outpatient,,,756.6,378.3,,582.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.88,74,,,Percent of Total Billed Charges,74% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,635.54,84,,,Percent of Total Billed Charges,84% of total billed charges,620.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.37,89,,,Percent of total Billed Charges,89% of total Billed charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.58,77,,,Percent of total Billed charges,77% of total billed charges,643.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.15,673.37,
Clarithromycin Oral Susp 250mg/5ml 100ml,781602346,CDM,250,RC,,,Outpatient,,,756.6,378.3,,582.58,77,,,Percent of Total Billed Charges,77% of total billed charges,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.88,74,,,Percent of Total Billed Charges,74% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,522.05,69,,,Percent of Total Billed Charges,69% of total billed charges,635.54,84,,,Percent of Total Billed Charges,84% of total billed charges,620.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.37,89,,,Percent of total Billed Charges,89% of total Billed charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.58,77,,,Percent of total Billed charges,77% of total billed charges,643.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.15,673.37,
Clarithromycin 250mg Tablet,781196160,CDM,250,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
Clarithromycin 250mg Tablet,781196160,CDM,250,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
Clarithromycin 250mg Tablet,781196160,CDM,250,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
Clarithromycin 250mg Tablet,781196160,CDM,250,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
Clarithromycin 250mg Tablet,781196160,CDM,250,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
Clarithromycin 250mg Tablet,781196160,CDM,250,RC,,,Outpatient,,,58,29,,44.66,77,,,Percent of Total Billed Charges,77% of total billed charges,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.92,74,,,Percent of Total Billed Charges,74% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,40.02,69,,,Percent of Total Billed Charges,69% of total billed charges,48.72,84,,,Percent of Total Billed Charges,84% of total billed charges,47.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.62,89,,,Percent of total Billed Charges,89% of total Billed charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.66,77,,,Percent of total Billed charges,77% of total billed charges,49.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.5,51.62,
Clindamycin 150mg Capsule,59762332801,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Clindamycin 150mg Capsule,59762332801,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Clindamycin 150mg Capsule,59762332801,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Clindamycin 150mg Capsule,59762332801,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Clindamycin 150mg Capsule,59762332801,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Clindamycin 150mg Capsule,59762332801,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 300mg/2ml SDV,9087026,CDM,250,RC,,,Outpatient,,,60.48,30.24,,46.57,77,,,Percent of Total Billed Charges,77% of total billed charges,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.76,74,,,Percent of Total Billed Charges,74% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,41.73,69,,,Percent of Total Billed Charges,69% of total billed charges,50.8,84,,,Percent of Total Billed Charges,84% of total billed charges,49.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.83,89,,,Percent of total Billed Charges,89% of total Billed charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.57,77,,,Percent of total Billed charges,77% of total billed charges,51.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,53.83,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 900mg/6ml SDV,9090211,CDM,250,RC,,,Outpatient,,,55.3,27.65,,42.58,77,,,Percent of Total Billed Charges,77% of total billed charges,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.92,74,,,Percent of Total Billed Charges,74% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,38.16,69,,,Percent of Total Billed Charges,69% of total billed charges,46.45,84,,,Percent of Total Billed Charges,84% of total billed charges,45.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.22,89,,,Percent of total Billed Charges,89% of total Billed charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,77,,,Percent of total Billed charges,77% of total billed charges,47.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.83,49.22,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 600mg/4ml SDV,9077526,CDM,250,RC,,,Outpatient,,,64.18,32.09,,49.42,77,,,Percent of Total Billed Charges,77% of total billed charges,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.49,74,,,Percent of Total Billed Charges,74% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,44.28,69,,,Percent of Total Billed Charges,69% of total billed charges,53.91,84,,,Percent of Total Billed Charges,84% of total billed charges,52.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.12,89,,,Percent of total Billed Charges,89% of total Billed charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.42,77,,,Percent of total Billed charges,77% of total billed charges,54.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.05,57.12,
Clindamycin 2% Vaginal Cream w/Applicators 40gm,59762500901,CDM,250,RC,,,Outpatient,,,304.32,152.16,,234.33,77,,,Percent of Total Billed Charges,77% of total billed charges,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.2,74,,,Percent of Total Billed Charges,74% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,255.63,84,,,Percent of Total Billed Charges,84% of total billed charges,249.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.84,89,,,Percent of total Billed Charges,89% of total Billed charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.33,77,,,Percent of total Billed charges,77% of total billed charges,258.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.08,270.84,
Clindamycin 2% Vaginal Cream w/Applicators 40gm,59762500901,CDM,250,RC,,,Outpatient,,,304.32,152.16,,234.33,77,,,Percent of Total Billed Charges,77% of total billed charges,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.2,74,,,Percent of Total Billed Charges,74% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,255.63,84,,,Percent of Total Billed Charges,84% of total billed charges,249.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.84,89,,,Percent of total Billed Charges,89% of total Billed charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.33,77,,,Percent of total Billed charges,77% of total billed charges,258.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.08,270.84,
Clindamycin 2% Vaginal Cream w/Applicators 40gm,59762500901,CDM,250,RC,,,Outpatient,,,304.32,152.16,,234.33,77,,,Percent of Total Billed Charges,77% of total billed charges,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.2,74,,,Percent of Total Billed Charges,74% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,255.63,84,,,Percent of Total Billed Charges,84% of total billed charges,249.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.84,89,,,Percent of total Billed Charges,89% of total Billed charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.33,77,,,Percent of total Billed charges,77% of total billed charges,258.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.08,270.84,
Clindamycin 2% Vaginal Cream w/Applicators 40gm,59762500901,CDM,250,RC,,,Outpatient,,,304.32,152.16,,234.33,77,,,Percent of Total Billed Charges,77% of total billed charges,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.2,74,,,Percent of Total Billed Charges,74% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,255.63,84,,,Percent of Total Billed Charges,84% of total billed charges,249.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.84,89,,,Percent of total Billed Charges,89% of total Billed charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.33,77,,,Percent of total Billed charges,77% of total billed charges,258.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.08,270.84,
Clindamycin 2% Vaginal Cream w/Applicators 40gm,59762500901,CDM,250,RC,,,Outpatient,,,304.32,152.16,,234.33,77,,,Percent of Total Billed Charges,77% of total billed charges,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.2,74,,,Percent of Total Billed Charges,74% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,255.63,84,,,Percent of Total Billed Charges,84% of total billed charges,249.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.84,89,,,Percent of total Billed Charges,89% of total Billed charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.33,77,,,Percent of total Billed charges,77% of total billed charges,258.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.08,270.84,
Clindamycin 2% Vaginal Cream w/Applicators 40gm,59762500901,CDM,250,RC,,,Outpatient,,,304.32,152.16,,234.33,77,,,Percent of Total Billed Charges,77% of total billed charges,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,225.2,74,,,Percent of Total Billed Charges,74% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,209.98,69,,,Percent of Total Billed Charges,69% of total billed charges,255.63,84,,,Percent of Total Billed Charges,84% of total billed charges,249.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.84,89,,,Percent of total Billed Charges,89% of total Billed charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.33,77,,,Percent of total Billed charges,77% of total billed charges,258.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,152.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,124.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.08,270.84,
Clindamycin Oral Susp 75mg/5ml 100ml,,,250,RC,,,Outpatient,,,218.71,109.36,,168.41,77,,,Percent of Total Billed Charges,77% of total billed charges,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.85,74,,,Percent of Total Billed Charges,74% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,84,,,Percent of Total Billed Charges,84% of total billed charges,179.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.65,89,,,Percent of total Billed Charges,89% of total Billed charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.41,77,,,Percent of total Billed charges,77% of total billed charges,185.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.68,194.65,
Clindamycin Oral Susp 75mg/5ml 100ml,,,250,RC,,,Outpatient,,,218.71,109.36,,168.41,77,,,Percent of Total Billed Charges,77% of total billed charges,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.85,74,,,Percent of Total Billed Charges,74% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,84,,,Percent of Total Billed Charges,84% of total billed charges,179.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.65,89,,,Percent of total Billed Charges,89% of total Billed charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.41,77,,,Percent of total Billed charges,77% of total billed charges,185.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.68,194.65,
Clindamycin Oral Susp 75mg/5ml 100ml,,,250,RC,,,Outpatient,,,218.71,109.36,,168.41,77,,,Percent of Total Billed Charges,77% of total billed charges,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.85,74,,,Percent of Total Billed Charges,74% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,84,,,Percent of Total Billed Charges,84% of total billed charges,179.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.65,89,,,Percent of total Billed Charges,89% of total Billed charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.41,77,,,Percent of total Billed charges,77% of total billed charges,185.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.68,194.65,
Clindamycin Oral Susp 75mg/5ml 100ml,,,250,RC,,,Outpatient,,,218.71,109.36,,168.41,77,,,Percent of Total Billed Charges,77% of total billed charges,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.85,74,,,Percent of Total Billed Charges,74% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,84,,,Percent of Total Billed Charges,84% of total billed charges,179.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.65,89,,,Percent of total Billed Charges,89% of total Billed charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.41,77,,,Percent of total Billed charges,77% of total billed charges,185.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.68,194.65,
Clindamycin Oral Susp 75mg/5ml 100ml,,,250,RC,,,Outpatient,,,218.71,109.36,,168.41,77,,,Percent of Total Billed Charges,77% of total billed charges,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.85,74,,,Percent of Total Billed Charges,74% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,84,,,Percent of Total Billed Charges,84% of total billed charges,179.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.65,89,,,Percent of total Billed Charges,89% of total Billed charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.41,77,,,Percent of total Billed charges,77% of total billed charges,185.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.68,194.65,
Clindamycin Oral Susp 75mg/5ml 100ml,,,250,RC,,,Outpatient,,,218.71,109.36,,168.41,77,,,Percent of Total Billed Charges,77% of total billed charges,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.85,74,,,Percent of Total Billed Charges,74% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,150.91,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,84,,,Percent of Total Billed Charges,84% of total billed charges,179.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.65,89,,,Percent of total Billed Charges,89% of total Billed charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.41,77,,,Percent of total Billed charges,77% of total billed charges,185.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.68,194.65,
Clobetasol Propionate Oint 45gm,51672125906,CDM,250,RC,,,Outpatient,,,1435.45,717.73,,1105.3,77,,,Percent of Total Billed Charges,77% of total billed charges,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1062.23,74,,,Percent of Total Billed Charges,74% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1205.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1177.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.3,77,,,Percent of total Billed charges,77% of total billed charges,1220.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,717.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.86,1277.55,
Clobetasol Propionate Oint 45gm,51672125906,CDM,250,RC,,,Outpatient,,,1435.45,717.73,,1105.3,77,,,Percent of Total Billed Charges,77% of total billed charges,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1062.23,74,,,Percent of Total Billed Charges,74% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1205.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1177.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.3,77,,,Percent of total Billed charges,77% of total billed charges,1220.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,717.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.86,1277.55,
Clobetasol Propionate Oint 45gm,51672125906,CDM,250,RC,,,Outpatient,,,1435.45,717.73,,1105.3,77,,,Percent of Total Billed Charges,77% of total billed charges,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1062.23,74,,,Percent of Total Billed Charges,74% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1205.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1177.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.3,77,,,Percent of total Billed charges,77% of total billed charges,1220.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,717.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.86,1277.55,
Clobetasol Propionate Oint 45gm,51672125906,CDM,250,RC,,,Outpatient,,,1435.45,717.73,,1105.3,77,,,Percent of Total Billed Charges,77% of total billed charges,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1062.23,74,,,Percent of Total Billed Charges,74% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1205.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1177.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.3,77,,,Percent of total Billed charges,77% of total billed charges,1220.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,717.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.86,1277.55,
Clobetasol Propionate Oint 45gm,51672125906,CDM,250,RC,,,Outpatient,,,1435.45,717.73,,1105.3,77,,,Percent of Total Billed Charges,77% of total billed charges,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1062.23,74,,,Percent of Total Billed Charges,74% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1205.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1177.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.3,77,,,Percent of total Billed charges,77% of total billed charges,1220.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,717.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.86,1277.55,
Clobetasol Propionate Oint 45gm,51672125906,CDM,250,RC,,,Outpatient,,,1435.45,717.73,,1105.3,77,,,Percent of Total Billed Charges,77% of total billed charges,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,366.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,448.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1062.23,74,,,Percent of Total Billed Charges,74% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,990.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1205.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1177.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1277.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.3,77,,,Percent of total Billed charges,77% of total billed charges,1220.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,412.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,717.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,585.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1277.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,358.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.86,1277.55,
cloNIDine 0.1mg Tablet,228212710,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
cloNIDine 0.1mg Tablet,228212710,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
cloNIDine 0.1mg Tablet,228212710,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
cloNIDine 0.1mg Tablet,228212710,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
cloNIDine 0.1mg Tablet,228212710,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
cloNIDine 0.1mg Tablet,228212710,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
clonazePAM 0.5mg Tablet,43547040610,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
clonazePAM 0.5mg Tablet,43547040610,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
clonazePAM 0.5mg Tablet,43547040610,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
clonazePAM 0.5mg Tablet,43547040610,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
clonazePAM 0.5mg Tablet,43547040610,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
clonazePAM 0.5mg Tablet,43547040610,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
cloNIDine 0.1mg Topical Patch (7 Day),,,250,RC,,,Outpatient,,,162.13,81.07,,124.84,77,,,Percent of Total Billed Charges,77% of total billed charges,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.98,74,,,Percent of Total Billed Charges,74% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,136.19,84,,,Percent of Total Billed Charges,84% of total billed charges,132.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.3,89,,,Percent of total Billed Charges,89% of total Billed charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.84,77,,,Percent of total Billed charges,77% of total billed charges,137.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.53,144.3,
cloNIDine 0.1mg Topical Patch (7 Day),,,250,RC,,,Outpatient,,,162.13,81.07,,124.84,77,,,Percent of Total Billed Charges,77% of total billed charges,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.98,74,,,Percent of Total Billed Charges,74% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,136.19,84,,,Percent of Total Billed Charges,84% of total billed charges,132.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.3,89,,,Percent of total Billed Charges,89% of total Billed charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.84,77,,,Percent of total Billed charges,77% of total billed charges,137.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.53,144.3,
cloNIDine 0.1mg Topical Patch (7 Day),,,250,RC,,,Outpatient,,,162.13,81.07,,124.84,77,,,Percent of Total Billed Charges,77% of total billed charges,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.98,74,,,Percent of Total Billed Charges,74% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,136.19,84,,,Percent of Total Billed Charges,84% of total billed charges,132.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.3,89,,,Percent of total Billed Charges,89% of total Billed charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.84,77,,,Percent of total Billed charges,77% of total billed charges,137.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.53,144.3,
cloNIDine 0.1mg Topical Patch (7 Day),,,250,RC,,,Outpatient,,,162.13,81.07,,124.84,77,,,Percent of Total Billed Charges,77% of total billed charges,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.98,74,,,Percent of Total Billed Charges,74% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,136.19,84,,,Percent of Total Billed Charges,84% of total billed charges,132.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.3,89,,,Percent of total Billed Charges,89% of total Billed charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.84,77,,,Percent of total Billed charges,77% of total billed charges,137.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.53,144.3,
cloNIDine 0.1mg Topical Patch (7 Day),,,250,RC,,,Outpatient,,,162.13,81.07,,124.84,77,,,Percent of Total Billed Charges,77% of total billed charges,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.98,74,,,Percent of Total Billed Charges,74% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,136.19,84,,,Percent of Total Billed Charges,84% of total billed charges,132.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.3,89,,,Percent of total Billed Charges,89% of total Billed charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.84,77,,,Percent of total Billed charges,77% of total billed charges,137.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.53,144.3,
cloNIDine 0.1mg Topical Patch (7 Day),,,250,RC,,,Outpatient,,,162.13,81.07,,124.84,77,,,Percent of Total Billed Charges,77% of total billed charges,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.98,74,,,Percent of Total Billed Charges,74% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,111.87,69,,,Percent of Total Billed Charges,69% of total billed charges,136.19,84,,,Percent of Total Billed Charges,84% of total billed charges,132.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.3,89,,,Percent of total Billed Charges,89% of total Billed charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.84,77,,,Percent of total Billed charges,77% of total billed charges,137.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.53,144.3,
cloNIDine 0.2mg Topical Patch (7 Day),378087299,CDM,250,RC,,,Outpatient,,,197.14,98.57,,151.8,77,,,Percent of Total Billed Charges,77% of total billed charges,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.88,74,,,Percent of Total Billed Charges,74% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,84,,,Percent of Total Billed Charges,84% of total billed charges,161.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.45,89,,,Percent of total Billed Charges,89% of total Billed charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.8,77,,,Percent of total Billed charges,77% of total billed charges,167.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.29,175.45,
cloNIDine 0.2mg Topical Patch (7 Day),378087299,CDM,250,RC,,,Outpatient,,,197.14,98.57,,151.8,77,,,Percent of Total Billed Charges,77% of total billed charges,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.88,74,,,Percent of Total Billed Charges,74% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,84,,,Percent of Total Billed Charges,84% of total billed charges,161.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.45,89,,,Percent of total Billed Charges,89% of total Billed charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.8,77,,,Percent of total Billed charges,77% of total billed charges,167.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.29,175.45,
cloNIDine 0.2mg Topical Patch (7 Day),378087299,CDM,250,RC,,,Outpatient,,,197.14,98.57,,151.8,77,,,Percent of Total Billed Charges,77% of total billed charges,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.88,74,,,Percent of Total Billed Charges,74% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,84,,,Percent of Total Billed Charges,84% of total billed charges,161.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.45,89,,,Percent of total Billed Charges,89% of total Billed charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.8,77,,,Percent of total Billed charges,77% of total billed charges,167.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.29,175.45,
cloNIDine 0.2mg Topical Patch (7 Day),378087299,CDM,250,RC,,,Outpatient,,,197.14,98.57,,151.8,77,,,Percent of Total Billed Charges,77% of total billed charges,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.88,74,,,Percent of Total Billed Charges,74% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,84,,,Percent of Total Billed Charges,84% of total billed charges,161.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.45,89,,,Percent of total Billed Charges,89% of total Billed charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.8,77,,,Percent of total Billed charges,77% of total billed charges,167.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.29,175.45,
cloNIDine 0.2mg Topical Patch (7 Day),378087299,CDM,250,RC,,,Outpatient,,,197.14,98.57,,151.8,77,,,Percent of Total Billed Charges,77% of total billed charges,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.88,74,,,Percent of Total Billed Charges,74% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,84,,,Percent of Total Billed Charges,84% of total billed charges,161.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.45,89,,,Percent of total Billed Charges,89% of total Billed charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.8,77,,,Percent of total Billed charges,77% of total billed charges,167.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.29,175.45,
cloNIDine 0.2mg Topical Patch (7 Day),378087299,CDM,250,RC,,,Outpatient,,,197.14,98.57,,151.8,77,,,Percent of Total Billed Charges,77% of total billed charges,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,145.88,74,,,Percent of Total Billed Charges,74% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,136.03,69,,,Percent of Total Billed Charges,69% of total billed charges,165.6,84,,,Percent of Total Billed Charges,84% of total billed charges,161.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.45,89,,,Percent of total Billed Charges,89% of total Billed charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.8,77,,,Percent of total Billed charges,77% of total billed charges,167.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.29,175.45,
cloNIDine 0.3mg Topical Patch (7 Day),378087399,CDM,250,RC,,,Outpatient,,,271.52,135.76,,209.07,77,,,Percent of Total Billed Charges,77% of total billed charges,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.92,74,,,Percent of Total Billed Charges,74% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,228.08,84,,,Percent of Total Billed Charges,84% of total billed charges,222.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.65,89,,,Percent of total Billed Charges,89% of total Billed charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,77,,,Percent of total Billed charges,77% of total billed charges,230.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,241.65,
cloNIDine 0.3mg Topical Patch (7 Day),378087399,CDM,250,RC,,,Outpatient,,,271.52,135.76,,209.07,77,,,Percent of Total Billed Charges,77% of total billed charges,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.92,74,,,Percent of Total Billed Charges,74% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,228.08,84,,,Percent of Total Billed Charges,84% of total billed charges,222.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.65,89,,,Percent of total Billed Charges,89% of total Billed charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,77,,,Percent of total Billed charges,77% of total billed charges,230.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,241.65,
cloNIDine 0.3mg Topical Patch (7 Day),378087399,CDM,250,RC,,,Outpatient,,,271.52,135.76,,209.07,77,,,Percent of Total Billed Charges,77% of total billed charges,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.92,74,,,Percent of Total Billed Charges,74% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,228.08,84,,,Percent of Total Billed Charges,84% of total billed charges,222.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.65,89,,,Percent of total Billed Charges,89% of total Billed charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,77,,,Percent of total Billed charges,77% of total billed charges,230.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,241.65,
cloNIDine 0.3mg Topical Patch (7 Day),378087399,CDM,250,RC,,,Outpatient,,,271.52,135.76,,209.07,77,,,Percent of Total Billed Charges,77% of total billed charges,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.92,74,,,Percent of Total Billed Charges,74% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,228.08,84,,,Percent of Total Billed Charges,84% of total billed charges,222.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.65,89,,,Percent of total Billed Charges,89% of total Billed charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,77,,,Percent of total Billed charges,77% of total billed charges,230.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,241.65,
cloNIDine 0.3mg Topical Patch (7 Day),378087399,CDM,250,RC,,,Outpatient,,,271.52,135.76,,209.07,77,,,Percent of Total Billed Charges,77% of total billed charges,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.92,74,,,Percent of Total Billed Charges,74% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,228.08,84,,,Percent of Total Billed Charges,84% of total billed charges,222.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.65,89,,,Percent of total Billed Charges,89% of total Billed charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,77,,,Percent of total Billed charges,77% of total billed charges,230.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,241.65,
cloNIDine 0.3mg Topical Patch (7 Day),378087399,CDM,250,RC,,,Outpatient,,,271.52,135.76,,209.07,77,,,Percent of Total Billed Charges,77% of total billed charges,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.92,74,,,Percent of Total Billed Charges,74% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,187.35,69,,,Percent of Total Billed Charges,69% of total billed charges,228.08,84,,,Percent of Total Billed Charges,84% of total billed charges,222.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.65,89,,,Percent of total Billed Charges,89% of total Billed charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.07,77,,,Percent of total Billed charges,77% of total billed charges,230.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,78.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.88,241.65,
Clopidogrel 75mg Tablet,,,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Clopidogrel 75mg Tablet,,,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Clopidogrel 75mg Tablet,,,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Clopidogrel 75mg Tablet,,,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Clopidogrel 75mg Tablet,,,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Clopidogrel 75mg Tablet,,,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Clotrimazole 10mg Troche,54414622,CDM,250,RC,,,Outpatient,,,35.22,17.61,,27.12,77,,,Percent of Total Billed Charges,77% of total billed charges,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.06,74,,,Percent of Total Billed Charges,74% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,29.58,84,,,Percent of Total Billed Charges,84% of total billed charges,28.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.35,89,,,Percent of total Billed Charges,89% of total Billed charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.12,77,,,Percent of total Billed charges,77% of total billed charges,29.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.81,31.35,
Clotrimazole 10mg Troche,54414622,CDM,250,RC,,,Outpatient,,,35.22,17.61,,27.12,77,,,Percent of Total Billed Charges,77% of total billed charges,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.06,74,,,Percent of Total Billed Charges,74% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,29.58,84,,,Percent of Total Billed Charges,84% of total billed charges,28.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.35,89,,,Percent of total Billed Charges,89% of total Billed charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.12,77,,,Percent of total Billed charges,77% of total billed charges,29.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.81,31.35,
Clotrimazole 10mg Troche,54414622,CDM,250,RC,,,Outpatient,,,35.22,17.61,,27.12,77,,,Percent of Total Billed Charges,77% of total billed charges,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.06,74,,,Percent of Total Billed Charges,74% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,29.58,84,,,Percent of Total Billed Charges,84% of total billed charges,28.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.35,89,,,Percent of total Billed Charges,89% of total Billed charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.12,77,,,Percent of total Billed charges,77% of total billed charges,29.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.81,31.35,
Clotrimazole 10mg Troche,54414622,CDM,250,RC,,,Outpatient,,,35.22,17.61,,27.12,77,,,Percent of Total Billed Charges,77% of total billed charges,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.06,74,,,Percent of Total Billed Charges,74% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,29.58,84,,,Percent of Total Billed Charges,84% of total billed charges,28.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.35,89,,,Percent of total Billed Charges,89% of total Billed charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.12,77,,,Percent of total Billed charges,77% of total billed charges,29.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.81,31.35,
Clotrimazole 10mg Troche,54414622,CDM,250,RC,,,Outpatient,,,35.22,17.61,,27.12,77,,,Percent of Total Billed Charges,77% of total billed charges,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.06,74,,,Percent of Total Billed Charges,74% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,29.58,84,,,Percent of Total Billed Charges,84% of total billed charges,28.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.35,89,,,Percent of total Billed Charges,89% of total Billed charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.12,77,,,Percent of total Billed charges,77% of total billed charges,29.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.81,31.35,
Clotrimazole 10mg Troche,54414622,CDM,250,RC,,,Outpatient,,,35.22,17.61,,27.12,77,,,Percent of Total Billed Charges,77% of total billed charges,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.06,74,,,Percent of Total Billed Charges,74% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,69,,,Percent of Total Billed Charges,69% of total billed charges,29.58,84,,,Percent of Total Billed Charges,84% of total billed charges,28.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,31.35,89,,,Percent of total Billed Charges,89% of total Billed charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.12,77,,,Percent of total Billed charges,77% of total billed charges,29.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.81,31.35,
Clotrimazole/Betamethasone (Lotrisone) Cream 15gm,168025815,CDM,250,RC,,,Outpatient,,,143.66,71.83,,110.62,77,,,Percent of Total Billed Charges,77% of total billed charges,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.31,74,,,Percent of Total Billed Charges,74% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,120.67,84,,,Percent of Total Billed Charges,84% of total billed charges,117.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.86,89,,,Percent of total Billed Charges,89% of total Billed charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.62,77,,,Percent of total Billed charges,77% of total billed charges,122.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.92,127.86,
Clotrimazole/Betamethasone (Lotrisone) Cream 15gm,168025815,CDM,250,RC,,,Outpatient,,,143.66,71.83,,110.62,77,,,Percent of Total Billed Charges,77% of total billed charges,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.31,74,,,Percent of Total Billed Charges,74% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,120.67,84,,,Percent of Total Billed Charges,84% of total billed charges,117.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.86,89,,,Percent of total Billed Charges,89% of total Billed charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.62,77,,,Percent of total Billed charges,77% of total billed charges,122.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.92,127.86,
Clotrimazole/Betamethasone (Lotrisone) Cream 15gm,168025815,CDM,250,RC,,,Outpatient,,,143.66,71.83,,110.62,77,,,Percent of Total Billed Charges,77% of total billed charges,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.31,74,,,Percent of Total Billed Charges,74% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,120.67,84,,,Percent of Total Billed Charges,84% of total billed charges,117.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.86,89,,,Percent of total Billed Charges,89% of total Billed charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.62,77,,,Percent of total Billed charges,77% of total billed charges,122.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.92,127.86,
Clotrimazole/Betamethasone (Lotrisone) Cream 15gm,168025815,CDM,250,RC,,,Outpatient,,,143.66,71.83,,110.62,77,,,Percent of Total Billed Charges,77% of total billed charges,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.31,74,,,Percent of Total Billed Charges,74% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,120.67,84,,,Percent of Total Billed Charges,84% of total billed charges,117.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.86,89,,,Percent of total Billed Charges,89% of total Billed charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.62,77,,,Percent of total Billed charges,77% of total billed charges,122.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.92,127.86,
Clotrimazole/Betamethasone (Lotrisone) Cream 15gm,168025815,CDM,250,RC,,,Outpatient,,,143.66,71.83,,110.62,77,,,Percent of Total Billed Charges,77% of total billed charges,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.31,74,,,Percent of Total Billed Charges,74% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,120.67,84,,,Percent of Total Billed Charges,84% of total billed charges,117.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.86,89,,,Percent of total Billed Charges,89% of total Billed charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.62,77,,,Percent of total Billed charges,77% of total billed charges,122.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.92,127.86,
Clotrimazole/Betamethasone (Lotrisone) Cream 15gm,168025815,CDM,250,RC,,,Outpatient,,,143.66,71.83,,110.62,77,,,Percent of Total Billed Charges,77% of total billed charges,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,106.31,74,,,Percent of Total Billed Charges,74% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,99.13,69,,,Percent of Total Billed Charges,69% of total billed charges,120.67,84,,,Percent of Total Billed Charges,84% of total billed charges,117.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.86,89,,,Percent of total Billed Charges,89% of total Billed charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.62,77,,,Percent of total Billed charges,77% of total billed charges,122.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.92,127.86,
Clotrimazole 1 % Cream 30gm Tube,51672200202,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Clotrimazole 1 % Cream 30gm Tube,51672200202,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Clotrimazole 1 % Cream 30gm Tube,51672200202,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Clotrimazole 1 % Cream 30gm Tube,51672200202,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Clotrimazole 1 % Cream 30gm Tube,51672200202,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Clotrimazole 1 % Cream 30gm Tube,51672200202,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Cocaine 4% Topical Solution 4ml,64950036204,CDM,250,RC,,,Outpatient,,,849.07,424.54,,653.78,77,,,Percent of Total Billed Charges,77% of total billed charges,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.31,74,,,Percent of Total Billed Charges,74% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,713.22,84,,,Percent of Total Billed Charges,84% of total billed charges,696.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,755.67,89,,,Percent of total Billed Charges,89% of total Billed charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.78,77,,,Percent of total Billed charges,77% of total billed charges,721.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.27,755.67,
Cocaine 4% Topical Solution 4ml,64950036204,CDM,250,RC,,,Outpatient,,,849.07,424.54,,653.78,77,,,Percent of Total Billed Charges,77% of total billed charges,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.31,74,,,Percent of Total Billed Charges,74% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,713.22,84,,,Percent of Total Billed Charges,84% of total billed charges,696.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,755.67,89,,,Percent of total Billed Charges,89% of total Billed charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.78,77,,,Percent of total Billed charges,77% of total billed charges,721.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.27,755.67,
Cocaine 4% Topical Solution 4ml,64950036204,CDM,250,RC,,,Outpatient,,,849.07,424.54,,653.78,77,,,Percent of Total Billed Charges,77% of total billed charges,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.31,74,,,Percent of Total Billed Charges,74% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,713.22,84,,,Percent of Total Billed Charges,84% of total billed charges,696.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,755.67,89,,,Percent of total Billed Charges,89% of total Billed charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.78,77,,,Percent of total Billed charges,77% of total billed charges,721.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.27,755.67,
Cocaine 4% Topical Solution 4ml,64950036204,CDM,250,RC,,,Outpatient,,,849.07,424.54,,653.78,77,,,Percent of Total Billed Charges,77% of total billed charges,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.31,74,,,Percent of Total Billed Charges,74% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,713.22,84,,,Percent of Total Billed Charges,84% of total billed charges,696.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,755.67,89,,,Percent of total Billed Charges,89% of total Billed charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.78,77,,,Percent of total Billed charges,77% of total billed charges,721.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.27,755.67,
Cocaine 4% Topical Solution 4ml,64950036204,CDM,250,RC,,,Outpatient,,,849.07,424.54,,653.78,77,,,Percent of Total Billed Charges,77% of total billed charges,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.31,74,,,Percent of Total Billed Charges,74% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,713.22,84,,,Percent of Total Billed Charges,84% of total billed charges,696.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,755.67,89,,,Percent of total Billed Charges,89% of total Billed charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.78,77,,,Percent of total Billed charges,77% of total billed charges,721.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.27,755.67,
Cocaine 4% Topical Solution 4ml,64950036204,CDM,250,RC,,,Outpatient,,,849.07,424.54,,653.78,77,,,Percent of Total Billed Charges,77% of total billed charges,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.31,74,,,Percent of Total Billed Charges,74% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,585.86,69,,,Percent of Total Billed Charges,69% of total billed charges,713.22,84,,,Percent of Total Billed Charges,84% of total billed charges,696.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,755.67,89,,,Percent of total Billed Charges,89% of total Billed charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.78,77,,,Percent of total Billed charges,77% of total billed charges,721.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,755.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.27,755.67,
guaiFENesin+Codeine 200-20mg/10ml UDC,,,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
guaiFENesin+Codeine 200-20mg/10ml UDC,,,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
guaiFENesin+Codeine 200-20mg/10ml UDC,,,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
guaiFENesin+Codeine 200-20mg/10ml UDC,,,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
guaiFENesin+Codeine 200-20mg/10ml UDC,,,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
guaiFENesin+Codeine 200-20mg/10ml UDC,,,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Codeine 30mg Tablet,54024425,CDM,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Codeine 30mg Tablet,54024425,CDM,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Codeine 30mg Tablet,54024425,CDM,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Codeine 30mg Tablet,54024425,CDM,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Codeine 30mg Tablet,54024425,CDM,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Codeine 30mg Tablet,54024425,CDM,250,RC,,,Outpatient,,,13.73,6.87,,10.57,77,,,Percent of Total Billed Charges,77% of total billed charges,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.16,74,,,Percent of Total Billed Charges,74% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.47,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,84,,,Percent of Total Billed Charges,84% of total billed charges,11.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.22,89,,,Percent of total Billed Charges,89% of total Billed charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,77,,,Percent of total Billed charges,77% of total billed charges,11.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.43,12.22,
Colchicine 0.6mg Tablet,64764011907,CDM,250,RC,,,Outpatient,,,68.3,34.15,,52.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.54,74,,,Percent of Total Billed Charges,74% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,57.37,84,,,Percent of Total Billed Charges,84% of total billed charges,56.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.79,89,,,Percent of total Billed Charges,89% of total Billed charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.59,77,,,Percent of total Billed charges,77% of total billed charges,58.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.08,60.79,
Colchicine 0.6mg Tablet,64764011907,CDM,250,RC,,,Outpatient,,,68.3,34.15,,52.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.54,74,,,Percent of Total Billed Charges,74% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,57.37,84,,,Percent of Total Billed Charges,84% of total billed charges,56.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.79,89,,,Percent of total Billed Charges,89% of total Billed charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.59,77,,,Percent of total Billed charges,77% of total billed charges,58.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.08,60.79,
Colchicine 0.6mg Tablet,64764011907,CDM,250,RC,,,Outpatient,,,68.3,34.15,,52.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.54,74,,,Percent of Total Billed Charges,74% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,57.37,84,,,Percent of Total Billed Charges,84% of total billed charges,56.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.79,89,,,Percent of total Billed Charges,89% of total Billed charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.59,77,,,Percent of total Billed charges,77% of total billed charges,58.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.08,60.79,
Colchicine 0.6mg Tablet,64764011907,CDM,250,RC,,,Outpatient,,,68.3,34.15,,52.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.54,74,,,Percent of Total Billed Charges,74% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,57.37,84,,,Percent of Total Billed Charges,84% of total billed charges,56.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.79,89,,,Percent of total Billed Charges,89% of total Billed charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.59,77,,,Percent of total Billed charges,77% of total billed charges,58.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.08,60.79,
Colchicine 0.6mg Tablet,64764011907,CDM,250,RC,,,Outpatient,,,68.3,34.15,,52.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.54,74,,,Percent of Total Billed Charges,74% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,57.37,84,,,Percent of Total Billed Charges,84% of total billed charges,56.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.79,89,,,Percent of total Billed Charges,89% of total Billed charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.59,77,,,Percent of total Billed charges,77% of total billed charges,58.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.08,60.79,
Colchicine 0.6mg Tablet,64764011907,CDM,250,RC,,,Outpatient,,,68.3,34.15,,52.59,77,,,Percent of Total Billed Charges,77% of total billed charges,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.54,74,,,Percent of Total Billed Charges,74% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.13,69,,,Percent of Total Billed Charges,69% of total billed charges,57.37,84,,,Percent of Total Billed Charges,84% of total billed charges,56.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.79,89,,,Percent of total Billed Charges,89% of total Billed charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.59,77,,,Percent of total Billed charges,77% of total billed charges,58.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.08,60.79,
Collagenase 250 Units/gm Ointment 30 gm,50484001030,CDM,250,RC,,,Outpatient,,,1046.66,523.33,,805.93,77,,,Percent of Total Billed Charges,77% of total billed charges,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,774.53,74,,,Percent of Total Billed Charges,74% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,879.19,84,,,Percent of Total Billed Charges,84% of total billed charges,858.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,931.53,89,,,Percent of total Billed Charges,89% of total Billed charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,805.93,77,,,Percent of total Billed charges,77% of total billed charges,889.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,523.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.67,931.53,
Collagenase 250 Units/gm Ointment 30 gm,50484001030,CDM,250,RC,,,Outpatient,,,1046.66,523.33,,805.93,77,,,Percent of Total Billed Charges,77% of total billed charges,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,774.53,74,,,Percent of Total Billed Charges,74% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,879.19,84,,,Percent of Total Billed Charges,84% of total billed charges,858.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,931.53,89,,,Percent of total Billed Charges,89% of total Billed charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,805.93,77,,,Percent of total Billed charges,77% of total billed charges,889.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,523.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.67,931.53,
Collagenase 250 Units/gm Ointment 30 gm,50484001030,CDM,250,RC,,,Outpatient,,,1046.66,523.33,,805.93,77,,,Percent of Total Billed Charges,77% of total billed charges,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,774.53,74,,,Percent of Total Billed Charges,74% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,879.19,84,,,Percent of Total Billed Charges,84% of total billed charges,858.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,931.53,89,,,Percent of total Billed Charges,89% of total Billed charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,805.93,77,,,Percent of total Billed charges,77% of total billed charges,889.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,523.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.67,931.53,
Collagenase 250 Units/gm Ointment 30 gm,50484001030,CDM,250,RC,,,Outpatient,,,1046.66,523.33,,805.93,77,,,Percent of Total Billed Charges,77% of total billed charges,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,774.53,74,,,Percent of Total Billed Charges,74% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,879.19,84,,,Percent of Total Billed Charges,84% of total billed charges,858.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,931.53,89,,,Percent of total Billed Charges,89% of total Billed charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,805.93,77,,,Percent of total Billed charges,77% of total billed charges,889.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,523.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.67,931.53,
Collagenase 250 Units/gm Ointment 30 gm,50484001030,CDM,250,RC,,,Outpatient,,,1046.66,523.33,,805.93,77,,,Percent of Total Billed Charges,77% of total billed charges,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,774.53,74,,,Percent of Total Billed Charges,74% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,879.19,84,,,Percent of Total Billed Charges,84% of total billed charges,858.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,931.53,89,,,Percent of total Billed Charges,89% of total Billed charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,805.93,77,,,Percent of total Billed charges,77% of total billed charges,889.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,523.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.67,931.53,
Collagenase 250 Units/gm Ointment 30 gm,50484001030,CDM,250,RC,,,Outpatient,,,1046.66,523.33,,805.93,77,,,Percent of Total Billed Charges,77% of total billed charges,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,327.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,774.53,74,,,Percent of Total Billed Charges,74% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,722.2,69,,,Percent of Total Billed Charges,69% of total billed charges,879.19,84,,,Percent of Total Billed Charges,84% of total billed charges,858.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,931.53,89,,,Percent of total Billed Charges,89% of total Billed charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,805.93,77,,,Percent of total Billed charges,77% of total billed charges,889.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,300.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,523.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,427.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,931.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.67,931.53,
Copper 1 each IUD,59365512801,CDM,250,RC,,,Outpatient,,,5202.67,2601.34,,4006.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3849.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4370.24,84,,,Percent of Total Billed Charges,84% of total billed charges,4266.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,4630.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4006.06,77,,,Percent of total Billed charges,77% of total billed charges,4422.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2601.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.67,4630.38,
Copper 1 each IUD,59365512801,CDM,250,RC,,,Outpatient,,,5202.67,2601.34,,4006.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3849.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4370.24,84,,,Percent of Total Billed Charges,84% of total billed charges,4266.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,4630.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4006.06,77,,,Percent of total Billed charges,77% of total billed charges,4422.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2601.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.67,4630.38,
Copper 1 each IUD,59365512801,CDM,250,RC,,,Outpatient,,,5202.67,2601.34,,4006.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3849.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4370.24,84,,,Percent of Total Billed Charges,84% of total billed charges,4266.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,4630.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4006.06,77,,,Percent of total Billed charges,77% of total billed charges,4422.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2601.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.67,4630.38,
Copper 1 each IUD,59365512801,CDM,250,RC,,,Outpatient,,,5202.67,2601.34,,4006.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3849.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4370.24,84,,,Percent of Total Billed Charges,84% of total billed charges,4266.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,4630.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4006.06,77,,,Percent of total Billed charges,77% of total billed charges,4422.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2601.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.67,4630.38,
Copper 1 each IUD,59365512801,CDM,250,RC,,,Outpatient,,,5202.67,2601.34,,4006.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3849.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4370.24,84,,,Percent of Total Billed Charges,84% of total billed charges,4266.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,4630.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4006.06,77,,,Percent of total Billed charges,77% of total billed charges,4422.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2601.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.67,4630.38,
Copper 1 each IUD,59365512801,CDM,250,RC,,,Outpatient,,,5202.67,2601.34,,4006.06,77,,,Percent of Total Billed Charges,77% of total billed charges,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1625.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3849.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3589.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4370.24,84,,,Percent of Total Billed Charges,84% of total billed charges,4266.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,4630.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4006.06,77,,,Percent of total Billed charges,77% of total billed charges,4422.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1495.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2601.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2122.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4630.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1300.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1300.67,4630.38,
Cosyntropin 0.25mg SDV,67457022702,CDM,250,RC,,,Outpatient,,,511.32,255.66,,393.72,77,,,Percent of Total Billed Charges,77% of total billed charges,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.38,74,,,Percent of Total Billed Charges,74% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,429.51,84,,,Percent of Total Billed Charges,84% of total billed charges,419.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,455.07,89,,,Percent of total Billed Charges,89% of total Billed charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.72,77,,,Percent of total Billed charges,77% of total billed charges,434.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.83,455.07,
Cosyntropin 0.25mg SDV,67457022702,CDM,250,RC,,,Outpatient,,,511.32,255.66,,393.72,77,,,Percent of Total Billed Charges,77% of total billed charges,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.38,74,,,Percent of Total Billed Charges,74% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,429.51,84,,,Percent of Total Billed Charges,84% of total billed charges,419.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,455.07,89,,,Percent of total Billed Charges,89% of total Billed charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.72,77,,,Percent of total Billed charges,77% of total billed charges,434.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.83,455.07,
Cosyntropin 0.25mg SDV,67457022702,CDM,250,RC,,,Outpatient,,,511.32,255.66,,393.72,77,,,Percent of Total Billed Charges,77% of total billed charges,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.38,74,,,Percent of Total Billed Charges,74% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,429.51,84,,,Percent of Total Billed Charges,84% of total billed charges,419.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,455.07,89,,,Percent of total Billed Charges,89% of total Billed charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.72,77,,,Percent of total Billed charges,77% of total billed charges,434.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.83,455.07,
Cosyntropin 0.25mg SDV,67457022702,CDM,250,RC,,,Outpatient,,,511.32,255.66,,393.72,77,,,Percent of Total Billed Charges,77% of total billed charges,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.38,74,,,Percent of Total Billed Charges,74% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,429.51,84,,,Percent of Total Billed Charges,84% of total billed charges,419.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,455.07,89,,,Percent of total Billed Charges,89% of total Billed charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.72,77,,,Percent of total Billed charges,77% of total billed charges,434.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.83,455.07,
Cosyntropin 0.25mg SDV,67457022702,CDM,250,RC,,,Outpatient,,,511.32,255.66,,393.72,77,,,Percent of Total Billed Charges,77% of total billed charges,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.38,74,,,Percent of Total Billed Charges,74% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,429.51,84,,,Percent of Total Billed Charges,84% of total billed charges,419.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,455.07,89,,,Percent of total Billed Charges,89% of total Billed charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.72,77,,,Percent of total Billed charges,77% of total billed charges,434.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.83,455.07,
Cosyntropin 0.25mg SDV,67457022702,CDM,250,RC,,,Outpatient,,,511.32,255.66,,393.72,77,,,Percent of Total Billed Charges,77% of total billed charges,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.38,74,,,Percent of Total Billed Charges,74% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,352.81,69,,,Percent of Total Billed Charges,69% of total billed charges,429.51,84,,,Percent of Total Billed Charges,84% of total billed charges,419.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,455.07,89,,,Percent of total Billed Charges,89% of total Billed charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.72,77,,,Percent of total Billed charges,77% of total billed charges,434.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,147,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,455.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.83,455.07,
Cyanocobalamin (Vitamin B-12) 1000mcg Tablet,11845006935,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cyanocobalamin (Vitamin B-12) 1000mcg Tablet,11845006935,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cyanocobalamin (Vitamin B-12) 1000mcg Tablet,11845006935,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cyanocobalamin (Vitamin B-12) 1000mcg Tablet,11845006935,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cyanocobalamin (Vitamin B-12) 1000mcg Tablet,11845006935,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cyanocobalamin (Vitamin B-12) 1000mcg Tablet,11845006935,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Cyanocobalamin (Vitamin B-12) 1000mcg MDV,517003125,CDM,250,RC,,,Outpatient,,,97.49,48.75,,75.07,77,,,Percent of Total Billed Charges,77% of total billed charges,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.14,74,,,Percent of Total Billed Charges,74% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,81.89,84,,,Percent of Total Billed Charges,84% of total billed charges,79.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.77,89,,,Percent of total Billed Charges,89% of total Billed charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.07,77,,,Percent of total Billed charges,77% of total billed charges,82.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.37,86.77,
Cyanocobalamin (Vitamin B-12) 1000mcg MDV,517003125,CDM,250,RC,,,Outpatient,,,97.49,48.75,,75.07,77,,,Percent of Total Billed Charges,77% of total billed charges,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.14,74,,,Percent of Total Billed Charges,74% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,81.89,84,,,Percent of Total Billed Charges,84% of total billed charges,79.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.77,89,,,Percent of total Billed Charges,89% of total Billed charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.07,77,,,Percent of total Billed charges,77% of total billed charges,82.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.37,86.77,
Cyanocobalamin (Vitamin B-12) 1000mcg MDV,517003125,CDM,250,RC,,,Outpatient,,,97.49,48.75,,75.07,77,,,Percent of Total Billed Charges,77% of total billed charges,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.14,74,,,Percent of Total Billed Charges,74% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,81.89,84,,,Percent of Total Billed Charges,84% of total billed charges,79.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.77,89,,,Percent of total Billed Charges,89% of total Billed charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.07,77,,,Percent of total Billed charges,77% of total billed charges,82.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.37,86.77,
Cyanocobalamin (Vitamin B-12) 1000mcg MDV,517003125,CDM,250,RC,,,Outpatient,,,97.49,48.75,,75.07,77,,,Percent of Total Billed Charges,77% of total billed charges,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.14,74,,,Percent of Total Billed Charges,74% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,81.89,84,,,Percent of Total Billed Charges,84% of total billed charges,79.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.77,89,,,Percent of total Billed Charges,89% of total Billed charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.07,77,,,Percent of total Billed charges,77% of total billed charges,82.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.37,86.77,
Cyanocobalamin (Vitamin B-12) 1000mcg MDV,517003125,CDM,250,RC,,,Outpatient,,,97.49,48.75,,75.07,77,,,Percent of Total Billed Charges,77% of total billed charges,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.14,74,,,Percent of Total Billed Charges,74% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,81.89,84,,,Percent of Total Billed Charges,84% of total billed charges,79.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.77,89,,,Percent of total Billed Charges,89% of total Billed charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.07,77,,,Percent of total Billed charges,77% of total billed charges,82.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.37,86.77,
Cyanocobalamin (Vitamin B-12) 1000mcg MDV,517003125,CDM,250,RC,,,Outpatient,,,97.49,48.75,,75.07,77,,,Percent of Total Billed Charges,77% of total billed charges,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.14,74,,,Percent of Total Billed Charges,74% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,67.27,69,,,Percent of Total Billed Charges,69% of total billed charges,81.89,84,,,Percent of Total Billed Charges,84% of total billed charges,79.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.77,89,,,Percent of total Billed Charges,89% of total Billed charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.07,77,,,Percent of total Billed charges,77% of total billed charges,82.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.37,86.77,
Cyclobenzaprine 10mg Tablet,69097084607,CDM,250,RC,,,Outpatient,,,15.89,7.95,,12.24,77,,,Percent of Total Billed Charges,77% of total billed charges,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.76,74,,,Percent of Total Billed Charges,74% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.35,84,,,Percent of Total Billed Charges,84% of total billed charges,13.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.14,89,,,Percent of total Billed Charges,89% of total Billed charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,77,,,Percent of total Billed charges,77% of total billed charges,13.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,14.14,
Cyclobenzaprine 10mg Tablet,69097084607,CDM,250,RC,,,Outpatient,,,15.89,7.95,,12.24,77,,,Percent of Total Billed Charges,77% of total billed charges,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.76,74,,,Percent of Total Billed Charges,74% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.35,84,,,Percent of Total Billed Charges,84% of total billed charges,13.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.14,89,,,Percent of total Billed Charges,89% of total Billed charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,77,,,Percent of total Billed charges,77% of total billed charges,13.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,14.14,
Cyclobenzaprine 10mg Tablet,69097084607,CDM,250,RC,,,Outpatient,,,15.89,7.95,,12.24,77,,,Percent of Total Billed Charges,77% of total billed charges,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.76,74,,,Percent of Total Billed Charges,74% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.35,84,,,Percent of Total Billed Charges,84% of total billed charges,13.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.14,89,,,Percent of total Billed Charges,89% of total Billed charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,77,,,Percent of total Billed charges,77% of total billed charges,13.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,14.14,
Cyclobenzaprine 10mg Tablet,69097084607,CDM,250,RC,,,Outpatient,,,15.89,7.95,,12.24,77,,,Percent of Total Billed Charges,77% of total billed charges,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.76,74,,,Percent of Total Billed Charges,74% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.35,84,,,Percent of Total Billed Charges,84% of total billed charges,13.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.14,89,,,Percent of total Billed Charges,89% of total Billed charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,77,,,Percent of total Billed charges,77% of total billed charges,13.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,14.14,
Cyclobenzaprine 10mg Tablet,69097084607,CDM,250,RC,,,Outpatient,,,15.89,7.95,,12.24,77,,,Percent of Total Billed Charges,77% of total billed charges,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.76,74,,,Percent of Total Billed Charges,74% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.35,84,,,Percent of Total Billed Charges,84% of total billed charges,13.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.14,89,,,Percent of total Billed Charges,89% of total Billed charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,77,,,Percent of total Billed charges,77% of total billed charges,13.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,14.14,
Cyclobenzaprine 10mg Tablet,69097084607,CDM,250,RC,,,Outpatient,,,15.89,7.95,,12.24,77,,,Percent of Total Billed Charges,77% of total billed charges,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.76,74,,,Percent of Total Billed Charges,74% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.35,84,,,Percent of Total Billed Charges,84% of total billed charges,13.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.14,89,,,Percent of total Billed Charges,89% of total Billed charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.24,77,,,Percent of total Billed charges,77% of total billed charges,13.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,14.14,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2406.4,1203.2,,1852.93,77,,,Percent of Total Billed Charges,77% of total billed charges,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1780.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2021.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1973.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2141.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1852.93,77,,,Percent of total Billed charges,77% of total billed charges,2045.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1203.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.6,2141.7,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2348.8,1174.4,,1808.58,77,,,Percent of Total Billed Charges,77% of total billed charges,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1738.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,84,,,Percent of Total Billed Charges,84% of total billed charges,1926.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.58,77,,,Percent of total Billed charges,77% of total billed charges,1996.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,675.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1174.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.2,2090.43,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2406.4,1203.2,,1852.93,77,,,Percent of Total Billed Charges,77% of total billed charges,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1780.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2021.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1973.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2141.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1852.93,77,,,Percent of total Billed charges,77% of total billed charges,2045.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1203.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.6,2141.7,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2348.8,1174.4,,1808.58,77,,,Percent of Total Billed Charges,77% of total billed charges,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1738.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,84,,,Percent of Total Billed Charges,84% of total billed charges,1926.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.58,77,,,Percent of total Billed charges,77% of total billed charges,1996.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,675.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1174.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.2,2090.43,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2406.4,1203.2,,1852.93,77,,,Percent of Total Billed Charges,77% of total billed charges,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1780.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2021.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1973.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2141.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1852.93,77,,,Percent of total Billed charges,77% of total billed charges,2045.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1203.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.6,2141.7,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2348.8,1174.4,,1808.58,77,,,Percent of Total Billed Charges,77% of total billed charges,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1738.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,84,,,Percent of Total Billed Charges,84% of total billed charges,1926.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.58,77,,,Percent of total Billed charges,77% of total billed charges,1996.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,675.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1174.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.2,2090.43,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2406.4,1203.2,,1852.93,77,,,Percent of Total Billed Charges,77% of total billed charges,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1780.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2021.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1973.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2141.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1852.93,77,,,Percent of total Billed charges,77% of total billed charges,2045.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1203.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.6,2141.7,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2348.8,1174.4,,1808.58,77,,,Percent of Total Billed Charges,77% of total billed charges,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1738.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,84,,,Percent of Total Billed Charges,84% of total billed charges,1926.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.58,77,,,Percent of total Billed charges,77% of total billed charges,1996.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,675.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1174.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.2,2090.43,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2406.4,1203.2,,1852.93,77,,,Percent of Total Billed Charges,77% of total billed charges,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1780.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2021.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1973.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2141.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1852.93,77,,,Percent of total Billed charges,77% of total billed charges,2045.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1203.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.6,2141.7,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2348.8,1174.4,,1808.58,77,,,Percent of Total Billed Charges,77% of total billed charges,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1738.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,84,,,Percent of Total Billed Charges,84% of total billed charges,1926.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.58,77,,,Percent of total Billed charges,77% of total billed charges,1996.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,675.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1174.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.2,2090.43,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2406.4,1203.2,,1852.93,77,,,Percent of Total Billed Charges,77% of total billed charges,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,613.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1780.74,74,,,Percent of Total Billed Charges,74% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1660.42,69,,,Percent of Total Billed Charges,69% of total billed charges,2021.38,84,,,Percent of Total Billed Charges,84% of total billed charges,1973.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,2141.7,89,,,Percent of total Billed Charges,89% of total Billed charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1852.93,77,,,Percent of total Billed charges,77% of total billed charges,2045.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,691.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1203.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,981.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2141.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,601.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.6,2141.7,
cycloPHOSphamide 1000mg/50ml Powder SDV,10019095601,CDM,250,RC,,,Outpatient,,,2348.8,1174.4,,1808.58,77,,,Percent of Total Billed Charges,77% of total billed charges,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,734,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1738.11,74,,,Percent of Total Billed Charges,74% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1620.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1972.99,84,,,Percent of Total Billed Charges,84% of total billed charges,1926.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2090.43,89,,,Percent of total Billed Charges,89% of total Billed charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.58,77,,,Percent of total Billed charges,77% of total billed charges,1996.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,675.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1174.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,958.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2090.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,587.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.2,2090.43,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4580.45,2290.23,,3526.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1431.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3389.53,74,,,Percent of Total Billed Charges,74% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3847.58,84,,,Percent of Total Billed Charges,84% of total billed charges,3755.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4076.6,89,,,Percent of total Billed Charges,89% of total Billed charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3526.95,77,,,Percent of total Billed charges,77% of total billed charges,3893.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1316.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2290.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1145.11,4076.6,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4466.62,2233.31,,3439.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1395.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3305.3,74,,,Percent of Total Billed Charges,74% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3751.96,84,,,Percent of Total Billed Charges,84% of total billed charges,3662.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,3975.29,89,,,Percent of total Billed Charges,89% of total Billed charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3439.3,77,,,Percent of total Billed charges,77% of total billed charges,3796.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1284.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2233.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.66,3975.29,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4580.45,2290.23,,3526.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1431.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3389.53,74,,,Percent of Total Billed Charges,74% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3847.58,84,,,Percent of Total Billed Charges,84% of total billed charges,3755.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4076.6,89,,,Percent of total Billed Charges,89% of total Billed charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3526.95,77,,,Percent of total Billed charges,77% of total billed charges,3893.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1316.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2290.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1145.11,4076.6,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4466.62,2233.31,,3439.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1395.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3305.3,74,,,Percent of Total Billed Charges,74% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3751.96,84,,,Percent of Total Billed Charges,84% of total billed charges,3662.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,3975.29,89,,,Percent of total Billed Charges,89% of total Billed charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3439.3,77,,,Percent of total Billed charges,77% of total billed charges,3796.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1284.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2233.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.66,3975.29,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4580.45,2290.23,,3526.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1431.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3389.53,74,,,Percent of Total Billed Charges,74% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3847.58,84,,,Percent of Total Billed Charges,84% of total billed charges,3755.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4076.6,89,,,Percent of total Billed Charges,89% of total Billed charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3526.95,77,,,Percent of total Billed charges,77% of total billed charges,3893.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1316.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2290.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1145.11,4076.6,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4466.62,2233.31,,3439.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1395.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3305.3,74,,,Percent of Total Billed Charges,74% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3751.96,84,,,Percent of Total Billed Charges,84% of total billed charges,3662.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,3975.29,89,,,Percent of total Billed Charges,89% of total Billed charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3439.3,77,,,Percent of total Billed charges,77% of total billed charges,3796.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1284.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2233.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.66,3975.29,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4580.45,2290.23,,3526.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1431.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3389.53,74,,,Percent of Total Billed Charges,74% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3847.58,84,,,Percent of Total Billed Charges,84% of total billed charges,3755.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4076.6,89,,,Percent of total Billed Charges,89% of total Billed charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3526.95,77,,,Percent of total Billed charges,77% of total billed charges,3893.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1316.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2290.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1145.11,4076.6,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4466.62,2233.31,,3439.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1395.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3305.3,74,,,Percent of Total Billed Charges,74% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3751.96,84,,,Percent of Total Billed Charges,84% of total billed charges,3662.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,3975.29,89,,,Percent of total Billed Charges,89% of total Billed charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3439.3,77,,,Percent of total Billed charges,77% of total billed charges,3796.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1284.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2233.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.66,3975.29,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4580.45,2290.23,,3526.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1431.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3389.53,74,,,Percent of Total Billed Charges,74% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3847.58,84,,,Percent of Total Billed Charges,84% of total billed charges,3755.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4076.6,89,,,Percent of total Billed Charges,89% of total Billed charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3526.95,77,,,Percent of total Billed charges,77% of total billed charges,3893.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1316.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2290.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1145.11,4076.6,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4466.62,2233.31,,3439.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1395.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3305.3,74,,,Percent of Total Billed Charges,74% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3751.96,84,,,Percent of Total Billed Charges,84% of total billed charges,3662.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,3975.29,89,,,Percent of total Billed Charges,89% of total Billed charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3439.3,77,,,Percent of total Billed charges,77% of total billed charges,3796.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1284.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2233.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.66,3975.29,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4580.45,2290.23,,3526.95,77,,,Percent of Total Billed Charges,77% of total billed charges,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1168.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1431.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3389.53,74,,,Percent of Total Billed Charges,74% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3160.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3847.58,84,,,Percent of Total Billed Charges,84% of total billed charges,3755.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4076.6,89,,,Percent of total Billed Charges,89% of total Billed charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3526.95,77,,,Percent of total Billed charges,77% of total billed charges,3893.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1316.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2290.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1868.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4076.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1145.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1145.11,4076.6,
cycloPHOSphamide 2000mg/100ml Powder SDV,10019095701,CDM,250,RC,,,Outpatient,,,4466.62,2233.31,,3439.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1138.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1395.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3305.3,74,,,Percent of Total Billed Charges,74% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3081.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3751.96,84,,,Percent of Total Billed Charges,84% of total billed charges,3662.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,3975.29,89,,,Percent of total Billed Charges,89% of total Billed charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3439.3,77,,,Percent of total Billed charges,77% of total billed charges,3796.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1284.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2233.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1822.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3975.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1116.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.66,3975.29,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2766.34,1383.17,,2130.08,77,,,Percent of Total Billed Charges,77% of total billed charges,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2047.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2323.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2268.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2462.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.08,77,,,Percent of total Billed charges,77% of total billed charges,2351.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1383.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.59,2462.04,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2699.42,1349.71,,2078.55,77,,,Percent of Total Billed Charges,77% of total billed charges,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1997.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.51,84,,,Percent of Total Billed Charges,84% of total billed charges,2213.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,2402.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.55,77,,,Percent of total Billed charges,77% of total billed charges,2294.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1349.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.86,2402.48,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2766.34,1383.17,,2130.08,77,,,Percent of Total Billed Charges,77% of total billed charges,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2047.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2323.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2268.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2462.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.08,77,,,Percent of total Billed charges,77% of total billed charges,2351.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1383.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.59,2462.04,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2699.42,1349.71,,2078.55,77,,,Percent of Total Billed Charges,77% of total billed charges,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1997.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.51,84,,,Percent of Total Billed Charges,84% of total billed charges,2213.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,2402.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.55,77,,,Percent of total Billed charges,77% of total billed charges,2294.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1349.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.86,2402.48,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2766.34,1383.17,,2130.08,77,,,Percent of Total Billed Charges,77% of total billed charges,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2047.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2323.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2268.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2462.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.08,77,,,Percent of total Billed charges,77% of total billed charges,2351.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1383.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.59,2462.04,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2699.42,1349.71,,2078.55,77,,,Percent of Total Billed Charges,77% of total billed charges,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1997.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.51,84,,,Percent of Total Billed Charges,84% of total billed charges,2213.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,2402.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.55,77,,,Percent of total Billed charges,77% of total billed charges,2294.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1349.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.86,2402.48,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2766.34,1383.17,,2130.08,77,,,Percent of Total Billed Charges,77% of total billed charges,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2047.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2323.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2268.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2462.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.08,77,,,Percent of total Billed charges,77% of total billed charges,2351.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1383.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.59,2462.04,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2699.42,1349.71,,2078.55,77,,,Percent of Total Billed Charges,77% of total billed charges,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1997.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.51,84,,,Percent of Total Billed Charges,84% of total billed charges,2213.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,2402.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.55,77,,,Percent of total Billed charges,77% of total billed charges,2294.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1349.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.86,2402.48,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2766.34,1383.17,,2130.08,77,,,Percent of Total Billed Charges,77% of total billed charges,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2047.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2323.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2268.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2462.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.08,77,,,Percent of total Billed charges,77% of total billed charges,2351.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1383.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.59,2462.04,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2699.42,1349.71,,2078.55,77,,,Percent of Total Billed Charges,77% of total billed charges,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1997.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.51,84,,,Percent of Total Billed Charges,84% of total billed charges,2213.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,2402.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.55,77,,,Percent of total Billed charges,77% of total billed charges,2294.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1349.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.86,2402.48,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2766.34,1383.17,,2130.08,77,,,Percent of Total Billed Charges,77% of total billed charges,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,705.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,864.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2047.09,74,,,Percent of Total Billed Charges,74% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1908.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2323.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2268.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,2462.04,89,,,Percent of total Billed Charges,89% of total Billed charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2130.08,77,,,Percent of total Billed charges,77% of total billed charges,2351.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,795.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1383.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1128.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2462.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,691.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,691.59,2462.04,
cycloPHOSphamide 500mg/25ml Powder SDV,10019095501,CDM,250,RC,,,Outpatient,,,2699.42,1349.71,,2078.55,77,,,Percent of Total Billed Charges,77% of total billed charges,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,688.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,843.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1997.57,74,,,Percent of Total Billed Charges,74% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,1862.6,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.51,84,,,Percent of Total Billed Charges,84% of total billed charges,2213.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,2402.48,89,,,Percent of total Billed Charges,89% of total Billed charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2078.55,77,,,Percent of total Billed charges,77% of total billed charges,2294.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,776.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1349.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1101.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2402.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,674.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,674.86,2402.48,
Cyclopentolate 1% OPHTH Soln 5ml,65039605,CDM,250,RC,,,Outpatient,,,214.02,107.01,,164.8,77,,,Percent of Total Billed Charges,77% of total billed charges,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.37,74,,,Percent of Total Billed Charges,74% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,179.78,84,,,Percent of Total Billed Charges,84% of total billed charges,175.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.48,89,,,Percent of total Billed Charges,89% of total Billed charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.8,77,,,Percent of total Billed charges,77% of total billed charges,181.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.51,190.48,
Cyclopentolate 1% OPHTH Soln 5ml,65039605,CDM,250,RC,,,Outpatient,,,214.02,107.01,,164.8,77,,,Percent of Total Billed Charges,77% of total billed charges,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.37,74,,,Percent of Total Billed Charges,74% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,179.78,84,,,Percent of Total Billed Charges,84% of total billed charges,175.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.48,89,,,Percent of total Billed Charges,89% of total Billed charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.8,77,,,Percent of total Billed charges,77% of total billed charges,181.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.51,190.48,
Cyclopentolate 1% OPHTH Soln 5ml,65039605,CDM,250,RC,,,Outpatient,,,214.02,107.01,,164.8,77,,,Percent of Total Billed Charges,77% of total billed charges,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.37,74,,,Percent of Total Billed Charges,74% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,179.78,84,,,Percent of Total Billed Charges,84% of total billed charges,175.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.48,89,,,Percent of total Billed Charges,89% of total Billed charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.8,77,,,Percent of total Billed charges,77% of total billed charges,181.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.51,190.48,
Cyclopentolate 1% OPHTH Soln 5ml,65039605,CDM,250,RC,,,Outpatient,,,214.02,107.01,,164.8,77,,,Percent of Total Billed Charges,77% of total billed charges,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.37,74,,,Percent of Total Billed Charges,74% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,179.78,84,,,Percent of Total Billed Charges,84% of total billed charges,175.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.48,89,,,Percent of total Billed Charges,89% of total Billed charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.8,77,,,Percent of total Billed charges,77% of total billed charges,181.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.51,190.48,
Cyclopentolate 1% OPHTH Soln 5ml,65039605,CDM,250,RC,,,Outpatient,,,214.02,107.01,,164.8,77,,,Percent of Total Billed Charges,77% of total billed charges,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.37,74,,,Percent of Total Billed Charges,74% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,179.78,84,,,Percent of Total Billed Charges,84% of total billed charges,175.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.48,89,,,Percent of total Billed Charges,89% of total Billed charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.8,77,,,Percent of total Billed charges,77% of total billed charges,181.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.51,190.48,
Cyclopentolate 1% OPHTH Soln 5ml,65039605,CDM,250,RC,,,Outpatient,,,214.02,107.01,,164.8,77,,,Percent of Total Billed Charges,77% of total billed charges,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,158.37,74,,,Percent of Total Billed Charges,74% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,147.67,69,,,Percent of Total Billed Charges,69% of total billed charges,179.78,84,,,Percent of Total Billed Charges,84% of total billed charges,175.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,190.48,89,,,Percent of total Billed Charges,89% of total Billed charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.8,77,,,Percent of total Billed charges,77% of total billed charges,181.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.51,190.48,
Cyproheptadine 4mg Tablet,,,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Cyproheptadine 4mg Tablet,,,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Cyproheptadine 4mg Tablet,,,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Cyproheptadine 4mg Tablet,,,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Cyproheptadine 4mg Tablet,,,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Cyproheptadine 4mg Tablet,,,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3144.03,1572.02,,2420.9,77,,,Percent of Total Billed Charges,77% of total billed charges,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,982.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2326.58,74,,,Percent of Total Billed Charges,74% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2640.99,84,,,Percent of Total Billed Charges,84% of total billed charges,2578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,2798.19,89,,,Percent of total Billed Charges,89% of total Billed charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.9,77,,,Percent of total Billed charges,77% of total billed charges,2672.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,903.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1572.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.01,2798.19,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3066.58,1533.29,,2361.27,77,,,Percent of Total Billed Charges,77% of total billed charges,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2269.27,74,,,Percent of Total Billed Charges,74% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2575.93,84,,,Percent of Total Billed Charges,84% of total billed charges,2514.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,2729.26,89,,,Percent of total Billed Charges,89% of total Billed charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2361.27,77,,,Percent of total Billed charges,77% of total billed charges,2606.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,881.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1533.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.65,2729.26,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3144.03,1572.02,,2420.9,77,,,Percent of Total Billed Charges,77% of total billed charges,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,982.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2326.58,74,,,Percent of Total Billed Charges,74% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2640.99,84,,,Percent of Total Billed Charges,84% of total billed charges,2578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,2798.19,89,,,Percent of total Billed Charges,89% of total Billed charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.9,77,,,Percent of total Billed charges,77% of total billed charges,2672.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,903.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1572.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.01,2798.19,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3066.58,1533.29,,2361.27,77,,,Percent of Total Billed Charges,77% of total billed charges,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2269.27,74,,,Percent of Total Billed Charges,74% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2575.93,84,,,Percent of Total Billed Charges,84% of total billed charges,2514.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,2729.26,89,,,Percent of total Billed Charges,89% of total Billed charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2361.27,77,,,Percent of total Billed charges,77% of total billed charges,2606.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,881.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1533.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.65,2729.26,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3144.03,1572.02,,2420.9,77,,,Percent of Total Billed Charges,77% of total billed charges,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,982.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2326.58,74,,,Percent of Total Billed Charges,74% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2640.99,84,,,Percent of Total Billed Charges,84% of total billed charges,2578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,2798.19,89,,,Percent of total Billed Charges,89% of total Billed charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.9,77,,,Percent of total Billed charges,77% of total billed charges,2672.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,903.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1572.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.01,2798.19,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3066.58,1533.29,,2361.27,77,,,Percent of Total Billed Charges,77% of total billed charges,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2269.27,74,,,Percent of Total Billed Charges,74% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2575.93,84,,,Percent of Total Billed Charges,84% of total billed charges,2514.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,2729.26,89,,,Percent of total Billed Charges,89% of total Billed charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2361.27,77,,,Percent of total Billed charges,77% of total billed charges,2606.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,881.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1533.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.65,2729.26,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3144.03,1572.02,,2420.9,77,,,Percent of Total Billed Charges,77% of total billed charges,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,982.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2326.58,74,,,Percent of Total Billed Charges,74% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2640.99,84,,,Percent of Total Billed Charges,84% of total billed charges,2578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,2798.19,89,,,Percent of total Billed Charges,89% of total Billed charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.9,77,,,Percent of total Billed charges,77% of total billed charges,2672.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,903.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1572.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.01,2798.19,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3066.58,1533.29,,2361.27,77,,,Percent of Total Billed Charges,77% of total billed charges,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2269.27,74,,,Percent of Total Billed Charges,74% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2575.93,84,,,Percent of Total Billed Charges,84% of total billed charges,2514.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,2729.26,89,,,Percent of total Billed Charges,89% of total Billed charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2361.27,77,,,Percent of total Billed charges,77% of total billed charges,2606.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,881.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1533.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.65,2729.26,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3144.03,1572.02,,2420.9,77,,,Percent of Total Billed Charges,77% of total billed charges,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,982.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2326.58,74,,,Percent of Total Billed Charges,74% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2640.99,84,,,Percent of Total Billed Charges,84% of total billed charges,2578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,2798.19,89,,,Percent of total Billed Charges,89% of total Billed charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.9,77,,,Percent of total Billed charges,77% of total billed charges,2672.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,903.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1572.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.01,2798.19,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3066.58,1533.29,,2361.27,77,,,Percent of Total Billed Charges,77% of total billed charges,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2269.27,74,,,Percent of Total Billed Charges,74% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2575.93,84,,,Percent of Total Billed Charges,84% of total billed charges,2514.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,2729.26,89,,,Percent of total Billed Charges,89% of total Billed charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2361.27,77,,,Percent of total Billed charges,77% of total billed charges,2606.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,881.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1533.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.65,2729.26,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3144.03,1572.02,,2420.9,77,,,Percent of Total Billed Charges,77% of total billed charges,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,801.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,982.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2326.58,74,,,Percent of Total Billed Charges,74% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2169.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2640.99,84,,,Percent of Total Billed Charges,84% of total billed charges,2578.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,2798.19,89,,,Percent of total Billed Charges,89% of total Billed charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2420.9,77,,,Percent of total Billed charges,77% of total billed charges,2672.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,903.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1572.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1282.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2798.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,786.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,786.01,2798.19,
Cytarabine 1000mg/50ml (20mg/ml) PF Liquid SDV,61703030346,CDM,250,RC,,,Outpatient,,,3066.58,1533.29,,2361.27,77,,,Percent of Total Billed Charges,77% of total billed charges,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,781.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,958.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2269.27,74,,,Percent of Total Billed Charges,74% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2575.93,84,,,Percent of Total Billed Charges,84% of total billed charges,2514.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,2729.26,89,,,Percent of total Billed Charges,89% of total Billed charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2361.27,77,,,Percent of total Billed charges,77% of total billed charges,2606.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,881.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1533.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1251.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2729.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,766.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,766.65,2729.26,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2296.6,1148.3,,1768.38,77,,,Percent of Total Billed Charges,77% of total billed charges,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1699.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,2043.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1768.38,77,,,Percent of total Billed charges,77% of total billed charges,1952.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1148.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.15,2043.97,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2241.07,1120.54,,1725.62,77,,,Percent of Total Billed Charges,77% of total billed charges,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1658.39,74,,,Percent of Total Billed Charges,74% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1837.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1994.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1725.62,77,,,Percent of total Billed charges,77% of total billed charges,1904.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1120.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.27,1994.55,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2296.6,1148.3,,1768.38,77,,,Percent of Total Billed Charges,77% of total billed charges,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1699.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,2043.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1768.38,77,,,Percent of total Billed charges,77% of total billed charges,1952.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1148.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.15,2043.97,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2241.07,1120.54,,1725.62,77,,,Percent of Total Billed Charges,77% of total billed charges,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1658.39,74,,,Percent of Total Billed Charges,74% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1837.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1994.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1725.62,77,,,Percent of total Billed charges,77% of total billed charges,1904.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1120.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.27,1994.55,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2296.6,1148.3,,1768.38,77,,,Percent of Total Billed Charges,77% of total billed charges,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1699.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,2043.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1768.38,77,,,Percent of total Billed charges,77% of total billed charges,1952.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1148.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.15,2043.97,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2241.07,1120.54,,1725.62,77,,,Percent of Total Billed Charges,77% of total billed charges,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1658.39,74,,,Percent of Total Billed Charges,74% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1837.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1994.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1725.62,77,,,Percent of total Billed charges,77% of total billed charges,1904.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1120.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.27,1994.55,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2296.6,1148.3,,1768.38,77,,,Percent of Total Billed Charges,77% of total billed charges,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1699.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,2043.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1768.38,77,,,Percent of total Billed charges,77% of total billed charges,1952.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1148.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.15,2043.97,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2241.07,1120.54,,1725.62,77,,,Percent of Total Billed Charges,77% of total billed charges,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1658.39,74,,,Percent of Total Billed Charges,74% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1837.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1994.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1725.62,77,,,Percent of total Billed charges,77% of total billed charges,1904.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1120.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.27,1994.55,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2296.6,1148.3,,1768.38,77,,,Percent of Total Billed Charges,77% of total billed charges,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1699.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,2043.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1768.38,77,,,Percent of total Billed charges,77% of total billed charges,1952.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1148.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.15,2043.97,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2241.07,1120.54,,1725.62,77,,,Percent of Total Billed Charges,77% of total billed charges,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1658.39,74,,,Percent of Total Billed Charges,74% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1837.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1994.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1725.62,77,,,Percent of total Billed charges,77% of total billed charges,1904.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1120.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.27,1994.55,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2296.6,1148.3,,1768.38,77,,,Percent of Total Billed Charges,77% of total billed charges,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1699.48,74,,,Percent of Total Billed Charges,74% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1584.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1929.14,84,,,Percent of Total Billed Charges,84% of total billed charges,1883.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,2043.97,89,,,Percent of total Billed Charges,89% of total Billed charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1768.38,77,,,Percent of total Billed charges,77% of total billed charges,1952.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,660.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1148.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,937.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2043.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,574.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,574.15,2043.97,
Cytarabine 2000mg/20ml (100mg/ml) PF Liquid SDV,61703031922,CDM,250,RC,,,Outpatient,,,2241.07,1120.54,,1725.62,77,,,Percent of Total Billed Charges,77% of total billed charges,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,571.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1658.39,74,,,Percent of Total Billed Charges,74% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1546.34,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.5,84,,,Percent of Total Billed Charges,84% of total billed charges,1837.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,1994.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1725.62,77,,,Percent of total Billed charges,77% of total billed charges,1904.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,644.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1120.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,914.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1994.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,560.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,560.27,1994.55,
miSOPROStol 25mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 25mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 25mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 25mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 25mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 25mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 50mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 50mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 50mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 50mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 50mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 50mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
Dabigatran 75mg Capsule,597035556,CDM,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Dabigatran 75mg Capsule,597035556,CDM,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Dabigatran 75mg Capsule,597035556,CDM,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Dabigatran 75mg Capsule,597035556,CDM,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Dabigatran 75mg Capsule,597035556,CDM,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Dabigatran 75mg Capsule,597035556,CDM,250,RC,,,Outpatient,,,36.06,18.03,,27.77,77,,,Percent of Total Billed Charges,77% of total billed charges,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.68,74,,,Percent of Total Billed Charges,74% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,24.88,69,,,Percent of Total Billed Charges,69% of total billed charges,30.29,84,,,Percent of Total Billed Charges,84% of total billed charges,29.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.09,89,,,Percent of total Billed Charges,89% of total Billed charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.77,77,,,Percent of total Billed charges,77% of total billed charges,30.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.02,32.09,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,913.29,456.65,,703.23,77,,,Percent of Total Billed Charges,77% of total billed charges,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,675.83,74,,,Percent of Total Billed Charges,74% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,767.16,84,,,Percent of Total Billed Charges,84% of total billed charges,748.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,812.83,89,,,Percent of total Billed Charges,89% of total Billed charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.23,77,,,Percent of total Billed charges,77% of total billed charges,776.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,456.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.32,812.83,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,894.3,447.15,,688.61,77,,,Percent of Total Billed Charges,77% of total billed charges,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,661.78,74,,,Percent of Total Billed Charges,74% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,751.21,84,,,Percent of Total Billed Charges,84% of total billed charges,733.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,795.93,89,,,Percent of total Billed Charges,89% of total Billed charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.61,77,,,Percent of total Billed charges,77% of total billed charges,760.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,447.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.58,795.93,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,913.29,456.65,,703.23,77,,,Percent of Total Billed Charges,77% of total billed charges,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,675.83,74,,,Percent of Total Billed Charges,74% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,767.16,84,,,Percent of Total Billed Charges,84% of total billed charges,748.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,812.83,89,,,Percent of total Billed Charges,89% of total Billed charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.23,77,,,Percent of total Billed charges,77% of total billed charges,776.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,456.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.32,812.83,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,894.3,447.15,,688.61,77,,,Percent of Total Billed Charges,77% of total billed charges,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,661.78,74,,,Percent of Total Billed Charges,74% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,751.21,84,,,Percent of Total Billed Charges,84% of total billed charges,733.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,795.93,89,,,Percent of total Billed Charges,89% of total Billed charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.61,77,,,Percent of total Billed charges,77% of total billed charges,760.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,447.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.58,795.93,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,913.29,456.65,,703.23,77,,,Percent of Total Billed Charges,77% of total billed charges,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,675.83,74,,,Percent of Total Billed Charges,74% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,767.16,84,,,Percent of Total Billed Charges,84% of total billed charges,748.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,812.83,89,,,Percent of total Billed Charges,89% of total Billed charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.23,77,,,Percent of total Billed charges,77% of total billed charges,776.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,456.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.32,812.83,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,894.3,447.15,,688.61,77,,,Percent of Total Billed Charges,77% of total billed charges,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,661.78,74,,,Percent of Total Billed Charges,74% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,751.21,84,,,Percent of Total Billed Charges,84% of total billed charges,733.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,795.93,89,,,Percent of total Billed Charges,89% of total Billed charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.61,77,,,Percent of total Billed charges,77% of total billed charges,760.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,447.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.58,795.93,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,913.29,456.65,,703.23,77,,,Percent of Total Billed Charges,77% of total billed charges,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,675.83,74,,,Percent of Total Billed Charges,74% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,767.16,84,,,Percent of Total Billed Charges,84% of total billed charges,748.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,812.83,89,,,Percent of total Billed Charges,89% of total Billed charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.23,77,,,Percent of total Billed charges,77% of total billed charges,776.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,456.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.32,812.83,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,894.3,447.15,,688.61,77,,,Percent of Total Billed Charges,77% of total billed charges,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,661.78,74,,,Percent of Total Billed Charges,74% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,751.21,84,,,Percent of Total Billed Charges,84% of total billed charges,733.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,795.93,89,,,Percent of total Billed Charges,89% of total Billed charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.61,77,,,Percent of total Billed charges,77% of total billed charges,760.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,447.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.58,795.93,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,913.29,456.65,,703.23,77,,,Percent of Total Billed Charges,77% of total billed charges,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,675.83,74,,,Percent of Total Billed Charges,74% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,767.16,84,,,Percent of Total Billed Charges,84% of total billed charges,748.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,812.83,89,,,Percent of total Billed Charges,89% of total Billed charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.23,77,,,Percent of total Billed charges,77% of total billed charges,776.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,456.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.32,812.83,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,894.3,447.15,,688.61,77,,,Percent of Total Billed Charges,77% of total billed charges,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,661.78,74,,,Percent of Total Billed Charges,74% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,751.21,84,,,Percent of Total Billed Charges,84% of total billed charges,733.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,795.93,89,,,Percent of total Billed Charges,89% of total Billed charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.61,77,,,Percent of total Billed charges,77% of total billed charges,760.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,447.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.58,795.93,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,913.29,456.65,,703.23,77,,,Percent of Total Billed Charges,77% of total billed charges,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,232.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,285.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,675.83,74,,,Percent of Total Billed Charges,74% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,630.17,69,,,Percent of Total Billed Charges,69% of total billed charges,767.16,84,,,Percent of Total Billed Charges,84% of total billed charges,748.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,812.83,89,,,Percent of total Billed Charges,89% of total Billed charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,703.23,77,,,Percent of total Billed charges,77% of total billed charges,776.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,262.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,456.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,372.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,812.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,228.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.32,812.83,
Dacarbazine 100mg/10ml Powder SDV,63323012710,CDM,250,RC,,,Outpatient,,,894.3,447.15,,688.61,77,,,Percent of Total Billed Charges,77% of total billed charges,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,228.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,279.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,661.78,74,,,Percent of Total Billed Charges,74% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.07,69,,,Percent of Total Billed Charges,69% of total billed charges,751.21,84,,,Percent of Total Billed Charges,84% of total billed charges,733.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,795.93,89,,,Percent of total Billed Charges,89% of total Billed charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,688.61,77,,,Percent of total Billed charges,77% of total billed charges,760.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,257.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,447.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,364.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,795.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.58,795.93,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,890.17,445.09,,685.43,77,,,Percent of Total Billed Charges,77% of total billed charges,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,658.73,74,,,Percent of Total Billed Charges,74% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,747.74,84,,,Percent of Total Billed Charges,84% of total billed charges,729.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,792.25,89,,,Percent of total Billed Charges,89% of total Billed charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.43,77,,,Percent of total Billed charges,77% of total billed charges,756.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,445.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.54,792.25,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,871.78,435.89,,671.27,77,,,Percent of Total Billed Charges,77% of total billed charges,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.12,74,,,Percent of Total Billed Charges,74% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,732.3,84,,,Percent of Total Billed Charges,84% of total billed charges,714.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,775.88,89,,,Percent of total Billed Charges,89% of total Billed charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.27,77,,,Percent of total Billed charges,77% of total billed charges,741.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.95,775.88,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,890.17,445.09,,685.43,77,,,Percent of Total Billed Charges,77% of total billed charges,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,658.73,74,,,Percent of Total Billed Charges,74% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,747.74,84,,,Percent of Total Billed Charges,84% of total billed charges,729.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,792.25,89,,,Percent of total Billed Charges,89% of total Billed charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.43,77,,,Percent of total Billed charges,77% of total billed charges,756.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,445.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.54,792.25,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,871.78,435.89,,671.27,77,,,Percent of Total Billed Charges,77% of total billed charges,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.12,74,,,Percent of Total Billed Charges,74% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,732.3,84,,,Percent of Total Billed Charges,84% of total billed charges,714.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,775.88,89,,,Percent of total Billed Charges,89% of total Billed charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.27,77,,,Percent of total Billed charges,77% of total billed charges,741.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.95,775.88,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,890.17,445.09,,685.43,77,,,Percent of Total Billed Charges,77% of total billed charges,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,658.73,74,,,Percent of Total Billed Charges,74% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,747.74,84,,,Percent of Total Billed Charges,84% of total billed charges,729.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,792.25,89,,,Percent of total Billed Charges,89% of total Billed charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.43,77,,,Percent of total Billed charges,77% of total billed charges,756.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,445.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.54,792.25,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,871.78,435.89,,671.27,77,,,Percent of Total Billed Charges,77% of total billed charges,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.12,74,,,Percent of Total Billed Charges,74% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,732.3,84,,,Percent of Total Billed Charges,84% of total billed charges,714.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,775.88,89,,,Percent of total Billed Charges,89% of total Billed charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.27,77,,,Percent of total Billed charges,77% of total billed charges,741.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.95,775.88,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,890.17,445.09,,685.43,77,,,Percent of Total Billed Charges,77% of total billed charges,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,658.73,74,,,Percent of Total Billed Charges,74% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,747.74,84,,,Percent of Total Billed Charges,84% of total billed charges,729.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,792.25,89,,,Percent of total Billed Charges,89% of total Billed charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.43,77,,,Percent of total Billed charges,77% of total billed charges,756.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,445.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.54,792.25,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,871.78,435.89,,671.27,77,,,Percent of Total Billed Charges,77% of total billed charges,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.12,74,,,Percent of Total Billed Charges,74% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,732.3,84,,,Percent of Total Billed Charges,84% of total billed charges,714.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,775.88,89,,,Percent of total Billed Charges,89% of total Billed charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.27,77,,,Percent of total Billed charges,77% of total billed charges,741.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.95,775.88,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,890.17,445.09,,685.43,77,,,Percent of Total Billed Charges,77% of total billed charges,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,658.73,74,,,Percent of Total Billed Charges,74% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,747.74,84,,,Percent of Total Billed Charges,84% of total billed charges,729.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,792.25,89,,,Percent of total Billed Charges,89% of total Billed charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.43,77,,,Percent of total Billed charges,77% of total billed charges,756.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,445.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.54,792.25,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,871.78,435.89,,671.27,77,,,Percent of Total Billed Charges,77% of total billed charges,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.12,74,,,Percent of Total Billed Charges,74% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,732.3,84,,,Percent of Total Billed Charges,84% of total billed charges,714.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,775.88,89,,,Percent of total Billed Charges,89% of total Billed charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.27,77,,,Percent of total Billed charges,77% of total billed charges,741.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.95,775.88,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,890.17,445.09,,685.43,77,,,Percent of Total Billed Charges,77% of total billed charges,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,226.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,278.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,658.73,74,,,Percent of Total Billed Charges,74% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,614.22,69,,,Percent of Total Billed Charges,69% of total billed charges,747.74,84,,,Percent of Total Billed Charges,84% of total billed charges,729.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,792.25,89,,,Percent of total Billed Charges,89% of total Billed charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,685.43,77,,,Percent of total Billed charges,77% of total billed charges,756.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,255.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,445.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,363.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,792.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.54,792.25,
Dacarbazine 200mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,871.78,435.89,,671.27,77,,,Percent of Total Billed Charges,77% of total billed charges,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.12,74,,,Percent of Total Billed Charges,74% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,601.53,69,,,Percent of Total Billed Charges,69% of total billed charges,732.3,84,,,Percent of Total Billed Charges,84% of total billed charges,714.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,775.88,89,,,Percent of total Billed Charges,89% of total Billed charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.27,77,,,Percent of total Billed charges,77% of total billed charges,741.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,775.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.95,775.88,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,7964.96,3982.48,,6133.02,77,,,Percent of Total Billed Charges,77% of total billed charges,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2489.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5894.07,74,,,Percent of Total Billed Charges,74% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6690.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6531.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,7088.81,89,,,Percent of total Billed Charges,89% of total Billed charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6133.02,77,,,Percent of total Billed charges,77% of total billed charges,6770.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2289.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3982.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1991.24,7088.81,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,8295.16,4147.58,,6387.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2592.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6138.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6967.93,84,,,Percent of Total Billed Charges,84% of total billed charges,6802.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7382.69,89,,,Percent of total Billed Charges,89% of total Billed charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6387.27,77,,,Percent of total Billed charges,77% of total billed charges,7050.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2384.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4147.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2073.79,7382.69,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,7964.96,3982.48,,6133.02,77,,,Percent of Total Billed Charges,77% of total billed charges,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2489.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5894.07,74,,,Percent of Total Billed Charges,74% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6690.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6531.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,7088.81,89,,,Percent of total Billed Charges,89% of total Billed charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6133.02,77,,,Percent of total Billed charges,77% of total billed charges,6770.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2289.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3982.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1991.24,7088.81,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,8295.16,4147.58,,6387.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2592.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6138.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6967.93,84,,,Percent of Total Billed Charges,84% of total billed charges,6802.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7382.69,89,,,Percent of total Billed Charges,89% of total Billed charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6387.27,77,,,Percent of total Billed charges,77% of total billed charges,7050.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2384.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4147.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2073.79,7382.69,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,7964.96,3982.48,,6133.02,77,,,Percent of Total Billed Charges,77% of total billed charges,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2489.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5894.07,74,,,Percent of Total Billed Charges,74% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6690.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6531.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,7088.81,89,,,Percent of total Billed Charges,89% of total Billed charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6133.02,77,,,Percent of total Billed charges,77% of total billed charges,6770.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2289.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3982.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1991.24,7088.81,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,8295.16,4147.58,,6387.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2592.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6138.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6967.93,84,,,Percent of Total Billed Charges,84% of total billed charges,6802.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7382.69,89,,,Percent of total Billed Charges,89% of total Billed charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6387.27,77,,,Percent of total Billed charges,77% of total billed charges,7050.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2384.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4147.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2073.79,7382.69,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,7964.96,3982.48,,6133.02,77,,,Percent of Total Billed Charges,77% of total billed charges,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2489.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5894.07,74,,,Percent of Total Billed Charges,74% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6690.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6531.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,7088.81,89,,,Percent of total Billed Charges,89% of total Billed charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6133.02,77,,,Percent of total Billed charges,77% of total billed charges,6770.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2289.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3982.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1991.24,7088.81,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,8295.16,4147.58,,6387.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2592.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6138.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6967.93,84,,,Percent of Total Billed Charges,84% of total billed charges,6802.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7382.69,89,,,Percent of total Billed Charges,89% of total Billed charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6387.27,77,,,Percent of total Billed charges,77% of total billed charges,7050.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2384.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4147.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2073.79,7382.69,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,7964.96,3982.48,,6133.02,77,,,Percent of Total Billed Charges,77% of total billed charges,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2489.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5894.07,74,,,Percent of Total Billed Charges,74% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6690.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6531.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,7088.81,89,,,Percent of total Billed Charges,89% of total Billed charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6133.02,77,,,Percent of total Billed charges,77% of total billed charges,6770.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2289.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3982.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1991.24,7088.81,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,8295.16,4147.58,,6387.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2592.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6138.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6967.93,84,,,Percent of Total Billed Charges,84% of total billed charges,6802.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7382.69,89,,,Percent of total Billed Charges,89% of total Billed charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6387.27,77,,,Percent of total Billed charges,77% of total billed charges,7050.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2384.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4147.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2073.79,7382.69,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,7964.96,3982.48,,6133.02,77,,,Percent of Total Billed Charges,77% of total billed charges,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2031.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2489.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5894.07,74,,,Percent of Total Billed Charges,74% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,5495.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6690.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6531.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,7088.81,89,,,Percent of total Billed Charges,89% of total Billed charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6133.02,77,,,Percent of total Billed charges,77% of total billed charges,6770.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2289.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3982.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3249.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7088.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1991.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1991.24,7088.81,
Dalbavancin 500mg SDV,57970010001,CDM,250,RC,,,Outpatient,,,8295.16,4147.58,,6387.27,77,,,Percent of Total Billed Charges,77% of total billed charges,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2115.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2592.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6138.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,5723.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6967.93,84,,,Percent of Total Billed Charges,84% of total billed charges,6802.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7382.69,89,,,Percent of total Billed Charges,89% of total Billed charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6387.27,77,,,Percent of total Billed charges,77% of total billed charges,7050.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2384.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4147.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3384.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7382.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2073.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2073.79,7382.69,
Dantrolene 20mg SDV (OR),42023012306,CDM,250,RC,,,Outpatient,,,434.84,217.42,,334.83,77,,,Percent of Total Billed Charges,77% of total billed charges,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.78,74,,,Percent of Total Billed Charges,74% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,365.27,84,,,Percent of Total Billed Charges,84% of total billed charges,356.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.01,89,,,Percent of total Billed Charges,89% of total Billed charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.83,77,,,Percent of total Billed charges,77% of total billed charges,369.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.71,387.01,
Dantrolene 20mg SDV (OR),42023012306,CDM,250,RC,,,Outpatient,,,434.84,217.42,,334.83,77,,,Percent of Total Billed Charges,77% of total billed charges,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.78,74,,,Percent of Total Billed Charges,74% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,365.27,84,,,Percent of Total Billed Charges,84% of total billed charges,356.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.01,89,,,Percent of total Billed Charges,89% of total Billed charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.83,77,,,Percent of total Billed charges,77% of total billed charges,369.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.71,387.01,
Dantrolene 20mg SDV (OR),42023012306,CDM,250,RC,,,Outpatient,,,434.84,217.42,,334.83,77,,,Percent of Total Billed Charges,77% of total billed charges,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.78,74,,,Percent of Total Billed Charges,74% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,365.27,84,,,Percent of Total Billed Charges,84% of total billed charges,356.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.01,89,,,Percent of total Billed Charges,89% of total Billed charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.83,77,,,Percent of total Billed charges,77% of total billed charges,369.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.71,387.01,
Dantrolene 20mg SDV (OR),42023012306,CDM,250,RC,,,Outpatient,,,434.84,217.42,,334.83,77,,,Percent of Total Billed Charges,77% of total billed charges,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.78,74,,,Percent of Total Billed Charges,74% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,365.27,84,,,Percent of Total Billed Charges,84% of total billed charges,356.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.01,89,,,Percent of total Billed Charges,89% of total Billed charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.83,77,,,Percent of total Billed charges,77% of total billed charges,369.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.71,387.01,
Dantrolene 20mg SDV (OR),42023012306,CDM,250,RC,,,Outpatient,,,434.84,217.42,,334.83,77,,,Percent of Total Billed Charges,77% of total billed charges,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.78,74,,,Percent of Total Billed Charges,74% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,365.27,84,,,Percent of Total Billed Charges,84% of total billed charges,356.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.01,89,,,Percent of total Billed Charges,89% of total Billed charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.83,77,,,Percent of total Billed charges,77% of total billed charges,369.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.71,387.01,
Dantrolene 20mg SDV (OR),42023012306,CDM,250,RC,,,Outpatient,,,434.84,217.42,,334.83,77,,,Percent of Total Billed Charges,77% of total billed charges,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,321.78,74,,,Percent of Total Billed Charges,74% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,300.04,69,,,Percent of Total Billed Charges,69% of total billed charges,365.27,84,,,Percent of Total Billed Charges,84% of total billed charges,356.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,387.01,89,,,Percent of total Billed Charges,89% of total Billed charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.83,77,,,Percent of total Billed charges,77% of total billed charges,369.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,125.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,217.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,177.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,387.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.71,387.01,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 350mg SDV,25021017915,CDM,250,RC,,,Outpatient,,,423.79,211.9,,326.32,77,,,Percent of Total Billed Charges,77% of total billed charges,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,313.6,74,,,Percent of Total Billed Charges,74% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,292.42,69,,,Percent of Total Billed Charges,69% of total billed charges,355.98,84,,,Percent of Total Billed Charges,84% of total billed charges,347.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,377.17,89,,,Percent of total Billed Charges,89% of total Billed charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,326.32,77,,,Percent of total Billed charges,77% of total billed charges,360.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,121.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,211.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,172.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.95,377.17,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
DAPTOmycin 500mg SDV,25021017415,CDM,250,RC,,,Outpatient,,,195.63,97.82,,150.64,77,,,Percent of Total Billed Charges,77% of total billed charges,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.77,74,,,Percent of Total Billed Charges,74% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,134.98,69,,,Percent of Total Billed Charges,69% of total billed charges,164.33,84,,,Percent of Total Billed Charges,84% of total billed charges,160.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.11,89,,,Percent of total Billed Charges,89% of total Billed charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.64,77,,,Percent of total Billed charges,77% of total billed charges,166.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.91,174.11,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5344.17,2672.09,,4115.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1670.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3954.69,74,,,Percent of Total Billed Charges,74% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4489.1,84,,,Percent of Total Billed Charges,84% of total billed charges,4382.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4756.31,89,,,Percent of total Billed Charges,89% of total Billed charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4115.01,77,,,Percent of total Billed charges,77% of total billed charges,4542.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1536.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2672.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.04,4756.31,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5209.82,2604.91,,4011.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1628.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3855.27,74,,,Percent of Total Billed Charges,74% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4376.25,84,,,Percent of Total Billed Charges,84% of total billed charges,4272.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,4636.74,89,,,Percent of total Billed Charges,89% of total Billed charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4011.56,77,,,Percent of total Billed charges,77% of total billed charges,4428.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1497.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2604.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1302.46,4636.74,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5344.17,2672.09,,4115.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1670.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3954.69,74,,,Percent of Total Billed Charges,74% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4489.1,84,,,Percent of Total Billed Charges,84% of total billed charges,4382.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4756.31,89,,,Percent of total Billed Charges,89% of total Billed charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4115.01,77,,,Percent of total Billed charges,77% of total billed charges,4542.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1536.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2672.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.04,4756.31,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5209.82,2604.91,,4011.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1628.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3855.27,74,,,Percent of Total Billed Charges,74% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4376.25,84,,,Percent of Total Billed Charges,84% of total billed charges,4272.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,4636.74,89,,,Percent of total Billed Charges,89% of total Billed charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4011.56,77,,,Percent of total Billed charges,77% of total billed charges,4428.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1497.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2604.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1302.46,4636.74,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5344.17,2672.09,,4115.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1670.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3954.69,74,,,Percent of Total Billed Charges,74% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4489.1,84,,,Percent of Total Billed Charges,84% of total billed charges,4382.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4756.31,89,,,Percent of total Billed Charges,89% of total Billed charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4115.01,77,,,Percent of total Billed charges,77% of total billed charges,4542.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1536.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2672.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.04,4756.31,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5209.82,2604.91,,4011.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1628.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3855.27,74,,,Percent of Total Billed Charges,74% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4376.25,84,,,Percent of Total Billed Charges,84% of total billed charges,4272.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,4636.74,89,,,Percent of total Billed Charges,89% of total Billed charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4011.56,77,,,Percent of total Billed charges,77% of total billed charges,4428.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1497.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2604.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1302.46,4636.74,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5344.17,2672.09,,4115.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1670.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3954.69,74,,,Percent of Total Billed Charges,74% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4489.1,84,,,Percent of Total Billed Charges,84% of total billed charges,4382.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4756.31,89,,,Percent of total Billed Charges,89% of total Billed charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4115.01,77,,,Percent of total Billed charges,77% of total billed charges,4542.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1536.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2672.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.04,4756.31,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5209.82,2604.91,,4011.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1628.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3855.27,74,,,Percent of Total Billed Charges,74% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4376.25,84,,,Percent of Total Billed Charges,84% of total billed charges,4272.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,4636.74,89,,,Percent of total Billed Charges,89% of total Billed charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4011.56,77,,,Percent of total Billed charges,77% of total billed charges,4428.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1497.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2604.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1302.46,4636.74,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5344.17,2672.09,,4115.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1670.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3954.69,74,,,Percent of Total Billed Charges,74% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4489.1,84,,,Percent of Total Billed Charges,84% of total billed charges,4382.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4756.31,89,,,Percent of total Billed Charges,89% of total Billed charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4115.01,77,,,Percent of total Billed charges,77% of total billed charges,4542.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1536.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2672.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.04,4756.31,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5209.82,2604.91,,4011.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1628.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3855.27,74,,,Percent of Total Billed Charges,74% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4376.25,84,,,Percent of Total Billed Charges,84% of total billed charges,4272.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,4636.74,89,,,Percent of total Billed Charges,89% of total Billed charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4011.56,77,,,Percent of total Billed charges,77% of total billed charges,4428.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1497.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2604.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1302.46,4636.74,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5344.17,2672.09,,4115.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1362.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1670.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3954.69,74,,,Percent of Total Billed Charges,74% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,3687.48,69,,,Percent of Total Billed Charges,69% of total billed charges,4489.1,84,,,Percent of Total Billed Charges,84% of total billed charges,4382.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4756.31,89,,,Percent of total Billed Charges,89% of total Billed charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4115.01,77,,,Percent of total Billed charges,77% of total billed charges,4542.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1536.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2672.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2180.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4756.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1336.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1336.04,4756.31,
Daratumumab (Darzalex) 100mg/5ml Liquid SDV,57894050205,CDM,250,RC,,,Outpatient,,,5209.82,2604.91,,4011.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1328.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1628.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3855.27,74,,,Percent of Total Billed Charges,74% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3594.78,69,,,Percent of Total Billed Charges,69% of total billed charges,4376.25,84,,,Percent of Total Billed Charges,84% of total billed charges,4272.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,4636.74,89,,,Percent of total Billed Charges,89% of total Billed charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4011.56,77,,,Percent of total Billed charges,77% of total billed charges,4428.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1497.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2604.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2125.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4636.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1302.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1302.46,4636.74,
Daratumumab-Hyalur-FIHJ (Darzalex Faspro) 1800mg/15ml SDV,57894050301,CDM,250,RC,,,Outpatient,,,47700.87,23850.44,,36729.67,77,,,Percent of Total Billed Charges,77% of total billed charges,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14906.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35298.64,74,,,Percent of Total Billed Charges,74% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,40068.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,42453.77,89,,,Percent of total Billed Charges,89% of total Billed charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36729.67,77,,,Percent of total Billed charges,77% of total billed charges,40545.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13714,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23850.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11925.22,42453.77,
Daratumumab-Hyalur-FIHJ (Darzalex Faspro) 1800mg/15ml SDV,57894050301,CDM,250,RC,,,Outpatient,,,47700.87,23850.44,,36729.67,77,,,Percent of Total Billed Charges,77% of total billed charges,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14906.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35298.64,74,,,Percent of Total Billed Charges,74% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,40068.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,42453.77,89,,,Percent of total Billed Charges,89% of total Billed charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36729.67,77,,,Percent of total Billed charges,77% of total billed charges,40545.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13714,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23850.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11925.22,42453.77,
Daratumumab-Hyalur-FIHJ (Darzalex Faspro) 1800mg/15ml SDV,57894050301,CDM,250,RC,,,Outpatient,,,47700.87,23850.44,,36729.67,77,,,Percent of Total Billed Charges,77% of total billed charges,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14906.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35298.64,74,,,Percent of Total Billed Charges,74% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,40068.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,42453.77,89,,,Percent of total Billed Charges,89% of total Billed charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36729.67,77,,,Percent of total Billed charges,77% of total billed charges,40545.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13714,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23850.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11925.22,42453.77,
Daratumumab-Hyalur-FIHJ (Darzalex Faspro) 1800mg/15ml SDV,57894050301,CDM,250,RC,,,Outpatient,,,47700.87,23850.44,,36729.67,77,,,Percent of Total Billed Charges,77% of total billed charges,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14906.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35298.64,74,,,Percent of Total Billed Charges,74% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,40068.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,42453.77,89,,,Percent of total Billed Charges,89% of total Billed charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36729.67,77,,,Percent of total Billed charges,77% of total billed charges,40545.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13714,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23850.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11925.22,42453.77,
Daratumumab-Hyalur-FIHJ (Darzalex Faspro) 1800mg/15ml SDV,57894050301,CDM,250,RC,,,Outpatient,,,47700.87,23850.44,,36729.67,77,,,Percent of Total Billed Charges,77% of total billed charges,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14906.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35298.64,74,,,Percent of Total Billed Charges,74% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,40068.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,42453.77,89,,,Percent of total Billed Charges,89% of total Billed charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36729.67,77,,,Percent of total Billed charges,77% of total billed charges,40545.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13714,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23850.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11925.22,42453.77,
Daratumumab-Hyalur-FIHJ (Darzalex Faspro) 1800mg/15ml SDV,57894050301,CDM,250,RC,,,Outpatient,,,47700.87,23850.44,,36729.67,77,,,Percent of Total Billed Charges,77% of total billed charges,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12163.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14906.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35298.64,74,,,Percent of Total Billed Charges,74% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,32913.6,69,,,Percent of Total Billed Charges,69% of total billed charges,40068.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,42453.77,89,,,Percent of total Billed Charges,89% of total Billed charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36729.67,77,,,Percent of total Billed charges,77% of total billed charges,40545.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13714,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23850.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19461.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42453.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11925.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11925.22,42453.77,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,19222.07,9611.04,,14800.99,77,,,Percent of Total Billed Charges,77% of total billed charges,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6006.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14224.33,74,,,Percent of Total Billed Charges,74% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16146.54,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17107.64,89,,,Percent of total Billed Charges,89% of total Billed charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14800.99,77,,,Percent of total Billed charges,77% of total billed charges,16338.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5526.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9611.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4805.52,17107.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,18728.81,9364.41,,14421.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5852.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13859.32,74,,,Percent of Total Billed Charges,74% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15732.2,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16668.64,89,,,Percent of total Billed Charges,89% of total Billed charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14421.18,77,,,Percent of total Billed charges,77% of total billed charges,15919.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5384.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9364.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4682.2,16668.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,19222.07,9611.04,,14800.99,77,,,Percent of Total Billed Charges,77% of total billed charges,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6006.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14224.33,74,,,Percent of Total Billed Charges,74% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16146.54,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17107.64,89,,,Percent of total Billed Charges,89% of total Billed charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14800.99,77,,,Percent of total Billed charges,77% of total billed charges,16338.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5526.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9611.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4805.52,17107.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,18728.81,9364.41,,14421.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5852.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13859.32,74,,,Percent of Total Billed Charges,74% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15732.2,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16668.64,89,,,Percent of total Billed Charges,89% of total Billed charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14421.18,77,,,Percent of total Billed charges,77% of total billed charges,15919.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5384.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9364.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4682.2,16668.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,19222.07,9611.04,,14800.99,77,,,Percent of Total Billed Charges,77% of total billed charges,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6006.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14224.33,74,,,Percent of Total Billed Charges,74% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16146.54,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17107.64,89,,,Percent of total Billed Charges,89% of total Billed charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14800.99,77,,,Percent of total Billed charges,77% of total billed charges,16338.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5526.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9611.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4805.52,17107.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,18728.81,9364.41,,14421.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5852.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13859.32,74,,,Percent of Total Billed Charges,74% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15732.2,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16668.64,89,,,Percent of total Billed Charges,89% of total Billed charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14421.18,77,,,Percent of total Billed charges,77% of total billed charges,15919.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5384.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9364.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4682.2,16668.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,19222.07,9611.04,,14800.99,77,,,Percent of Total Billed Charges,77% of total billed charges,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6006.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14224.33,74,,,Percent of Total Billed Charges,74% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16146.54,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17107.64,89,,,Percent of total Billed Charges,89% of total Billed charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14800.99,77,,,Percent of total Billed charges,77% of total billed charges,16338.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5526.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9611.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4805.52,17107.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,18728.81,9364.41,,14421.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5852.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13859.32,74,,,Percent of Total Billed Charges,74% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15732.2,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16668.64,89,,,Percent of total Billed Charges,89% of total Billed charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14421.18,77,,,Percent of total Billed charges,77% of total billed charges,15919.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5384.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9364.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4682.2,16668.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,19222.07,9611.04,,14800.99,77,,,Percent of Total Billed Charges,77% of total billed charges,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6006.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14224.33,74,,,Percent of Total Billed Charges,74% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16146.54,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17107.64,89,,,Percent of total Billed Charges,89% of total Billed charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14800.99,77,,,Percent of total Billed charges,77% of total billed charges,16338.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5526.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9611.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4805.52,17107.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,18728.81,9364.41,,14421.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5852.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13859.32,74,,,Percent of Total Billed Charges,74% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15732.2,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16668.64,89,,,Percent of total Billed Charges,89% of total Billed charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14421.18,77,,,Percent of total Billed charges,77% of total billed charges,15919.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5384.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9364.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4682.2,16668.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,19222.07,9611.04,,14800.99,77,,,Percent of Total Billed Charges,77% of total billed charges,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4901.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6006.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14224.33,74,,,Percent of Total Billed Charges,74% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,13263.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16146.54,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17107.64,89,,,Percent of total Billed Charges,89% of total Billed charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14800.99,77,,,Percent of total Billed charges,77% of total billed charges,16338.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5526.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9611.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7842.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17107.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4805.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4805.52,17107.64,
Daratumumab (Darzalex) 400mg/20ml Liquid SDV,57894050220,CDM,250,RC,,,Outpatient,,,18728.81,9364.41,,14421.18,77,,,Percent of Total Billed Charges,77% of total billed charges,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4775.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5852.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13859.32,74,,,Percent of Total Billed Charges,74% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,12922.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15732.2,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16668.64,89,,,Percent of total Billed Charges,89% of total Billed charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14421.18,77,,,Percent of total Billed charges,77% of total billed charges,15919.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5384.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9364.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7641.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16668.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4682.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4682.2,16668.64,
Darbepoetin (Aranesp) 100mcg/0.5ml Syringe,55513002501,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/0.5ml Syringe,55513002501,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/0.5ml Syringe,55513002501,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/0.5ml Syringe,55513002501,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/0.5ml Syringe,55513002501,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/0.5ml Syringe,55513002501,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/1ml SDV,55513000504,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/1ml SDV,55513000504,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/1ml SDV,55513000504,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/1ml SDV,55513000504,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/1ml SDV,55513000504,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 100mcg/1ml SDV,55513000504,CDM,250,RC,,,Outpatient,,,3360.46,1680.23,,2587.55,77,,,Percent of Total Billed Charges,77% of total billed charges,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,856.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2486.74,74,,,Percent of Total Billed Charges,74% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2318.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2822.79,84,,,Percent of Total Billed Charges,84% of total billed charges,2755.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,2990.81,89,,,Percent of total Billed Charges,89% of total Billed charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2587.55,77,,,Percent of total Billed charges,77% of total billed charges,2856.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2990.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.12,2990.81,
Darbepoetin (Aranesp) 150mcg/0.3ml Syringe,55513002704,CDM,250,RC,,,Outpatient,,,5020.69,2510.35,,3865.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1568.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3715.31,74,,,Percent of Total Billed Charges,74% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,4217.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4116.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4468.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3865.93,77,,,Percent of total Billed charges,77% of total billed charges,4267.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1443.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2510.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.17,4468.41,
Darbepoetin (Aranesp) 150mcg/0.3ml Syringe,55513002704,CDM,250,RC,,,Outpatient,,,5020.69,2510.35,,3865.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1568.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3715.31,74,,,Percent of Total Billed Charges,74% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,4217.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4116.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4468.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3865.93,77,,,Percent of total Billed charges,77% of total billed charges,4267.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1443.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2510.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.17,4468.41,
Darbepoetin (Aranesp) 150mcg/0.3ml Syringe,55513002704,CDM,250,RC,,,Outpatient,,,5020.69,2510.35,,3865.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1568.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3715.31,74,,,Percent of Total Billed Charges,74% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,4217.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4116.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4468.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3865.93,77,,,Percent of total Billed charges,77% of total billed charges,4267.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1443.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2510.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.17,4468.41,
Darbepoetin (Aranesp) 150mcg/0.3ml Syringe,55513002704,CDM,250,RC,,,Outpatient,,,5020.69,2510.35,,3865.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1568.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3715.31,74,,,Percent of Total Billed Charges,74% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,4217.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4116.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4468.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3865.93,77,,,Percent of total Billed charges,77% of total billed charges,4267.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1443.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2510.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.17,4468.41,
Darbepoetin (Aranesp) 150mcg/0.3ml Syringe,55513002704,CDM,250,RC,,,Outpatient,,,5020.69,2510.35,,3865.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1568.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3715.31,74,,,Percent of Total Billed Charges,74% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,4217.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4116.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4468.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3865.93,77,,,Percent of total Billed charges,77% of total billed charges,4267.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1443.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2510.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.17,4468.41,
Darbepoetin (Aranesp) 150mcg/0.3ml Syringe,55513002704,CDM,250,RC,,,Outpatient,,,5020.69,2510.35,,3865.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1280.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1568.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3715.31,74,,,Percent of Total Billed Charges,74% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3464.28,69,,,Percent of Total Billed Charges,69% of total billed charges,4217.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4116.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,4468.41,89,,,Percent of total Billed Charges,89% of total Billed charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3865.93,77,,,Percent of total Billed charges,77% of total billed charges,4267.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1443.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2510.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2048.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4468.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1255.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.17,4468.41,
Darbepoetin (Aranesp) 200mcg/0.4ml Syringe,55513002801,CDM,250,RC,,,Outpatient,,,6680.92,3340.46,,5144.31,77,,,Percent of Total Billed Charges,77% of total billed charges,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2087.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4943.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5611.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5478.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,5946.02,89,,,Percent of total Billed Charges,89% of total Billed charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5144.31,77,,,Percent of total Billed charges,77% of total billed charges,5678.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1920.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3340.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.23,5946.02,
Darbepoetin (Aranesp) 200mcg/0.4ml Syringe,55513002801,CDM,250,RC,,,Outpatient,,,6680.92,3340.46,,5144.31,77,,,Percent of Total Billed Charges,77% of total billed charges,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2087.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4943.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5611.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5478.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,5946.02,89,,,Percent of total Billed Charges,89% of total Billed charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5144.31,77,,,Percent of total Billed charges,77% of total billed charges,5678.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1920.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3340.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.23,5946.02,
Darbepoetin (Aranesp) 200mcg/0.4ml Syringe,55513002801,CDM,250,RC,,,Outpatient,,,6680.92,3340.46,,5144.31,77,,,Percent of Total Billed Charges,77% of total billed charges,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2087.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4943.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5611.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5478.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,5946.02,89,,,Percent of total Billed Charges,89% of total Billed charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5144.31,77,,,Percent of total Billed charges,77% of total billed charges,5678.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1920.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3340.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.23,5946.02,
Darbepoetin (Aranesp) 200mcg/0.4ml Syringe,55513002801,CDM,250,RC,,,Outpatient,,,6680.92,3340.46,,5144.31,77,,,Percent of Total Billed Charges,77% of total billed charges,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2087.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4943.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5611.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5478.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,5946.02,89,,,Percent of total Billed Charges,89% of total Billed charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5144.31,77,,,Percent of total Billed charges,77% of total billed charges,5678.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1920.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3340.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.23,5946.02,
Darbepoetin (Aranesp) 200mcg/0.4ml Syringe,55513002801,CDM,250,RC,,,Outpatient,,,6680.92,3340.46,,5144.31,77,,,Percent of Total Billed Charges,77% of total billed charges,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2087.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4943.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5611.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5478.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,5946.02,89,,,Percent of total Billed Charges,89% of total Billed charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5144.31,77,,,Percent of total Billed charges,77% of total billed charges,5678.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1920.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3340.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.23,5946.02,
Darbepoetin (Aranesp) 200mcg/0.4ml Syringe,55513002801,CDM,250,RC,,,Outpatient,,,6680.92,3340.46,,5144.31,77,,,Percent of Total Billed Charges,77% of total billed charges,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1703.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2087.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4943.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,4609.83,69,,,Percent of Total Billed Charges,69% of total billed charges,5611.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5478.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,5946.02,89,,,Percent of total Billed Charges,89% of total Billed charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5144.31,77,,,Percent of total Billed charges,77% of total billed charges,5678.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1920.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3340.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2725.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5946.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.23,5946.02,
Darbepoetin (Aranesp) 25mcg/0.42ml Syringe,55513005704,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/0.42ml Syringe,55513005704,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/0.42ml Syringe,55513005704,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/0.42ml Syringe,55513005704,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/0.42ml Syringe,55513005704,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/0.42ml Syringe,55513005704,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/ml SDV,55513000204,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/ml SDV,55513000204,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/ml SDV,55513000204,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/ml SDV,55513000204,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/ml SDV,55513000204,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 25mcg/ml SDV,55513000204,CDM,250,RC,,,Outpatient,,,870.12,435.06,,669.99,77,,,Percent of Total Billed Charges,77% of total billed charges,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,643.89,74,,,Percent of Total Billed Charges,74% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,600.38,69,,,Percent of Total Billed Charges,69% of total billed charges,730.9,84,,,Percent of Total Billed Charges,84% of total billed charges,713.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,774.41,89,,,Percent of total Billed Charges,89% of total Billed charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,669.99,77,,,Percent of total Billed charges,77% of total billed charges,739.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,435.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,774.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.53,774.41,
Darbepoetin (Aranesp) 300mcg/0.6ml Syringe,55513011101,CDM,250,RC,,,Outpatient,,,10001.38,5000.69,,7701.06,77,,,Percent of Total Billed Charges,77% of total billed charges,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3125.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7401.02,74,,,Percent of Total Billed Charges,74% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8401.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8201.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,8901.23,89,,,Percent of total Billed Charges,89% of total Billed charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.06,77,,,Percent of total Billed charges,77% of total billed charges,8501.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2875.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5000.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2500.35,8901.23,
Darbepoetin (Aranesp) 300mcg/0.6ml Syringe,55513011101,CDM,250,RC,,,Outpatient,,,10001.38,5000.69,,7701.06,77,,,Percent of Total Billed Charges,77% of total billed charges,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3125.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7401.02,74,,,Percent of Total Billed Charges,74% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8401.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8201.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,8901.23,89,,,Percent of total Billed Charges,89% of total Billed charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.06,77,,,Percent of total Billed charges,77% of total billed charges,8501.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2875.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5000.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2500.35,8901.23,
Darbepoetin (Aranesp) 300mcg/0.6ml Syringe,55513011101,CDM,250,RC,,,Outpatient,,,10001.38,5000.69,,7701.06,77,,,Percent of Total Billed Charges,77% of total billed charges,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3125.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7401.02,74,,,Percent of Total Billed Charges,74% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8401.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8201.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,8901.23,89,,,Percent of total Billed Charges,89% of total Billed charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.06,77,,,Percent of total Billed charges,77% of total billed charges,8501.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2875.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5000.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2500.35,8901.23,
Darbepoetin (Aranesp) 300mcg/0.6ml Syringe,55513011101,CDM,250,RC,,,Outpatient,,,10001.38,5000.69,,7701.06,77,,,Percent of Total Billed Charges,77% of total billed charges,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3125.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7401.02,74,,,Percent of Total Billed Charges,74% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8401.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8201.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,8901.23,89,,,Percent of total Billed Charges,89% of total Billed charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.06,77,,,Percent of total Billed charges,77% of total billed charges,8501.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2875.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5000.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2500.35,8901.23,
Darbepoetin (Aranesp) 300mcg/0.6ml Syringe,55513011101,CDM,250,RC,,,Outpatient,,,10001.38,5000.69,,7701.06,77,,,Percent of Total Billed Charges,77% of total billed charges,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3125.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7401.02,74,,,Percent of Total Billed Charges,74% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8401.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8201.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,8901.23,89,,,Percent of total Billed Charges,89% of total Billed charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.06,77,,,Percent of total Billed charges,77% of total billed charges,8501.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2875.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5000.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2500.35,8901.23,
Darbepoetin (Aranesp) 300mcg/0.6ml Syringe,55513011101,CDM,250,RC,,,Outpatient,,,10001.38,5000.69,,7701.06,77,,,Percent of Total Billed Charges,77% of total billed charges,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2550.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3125.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7401.02,74,,,Percent of Total Billed Charges,74% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6900.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8401.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8201.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,8901.23,89,,,Percent of total Billed Charges,89% of total Billed charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7701.06,77,,,Percent of total Billed charges,77% of total billed charges,8501.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2875.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5000.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4080.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8901.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2500.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2500.35,8901.23,
Darbepoetin (Aranesp) 40mcg/0.4ml Syringe,55513002104,CDM,250,RC,,,Outpatient,,,1368.18,684.09,,1053.5,77,,,Percent of Total Billed Charges,77% of total billed charges,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1012.45,74,,,Percent of Total Billed Charges,74% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1149.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1121.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1217.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1053.5,77,,,Percent of total Billed charges,77% of total billed charges,1162.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,393.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,684.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.05,1217.68,
Darbepoetin (Aranesp) 40mcg/0.4ml Syringe,55513002104,CDM,250,RC,,,Outpatient,,,1368.18,684.09,,1053.5,77,,,Percent of Total Billed Charges,77% of total billed charges,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1012.45,74,,,Percent of Total Billed Charges,74% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1149.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1121.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1217.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1053.5,77,,,Percent of total Billed charges,77% of total billed charges,1162.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,393.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,684.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.05,1217.68,
Darbepoetin (Aranesp) 40mcg/0.4ml Syringe,55513002104,CDM,250,RC,,,Outpatient,,,1368.18,684.09,,1053.5,77,,,Percent of Total Billed Charges,77% of total billed charges,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1012.45,74,,,Percent of Total Billed Charges,74% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1149.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1121.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1217.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1053.5,77,,,Percent of total Billed charges,77% of total billed charges,1162.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,393.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,684.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.05,1217.68,
Darbepoetin (Aranesp) 40mcg/0.4ml Syringe,55513002104,CDM,250,RC,,,Outpatient,,,1368.18,684.09,,1053.5,77,,,Percent of Total Billed Charges,77% of total billed charges,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1012.45,74,,,Percent of Total Billed Charges,74% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1149.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1121.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1217.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1053.5,77,,,Percent of total Billed charges,77% of total billed charges,1162.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,393.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,684.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.05,1217.68,
Darbepoetin (Aranesp) 40mcg/0.4ml Syringe,55513002104,CDM,250,RC,,,Outpatient,,,1368.18,684.09,,1053.5,77,,,Percent of Total Billed Charges,77% of total billed charges,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1012.45,74,,,Percent of Total Billed Charges,74% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1149.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1121.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1217.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1053.5,77,,,Percent of total Billed charges,77% of total billed charges,1162.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,393.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,684.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.05,1217.68,
Darbepoetin (Aranesp) 40mcg/0.4ml Syringe,55513002104,CDM,250,RC,,,Outpatient,,,1368.18,684.09,,1053.5,77,,,Percent of Total Billed Charges,77% of total billed charges,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,348.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,427.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1012.45,74,,,Percent of Total Billed Charges,74% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,944.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1149.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1121.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,1217.68,89,,,Percent of total Billed Charges,89% of total Billed charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1053.5,77,,,Percent of total Billed charges,77% of total billed charges,1162.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,393.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,684.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,558.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1217.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,342.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.05,1217.68,
Darbepoetin (Aranesp) 500mcg/ml Syringe,55513003201,CDM,250,RC,,,Outpatient,,,16642.3,8321.15,,12814.57,77,,,Percent of Total Billed Charges,77% of total billed charges,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5200.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12315.3,74,,,Percent of Total Billed Charges,74% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13979.53,84,,,Percent of Total Billed Charges,84% of total billed charges,13646.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,14811.65,89,,,Percent of total Billed Charges,89% of total Billed charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12814.57,77,,,Percent of total Billed charges,77% of total billed charges,14145.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4784.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8321.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4160.58,14811.65,
Darbepoetin (Aranesp) 500mcg/ml Syringe,55513003201,CDM,250,RC,,,Outpatient,,,16642.3,8321.15,,12814.57,77,,,Percent of Total Billed Charges,77% of total billed charges,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5200.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12315.3,74,,,Percent of Total Billed Charges,74% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13979.53,84,,,Percent of Total Billed Charges,84% of total billed charges,13646.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,14811.65,89,,,Percent of total Billed Charges,89% of total Billed charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12814.57,77,,,Percent of total Billed charges,77% of total billed charges,14145.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4784.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8321.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4160.58,14811.65,
Darbepoetin (Aranesp) 500mcg/ml Syringe,55513003201,CDM,250,RC,,,Outpatient,,,16642.3,8321.15,,12814.57,77,,,Percent of Total Billed Charges,77% of total billed charges,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5200.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12315.3,74,,,Percent of Total Billed Charges,74% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13979.53,84,,,Percent of Total Billed Charges,84% of total billed charges,13646.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,14811.65,89,,,Percent of total Billed Charges,89% of total Billed charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12814.57,77,,,Percent of total Billed charges,77% of total billed charges,14145.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4784.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8321.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4160.58,14811.65,
Darbepoetin (Aranesp) 500mcg/ml Syringe,55513003201,CDM,250,RC,,,Outpatient,,,16642.3,8321.15,,12814.57,77,,,Percent of Total Billed Charges,77% of total billed charges,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5200.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12315.3,74,,,Percent of Total Billed Charges,74% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13979.53,84,,,Percent of Total Billed Charges,84% of total billed charges,13646.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,14811.65,89,,,Percent of total Billed Charges,89% of total Billed charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12814.57,77,,,Percent of total Billed charges,77% of total billed charges,14145.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4784.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8321.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4160.58,14811.65,
Darbepoetin (Aranesp) 500mcg/ml Syringe,55513003201,CDM,250,RC,,,Outpatient,,,16642.3,8321.15,,12814.57,77,,,Percent of Total Billed Charges,77% of total billed charges,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5200.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12315.3,74,,,Percent of Total Billed Charges,74% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13979.53,84,,,Percent of Total Billed Charges,84% of total billed charges,13646.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,14811.65,89,,,Percent of total Billed Charges,89% of total Billed charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12814.57,77,,,Percent of total Billed charges,77% of total billed charges,14145.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4784.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8321.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4160.58,14811.65,
Darbepoetin (Aranesp) 500mcg/ml Syringe,55513003201,CDM,250,RC,,,Outpatient,,,16642.3,8321.15,,12814.57,77,,,Percent of Total Billed Charges,77% of total billed charges,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4243.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5200.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12315.3,74,,,Percent of Total Billed Charges,74% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,11483.19,69,,,Percent of Total Billed Charges,69% of total billed charges,13979.53,84,,,Percent of Total Billed Charges,84% of total billed charges,13646.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,14811.65,89,,,Percent of total Billed Charges,89% of total Billed charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12814.57,77,,,Percent of total Billed charges,77% of total billed charges,14145.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4784.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8321.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6790.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14811.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4160.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4160.58,14811.65,
Darbepoetin (Aranesp) 60mcg/0.3ml Syringe,55513002304,CDM,250,RC,,,Outpatient,,,2032.28,1016.14,,1564.86,77,,,Percent of Total Billed Charges,77% of total billed charges,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1503.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1707.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1666.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1808.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.86,77,,,Percent of total Billed charges,77% of total billed charges,1727.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,584.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1016.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.07,1808.73,
Darbepoetin (Aranesp) 60mcg/0.3ml Syringe,55513002304,CDM,250,RC,,,Outpatient,,,2032.28,1016.14,,1564.86,77,,,Percent of Total Billed Charges,77% of total billed charges,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1503.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1707.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1666.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1808.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.86,77,,,Percent of total Billed charges,77% of total billed charges,1727.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,584.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1016.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.07,1808.73,
Darbepoetin (Aranesp) 60mcg/0.3ml Syringe,55513002304,CDM,250,RC,,,Outpatient,,,2032.28,1016.14,,1564.86,77,,,Percent of Total Billed Charges,77% of total billed charges,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1503.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1707.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1666.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1808.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.86,77,,,Percent of total Billed charges,77% of total billed charges,1727.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,584.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1016.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.07,1808.73,
Darbepoetin (Aranesp) 60mcg/0.3ml Syringe,55513002304,CDM,250,RC,,,Outpatient,,,2032.28,1016.14,,1564.86,77,,,Percent of Total Billed Charges,77% of total billed charges,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1503.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1707.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1666.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1808.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.86,77,,,Percent of total Billed charges,77% of total billed charges,1727.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,584.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1016.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.07,1808.73,
Darbepoetin (Aranesp) 60mcg/0.3ml Syringe,55513002304,CDM,250,RC,,,Outpatient,,,2032.28,1016.14,,1564.86,77,,,Percent of Total Billed Charges,77% of total billed charges,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1503.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1707.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1666.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1808.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.86,77,,,Percent of total Billed charges,77% of total billed charges,1727.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,584.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1016.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.07,1808.73,
Darbepoetin (Aranesp) 60mcg/0.3ml Syringe,55513002304,CDM,250,RC,,,Outpatient,,,2032.28,1016.14,,1564.86,77,,,Percent of Total Billed Charges,77% of total billed charges,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,518.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,635.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1503.89,74,,,Percent of Total Billed Charges,74% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1402.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1707.12,84,,,Percent of Total Billed Charges,84% of total billed charges,1666.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1808.73,89,,,Percent of total Billed Charges,89% of total Billed charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1564.86,77,,,Percent of total Billed charges,77% of total billed charges,1727.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,584.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1016.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,829.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1808.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,508.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,508.07,1808.73,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,3025.64,1512.82,,2329.74,77,,,Percent of Total Billed Charges,77% of total billed charges,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.97,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2481.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.82,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.74,77,,,Percent of total Billed charges,77% of total billed charges,2571.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.41,2692.82,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,2952.02,1476.01,,2273.06,77,,,Percent of Total Billed Charges,77% of total billed charges,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2184.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2479.7,84,,,Percent of Total Billed Charges,84% of total billed charges,2420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,2627.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.06,77,,,Percent of total Billed charges,77% of total billed charges,2509.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1476.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.01,2627.3,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,3025.64,1512.82,,2329.74,77,,,Percent of Total Billed Charges,77% of total billed charges,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.97,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2481.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.82,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.74,77,,,Percent of total Billed charges,77% of total billed charges,2571.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.41,2692.82,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,2952.02,1476.01,,2273.06,77,,,Percent of Total Billed Charges,77% of total billed charges,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2184.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2479.7,84,,,Percent of Total Billed Charges,84% of total billed charges,2420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,2627.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.06,77,,,Percent of total Billed charges,77% of total billed charges,2509.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1476.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.01,2627.3,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,3025.64,1512.82,,2329.74,77,,,Percent of Total Billed Charges,77% of total billed charges,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.97,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2481.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.82,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.74,77,,,Percent of total Billed charges,77% of total billed charges,2571.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.41,2692.82,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,2952.02,1476.01,,2273.06,77,,,Percent of Total Billed Charges,77% of total billed charges,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2184.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2479.7,84,,,Percent of Total Billed Charges,84% of total billed charges,2420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,2627.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.06,77,,,Percent of total Billed charges,77% of total billed charges,2509.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1476.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.01,2627.3,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,3025.64,1512.82,,2329.74,77,,,Percent of Total Billed Charges,77% of total billed charges,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.97,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2481.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.82,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.74,77,,,Percent of total Billed charges,77% of total billed charges,2571.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.41,2692.82,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,2952.02,1476.01,,2273.06,77,,,Percent of Total Billed Charges,77% of total billed charges,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2184.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2479.7,84,,,Percent of Total Billed Charges,84% of total billed charges,2420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,2627.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.06,77,,,Percent of total Billed charges,77% of total billed charges,2509.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1476.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.01,2627.3,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,3025.64,1512.82,,2329.74,77,,,Percent of Total Billed Charges,77% of total billed charges,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.97,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2481.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.82,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.74,77,,,Percent of total Billed charges,77% of total billed charges,2571.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.41,2692.82,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,2952.02,1476.01,,2273.06,77,,,Percent of Total Billed Charges,77% of total billed charges,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2184.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2479.7,84,,,Percent of Total Billed Charges,84% of total billed charges,2420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,2627.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.06,77,,,Percent of total Billed charges,77% of total billed charges,2509.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1476.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.01,2627.3,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,3025.64,1512.82,,2329.74,77,,,Percent of Total Billed Charges,77% of total billed charges,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,771.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,945.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2238.97,74,,,Percent of Total Billed Charges,74% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2087.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2541.54,84,,,Percent of Total Billed Charges,84% of total billed charges,2481.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2692.82,89,,,Percent of total Billed Charges,89% of total Billed charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2329.74,77,,,Percent of total Billed charges,77% of total billed charges,2571.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,869.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1512.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1234.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.41,2692.82,
Decitabine 50mg/10ml Powder SDV,55111055610,CDM,250,RC,,,Outpatient,,,2952.02,1476.01,,2273.06,77,,,Percent of Total Billed Charges,77% of total billed charges,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,752.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,922.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2184.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.89,69,,,Percent of Total Billed Charges,69% of total billed charges,2479.7,84,,,Percent of Total Billed Charges,84% of total billed charges,2420.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,2627.3,89,,,Percent of total Billed Charges,89% of total Billed charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2273.06,77,,,Percent of total Billed charges,77% of total billed charges,2509.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,848.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1476.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1204.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2627.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,738.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,738.01,2627.3,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Deferoxamine 500mg SDV,63323059710,CDM,250,RC,,,Outpatient,,,146.51,73.26,,112.81,77,,,Percent of Total Billed Charges,77% of total billed charges,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108.42,74,,,Percent of Total Billed Charges,74% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,101.09,69,,,Percent of Total Billed Charges,69% of total billed charges,123.07,84,,,Percent of Total Billed Charges,84% of total billed charges,120.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,130.39,89,,,Percent of total Billed Charges,89% of total Billed charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.81,77,,,Percent of total Billed charges,77% of total billed charges,124.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,130.39,
Degarelix (Firmagon) 120mg/3ml Powder SDV (2X120mg Pack),55566840301,CDM,250,RC,,,Outpatient,,,5562.71,2781.36,,4283.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1738.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4116.41,74,,,Percent of Total Billed Charges,74% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,4672.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4561.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,4950.81,89,,,Percent of total Billed Charges,89% of total Billed charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4283.29,77,,,Percent of total Billed charges,77% of total billed charges,4728.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1599.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2781.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1390.68,4950.81,
Degarelix (Firmagon) 120mg/3ml Powder SDV (2X120mg Pack),55566840301,CDM,250,RC,,,Outpatient,,,5533.21,2766.61,,4260.57,77,,,Percent of Total Billed Charges,77% of total billed charges,1410.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1410.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1729.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4094.58,74,,,Percent of Total Billed Charges,74% of total billed charges,3817.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3817.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1383.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3817.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4647.9,84,,,Percent of Total Billed Charges,84% of total billed charges,4537.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,4924.56,89,,,Percent of total Billed Charges,89% of total Billed charges,4924.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4924.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2257.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2257.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2257.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1383.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4260.57,77,,,Percent of total Billed charges,77% of total billed charges,4703.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1590.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2766.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2257.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1383.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4924.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1383.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1383.3,4924.56,
Degarelix (Firmagon) 120mg/3ml Powder SDV (2X120mg Pack),55566840301,CDM,250,RC,,,Outpatient,,,5562.71,2781.36,,4283.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1738.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4116.41,74,,,Percent of Total Billed Charges,74% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,4672.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4561.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,4950.81,89,,,Percent of total Billed Charges,89% of total Billed charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4283.29,77,,,Percent of total Billed charges,77% of total billed charges,4728.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1599.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2781.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1390.68,4950.81,
Degarelix (Firmagon) 120mg/3ml Powder SDV (2X120mg Pack),55566840301,CDM,250,RC,,,Outpatient,,,5562.71,2781.36,,4283.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1738.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4116.41,74,,,Percent of Total Billed Charges,74% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,4672.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4561.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,4950.81,89,,,Percent of total Billed Charges,89% of total Billed charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4283.29,77,,,Percent of total Billed charges,77% of total billed charges,4728.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1599.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2781.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1390.68,4950.81,
Degarelix (Firmagon) 120mg/3ml Powder SDV (2X120mg Pack),55566840301,CDM,250,RC,,,Outpatient,,,5562.71,2781.36,,4283.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1738.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4116.41,74,,,Percent of Total Billed Charges,74% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,4672.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4561.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,4950.81,89,,,Percent of total Billed Charges,89% of total Billed charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4283.29,77,,,Percent of total Billed charges,77% of total billed charges,4728.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1599.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2781.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1390.68,4950.81,
Degarelix (Firmagon) 120mg/3ml Powder SDV (2X120mg Pack),55566840301,CDM,250,RC,,,Outpatient,,,5562.71,2781.36,,4283.29,77,,,Percent of Total Billed Charges,77% of total billed charges,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1418.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1738.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4116.41,74,,,Percent of Total Billed Charges,74% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,3838.27,69,,,Percent of Total Billed Charges,69% of total billed charges,4672.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4561.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,4950.81,89,,,Percent of total Billed Charges,89% of total Billed charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4283.29,77,,,Percent of total Billed charges,77% of total billed charges,4728.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1599.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2781.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2269.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4950.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1390.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1390.68,4950.81,
Degarelix (Firmagon) 80mg/4ml Powder SDV,55566830301,CDM,250,RC,,,Outpatient,,,3629.61,1814.81,,2794.8,77,,,Percent of Total Billed Charges,77% of total billed charges,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1134.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2685.91,74,,,Percent of Total Billed Charges,74% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3048.87,84,,,Percent of Total Billed Charges,84% of total billed charges,2976.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2794.8,77,,,Percent of total Billed charges,77% of total billed charges,3085.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1043.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1814.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,907.4,3230.35,
Degarelix (Firmagon) 80mg/4ml Powder SDV,55566830301,CDM,250,RC,,,Outpatient,,,3629.61,1814.81,,2794.8,77,,,Percent of Total Billed Charges,77% of total billed charges,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1134.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2685.91,74,,,Percent of Total Billed Charges,74% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3048.87,84,,,Percent of Total Billed Charges,84% of total billed charges,2976.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2794.8,77,,,Percent of total Billed charges,77% of total billed charges,3085.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1043.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1814.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,907.4,3230.35,
Degarelix (Firmagon) 80mg/4ml Powder SDV,55566830301,CDM,250,RC,,,Outpatient,,,3629.61,1814.81,,2794.8,77,,,Percent of Total Billed Charges,77% of total billed charges,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1134.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2685.91,74,,,Percent of Total Billed Charges,74% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3048.87,84,,,Percent of Total Billed Charges,84% of total billed charges,2976.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2794.8,77,,,Percent of total Billed charges,77% of total billed charges,3085.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1043.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1814.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,907.4,3230.35,
Degarelix (Firmagon) 80mg/4ml Powder SDV,55566830301,CDM,250,RC,,,Outpatient,,,3629.61,1814.81,,2794.8,77,,,Percent of Total Billed Charges,77% of total billed charges,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1134.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2685.91,74,,,Percent of Total Billed Charges,74% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3048.87,84,,,Percent of Total Billed Charges,84% of total billed charges,2976.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2794.8,77,,,Percent of total Billed charges,77% of total billed charges,3085.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1043.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1814.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,907.4,3230.35,
Degarelix (Firmagon) 80mg/4ml Powder SDV,55566830301,CDM,250,RC,,,Outpatient,,,3629.61,1814.81,,2794.8,77,,,Percent of Total Billed Charges,77% of total billed charges,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1134.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2685.91,74,,,Percent of Total Billed Charges,74% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3048.87,84,,,Percent of Total Billed Charges,84% of total billed charges,2976.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2794.8,77,,,Percent of total Billed charges,77% of total billed charges,3085.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1043.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1814.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,907.4,3230.35,
Degarelix (Firmagon) 80mg/4ml Powder SDV,55566830301,CDM,250,RC,,,Outpatient,,,3629.61,1814.81,,2794.8,77,,,Percent of Total Billed Charges,77% of total billed charges,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,925.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1134.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2685.91,74,,,Percent of Total Billed Charges,74% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,2504.43,69,,,Percent of Total Billed Charges,69% of total billed charges,3048.87,84,,,Percent of Total Billed Charges,84% of total billed charges,2976.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2794.8,77,,,Percent of total Billed charges,77% of total billed charges,3085.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1043.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1814.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1480.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,907.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,907.4,3230.35,
Demeclocycline 150mg Tablet,65162055410,CDM,250,RC,,,Outpatient,,,71.41,35.71,,54.99,77,,,Percent of Total Billed Charges,77% of total billed charges,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.84,74,,,Percent of Total Billed Charges,74% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,59.98,84,,,Percent of Total Billed Charges,84% of total billed charges,58.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.55,89,,,Percent of total Billed Charges,89% of total Billed charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.99,77,,,Percent of total Billed charges,77% of total billed charges,60.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.85,63.55,
Demeclocycline 150mg Tablet,65162055410,CDM,250,RC,,,Outpatient,,,71.41,35.71,,54.99,77,,,Percent of Total Billed Charges,77% of total billed charges,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.84,74,,,Percent of Total Billed Charges,74% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,59.98,84,,,Percent of Total Billed Charges,84% of total billed charges,58.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.55,89,,,Percent of total Billed Charges,89% of total Billed charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.99,77,,,Percent of total Billed charges,77% of total billed charges,60.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.85,63.55,
Demeclocycline 150mg Tablet,65162055410,CDM,250,RC,,,Outpatient,,,71.41,35.71,,54.99,77,,,Percent of Total Billed Charges,77% of total billed charges,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.84,74,,,Percent of Total Billed Charges,74% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,59.98,84,,,Percent of Total Billed Charges,84% of total billed charges,58.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.55,89,,,Percent of total Billed Charges,89% of total Billed charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.99,77,,,Percent of total Billed charges,77% of total billed charges,60.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.85,63.55,
Demeclocycline 150mg Tablet,65162055410,CDM,250,RC,,,Outpatient,,,71.41,35.71,,54.99,77,,,Percent of Total Billed Charges,77% of total billed charges,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.84,74,,,Percent of Total Billed Charges,74% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,59.98,84,,,Percent of Total Billed Charges,84% of total billed charges,58.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.55,89,,,Percent of total Billed Charges,89% of total Billed charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.99,77,,,Percent of total Billed charges,77% of total billed charges,60.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.85,63.55,
Demeclocycline 150mg Tablet,65162055410,CDM,250,RC,,,Outpatient,,,71.41,35.71,,54.99,77,,,Percent of Total Billed Charges,77% of total billed charges,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.84,74,,,Percent of Total Billed Charges,74% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,59.98,84,,,Percent of Total Billed Charges,84% of total billed charges,58.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.55,89,,,Percent of total Billed Charges,89% of total Billed charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.99,77,,,Percent of total Billed charges,77% of total billed charges,60.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.85,63.55,
Demeclocycline 150mg Tablet,65162055410,CDM,250,RC,,,Outpatient,,,71.41,35.71,,54.99,77,,,Percent of Total Billed Charges,77% of total billed charges,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.84,74,,,Percent of Total Billed Charges,74% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,49.27,69,,,Percent of Total Billed Charges,69% of total billed charges,59.98,84,,,Percent of Total Billed Charges,84% of total billed charges,58.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.55,89,,,Percent of total Billed Charges,89% of total Billed charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.99,77,,,Percent of total Billed charges,77% of total billed charges,60.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.85,63.55,
Denosumab (Xgeva) 120mg/1.7ml SDV,55513073001,CDM,250,RC,,,Outpatient,,,21453.8,10726.9,,16519.43,77,,,Percent of Total Billed Charges,77% of total billed charges,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6704.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15875.81,74,,,Percent of Total Billed Charges,74% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18021.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19093.88,89,,,Percent of total Billed Charges,89% of total Billed charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16519.43,77,,,Percent of total Billed charges,77% of total billed charges,18235.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6167.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10726.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5363.45,19093.88,
Denosumab (Xgeva) 120mg/1.7ml SDV,55513073001,CDM,250,RC,,,Outpatient,,,21453.8,10726.9,,16519.43,77,,,Percent of Total Billed Charges,77% of total billed charges,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6704.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15875.81,74,,,Percent of Total Billed Charges,74% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18021.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19093.88,89,,,Percent of total Billed Charges,89% of total Billed charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16519.43,77,,,Percent of total Billed charges,77% of total billed charges,18235.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6167.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10726.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5363.45,19093.88,
Denosumab (Xgeva) 120mg/1.7ml SDV,55513073001,CDM,250,RC,,,Outpatient,,,21453.8,10726.9,,16519.43,77,,,Percent of Total Billed Charges,77% of total billed charges,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6704.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15875.81,74,,,Percent of Total Billed Charges,74% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18021.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19093.88,89,,,Percent of total Billed Charges,89% of total Billed charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16519.43,77,,,Percent of total Billed charges,77% of total billed charges,18235.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6167.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10726.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5363.45,19093.88,
Denosumab (Xgeva) 120mg/1.7ml SDV,55513073001,CDM,250,RC,,,Outpatient,,,21453.8,10726.9,,16519.43,77,,,Percent of Total Billed Charges,77% of total billed charges,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6704.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15875.81,74,,,Percent of Total Billed Charges,74% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18021.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19093.88,89,,,Percent of total Billed Charges,89% of total Billed charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16519.43,77,,,Percent of total Billed charges,77% of total billed charges,18235.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6167.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10726.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5363.45,19093.88,
Denosumab (Xgeva) 120mg/1.7ml SDV,55513073001,CDM,250,RC,,,Outpatient,,,21453.8,10726.9,,16519.43,77,,,Percent of Total Billed Charges,77% of total billed charges,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6704.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15875.81,74,,,Percent of Total Billed Charges,74% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18021.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19093.88,89,,,Percent of total Billed Charges,89% of total Billed charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16519.43,77,,,Percent of total Billed charges,77% of total billed charges,18235.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6167.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10726.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5363.45,19093.88,
Denosumab (Xgeva) 120mg/1.7ml SDV,55513073001,CDM,250,RC,,,Outpatient,,,21453.8,10726.9,,16519.43,77,,,Percent of Total Billed Charges,77% of total billed charges,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5470.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6704.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15875.81,74,,,Percent of Total Billed Charges,74% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,14803.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18021.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19093.88,89,,,Percent of total Billed Charges,89% of total Billed charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16519.43,77,,,Percent of total Billed charges,77% of total billed charges,18235.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6167.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10726.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8753.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19093.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5363.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5363.45,19093.88,
Denosumab (Prolia) 60mg/ml Syringe,55513071001,CDM,250,RC,,,Outpatient,,,7702.45,3851.23,,5930.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2407.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5699.81,74,,,Percent of Total Billed Charges,74% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6470.06,84,,,Percent of Total Billed Charges,84% of total billed charges,6316.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,6855.18,89,,,Percent of total Billed Charges,89% of total Billed charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5930.89,77,,,Percent of total Billed charges,77% of total billed charges,6547.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2214.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3851.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.61,6855.18,
Denosumab (Prolia) 60mg/ml Syringe,55513071001,CDM,250,RC,,,Outpatient,,,7702.45,3851.23,,5930.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2407.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5699.81,74,,,Percent of Total Billed Charges,74% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6470.06,84,,,Percent of Total Billed Charges,84% of total billed charges,6316.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,6855.18,89,,,Percent of total Billed Charges,89% of total Billed charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5930.89,77,,,Percent of total Billed charges,77% of total billed charges,6547.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2214.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3851.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.61,6855.18,
Denosumab (Prolia) 60mg/ml Syringe,55513071001,CDM,250,RC,,,Outpatient,,,7702.45,3851.23,,5930.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2407.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5699.81,74,,,Percent of Total Billed Charges,74% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6470.06,84,,,Percent of Total Billed Charges,84% of total billed charges,6316.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,6855.18,89,,,Percent of total Billed Charges,89% of total Billed charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5930.89,77,,,Percent of total Billed charges,77% of total billed charges,6547.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2214.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3851.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.61,6855.18,
Denosumab (Prolia) 60mg/ml Syringe,55513071001,CDM,250,RC,,,Outpatient,,,7702.45,3851.23,,5930.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2407.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5699.81,74,,,Percent of Total Billed Charges,74% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6470.06,84,,,Percent of Total Billed Charges,84% of total billed charges,6316.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,6855.18,89,,,Percent of total Billed Charges,89% of total Billed charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5930.89,77,,,Percent of total Billed charges,77% of total billed charges,6547.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2214.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3851.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.61,6855.18,
Denosumab (Prolia) 60mg/ml Syringe,55513071001,CDM,250,RC,,,Outpatient,,,7702.45,3851.23,,5930.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2407.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5699.81,74,,,Percent of Total Billed Charges,74% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6470.06,84,,,Percent of Total Billed Charges,84% of total billed charges,6316.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,6855.18,89,,,Percent of total Billed Charges,89% of total Billed charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5930.89,77,,,Percent of total Billed charges,77% of total billed charges,6547.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2214.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3851.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.61,6855.18,
Denosumab (Prolia) 60mg/ml Syringe,55513071001,CDM,250,RC,,,Outpatient,,,7702.45,3851.23,,5930.89,77,,,Percent of Total Billed Charges,77% of total billed charges,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1964.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2407.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5699.81,74,,,Percent of Total Billed Charges,74% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,5314.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6470.06,84,,,Percent of Total Billed Charges,84% of total billed charges,6316.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,6855.18,89,,,Percent of total Billed Charges,89% of total Billed charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5930.89,77,,,Percent of total Billed charges,77% of total billed charges,6547.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2214.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3851.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3142.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6855.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1925.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.61,6855.18,
Desflurane Charge Per Hour (OE-N),10019064134,CDM,250,RC,,,Outpatient,,,171.73,85.87,,132.23,77,,,Percent of Total Billed Charges,77% of total billed charges,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.08,74,,,Percent of Total Billed Charges,74% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,144.25,84,,,Percent of Total Billed Charges,84% of total billed charges,140.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.84,89,,,Percent of total Billed Charges,89% of total Billed charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.23,77,,,Percent of total Billed charges,77% of total billed charges,145.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.93,152.84,
Desflurane Charge Per Hour (OE-N),10019064134,CDM,250,RC,,,Outpatient,,,171.73,85.87,,132.23,77,,,Percent of Total Billed Charges,77% of total billed charges,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.08,74,,,Percent of Total Billed Charges,74% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,144.25,84,,,Percent of Total Billed Charges,84% of total billed charges,140.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.84,89,,,Percent of total Billed Charges,89% of total Billed charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.23,77,,,Percent of total Billed charges,77% of total billed charges,145.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.93,152.84,
Desflurane Charge Per Hour (OE-N),10019064134,CDM,250,RC,,,Outpatient,,,171.73,85.87,,132.23,77,,,Percent of Total Billed Charges,77% of total billed charges,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.08,74,,,Percent of Total Billed Charges,74% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,144.25,84,,,Percent of Total Billed Charges,84% of total billed charges,140.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.84,89,,,Percent of total Billed Charges,89% of total Billed charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.23,77,,,Percent of total Billed charges,77% of total billed charges,145.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.93,152.84,
Desflurane Charge Per Hour (OE-N),10019064134,CDM,250,RC,,,Outpatient,,,171.73,85.87,,132.23,77,,,Percent of Total Billed Charges,77% of total billed charges,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.08,74,,,Percent of Total Billed Charges,74% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,144.25,84,,,Percent of Total Billed Charges,84% of total billed charges,140.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.84,89,,,Percent of total Billed Charges,89% of total Billed charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.23,77,,,Percent of total Billed charges,77% of total billed charges,145.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.93,152.84,
Desflurane Charge Per Hour (OE-N),10019064134,CDM,250,RC,,,Outpatient,,,171.73,85.87,,132.23,77,,,Percent of Total Billed Charges,77% of total billed charges,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.08,74,,,Percent of Total Billed Charges,74% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,144.25,84,,,Percent of Total Billed Charges,84% of total billed charges,140.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.84,89,,,Percent of total Billed Charges,89% of total Billed charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.23,77,,,Percent of total Billed charges,77% of total billed charges,145.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.93,152.84,
Desflurane Charge Per Hour (OE-N),10019064134,CDM,250,RC,,,Outpatient,,,171.73,85.87,,132.23,77,,,Percent of Total Billed Charges,77% of total billed charges,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.08,74,,,Percent of Total Billed Charges,74% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,118.49,69,,,Percent of Total Billed Charges,69% of total billed charges,144.25,84,,,Percent of Total Billed Charges,84% of total billed charges,140.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.84,89,,,Percent of total Billed Charges,89% of total Billed charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.23,77,,,Percent of total Billed charges,77% of total billed charges,145.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.93,152.84,
Desmopressin 0.1mg Tablet,23155048901,CDM,250,RC,,,Outpatient,,,51.58,25.79,,39.72,77,,,Percent of Total Billed Charges,77% of total billed charges,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.17,74,,,Percent of Total Billed Charges,74% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,43.33,84,,,Percent of Total Billed Charges,84% of total billed charges,42.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.91,89,,,Percent of total Billed Charges,89% of total Billed charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.72,77,,,Percent of total Billed charges,77% of total billed charges,43.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,45.91,
Desmopressin 0.1mg Tablet,23155048901,CDM,250,RC,,,Outpatient,,,51.58,25.79,,39.72,77,,,Percent of Total Billed Charges,77% of total billed charges,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.17,74,,,Percent of Total Billed Charges,74% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,43.33,84,,,Percent of Total Billed Charges,84% of total billed charges,42.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.91,89,,,Percent of total Billed Charges,89% of total Billed charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.72,77,,,Percent of total Billed charges,77% of total billed charges,43.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,45.91,
Desmopressin 0.1mg Tablet,23155048901,CDM,250,RC,,,Outpatient,,,51.58,25.79,,39.72,77,,,Percent of Total Billed Charges,77% of total billed charges,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.17,74,,,Percent of Total Billed Charges,74% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,43.33,84,,,Percent of Total Billed Charges,84% of total billed charges,42.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.91,89,,,Percent of total Billed Charges,89% of total Billed charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.72,77,,,Percent of total Billed charges,77% of total billed charges,43.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,45.91,
Desmopressin 0.1mg Tablet,23155048901,CDM,250,RC,,,Outpatient,,,51.58,25.79,,39.72,77,,,Percent of Total Billed Charges,77% of total billed charges,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.17,74,,,Percent of Total Billed Charges,74% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,43.33,84,,,Percent of Total Billed Charges,84% of total billed charges,42.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.91,89,,,Percent of total Billed Charges,89% of total Billed charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.72,77,,,Percent of total Billed charges,77% of total billed charges,43.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,45.91,
Desmopressin 0.1mg Tablet,23155048901,CDM,250,RC,,,Outpatient,,,51.58,25.79,,39.72,77,,,Percent of Total Billed Charges,77% of total billed charges,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.17,74,,,Percent of Total Billed Charges,74% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,43.33,84,,,Percent of Total Billed Charges,84% of total billed charges,42.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.91,89,,,Percent of total Billed Charges,89% of total Billed charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.72,77,,,Percent of total Billed charges,77% of total billed charges,43.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,45.91,
Desmopressin 0.1mg Tablet,23155048901,CDM,250,RC,,,Outpatient,,,51.58,25.79,,39.72,77,,,Percent of Total Billed Charges,77% of total billed charges,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.17,74,,,Percent of Total Billed Charges,74% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,35.59,69,,,Percent of Total Billed Charges,69% of total billed charges,43.33,84,,,Percent of Total Billed Charges,84% of total billed charges,42.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.91,89,,,Percent of total Billed Charges,89% of total Billed charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.72,77,,,Percent of total Billed charges,77% of total billed charges,43.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.9,45.91,
Desmopressin Nasal Spray 10mcg/Spray 50 Sprays 5ml,24208034205,CDM,250,RC,,,Outpatient,,,853.41,426.71,,657.13,77,,,Percent of Total Billed Charges,77% of total billed charges,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.52,74,,,Percent of Total Billed Charges,74% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,716.86,84,,,Percent of Total Billed Charges,84% of total billed charges,699.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.53,89,,,Percent of total Billed Charges,89% of total Billed charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.13,77,,,Percent of total Billed charges,77% of total billed charges,725.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.35,759.53,
Desmopressin Nasal Spray 10mcg/Spray 50 Sprays 5ml,24208034205,CDM,250,RC,,,Outpatient,,,853.41,426.71,,657.13,77,,,Percent of Total Billed Charges,77% of total billed charges,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.52,74,,,Percent of Total Billed Charges,74% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,716.86,84,,,Percent of Total Billed Charges,84% of total billed charges,699.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.53,89,,,Percent of total Billed Charges,89% of total Billed charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.13,77,,,Percent of total Billed charges,77% of total billed charges,725.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.35,759.53,
Desmopressin Nasal Spray 10mcg/Spray 50 Sprays 5ml,24208034205,CDM,250,RC,,,Outpatient,,,853.41,426.71,,657.13,77,,,Percent of Total Billed Charges,77% of total billed charges,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.52,74,,,Percent of Total Billed Charges,74% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,716.86,84,,,Percent of Total Billed Charges,84% of total billed charges,699.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.53,89,,,Percent of total Billed Charges,89% of total Billed charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.13,77,,,Percent of total Billed charges,77% of total billed charges,725.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.35,759.53,
Desmopressin Nasal Spray 10mcg/Spray 50 Sprays 5ml,24208034205,CDM,250,RC,,,Outpatient,,,853.41,426.71,,657.13,77,,,Percent of Total Billed Charges,77% of total billed charges,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.52,74,,,Percent of Total Billed Charges,74% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,716.86,84,,,Percent of Total Billed Charges,84% of total billed charges,699.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.53,89,,,Percent of total Billed Charges,89% of total Billed charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.13,77,,,Percent of total Billed charges,77% of total billed charges,725.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.35,759.53,
Desmopressin Nasal Spray 10mcg/Spray 50 Sprays 5ml,24208034205,CDM,250,RC,,,Outpatient,,,853.41,426.71,,657.13,77,,,Percent of Total Billed Charges,77% of total billed charges,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.52,74,,,Percent of Total Billed Charges,74% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,716.86,84,,,Percent of Total Billed Charges,84% of total billed charges,699.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.53,89,,,Percent of total Billed Charges,89% of total Billed charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.13,77,,,Percent of total Billed charges,77% of total billed charges,725.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.35,759.53,
Desmopressin Nasal Spray 10mcg/Spray 50 Sprays 5ml,24208034205,CDM,250,RC,,,Outpatient,,,853.41,426.71,,657.13,77,,,Percent of Total Billed Charges,77% of total billed charges,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.52,74,,,Percent of Total Billed Charges,74% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,588.85,69,,,Percent of Total Billed Charges,69% of total billed charges,716.86,84,,,Percent of Total Billed Charges,84% of total billed charges,699.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.53,89,,,Percent of total Billed Charges,89% of total Billed charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.13,77,,,Percent of total Billed charges,77% of total billed charges,725.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.35,759.53,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desmopressin 4mcg/ml Ampule,69918089901,CDM,250,RC,,,Outpatient,,,124.55,62.28,,95.9,77,,,Percent of Total Billed Charges,77% of total billed charges,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92.17,74,,,Percent of Total Billed Charges,74% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,85.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.62,84,,,Percent of Total Billed Charges,84% of total billed charges,102.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,110.85,89,,,Percent of total Billed Charges,89% of total Billed charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.9,77,,,Percent of total Billed charges,77% of total billed charges,105.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.14,110.85,
Desonide 0.05% Cream 15gm,51672128001,CDM,250,RC,,,Outpatient,,,281.62,140.81,,216.85,77,,,Percent of Total Billed Charges,77% of total billed charges,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.4,74,,,Percent of Total Billed Charges,74% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,236.56,84,,,Percent of Total Billed Charges,84% of total billed charges,230.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.64,89,,,Percent of total Billed Charges,89% of total Billed charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.85,77,,,Percent of total Billed charges,77% of total billed charges,239.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.41,250.64,
Desonide 0.05% Cream 15gm,51672128001,CDM,250,RC,,,Outpatient,,,281.62,140.81,,216.85,77,,,Percent of Total Billed Charges,77% of total billed charges,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.4,74,,,Percent of Total Billed Charges,74% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,236.56,84,,,Percent of Total Billed Charges,84% of total billed charges,230.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.64,89,,,Percent of total Billed Charges,89% of total Billed charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.85,77,,,Percent of total Billed charges,77% of total billed charges,239.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.41,250.64,
Desonide 0.05% Cream 15gm,51672128001,CDM,250,RC,,,Outpatient,,,281.62,140.81,,216.85,77,,,Percent of Total Billed Charges,77% of total billed charges,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.4,74,,,Percent of Total Billed Charges,74% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,236.56,84,,,Percent of Total Billed Charges,84% of total billed charges,230.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.64,89,,,Percent of total Billed Charges,89% of total Billed charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.85,77,,,Percent of total Billed charges,77% of total billed charges,239.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.41,250.64,
Desonide 0.05% Cream 15gm,51672128001,CDM,250,RC,,,Outpatient,,,281.62,140.81,,216.85,77,,,Percent of Total Billed Charges,77% of total billed charges,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.4,74,,,Percent of Total Billed Charges,74% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,236.56,84,,,Percent of Total Billed Charges,84% of total billed charges,230.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.64,89,,,Percent of total Billed Charges,89% of total Billed charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.85,77,,,Percent of total Billed charges,77% of total billed charges,239.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.41,250.64,
Desonide 0.05% Cream 15gm,51672128001,CDM,250,RC,,,Outpatient,,,281.62,140.81,,216.85,77,,,Percent of Total Billed Charges,77% of total billed charges,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.4,74,,,Percent of Total Billed Charges,74% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,236.56,84,,,Percent of Total Billed Charges,84% of total billed charges,230.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.64,89,,,Percent of total Billed Charges,89% of total Billed charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.85,77,,,Percent of total Billed charges,77% of total billed charges,239.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.41,250.64,
Desonide 0.05% Cream 15gm,51672128001,CDM,250,RC,,,Outpatient,,,281.62,140.81,,216.85,77,,,Percent of Total Billed Charges,77% of total billed charges,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.4,74,,,Percent of Total Billed Charges,74% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,194.32,69,,,Percent of Total Billed Charges,69% of total billed charges,236.56,84,,,Percent of Total Billed Charges,84% of total billed charges,230.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,250.64,89,,,Percent of total Billed Charges,89% of total Billed charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.85,77,,,Percent of total Billed charges,77% of total billed charges,239.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,80.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,140.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,114.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,250.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.41,250.64,
dexAMETHasone 0.5mg Tablet,54817925,CDM,250,RC,,,Outpatient,,,6.97,3.49,,5.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,5.85,84,,,Percent of Total Billed Charges,84% of total billed charges,5.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.2,89,,,Percent of total Billed Charges,89% of total Billed charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.37,77,,,Percent of total Billed charges,77% of total billed charges,5.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.74,6.2,
dexAMETHasone 0.5mg Tablet,54817925,CDM,250,RC,,,Outpatient,,,6.97,3.49,,5.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,5.85,84,,,Percent of Total Billed Charges,84% of total billed charges,5.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.2,89,,,Percent of total Billed Charges,89% of total Billed charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.37,77,,,Percent of total Billed charges,77% of total billed charges,5.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.74,6.2,
dexAMETHasone 0.5mg Tablet,54817925,CDM,250,RC,,,Outpatient,,,6.97,3.49,,5.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,5.85,84,,,Percent of Total Billed Charges,84% of total billed charges,5.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.2,89,,,Percent of total Billed Charges,89% of total Billed charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.37,77,,,Percent of total Billed charges,77% of total billed charges,5.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.74,6.2,
dexAMETHasone 0.5mg Tablet,54817925,CDM,250,RC,,,Outpatient,,,6.97,3.49,,5.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,5.85,84,,,Percent of Total Billed Charges,84% of total billed charges,5.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.2,89,,,Percent of total Billed Charges,89% of total Billed charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.37,77,,,Percent of total Billed charges,77% of total billed charges,5.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.74,6.2,
dexAMETHasone 0.5mg Tablet,54817925,CDM,250,RC,,,Outpatient,,,6.97,3.49,,5.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,5.85,84,,,Percent of Total Billed Charges,84% of total billed charges,5.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.2,89,,,Percent of total Billed Charges,89% of total Billed charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.37,77,,,Percent of total Billed charges,77% of total billed charges,5.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.74,6.2,
dexAMETHasone 0.5mg Tablet,54817925,CDM,250,RC,,,Outpatient,,,6.97,3.49,,5.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.81,69,,,Percent of Total Billed Charges,69% of total billed charges,5.85,84,,,Percent of Total Billed Charges,84% of total billed charges,5.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.2,89,,,Percent of total Billed Charges,89% of total Billed charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.37,77,,,Percent of total Billed charges,77% of total billed charges,5.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.74,6.2,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone PF 10mg/ml SDV,,,250,RC,,,Outpatient,,,101.68,50.84,,78.29,77,,,Percent of Total Billed Charges,77% of total billed charges,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,75.24,74,,,Percent of Total Billed Charges,74% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,70.16,69,,,Percent of Total Billed Charges,69% of total billed charges,85.41,84,,,Percent of Total Billed Charges,84% of total billed charges,83.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.5,89,,,Percent of total Billed Charges,89% of total Billed charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.29,77,,,Percent of total Billed charges,77% of total billed charges,86.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.42,90.5,
dexAMETHasone 4mg Tablet,54817525,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
dexAMETHasone 4mg Tablet,54817525,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
dexAMETHasone 4mg Tablet,54817525,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
dexAMETHasone 4mg Tablet,54817525,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
dexAMETHasone 4mg Tablet,54817525,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
dexAMETHasone 4mg Tablet,54817525,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,354.28,177.14,,272.8,77,,,Percent of Total Billed Charges,77% of total billed charges,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.17,74,,,Percent of Total Billed Charges,74% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,297.6,84,,,Percent of Total Billed Charges,84% of total billed charges,290.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.31,89,,,Percent of total Billed Charges,89% of total Billed charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,77,,,Percent of total Billed charges,77% of total billed charges,301.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.57,315.31,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,349.43,174.72,,269.06,77,,,Percent of Total Billed Charges,77% of total billed charges,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.58,74,,,Percent of Total Billed Charges,74% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,293.52,84,,,Percent of Total Billed Charges,84% of total billed charges,286.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,310.99,89,,,Percent of total Billed Charges,89% of total Billed charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.06,77,,,Percent of total Billed charges,77% of total billed charges,297.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.36,310.99,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,354.28,177.14,,272.8,77,,,Percent of Total Billed Charges,77% of total billed charges,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.17,74,,,Percent of Total Billed Charges,74% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,297.6,84,,,Percent of Total Billed Charges,84% of total billed charges,290.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.31,89,,,Percent of total Billed Charges,89% of total Billed charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,77,,,Percent of total Billed charges,77% of total billed charges,301.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.57,315.31,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,349.43,174.72,,269.06,77,,,Percent of Total Billed Charges,77% of total billed charges,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.58,74,,,Percent of Total Billed Charges,74% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,293.52,84,,,Percent of Total Billed Charges,84% of total billed charges,286.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,310.99,89,,,Percent of total Billed Charges,89% of total Billed charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.06,77,,,Percent of total Billed charges,77% of total billed charges,297.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.36,310.99,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,354.28,177.14,,272.8,77,,,Percent of Total Billed Charges,77% of total billed charges,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.17,74,,,Percent of Total Billed Charges,74% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,297.6,84,,,Percent of Total Billed Charges,84% of total billed charges,290.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.31,89,,,Percent of total Billed Charges,89% of total Billed charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,77,,,Percent of total Billed charges,77% of total billed charges,301.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.57,315.31,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,349.43,174.72,,269.06,77,,,Percent of Total Billed Charges,77% of total billed charges,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.58,74,,,Percent of Total Billed Charges,74% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,293.52,84,,,Percent of Total Billed Charges,84% of total billed charges,286.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,310.99,89,,,Percent of total Billed Charges,89% of total Billed charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.06,77,,,Percent of total Billed charges,77% of total billed charges,297.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.36,310.99,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,354.28,177.14,,272.8,77,,,Percent of Total Billed Charges,77% of total billed charges,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.17,74,,,Percent of Total Billed Charges,74% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,297.6,84,,,Percent of Total Billed Charges,84% of total billed charges,290.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.31,89,,,Percent of total Billed Charges,89% of total Billed charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,77,,,Percent of total Billed charges,77% of total billed charges,301.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.57,315.31,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,349.43,174.72,,269.06,77,,,Percent of Total Billed Charges,77% of total billed charges,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.58,74,,,Percent of Total Billed Charges,74% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,293.52,84,,,Percent of Total Billed Charges,84% of total billed charges,286.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,310.99,89,,,Percent of total Billed Charges,89% of total Billed charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.06,77,,,Percent of total Billed charges,77% of total billed charges,297.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.36,310.99,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,354.28,177.14,,272.8,77,,,Percent of Total Billed Charges,77% of total billed charges,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.17,74,,,Percent of Total Billed Charges,74% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,297.6,84,,,Percent of Total Billed Charges,84% of total billed charges,290.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.31,89,,,Percent of total Billed Charges,89% of total Billed charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,77,,,Percent of total Billed charges,77% of total billed charges,301.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.57,315.31,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,349.43,174.72,,269.06,77,,,Percent of Total Billed Charges,77% of total billed charges,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.58,74,,,Percent of Total Billed Charges,74% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,293.52,84,,,Percent of Total Billed Charges,84% of total billed charges,286.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,310.99,89,,,Percent of total Billed Charges,89% of total Billed charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.06,77,,,Percent of total Billed charges,77% of total billed charges,297.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.36,310.99,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,354.28,177.14,,272.8,77,,,Percent of Total Billed Charges,77% of total billed charges,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,262.17,74,,,Percent of Total Billed Charges,74% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,244.45,69,,,Percent of Total Billed Charges,69% of total billed charges,297.6,84,,,Percent of Total Billed Charges,84% of total billed charges,290.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,315.31,89,,,Percent of total Billed Charges,89% of total Billed charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,77,,,Percent of total Billed charges,77% of total billed charges,301.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,177.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,144.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,315.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.57,315.31,
DexmedeTOMIDine in 0.9% NACL 80mcg/20ml SDV,409166020,CDM,250,RC,,,Outpatient,,,349.43,174.72,,269.06,77,,,Percent of Total Billed Charges,77% of total billed charges,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,258.58,74,,,Percent of Total Billed Charges,74% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,241.11,69,,,Percent of Total Billed Charges,69% of total billed charges,293.52,84,,,Percent of Total Billed Charges,84% of total billed charges,286.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,310.99,89,,,Percent of total Billed Charges,89% of total Billed charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.06,77,,,Percent of total Billed charges,77% of total billed charges,297.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,100.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,174.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,142.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.36,310.99,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2082.39,1041.2,,1603.44,77,,,Percent of Total Billed Charges,77% of total billed charges,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1540.97,74,,,Percent of Total Billed Charges,74% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1749.21,84,,,Percent of Total Billed Charges,84% of total billed charges,1707.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1853.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.44,77,,,Percent of total Billed charges,77% of total billed charges,1770.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1041.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.6,1853.33,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2167.49,1083.75,,1668.97,77,,,Percent of Total Billed Charges,77% of total billed charges,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1603.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1820.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1777.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1668.97,77,,,Percent of total Billed charges,77% of total billed charges,1842.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,623.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1083.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.87,1929.07,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2082.39,1041.2,,1603.44,77,,,Percent of Total Billed Charges,77% of total billed charges,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1540.97,74,,,Percent of Total Billed Charges,74% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1749.21,84,,,Percent of Total Billed Charges,84% of total billed charges,1707.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1853.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.44,77,,,Percent of total Billed charges,77% of total billed charges,1770.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1041.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.6,1853.33,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2167.49,1083.75,,1668.97,77,,,Percent of Total Billed Charges,77% of total billed charges,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1603.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1820.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1777.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1668.97,77,,,Percent of total Billed charges,77% of total billed charges,1842.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,623.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1083.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.87,1929.07,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2082.39,1041.2,,1603.44,77,,,Percent of Total Billed Charges,77% of total billed charges,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1540.97,74,,,Percent of Total Billed Charges,74% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1749.21,84,,,Percent of Total Billed Charges,84% of total billed charges,1707.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1853.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.44,77,,,Percent of total Billed charges,77% of total billed charges,1770.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1041.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.6,1853.33,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2167.49,1083.75,,1668.97,77,,,Percent of Total Billed Charges,77% of total billed charges,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1603.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1820.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1777.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1668.97,77,,,Percent of total Billed charges,77% of total billed charges,1842.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,623.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1083.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.87,1929.07,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2082.39,1041.2,,1603.44,77,,,Percent of Total Billed Charges,77% of total billed charges,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1540.97,74,,,Percent of Total Billed Charges,74% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1749.21,84,,,Percent of Total Billed Charges,84% of total billed charges,1707.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1853.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.44,77,,,Percent of total Billed charges,77% of total billed charges,1770.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1041.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.6,1853.33,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2167.49,1083.75,,1668.97,77,,,Percent of Total Billed Charges,77% of total billed charges,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1603.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1820.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1777.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1668.97,77,,,Percent of total Billed charges,77% of total billed charges,1842.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,623.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1083.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.87,1929.07,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2082.39,1041.2,,1603.44,77,,,Percent of Total Billed Charges,77% of total billed charges,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1540.97,74,,,Percent of Total Billed Charges,74% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1749.21,84,,,Percent of Total Billed Charges,84% of total billed charges,1707.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1853.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.44,77,,,Percent of total Billed charges,77% of total billed charges,1770.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1041.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.6,1853.33,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2167.49,1083.75,,1668.97,77,,,Percent of Total Billed Charges,77% of total billed charges,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1603.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1820.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1777.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1668.97,77,,,Percent of total Billed charges,77% of total billed charges,1842.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,623.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1083.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.87,1929.07,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2082.39,1041.2,,1603.44,77,,,Percent of Total Billed Charges,77% of total billed charges,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,531.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,650.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1540.97,74,,,Percent of Total Billed Charges,74% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1436.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1749.21,84,,,Percent of Total Billed Charges,84% of total billed charges,1707.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,1853.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1603.44,77,,,Percent of total Billed charges,77% of total billed charges,1770.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,598.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1041.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,849.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1853.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,520.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.6,1853.33,
Dexrazoxane 500mg SDV,,,250,RC,,,Outpatient,,,2167.49,1083.75,,1668.97,77,,,Percent of Total Billed Charges,77% of total billed charges,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,552.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,677.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1603.94,74,,,Percent of Total Billed Charges,74% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1495.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1820.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1777.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,1929.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1668.97,77,,,Percent of total Billed charges,77% of total billed charges,1842.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,623.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1083.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,884.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1929.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,541.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,541.87,1929.07,
Dextrose 5%-0.2% NACL 1000ml IV Bag,338007704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.2% NACL 1000ml IV Bag,338007704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.2% NACL 1000ml IV Bag,338007704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.2% NACL 1000ml IV Bag,338007704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.2% NACL 1000ml IV Bag,338007704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.2% NACL 1000ml IV Bag,338007704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 1000ml IV Bag,338008504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 1000ml IV Bag,338008504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 1000ml IV Bag,338008504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 1000ml IV Bag,338008504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 1000ml IV Bag,338008504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 1000ml IV Bag,338008504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-NS 1,000ml IV Bag",338008904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-NS 1,000ml IV Bag",338008904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-NS 1,000ml IV Bag",338008904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-NS 1,000ml IV Bag",338008904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-NS 1,000ml IV Bag",338008904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-NS 1,000ml IV Bag",338008904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-LR 1,000ml IV Bag",338012504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-LR 1,000ml IV Bag",338012504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-LR 1,000ml IV Bag",338012504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-LR 1,000ml IV Bag",338012504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-LR 1,000ml IV Bag",338012504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
"Dextrose 5%-LR 1,000ml IV Bag",338012504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 1000ml IV Bag,338001704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 1000ml IV Bag,338001704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 1000ml IV Bag,338001704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 1000ml IV Bag,338001704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 1000ml IV Bag,338001704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 1000ml IV Bag,338001704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 100ml IV Bag,338001738,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 25% 2.5gm/10ml Pediatric IV Syringe,409177510,CDM,250,RC,,,Outpatient,,,179.9,89.95,,138.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.13,74,,,Percent of Total Billed Charges,74% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,151.12,84,,,Percent of Total Billed Charges,84% of total billed charges,147.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.11,89,,,Percent of total Billed Charges,89% of total Billed charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.52,77,,,Percent of total Billed charges,77% of total billed charges,152.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.98,160.11,
Dextrose 25% 2.5gm/10ml Pediatric IV Syringe,409177510,CDM,250,RC,,,Outpatient,,,179.9,89.95,,138.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.13,74,,,Percent of Total Billed Charges,74% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,151.12,84,,,Percent of Total Billed Charges,84% of total billed charges,147.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.11,89,,,Percent of total Billed Charges,89% of total Billed charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.52,77,,,Percent of total Billed charges,77% of total billed charges,152.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.98,160.11,
Dextrose 25% 2.5gm/10ml Pediatric IV Syringe,409177510,CDM,250,RC,,,Outpatient,,,179.9,89.95,,138.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.13,74,,,Percent of Total Billed Charges,74% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,151.12,84,,,Percent of Total Billed Charges,84% of total billed charges,147.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.11,89,,,Percent of total Billed Charges,89% of total Billed charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.52,77,,,Percent of total Billed charges,77% of total billed charges,152.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.98,160.11,
Dextrose 25% 2.5gm/10ml Pediatric IV Syringe,409177510,CDM,250,RC,,,Outpatient,,,179.9,89.95,,138.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.13,74,,,Percent of Total Billed Charges,74% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,151.12,84,,,Percent of Total Billed Charges,84% of total billed charges,147.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.11,89,,,Percent of total Billed Charges,89% of total Billed charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.52,77,,,Percent of total Billed charges,77% of total billed charges,152.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.98,160.11,
Dextrose 25% 2.5gm/10ml Pediatric IV Syringe,409177510,CDM,250,RC,,,Outpatient,,,179.9,89.95,,138.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.13,74,,,Percent of Total Billed Charges,74% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,151.12,84,,,Percent of Total Billed Charges,84% of total billed charges,147.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.11,89,,,Percent of total Billed Charges,89% of total Billed charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.52,77,,,Percent of total Billed charges,77% of total billed charges,152.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.98,160.11,
Dextrose 25% 2.5gm/10ml Pediatric IV Syringe,409177510,CDM,250,RC,,,Outpatient,,,179.9,89.95,,138.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.13,74,,,Percent of Total Billed Charges,74% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,124.13,69,,,Percent of Total Billed Charges,69% of total billed charges,151.12,84,,,Percent of Total Billed Charges,84% of total billed charges,147.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.11,89,,,Percent of total Billed Charges,89% of total Billed charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.52,77,,,Percent of total Billed charges,77% of total billed charges,152.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.98,160.11,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 250ml IV Bag,338001702,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextromethorphan 12-Hr 30mg/5ml UDC,904631256,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dextromethorphan 12-Hr 30mg/5ml UDC,904631256,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dextromethorphan 12-Hr 30mg/5ml UDC,904631256,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dextromethorphan 12-Hr 30mg/5ml UDC,904631256,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dextromethorphan 12-Hr 30mg/5ml UDC,904631256,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dextromethorphan 12-Hr 30mg/5ml UDC,904631256,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Glucose Gel 15gm Oral Tube,574006930,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Glucose Gel 15gm Oral Tube,574006930,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Glucose Gel 15gm Oral Tube,574006930,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Glucose Gel 15gm Oral Tube,574006930,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Glucose Gel 15gm Oral Tube,574006930,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Glucose Gel 15gm Oral Tube,574006930,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dextrose 5%-0.33% NACL 500ml IV Bag,338008103,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.33% NACL 500ml IV Bag,338008103,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.33% NACL 500ml IV Bag,338008103,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.33% NACL 500ml IV Bag,338008103,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.33% NACL 500ml IV Bag,338008103,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-0.33% NACL 500ml IV Bag,338008103,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 500ml IV Bag,338008503,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 500ml IV Bag,338008503,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 500ml IV Bag,338008503,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 500ml IV Bag,338008503,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 500ml IV Bag,338008503,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS 500ml IV Bag,338008503,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 500ml IV Bag,338001703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 500ml IV Bag,338001703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 500ml IV Bag,338001703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 500ml IV Bag,338001703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 500ml IV Bag,338001703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5% 500ml IV Bag,338001703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 10% Water 500ml IV Bag,338002303,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 10% Water 500ml IV Bag,338002303,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 10% Water 500ml IV Bag,338002303,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 10% Water 500ml IV Bag,338002303,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 10% Water 500ml IV Bag,338002303,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 10% Water 500ml IV Bag,338002303,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,174.06,87.03,,134.03,77,,,Percent of Total Billed Charges,77% of total billed charges,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.8,74,,,Percent of Total Billed Charges,74% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,120.1,69,,,Percent of Total Billed Charges,69% of total billed charges,146.21,84,,,Percent of Total Billed Charges,84% of total billed charges,142.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.91,89,,,Percent of total Billed Charges,89% of total Billed charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.03,77,,,Percent of total Billed charges,77% of total billed charges,147.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.52,154.91,
Dextrose 50% 25gm/50ml IV Syringe,409751716,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Amphetamine Salt 5mg Tablet,42806033901,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Amphetamine Salt 5mg Tablet,42806033901,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Amphetamine Salt 5mg Tablet,42806033901,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Amphetamine Salt 5mg Tablet,42806033901,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Amphetamine Salt 5mg Tablet,42806033901,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Amphetamine Salt 5mg Tablet,42806033901,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
diazePAM 20mg Rectal Gel,,,250,RC,,,Outpatient,,,1050.2,525.1,,808.65,77,,,Percent of Total Billed Charges,77% of total billed charges,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777.15,74,,,Percent of Total Billed Charges,74% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,882.17,84,,,Percent of Total Billed Charges,84% of total billed charges,861.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.68,89,,,Percent of total Billed Charges,89% of total Billed charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.65,77,,,Percent of total Billed charges,77% of total billed charges,892.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,934.68,
diazePAM 20mg Rectal Gel,,,250,RC,,,Outpatient,,,1050.2,525.1,,808.65,77,,,Percent of Total Billed Charges,77% of total billed charges,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777.15,74,,,Percent of Total Billed Charges,74% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,882.17,84,,,Percent of Total Billed Charges,84% of total billed charges,861.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.68,89,,,Percent of total Billed Charges,89% of total Billed charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.65,77,,,Percent of total Billed charges,77% of total billed charges,892.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,934.68,
diazePAM 20mg Rectal Gel,,,250,RC,,,Outpatient,,,1050.2,525.1,,808.65,77,,,Percent of Total Billed Charges,77% of total billed charges,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777.15,74,,,Percent of Total Billed Charges,74% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,882.17,84,,,Percent of Total Billed Charges,84% of total billed charges,861.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.68,89,,,Percent of total Billed Charges,89% of total Billed charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.65,77,,,Percent of total Billed charges,77% of total billed charges,892.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,934.68,
diazePAM 20mg Rectal Gel,,,250,RC,,,Outpatient,,,1050.2,525.1,,808.65,77,,,Percent of Total Billed Charges,77% of total billed charges,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777.15,74,,,Percent of Total Billed Charges,74% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,882.17,84,,,Percent of Total Billed Charges,84% of total billed charges,861.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.68,89,,,Percent of total Billed Charges,89% of total Billed charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.65,77,,,Percent of total Billed charges,77% of total billed charges,892.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,934.68,
diazePAM 20mg Rectal Gel,,,250,RC,,,Outpatient,,,1050.2,525.1,,808.65,77,,,Percent of Total Billed Charges,77% of total billed charges,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777.15,74,,,Percent of Total Billed Charges,74% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,882.17,84,,,Percent of Total Billed Charges,84% of total billed charges,861.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.68,89,,,Percent of total Billed Charges,89% of total Billed charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.65,77,,,Percent of total Billed charges,77% of total billed charges,892.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,934.68,
diazePAM 20mg Rectal Gel,,,250,RC,,,Outpatient,,,1050.2,525.1,,808.65,77,,,Percent of Total Billed Charges,77% of total billed charges,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,267.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,328.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,777.15,74,,,Percent of Total Billed Charges,74% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,724.64,69,,,Percent of Total Billed Charges,69% of total billed charges,882.17,84,,,Percent of Total Billed Charges,84% of total billed charges,861.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,934.68,89,,,Percent of total Billed Charges,89% of total Billed charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,808.65,77,,,Percent of total Billed charges,77% of total billed charges,892.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,301.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,525.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,428.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,262.55,934.68,
diazePAM Pediatric Rectal 2.5mg Gel,,,250,RC,,,Outpatient,,,886.11,443.06,,682.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.72,74,,,Percent of Total Billed Charges,74% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,744.33,84,,,Percent of Total Billed Charges,84% of total billed charges,726.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.64,89,,,Percent of total Billed Charges,89% of total Billed charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.3,77,,,Percent of total Billed charges,77% of total billed charges,753.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.53,788.64,
diazePAM Pediatric Rectal 2.5mg Gel,,,250,RC,,,Outpatient,,,886.11,443.06,,682.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.72,74,,,Percent of Total Billed Charges,74% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,744.33,84,,,Percent of Total Billed Charges,84% of total billed charges,726.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.64,89,,,Percent of total Billed Charges,89% of total Billed charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.3,77,,,Percent of total Billed charges,77% of total billed charges,753.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.53,788.64,
diazePAM Pediatric Rectal 2.5mg Gel,,,250,RC,,,Outpatient,,,886.11,443.06,,682.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.72,74,,,Percent of Total Billed Charges,74% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,744.33,84,,,Percent of Total Billed Charges,84% of total billed charges,726.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.64,89,,,Percent of total Billed Charges,89% of total Billed charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.3,77,,,Percent of total Billed charges,77% of total billed charges,753.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.53,788.64,
diazePAM Pediatric Rectal 2.5mg Gel,,,250,RC,,,Outpatient,,,886.11,443.06,,682.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.72,74,,,Percent of Total Billed Charges,74% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,744.33,84,,,Percent of Total Billed Charges,84% of total billed charges,726.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.64,89,,,Percent of total Billed Charges,89% of total Billed charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.3,77,,,Percent of total Billed charges,77% of total billed charges,753.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.53,788.64,
diazePAM Pediatric Rectal 2.5mg Gel,,,250,RC,,,Outpatient,,,886.11,443.06,,682.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.72,74,,,Percent of Total Billed Charges,74% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,744.33,84,,,Percent of Total Billed Charges,84% of total billed charges,726.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.64,89,,,Percent of total Billed Charges,89% of total Billed charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.3,77,,,Percent of total Billed charges,77% of total billed charges,753.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.53,788.64,
diazePAM Pediatric Rectal 2.5mg Gel,,,250,RC,,,Outpatient,,,886.11,443.06,,682.3,77,,,Percent of Total Billed Charges,77% of total billed charges,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,225.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,655.72,74,,,Percent of Total Billed Charges,74% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,611.42,69,,,Percent of Total Billed Charges,69% of total billed charges,744.33,84,,,Percent of Total Billed Charges,84% of total billed charges,726.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,788.64,89,,,Percent of total Billed Charges,89% of total Billed charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,682.3,77,,,Percent of total Billed charges,77% of total billed charges,753.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,254.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,443.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,361.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,788.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,221.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,221.53,788.64,
diazePAM 10mg/2ml Carpuject Syringe,409127332,CDM,250,RC,,,Outpatient,,,258.26,129.13,,198.86,77,,,Percent of Total Billed Charges,77% of total billed charges,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.11,74,,,Percent of Total Billed Charges,74% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.94,84,,,Percent of Total Billed Charges,84% of total billed charges,211.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.85,89,,,Percent of total Billed Charges,89% of total Billed charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.86,77,,,Percent of total Billed charges,77% of total billed charges,219.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,229.85,
diazePAM 10mg/2ml Carpuject Syringe,409127332,CDM,250,RC,,,Outpatient,,,258.26,129.13,,198.86,77,,,Percent of Total Billed Charges,77% of total billed charges,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.11,74,,,Percent of Total Billed Charges,74% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.94,84,,,Percent of Total Billed Charges,84% of total billed charges,211.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.85,89,,,Percent of total Billed Charges,89% of total Billed charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.86,77,,,Percent of total Billed charges,77% of total billed charges,219.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,229.85,
diazePAM 10mg/2ml Carpuject Syringe,409127332,CDM,250,RC,,,Outpatient,,,258.26,129.13,,198.86,77,,,Percent of Total Billed Charges,77% of total billed charges,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.11,74,,,Percent of Total Billed Charges,74% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.94,84,,,Percent of Total Billed Charges,84% of total billed charges,211.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.85,89,,,Percent of total Billed Charges,89% of total Billed charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.86,77,,,Percent of total Billed charges,77% of total billed charges,219.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,229.85,
diazePAM 10mg/2ml Carpuject Syringe,409127332,CDM,250,RC,,,Outpatient,,,258.26,129.13,,198.86,77,,,Percent of Total Billed Charges,77% of total billed charges,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.11,74,,,Percent of Total Billed Charges,74% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.94,84,,,Percent of Total Billed Charges,84% of total billed charges,211.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.85,89,,,Percent of total Billed Charges,89% of total Billed charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.86,77,,,Percent of total Billed charges,77% of total billed charges,219.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,229.85,
diazePAM 10mg/2ml Carpuject Syringe,409127332,CDM,250,RC,,,Outpatient,,,258.26,129.13,,198.86,77,,,Percent of Total Billed Charges,77% of total billed charges,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.11,74,,,Percent of Total Billed Charges,74% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.94,84,,,Percent of Total Billed Charges,84% of total billed charges,211.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.85,89,,,Percent of total Billed Charges,89% of total Billed charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.86,77,,,Percent of total Billed charges,77% of total billed charges,219.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,229.85,
diazePAM 10mg/2ml Carpuject Syringe,409127332,CDM,250,RC,,,Outpatient,,,258.26,129.13,,198.86,77,,,Percent of Total Billed Charges,77% of total billed charges,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.11,74,,,Percent of Total Billed Charges,74% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,178.2,69,,,Percent of Total Billed Charges,69% of total billed charges,216.94,84,,,Percent of Total Billed Charges,84% of total billed charges,211.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,229.85,89,,,Percent of total Billed Charges,89% of total Billed charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.86,77,,,Percent of total Billed charges,77% of total billed charges,219.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.57,229.85,
diazePAM 5mg Tablet,51079028520,CDM,250,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
diazePAM 5mg Tablet,51079028520,CDM,250,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
diazePAM 5mg Tablet,51079028520,CDM,250,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
diazePAM 5mg Tablet,51079028520,CDM,250,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
diazePAM 5mg Tablet,51079028520,CDM,250,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
diazePAM 5mg Tablet,51079028520,CDM,250,RC,,,Outpatient,,,8,4,,6.16,77,,,Percent of Total Billed Charges,77% of total billed charges,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.92,74,,,Percent of Total Billed Charges,74% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,84,,,Percent of Total Billed Charges,84% of total billed charges,6.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.12,89,,,Percent of total Billed Charges,89% of total Billed charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,77,,,Percent of total Billed charges,77% of total billed charges,6.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2,7.12,
Dibucaine 1% Ointment 30gm,55741040202,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Dibucaine 1% Ointment 30gm,55741040202,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Dibucaine 1% Ointment 30gm,55741040202,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Dibucaine 1% Ointment 30gm,55741040202,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Dibucaine 1% Ointment 30gm,55741040202,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Dibucaine 1% Ointment 30gm,55741040202,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Diclofenac Gel 100gm,,,250,RC,,,Outpatient,,,105.75,52.88,,81.43,77,,,Percent of Total Billed Charges,77% of total billed charges,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.26,74,,,Percent of Total Billed Charges,74% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,88.83,84,,,Percent of Total Billed Charges,84% of total billed charges,86.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.12,89,,,Percent of total Billed Charges,89% of total Billed charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.43,77,,,Percent of total Billed charges,77% of total billed charges,89.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.44,94.12,
Diclofenac Gel 100gm,,,250,RC,,,Outpatient,,,105.75,52.88,,81.43,77,,,Percent of Total Billed Charges,77% of total billed charges,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.26,74,,,Percent of Total Billed Charges,74% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,88.83,84,,,Percent of Total Billed Charges,84% of total billed charges,86.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.12,89,,,Percent of total Billed Charges,89% of total Billed charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.43,77,,,Percent of total Billed charges,77% of total billed charges,89.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.44,94.12,
Diclofenac Gel 100gm,,,250,RC,,,Outpatient,,,105.75,52.88,,81.43,77,,,Percent of Total Billed Charges,77% of total billed charges,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.26,74,,,Percent of Total Billed Charges,74% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,88.83,84,,,Percent of Total Billed Charges,84% of total billed charges,86.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.12,89,,,Percent of total Billed Charges,89% of total Billed charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.43,77,,,Percent of total Billed charges,77% of total billed charges,89.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.44,94.12,
Diclofenac Gel 100gm,,,250,RC,,,Outpatient,,,105.75,52.88,,81.43,77,,,Percent of Total Billed Charges,77% of total billed charges,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.26,74,,,Percent of Total Billed Charges,74% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,88.83,84,,,Percent of Total Billed Charges,84% of total billed charges,86.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.12,89,,,Percent of total Billed Charges,89% of total Billed charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.43,77,,,Percent of total Billed charges,77% of total billed charges,89.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.44,94.12,
Diclofenac Gel 100gm,,,250,RC,,,Outpatient,,,105.75,52.88,,81.43,77,,,Percent of Total Billed Charges,77% of total billed charges,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.26,74,,,Percent of Total Billed Charges,74% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,88.83,84,,,Percent of Total Billed Charges,84% of total billed charges,86.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.12,89,,,Percent of total Billed Charges,89% of total Billed charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.43,77,,,Percent of total Billed charges,77% of total billed charges,89.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.44,94.12,
Diclofenac Gel 100gm,,,250,RC,,,Outpatient,,,105.75,52.88,,81.43,77,,,Percent of Total Billed Charges,77% of total billed charges,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.26,74,,,Percent of Total Billed Charges,74% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,72.97,69,,,Percent of Total Billed Charges,69% of total billed charges,88.83,84,,,Percent of Total Billed Charges,84% of total billed charges,86.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.12,89,,,Percent of total Billed Charges,89% of total Billed charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.43,77,,,Percent of total Billed charges,77% of total billed charges,89.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.44,94.12,
Dicloxacillin 250mg Capsule,93312301,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicloxacillin 250mg Capsule,93312301,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicloxacillin 250mg Capsule,93312301,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicloxacillin 250mg Capsule,93312301,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicloxacillin 250mg Capsule,93312301,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicloxacillin 250mg Capsule,93312301,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 10mg Capsule,591079401,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Dicyclomine 10mg Capsule,591079401,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Dicyclomine 10mg Capsule,591079401,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Dicyclomine 10mg Capsule,591079401,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Dicyclomine 10mg Capsule,591079401,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Dicyclomine 10mg Capsule,591079401,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Dicyclomine 10mg/5ml Oral Syrup UDC,603116158,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 10mg/5ml Oral Syrup UDC,603116158,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 10mg/5ml Oral Syrup UDC,603116158,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 10mg/5ml Oral Syrup UDC,603116158,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 10mg/5ml Oral Syrup UDC,603116158,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 10mg/5ml Oral Syrup UDC,603116158,CDM,250,RC,,,Outpatient,,,19.08,9.54,,14.69,77,,,Percent of Total Billed Charges,77% of total billed charges,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.12,74,,,Percent of Total Billed Charges,74% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,13.17,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.98,89,,,Percent of total Billed Charges,89% of total Billed charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.69,77,,,Percent of total Billed charges,77% of total billed charges,16.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.77,16.98,
Dicyclomine 20mg/2ml SDV,31722096331,CDM,250,RC,,,Outpatient,,,443.92,221.96,,341.82,77,,,Percent of Total Billed Charges,77% of total billed charges,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.5,74,,,Percent of Total Billed Charges,74% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,372.89,84,,,Percent of Total Billed Charges,84% of total billed charges,364.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.09,89,,,Percent of total Billed Charges,89% of total Billed charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.82,77,,,Percent of total Billed charges,77% of total billed charges,377.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.98,395.09,
Dicyclomine 20mg/2ml SDV,31722096331,CDM,250,RC,,,Outpatient,,,443.92,221.96,,341.82,77,,,Percent of Total Billed Charges,77% of total billed charges,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.5,74,,,Percent of Total Billed Charges,74% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,372.89,84,,,Percent of Total Billed Charges,84% of total billed charges,364.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.09,89,,,Percent of total Billed Charges,89% of total Billed charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.82,77,,,Percent of total Billed charges,77% of total billed charges,377.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.98,395.09,
Dicyclomine 20mg/2ml SDV,31722096331,CDM,250,RC,,,Outpatient,,,443.92,221.96,,341.82,77,,,Percent of Total Billed Charges,77% of total billed charges,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.5,74,,,Percent of Total Billed Charges,74% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,372.89,84,,,Percent of Total Billed Charges,84% of total billed charges,364.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.09,89,,,Percent of total Billed Charges,89% of total Billed charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.82,77,,,Percent of total Billed charges,77% of total billed charges,377.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.98,395.09,
Dicyclomine 20mg/2ml SDV,31722096331,CDM,250,RC,,,Outpatient,,,443.92,221.96,,341.82,77,,,Percent of Total Billed Charges,77% of total billed charges,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.5,74,,,Percent of Total Billed Charges,74% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,372.89,84,,,Percent of Total Billed Charges,84% of total billed charges,364.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.09,89,,,Percent of total Billed Charges,89% of total Billed charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.82,77,,,Percent of total Billed charges,77% of total billed charges,377.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.98,395.09,
Dicyclomine 20mg/2ml SDV,31722096331,CDM,250,RC,,,Outpatient,,,443.92,221.96,,341.82,77,,,Percent of Total Billed Charges,77% of total billed charges,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.5,74,,,Percent of Total Billed Charges,74% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,372.89,84,,,Percent of Total Billed Charges,84% of total billed charges,364.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.09,89,,,Percent of total Billed Charges,89% of total Billed charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.82,77,,,Percent of total Billed charges,77% of total billed charges,377.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.98,395.09,
Dicyclomine 20mg/2ml SDV,31722096331,CDM,250,RC,,,Outpatient,,,443.92,221.96,,341.82,77,,,Percent of Total Billed Charges,77% of total billed charges,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.5,74,,,Percent of Total Billed Charges,74% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,306.3,69,,,Percent of Total Billed Charges,69% of total billed charges,372.89,84,,,Percent of Total Billed Charges,84% of total billed charges,364.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.09,89,,,Percent of total Billed Charges,89% of total Billed charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.82,77,,,Percent of total Billed charges,77% of total billed charges,377.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.98,395.09,
Digoxin 125mcg (0.125mg) Tablet,904592161,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Digoxin 125mcg (0.125mg) Tablet,904592161,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Digoxin 125mcg (0.125mg) Tablet,904592161,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Digoxin 125mcg (0.125mg) Tablet,904592161,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Digoxin 125mcg (0.125mg) Tablet,904592161,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Digoxin 125mcg (0.125mg) Tablet,904592161,CDM,250,RC,,,Outpatient,,,17.67,8.84,,13.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.08,74,,,Percent of Total Billed Charges,74% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,12.19,69,,,Percent of Total Billed Charges,69% of total billed charges,14.84,84,,,Percent of Total Billed Charges,84% of total billed charges,14.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.73,89,,,Percent of total Billed Charges,89% of total Billed charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,77,,,Percent of total Billed charges,77% of total billed charges,15.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,15.73,
Digoxin 250mcg/1ml Ampule,781305995,CDM,250,RC,,,Outpatient,,,70.76,35.38,,54.49,77,,,Percent of Total Billed Charges,77% of total billed charges,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.36,74,,,Percent of Total Billed Charges,74% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,59.44,84,,,Percent of Total Billed Charges,84% of total billed charges,58.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.98,89,,,Percent of total Billed Charges,89% of total Billed charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.49,77,,,Percent of total Billed charges,77% of total billed charges,60.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.69,62.98,
Digoxin 250mcg/1ml Ampule,781305995,CDM,250,RC,,,Outpatient,,,70.76,35.38,,54.49,77,,,Percent of Total Billed Charges,77% of total billed charges,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.36,74,,,Percent of Total Billed Charges,74% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,59.44,84,,,Percent of Total Billed Charges,84% of total billed charges,58.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.98,89,,,Percent of total Billed Charges,89% of total Billed charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.49,77,,,Percent of total Billed charges,77% of total billed charges,60.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.69,62.98,
Digoxin 250mcg/1ml Ampule,781305995,CDM,250,RC,,,Outpatient,,,70.76,35.38,,54.49,77,,,Percent of Total Billed Charges,77% of total billed charges,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.36,74,,,Percent of Total Billed Charges,74% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,59.44,84,,,Percent of Total Billed Charges,84% of total billed charges,58.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.98,89,,,Percent of total Billed Charges,89% of total Billed charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.49,77,,,Percent of total Billed charges,77% of total billed charges,60.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.69,62.98,
Digoxin 250mcg/1ml Ampule,781305995,CDM,250,RC,,,Outpatient,,,70.76,35.38,,54.49,77,,,Percent of Total Billed Charges,77% of total billed charges,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.36,74,,,Percent of Total Billed Charges,74% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,59.44,84,,,Percent of Total Billed Charges,84% of total billed charges,58.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.98,89,,,Percent of total Billed Charges,89% of total Billed charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.49,77,,,Percent of total Billed charges,77% of total billed charges,60.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.69,62.98,
Digoxin 250mcg/1ml Ampule,781305995,CDM,250,RC,,,Outpatient,,,70.76,35.38,,54.49,77,,,Percent of Total Billed Charges,77% of total billed charges,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.36,74,,,Percent of Total Billed Charges,74% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,59.44,84,,,Percent of Total Billed Charges,84% of total billed charges,58.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.98,89,,,Percent of total Billed Charges,89% of total Billed charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.49,77,,,Percent of total Billed charges,77% of total billed charges,60.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.69,62.98,
Digoxin 250mcg/1ml Ampule,781305995,CDM,250,RC,,,Outpatient,,,70.76,35.38,,54.49,77,,,Percent of Total Billed Charges,77% of total billed charges,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.36,74,,,Percent of Total Billed Charges,74% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,48.82,69,,,Percent of Total Billed Charges,69% of total billed charges,59.44,84,,,Percent of Total Billed Charges,84% of total billed charges,58.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.98,89,,,Percent of total Billed Charges,89% of total Billed charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.49,77,,,Percent of total Billed charges,77% of total billed charges,60.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.69,62.98,
Dihydroergotamine 1mg/ml Ampule,574085010,CDM,250,RC,,,Outpatient,,,595.82,297.91,,458.78,77,,,Percent of Total Billed Charges,77% of total billed charges,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,440.91,74,,,Percent of Total Billed Charges,74% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,500.49,84,,,Percent of Total Billed Charges,84% of total billed charges,488.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,530.28,89,,,Percent of total Billed Charges,89% of total Billed charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.78,77,,,Percent of total Billed charges,77% of total billed charges,506.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,297.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.96,530.28,
Dihydroergotamine 1mg/ml Ampule,574085010,CDM,250,RC,,,Outpatient,,,595.82,297.91,,458.78,77,,,Percent of Total Billed Charges,77% of total billed charges,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,440.91,74,,,Percent of Total Billed Charges,74% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,500.49,84,,,Percent of Total Billed Charges,84% of total billed charges,488.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,530.28,89,,,Percent of total Billed Charges,89% of total Billed charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.78,77,,,Percent of total Billed charges,77% of total billed charges,506.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,297.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.96,530.28,
Dihydroergotamine 1mg/ml Ampule,574085010,CDM,250,RC,,,Outpatient,,,595.82,297.91,,458.78,77,,,Percent of Total Billed Charges,77% of total billed charges,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,440.91,74,,,Percent of Total Billed Charges,74% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,500.49,84,,,Percent of Total Billed Charges,84% of total billed charges,488.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,530.28,89,,,Percent of total Billed Charges,89% of total Billed charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.78,77,,,Percent of total Billed charges,77% of total billed charges,506.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,297.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.96,530.28,
Dihydroergotamine 1mg/ml Ampule,574085010,CDM,250,RC,,,Outpatient,,,595.82,297.91,,458.78,77,,,Percent of Total Billed Charges,77% of total billed charges,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,440.91,74,,,Percent of Total Billed Charges,74% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,500.49,84,,,Percent of Total Billed Charges,84% of total billed charges,488.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,530.28,89,,,Percent of total Billed Charges,89% of total Billed charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.78,77,,,Percent of total Billed charges,77% of total billed charges,506.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,297.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.96,530.28,
Dihydroergotamine 1mg/ml Ampule,574085010,CDM,250,RC,,,Outpatient,,,595.82,297.91,,458.78,77,,,Percent of Total Billed Charges,77% of total billed charges,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,440.91,74,,,Percent of Total Billed Charges,74% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,500.49,84,,,Percent of Total Billed Charges,84% of total billed charges,488.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,530.28,89,,,Percent of total Billed Charges,89% of total Billed charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.78,77,,,Percent of total Billed charges,77% of total billed charges,506.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,297.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.96,530.28,
Dihydroergotamine 1mg/ml Ampule,574085010,CDM,250,RC,,,Outpatient,,,595.82,297.91,,458.78,77,,,Percent of Total Billed Charges,77% of total billed charges,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,151.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,186.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,440.91,74,,,Percent of Total Billed Charges,74% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,411.12,69,,,Percent of Total Billed Charges,69% of total billed charges,500.49,84,,,Percent of Total Billed Charges,84% of total billed charges,488.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,530.28,89,,,Percent of total Billed Charges,89% of total Billed charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,458.78,77,,,Percent of total Billed charges,77% of total billed charges,506.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,171.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,297.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,243.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,530.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.96,530.28,
dilTIAZem 120mg CD Capsule,60687019501,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 120mg CD Capsule,60687019501,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 120mg CD Capsule,60687019501,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 120mg CD Capsule,60687019501,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 120mg CD Capsule,60687019501,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 120mg CD Capsule,60687019501,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 180mg CD Capsule,60687020601,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 180mg CD Capsule,60687020601,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 180mg CD Capsule,60687020601,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 180mg CD Capsule,60687020601,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 180mg CD Capsule,60687020601,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 180mg CD Capsule,60687020601,CDM,250,RC,,,Outpatient,,,14.1,7.05,,10.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.43,74,,,Percent of Total Billed Charges,74% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,9.73,69,,,Percent of Total Billed Charges,69% of total billed charges,11.84,84,,,Percent of Total Billed Charges,84% of total billed charges,11.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.55,89,,,Percent of total Billed Charges,89% of total Billed charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.86,77,,,Percent of total Billed charges,77% of total billed charges,11.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.53,12.55,
dilTIAZem 30mg Tablet,51079074520,CDM,250,RC,,,Outpatient,,,9.22,4.61,,7.1,77,,,Percent of Total Billed Charges,77% of total billed charges,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.82,74,,,Percent of Total Billed Charges,74% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.21,89,,,Percent of total Billed Charges,89% of total Billed charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.1,77,,,Percent of total Billed charges,77% of total billed charges,7.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.31,8.21,
dilTIAZem 30mg Tablet,51079074520,CDM,250,RC,,,Outpatient,,,9.22,4.61,,7.1,77,,,Percent of Total Billed Charges,77% of total billed charges,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.82,74,,,Percent of Total Billed Charges,74% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.21,89,,,Percent of total Billed Charges,89% of total Billed charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.1,77,,,Percent of total Billed charges,77% of total billed charges,7.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.31,8.21,
dilTIAZem 30mg Tablet,51079074520,CDM,250,RC,,,Outpatient,,,9.22,4.61,,7.1,77,,,Percent of Total Billed Charges,77% of total billed charges,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.82,74,,,Percent of Total Billed Charges,74% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.21,89,,,Percent of total Billed Charges,89% of total Billed charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.1,77,,,Percent of total Billed charges,77% of total billed charges,7.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.31,8.21,
dilTIAZem 30mg Tablet,51079074520,CDM,250,RC,,,Outpatient,,,9.22,4.61,,7.1,77,,,Percent of Total Billed Charges,77% of total billed charges,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.82,74,,,Percent of Total Billed Charges,74% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.21,89,,,Percent of total Billed Charges,89% of total Billed charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.1,77,,,Percent of total Billed charges,77% of total billed charges,7.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.31,8.21,
dilTIAZem 30mg Tablet,51079074520,CDM,250,RC,,,Outpatient,,,9.22,4.61,,7.1,77,,,Percent of Total Billed Charges,77% of total billed charges,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.82,74,,,Percent of Total Billed Charges,74% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.21,89,,,Percent of total Billed Charges,89% of total Billed charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.1,77,,,Percent of total Billed charges,77% of total billed charges,7.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.31,8.21,
dilTIAZem 30mg Tablet,51079074520,CDM,250,RC,,,Outpatient,,,9.22,4.61,,7.1,77,,,Percent of Total Billed Charges,77% of total billed charges,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.82,74,,,Percent of Total Billed Charges,74% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6.36,69,,,Percent of Total Billed Charges,69% of total billed charges,7.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.21,89,,,Percent of total Billed Charges,89% of total Billed charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.1,77,,,Percent of total Billed charges,77% of total billed charges,7.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.31,8.21,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
dilTIAZem 50mg/10ml SDV,641601410,CDM,250,RC,,,Outpatient,,,91.24,45.62,,70.25,77,,,Percent of Total Billed Charges,77% of total billed charges,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.52,74,,,Percent of Total Billed Charges,74% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,62.96,69,,,Percent of Total Billed Charges,69% of total billed charges,76.64,84,,,Percent of Total Billed Charges,84% of total billed charges,74.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.2,89,,,Percent of total Billed Charges,89% of total Billed charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.25,77,,,Percent of total Billed charges,77% of total billed charges,77.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.81,81.2,
Dimethyl Sulfoxide 50ml Topical Vial,67457017750,CDM,250,RC,,,Outpatient,,,2399.35,1199.68,,1847.5,77,,,Percent of Total Billed Charges,77% of total billed charges,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1775.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2015.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1967.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2135.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1847.5,77,,,Percent of total Billed charges,77% of total billed charges,2039.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,689.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1199.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.84,2135.42,
Dimethyl Sulfoxide 50ml Topical Vial,67457017750,CDM,250,RC,,,Outpatient,,,2399.35,1199.68,,1847.5,77,,,Percent of Total Billed Charges,77% of total billed charges,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1775.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2015.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1967.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2135.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1847.5,77,,,Percent of total Billed charges,77% of total billed charges,2039.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,689.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1199.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.84,2135.42,
Dimethyl Sulfoxide 50ml Topical Vial,67457017750,CDM,250,RC,,,Outpatient,,,2399.35,1199.68,,1847.5,77,,,Percent of Total Billed Charges,77% of total billed charges,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1775.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2015.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1967.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2135.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1847.5,77,,,Percent of total Billed charges,77% of total billed charges,2039.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,689.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1199.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.84,2135.42,
Dimethyl Sulfoxide 50ml Topical Vial,67457017750,CDM,250,RC,,,Outpatient,,,2399.35,1199.68,,1847.5,77,,,Percent of Total Billed Charges,77% of total billed charges,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1775.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2015.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1967.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2135.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1847.5,77,,,Percent of total Billed charges,77% of total billed charges,2039.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,689.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1199.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.84,2135.42,
Dimethyl Sulfoxide 50ml Topical Vial,67457017750,CDM,250,RC,,,Outpatient,,,2399.35,1199.68,,1847.5,77,,,Percent of Total Billed Charges,77% of total billed charges,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1775.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2015.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1967.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2135.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1847.5,77,,,Percent of total Billed charges,77% of total billed charges,2039.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,689.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1199.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.84,2135.42,
Dimethyl Sulfoxide 50ml Topical Vial,67457017750,CDM,250,RC,,,Outpatient,,,2399.35,1199.68,,1847.5,77,,,Percent of Total Billed Charges,77% of total billed charges,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,611.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,749.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1775.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1655.55,69,,,Percent of Total Billed Charges,69% of total billed charges,2015.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1967.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,2135.42,89,,,Percent of total Billed Charges,89% of total Billed charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1847.5,77,,,Percent of total Billed charges,77% of total billed charges,2039.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,689.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1199.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,978.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2135.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,599.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.84,2135.42,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Tdap Syringe 0.5ml Syringe,58160084252,CDM,250,RC,,,Outpatient,,,306.52,153.26,,236.02,77,,,Percent of Total Billed Charges,77% of total billed charges,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.82,74,,,Percent of Total Billed Charges,74% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,257.48,84,,,Percent of Total Billed Charges,84% of total billed charges,251.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.8,89,,,Percent of total Billed Charges,89% of total Billed charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.02,77,,,Percent of total Billed charges,77% of total billed charges,260.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,272.8,
Tdap Syringe 0.5ml Syringe,58160084252,CDM,250,RC,,,Outpatient,,,306.52,153.26,,236.02,77,,,Percent of Total Billed Charges,77% of total billed charges,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.82,74,,,Percent of Total Billed Charges,74% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,257.48,84,,,Percent of Total Billed Charges,84% of total billed charges,251.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.8,89,,,Percent of total Billed Charges,89% of total Billed charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.02,77,,,Percent of total Billed charges,77% of total billed charges,260.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,272.8,
Tdap Syringe 0.5ml Syringe,58160084252,CDM,250,RC,,,Outpatient,,,306.52,153.26,,236.02,77,,,Percent of Total Billed Charges,77% of total billed charges,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.82,74,,,Percent of Total Billed Charges,74% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,257.48,84,,,Percent of Total Billed Charges,84% of total billed charges,251.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.8,89,,,Percent of total Billed Charges,89% of total Billed charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.02,77,,,Percent of total Billed charges,77% of total billed charges,260.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,272.8,
Tdap Syringe 0.5ml Syringe,58160084252,CDM,250,RC,,,Outpatient,,,306.52,153.26,,236.02,77,,,Percent of Total Billed Charges,77% of total billed charges,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.82,74,,,Percent of Total Billed Charges,74% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,257.48,84,,,Percent of Total Billed Charges,84% of total billed charges,251.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.8,89,,,Percent of total Billed Charges,89% of total Billed charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.02,77,,,Percent of total Billed charges,77% of total billed charges,260.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,272.8,
Tdap Syringe 0.5ml Syringe,58160084252,CDM,250,RC,,,Outpatient,,,306.52,153.26,,236.02,77,,,Percent of Total Billed Charges,77% of total billed charges,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.82,74,,,Percent of Total Billed Charges,74% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,257.48,84,,,Percent of Total Billed Charges,84% of total billed charges,251.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.8,89,,,Percent of total Billed Charges,89% of total Billed charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.02,77,,,Percent of total Billed charges,77% of total billed charges,260.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,272.8,
Tdap Syringe 0.5ml Syringe,58160084252,CDM,250,RC,,,Outpatient,,,306.52,153.26,,236.02,77,,,Percent of Total Billed Charges,77% of total billed charges,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,226.82,74,,,Percent of Total Billed Charges,74% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,211.5,69,,,Percent of Total Billed Charges,69% of total billed charges,257.48,84,,,Percent of Total Billed Charges,84% of total billed charges,251.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,272.8,89,,,Percent of total Billed Charges,89% of total Billed charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,236.02,77,,,Percent of total Billed charges,77% of total billed charges,260.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,88.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,153.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,125.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,272.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.63,272.8,
diphenhydrAMINE Oral Soln 12.5mg/5ml UDC,121048905,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Soln 12.5mg/5ml UDC,121048905,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Soln 12.5mg/5ml UDC,121048905,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Soln 12.5mg/5ml UDC,121048905,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Soln 12.5mg/5ml UDC,121048905,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Soln 12.5mg/5ml UDC,121048905,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Diphenoxylate/Atropine Tablet,,,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
Diphenoxylate/Atropine Tablet,,,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
Diphenoxylate/Atropine Tablet,,,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
Diphenoxylate/Atropine Tablet,,,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
Diphenoxylate/Atropine Tablet,,,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
Diphenoxylate/Atropine Tablet,,,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
diphenhydrAMINE 25mg Capsule,904723760,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 25mg Capsule,904723760,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 25mg Capsule,904723760,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 25mg Capsule,904723760,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 25mg Capsule,904723760,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 25mg Capsule,904723760,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE-Zinc 1% Cream 30gm,12547017162,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
diphenhydrAMINE-Zinc 1% Cream 30gm,12547017162,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
diphenhydrAMINE-Zinc 1% Cream 30gm,12547017162,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
diphenhydrAMINE-Zinc 1% Cream 30gm,12547017162,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
diphenhydrAMINE-Zinc 1% Cream 30gm,12547017162,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
diphenhydrAMINE-Zinc 1% Cream 30gm,12547017162,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
diphenhydrAMINE 50mg Capsule,904205661,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 50mg Capsule,904205661,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 50mg Capsule,904205661,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 50mg Capsule,904205661,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 50mg Capsule,904205661,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 50mg Capsule,904205661,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE 50mg/ml SDV,63323066401,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
diphenhydrAMINE 50mg/ml SDV,63323066401,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
diphenhydrAMINE 50mg/ml SDV,63323066401,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
diphenhydrAMINE 50mg/ml SDV,63323066401,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
diphenhydrAMINE 50mg/ml SDV,63323066401,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
diphenhydrAMINE 50mg/ml SDV,63323066401,CDM,250,RC,,,Outpatient,,,64.76,32.38,,49.87,77,,,Percent of Total Billed Charges,77% of total billed charges,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.92,74,,,Percent of Total Billed Charges,74% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.68,69,,,Percent of Total Billed Charges,69% of total billed charges,54.4,84,,,Percent of Total Billed Charges,84% of total billed charges,53.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.64,89,,,Percent of total Billed Charges,89% of total Billed charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.87,77,,,Percent of total Billed charges,77% of total billed charges,55.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.19,57.64,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW-nyst),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW-nyst),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW-nyst),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW-nyst),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW-nyst),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
diphenhydrAMINE Oral Liquid 12.5mg/5ml 30ml (MMW-nyst),,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dipyridamole 25mg Tablet,64980013301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Dipyridamole 25mg Tablet,64980013301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Dipyridamole 25mg Tablet,64980013301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Dipyridamole 25mg Tablet,64980013301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Dipyridamole 25mg Tablet,64980013301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Dipyridamole 25mg Tablet,64980013301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Disopyramide 100mg Capsule,25275231,CDM,250,RC,,,Outpatient,,,46.56,23.28,,35.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.45,74,,,Percent of Total Billed Charges,74% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,39.11,84,,,Percent of Total Billed Charges,84% of total billed charges,38.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.44,89,,,Percent of total Billed Charges,89% of total Billed charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.85,77,,,Percent of total Billed charges,77% of total billed charges,39.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.64,41.44,
Disopyramide 100mg Capsule,25275231,CDM,250,RC,,,Outpatient,,,46.56,23.28,,35.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.45,74,,,Percent of Total Billed Charges,74% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,39.11,84,,,Percent of Total Billed Charges,84% of total billed charges,38.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.44,89,,,Percent of total Billed Charges,89% of total Billed charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.85,77,,,Percent of total Billed charges,77% of total billed charges,39.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.64,41.44,
Disopyramide 100mg Capsule,25275231,CDM,250,RC,,,Outpatient,,,46.56,23.28,,35.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.45,74,,,Percent of Total Billed Charges,74% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,39.11,84,,,Percent of Total Billed Charges,84% of total billed charges,38.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.44,89,,,Percent of total Billed Charges,89% of total Billed charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.85,77,,,Percent of total Billed charges,77% of total billed charges,39.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.64,41.44,
Disopyramide 100mg Capsule,25275231,CDM,250,RC,,,Outpatient,,,46.56,23.28,,35.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.45,74,,,Percent of Total Billed Charges,74% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,39.11,84,,,Percent of Total Billed Charges,84% of total billed charges,38.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.44,89,,,Percent of total Billed Charges,89% of total Billed charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.85,77,,,Percent of total Billed charges,77% of total billed charges,39.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.64,41.44,
Disopyramide 100mg Capsule,25275231,CDM,250,RC,,,Outpatient,,,46.56,23.28,,35.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.45,74,,,Percent of Total Billed Charges,74% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,39.11,84,,,Percent of Total Billed Charges,84% of total billed charges,38.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.44,89,,,Percent of total Billed Charges,89% of total Billed charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.85,77,,,Percent of total Billed charges,77% of total billed charges,39.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.64,41.44,
Disopyramide 100mg Capsule,25275231,CDM,250,RC,,,Outpatient,,,46.56,23.28,,35.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.45,74,,,Percent of Total Billed Charges,74% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,32.13,69,,,Percent of Total Billed Charges,69% of total billed charges,39.11,84,,,Percent of Total Billed Charges,84% of total billed charges,38.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.44,89,,,Percent of total Billed Charges,89% of total Billed charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.85,77,,,Percent of total Billed charges,77% of total billed charges,39.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.64,41.44,
Divalproex Delayed Release 125mg Sprinkle Capsule,68084031301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Divalproex Delayed Release 125mg Sprinkle Capsule,68084031301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Divalproex Delayed Release 125mg Sprinkle Capsule,68084031301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Divalproex Delayed Release 125mg Sprinkle Capsule,68084031301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Divalproex Delayed Release 125mg Sprinkle Capsule,68084031301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Divalproex Delayed Release 125mg Sprinkle Capsule,68084031301,CDM,250,RC,,,Outpatient,,,18.33,9.17,,14.11,77,,,Percent of Total Billed Charges,77% of total billed charges,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.56,74,,,Percent of Total Billed Charges,74% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,69,,,Percent of Total Billed Charges,69% of total billed charges,15.4,84,,,Percent of Total Billed Charges,84% of total billed charges,15.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.31,89,,,Percent of total Billed Charges,89% of total Billed charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,77,,,Percent of total Billed charges,77% of total billed charges,15.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,16.31,
Divalproex Extended Release 250mg Tablet,904636361,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Divalproex Extended Release 250mg Tablet,904636361,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Divalproex Extended Release 250mg Tablet,904636361,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Divalproex Extended Release 250mg Tablet,904636361,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Divalproex Extended Release 250mg Tablet,904636361,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Divalproex Extended Release 250mg Tablet,904636361,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Divalproex Delayed Release 250mg Tablet,57237004701,CDM,250,RC,,,Outpatient,,,21.33,10.67,,16.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.78,74,,,Percent of Total Billed Charges,74% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,17.92,84,,,Percent of Total Billed Charges,84% of total billed charges,17.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.98,89,,,Percent of total Billed Charges,89% of total Billed charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,77,,,Percent of total Billed charges,77% of total billed charges,18.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,18.98,
Divalproex Delayed Release 250mg Tablet,57237004701,CDM,250,RC,,,Outpatient,,,21.33,10.67,,16.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.78,74,,,Percent of Total Billed Charges,74% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,17.92,84,,,Percent of Total Billed Charges,84% of total billed charges,17.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.98,89,,,Percent of total Billed Charges,89% of total Billed charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,77,,,Percent of total Billed charges,77% of total billed charges,18.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,18.98,
Divalproex Delayed Release 250mg Tablet,57237004701,CDM,250,RC,,,Outpatient,,,21.33,10.67,,16.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.78,74,,,Percent of Total Billed Charges,74% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,17.92,84,,,Percent of Total Billed Charges,84% of total billed charges,17.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.98,89,,,Percent of total Billed Charges,89% of total Billed charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,77,,,Percent of total Billed charges,77% of total billed charges,18.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,18.98,
Divalproex Delayed Release 250mg Tablet,57237004701,CDM,250,RC,,,Outpatient,,,21.33,10.67,,16.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.78,74,,,Percent of Total Billed Charges,74% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,17.92,84,,,Percent of Total Billed Charges,84% of total billed charges,17.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.98,89,,,Percent of total Billed Charges,89% of total Billed charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,77,,,Percent of total Billed charges,77% of total billed charges,18.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,18.98,
Divalproex Delayed Release 250mg Tablet,57237004701,CDM,250,RC,,,Outpatient,,,21.33,10.67,,16.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.78,74,,,Percent of Total Billed Charges,74% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,17.92,84,,,Percent of Total Billed Charges,84% of total billed charges,17.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.98,89,,,Percent of total Billed Charges,89% of total Billed charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,77,,,Percent of total Billed charges,77% of total billed charges,18.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,18.98,
Divalproex Delayed Release 250mg Tablet,57237004701,CDM,250,RC,,,Outpatient,,,21.33,10.67,,16.42,77,,,Percent of Total Billed Charges,77% of total billed charges,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.78,74,,,Percent of Total Billed Charges,74% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,14.72,69,,,Percent of Total Billed Charges,69% of total billed charges,17.92,84,,,Percent of Total Billed Charges,84% of total billed charges,17.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.98,89,,,Percent of total Billed Charges,89% of total Billed charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.42,77,,,Percent of total Billed charges,77% of total billed charges,18.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,18.98,
Divalproex Extended Release 500mg Tablet,68084041501,CDM,250,RC,,,Outpatient,,,40.94,20.47,,31.52,77,,,Percent of Total Billed Charges,77% of total billed charges,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.3,74,,,Percent of Total Billed Charges,74% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,34.39,84,,,Percent of Total Billed Charges,84% of total billed charges,33.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.44,89,,,Percent of total Billed Charges,89% of total Billed charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.52,77,,,Percent of total Billed charges,77% of total billed charges,34.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,36.44,
Divalproex Extended Release 500mg Tablet,68084041501,CDM,250,RC,,,Outpatient,,,40.94,20.47,,31.52,77,,,Percent of Total Billed Charges,77% of total billed charges,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.3,74,,,Percent of Total Billed Charges,74% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,34.39,84,,,Percent of Total Billed Charges,84% of total billed charges,33.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.44,89,,,Percent of total Billed Charges,89% of total Billed charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.52,77,,,Percent of total Billed charges,77% of total billed charges,34.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,36.44,
Divalproex Extended Release 500mg Tablet,68084041501,CDM,250,RC,,,Outpatient,,,40.94,20.47,,31.52,77,,,Percent of Total Billed Charges,77% of total billed charges,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.3,74,,,Percent of Total Billed Charges,74% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,34.39,84,,,Percent of Total Billed Charges,84% of total billed charges,33.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.44,89,,,Percent of total Billed Charges,89% of total Billed charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.52,77,,,Percent of total Billed charges,77% of total billed charges,34.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,36.44,
Divalproex Extended Release 500mg Tablet,68084041501,CDM,250,RC,,,Outpatient,,,40.94,20.47,,31.52,77,,,Percent of Total Billed Charges,77% of total billed charges,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.3,74,,,Percent of Total Billed Charges,74% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,34.39,84,,,Percent of Total Billed Charges,84% of total billed charges,33.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.44,89,,,Percent of total Billed Charges,89% of total Billed charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.52,77,,,Percent of total Billed charges,77% of total billed charges,34.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,36.44,
Divalproex Extended Release 500mg Tablet,68084041501,CDM,250,RC,,,Outpatient,,,40.94,20.47,,31.52,77,,,Percent of Total Billed Charges,77% of total billed charges,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.3,74,,,Percent of Total Billed Charges,74% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,34.39,84,,,Percent of Total Billed Charges,84% of total billed charges,33.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.44,89,,,Percent of total Billed Charges,89% of total Billed charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.52,77,,,Percent of total Billed charges,77% of total billed charges,34.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,36.44,
Divalproex Extended Release 500mg Tablet,68084041501,CDM,250,RC,,,Outpatient,,,40.94,20.47,,31.52,77,,,Percent of Total Billed Charges,77% of total billed charges,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.3,74,,,Percent of Total Billed Charges,74% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,28.25,69,,,Percent of Total Billed Charges,69% of total billed charges,34.39,84,,,Percent of Total Billed Charges,84% of total billed charges,33.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.44,89,,,Percent of total Billed Charges,89% of total Billed charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.52,77,,,Percent of total Billed charges,77% of total billed charges,34.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.24,36.44,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOBUTamine 250mg/250ml (1mg/ml) IV Bag,338107302,CDM,250,RC,,,Outpatient,,,263.93,131.97,,203.23,77,,,Percent of Total Billed Charges,77% of total billed charges,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,195.31,74,,,Percent of Total Billed Charges,74% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,182.11,69,,,Percent of Total Billed Charges,69% of total billed charges,221.7,84,,,Percent of Total Billed Charges,84% of total billed charges,216.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,234.9,89,,,Percent of total Billed Charges,89% of total Billed charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,203.23,77,,,Percent of total Billed charges,77% of total billed charges,224.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,75.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,131.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,107.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.98,234.9,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3894.91,1947.46,,2999.08,77,,,Percent of Total Billed Charges,77% of total billed charges,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.47,89,,,Percent of total Billed Charges,89% of total Billed charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.08,77,,,Percent of total Billed charges,77% of total billed charges,3310.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.73,3466.47,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3798.04,1899.02,,2924.49,77,,,Percent of Total Billed Charges,77% of total billed charges,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1186.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2810.55,74,,,Percent of Total Billed Charges,74% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,3190.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3114.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,3380.26,89,,,Percent of total Billed Charges,89% of total Billed charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2924.49,77,,,Percent of total Billed charges,77% of total billed charges,3228.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1091.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1899.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,949.51,3380.26,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3894.91,1947.46,,2999.08,77,,,Percent of Total Billed Charges,77% of total billed charges,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.47,89,,,Percent of total Billed Charges,89% of total Billed charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.08,77,,,Percent of total Billed charges,77% of total billed charges,3310.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.73,3466.47,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3798.04,1899.02,,2924.49,77,,,Percent of Total Billed Charges,77% of total billed charges,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1186.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2810.55,74,,,Percent of Total Billed Charges,74% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,3190.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3114.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,3380.26,89,,,Percent of total Billed Charges,89% of total Billed charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2924.49,77,,,Percent of total Billed charges,77% of total billed charges,3228.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1091.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1899.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,949.51,3380.26,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3894.91,1947.46,,2999.08,77,,,Percent of Total Billed Charges,77% of total billed charges,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.47,89,,,Percent of total Billed Charges,89% of total Billed charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.08,77,,,Percent of total Billed charges,77% of total billed charges,3310.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.73,3466.47,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3798.04,1899.02,,2924.49,77,,,Percent of Total Billed Charges,77% of total billed charges,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1186.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2810.55,74,,,Percent of Total Billed Charges,74% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,3190.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3114.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,3380.26,89,,,Percent of total Billed Charges,89% of total Billed charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2924.49,77,,,Percent of total Billed charges,77% of total billed charges,3228.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1091.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1899.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,949.51,3380.26,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3894.91,1947.46,,2999.08,77,,,Percent of Total Billed Charges,77% of total billed charges,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.47,89,,,Percent of total Billed Charges,89% of total Billed charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.08,77,,,Percent of total Billed charges,77% of total billed charges,3310.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.73,3466.47,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3798.04,1899.02,,2924.49,77,,,Percent of Total Billed Charges,77% of total billed charges,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1186.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2810.55,74,,,Percent of Total Billed Charges,74% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,3190.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3114.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,3380.26,89,,,Percent of total Billed Charges,89% of total Billed charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2924.49,77,,,Percent of total Billed charges,77% of total billed charges,3228.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1091.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1899.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,949.51,3380.26,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3894.91,1947.46,,2999.08,77,,,Percent of Total Billed Charges,77% of total billed charges,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.47,89,,,Percent of total Billed Charges,89% of total Billed charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.08,77,,,Percent of total Billed charges,77% of total billed charges,3310.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.73,3466.47,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3798.04,1899.02,,2924.49,77,,,Percent of Total Billed Charges,77% of total billed charges,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1186.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2810.55,74,,,Percent of Total Billed Charges,74% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,3190.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3114.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,3380.26,89,,,Percent of total Billed Charges,89% of total Billed charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2924.49,77,,,Percent of total Billed charges,77% of total billed charges,3228.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1091.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1899.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,949.51,3380.26,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3894.91,1947.46,,2999.08,77,,,Percent of Total Billed Charges,77% of total billed charges,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,993.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1217.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2882.23,74,,,Percent of Total Billed Charges,74% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2687.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3271.72,84,,,Percent of Total Billed Charges,84% of total billed charges,3193.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,3466.47,89,,,Percent of total Billed Charges,89% of total Billed charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2999.08,77,,,Percent of total Billed charges,77% of total billed charges,3310.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1119.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1947.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1589.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,973.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,973.73,3466.47,
DOCEtaxeL 160mg/16ml Liquid MDV,,,250,RC,,,Outpatient,,,3798.04,1899.02,,2924.49,77,,,Percent of Total Billed Charges,77% of total billed charges,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,968.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1186.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2810.55,74,,,Percent of Total Billed Charges,74% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2620.65,69,,,Percent of Total Billed Charges,69% of total billed charges,3190.35,84,,,Percent of Total Billed Charges,84% of total billed charges,3114.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,3380.26,89,,,Percent of total Billed Charges,89% of total Billed charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2924.49,77,,,Percent of total Billed charges,77% of total billed charges,3228.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1091.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1899.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1549.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3380.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,949.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,949.51,3380.26,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,14008.84,7004.42,,10786.81,77,,,Percent of Total Billed Charges,77% of total billed charges,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4377.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10366.54,74,,,Percent of Total Billed Charges,74% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,11767.43,84,,,Percent of Total Billed Charges,84% of total billed charges,11487.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,12467.87,89,,,Percent of total Billed Charges,89% of total Billed charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10786.81,77,,,Percent of total Billed charges,77% of total billed charges,11907.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4027.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7004.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.21,12467.87,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,13650.41,6825.21,,10510.82,77,,,Percent of Total Billed Charges,77% of total billed charges,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4265.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10101.3,74,,,Percent of Total Billed Charges,74% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11466.34,84,,,Percent of Total Billed Charges,84% of total billed charges,11193.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,12148.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10510.82,77,,,Percent of total Billed charges,77% of total billed charges,11602.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3924.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6825.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.6,12148.86,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,14008.84,7004.42,,10786.81,77,,,Percent of Total Billed Charges,77% of total billed charges,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4377.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10366.54,74,,,Percent of Total Billed Charges,74% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,11767.43,84,,,Percent of Total Billed Charges,84% of total billed charges,11487.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,12467.87,89,,,Percent of total Billed Charges,89% of total Billed charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10786.81,77,,,Percent of total Billed charges,77% of total billed charges,11907.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4027.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7004.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.21,12467.87,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,13650.41,6825.21,,10510.82,77,,,Percent of Total Billed Charges,77% of total billed charges,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4265.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10101.3,74,,,Percent of Total Billed Charges,74% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11466.34,84,,,Percent of Total Billed Charges,84% of total billed charges,11193.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,12148.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10510.82,77,,,Percent of total Billed charges,77% of total billed charges,11602.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3924.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6825.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.6,12148.86,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,14008.84,7004.42,,10786.81,77,,,Percent of Total Billed Charges,77% of total billed charges,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4377.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10366.54,74,,,Percent of Total Billed Charges,74% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,11767.43,84,,,Percent of Total Billed Charges,84% of total billed charges,11487.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,12467.87,89,,,Percent of total Billed Charges,89% of total Billed charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10786.81,77,,,Percent of total Billed charges,77% of total billed charges,11907.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4027.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7004.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.21,12467.87,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,13650.41,6825.21,,10510.82,77,,,Percent of Total Billed Charges,77% of total billed charges,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4265.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10101.3,74,,,Percent of Total Billed Charges,74% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11466.34,84,,,Percent of Total Billed Charges,84% of total billed charges,11193.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,12148.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10510.82,77,,,Percent of total Billed charges,77% of total billed charges,11602.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3924.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6825.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.6,12148.86,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,14008.84,7004.42,,10786.81,77,,,Percent of Total Billed Charges,77% of total billed charges,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4377.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10366.54,74,,,Percent of Total Billed Charges,74% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,11767.43,84,,,Percent of Total Billed Charges,84% of total billed charges,11487.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,12467.87,89,,,Percent of total Billed Charges,89% of total Billed charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10786.81,77,,,Percent of total Billed charges,77% of total billed charges,11907.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4027.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7004.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.21,12467.87,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,13650.41,6825.21,,10510.82,77,,,Percent of Total Billed Charges,77% of total billed charges,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4265.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10101.3,74,,,Percent of Total Billed Charges,74% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11466.34,84,,,Percent of Total Billed Charges,84% of total billed charges,11193.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,12148.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10510.82,77,,,Percent of total Billed charges,77% of total billed charges,11602.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3924.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6825.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.6,12148.86,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,14008.84,7004.42,,10786.81,77,,,Percent of Total Billed Charges,77% of total billed charges,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4377.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10366.54,74,,,Percent of Total Billed Charges,74% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,11767.43,84,,,Percent of Total Billed Charges,84% of total billed charges,11487.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,12467.87,89,,,Percent of total Billed Charges,89% of total Billed charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10786.81,77,,,Percent of total Billed charges,77% of total billed charges,11907.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4027.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7004.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.21,12467.87,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,13650.41,6825.21,,10510.82,77,,,Percent of Total Billed Charges,77% of total billed charges,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4265.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10101.3,74,,,Percent of Total Billed Charges,74% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11466.34,84,,,Percent of Total Billed Charges,84% of total billed charges,11193.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,12148.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10510.82,77,,,Percent of total Billed charges,77% of total billed charges,11602.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3924.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6825.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.6,12148.86,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,14008.84,7004.42,,10786.81,77,,,Percent of Total Billed Charges,77% of total billed charges,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3572.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4377.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10366.54,74,,,Percent of Total Billed Charges,74% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,9666.1,69,,,Percent of Total Billed Charges,69% of total billed charges,11767.43,84,,,Percent of Total Billed Charges,84% of total billed charges,11487.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,12467.87,89,,,Percent of total Billed Charges,89% of total Billed charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10786.81,77,,,Percent of total Billed charges,77% of total billed charges,11907.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4027.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7004.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5715.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12467.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3502.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3502.21,12467.87,
DOCEtaxeL 160mg/8ml Liquid MDV,16729026765,CDM,250,RC,,,Outpatient,,,13650.41,6825.21,,10510.82,77,,,Percent of Total Billed Charges,77% of total billed charges,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3480.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4265.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10101.3,74,,,Percent of Total Billed Charges,74% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,9418.78,69,,,Percent of Total Billed Charges,69% of total billed charges,11466.34,84,,,Percent of Total Billed Charges,84% of total billed charges,11193.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,12148.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10510.82,77,,,Percent of total Billed charges,77% of total billed charges,11602.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3924.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6825.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12148.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3412.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3412.6,12148.86,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7909.81,3954.91,,6090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2471.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5853.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6644.24,84,,,Percent of Total Billed Charges,84% of total billed charges,6486.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,7039.73,89,,,Percent of total Billed Charges,89% of total Billed charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6090.55,77,,,Percent of total Billed charges,77% of total billed charges,6723.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2274.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3954.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1977.45,7039.73,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7709.12,3854.56,,5936.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5704.75,74,,,Percent of Total Billed Charges,74% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,6475.66,84,,,Percent of Total Billed Charges,84% of total billed charges,6321.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,6861.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5936.02,77,,,Percent of total Billed charges,77% of total billed charges,6552.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2216.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3854.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.28,6861.12,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7909.81,3954.91,,6090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2471.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5853.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6644.24,84,,,Percent of Total Billed Charges,84% of total billed charges,6486.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,7039.73,89,,,Percent of total Billed Charges,89% of total Billed charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6090.55,77,,,Percent of total Billed charges,77% of total billed charges,6723.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2274.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3954.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1977.45,7039.73,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7709.12,3854.56,,5936.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5704.75,74,,,Percent of Total Billed Charges,74% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,6475.66,84,,,Percent of Total Billed Charges,84% of total billed charges,6321.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,6861.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5936.02,77,,,Percent of total Billed charges,77% of total billed charges,6552.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2216.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3854.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.28,6861.12,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7909.81,3954.91,,6090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2471.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5853.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6644.24,84,,,Percent of Total Billed Charges,84% of total billed charges,6486.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,7039.73,89,,,Percent of total Billed Charges,89% of total Billed charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6090.55,77,,,Percent of total Billed charges,77% of total billed charges,6723.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2274.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3954.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1977.45,7039.73,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7709.12,3854.56,,5936.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5704.75,74,,,Percent of Total Billed Charges,74% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,6475.66,84,,,Percent of Total Billed Charges,84% of total billed charges,6321.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,6861.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5936.02,77,,,Percent of total Billed charges,77% of total billed charges,6552.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2216.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3854.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.28,6861.12,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7909.81,3954.91,,6090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2471.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5853.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6644.24,84,,,Percent of Total Billed Charges,84% of total billed charges,6486.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,7039.73,89,,,Percent of total Billed Charges,89% of total Billed charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6090.55,77,,,Percent of total Billed charges,77% of total billed charges,6723.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2274.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3954.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1977.45,7039.73,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7709.12,3854.56,,5936.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5704.75,74,,,Percent of Total Billed Charges,74% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,6475.66,84,,,Percent of Total Billed Charges,84% of total billed charges,6321.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,6861.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5936.02,77,,,Percent of total Billed charges,77% of total billed charges,6552.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2216.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3854.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.28,6861.12,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7909.81,3954.91,,6090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2471.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5853.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6644.24,84,,,Percent of Total Billed Charges,84% of total billed charges,6486.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,7039.73,89,,,Percent of total Billed Charges,89% of total Billed charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6090.55,77,,,Percent of total Billed charges,77% of total billed charges,6723.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2274.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3954.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1977.45,7039.73,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7709.12,3854.56,,5936.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5704.75,74,,,Percent of Total Billed Charges,74% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,6475.66,84,,,Percent of Total Billed Charges,84% of total billed charges,6321.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,6861.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5936.02,77,,,Percent of total Billed charges,77% of total billed charges,6552.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2216.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3854.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.28,6861.12,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7909.81,3954.91,,6090.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2017,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2471.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5853.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,5457.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6644.24,84,,,Percent of Total Billed Charges,84% of total billed charges,6486.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,7039.73,89,,,Percent of total Billed Charges,89% of total Billed charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6090.55,77,,,Percent of total Billed charges,77% of total billed charges,6723.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2274.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3954.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3227.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7039.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1977.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1977.45,7039.73,
DOCEtaxeL 20mg/2ml Liquid MDV,,,250,RC,,,Outpatient,,,7709.12,3854.56,,5936.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1965.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2409.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5704.75,74,,,Percent of Total Billed Charges,74% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,5319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,6475.66,84,,,Percent of Total Billed Charges,84% of total billed charges,6321.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,6861.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5936.02,77,,,Percent of total Billed charges,77% of total billed charges,6552.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2216.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3854.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3145.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6861.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1927.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1927.28,6861.12,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4423.36,2211.68,,3405.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3273.29,74,,,Percent of Total Billed Charges,74% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3715.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3627.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3936.79,89,,,Percent of total Billed Charges,89% of total Billed charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.99,77,,,Percent of total Billed charges,77% of total billed charges,3759.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1271.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2211.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.84,3936.79,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4312.83,2156.42,,3320.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3191.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3622.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3536.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3838.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.88,77,,,Percent of total Billed charges,77% of total billed charges,3665.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1239.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2156.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078.21,3838.42,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4423.36,2211.68,,3405.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3273.29,74,,,Percent of Total Billed Charges,74% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3715.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3627.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3936.79,89,,,Percent of total Billed Charges,89% of total Billed charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.99,77,,,Percent of total Billed charges,77% of total billed charges,3759.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1271.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2211.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.84,3936.79,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4312.83,2156.42,,3320.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3191.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3622.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3536.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3838.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.88,77,,,Percent of total Billed charges,77% of total billed charges,3665.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1239.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2156.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078.21,3838.42,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4423.36,2211.68,,3405.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3273.29,74,,,Percent of Total Billed Charges,74% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3715.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3627.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3936.79,89,,,Percent of total Billed Charges,89% of total Billed charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.99,77,,,Percent of total Billed charges,77% of total billed charges,3759.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1271.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2211.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.84,3936.79,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4312.83,2156.42,,3320.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3191.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3622.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3536.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3838.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.88,77,,,Percent of total Billed charges,77% of total billed charges,3665.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1239.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2156.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078.21,3838.42,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4423.36,2211.68,,3405.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3273.29,74,,,Percent of Total Billed Charges,74% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3715.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3627.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3936.79,89,,,Percent of total Billed Charges,89% of total Billed charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.99,77,,,Percent of total Billed charges,77% of total billed charges,3759.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1271.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2211.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.84,3936.79,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4312.83,2156.42,,3320.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3191.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3622.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3536.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3838.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.88,77,,,Percent of total Billed charges,77% of total billed charges,3665.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1239.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2156.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078.21,3838.42,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4423.36,2211.68,,3405.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3273.29,74,,,Percent of Total Billed Charges,74% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3715.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3627.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3936.79,89,,,Percent of total Billed Charges,89% of total Billed charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.99,77,,,Percent of total Billed charges,77% of total billed charges,3759.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1271.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2211.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.84,3936.79,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4312.83,2156.42,,3320.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3191.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3622.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3536.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3838.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.88,77,,,Percent of total Billed charges,77% of total billed charges,3665.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1239.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2156.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078.21,3838.42,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4423.36,2211.68,,3405.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1127.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1382.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3273.29,74,,,Percent of Total Billed Charges,74% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3052.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3715.62,84,,,Percent of Total Billed Charges,84% of total billed charges,3627.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,3936.79,89,,,Percent of total Billed Charges,89% of total Billed charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.99,77,,,Percent of total Billed charges,77% of total billed charges,3759.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1271.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2211.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1804.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3936.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1105.84,3936.79,
DOCEtaxeL 20mg/ml Liquid MDV,16729026763,CDM,250,RC,,,Outpatient,,,4312.83,2156.42,,3320.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1099.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1347.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3191.49,74,,,Percent of Total Billed Charges,74% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2975.85,69,,,Percent of Total Billed Charges,69% of total billed charges,3622.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3536.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,3838.42,89,,,Percent of total Billed Charges,89% of total Billed charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.88,77,,,Percent of total Billed charges,77% of total billed charges,3665.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1239.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2156.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1759.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3838.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1078.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1078.21,3838.42,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,8144.97,4072.49,,6271.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2545.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6027.28,74,,,Percent of Total Billed Charges,74% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,6841.77,84,,,Percent of Total Billed Charges,84% of total billed charges,6678.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,7249.02,89,,,Percent of total Billed Charges,89% of total Billed charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6271.63,77,,,Percent of total Billed charges,77% of total billed charges,6923.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2341.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4072.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.24,7249.02,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,7938.19,3969.1,,6112.41,77,,,Percent of Total Billed Charges,77% of total billed charges,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2480.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5874.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6668.08,84,,,Percent of Total Billed Charges,84% of total billed charges,6509.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,7064.99,89,,,Percent of total Billed Charges,89% of total Billed charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6112.41,77,,,Percent of total Billed charges,77% of total billed charges,6747.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2282.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3969.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.55,7064.99,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,8144.97,4072.49,,6271.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2545.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6027.28,74,,,Percent of Total Billed Charges,74% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,6841.77,84,,,Percent of Total Billed Charges,84% of total billed charges,6678.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,7249.02,89,,,Percent of total Billed Charges,89% of total Billed charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6271.63,77,,,Percent of total Billed charges,77% of total billed charges,6923.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2341.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4072.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.24,7249.02,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,7938.19,3969.1,,6112.41,77,,,Percent of Total Billed Charges,77% of total billed charges,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2480.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5874.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6668.08,84,,,Percent of Total Billed Charges,84% of total billed charges,6509.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,7064.99,89,,,Percent of total Billed Charges,89% of total Billed charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6112.41,77,,,Percent of total Billed charges,77% of total billed charges,6747.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2282.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3969.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.55,7064.99,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,8144.97,4072.49,,6271.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2545.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6027.28,74,,,Percent of Total Billed Charges,74% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,6841.77,84,,,Percent of Total Billed Charges,84% of total billed charges,6678.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,7249.02,89,,,Percent of total Billed Charges,89% of total Billed charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6271.63,77,,,Percent of total Billed charges,77% of total billed charges,6923.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2341.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4072.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.24,7249.02,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,7938.19,3969.1,,6112.41,77,,,Percent of Total Billed Charges,77% of total billed charges,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2480.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5874.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6668.08,84,,,Percent of Total Billed Charges,84% of total billed charges,6509.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,7064.99,89,,,Percent of total Billed Charges,89% of total Billed charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6112.41,77,,,Percent of total Billed charges,77% of total billed charges,6747.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2282.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3969.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.55,7064.99,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,8144.97,4072.49,,6271.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2545.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6027.28,74,,,Percent of Total Billed Charges,74% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,6841.77,84,,,Percent of Total Billed Charges,84% of total billed charges,6678.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,7249.02,89,,,Percent of total Billed Charges,89% of total Billed charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6271.63,77,,,Percent of total Billed charges,77% of total billed charges,6923.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2341.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4072.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.24,7249.02,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,7938.19,3969.1,,6112.41,77,,,Percent of Total Billed Charges,77% of total billed charges,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2480.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5874.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6668.08,84,,,Percent of Total Billed Charges,84% of total billed charges,6509.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,7064.99,89,,,Percent of total Billed Charges,89% of total Billed charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6112.41,77,,,Percent of total Billed charges,77% of total billed charges,6747.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2282.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3969.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.55,7064.99,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,8144.97,4072.49,,6271.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2545.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6027.28,74,,,Percent of Total Billed Charges,74% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,6841.77,84,,,Percent of Total Billed Charges,84% of total billed charges,6678.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,7249.02,89,,,Percent of total Billed Charges,89% of total Billed charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6271.63,77,,,Percent of total Billed charges,77% of total billed charges,6923.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2341.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4072.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.24,7249.02,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,7938.19,3969.1,,6112.41,77,,,Percent of Total Billed Charges,77% of total billed charges,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2480.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5874.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6668.08,84,,,Percent of Total Billed Charges,84% of total billed charges,6509.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,7064.99,89,,,Percent of total Billed Charges,89% of total Billed charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6112.41,77,,,Percent of total Billed charges,77% of total billed charges,6747.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2282.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3969.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.55,7064.99,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,8144.97,4072.49,,6271.63,77,,,Percent of Total Billed Charges,77% of total billed charges,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2076.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2545.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6027.28,74,,,Percent of Total Billed Charges,74% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,5620.03,69,,,Percent of Total Billed Charges,69% of total billed charges,6841.77,84,,,Percent of Total Billed Charges,84% of total billed charges,6678.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,7249.02,89,,,Percent of total Billed Charges,89% of total Billed charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6271.63,77,,,Percent of total Billed charges,77% of total billed charges,6923.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2341.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4072.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3323.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7249.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2036.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2036.24,7249.02,
DOCEtaxeL 80mg/4ml Liquid MDV,25021024504,CDM,250,RC,,,Outpatient,,,7938.19,3969.1,,6112.41,77,,,Percent of Total Billed Charges,77% of total billed charges,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2024.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2480.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5874.26,74,,,Percent of Total Billed Charges,74% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5477.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6668.08,84,,,Percent of Total Billed Charges,84% of total billed charges,6509.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,7064.99,89,,,Percent of total Billed Charges,89% of total Billed charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6112.41,77,,,Percent of total Billed charges,77% of total billed charges,6747.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2282.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3969.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3238.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7064.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1984.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1984.55,7064.99,
Docusate Sodium 100mg Capsule,60687012901,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Sodium 100mg Capsule,60687012901,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Sodium 100mg Capsule,60687012901,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Sodium 100mg Capsule,60687012901,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Sodium 100mg Capsule,60687012901,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Sodium 100mg Capsule,60687012901,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Oral Solution 100mg/10ml UDC,121187000,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Oral Solution 100mg/10ml UDC,121187000,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Oral Solution 100mg/10ml UDC,121187000,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Oral Solution 100mg/10ml UDC,121187000,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Oral Solution 100mg/10ml UDC,121187000,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Docusate Oral Solution 100mg/10ml UDC,121187000,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Donepezil 5mg Oral Disintegrating Tablet,33342002907,CDM,250,RC,,,Outpatient,,,60.03,30.02,,46.22,77,,,Percent of Total Billed Charges,77% of total billed charges,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.42,74,,,Percent of Total Billed Charges,74% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,50.43,84,,,Percent of Total Billed Charges,84% of total billed charges,49.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.43,89,,,Percent of total Billed Charges,89% of total Billed charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,77,,,Percent of total Billed charges,77% of total billed charges,51.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.01,53.43,
Donepezil 5mg Oral Disintegrating Tablet,33342002907,CDM,250,RC,,,Outpatient,,,60.03,30.02,,46.22,77,,,Percent of Total Billed Charges,77% of total billed charges,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.42,74,,,Percent of Total Billed Charges,74% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,50.43,84,,,Percent of Total Billed Charges,84% of total billed charges,49.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.43,89,,,Percent of total Billed Charges,89% of total Billed charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,77,,,Percent of total Billed charges,77% of total billed charges,51.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.01,53.43,
Donepezil 5mg Oral Disintegrating Tablet,33342002907,CDM,250,RC,,,Outpatient,,,60.03,30.02,,46.22,77,,,Percent of Total Billed Charges,77% of total billed charges,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.42,74,,,Percent of Total Billed Charges,74% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,50.43,84,,,Percent of Total Billed Charges,84% of total billed charges,49.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.43,89,,,Percent of total Billed Charges,89% of total Billed charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,77,,,Percent of total Billed charges,77% of total billed charges,51.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.01,53.43,
Donepezil 5mg Oral Disintegrating Tablet,33342002907,CDM,250,RC,,,Outpatient,,,60.03,30.02,,46.22,77,,,Percent of Total Billed Charges,77% of total billed charges,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.42,74,,,Percent of Total Billed Charges,74% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,50.43,84,,,Percent of Total Billed Charges,84% of total billed charges,49.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.43,89,,,Percent of total Billed Charges,89% of total Billed charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,77,,,Percent of total Billed charges,77% of total billed charges,51.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.01,53.43,
Donepezil 5mg Oral Disintegrating Tablet,33342002907,CDM,250,RC,,,Outpatient,,,60.03,30.02,,46.22,77,,,Percent of Total Billed Charges,77% of total billed charges,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.42,74,,,Percent of Total Billed Charges,74% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,50.43,84,,,Percent of Total Billed Charges,84% of total billed charges,49.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.43,89,,,Percent of total Billed Charges,89% of total Billed charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,77,,,Percent of total Billed charges,77% of total billed charges,51.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.01,53.43,
Donepezil 5mg Oral Disintegrating Tablet,33342002907,CDM,250,RC,,,Outpatient,,,60.03,30.02,,46.22,77,,,Percent of Total Billed Charges,77% of total billed charges,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.42,74,,,Percent of Total Billed Charges,74% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,41.42,69,,,Percent of Total Billed Charges,69% of total billed charges,50.43,84,,,Percent of Total Billed Charges,84% of total billed charges,49.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.43,89,,,Percent of total Billed Charges,89% of total Billed charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.22,77,,,Percent of total Billed charges,77% of total billed charges,51.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.01,53.43,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine Pediatric 200mg/250ml (0.8mg/ml) IV Bag,338100502,CDM,250,RC,,,Outpatient,,,192.64,96.32,,148.33,77,,,Percent of Total Billed Charges,77% of total billed charges,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.55,74,,,Percent of Total Billed Charges,74% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,132.92,69,,,Percent of Total Billed Charges,69% of total billed charges,161.82,84,,,Percent of Total Billed Charges,84% of total billed charges,157.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.45,89,,,Percent of total Billed Charges,89% of total Billed charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.33,77,,,Percent of total Billed charges,77% of total billed charges,163.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.16,171.45,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
DOPamine 400mg/250ml (1.6mg/ml) IV Bag,409780922,CDM,250,RC,,,Outpatient,,,206.84,103.42,,159.27,77,,,Percent of Total Billed Charges,77% of total billed charges,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,153.06,74,,,Percent of Total Billed Charges,74% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,142.72,69,,,Percent of Total Billed Charges,69% of total billed charges,173.75,84,,,Percent of Total Billed Charges,84% of total billed charges,169.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,184.09,89,,,Percent of total Billed Charges,89% of total Billed charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.27,77,,,Percent of total Billed charges,77% of total billed charges,175.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,59.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,103.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,84.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.71,184.09,
Dorzolamide 2% OPHTH Soln 10ml,24208048510,CDM,250,RC,,,Outpatient,,,163.1,81.55,,125.59,77,,,Percent of Total Billed Charges,77% of total billed charges,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.69,74,,,Percent of Total Billed Charges,74% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,137,84,,,Percent of Total Billed Charges,84% of total billed charges,133.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.16,89,,,Percent of total Billed Charges,89% of total Billed charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.59,77,,,Percent of total Billed charges,77% of total billed charges,138.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,145.16,
Dorzolamide 2% OPHTH Soln 10ml,24208048510,CDM,250,RC,,,Outpatient,,,163.1,81.55,,125.59,77,,,Percent of Total Billed Charges,77% of total billed charges,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.69,74,,,Percent of Total Billed Charges,74% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,137,84,,,Percent of Total Billed Charges,84% of total billed charges,133.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.16,89,,,Percent of total Billed Charges,89% of total Billed charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.59,77,,,Percent of total Billed charges,77% of total billed charges,138.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,145.16,
Dorzolamide 2% OPHTH Soln 10ml,24208048510,CDM,250,RC,,,Outpatient,,,163.1,81.55,,125.59,77,,,Percent of Total Billed Charges,77% of total billed charges,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.69,74,,,Percent of Total Billed Charges,74% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,137,84,,,Percent of Total Billed Charges,84% of total billed charges,133.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.16,89,,,Percent of total Billed Charges,89% of total Billed charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.59,77,,,Percent of total Billed charges,77% of total billed charges,138.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,145.16,
Dorzolamide 2% OPHTH Soln 10ml,24208048510,CDM,250,RC,,,Outpatient,,,163.1,81.55,,125.59,77,,,Percent of Total Billed Charges,77% of total billed charges,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.69,74,,,Percent of Total Billed Charges,74% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,137,84,,,Percent of Total Billed Charges,84% of total billed charges,133.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.16,89,,,Percent of total Billed Charges,89% of total Billed charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.59,77,,,Percent of total Billed charges,77% of total billed charges,138.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,145.16,
Dorzolamide 2% OPHTH Soln 10ml,24208048510,CDM,250,RC,,,Outpatient,,,163.1,81.55,,125.59,77,,,Percent of Total Billed Charges,77% of total billed charges,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.69,74,,,Percent of Total Billed Charges,74% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,137,84,,,Percent of Total Billed Charges,84% of total billed charges,133.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.16,89,,,Percent of total Billed Charges,89% of total Billed charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.59,77,,,Percent of total Billed charges,77% of total billed charges,138.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,145.16,
Dorzolamide 2% OPHTH Soln 10ml,24208048510,CDM,250,RC,,,Outpatient,,,163.1,81.55,,125.59,77,,,Percent of Total Billed Charges,77% of total billed charges,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.69,74,,,Percent of Total Billed Charges,74% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,112.54,69,,,Percent of Total Billed Charges,69% of total billed charges,137,84,,,Percent of Total Billed Charges,84% of total billed charges,133.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.16,89,,,Percent of total Billed Charges,89% of total Billed charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.59,77,,,Percent of total Billed charges,77% of total billed charges,138.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.78,145.16,
Dorzolamide/Timolol 2%-0.5% OPHTH Soln 10ml,24208048610,CDM,250,RC,,,Outpatient,,,237.52,118.76,,182.89,77,,,Percent of Total Billed Charges,77% of total billed charges,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.76,74,,,Percent of Total Billed Charges,74% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,199.52,84,,,Percent of Total Billed Charges,84% of total billed charges,194.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.39,89,,,Percent of total Billed Charges,89% of total Billed charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.89,77,,,Percent of total Billed charges,77% of total billed charges,201.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.38,211.39,
Dorzolamide/Timolol 2%-0.5% OPHTH Soln 10ml,24208048610,CDM,250,RC,,,Outpatient,,,237.52,118.76,,182.89,77,,,Percent of Total Billed Charges,77% of total billed charges,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.76,74,,,Percent of Total Billed Charges,74% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,199.52,84,,,Percent of Total Billed Charges,84% of total billed charges,194.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.39,89,,,Percent of total Billed Charges,89% of total Billed charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.89,77,,,Percent of total Billed charges,77% of total billed charges,201.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.38,211.39,
Dorzolamide/Timolol 2%-0.5% OPHTH Soln 10ml,24208048610,CDM,250,RC,,,Outpatient,,,237.52,118.76,,182.89,77,,,Percent of Total Billed Charges,77% of total billed charges,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.76,74,,,Percent of Total Billed Charges,74% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,199.52,84,,,Percent of Total Billed Charges,84% of total billed charges,194.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.39,89,,,Percent of total Billed Charges,89% of total Billed charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.89,77,,,Percent of total Billed charges,77% of total billed charges,201.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.38,211.39,
Dorzolamide/Timolol 2%-0.5% OPHTH Soln 10ml,24208048610,CDM,250,RC,,,Outpatient,,,237.52,118.76,,182.89,77,,,Percent of Total Billed Charges,77% of total billed charges,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.76,74,,,Percent of Total Billed Charges,74% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,199.52,84,,,Percent of Total Billed Charges,84% of total billed charges,194.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.39,89,,,Percent of total Billed Charges,89% of total Billed charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.89,77,,,Percent of total Billed charges,77% of total billed charges,201.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.38,211.39,
Dorzolamide/Timolol 2%-0.5% OPHTH Soln 10ml,24208048610,CDM,250,RC,,,Outpatient,,,237.52,118.76,,182.89,77,,,Percent of Total Billed Charges,77% of total billed charges,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.76,74,,,Percent of Total Billed Charges,74% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,199.52,84,,,Percent of Total Billed Charges,84% of total billed charges,194.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.39,89,,,Percent of total Billed Charges,89% of total Billed charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.89,77,,,Percent of total Billed charges,77% of total billed charges,201.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.38,211.39,
Dorzolamide/Timolol 2%-0.5% OPHTH Soln 10ml,24208048610,CDM,250,RC,,,Outpatient,,,237.52,118.76,,182.89,77,,,Percent of Total Billed Charges,77% of total billed charges,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.76,74,,,Percent of Total Billed Charges,74% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,163.89,69,,,Percent of Total Billed Charges,69% of total billed charges,199.52,84,,,Percent of Total Billed Charges,84% of total billed charges,194.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,211.39,89,,,Percent of total Billed Charges,89% of total Billed charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.89,77,,,Percent of total Billed charges,77% of total billed charges,201.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,211.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.38,211.39,
Dorzolamide/Timolol/PF 2%-0.5% OPHTH Soln 1ea (CATS),42571038271,CDM,250,RC,,,Outpatient,,,38.6,19.3,,29.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.56,74,,,Percent of Total Billed Charges,74% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,32.42,84,,,Percent of Total Billed Charges,84% of total billed charges,31.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.35,89,,,Percent of total Billed Charges,89% of total Billed charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.72,77,,,Percent of total Billed charges,77% of total billed charges,32.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.65,34.35,
Dorzolamide/Timolol/PF 2%-0.5% OPHTH Soln 1ea (CATS),42571038271,CDM,250,RC,,,Outpatient,,,38.6,19.3,,29.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.56,74,,,Percent of Total Billed Charges,74% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,32.42,84,,,Percent of Total Billed Charges,84% of total billed charges,31.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.35,89,,,Percent of total Billed Charges,89% of total Billed charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.72,77,,,Percent of total Billed charges,77% of total billed charges,32.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.65,34.35,
Dorzolamide/Timolol/PF 2%-0.5% OPHTH Soln 1ea (CATS),42571038271,CDM,250,RC,,,Outpatient,,,38.6,19.3,,29.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.56,74,,,Percent of Total Billed Charges,74% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,32.42,84,,,Percent of Total Billed Charges,84% of total billed charges,31.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.35,89,,,Percent of total Billed Charges,89% of total Billed charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.72,77,,,Percent of total Billed charges,77% of total billed charges,32.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.65,34.35,
Dorzolamide/Timolol/PF 2%-0.5% OPHTH Soln 1ea (CATS),42571038271,CDM,250,RC,,,Outpatient,,,38.6,19.3,,29.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.56,74,,,Percent of Total Billed Charges,74% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,32.42,84,,,Percent of Total Billed Charges,84% of total billed charges,31.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.35,89,,,Percent of total Billed Charges,89% of total Billed charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.72,77,,,Percent of total Billed charges,77% of total billed charges,32.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.65,34.35,
Dorzolamide/Timolol/PF 2%-0.5% OPHTH Soln 1ea (CATS),42571038271,CDM,250,RC,,,Outpatient,,,38.6,19.3,,29.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.56,74,,,Percent of Total Billed Charges,74% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,32.42,84,,,Percent of Total Billed Charges,84% of total billed charges,31.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.35,89,,,Percent of total Billed Charges,89% of total Billed charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.72,77,,,Percent of total Billed charges,77% of total billed charges,32.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.65,34.35,
Dorzolamide/Timolol/PF 2%-0.5% OPHTH Soln 1ea (CATS),42571038271,CDM,250,RC,,,Outpatient,,,38.6,19.3,,29.72,77,,,Percent of Total Billed Charges,77% of total billed charges,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.56,74,,,Percent of Total Billed Charges,74% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,26.63,69,,,Percent of Total Billed Charges,69% of total billed charges,32.42,84,,,Percent of Total Billed Charges,84% of total billed charges,31.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.35,89,,,Percent of total Billed Charges,89% of total Billed charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.72,77,,,Percent of total Billed charges,77% of total billed charges,32.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.65,34.35,
Doxazosin Mesylate 2mg Tablet,51079095820,CDM,250,RC,,,Outpatient,,,40.29,20.15,,31.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.81,74,,,Percent of Total Billed Charges,74% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,33.84,84,,,Percent of Total Billed Charges,84% of total billed charges,33.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.86,89,,,Percent of total Billed Charges,89% of total Billed charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.02,77,,,Percent of total Billed charges,77% of total billed charges,34.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.07,35.86,
Doxazosin Mesylate 2mg Tablet,51079095820,CDM,250,RC,,,Outpatient,,,40.29,20.15,,31.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.81,74,,,Percent of Total Billed Charges,74% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,33.84,84,,,Percent of Total Billed Charges,84% of total billed charges,33.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.86,89,,,Percent of total Billed Charges,89% of total Billed charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.02,77,,,Percent of total Billed charges,77% of total billed charges,34.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.07,35.86,
Doxazosin Mesylate 2mg Tablet,51079095820,CDM,250,RC,,,Outpatient,,,40.29,20.15,,31.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.81,74,,,Percent of Total Billed Charges,74% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,33.84,84,,,Percent of Total Billed Charges,84% of total billed charges,33.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.86,89,,,Percent of total Billed Charges,89% of total Billed charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.02,77,,,Percent of total Billed charges,77% of total billed charges,34.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.07,35.86,
Doxazosin Mesylate 2mg Tablet,51079095820,CDM,250,RC,,,Outpatient,,,40.29,20.15,,31.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.81,74,,,Percent of Total Billed Charges,74% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,33.84,84,,,Percent of Total Billed Charges,84% of total billed charges,33.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.86,89,,,Percent of total Billed Charges,89% of total Billed charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.02,77,,,Percent of total Billed charges,77% of total billed charges,34.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.07,35.86,
Doxazosin Mesylate 2mg Tablet,51079095820,CDM,250,RC,,,Outpatient,,,40.29,20.15,,31.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.81,74,,,Percent of Total Billed Charges,74% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,33.84,84,,,Percent of Total Billed Charges,84% of total billed charges,33.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.86,89,,,Percent of total Billed Charges,89% of total Billed charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.02,77,,,Percent of total Billed charges,77% of total billed charges,34.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.07,35.86,
Doxazosin Mesylate 2mg Tablet,51079095820,CDM,250,RC,,,Outpatient,,,40.29,20.15,,31.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.81,74,,,Percent of Total Billed Charges,74% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.8,69,,,Percent of Total Billed Charges,69% of total billed charges,33.84,84,,,Percent of Total Billed Charges,84% of total billed charges,33.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.86,89,,,Percent of total Billed Charges,89% of total Billed charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.02,77,,,Percent of total Billed charges,77% of total billed charges,34.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.07,35.86,
Doxorubicin 10mg/5ml Liquid SDV,45963073355,CDM,250,RC,,,Outpatient,,,1417.47,708.74,,1091.45,77,,,Percent of Total Billed Charges,77% of total billed charges,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1048.93,74,,,Percent of Total Billed Charges,74% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1190.67,84,,,Percent of Total Billed Charges,84% of total billed charges,1162.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1261.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.45,77,,,Percent of total Billed charges,77% of total billed charges,1204.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,708.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.37,1261.55,
Doxorubicin 10mg/5ml Liquid SDV,45963073355,CDM,250,RC,,,Outpatient,,,1417.47,708.74,,1091.45,77,,,Percent of Total Billed Charges,77% of total billed charges,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1048.93,74,,,Percent of Total Billed Charges,74% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1190.67,84,,,Percent of Total Billed Charges,84% of total billed charges,1162.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1261.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.45,77,,,Percent of total Billed charges,77% of total billed charges,1204.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,708.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.37,1261.55,
Doxorubicin 10mg/5ml Liquid SDV,45963073355,CDM,250,RC,,,Outpatient,,,1417.47,708.74,,1091.45,77,,,Percent of Total Billed Charges,77% of total billed charges,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1048.93,74,,,Percent of Total Billed Charges,74% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1190.67,84,,,Percent of Total Billed Charges,84% of total billed charges,1162.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1261.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.45,77,,,Percent of total Billed charges,77% of total billed charges,1204.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,708.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.37,1261.55,
Doxorubicin 10mg/5ml Liquid SDV,45963073355,CDM,250,RC,,,Outpatient,,,1417.47,708.74,,1091.45,77,,,Percent of Total Billed Charges,77% of total billed charges,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1048.93,74,,,Percent of Total Billed Charges,74% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1190.67,84,,,Percent of Total Billed Charges,84% of total billed charges,1162.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1261.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.45,77,,,Percent of total Billed charges,77% of total billed charges,1204.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,708.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.37,1261.55,
Doxorubicin 10mg/5ml Liquid SDV,45963073355,CDM,250,RC,,,Outpatient,,,1417.47,708.74,,1091.45,77,,,Percent of Total Billed Charges,77% of total billed charges,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1048.93,74,,,Percent of Total Billed Charges,74% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1190.67,84,,,Percent of Total Billed Charges,84% of total billed charges,1162.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1261.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.45,77,,,Percent of total Billed charges,77% of total billed charges,1204.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,708.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.37,1261.55,
Doxorubicin 10mg/5ml Liquid SDV,45963073355,CDM,250,RC,,,Outpatient,,,1417.47,708.74,,1091.45,77,,,Percent of Total Billed Charges,77% of total billed charges,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,361.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,442.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1048.93,74,,,Percent of Total Billed Charges,74% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,978.05,69,,,Percent of Total Billed Charges,69% of total billed charges,1190.67,84,,,Percent of Total Billed Charges,84% of total billed charges,1162.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1261.55,89,,,Percent of total Billed Charges,89% of total Billed charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.45,77,,,Percent of total Billed charges,77% of total billed charges,1204.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,407.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,708.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,578.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1261.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,354.37,1261.55,
Doxorubicin 20mg/10ml Liquid SDV,69303120,CDM,250,RC,,,Outpatient,,,2294.49,1147.25,,1766.76,77,,,Percent of Total Billed Charges,77% of total billed charges,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1697.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.37,84,,,Percent of Total Billed Charges,84% of total billed charges,1881.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2042.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.76,77,,,Percent of total Billed charges,77% of total billed charges,1950.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1147.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.62,2042.1,
Doxorubicin 20mg/10ml Liquid SDV,69303120,CDM,250,RC,,,Outpatient,,,2294.49,1147.25,,1766.76,77,,,Percent of Total Billed Charges,77% of total billed charges,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1697.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.37,84,,,Percent of Total Billed Charges,84% of total billed charges,1881.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2042.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.76,77,,,Percent of total Billed charges,77% of total billed charges,1950.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1147.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.62,2042.1,
Doxorubicin 20mg/10ml Liquid SDV,69303120,CDM,250,RC,,,Outpatient,,,2294.49,1147.25,,1766.76,77,,,Percent of Total Billed Charges,77% of total billed charges,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1697.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.37,84,,,Percent of Total Billed Charges,84% of total billed charges,1881.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2042.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.76,77,,,Percent of total Billed charges,77% of total billed charges,1950.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1147.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.62,2042.1,
Doxorubicin 20mg/10ml Liquid SDV,69303120,CDM,250,RC,,,Outpatient,,,2294.49,1147.25,,1766.76,77,,,Percent of Total Billed Charges,77% of total billed charges,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1697.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.37,84,,,Percent of Total Billed Charges,84% of total billed charges,1881.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2042.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.76,77,,,Percent of total Billed charges,77% of total billed charges,1950.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1147.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.62,2042.1,
Doxorubicin 20mg/10ml Liquid SDV,69303120,CDM,250,RC,,,Outpatient,,,2294.49,1147.25,,1766.76,77,,,Percent of Total Billed Charges,77% of total billed charges,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1697.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.37,84,,,Percent of Total Billed Charges,84% of total billed charges,1881.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2042.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.76,77,,,Percent of total Billed charges,77% of total billed charges,1950.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1147.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.62,2042.1,
Doxorubicin 20mg/10ml Liquid SDV,69303120,CDM,250,RC,,,Outpatient,,,2294.49,1147.25,,1766.76,77,,,Percent of Total Billed Charges,77% of total billed charges,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,585.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,717.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1697.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1583.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1927.37,84,,,Percent of Total Billed Charges,84% of total billed charges,1881.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2042.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.76,77,,,Percent of total Billed charges,77% of total billed charges,1950.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,659.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1147.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,936.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2042.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.62,2042.1,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5666.29,2833.15,,4363.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1770.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4193.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4646.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,5043,89,,,Percent of total Billed Charges,89% of total Billed charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4363.04,77,,,Percent of total Billed charges,77% of total billed charges,4816.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1629.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2833.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.57,5043,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5523.61,2761.81,,4253.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1726.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4087.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4639.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4529.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,4916.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4253.18,77,,,Percent of total Billed charges,77% of total billed charges,4695.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1588.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2761.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.9,4916.01,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5666.29,2833.15,,4363.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1770.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4193.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4646.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,5043,89,,,Percent of total Billed Charges,89% of total Billed charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4363.04,77,,,Percent of total Billed charges,77% of total billed charges,4816.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1629.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2833.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.57,5043,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5523.61,2761.81,,4253.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1726.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4087.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4639.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4529.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,4916.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4253.18,77,,,Percent of total Billed charges,77% of total billed charges,4695.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1588.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2761.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.9,4916.01,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5666.29,2833.15,,4363.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1770.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4193.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4646.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,5043,89,,,Percent of total Billed Charges,89% of total Billed charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4363.04,77,,,Percent of total Billed charges,77% of total billed charges,4816.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1629.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2833.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.57,5043,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5523.61,2761.81,,4253.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1726.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4087.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4639.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4529.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,4916.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4253.18,77,,,Percent of total Billed charges,77% of total billed charges,4695.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1588.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2761.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.9,4916.01,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5666.29,2833.15,,4363.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1770.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4193.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4646.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,5043,89,,,Percent of total Billed Charges,89% of total Billed charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4363.04,77,,,Percent of total Billed charges,77% of total billed charges,4816.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1629.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2833.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.57,5043,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5523.61,2761.81,,4253.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1726.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4087.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4639.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4529.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,4916.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4253.18,77,,,Percent of total Billed charges,77% of total billed charges,4695.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1588.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2761.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.9,4916.01,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5666.29,2833.15,,4363.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1770.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4193.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4646.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,5043,89,,,Percent of total Billed Charges,89% of total Billed charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4363.04,77,,,Percent of total Billed charges,77% of total billed charges,4816.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1629.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2833.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.57,5043,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5523.61,2761.81,,4253.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1726.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4087.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4639.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4529.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,4916.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4253.18,77,,,Percent of total Billed charges,77% of total billed charges,4695.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1588.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2761.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.9,4916.01,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5666.29,2833.15,,4363.04,77,,,Percent of Total Billed Charges,77% of total billed charges,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1444.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1770.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4193.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3909.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4759.68,84,,,Percent of Total Billed Charges,84% of total billed charges,4646.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,5043,89,,,Percent of total Billed Charges,89% of total Billed charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4363.04,77,,,Percent of total Billed charges,77% of total billed charges,4816.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1629.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2833.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2311.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5043,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1416.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1416.57,5043,
Doxorubicin Liposomal 20mg/10ml Liquid SDV,47335004940,CDM,250,RC,,,Outpatient,,,5523.61,2761.81,,4253.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1408.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1726.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4087.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3811.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4639.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4529.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,4916.01,89,,,Percent of total Billed Charges,89% of total Billed charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4253.18,77,,,Percent of total Billed charges,77% of total billed charges,4695.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1588.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2761.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2253.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4916.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1380.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1380.9,4916.01,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13941.95,6970.98,,10735.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4356.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10317.04,74,,,Percent of Total Billed Charges,74% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,11711.24,84,,,Percent of Total Billed Charges,84% of total billed charges,11432.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,12408.34,89,,,Percent of total Billed Charges,89% of total Billed charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10735.3,77,,,Percent of total Billed charges,77% of total billed charges,11850.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4008.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6970.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3485.49,12408.34,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13585.24,6792.62,,10460.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4245.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10053.08,74,,,Percent of Total Billed Charges,74% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11411.6,84,,,Percent of Total Billed Charges,84% of total billed charges,11139.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,12090.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10460.63,77,,,Percent of total Billed charges,77% of total billed charges,11547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3905.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6792.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3396.31,12090.86,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13941.95,6970.98,,10735.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4356.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10317.04,74,,,Percent of Total Billed Charges,74% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,11711.24,84,,,Percent of Total Billed Charges,84% of total billed charges,11432.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,12408.34,89,,,Percent of total Billed Charges,89% of total Billed charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10735.3,77,,,Percent of total Billed charges,77% of total billed charges,11850.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4008.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6970.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3485.49,12408.34,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13585.24,6792.62,,10460.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4245.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10053.08,74,,,Percent of Total Billed Charges,74% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11411.6,84,,,Percent of Total Billed Charges,84% of total billed charges,11139.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,12090.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10460.63,77,,,Percent of total Billed charges,77% of total billed charges,11547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3905.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6792.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3396.31,12090.86,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13941.95,6970.98,,10735.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4356.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10317.04,74,,,Percent of Total Billed Charges,74% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,11711.24,84,,,Percent of Total Billed Charges,84% of total billed charges,11432.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,12408.34,89,,,Percent of total Billed Charges,89% of total Billed charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10735.3,77,,,Percent of total Billed charges,77% of total billed charges,11850.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4008.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6970.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3485.49,12408.34,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13585.24,6792.62,,10460.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4245.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10053.08,74,,,Percent of Total Billed Charges,74% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11411.6,84,,,Percent of Total Billed Charges,84% of total billed charges,11139.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,12090.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10460.63,77,,,Percent of total Billed charges,77% of total billed charges,11547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3905.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6792.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3396.31,12090.86,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13941.95,6970.98,,10735.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4356.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10317.04,74,,,Percent of Total Billed Charges,74% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,11711.24,84,,,Percent of Total Billed Charges,84% of total billed charges,11432.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,12408.34,89,,,Percent of total Billed Charges,89% of total Billed charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10735.3,77,,,Percent of total Billed charges,77% of total billed charges,11850.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4008.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6970.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3485.49,12408.34,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13585.24,6792.62,,10460.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4245.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10053.08,74,,,Percent of Total Billed Charges,74% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11411.6,84,,,Percent of Total Billed Charges,84% of total billed charges,11139.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,12090.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10460.63,77,,,Percent of total Billed charges,77% of total billed charges,11547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3905.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6792.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3396.31,12090.86,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13941.95,6970.98,,10735.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4356.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10317.04,74,,,Percent of Total Billed Charges,74% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,11711.24,84,,,Percent of Total Billed Charges,84% of total billed charges,11432.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,12408.34,89,,,Percent of total Billed Charges,89% of total Billed charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10735.3,77,,,Percent of total Billed charges,77% of total billed charges,11850.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4008.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6970.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3485.49,12408.34,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13585.24,6792.62,,10460.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4245.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10053.08,74,,,Percent of Total Billed Charges,74% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11411.6,84,,,Percent of Total Billed Charges,84% of total billed charges,11139.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,12090.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10460.63,77,,,Percent of total Billed charges,77% of total billed charges,11547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3905.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6792.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3396.31,12090.86,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13941.95,6970.98,,10735.3,77,,,Percent of Total Billed Charges,77% of total billed charges,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3555.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4356.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10317.04,74,,,Percent of Total Billed Charges,74% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,9619.95,69,,,Percent of Total Billed Charges,69% of total billed charges,11711.24,84,,,Percent of Total Billed Charges,84% of total billed charges,11432.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,12408.34,89,,,Percent of total Billed Charges,89% of total Billed charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10735.3,77,,,Percent of total Billed charges,77% of total billed charges,11850.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4008.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6970.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5688.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12408.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3485.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3485.49,12408.34,
Doxorubicin Liposomal 50mg/25ml Liquid SDV,47335005040,CDM,250,RC,,,Outpatient,,,13585.24,6792.62,,10460.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3464.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4245.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10053.08,74,,,Percent of Total Billed Charges,74% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,9373.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11411.6,84,,,Percent of Total Billed Charges,84% of total billed charges,11139.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,12090.86,89,,,Percent of total Billed Charges,89% of total Billed charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10460.63,77,,,Percent of total Billed charges,77% of total billed charges,11547.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3905.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6792.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5542.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12090.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3396.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3396.31,12090.86,
Doxorubicin 200mg/100ml Liquid SDV,63323010161,CDM,250,RC,,,Outpatient,,,4957.25,2478.63,,3817.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1549.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3668.37,74,,,Percent of Total Billed Charges,74% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,4164.09,84,,,Percent of Total Billed Charges,84% of total billed charges,4064.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,4411.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.08,77,,,Percent of total Billed charges,77% of total billed charges,4213.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1425.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2478.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1239.31,4411.95,
Doxorubicin 200mg/100ml Liquid SDV,63323010161,CDM,250,RC,,,Outpatient,,,4957.25,2478.63,,3817.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1549.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3668.37,74,,,Percent of Total Billed Charges,74% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,4164.09,84,,,Percent of Total Billed Charges,84% of total billed charges,4064.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,4411.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.08,77,,,Percent of total Billed charges,77% of total billed charges,4213.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1425.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2478.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1239.31,4411.95,
Doxorubicin 200mg/100ml Liquid SDV,63323010161,CDM,250,RC,,,Outpatient,,,4957.25,2478.63,,3817.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1549.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3668.37,74,,,Percent of Total Billed Charges,74% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,4164.09,84,,,Percent of Total Billed Charges,84% of total billed charges,4064.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,4411.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.08,77,,,Percent of total Billed charges,77% of total billed charges,4213.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1425.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2478.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1239.31,4411.95,
Doxorubicin 200mg/100ml Liquid SDV,63323010161,CDM,250,RC,,,Outpatient,,,4957.25,2478.63,,3817.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1549.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3668.37,74,,,Percent of Total Billed Charges,74% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,4164.09,84,,,Percent of Total Billed Charges,84% of total billed charges,4064.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,4411.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.08,77,,,Percent of total Billed charges,77% of total billed charges,4213.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1425.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2478.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1239.31,4411.95,
Doxorubicin 200mg/100ml Liquid SDV,63323010161,CDM,250,RC,,,Outpatient,,,4957.25,2478.63,,3817.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1549.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3668.37,74,,,Percent of Total Billed Charges,74% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,4164.09,84,,,Percent of Total Billed Charges,84% of total billed charges,4064.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,4411.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.08,77,,,Percent of total Billed charges,77% of total billed charges,4213.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1425.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2478.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1239.31,4411.95,
Doxorubicin 200mg/100ml Liquid SDV,63323010161,CDM,250,RC,,,Outpatient,,,4957.25,2478.63,,3817.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1264.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1549.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3668.37,74,,,Percent of Total Billed Charges,74% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3420.5,69,,,Percent of Total Billed Charges,69% of total billed charges,4164.09,84,,,Percent of Total Billed Charges,84% of total billed charges,4064.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,4411.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3817.08,77,,,Percent of total Billed charges,77% of total billed charges,4213.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1425.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2478.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2022.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4411.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1239.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1239.31,4411.95,
Doxorubicin 50mg/25ml Liquid SDV,69303220,CDM,250,RC,,,Outpatient,,,2745.67,1372.84,,2114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2031.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2306.36,84,,,Percent of Total Billed Charges,84% of total billed charges,2251.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,2443.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.17,77,,,Percent of total Billed charges,77% of total billed charges,2333.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1372.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.42,2443.65,
Doxorubicin 50mg/25ml Liquid SDV,69303220,CDM,250,RC,,,Outpatient,,,2745.67,1372.84,,2114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2031.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2306.36,84,,,Percent of Total Billed Charges,84% of total billed charges,2251.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,2443.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.17,77,,,Percent of total Billed charges,77% of total billed charges,2333.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1372.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.42,2443.65,
Doxorubicin 50mg/25ml Liquid SDV,69303220,CDM,250,RC,,,Outpatient,,,2745.67,1372.84,,2114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2031.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2306.36,84,,,Percent of Total Billed Charges,84% of total billed charges,2251.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,2443.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.17,77,,,Percent of total Billed charges,77% of total billed charges,2333.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1372.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.42,2443.65,
Doxorubicin 50mg/25ml Liquid SDV,69303220,CDM,250,RC,,,Outpatient,,,2745.67,1372.84,,2114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2031.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2306.36,84,,,Percent of Total Billed Charges,84% of total billed charges,2251.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,2443.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.17,77,,,Percent of total Billed charges,77% of total billed charges,2333.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1372.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.42,2443.65,
Doxorubicin 50mg/25ml Liquid SDV,69303220,CDM,250,RC,,,Outpatient,,,2745.67,1372.84,,2114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2031.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2306.36,84,,,Percent of Total Billed Charges,84% of total billed charges,2251.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,2443.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.17,77,,,Percent of total Billed charges,77% of total billed charges,2333.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1372.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.42,2443.65,
Doxorubicin 50mg/25ml Liquid SDV,69303220,CDM,250,RC,,,Outpatient,,,2745.67,1372.84,,2114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,700.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,858.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2031.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1894.51,69,,,Percent of Total Billed Charges,69% of total billed charges,2306.36,84,,,Percent of Total Billed Charges,84% of total billed charges,2251.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,2443.65,89,,,Percent of total Billed Charges,89% of total Billed charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2114.17,77,,,Percent of total Billed charges,77% of total billed charges,2333.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,789.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1372.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1120.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2443.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.42,2443.65,
Doxycycline Hyclate 100mg Capsule,143314250,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
Doxycycline Hyclate 100mg Capsule,143314250,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
Doxycycline Hyclate 100mg Capsule,143314250,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
Doxycycline Hyclate 100mg Capsule,143314250,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
Doxycycline Hyclate 100mg Capsule,143314250,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
Doxycycline Hyclate 100mg Capsule,143314250,CDM,250,RC,,,Outpatient,,,16.26,8.13,,12.52,77,,,Percent of Total Billed Charges,77% of total billed charges,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.03,74,,,Percent of Total Billed Charges,74% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,69,,,Percent of Total Billed Charges,69% of total billed charges,13.66,84,,,Percent of Total Billed Charges,84% of total billed charges,13.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.47,89,,,Percent of total Billed Charges,89% of total Billed charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.52,77,,,Percent of total Billed charges,77% of total billed charges,13.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.07,14.47,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Doxycycline 100mg SDV,63323013011,CDM,250,RC,,,Outpatient,,,210.73,105.37,,162.26,77,,,Percent of Total Billed Charges,77% of total billed charges,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.94,74,,,Percent of Total Billed Charges,74% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,145.4,69,,,Percent of Total Billed Charges,69% of total billed charges,177.01,84,,,Percent of Total Billed Charges,84% of total billed charges,172.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,187.55,89,,,Percent of total Billed Charges,89% of total Billed charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.26,77,,,Percent of total Billed charges,77% of total billed charges,179.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.68,187.55,
Droperidol 5mg/2ml SDV,517970225,CDM,250,RC,,,Outpatient,,,119.61,59.81,,92.1,77,,,Percent of Total Billed Charges,77% of total billed charges,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.51,74,,,Percent of Total Billed Charges,74% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,100.47,84,,,Percent of Total Billed Charges,84% of total billed charges,98.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.45,89,,,Percent of total Billed Charges,89% of total Billed charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.1,77,,,Percent of total Billed charges,77% of total billed charges,101.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.9,106.45,
Droperidol 5mg/2ml SDV,517970225,CDM,250,RC,,,Outpatient,,,119.61,59.81,,92.1,77,,,Percent of Total Billed Charges,77% of total billed charges,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.51,74,,,Percent of Total Billed Charges,74% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,100.47,84,,,Percent of Total Billed Charges,84% of total billed charges,98.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.45,89,,,Percent of total Billed Charges,89% of total Billed charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.1,77,,,Percent of total Billed charges,77% of total billed charges,101.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.9,106.45,
Droperidol 5mg/2ml SDV,517970225,CDM,250,RC,,,Outpatient,,,119.61,59.81,,92.1,77,,,Percent of Total Billed Charges,77% of total billed charges,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.51,74,,,Percent of Total Billed Charges,74% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,100.47,84,,,Percent of Total Billed Charges,84% of total billed charges,98.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.45,89,,,Percent of total Billed Charges,89% of total Billed charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.1,77,,,Percent of total Billed charges,77% of total billed charges,101.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.9,106.45,
Droperidol 5mg/2ml SDV,517970225,CDM,250,RC,,,Outpatient,,,119.61,59.81,,92.1,77,,,Percent of Total Billed Charges,77% of total billed charges,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.51,74,,,Percent of Total Billed Charges,74% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,100.47,84,,,Percent of Total Billed Charges,84% of total billed charges,98.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.45,89,,,Percent of total Billed Charges,89% of total Billed charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.1,77,,,Percent of total Billed charges,77% of total billed charges,101.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.9,106.45,
Droperidol 5mg/2ml SDV,517970225,CDM,250,RC,,,Outpatient,,,119.61,59.81,,92.1,77,,,Percent of Total Billed Charges,77% of total billed charges,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.51,74,,,Percent of Total Billed Charges,74% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,100.47,84,,,Percent of Total Billed Charges,84% of total billed charges,98.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.45,89,,,Percent of total Billed Charges,89% of total Billed charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.1,77,,,Percent of total Billed charges,77% of total billed charges,101.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.9,106.45,
Droperidol 5mg/2ml SDV,517970225,CDM,250,RC,,,Outpatient,,,119.61,59.81,,92.1,77,,,Percent of Total Billed Charges,77% of total billed charges,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.51,74,,,Percent of Total Billed Charges,74% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,82.53,69,,,Percent of Total Billed Charges,69% of total billed charges,100.47,84,,,Percent of Total Billed Charges,84% of total billed charges,98.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.45,89,,,Percent of total Billed Charges,89% of total Billed charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.1,77,,,Percent of total Billed charges,77% of total billed charges,101.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,59.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.9,106.45,
DULoxetine 30mg Capsule,2324030,CDM,250,RC,,,Outpatient,,,71.05,35.53,,54.71,77,,,Percent of Total Billed Charges,77% of total billed charges,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.58,74,,,Percent of Total Billed Charges,74% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,84,,,Percent of Total Billed Charges,84% of total billed charges,58.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.23,89,,,Percent of total Billed Charges,89% of total Billed charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,77,,,Percent of total Billed charges,77% of total billed charges,60.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.76,63.23,
DULoxetine 30mg Capsule,2324030,CDM,250,RC,,,Outpatient,,,71.05,35.53,,54.71,77,,,Percent of Total Billed Charges,77% of total billed charges,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.58,74,,,Percent of Total Billed Charges,74% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,84,,,Percent of Total Billed Charges,84% of total billed charges,58.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.23,89,,,Percent of total Billed Charges,89% of total Billed charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,77,,,Percent of total Billed charges,77% of total billed charges,60.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.76,63.23,
DULoxetine 30mg Capsule,2324030,CDM,250,RC,,,Outpatient,,,71.05,35.53,,54.71,77,,,Percent of Total Billed Charges,77% of total billed charges,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.58,74,,,Percent of Total Billed Charges,74% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,84,,,Percent of Total Billed Charges,84% of total billed charges,58.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.23,89,,,Percent of total Billed Charges,89% of total Billed charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,77,,,Percent of total Billed charges,77% of total billed charges,60.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.76,63.23,
DULoxetine 30mg Capsule,2324030,CDM,250,RC,,,Outpatient,,,71.05,35.53,,54.71,77,,,Percent of Total Billed Charges,77% of total billed charges,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.58,74,,,Percent of Total Billed Charges,74% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,84,,,Percent of Total Billed Charges,84% of total billed charges,58.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.23,89,,,Percent of total Billed Charges,89% of total Billed charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,77,,,Percent of total Billed charges,77% of total billed charges,60.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.76,63.23,
DULoxetine 30mg Capsule,2324030,CDM,250,RC,,,Outpatient,,,71.05,35.53,,54.71,77,,,Percent of Total Billed Charges,77% of total billed charges,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.58,74,,,Percent of Total Billed Charges,74% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,84,,,Percent of Total Billed Charges,84% of total billed charges,58.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.23,89,,,Percent of total Billed Charges,89% of total Billed charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,77,,,Percent of total Billed charges,77% of total billed charges,60.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.76,63.23,
DULoxetine 30mg Capsule,2324030,CDM,250,RC,,,Outpatient,,,71.05,35.53,,54.71,77,,,Percent of Total Billed Charges,77% of total billed charges,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.58,74,,,Percent of Total Billed Charges,74% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,49.02,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,84,,,Percent of Total Billed Charges,84% of total billed charges,58.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.23,89,,,Percent of total Billed Charges,89% of total Billed charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.71,77,,,Percent of total Billed charges,77% of total billed charges,60.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.76,63.23,
Dupilumab (Dupixent) 200mg/1.14ml Syringe,24591801,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 200mg/1.14ml Syringe,24591801,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 200mg/1.14ml Syringe,24591801,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 200mg/1.14ml Syringe,24591801,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 200mg/1.14ml Syringe,24591801,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 200mg/1.14ml Syringe,24591801,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 300mg/2ml Syringe,24591401,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 300mg/2ml Syringe,24591401,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 300mg/2ml Syringe,24591401,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 300mg/2ml Syringe,24591401,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 300mg/2ml Syringe,24591401,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Dupilumab (Dupixent) 300mg/2ml Syringe,24591401,CDM,250,RC,,,Outpatient,,,9071.95,4535.98,,6985.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2313.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2834.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6713.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,6259.65,69,,,Percent of Total Billed Charges,69% of total billed charges,7620.44,84,,,Percent of Total Billed Charges,84% of total billed charges,7439,82,,,Percent of Total Billed Charges,82% of total billed charges ,8074.04,89,,,Percent of total Billed Charges,89% of total Billed charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6985.4,77,,,Percent of total Billed charges,77% of total billed charges,7711.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2608.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4535.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3701.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8074.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2267.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2267.99,8074.04,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,7148.2,3574.1,,5504.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2233.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5289.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6004.49,84,,,Percent of Total Billed Charges,84% of total billed charges,5861.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,6361.9,89,,,Percent of total Billed Charges,89% of total Billed charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5504.11,77,,,Percent of total Billed charges,77% of total billed charges,6075.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2055.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3574.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1787.05,6361.9,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,6967.2,3483.6,,5364.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2177.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5155.73,74,,,Percent of Total Billed Charges,74% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,5852.45,84,,,Percent of Total Billed Charges,84% of total billed charges,5713.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6200.81,89,,,Percent of total Billed Charges,89% of total Billed charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5364.74,77,,,Percent of total Billed charges,77% of total billed charges,5922.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2003.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3483.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1741.8,6200.81,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,7148.2,3574.1,,5504.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2233.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5289.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6004.49,84,,,Percent of Total Billed Charges,84% of total billed charges,5861.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,6361.9,89,,,Percent of total Billed Charges,89% of total Billed charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5504.11,77,,,Percent of total Billed charges,77% of total billed charges,6075.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2055.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3574.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1787.05,6361.9,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,6967.2,3483.6,,5364.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2177.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5155.73,74,,,Percent of Total Billed Charges,74% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,5852.45,84,,,Percent of Total Billed Charges,84% of total billed charges,5713.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6200.81,89,,,Percent of total Billed Charges,89% of total Billed charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5364.74,77,,,Percent of total Billed charges,77% of total billed charges,5922.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2003.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3483.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1741.8,6200.81,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,7148.2,3574.1,,5504.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2233.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5289.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6004.49,84,,,Percent of Total Billed Charges,84% of total billed charges,5861.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,6361.9,89,,,Percent of total Billed Charges,89% of total Billed charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5504.11,77,,,Percent of total Billed charges,77% of total billed charges,6075.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2055.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3574.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1787.05,6361.9,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,6967.2,3483.6,,5364.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2177.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5155.73,74,,,Percent of Total Billed Charges,74% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,5852.45,84,,,Percent of Total Billed Charges,84% of total billed charges,5713.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6200.81,89,,,Percent of total Billed Charges,89% of total Billed charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5364.74,77,,,Percent of total Billed charges,77% of total billed charges,5922.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2003.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3483.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1741.8,6200.81,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,7148.2,3574.1,,5504.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2233.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5289.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6004.49,84,,,Percent of Total Billed Charges,84% of total billed charges,5861.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,6361.9,89,,,Percent of total Billed Charges,89% of total Billed charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5504.11,77,,,Percent of total Billed charges,77% of total billed charges,6075.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2055.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3574.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1787.05,6361.9,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,6967.2,3483.6,,5364.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2177.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5155.73,74,,,Percent of Total Billed Charges,74% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,5852.45,84,,,Percent of Total Billed Charges,84% of total billed charges,5713.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6200.81,89,,,Percent of total Billed Charges,89% of total Billed charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5364.74,77,,,Percent of total Billed charges,77% of total billed charges,5922.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2003.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3483.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1741.8,6200.81,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,7148.2,3574.1,,5504.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2233.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5289.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6004.49,84,,,Percent of Total Billed Charges,84% of total billed charges,5861.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,6361.9,89,,,Percent of total Billed Charges,89% of total Billed charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5504.11,77,,,Percent of total Billed charges,77% of total billed charges,6075.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2055.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3574.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1787.05,6361.9,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,6967.2,3483.6,,5364.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2177.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5155.73,74,,,Percent of Total Billed Charges,74% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,5852.45,84,,,Percent of Total Billed Charges,84% of total billed charges,5713.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6200.81,89,,,Percent of total Billed Charges,89% of total Billed charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5364.74,77,,,Percent of total Billed charges,77% of total billed charges,5922.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2003.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3483.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1741.8,6200.81,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,7148.2,3574.1,,5504.11,77,,,Percent of Total Billed Charges,77% of total billed charges,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1822.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2233.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5289.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,4932.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6004.49,84,,,Percent of Total Billed Charges,84% of total billed charges,5861.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,6361.9,89,,,Percent of total Billed Charges,89% of total Billed charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5504.11,77,,,Percent of total Billed charges,77% of total billed charges,6075.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2055.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3574.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2916.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6361.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1787.05,6361.9,
Durvalumab (Imfinzi) 120mg/2.4ml Liquid SDV,310450012,CDM,250,RC,,,Outpatient,,,6967.2,3483.6,,5364.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1776.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2177.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5155.73,74,,,Percent of Total Billed Charges,74% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,4807.37,69,,,Percent of Total Billed Charges,69% of total billed charges,5852.45,84,,,Percent of Total Billed Charges,84% of total billed charges,5713.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6200.81,89,,,Percent of total Billed Charges,89% of total Billed charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5364.74,77,,,Percent of total Billed charges,77% of total billed charges,5922.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2003.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3483.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2842.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6200.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1741.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1741.8,6200.81,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26916.45,13458.23,,20725.67,77,,,Percent of Total Billed Charges,77% of total billed charges,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8411.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19918.17,74,,,Percent of Total Billed Charges,74% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,22609.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23955.64,89,,,Percent of total Billed Charges,89% of total Billed charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20725.67,77,,,Percent of total Billed charges,77% of total billed charges,22878.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7738.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13458.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6729.11,23955.64,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26224.21,13112.11,,20192.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8195.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19405.92,74,,,Percent of Total Billed Charges,74% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,22028.34,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23339.55,89,,,Percent of total Billed Charges,89% of total Billed charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20192.64,77,,,Percent of total Billed charges,77% of total billed charges,22290.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7539.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13112.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6556.05,23339.55,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26916.45,13458.23,,20725.67,77,,,Percent of Total Billed Charges,77% of total billed charges,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8411.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19918.17,74,,,Percent of Total Billed Charges,74% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,22609.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23955.64,89,,,Percent of total Billed Charges,89% of total Billed charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20725.67,77,,,Percent of total Billed charges,77% of total billed charges,22878.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7738.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13458.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6729.11,23955.64,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26224.21,13112.11,,20192.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8195.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19405.92,74,,,Percent of Total Billed Charges,74% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,22028.34,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23339.55,89,,,Percent of total Billed Charges,89% of total Billed charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20192.64,77,,,Percent of total Billed charges,77% of total billed charges,22290.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7539.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13112.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6556.05,23339.55,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26916.45,13458.23,,20725.67,77,,,Percent of Total Billed Charges,77% of total billed charges,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8411.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19918.17,74,,,Percent of Total Billed Charges,74% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,22609.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23955.64,89,,,Percent of total Billed Charges,89% of total Billed charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20725.67,77,,,Percent of total Billed charges,77% of total billed charges,22878.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7738.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13458.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6729.11,23955.64,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26224.21,13112.11,,20192.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8195.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19405.92,74,,,Percent of Total Billed Charges,74% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,22028.34,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23339.55,89,,,Percent of total Billed Charges,89% of total Billed charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20192.64,77,,,Percent of total Billed charges,77% of total billed charges,22290.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7539.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13112.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6556.05,23339.55,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26916.45,13458.23,,20725.67,77,,,Percent of Total Billed Charges,77% of total billed charges,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8411.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19918.17,74,,,Percent of Total Billed Charges,74% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,22609.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23955.64,89,,,Percent of total Billed Charges,89% of total Billed charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20725.67,77,,,Percent of total Billed charges,77% of total billed charges,22878.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7738.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13458.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6729.11,23955.64,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26224.21,13112.11,,20192.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8195.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19405.92,74,,,Percent of Total Billed Charges,74% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,22028.34,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23339.55,89,,,Percent of total Billed Charges,89% of total Billed charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20192.64,77,,,Percent of total Billed charges,77% of total billed charges,22290.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7539.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13112.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6556.05,23339.55,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26916.45,13458.23,,20725.67,77,,,Percent of Total Billed Charges,77% of total billed charges,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8411.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19918.17,74,,,Percent of Total Billed Charges,74% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,22609.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23955.64,89,,,Percent of total Billed Charges,89% of total Billed charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20725.67,77,,,Percent of total Billed charges,77% of total billed charges,22878.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7738.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13458.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6729.11,23955.64,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26224.21,13112.11,,20192.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8195.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19405.92,74,,,Percent of Total Billed Charges,74% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,22028.34,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23339.55,89,,,Percent of total Billed Charges,89% of total Billed charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20192.64,77,,,Percent of total Billed charges,77% of total billed charges,22290.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7539.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13112.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6556.05,23339.55,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26916.45,13458.23,,20725.67,77,,,Percent of Total Billed Charges,77% of total billed charges,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6863.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8411.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19918.17,74,,,Percent of Total Billed Charges,74% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,18572.35,69,,,Percent of Total Billed Charges,69% of total billed charges,22609.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23955.64,89,,,Percent of total Billed Charges,89% of total Billed charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20725.67,77,,,Percent of total Billed charges,77% of total billed charges,22878.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7738.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13458.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10981.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23955.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6729.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6729.11,23955.64,
Durvalumab (Imfinzi) 500mg/10ml Liquid SDV,310461150,CDM,250,RC,,,Outpatient,,,26224.21,13112.11,,20192.64,77,,,Percent of Total Billed Charges,77% of total billed charges,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6687.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8195.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19405.92,74,,,Percent of Total Billed Charges,74% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,18094.7,69,,,Percent of Total Billed Charges,69% of total billed charges,22028.34,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23339.55,89,,,Percent of total Billed Charges,89% of total Billed charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20192.64,77,,,Percent of total Billed charges,77% of total billed charges,22290.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7539.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13112.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10699.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23339.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6556.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6556.05,23339.55,
Edaravone (Radicava) 30mg/100ml IV Bag,70510217102,CDM,250,RC,,,Outpatient,,,2933.3,1466.65,,2258.64,77,,,Percent of Total Billed Charges,77% of total billed charges,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2170.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.97,84,,,Percent of Total Billed Charges,84% of total billed charges,2405.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2610.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2258.64,77,,,Percent of total Billed charges,77% of total billed charges,2493.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,843.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1466.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.33,2610.64,
Edaravone (Radicava) 30mg/100ml IV Bag,70510217102,CDM,250,RC,,,Outpatient,,,2933.3,1466.65,,2258.64,77,,,Percent of Total Billed Charges,77% of total billed charges,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2170.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.97,84,,,Percent of Total Billed Charges,84% of total billed charges,2405.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2610.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2258.64,77,,,Percent of total Billed charges,77% of total billed charges,2493.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,843.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1466.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.33,2610.64,
Edaravone (Radicava) 30mg/100ml IV Bag,70510217102,CDM,250,RC,,,Outpatient,,,2933.3,1466.65,,2258.64,77,,,Percent of Total Billed Charges,77% of total billed charges,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2170.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.97,84,,,Percent of Total Billed Charges,84% of total billed charges,2405.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2610.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2258.64,77,,,Percent of total Billed charges,77% of total billed charges,2493.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,843.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1466.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.33,2610.64,
Edaravone (Radicava) 30mg/100ml IV Bag,70510217102,CDM,250,RC,,,Outpatient,,,2933.3,1466.65,,2258.64,77,,,Percent of Total Billed Charges,77% of total billed charges,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2170.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.97,84,,,Percent of Total Billed Charges,84% of total billed charges,2405.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2610.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2258.64,77,,,Percent of total Billed charges,77% of total billed charges,2493.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,843.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1466.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.33,2610.64,
Edaravone (Radicava) 30mg/100ml IV Bag,70510217102,CDM,250,RC,,,Outpatient,,,2933.3,1466.65,,2258.64,77,,,Percent of Total Billed Charges,77% of total billed charges,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2170.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.97,84,,,Percent of Total Billed Charges,84% of total billed charges,2405.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2610.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2258.64,77,,,Percent of total Billed charges,77% of total billed charges,2493.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,843.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1466.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.33,2610.64,
Edaravone (Radicava) 30mg/100ml IV Bag,70510217102,CDM,250,RC,,,Outpatient,,,2933.3,1466.65,,2258.64,77,,,Percent of Total Billed Charges,77% of total billed charges,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2170.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2023.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.97,84,,,Percent of Total Billed Charges,84% of total billed charges,2405.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2610.64,89,,,Percent of total Billed Charges,89% of total Billed charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2258.64,77,,,Percent of total Billed charges,77% of total billed charges,2493.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,843.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1466.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2610.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,733.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,733.33,2610.64,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,29519.14,14759.57,,22729.74,77,,,Percent of Total Billed Charges,77% of total billed charges,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9224.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21844.16,74,,,Percent of Total Billed Charges,74% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,24796.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26272.03,89,,,Percent of total Billed Charges,89% of total Billed charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22729.74,77,,,Percent of total Billed charges,77% of total billed charges,25091.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8486.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14759.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7379.79,26272.03,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,28789.08,14394.54,,22167.59,77,,,Percent of Total Billed Charges,77% of total billed charges,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8996.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21303.92,74,,,Percent of Total Billed Charges,74% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24182.83,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25622.28,89,,,Percent of total Billed Charges,89% of total Billed charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22167.59,77,,,Percent of total Billed charges,77% of total billed charges,24470.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14394.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7197.27,25622.28,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,29519.14,14759.57,,22729.74,77,,,Percent of Total Billed Charges,77% of total billed charges,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9224.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21844.16,74,,,Percent of Total Billed Charges,74% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,24796.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26272.03,89,,,Percent of total Billed Charges,89% of total Billed charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22729.74,77,,,Percent of total Billed charges,77% of total billed charges,25091.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8486.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14759.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7379.79,26272.03,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,28789.08,14394.54,,22167.59,77,,,Percent of Total Billed Charges,77% of total billed charges,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8996.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21303.92,74,,,Percent of Total Billed Charges,74% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24182.83,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25622.28,89,,,Percent of total Billed Charges,89% of total Billed charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22167.59,77,,,Percent of total Billed charges,77% of total billed charges,24470.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14394.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7197.27,25622.28,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,29519.14,14759.57,,22729.74,77,,,Percent of Total Billed Charges,77% of total billed charges,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9224.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21844.16,74,,,Percent of Total Billed Charges,74% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,24796.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26272.03,89,,,Percent of total Billed Charges,89% of total Billed charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22729.74,77,,,Percent of total Billed charges,77% of total billed charges,25091.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8486.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14759.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7379.79,26272.03,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,28789.08,14394.54,,22167.59,77,,,Percent of Total Billed Charges,77% of total billed charges,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8996.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21303.92,74,,,Percent of Total Billed Charges,74% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24182.83,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25622.28,89,,,Percent of total Billed Charges,89% of total Billed charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22167.59,77,,,Percent of total Billed charges,77% of total billed charges,24470.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14394.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7197.27,25622.28,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,29519.14,14759.57,,22729.74,77,,,Percent of Total Billed Charges,77% of total billed charges,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9224.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21844.16,74,,,Percent of Total Billed Charges,74% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,24796.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26272.03,89,,,Percent of total Billed Charges,89% of total Billed charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22729.74,77,,,Percent of total Billed charges,77% of total billed charges,25091.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8486.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14759.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7379.79,26272.03,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,28789.08,14394.54,,22167.59,77,,,Percent of Total Billed Charges,77% of total billed charges,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8996.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21303.92,74,,,Percent of Total Billed Charges,74% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24182.83,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25622.28,89,,,Percent of total Billed Charges,89% of total Billed charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22167.59,77,,,Percent of total Billed charges,77% of total billed charges,24470.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14394.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7197.27,25622.28,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,29519.14,14759.57,,22729.74,77,,,Percent of Total Billed Charges,77% of total billed charges,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9224.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21844.16,74,,,Percent of Total Billed Charges,74% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,24796.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26272.03,89,,,Percent of total Billed Charges,89% of total Billed charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22729.74,77,,,Percent of total Billed charges,77% of total billed charges,25091.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8486.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14759.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7379.79,26272.03,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,28789.08,14394.54,,22167.59,77,,,Percent of Total Billed Charges,77% of total billed charges,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8996.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21303.92,74,,,Percent of Total Billed Charges,74% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24182.83,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25622.28,89,,,Percent of total Billed Charges,89% of total Billed charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22167.59,77,,,Percent of total Billed charges,77% of total billed charges,24470.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14394.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7197.27,25622.28,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,29519.14,14759.57,,22729.74,77,,,Percent of Total Billed Charges,77% of total billed charges,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7527.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9224.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21844.16,74,,,Percent of Total Billed Charges,74% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,20368.21,69,,,Percent of Total Billed Charges,69% of total billed charges,24796.08,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26272.03,89,,,Percent of total Billed Charges,89% of total Billed charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22729.74,77,,,Percent of total Billed charges,77% of total billed charges,25091.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8486.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14759.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12043.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26272.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7379.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7379.79,26272.03,
Efgartigimod Alfa-fcab (Vyvgart) 400mg/20ml Liquid SDV,73475304105,CDM,250,RC,,,Outpatient,,,28789.08,14394.54,,22167.59,77,,,Percent of Total Billed Charges,77% of total billed charges,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7341.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8996.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21303.92,74,,,Percent of Total Billed Charges,74% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19864.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24182.83,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25622.28,89,,,Percent of total Billed Charges,89% of total Billed charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22167.59,77,,,Percent of total Billed charges,77% of total billed charges,24470.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8276.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14394.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11745.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25622.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7197.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7197.27,25622.28,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14645.96,7322.98,,11277.39,77,,,Percent of Total Billed Charges,77% of total billed charges,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4576.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10838.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12302.61,84,,,Percent of Total Billed Charges,84% of total billed charges,12009.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,13034.9,89,,,Percent of total Billed Charges,89% of total Billed charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11277.39,77,,,Percent of total Billed charges,77% of total billed charges,12449.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4210.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7322.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3661.49,13034.9,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14271.81,7135.91,,10989.29,77,,,Percent of Total Billed Charges,77% of total billed charges,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4459.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10561.14,74,,,Percent of Total Billed Charges,74% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,11988.32,84,,,Percent of Total Billed Charges,84% of total billed charges,11702.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,12701.91,89,,,Percent of total Billed Charges,89% of total Billed charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10989.29,77,,,Percent of total Billed charges,77% of total billed charges,12131.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4103.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7135.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3567.95,12701.91,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14645.96,7322.98,,11277.39,77,,,Percent of Total Billed Charges,77% of total billed charges,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4576.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10838.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12302.61,84,,,Percent of Total Billed Charges,84% of total billed charges,12009.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,13034.9,89,,,Percent of total Billed Charges,89% of total Billed charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11277.39,77,,,Percent of total Billed charges,77% of total billed charges,12449.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4210.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7322.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3661.49,13034.9,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14271.81,7135.91,,10989.29,77,,,Percent of Total Billed Charges,77% of total billed charges,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4459.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10561.14,74,,,Percent of Total Billed Charges,74% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,11988.32,84,,,Percent of Total Billed Charges,84% of total billed charges,11702.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,12701.91,89,,,Percent of total Billed Charges,89% of total Billed charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10989.29,77,,,Percent of total Billed charges,77% of total billed charges,12131.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4103.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7135.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3567.95,12701.91,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14645.96,7322.98,,11277.39,77,,,Percent of Total Billed Charges,77% of total billed charges,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4576.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10838.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12302.61,84,,,Percent of Total Billed Charges,84% of total billed charges,12009.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,13034.9,89,,,Percent of total Billed Charges,89% of total Billed charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11277.39,77,,,Percent of total Billed charges,77% of total billed charges,12449.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4210.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7322.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3661.49,13034.9,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14271.81,7135.91,,10989.29,77,,,Percent of Total Billed Charges,77% of total billed charges,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4459.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10561.14,74,,,Percent of Total Billed Charges,74% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,11988.32,84,,,Percent of Total Billed Charges,84% of total billed charges,11702.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,12701.91,89,,,Percent of total Billed Charges,89% of total Billed charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10989.29,77,,,Percent of total Billed charges,77% of total billed charges,12131.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4103.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7135.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3567.95,12701.91,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14645.96,7322.98,,11277.39,77,,,Percent of Total Billed Charges,77% of total billed charges,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4576.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10838.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12302.61,84,,,Percent of Total Billed Charges,84% of total billed charges,12009.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,13034.9,89,,,Percent of total Billed Charges,89% of total Billed charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11277.39,77,,,Percent of total Billed charges,77% of total billed charges,12449.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4210.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7322.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3661.49,13034.9,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14271.81,7135.91,,10989.29,77,,,Percent of Total Billed Charges,77% of total billed charges,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4459.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10561.14,74,,,Percent of Total Billed Charges,74% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,11988.32,84,,,Percent of Total Billed Charges,84% of total billed charges,11702.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,12701.91,89,,,Percent of total Billed Charges,89% of total Billed charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10989.29,77,,,Percent of total Billed charges,77% of total billed charges,12131.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4103.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7135.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3567.95,12701.91,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14645.96,7322.98,,11277.39,77,,,Percent of Total Billed Charges,77% of total billed charges,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4576.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10838.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12302.61,84,,,Percent of Total Billed Charges,84% of total billed charges,12009.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,13034.9,89,,,Percent of total Billed Charges,89% of total Billed charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11277.39,77,,,Percent of total Billed charges,77% of total billed charges,12449.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4210.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7322.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3661.49,13034.9,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14271.81,7135.91,,10989.29,77,,,Percent of Total Billed Charges,77% of total billed charges,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4459.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10561.14,74,,,Percent of Total Billed Charges,74% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,11988.32,84,,,Percent of Total Billed Charges,84% of total billed charges,11702.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,12701.91,89,,,Percent of total Billed Charges,89% of total Billed charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10989.29,77,,,Percent of total Billed charges,77% of total billed charges,12131.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4103.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7135.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3567.95,12701.91,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14645.96,7322.98,,11277.39,77,,,Percent of Total Billed Charges,77% of total billed charges,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3734.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4576.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10838.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,10105.71,69,,,Percent of Total Billed Charges,69% of total billed charges,12302.61,84,,,Percent of Total Billed Charges,84% of total billed charges,12009.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,13034.9,89,,,Percent of total Billed Charges,89% of total Billed charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11277.39,77,,,Percent of total Billed charges,77% of total billed charges,12449.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4210.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7322.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5975.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13034.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3661.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3661.49,13034.9,
Elotuzumab (Empliciti) 300mg Powder SDV,3229111,CDM,250,RC,,,Outpatient,,,14271.81,7135.91,,10989.29,77,,,Percent of Total Billed Charges,77% of total billed charges,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3639.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4459.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10561.14,74,,,Percent of Total Billed Charges,74% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,9847.55,69,,,Percent of Total Billed Charges,69% of total billed charges,11988.32,84,,,Percent of Total Billed Charges,84% of total billed charges,11702.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,12701.91,89,,,Percent of total Billed Charges,89% of total Billed charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10989.29,77,,,Percent of total Billed charges,77% of total billed charges,12131.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4103.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7135.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5822.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12701.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3567.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3567.95,12701.91,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,19468.08,9734.04,,14990.42,77,,,Percent of Total Billed Charges,77% of total billed charges,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6083.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14406.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,16353.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17326.59,89,,,Percent of total Billed Charges,89% of total Billed charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14990.42,77,,,Percent of total Billed charges,77% of total billed charges,16547.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5597.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9734.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4867.02,17326.59,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,18969.22,9484.61,,14606.3,77,,,Percent of Total Billed Charges,77% of total billed charges,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5927.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14037.22,74,,,Percent of Total Billed Charges,74% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,15934.14,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16882.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14606.3,77,,,Percent of total Billed charges,77% of total billed charges,16123.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5453.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9484.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4742.31,16882.61,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,19468.08,9734.04,,14990.42,77,,,Percent of Total Billed Charges,77% of total billed charges,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6083.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14406.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,16353.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17326.59,89,,,Percent of total Billed Charges,89% of total Billed charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14990.42,77,,,Percent of total Billed charges,77% of total billed charges,16547.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5597.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9734.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4867.02,17326.59,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,18969.22,9484.61,,14606.3,77,,,Percent of Total Billed Charges,77% of total billed charges,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5927.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14037.22,74,,,Percent of Total Billed Charges,74% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,15934.14,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16882.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14606.3,77,,,Percent of total Billed charges,77% of total billed charges,16123.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5453.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9484.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4742.31,16882.61,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,19468.08,9734.04,,14990.42,77,,,Percent of Total Billed Charges,77% of total billed charges,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6083.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14406.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,16353.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17326.59,89,,,Percent of total Billed Charges,89% of total Billed charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14990.42,77,,,Percent of total Billed charges,77% of total billed charges,16547.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5597.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9734.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4867.02,17326.59,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,18969.22,9484.61,,14606.3,77,,,Percent of Total Billed Charges,77% of total billed charges,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5927.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14037.22,74,,,Percent of Total Billed Charges,74% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,15934.14,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16882.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14606.3,77,,,Percent of total Billed charges,77% of total billed charges,16123.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5453.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9484.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4742.31,16882.61,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,19468.08,9734.04,,14990.42,77,,,Percent of Total Billed Charges,77% of total billed charges,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6083.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14406.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,16353.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17326.59,89,,,Percent of total Billed Charges,89% of total Billed charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14990.42,77,,,Percent of total Billed charges,77% of total billed charges,16547.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5597.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9734.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4867.02,17326.59,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,18969.22,9484.61,,14606.3,77,,,Percent of Total Billed Charges,77% of total billed charges,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5927.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14037.22,74,,,Percent of Total Billed Charges,74% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,15934.14,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16882.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14606.3,77,,,Percent of total Billed charges,77% of total billed charges,16123.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5453.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9484.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4742.31,16882.61,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,19468.08,9734.04,,14990.42,77,,,Percent of Total Billed Charges,77% of total billed charges,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6083.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14406.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,16353.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17326.59,89,,,Percent of total Billed Charges,89% of total Billed charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14990.42,77,,,Percent of total Billed charges,77% of total billed charges,16547.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5597.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9734.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4867.02,17326.59,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,18969.22,9484.61,,14606.3,77,,,Percent of Total Billed Charges,77% of total billed charges,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5927.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14037.22,74,,,Percent of Total Billed Charges,74% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,15934.14,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16882.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14606.3,77,,,Percent of total Billed charges,77% of total billed charges,16123.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5453.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9484.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4742.31,16882.61,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,19468.08,9734.04,,14990.42,77,,,Percent of Total Billed Charges,77% of total billed charges,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4964.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6083.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14406.38,74,,,Percent of Total Billed Charges,74% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,13432.98,69,,,Percent of Total Billed Charges,69% of total billed charges,16353.19,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17326.59,89,,,Percent of total Billed Charges,89% of total Billed charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14990.42,77,,,Percent of total Billed charges,77% of total billed charges,16547.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5597.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9734.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7942.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17326.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4867.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4867.02,17326.59,
Elotuzumab (Empliciti) 400mg Powder SDV,3452211,CDM,250,RC,,,Outpatient,,,18969.22,9484.61,,14606.3,77,,,Percent of Total Billed Charges,77% of total billed charges,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4837.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5927.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14037.22,74,,,Percent of Total Billed Charges,74% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13088.76,69,,,Percent of Total Billed Charges,69% of total billed charges,15934.14,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16882.61,89,,,Percent of total Billed Charges,89% of total Billed charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14606.3,77,,,Percent of total Billed charges,77% of total billed charges,16123.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5453.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9484.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7739.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16882.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4742.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4742.31,16882.61,
Empagliflozin 10mg Tablet,597015237,CDM,250,RC,,,Outpatient,,,148.9,74.45,,114.65,77,,,Percent of Total Billed Charges,77% of total billed charges,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.19,74,,,Percent of Total Billed Charges,74% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,125.08,84,,,Percent of Total Billed Charges,84% of total billed charges,122.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.52,89,,,Percent of total Billed Charges,89% of total Billed charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.65,77,,,Percent of total Billed charges,77% of total billed charges,126.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.23,132.52,
Empagliflozin 10mg Tablet,597015237,CDM,250,RC,,,Outpatient,,,148.9,74.45,,114.65,77,,,Percent of Total Billed Charges,77% of total billed charges,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.19,74,,,Percent of Total Billed Charges,74% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,125.08,84,,,Percent of Total Billed Charges,84% of total billed charges,122.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.52,89,,,Percent of total Billed Charges,89% of total Billed charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.65,77,,,Percent of total Billed charges,77% of total billed charges,126.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.23,132.52,
Empagliflozin 10mg Tablet,597015237,CDM,250,RC,,,Outpatient,,,148.9,74.45,,114.65,77,,,Percent of Total Billed Charges,77% of total billed charges,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.19,74,,,Percent of Total Billed Charges,74% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,125.08,84,,,Percent of Total Billed Charges,84% of total billed charges,122.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.52,89,,,Percent of total Billed Charges,89% of total Billed charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.65,77,,,Percent of total Billed charges,77% of total billed charges,126.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.23,132.52,
Empagliflozin 10mg Tablet,597015237,CDM,250,RC,,,Outpatient,,,148.9,74.45,,114.65,77,,,Percent of Total Billed Charges,77% of total billed charges,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.19,74,,,Percent of Total Billed Charges,74% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,125.08,84,,,Percent of Total Billed Charges,84% of total billed charges,122.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.52,89,,,Percent of total Billed Charges,89% of total Billed charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.65,77,,,Percent of total Billed charges,77% of total billed charges,126.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.23,132.52,
Empagliflozin 10mg Tablet,597015237,CDM,250,RC,,,Outpatient,,,148.9,74.45,,114.65,77,,,Percent of Total Billed Charges,77% of total billed charges,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.19,74,,,Percent of Total Billed Charges,74% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,125.08,84,,,Percent of Total Billed Charges,84% of total billed charges,122.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.52,89,,,Percent of total Billed Charges,89% of total Billed charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.65,77,,,Percent of total Billed charges,77% of total billed charges,126.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.23,132.52,
Empagliflozin 10mg Tablet,597015237,CDM,250,RC,,,Outpatient,,,148.9,74.45,,114.65,77,,,Percent of Total Billed Charges,77% of total billed charges,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,110.19,74,,,Percent of Total Billed Charges,74% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,102.74,69,,,Percent of Total Billed Charges,69% of total billed charges,125.08,84,,,Percent of Total Billed Charges,84% of total billed charges,122.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.52,89,,,Percent of total Billed Charges,89% of total Billed charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.65,77,,,Percent of total Billed charges,77% of total billed charges,126.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.23,132.52,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalaprilat 2.5mg/2ml SDV,143978610,CDM,250,RC,,,Outpatient,,,117.97,58.99,,90.84,77,,,Percent of Total Billed Charges,77% of total billed charges,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,87.3,74,,,Percent of Total Billed Charges,74% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,81.4,69,,,Percent of Total Billed Charges,69% of total billed charges,99.09,84,,,Percent of Total Billed Charges,84% of total billed charges,96.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.99,89,,,Percent of total Billed Charges,89% of total Billed charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.84,77,,,Percent of total Billed charges,77% of total billed charges,100.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,48.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.49,104.99,
Enalapril 10mg Tablet,64679092502,CDM,250,RC,,,Outpatient,,,23.21,11.61,,17.87,77,,,Percent of Total Billed Charges,77% of total billed charges,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.18,74,,,Percent of Total Billed Charges,74% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,84,,,Percent of Total Billed Charges,84% of total billed charges,19.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.66,89,,,Percent of total Billed Charges,89% of total Billed charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.87,77,,,Percent of total Billed charges,77% of total billed charges,19.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,20.66,
Enalapril 10mg Tablet,64679092502,CDM,250,RC,,,Outpatient,,,23.21,11.61,,17.87,77,,,Percent of Total Billed Charges,77% of total billed charges,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.18,74,,,Percent of Total Billed Charges,74% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,84,,,Percent of Total Billed Charges,84% of total billed charges,19.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.66,89,,,Percent of total Billed Charges,89% of total Billed charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.87,77,,,Percent of total Billed charges,77% of total billed charges,19.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,20.66,
Enalapril 10mg Tablet,64679092502,CDM,250,RC,,,Outpatient,,,23.21,11.61,,17.87,77,,,Percent of Total Billed Charges,77% of total billed charges,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.18,74,,,Percent of Total Billed Charges,74% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,84,,,Percent of Total Billed Charges,84% of total billed charges,19.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.66,89,,,Percent of total Billed Charges,89% of total Billed charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.87,77,,,Percent of total Billed charges,77% of total billed charges,19.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,20.66,
Enalapril 10mg Tablet,64679092502,CDM,250,RC,,,Outpatient,,,23.21,11.61,,17.87,77,,,Percent of Total Billed Charges,77% of total billed charges,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.18,74,,,Percent of Total Billed Charges,74% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,84,,,Percent of Total Billed Charges,84% of total billed charges,19.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.66,89,,,Percent of total Billed Charges,89% of total Billed charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.87,77,,,Percent of total Billed charges,77% of total billed charges,19.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,20.66,
Enalapril 10mg Tablet,64679092502,CDM,250,RC,,,Outpatient,,,23.21,11.61,,17.87,77,,,Percent of Total Billed Charges,77% of total billed charges,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.18,74,,,Percent of Total Billed Charges,74% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,84,,,Percent of Total Billed Charges,84% of total billed charges,19.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.66,89,,,Percent of total Billed Charges,89% of total Billed charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.87,77,,,Percent of total Billed charges,77% of total billed charges,19.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,20.66,
Enalapril 10mg Tablet,64679092502,CDM,250,RC,,,Outpatient,,,23.21,11.61,,17.87,77,,,Percent of Total Billed Charges,77% of total billed charges,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.18,74,,,Percent of Total Billed Charges,74% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,16.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.5,84,,,Percent of Total Billed Charges,84% of total billed charges,19.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.66,89,,,Percent of total Billed Charges,89% of total Billed charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.87,77,,,Percent of total Billed charges,77% of total billed charges,19.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,20.66,
Enalapril 20mg Tablet,51672404001,CDM,250,RC,,,Outpatient,,,30.99,15.5,,23.86,77,,,Percent of Total Billed Charges,77% of total billed charges,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.93,74,,,Percent of Total Billed Charges,74% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,26.03,84,,,Percent of Total Billed Charges,84% of total billed charges,25.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.58,89,,,Percent of total Billed Charges,89% of total Billed charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.86,77,,,Percent of total Billed charges,77% of total billed charges,26.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.58,
Enalapril 20mg Tablet,51672404001,CDM,250,RC,,,Outpatient,,,30.99,15.5,,23.86,77,,,Percent of Total Billed Charges,77% of total billed charges,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.93,74,,,Percent of Total Billed Charges,74% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,26.03,84,,,Percent of Total Billed Charges,84% of total billed charges,25.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.58,89,,,Percent of total Billed Charges,89% of total Billed charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.86,77,,,Percent of total Billed charges,77% of total billed charges,26.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.58,
Enalapril 20mg Tablet,51672404001,CDM,250,RC,,,Outpatient,,,30.99,15.5,,23.86,77,,,Percent of Total Billed Charges,77% of total billed charges,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.93,74,,,Percent of Total Billed Charges,74% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,26.03,84,,,Percent of Total Billed Charges,84% of total billed charges,25.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.58,89,,,Percent of total Billed Charges,89% of total Billed charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.86,77,,,Percent of total Billed charges,77% of total billed charges,26.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.58,
Enalapril 20mg Tablet,51672404001,CDM,250,RC,,,Outpatient,,,30.99,15.5,,23.86,77,,,Percent of Total Billed Charges,77% of total billed charges,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.93,74,,,Percent of Total Billed Charges,74% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,26.03,84,,,Percent of Total Billed Charges,84% of total billed charges,25.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.58,89,,,Percent of total Billed Charges,89% of total Billed charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.86,77,,,Percent of total Billed charges,77% of total billed charges,26.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.58,
Enalapril 20mg Tablet,51672404001,CDM,250,RC,,,Outpatient,,,30.99,15.5,,23.86,77,,,Percent of Total Billed Charges,77% of total billed charges,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.93,74,,,Percent of Total Billed Charges,74% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,26.03,84,,,Percent of Total Billed Charges,84% of total billed charges,25.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.58,89,,,Percent of total Billed Charges,89% of total Billed charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.86,77,,,Percent of total Billed charges,77% of total billed charges,26.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.58,
Enalapril 20mg Tablet,51672404001,CDM,250,RC,,,Outpatient,,,30.99,15.5,,23.86,77,,,Percent of Total Billed Charges,77% of total billed charges,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.93,74,,,Percent of Total Billed Charges,74% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,21.38,69,,,Percent of Total Billed Charges,69% of total billed charges,26.03,84,,,Percent of Total Billed Charges,84% of total billed charges,25.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.58,89,,,Percent of total Billed Charges,89% of total Billed charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.86,77,,,Percent of total Billed charges,77% of total billed charges,26.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,27.58,
Enalapril 5mg Tablet,64679092402,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Enalapril 5mg Tablet,64679092402,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Enalapril 5mg Tablet,64679092402,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Enalapril 5mg Tablet,64679092402,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Enalapril 5mg Tablet,64679092402,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Enalapril 5mg Tablet,64679092402,CDM,250,RC,,,Outpatient,,,22.36,11.18,,17.22,77,,,Percent of Total Billed Charges,77% of total billed charges,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.55,74,,,Percent of Total Billed Charges,74% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,69,,,Percent of Total Billed Charges,69% of total billed charges,18.78,84,,,Percent of Total Billed Charges,84% of total billed charges,18.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.9,89,,,Percent of total Billed Charges,89% of total Billed charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.22,77,,,Percent of total Billed charges,77% of total billed charges,19.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.59,19.9,
Enoxaparin 100mg/1ml Syringe,75062300,CDM,250,RC,,,Outpatient,,,201.07,100.54,,154.82,77,,,Percent of Total Billed Charges,77% of total billed charges,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.79,74,,,Percent of Total Billed Charges,74% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,168.9,84,,,Percent of Total Billed Charges,84% of total billed charges,164.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.95,89,,,Percent of total Billed Charges,89% of total Billed charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.82,77,,,Percent of total Billed charges,77% of total billed charges,170.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.27,178.95,
Enoxaparin 100mg/1ml Syringe,75062300,CDM,250,RC,,,Outpatient,,,201.07,100.54,,154.82,77,,,Percent of Total Billed Charges,77% of total billed charges,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.79,74,,,Percent of Total Billed Charges,74% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,168.9,84,,,Percent of Total Billed Charges,84% of total billed charges,164.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.95,89,,,Percent of total Billed Charges,89% of total Billed charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.82,77,,,Percent of total Billed charges,77% of total billed charges,170.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.27,178.95,
Enoxaparin 100mg/1ml Syringe,75062300,CDM,250,RC,,,Outpatient,,,201.07,100.54,,154.82,77,,,Percent of Total Billed Charges,77% of total billed charges,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.79,74,,,Percent of Total Billed Charges,74% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,168.9,84,,,Percent of Total Billed Charges,84% of total billed charges,164.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.95,89,,,Percent of total Billed Charges,89% of total Billed charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.82,77,,,Percent of total Billed charges,77% of total billed charges,170.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.27,178.95,
Enoxaparin 100mg/1ml Syringe,75062300,CDM,250,RC,,,Outpatient,,,201.07,100.54,,154.82,77,,,Percent of Total Billed Charges,77% of total billed charges,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.79,74,,,Percent of Total Billed Charges,74% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,168.9,84,,,Percent of Total Billed Charges,84% of total billed charges,164.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.95,89,,,Percent of total Billed Charges,89% of total Billed charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.82,77,,,Percent of total Billed charges,77% of total billed charges,170.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.27,178.95,
Enoxaparin 100mg/1ml Syringe,75062300,CDM,250,RC,,,Outpatient,,,201.07,100.54,,154.82,77,,,Percent of Total Billed Charges,77% of total billed charges,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.79,74,,,Percent of Total Billed Charges,74% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,168.9,84,,,Percent of Total Billed Charges,84% of total billed charges,164.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.95,89,,,Percent of total Billed Charges,89% of total Billed charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.82,77,,,Percent of total Billed charges,77% of total billed charges,170.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.27,178.95,
Enoxaparin 100mg/1ml Syringe,75062300,CDM,250,RC,,,Outpatient,,,201.07,100.54,,154.82,77,,,Percent of Total Billed Charges,77% of total billed charges,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.79,74,,,Percent of Total Billed Charges,74% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,138.74,69,,,Percent of Total Billed Charges,69% of total billed charges,168.9,84,,,Percent of Total Billed Charges,84% of total billed charges,164.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.95,89,,,Percent of total Billed Charges,89% of total Billed charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.82,77,,,Percent of total Billed charges,77% of total billed charges,170.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.27,178.95,
Enoxaparin 30mg/0.3ml Syringe,75062430,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Enoxaparin 30mg/0.3ml Syringe,75062430,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Enoxaparin 30mg/0.3ml Syringe,75062430,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Enoxaparin 30mg/0.3ml Syringe,75062430,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Enoxaparin 30mg/0.3ml Syringe,75062430,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Enoxaparin 30mg/0.3ml Syringe,75062430,CDM,250,RC,,,Outpatient,,,101.19,50.6,,77.92,77,,,Percent of Total Billed Charges,77% of total billed charges,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.88,74,,,Percent of Total Billed Charges,74% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,69.82,69,,,Percent of Total Billed Charges,69% of total billed charges,85,84,,,Percent of Total Billed Charges,84% of total billed charges,82.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,90.06,89,,,Percent of total Billed Charges,89% of total Billed charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.92,77,,,Percent of total Billed charges,77% of total billed charges,86.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.3,90.06,
Enoxaparin 40mg/0.4ml Syringe,75062040,CDM,250,RC,,,Outpatient,,,121.59,60.8,,93.62,77,,,Percent of Total Billed Charges,77% of total billed charges,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.98,74,,,Percent of Total Billed Charges,74% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.14,84,,,Percent of Total Billed Charges,84% of total billed charges,99.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.22,89,,,Percent of total Billed Charges,89% of total Billed charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.62,77,,,Percent of total Billed charges,77% of total billed charges,103.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.4,108.22,
Enoxaparin 40mg/0.4ml Syringe,75062040,CDM,250,RC,,,Outpatient,,,121.59,60.8,,93.62,77,,,Percent of Total Billed Charges,77% of total billed charges,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.98,74,,,Percent of Total Billed Charges,74% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.14,84,,,Percent of Total Billed Charges,84% of total billed charges,99.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.22,89,,,Percent of total Billed Charges,89% of total Billed charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.62,77,,,Percent of total Billed charges,77% of total billed charges,103.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.4,108.22,
Enoxaparin 40mg/0.4ml Syringe,75062040,CDM,250,RC,,,Outpatient,,,121.59,60.8,,93.62,77,,,Percent of Total Billed Charges,77% of total billed charges,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.98,74,,,Percent of Total Billed Charges,74% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.14,84,,,Percent of Total Billed Charges,84% of total billed charges,99.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.22,89,,,Percent of total Billed Charges,89% of total Billed charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.62,77,,,Percent of total Billed charges,77% of total billed charges,103.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.4,108.22,
Enoxaparin 40mg/0.4ml Syringe,75062040,CDM,250,RC,,,Outpatient,,,121.59,60.8,,93.62,77,,,Percent of Total Billed Charges,77% of total billed charges,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.98,74,,,Percent of Total Billed Charges,74% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.14,84,,,Percent of Total Billed Charges,84% of total billed charges,99.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.22,89,,,Percent of total Billed Charges,89% of total Billed charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.62,77,,,Percent of total Billed charges,77% of total billed charges,103.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.4,108.22,
Enoxaparin 40mg/0.4ml Syringe,75062040,CDM,250,RC,,,Outpatient,,,121.59,60.8,,93.62,77,,,Percent of Total Billed Charges,77% of total billed charges,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.98,74,,,Percent of Total Billed Charges,74% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.14,84,,,Percent of Total Billed Charges,84% of total billed charges,99.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.22,89,,,Percent of total Billed Charges,89% of total Billed charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.62,77,,,Percent of total Billed charges,77% of total billed charges,103.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.4,108.22,
Enoxaparin 40mg/0.4ml Syringe,75062040,CDM,250,RC,,,Outpatient,,,121.59,60.8,,93.62,77,,,Percent of Total Billed Charges,77% of total billed charges,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.98,74,,,Percent of Total Billed Charges,74% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,83.9,69,,,Percent of Total Billed Charges,69% of total billed charges,102.14,84,,,Percent of Total Billed Charges,84% of total billed charges,99.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.22,89,,,Percent of total Billed Charges,89% of total Billed charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.62,77,,,Percent of total Billed charges,77% of total billed charges,103.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.4,108.22,
Enoxaparin 60mg/0.6ml Syringe,75062160,CDM,250,RC,,,Outpatient,,,162.54,81.27,,125.16,77,,,Percent of Total Billed Charges,77% of total billed charges,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.28,74,,,Percent of Total Billed Charges,74% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,136.53,84,,,Percent of Total Billed Charges,84% of total billed charges,133.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.66,89,,,Percent of total Billed Charges,89% of total Billed charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.16,77,,,Percent of total Billed charges,77% of total billed charges,138.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.64,144.66,
Enoxaparin 60mg/0.6ml Syringe,75062160,CDM,250,RC,,,Outpatient,,,162.54,81.27,,125.16,77,,,Percent of Total Billed Charges,77% of total billed charges,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.28,74,,,Percent of Total Billed Charges,74% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,136.53,84,,,Percent of Total Billed Charges,84% of total billed charges,133.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.66,89,,,Percent of total Billed Charges,89% of total Billed charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.16,77,,,Percent of total Billed charges,77% of total billed charges,138.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.64,144.66,
Enoxaparin 60mg/0.6ml Syringe,75062160,CDM,250,RC,,,Outpatient,,,162.54,81.27,,125.16,77,,,Percent of Total Billed Charges,77% of total billed charges,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.28,74,,,Percent of Total Billed Charges,74% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,136.53,84,,,Percent of Total Billed Charges,84% of total billed charges,133.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.66,89,,,Percent of total Billed Charges,89% of total Billed charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.16,77,,,Percent of total Billed charges,77% of total billed charges,138.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.64,144.66,
Enoxaparin 60mg/0.6ml Syringe,75062160,CDM,250,RC,,,Outpatient,,,162.54,81.27,,125.16,77,,,Percent of Total Billed Charges,77% of total billed charges,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.28,74,,,Percent of Total Billed Charges,74% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,136.53,84,,,Percent of Total Billed Charges,84% of total billed charges,133.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.66,89,,,Percent of total Billed Charges,89% of total Billed charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.16,77,,,Percent of total Billed charges,77% of total billed charges,138.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.64,144.66,
Enoxaparin 60mg/0.6ml Syringe,75062160,CDM,250,RC,,,Outpatient,,,162.54,81.27,,125.16,77,,,Percent of Total Billed Charges,77% of total billed charges,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.28,74,,,Percent of Total Billed Charges,74% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,136.53,84,,,Percent of Total Billed Charges,84% of total billed charges,133.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.66,89,,,Percent of total Billed Charges,89% of total Billed charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.16,77,,,Percent of total Billed charges,77% of total billed charges,138.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.64,144.66,
Enoxaparin 60mg/0.6ml Syringe,75062160,CDM,250,RC,,,Outpatient,,,162.54,81.27,,125.16,77,,,Percent of Total Billed Charges,77% of total billed charges,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.28,74,,,Percent of Total Billed Charges,74% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,112.15,69,,,Percent of Total Billed Charges,69% of total billed charges,136.53,84,,,Percent of Total Billed Charges,84% of total billed charges,133.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,144.66,89,,,Percent of total Billed Charges,89% of total Billed charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.16,77,,,Percent of total Billed charges,77% of total billed charges,138.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.64,144.66,
Enoxaparin 80mg/0.8ml Syringe,75062280,CDM,250,RC,,,Outpatient,,,168.85,84.43,,130.01,77,,,Percent of Total Billed Charges,77% of total billed charges,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.95,74,,,Percent of Total Billed Charges,74% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,141.83,84,,,Percent of Total Billed Charges,84% of total billed charges,138.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.28,89,,,Percent of total Billed Charges,89% of total Billed charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.01,77,,,Percent of total Billed charges,77% of total billed charges,143.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.21,150.28,
Enoxaparin 80mg/0.8ml Syringe,75062280,CDM,250,RC,,,Outpatient,,,168.85,84.43,,130.01,77,,,Percent of Total Billed Charges,77% of total billed charges,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.95,74,,,Percent of Total Billed Charges,74% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,141.83,84,,,Percent of Total Billed Charges,84% of total billed charges,138.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.28,89,,,Percent of total Billed Charges,89% of total Billed charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.01,77,,,Percent of total Billed charges,77% of total billed charges,143.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.21,150.28,
Enoxaparin 80mg/0.8ml Syringe,75062280,CDM,250,RC,,,Outpatient,,,168.85,84.43,,130.01,77,,,Percent of Total Billed Charges,77% of total billed charges,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.95,74,,,Percent of Total Billed Charges,74% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,141.83,84,,,Percent of Total Billed Charges,84% of total billed charges,138.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.28,89,,,Percent of total Billed Charges,89% of total Billed charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.01,77,,,Percent of total Billed charges,77% of total billed charges,143.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.21,150.28,
Enoxaparin 80mg/0.8ml Syringe,75062280,CDM,250,RC,,,Outpatient,,,168.85,84.43,,130.01,77,,,Percent of Total Billed Charges,77% of total billed charges,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.95,74,,,Percent of Total Billed Charges,74% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,141.83,84,,,Percent of Total Billed Charges,84% of total billed charges,138.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.28,89,,,Percent of total Billed Charges,89% of total Billed charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.01,77,,,Percent of total Billed charges,77% of total billed charges,143.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.21,150.28,
Enoxaparin 80mg/0.8ml Syringe,75062280,CDM,250,RC,,,Outpatient,,,168.85,84.43,,130.01,77,,,Percent of Total Billed Charges,77% of total billed charges,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.95,74,,,Percent of Total Billed Charges,74% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,141.83,84,,,Percent of Total Billed Charges,84% of total billed charges,138.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.28,89,,,Percent of total Billed Charges,89% of total Billed charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.01,77,,,Percent of total Billed charges,77% of total billed charges,143.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.21,150.28,
Enoxaparin 80mg/0.8ml Syringe,75062280,CDM,250,RC,,,Outpatient,,,168.85,84.43,,130.01,77,,,Percent of Total Billed Charges,77% of total billed charges,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.95,74,,,Percent of Total Billed Charges,74% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,116.51,69,,,Percent of Total Billed Charges,69% of total billed charges,141.83,84,,,Percent of Total Billed Charges,84% of total billed charges,138.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.28,89,,,Percent of total Billed Charges,89% of total Billed charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.01,77,,,Percent of total Billed charges,77% of total billed charges,143.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.21,150.28,
ePHEDrine 50mg/ml SDV,70121163707,CDM,250,RC,,,Outpatient,,,375.07,187.54,,288.8,77,,,Percent of Total Billed Charges,77% of total billed charges,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.55,74,,,Percent of Total Billed Charges,74% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,315.06,84,,,Percent of Total Billed Charges,84% of total billed charges,307.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.81,89,,,Percent of total Billed Charges,89% of total Billed charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.8,77,,,Percent of total Billed charges,77% of total billed charges,318.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.77,333.81,
ePHEDrine 50mg/ml SDV,70121163707,CDM,250,RC,,,Outpatient,,,375.07,187.54,,288.8,77,,,Percent of Total Billed Charges,77% of total billed charges,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.55,74,,,Percent of Total Billed Charges,74% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,315.06,84,,,Percent of Total Billed Charges,84% of total billed charges,307.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.81,89,,,Percent of total Billed Charges,89% of total Billed charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.8,77,,,Percent of total Billed charges,77% of total billed charges,318.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.77,333.81,
ePHEDrine 50mg/ml SDV,70121163707,CDM,250,RC,,,Outpatient,,,375.07,187.54,,288.8,77,,,Percent of Total Billed Charges,77% of total billed charges,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.55,74,,,Percent of Total Billed Charges,74% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,315.06,84,,,Percent of Total Billed Charges,84% of total billed charges,307.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.81,89,,,Percent of total Billed Charges,89% of total Billed charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.8,77,,,Percent of total Billed charges,77% of total billed charges,318.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.77,333.81,
ePHEDrine 50mg/ml SDV,70121163707,CDM,250,RC,,,Outpatient,,,375.07,187.54,,288.8,77,,,Percent of Total Billed Charges,77% of total billed charges,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.55,74,,,Percent of Total Billed Charges,74% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,315.06,84,,,Percent of Total Billed Charges,84% of total billed charges,307.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.81,89,,,Percent of total Billed Charges,89% of total Billed charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.8,77,,,Percent of total Billed charges,77% of total billed charges,318.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.77,333.81,
ePHEDrine 50mg/ml SDV,70121163707,CDM,250,RC,,,Outpatient,,,375.07,187.54,,288.8,77,,,Percent of Total Billed Charges,77% of total billed charges,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.55,74,,,Percent of Total Billed Charges,74% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,315.06,84,,,Percent of Total Billed Charges,84% of total billed charges,307.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.81,89,,,Percent of total Billed Charges,89% of total Billed charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.8,77,,,Percent of total Billed charges,77% of total billed charges,318.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.77,333.81,
ePHEDrine 50mg/ml SDV,70121163707,CDM,250,RC,,,Outpatient,,,375.07,187.54,,288.8,77,,,Percent of Total Billed Charges,77% of total billed charges,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,95.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,277.55,74,,,Percent of Total Billed Charges,74% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,258.8,69,,,Percent of Total Billed Charges,69% of total billed charges,315.06,84,,,Percent of Total Billed Charges,84% of total billed charges,307.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,333.81,89,,,Percent of total Billed Charges,89% of total Billed charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,288.8,77,,,Percent of total Billed charges,77% of total billed charges,318.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,107.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,187.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,153.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,93.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.77,333.81,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 1mg/10ml Syringe,76329331801,CDM,250,RC,,,Outpatient,,,142.81,71.41,,109.96,77,,,Percent of Total Billed Charges,77% of total billed charges,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.68,74,,,Percent of Total Billed Charges,74% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,98.54,69,,,Percent of Total Billed Charges,69% of total billed charges,119.96,84,,,Percent of Total Billed Charges,84% of total billed charges,117.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,127.1,89,,,Percent of total Billed Charges,89% of total Billed charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.96,77,,,Percent of total Billed charges,77% of total billed charges,121.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.7,127.1,
EPINEPHrine 0.3mg/0.3ml Autoinjector 2-Pack,49502050002,CDM,250,RC,,,Outpatient,,,1395.52,697.76,,1074.55,77,,,Percent of Total Billed Charges,77% of total billed charges,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1032.68,74,,,Percent of Total Billed Charges,74% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.55,77,,,Percent of total Billed charges,77% of total billed charges,1186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,697.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.88,1242.01,
EPINEPHrine 0.3mg/0.3ml Autoinjector 2-Pack,49502050002,CDM,250,RC,,,Outpatient,,,1395.52,697.76,,1074.55,77,,,Percent of Total Billed Charges,77% of total billed charges,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1032.68,74,,,Percent of Total Billed Charges,74% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.55,77,,,Percent of total Billed charges,77% of total billed charges,1186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,697.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.88,1242.01,
EPINEPHrine 0.3mg/0.3ml Autoinjector 2-Pack,49502050002,CDM,250,RC,,,Outpatient,,,1395.52,697.76,,1074.55,77,,,Percent of Total Billed Charges,77% of total billed charges,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1032.68,74,,,Percent of Total Billed Charges,74% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.55,77,,,Percent of total Billed charges,77% of total billed charges,1186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,697.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.88,1242.01,
EPINEPHrine 0.3mg/0.3ml Autoinjector 2-Pack,49502050002,CDM,250,RC,,,Outpatient,,,1395.52,697.76,,1074.55,77,,,Percent of Total Billed Charges,77% of total billed charges,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1032.68,74,,,Percent of Total Billed Charges,74% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.55,77,,,Percent of total Billed charges,77% of total billed charges,1186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,697.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.88,1242.01,
EPINEPHrine 0.3mg/0.3ml Autoinjector 2-Pack,49502050002,CDM,250,RC,,,Outpatient,,,1395.52,697.76,,1074.55,77,,,Percent of Total Billed Charges,77% of total billed charges,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1032.68,74,,,Percent of Total Billed Charges,74% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.55,77,,,Percent of total Billed charges,77% of total billed charges,1186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,697.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.88,1242.01,
EPINEPHrine 0.3mg/0.3ml Autoinjector 2-Pack,49502050002,CDM,250,RC,,,Outpatient,,,1395.52,697.76,,1074.55,77,,,Percent of Total Billed Charges,77% of total billed charges,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,436.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1032.68,74,,,Percent of Total Billed Charges,74% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,962.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1172.24,84,,,Percent of Total Billed Charges,84% of total billed charges,1144.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,1242.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1074.55,77,,,Percent of total Billed charges,77% of total billed charges,1186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,401.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,697.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,569.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1242.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,348.88,1242.01,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml Ampule,54288010310,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
EPINEPHrine 1mg/ml PF SDV,42023015925,CDM,250,RC,,,Outpatient,,,163.04,81.52,,125.54,77,,,Percent of Total Billed Charges,77% of total billed charges,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,120.65,74,,,Percent of Total Billed Charges,74% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,112.5,69,,,Percent of Total Billed Charges,69% of total billed charges,136.95,84,,,Percent of Total Billed Charges,84% of total billed charges,133.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.11,89,,,Percent of total Billed Charges,89% of total Billed charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.54,77,,,Percent of total Billed charges,77% of total billed charges,138.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,81.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.76,145.11,
epiRUBicin 50mg/25ml Liquid SDV,9509101,CDM,250,RC,,,Outpatient,,,479.34,239.67,,369.09,77,,,Percent of Total Billed Charges,77% of total billed charges,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.71,74,,,Percent of Total Billed Charges,74% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,402.65,84,,,Percent of Total Billed Charges,84% of total billed charges,393.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.61,89,,,Percent of total Billed Charges,89% of total Billed charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.09,77,,,Percent of total Billed charges,77% of total billed charges,407.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.84,426.61,
epiRUBicin 50mg/25ml Liquid SDV,9509101,CDM,250,RC,,,Outpatient,,,479.34,239.67,,369.09,77,,,Percent of Total Billed Charges,77% of total billed charges,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.71,74,,,Percent of Total Billed Charges,74% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,402.65,84,,,Percent of Total Billed Charges,84% of total billed charges,393.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.61,89,,,Percent of total Billed Charges,89% of total Billed charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.09,77,,,Percent of total Billed charges,77% of total billed charges,407.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.84,426.61,
epiRUBicin 50mg/25ml Liquid SDV,9509101,CDM,250,RC,,,Outpatient,,,479.34,239.67,,369.09,77,,,Percent of Total Billed Charges,77% of total billed charges,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.71,74,,,Percent of Total Billed Charges,74% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,402.65,84,,,Percent of Total Billed Charges,84% of total billed charges,393.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.61,89,,,Percent of total Billed Charges,89% of total Billed charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.09,77,,,Percent of total Billed charges,77% of total billed charges,407.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.84,426.61,
epiRUBicin 50mg/25ml Liquid SDV,9509101,CDM,250,RC,,,Outpatient,,,479.34,239.67,,369.09,77,,,Percent of Total Billed Charges,77% of total billed charges,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.71,74,,,Percent of Total Billed Charges,74% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,402.65,84,,,Percent of Total Billed Charges,84% of total billed charges,393.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.61,89,,,Percent of total Billed Charges,89% of total Billed charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.09,77,,,Percent of total Billed charges,77% of total billed charges,407.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.84,426.61,
epiRUBicin 50mg/25ml Liquid SDV,9509101,CDM,250,RC,,,Outpatient,,,479.34,239.67,,369.09,77,,,Percent of Total Billed Charges,77% of total billed charges,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.71,74,,,Percent of Total Billed Charges,74% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,402.65,84,,,Percent of Total Billed Charges,84% of total billed charges,393.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.61,89,,,Percent of total Billed Charges,89% of total Billed charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.09,77,,,Percent of total Billed charges,77% of total billed charges,407.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.84,426.61,
epiRUBicin 50mg/25ml Liquid SDV,9509101,CDM,250,RC,,,Outpatient,,,479.34,239.67,,369.09,77,,,Percent of Total Billed Charges,77% of total billed charges,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,122.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,149.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,354.71,74,,,Percent of Total Billed Charges,74% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,330.74,69,,,Percent of Total Billed Charges,69% of total billed charges,402.65,84,,,Percent of Total Billed Charges,84% of total billed charges,393.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,426.61,89,,,Percent of total Billed Charges,89% of total Billed charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,369.09,77,,,Percent of total Billed charges,77% of total billed charges,407.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,137.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,239.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,195.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.84,426.61,
"Epoetin Alfa  (Procrit) 10,000 units/ml SDV",59676031001,CDM,250,RC,,,Outpatient,,,1186.5,593.25,,913.61,77,,,Percent of Total Billed Charges,77% of total billed charges,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,878.01,74,,,Percent of Total Billed Charges,74% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,996.66,84,,,Percent of Total Billed Charges,84% of total billed charges,972.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1055.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.61,77,,,Percent of total Billed charges,77% of total billed charges,1008.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,593.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.63,1055.99,
"Epoetin Alfa  (Procrit) 10,000 units/ml SDV",59676031001,CDM,250,RC,,,Outpatient,,,1186.5,593.25,,913.61,77,,,Percent of Total Billed Charges,77% of total billed charges,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,878.01,74,,,Percent of Total Billed Charges,74% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,996.66,84,,,Percent of Total Billed Charges,84% of total billed charges,972.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1055.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.61,77,,,Percent of total Billed charges,77% of total billed charges,1008.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,593.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.63,1055.99,
"Epoetin Alfa  (Procrit) 10,000 units/ml SDV",59676031001,CDM,250,RC,,,Outpatient,,,1186.5,593.25,,913.61,77,,,Percent of Total Billed Charges,77% of total billed charges,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,878.01,74,,,Percent of Total Billed Charges,74% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,996.66,84,,,Percent of Total Billed Charges,84% of total billed charges,972.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1055.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.61,77,,,Percent of total Billed charges,77% of total billed charges,1008.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,593.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.63,1055.99,
"Epoetin Alfa  (Procrit) 10,000 units/ml SDV",59676031001,CDM,250,RC,,,Outpatient,,,1186.5,593.25,,913.61,77,,,Percent of Total Billed Charges,77% of total billed charges,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,878.01,74,,,Percent of Total Billed Charges,74% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,996.66,84,,,Percent of Total Billed Charges,84% of total billed charges,972.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1055.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.61,77,,,Percent of total Billed charges,77% of total billed charges,1008.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,593.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.63,1055.99,
"Epoetin Alfa  (Procrit) 10,000 units/ml SDV",59676031001,CDM,250,RC,,,Outpatient,,,1186.5,593.25,,913.61,77,,,Percent of Total Billed Charges,77% of total billed charges,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,878.01,74,,,Percent of Total Billed Charges,74% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,996.66,84,,,Percent of Total Billed Charges,84% of total billed charges,972.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1055.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.61,77,,,Percent of total Billed charges,77% of total billed charges,1008.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,593.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.63,1055.99,
"Epoetin Alfa  (Procrit) 10,000 units/ml SDV",59676031001,CDM,250,RC,,,Outpatient,,,1186.5,593.25,,913.61,77,,,Percent of Total Billed Charges,77% of total billed charges,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,302.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,370.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,878.01,74,,,Percent of Total Billed Charges,74% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,818.69,69,,,Percent of Total Billed Charges,69% of total billed charges,996.66,84,,,Percent of Total Billed Charges,84% of total billed charges,972.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1055.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,913.61,77,,,Percent of total Billed charges,77% of total billed charges,1008.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,341.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,593.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,484.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1055.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,296.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,296.63,1055.99,
"Epoetin Alfa  (Procrit) 20,000 units/ml MDV",59676032004,CDM,250,RC,,,Outpatient,,,2333.01,1166.51,,1796.42,77,,,Percent of Total Billed Charges,77% of total billed charges,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,729.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1726.43,74,,,Percent of Total Billed Charges,74% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1959.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1913.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,2076.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.42,77,,,Percent of total Billed charges,77% of total billed charges,1983.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1166.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.25,2076.38,
"Epoetin Alfa  (Procrit) 20,000 units/ml MDV",59676032004,CDM,250,RC,,,Outpatient,,,2333.01,1166.51,,1796.42,77,,,Percent of Total Billed Charges,77% of total billed charges,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,729.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1726.43,74,,,Percent of Total Billed Charges,74% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1959.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1913.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,2076.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.42,77,,,Percent of total Billed charges,77% of total billed charges,1983.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1166.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.25,2076.38,
"Epoetin Alfa  (Procrit) 20,000 units/ml MDV",59676032004,CDM,250,RC,,,Outpatient,,,2333.01,1166.51,,1796.42,77,,,Percent of Total Billed Charges,77% of total billed charges,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,729.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1726.43,74,,,Percent of Total Billed Charges,74% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1959.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1913.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,2076.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.42,77,,,Percent of total Billed charges,77% of total billed charges,1983.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1166.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.25,2076.38,
"Epoetin Alfa  (Procrit) 20,000 units/ml MDV",59676032004,CDM,250,RC,,,Outpatient,,,2333.01,1166.51,,1796.42,77,,,Percent of Total Billed Charges,77% of total billed charges,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,729.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1726.43,74,,,Percent of Total Billed Charges,74% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1959.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1913.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,2076.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.42,77,,,Percent of total Billed charges,77% of total billed charges,1983.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1166.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.25,2076.38,
"Epoetin Alfa  (Procrit) 20,000 units/ml MDV",59676032004,CDM,250,RC,,,Outpatient,,,2333.01,1166.51,,1796.42,77,,,Percent of Total Billed Charges,77% of total billed charges,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,729.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1726.43,74,,,Percent of Total Billed Charges,74% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1959.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1913.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,2076.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.42,77,,,Percent of total Billed charges,77% of total billed charges,1983.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1166.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.25,2076.38,
"Epoetin Alfa  (Procrit) 20,000 units/ml MDV",59676032004,CDM,250,RC,,,Outpatient,,,2333.01,1166.51,,1796.42,77,,,Percent of Total Billed Charges,77% of total billed charges,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,594.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,729.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1726.43,74,,,Percent of Total Billed Charges,74% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1609.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1959.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1913.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,2076.38,89,,,Percent of total Billed Charges,89% of total Billed charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1796.42,77,,,Percent of total Billed charges,77% of total billed charges,1983.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,670.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1166.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,951.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2076.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,583.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,583.25,2076.38,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8821.46,4410.73,,6792.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2756.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6527.88,74,,,Percent of Total Billed Charges,74% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,7410.03,84,,,Percent of Total Billed Charges,84% of total billed charges,7233.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,7851.1,89,,,Percent of total Billed Charges,89% of total Billed charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.52,77,,,Percent of total Billed charges,77% of total billed charges,7498.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2536.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4410.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2205.37,7851.1,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8597.18,4298.59,,6619.83,77,,,Percent of Total Billed Charges,77% of total billed charges,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2686.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6361.91,74,,,Percent of Total Billed Charges,74% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7221.63,84,,,Percent of Total Billed Charges,84% of total billed charges,7049.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7651.49,89,,,Percent of total Billed Charges,89% of total Billed charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6619.83,77,,,Percent of total Billed charges,77% of total billed charges,7307.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2471.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4298.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.3,7651.49,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8821.46,4410.73,,6792.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2756.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6527.88,74,,,Percent of Total Billed Charges,74% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,7410.03,84,,,Percent of Total Billed Charges,84% of total billed charges,7233.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,7851.1,89,,,Percent of total Billed Charges,89% of total Billed charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.52,77,,,Percent of total Billed charges,77% of total billed charges,7498.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2536.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4410.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2205.37,7851.1,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8597.18,4298.59,,6619.83,77,,,Percent of Total Billed Charges,77% of total billed charges,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2686.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6361.91,74,,,Percent of Total Billed Charges,74% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7221.63,84,,,Percent of Total Billed Charges,84% of total billed charges,7049.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7651.49,89,,,Percent of total Billed Charges,89% of total Billed charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6619.83,77,,,Percent of total Billed charges,77% of total billed charges,7307.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2471.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4298.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.3,7651.49,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8821.46,4410.73,,6792.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2756.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6527.88,74,,,Percent of Total Billed Charges,74% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,7410.03,84,,,Percent of Total Billed Charges,84% of total billed charges,7233.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,7851.1,89,,,Percent of total Billed Charges,89% of total Billed charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.52,77,,,Percent of total Billed charges,77% of total billed charges,7498.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2536.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4410.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2205.37,7851.1,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8597.18,4298.59,,6619.83,77,,,Percent of Total Billed Charges,77% of total billed charges,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2686.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6361.91,74,,,Percent of Total Billed Charges,74% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7221.63,84,,,Percent of Total Billed Charges,84% of total billed charges,7049.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7651.49,89,,,Percent of total Billed Charges,89% of total Billed charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6619.83,77,,,Percent of total Billed charges,77% of total billed charges,7307.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2471.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4298.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.3,7651.49,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8821.46,4410.73,,6792.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2756.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6527.88,74,,,Percent of Total Billed Charges,74% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,7410.03,84,,,Percent of Total Billed Charges,84% of total billed charges,7233.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,7851.1,89,,,Percent of total Billed Charges,89% of total Billed charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.52,77,,,Percent of total Billed charges,77% of total billed charges,7498.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2536.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4410.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2205.37,7851.1,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8597.18,4298.59,,6619.83,77,,,Percent of Total Billed Charges,77% of total billed charges,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2686.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6361.91,74,,,Percent of Total Billed Charges,74% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7221.63,84,,,Percent of Total Billed Charges,84% of total billed charges,7049.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7651.49,89,,,Percent of total Billed Charges,89% of total Billed charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6619.83,77,,,Percent of total Billed charges,77% of total billed charges,7307.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2471.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4298.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.3,7651.49,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8821.46,4410.73,,6792.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2756.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6527.88,74,,,Percent of Total Billed Charges,74% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,7410.03,84,,,Percent of Total Billed Charges,84% of total billed charges,7233.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,7851.1,89,,,Percent of total Billed Charges,89% of total Billed charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.52,77,,,Percent of total Billed charges,77% of total billed charges,7498.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2536.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4410.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2205.37,7851.1,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8597.18,4298.59,,6619.83,77,,,Percent of Total Billed Charges,77% of total billed charges,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2686.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6361.91,74,,,Percent of Total Billed Charges,74% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7221.63,84,,,Percent of Total Billed Charges,84% of total billed charges,7049.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7651.49,89,,,Percent of total Billed Charges,89% of total Billed charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6619.83,77,,,Percent of total Billed charges,77% of total billed charges,7307.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2471.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4298.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.3,7651.49,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8821.46,4410.73,,6792.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2249.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2756.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6527.88,74,,,Percent of Total Billed Charges,74% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,6086.81,69,,,Percent of Total Billed Charges,69% of total billed charges,7410.03,84,,,Percent of Total Billed Charges,84% of total billed charges,7233.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,7851.1,89,,,Percent of total Billed Charges,89% of total Billed charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.52,77,,,Percent of total Billed charges,77% of total billed charges,7498.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2536.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4410.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3599.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7851.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2205.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2205.37,7851.1,
Eptinezumab-JJMR (Vyepti) 100mg/ml Liquid SDV,67386013051,CDM,250,RC,,,Outpatient,,,8597.18,4298.59,,6619.83,77,,,Percent of Total Billed Charges,77% of total billed charges,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2192.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2686.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6361.91,74,,,Percent of Total Billed Charges,74% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,5932.05,69,,,Percent of Total Billed Charges,69% of total billed charges,7221.63,84,,,Percent of Total Billed Charges,84% of total billed charges,7049.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,7651.49,89,,,Percent of total Billed Charges,89% of total Billed charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6619.83,77,,,Percent of total Billed charges,77% of total billed charges,7307.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2471.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4298.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3507.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7651.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2149.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.3,7651.49,
"Ergocalciferol (Vitamin D2) 1250mcg  (50,000 Unit) Capsule",50268029715,CDM,250,RC,,,Outpatient,,,23.02,11.51,,17.73,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.03,74,,,Percent of Total Billed Charges,74% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,19.34,84,,,Percent of Total Billed Charges,84% of total billed charges,18.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.49,89,,,Percent of total Billed Charges,89% of total Billed charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.73,77,,,Percent of total Billed charges,77% of total billed charges,19.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,20.49,
"Ergocalciferol (Vitamin D2) 1250mcg  (50,000 Unit) Capsule",50268029715,CDM,250,RC,,,Outpatient,,,23.02,11.51,,17.73,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.03,74,,,Percent of Total Billed Charges,74% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,19.34,84,,,Percent of Total Billed Charges,84% of total billed charges,18.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.49,89,,,Percent of total Billed Charges,89% of total Billed charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.73,77,,,Percent of total Billed charges,77% of total billed charges,19.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,20.49,
"Ergocalciferol (Vitamin D2) 1250mcg  (50,000 Unit) Capsule",50268029715,CDM,250,RC,,,Outpatient,,,23.02,11.51,,17.73,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.03,74,,,Percent of Total Billed Charges,74% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,19.34,84,,,Percent of Total Billed Charges,84% of total billed charges,18.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.49,89,,,Percent of total Billed Charges,89% of total Billed charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.73,77,,,Percent of total Billed charges,77% of total billed charges,19.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,20.49,
"Ergocalciferol (Vitamin D2) 1250mcg  (50,000 Unit) Capsule",50268029715,CDM,250,RC,,,Outpatient,,,23.02,11.51,,17.73,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.03,74,,,Percent of Total Billed Charges,74% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,19.34,84,,,Percent of Total Billed Charges,84% of total billed charges,18.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.49,89,,,Percent of total Billed Charges,89% of total Billed charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.73,77,,,Percent of total Billed charges,77% of total billed charges,19.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,20.49,
"Ergocalciferol (Vitamin D2) 1250mcg  (50,000 Unit) Capsule",50268029715,CDM,250,RC,,,Outpatient,,,23.02,11.51,,17.73,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.03,74,,,Percent of Total Billed Charges,74% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,19.34,84,,,Percent of Total Billed Charges,84% of total billed charges,18.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.49,89,,,Percent of total Billed Charges,89% of total Billed charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.73,77,,,Percent of total Billed charges,77% of total billed charges,19.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,20.49,
"Ergocalciferol (Vitamin D2) 1250mcg  (50,000 Unit) Capsule",50268029715,CDM,250,RC,,,Outpatient,,,23.02,11.51,,17.73,77,,,Percent of Total Billed Charges,77% of total billed charges,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.03,74,,,Percent of Total Billed Charges,74% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,15.88,69,,,Percent of Total Billed Charges,69% of total billed charges,19.34,84,,,Percent of Total Billed Charges,84% of total billed charges,18.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.49,89,,,Percent of total Billed Charges,89% of total Billed charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.73,77,,,Percent of total Billed charges,77% of total billed charges,19.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.76,20.49,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,10110.3,5055.15,,7784.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7481.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8492.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8290.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8998.17,89,,,Percent of total Billed Charges,89% of total Billed charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7784.93,77,,,Percent of total Billed charges,77% of total billed charges,8593.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2906.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5055.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.58,8998.17,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,9852.7,4926.35,,7586.58,77,,,Percent of Total Billed Charges,77% of total billed charges,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3078.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7291,74,,,Percent of Total Billed Charges,74% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,8276.27,84,,,Percent of Total Billed Charges,84% of total billed charges,8079.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,8768.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7586.58,77,,,Percent of total Billed charges,77% of total billed charges,8374.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2832.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4926.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2463.18,8768.9,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,10110.3,5055.15,,7784.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7481.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8492.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8290.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8998.17,89,,,Percent of total Billed Charges,89% of total Billed charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7784.93,77,,,Percent of total Billed charges,77% of total billed charges,8593.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2906.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5055.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.58,8998.17,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,9852.7,4926.35,,7586.58,77,,,Percent of Total Billed Charges,77% of total billed charges,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3078.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7291,74,,,Percent of Total Billed Charges,74% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,8276.27,84,,,Percent of Total Billed Charges,84% of total billed charges,8079.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,8768.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7586.58,77,,,Percent of total Billed charges,77% of total billed charges,8374.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2832.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4926.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2463.18,8768.9,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,10110.3,5055.15,,7784.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7481.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8492.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8290.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8998.17,89,,,Percent of total Billed Charges,89% of total Billed charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7784.93,77,,,Percent of total Billed charges,77% of total billed charges,8593.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2906.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5055.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.58,8998.17,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,9852.7,4926.35,,7586.58,77,,,Percent of Total Billed Charges,77% of total billed charges,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3078.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7291,74,,,Percent of Total Billed Charges,74% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,8276.27,84,,,Percent of Total Billed Charges,84% of total billed charges,8079.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,8768.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7586.58,77,,,Percent of total Billed charges,77% of total billed charges,8374.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2832.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4926.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2463.18,8768.9,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,10110.3,5055.15,,7784.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7481.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8492.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8290.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8998.17,89,,,Percent of total Billed Charges,89% of total Billed charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7784.93,77,,,Percent of total Billed charges,77% of total billed charges,8593.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2906.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5055.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.58,8998.17,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,9852.7,4926.35,,7586.58,77,,,Percent of Total Billed Charges,77% of total billed charges,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3078.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7291,74,,,Percent of Total Billed Charges,74% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,8276.27,84,,,Percent of Total Billed Charges,84% of total billed charges,8079.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,8768.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7586.58,77,,,Percent of total Billed charges,77% of total billed charges,8374.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2832.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4926.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2463.18,8768.9,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,10110.3,5055.15,,7784.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7481.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8492.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8290.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8998.17,89,,,Percent of total Billed Charges,89% of total Billed charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7784.93,77,,,Percent of total Billed charges,77% of total billed charges,8593.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2906.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5055.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.58,8998.17,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,9852.7,4926.35,,7586.58,77,,,Percent of Total Billed Charges,77% of total billed charges,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3078.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7291,74,,,Percent of Total Billed Charges,74% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,8276.27,84,,,Percent of Total Billed Charges,84% of total billed charges,8079.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,8768.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7586.58,77,,,Percent of total Billed charges,77% of total billed charges,8374.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2832.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4926.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2463.18,8768.9,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,10110.3,5055.15,,7784.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2578.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7481.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6976.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8492.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8290.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,8998.17,89,,,Percent of total Billed Charges,89% of total Billed charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7784.93,77,,,Percent of total Billed charges,77% of total billed charges,8593.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2906.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5055.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4125,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8998.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2527.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.58,8998.17,
eriBULin 1mg/2ml Liquid SDV,62856038901,CDM,250,RC,,,Outpatient,,,9852.7,4926.35,,7586.58,77,,,Percent of Total Billed Charges,77% of total billed charges,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2512.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3078.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7291,74,,,Percent of Total Billed Charges,74% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,6798.36,69,,,Percent of Total Billed Charges,69% of total billed charges,8276.27,84,,,Percent of Total Billed Charges,84% of total billed charges,8079.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,8768.9,89,,,Percent of total Billed Charges,89% of total Billed charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7586.58,77,,,Percent of total Billed charges,77% of total billed charges,8374.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2832.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4926.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4019.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8768.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2463.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2463.18,8768.9,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Ertapenem 1gm SDV,55150028209,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Erythromycin OPHTH Oint 0.5% 1gm UD,24208091019,CDM,250,RC,,,Outpatient,,,107.06,53.53,,82.44,77,,,Percent of Total Billed Charges,77% of total billed charges,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.22,74,,,Percent of Total Billed Charges,74% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,89.93,84,,,Percent of Total Billed Charges,84% of total billed charges,87.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.28,89,,,Percent of total Billed Charges,89% of total Billed charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.44,77,,,Percent of total Billed charges,77% of total billed charges,91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.77,95.28,
Erythromycin OPHTH Oint 0.5% 1gm UD,24208091019,CDM,250,RC,,,Outpatient,,,107.06,53.53,,82.44,77,,,Percent of Total Billed Charges,77% of total billed charges,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.22,74,,,Percent of Total Billed Charges,74% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,89.93,84,,,Percent of Total Billed Charges,84% of total billed charges,87.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.28,89,,,Percent of total Billed Charges,89% of total Billed charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.44,77,,,Percent of total Billed charges,77% of total billed charges,91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.77,95.28,
Erythromycin OPHTH Oint 0.5% 1gm UD,24208091019,CDM,250,RC,,,Outpatient,,,107.06,53.53,,82.44,77,,,Percent of Total Billed Charges,77% of total billed charges,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.22,74,,,Percent of Total Billed Charges,74% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,89.93,84,,,Percent of Total Billed Charges,84% of total billed charges,87.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.28,89,,,Percent of total Billed Charges,89% of total Billed charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.44,77,,,Percent of total Billed charges,77% of total billed charges,91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.77,95.28,
Erythromycin OPHTH Oint 0.5% 1gm UD,24208091019,CDM,250,RC,,,Outpatient,,,107.06,53.53,,82.44,77,,,Percent of Total Billed Charges,77% of total billed charges,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.22,74,,,Percent of Total Billed Charges,74% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,89.93,84,,,Percent of Total Billed Charges,84% of total billed charges,87.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.28,89,,,Percent of total Billed Charges,89% of total Billed charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.44,77,,,Percent of total Billed charges,77% of total billed charges,91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.77,95.28,
Erythromycin OPHTH Oint 0.5% 1gm UD,24208091019,CDM,250,RC,,,Outpatient,,,107.06,53.53,,82.44,77,,,Percent of Total Billed Charges,77% of total billed charges,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.22,74,,,Percent of Total Billed Charges,74% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,89.93,84,,,Percent of Total Billed Charges,84% of total billed charges,87.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.28,89,,,Percent of total Billed Charges,89% of total Billed charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.44,77,,,Percent of total Billed charges,77% of total billed charges,91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.77,95.28,
Erythromycin OPHTH Oint 0.5% 1gm UD,24208091019,CDM,250,RC,,,Outpatient,,,107.06,53.53,,82.44,77,,,Percent of Total Billed Charges,77% of total billed charges,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.22,74,,,Percent of Total Billed Charges,74% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,73.87,69,,,Percent of Total Billed Charges,69% of total billed charges,89.93,84,,,Percent of Total Billed Charges,84% of total billed charges,87.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.28,89,,,Percent of total Billed Charges,89% of total Billed charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.44,77,,,Percent of total Billed charges,77% of total billed charges,91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.77,95.28,
Erythromycin Ethylsuccinate Oral Susp 200mg/5ml 100ml,24338013213,CDM,250,RC,,,Outpatient,,,1301.19,650.6,,1001.92,77,,,Percent of Total Billed Charges,77% of total billed charges,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,962.88,74,,,Percent of Total Billed Charges,74% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1093,84,,,Percent of Total Billed Charges,84% of total billed charges,1066.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1158.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.92,77,,,Percent of total Billed charges,77% of total billed charges,1106.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.3,1158.06,
Erythromycin Ethylsuccinate Oral Susp 200mg/5ml 100ml,24338013213,CDM,250,RC,,,Outpatient,,,1301.19,650.6,,1001.92,77,,,Percent of Total Billed Charges,77% of total billed charges,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,962.88,74,,,Percent of Total Billed Charges,74% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1093,84,,,Percent of Total Billed Charges,84% of total billed charges,1066.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1158.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.92,77,,,Percent of total Billed charges,77% of total billed charges,1106.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.3,1158.06,
Erythromycin Ethylsuccinate Oral Susp 200mg/5ml 100ml,24338013213,CDM,250,RC,,,Outpatient,,,1301.19,650.6,,1001.92,77,,,Percent of Total Billed Charges,77% of total billed charges,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,962.88,74,,,Percent of Total Billed Charges,74% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1093,84,,,Percent of Total Billed Charges,84% of total billed charges,1066.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1158.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.92,77,,,Percent of total Billed charges,77% of total billed charges,1106.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.3,1158.06,
Erythromycin Ethylsuccinate Oral Susp 200mg/5ml 100ml,24338013213,CDM,250,RC,,,Outpatient,,,1301.19,650.6,,1001.92,77,,,Percent of Total Billed Charges,77% of total billed charges,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,962.88,74,,,Percent of Total Billed Charges,74% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1093,84,,,Percent of Total Billed Charges,84% of total billed charges,1066.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1158.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.92,77,,,Percent of total Billed charges,77% of total billed charges,1106.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.3,1158.06,
Erythromycin Ethylsuccinate Oral Susp 200mg/5ml 100ml,24338013213,CDM,250,RC,,,Outpatient,,,1301.19,650.6,,1001.92,77,,,Percent of Total Billed Charges,77% of total billed charges,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,962.88,74,,,Percent of Total Billed Charges,74% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1093,84,,,Percent of Total Billed Charges,84% of total billed charges,1066.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1158.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.92,77,,,Percent of total Billed charges,77% of total billed charges,1106.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.3,1158.06,
Erythromycin Ethylsuccinate Oral Susp 200mg/5ml 100ml,24338013213,CDM,250,RC,,,Outpatient,,,1301.19,650.6,,1001.92,77,,,Percent of Total Billed Charges,77% of total billed charges,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,962.88,74,,,Percent of Total Billed Charges,74% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,897.82,69,,,Percent of Total Billed Charges,69% of total billed charges,1093,84,,,Percent of Total Billed Charges,84% of total billed charges,1066.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,1158.06,89,,,Percent of total Billed Charges,89% of total Billed charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1001.92,77,,,Percent of total Billed charges,77% of total billed charges,1106.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,374.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,650.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,530.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,325.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,325.3,1158.06,
Erythromycin Base 250mg Capsule,,,250,RC,,,Outpatient,,,69.99,35,,53.89,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.79,74,,,Percent of Total Billed Charges,74% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,58.79,84,,,Percent of Total Billed Charges,84% of total billed charges,57.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.29,89,,,Percent of total Billed Charges,89% of total Billed charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.89,77,,,Percent of total Billed charges,77% of total billed charges,59.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.29,
Erythromycin Base 250mg Capsule,,,250,RC,,,Outpatient,,,69.99,35,,53.89,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.79,74,,,Percent of Total Billed Charges,74% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,58.79,84,,,Percent of Total Billed Charges,84% of total billed charges,57.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.29,89,,,Percent of total Billed Charges,89% of total Billed charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.89,77,,,Percent of total Billed charges,77% of total billed charges,59.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.29,
Erythromycin Base 250mg Capsule,,,250,RC,,,Outpatient,,,69.99,35,,53.89,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.79,74,,,Percent of Total Billed Charges,74% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,58.79,84,,,Percent of Total Billed Charges,84% of total billed charges,57.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.29,89,,,Percent of total Billed Charges,89% of total Billed charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.89,77,,,Percent of total Billed charges,77% of total billed charges,59.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.29,
Erythromycin Base 250mg Capsule,,,250,RC,,,Outpatient,,,69.99,35,,53.89,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.79,74,,,Percent of Total Billed Charges,74% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,58.79,84,,,Percent of Total Billed Charges,84% of total billed charges,57.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.29,89,,,Percent of total Billed Charges,89% of total Billed charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.89,77,,,Percent of total Billed charges,77% of total billed charges,59.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.29,
Erythromycin Base 250mg Capsule,,,250,RC,,,Outpatient,,,69.99,35,,53.89,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.79,74,,,Percent of Total Billed Charges,74% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,58.79,84,,,Percent of Total Billed Charges,84% of total billed charges,57.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.29,89,,,Percent of total Billed Charges,89% of total Billed charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.89,77,,,Percent of total Billed charges,77% of total billed charges,59.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.29,
Erythromycin Base 250mg Capsule,,,250,RC,,,Outpatient,,,69.99,35,,53.89,77,,,Percent of Total Billed Charges,77% of total billed charges,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.79,74,,,Percent of Total Billed Charges,74% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,48.29,69,,,Percent of Total Billed Charges,69% of total billed charges,58.79,84,,,Percent of Total Billed Charges,84% of total billed charges,57.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.29,89,,,Percent of total Billed Charges,89% of total Billed charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.89,77,,,Percent of total Billed charges,77% of total billed charges,59.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,62.29,
Erythromycin 0 .5% OPHTH Oint 3.5gm,24208091055,CDM,250,RC,,,Outpatient,,,161.26,80.63,,124.17,77,,,Percent of Total Billed Charges,77% of total billed charges,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.33,74,,,Percent of Total Billed Charges,74% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,135.46,84,,,Percent of Total Billed Charges,84% of total billed charges,132.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.52,89,,,Percent of total Billed Charges,89% of total Billed charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.17,77,,,Percent of total Billed charges,77% of total billed charges,137.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.32,143.52,
Erythromycin 0 .5% OPHTH Oint 3.5gm,24208091055,CDM,250,RC,,,Outpatient,,,161.26,80.63,,124.17,77,,,Percent of Total Billed Charges,77% of total billed charges,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.33,74,,,Percent of Total Billed Charges,74% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,135.46,84,,,Percent of Total Billed Charges,84% of total billed charges,132.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.52,89,,,Percent of total Billed Charges,89% of total Billed charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.17,77,,,Percent of total Billed charges,77% of total billed charges,137.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.32,143.52,
Erythromycin 0 .5% OPHTH Oint 3.5gm,24208091055,CDM,250,RC,,,Outpatient,,,161.26,80.63,,124.17,77,,,Percent of Total Billed Charges,77% of total billed charges,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.33,74,,,Percent of Total Billed Charges,74% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,135.46,84,,,Percent of Total Billed Charges,84% of total billed charges,132.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.52,89,,,Percent of total Billed Charges,89% of total Billed charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.17,77,,,Percent of total Billed charges,77% of total billed charges,137.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.32,143.52,
Erythromycin 0 .5% OPHTH Oint 3.5gm,24208091055,CDM,250,RC,,,Outpatient,,,161.26,80.63,,124.17,77,,,Percent of Total Billed Charges,77% of total billed charges,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.33,74,,,Percent of Total Billed Charges,74% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,135.46,84,,,Percent of Total Billed Charges,84% of total billed charges,132.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.52,89,,,Percent of total Billed Charges,89% of total Billed charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.17,77,,,Percent of total Billed charges,77% of total billed charges,137.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.32,143.52,
Erythromycin 0 .5% OPHTH Oint 3.5gm,24208091055,CDM,250,RC,,,Outpatient,,,161.26,80.63,,124.17,77,,,Percent of Total Billed Charges,77% of total billed charges,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.33,74,,,Percent of Total Billed Charges,74% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,135.46,84,,,Percent of Total Billed Charges,84% of total billed charges,132.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.52,89,,,Percent of total Billed Charges,89% of total Billed charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.17,77,,,Percent of total Billed charges,77% of total billed charges,137.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.32,143.52,
Erythromycin 0 .5% OPHTH Oint 3.5gm,24208091055,CDM,250,RC,,,Outpatient,,,161.26,80.63,,124.17,77,,,Percent of Total Billed Charges,77% of total billed charges,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.33,74,,,Percent of Total Billed Charges,74% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,111.27,69,,,Percent of Total Billed Charges,69% of total billed charges,135.46,84,,,Percent of Total Billed Charges,84% of total billed charges,132.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.52,89,,,Percent of total Billed Charges,89% of total Billed charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.17,77,,,Percent of total Billed charges,77% of total billed charges,137.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.32,143.52,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,444.82,222.41,,342.51,77,,,Percent of Total Billed Charges,77% of total billed charges,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.17,74,,,Percent of Total Billed Charges,74% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,373.65,84,,,Percent of Total Billed Charges,84% of total billed charges,364.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.89,89,,,Percent of total Billed Charges,89% of total Billed charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.51,77,,,Percent of total Billed charges,77% of total billed charges,378.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.21,395.89,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,461.68,230.84,,355.49,77,,,Percent of Total Billed Charges,77% of total billed charges,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.64,74,,,Percent of Total Billed Charges,74% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,387.81,84,,,Percent of Total Billed Charges,84% of total billed charges,378.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,410.9,89,,,Percent of total Billed Charges,89% of total Billed charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.49,77,,,Percent of total Billed charges,77% of total billed charges,392.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,230.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.42,410.9,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,444.82,222.41,,342.51,77,,,Percent of Total Billed Charges,77% of total billed charges,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.17,74,,,Percent of Total Billed Charges,74% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,373.65,84,,,Percent of Total Billed Charges,84% of total billed charges,364.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.89,89,,,Percent of total Billed Charges,89% of total Billed charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.51,77,,,Percent of total Billed charges,77% of total billed charges,378.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.21,395.89,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,461.68,230.84,,355.49,77,,,Percent of Total Billed Charges,77% of total billed charges,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.64,74,,,Percent of Total Billed Charges,74% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,387.81,84,,,Percent of Total Billed Charges,84% of total billed charges,378.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,410.9,89,,,Percent of total Billed Charges,89% of total Billed charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.49,77,,,Percent of total Billed charges,77% of total billed charges,392.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,230.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.42,410.9,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,444.82,222.41,,342.51,77,,,Percent of Total Billed Charges,77% of total billed charges,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.17,74,,,Percent of Total Billed Charges,74% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,373.65,84,,,Percent of Total Billed Charges,84% of total billed charges,364.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.89,89,,,Percent of total Billed Charges,89% of total Billed charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.51,77,,,Percent of total Billed charges,77% of total billed charges,378.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.21,395.89,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,461.68,230.84,,355.49,77,,,Percent of Total Billed Charges,77% of total billed charges,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.64,74,,,Percent of Total Billed Charges,74% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,387.81,84,,,Percent of Total Billed Charges,84% of total billed charges,378.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,410.9,89,,,Percent of total Billed Charges,89% of total Billed charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.49,77,,,Percent of total Billed charges,77% of total billed charges,392.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,230.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.42,410.9,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,444.82,222.41,,342.51,77,,,Percent of Total Billed Charges,77% of total billed charges,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.17,74,,,Percent of Total Billed Charges,74% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,373.65,84,,,Percent of Total Billed Charges,84% of total billed charges,364.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.89,89,,,Percent of total Billed Charges,89% of total Billed charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.51,77,,,Percent of total Billed charges,77% of total billed charges,378.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.21,395.89,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,461.68,230.84,,355.49,77,,,Percent of Total Billed Charges,77% of total billed charges,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.64,74,,,Percent of Total Billed Charges,74% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,387.81,84,,,Percent of Total Billed Charges,84% of total billed charges,378.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,410.9,89,,,Percent of total Billed Charges,89% of total Billed charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.49,77,,,Percent of total Billed charges,77% of total billed charges,392.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,230.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.42,410.9,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,444.82,222.41,,342.51,77,,,Percent of Total Billed Charges,77% of total billed charges,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.17,74,,,Percent of Total Billed Charges,74% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,373.65,84,,,Percent of Total Billed Charges,84% of total billed charges,364.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.89,89,,,Percent of total Billed Charges,89% of total Billed charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.51,77,,,Percent of total Billed charges,77% of total billed charges,378.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.21,395.89,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,461.68,230.84,,355.49,77,,,Percent of Total Billed Charges,77% of total billed charges,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.64,74,,,Percent of Total Billed Charges,74% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,387.81,84,,,Percent of Total Billed Charges,84% of total billed charges,378.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,410.9,89,,,Percent of total Billed Charges,89% of total Billed charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.49,77,,,Percent of total Billed charges,77% of total billed charges,392.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,230.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.42,410.9,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,444.82,222.41,,342.51,77,,,Percent of Total Billed Charges,77% of total billed charges,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.17,74,,,Percent of Total Billed Charges,74% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,306.93,69,,,Percent of Total Billed Charges,69% of total billed charges,373.65,84,,,Percent of Total Billed Charges,84% of total billed charges,364.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.89,89,,,Percent of total Billed Charges,89% of total Billed charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,342.51,77,,,Percent of total Billed charges,77% of total billed charges,378.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.21,395.89,
Erythromycin Lactobionate 500mg SDV,409648201,CDM,250,RC,,,Outpatient,,,461.68,230.84,,355.49,77,,,Percent of Total Billed Charges,77% of total billed charges,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,117.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,144.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,341.64,74,,,Percent of Total Billed Charges,74% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,318.56,69,,,Percent of Total Billed Charges,69% of total billed charges,387.81,84,,,Percent of Total Billed Charges,84% of total billed charges,378.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,410.9,89,,,Percent of total Billed Charges,89% of total Billed charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,355.49,77,,,Percent of total Billed charges,77% of total billed charges,392.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,132.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,230.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,188.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,410.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.42,410.9,
Escitalopram 10mg Tablet,68084061701,CDM,250,RC,,,Outpatient,,,43.04,21.52,,33.14,77,,,Percent of Total Billed Charges,77% of total billed charges,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.85,74,,,Percent of Total Billed Charges,74% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,84,,,Percent of Total Billed Charges,84% of total billed charges,35.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.31,89,,,Percent of total Billed Charges,89% of total Billed charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.14,77,,,Percent of total Billed charges,77% of total billed charges,36.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,38.31,
Escitalopram 10mg Tablet,68084061701,CDM,250,RC,,,Outpatient,,,43.04,21.52,,33.14,77,,,Percent of Total Billed Charges,77% of total billed charges,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.85,74,,,Percent of Total Billed Charges,74% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,84,,,Percent of Total Billed Charges,84% of total billed charges,35.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.31,89,,,Percent of total Billed Charges,89% of total Billed charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.14,77,,,Percent of total Billed charges,77% of total billed charges,36.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,38.31,
Escitalopram 10mg Tablet,68084061701,CDM,250,RC,,,Outpatient,,,43.04,21.52,,33.14,77,,,Percent of Total Billed Charges,77% of total billed charges,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.85,74,,,Percent of Total Billed Charges,74% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,84,,,Percent of Total Billed Charges,84% of total billed charges,35.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.31,89,,,Percent of total Billed Charges,89% of total Billed charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.14,77,,,Percent of total Billed charges,77% of total billed charges,36.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,38.31,
Escitalopram 10mg Tablet,68084061701,CDM,250,RC,,,Outpatient,,,43.04,21.52,,33.14,77,,,Percent of Total Billed Charges,77% of total billed charges,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.85,74,,,Percent of Total Billed Charges,74% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,84,,,Percent of Total Billed Charges,84% of total billed charges,35.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.31,89,,,Percent of total Billed Charges,89% of total Billed charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.14,77,,,Percent of total Billed charges,77% of total billed charges,36.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,38.31,
Escitalopram 10mg Tablet,68084061701,CDM,250,RC,,,Outpatient,,,43.04,21.52,,33.14,77,,,Percent of Total Billed Charges,77% of total billed charges,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.85,74,,,Percent of Total Billed Charges,74% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,84,,,Percent of Total Billed Charges,84% of total billed charges,35.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.31,89,,,Percent of total Billed Charges,89% of total Billed charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.14,77,,,Percent of total Billed charges,77% of total billed charges,36.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,38.31,
Escitalopram 10mg Tablet,68084061701,CDM,250,RC,,,Outpatient,,,43.04,21.52,,33.14,77,,,Percent of Total Billed Charges,77% of total billed charges,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.85,74,,,Percent of Total Billed Charges,74% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,29.7,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,84,,,Percent of Total Billed Charges,84% of total billed charges,35.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.31,89,,,Percent of total Billed Charges,89% of total Billed charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.14,77,,,Percent of total Billed charges,77% of total billed charges,36.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,38.31,
Esmolol 100mg/10ml SDV,10019011501,CDM,250,RC,,,Outpatient,,,178.31,89.16,,137.3,77,,,Percent of Total Billed Charges,77% of total billed charges,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.95,74,,,Percent of Total Billed Charges,74% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,149.78,84,,,Percent of Total Billed Charges,84% of total billed charges,146.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.7,89,,,Percent of total Billed Charges,89% of total Billed charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.3,77,,,Percent of total Billed charges,77% of total billed charges,151.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,158.7,
Esmolol 100mg/10ml SDV,10019011501,CDM,250,RC,,,Outpatient,,,178.31,89.16,,137.3,77,,,Percent of Total Billed Charges,77% of total billed charges,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.95,74,,,Percent of Total Billed Charges,74% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,149.78,84,,,Percent of Total Billed Charges,84% of total billed charges,146.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.7,89,,,Percent of total Billed Charges,89% of total Billed charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.3,77,,,Percent of total Billed charges,77% of total billed charges,151.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,158.7,
Esmolol 100mg/10ml SDV,10019011501,CDM,250,RC,,,Outpatient,,,178.31,89.16,,137.3,77,,,Percent of Total Billed Charges,77% of total billed charges,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.95,74,,,Percent of Total Billed Charges,74% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,149.78,84,,,Percent of Total Billed Charges,84% of total billed charges,146.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.7,89,,,Percent of total Billed Charges,89% of total Billed charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.3,77,,,Percent of total Billed charges,77% of total billed charges,151.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,158.7,
Esmolol 100mg/10ml SDV,10019011501,CDM,250,RC,,,Outpatient,,,178.31,89.16,,137.3,77,,,Percent of Total Billed Charges,77% of total billed charges,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.95,74,,,Percent of Total Billed Charges,74% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,149.78,84,,,Percent of Total Billed Charges,84% of total billed charges,146.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.7,89,,,Percent of total Billed Charges,89% of total Billed charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.3,77,,,Percent of total Billed charges,77% of total billed charges,151.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,158.7,
Esmolol 100mg/10ml SDV,10019011501,CDM,250,RC,,,Outpatient,,,178.31,89.16,,137.3,77,,,Percent of Total Billed Charges,77% of total billed charges,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.95,74,,,Percent of Total Billed Charges,74% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,149.78,84,,,Percent of Total Billed Charges,84% of total billed charges,146.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.7,89,,,Percent of total Billed Charges,89% of total Billed charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.3,77,,,Percent of total Billed charges,77% of total billed charges,151.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,158.7,
Esmolol 100mg/10ml SDV,10019011501,CDM,250,RC,,,Outpatient,,,178.31,89.16,,137.3,77,,,Percent of Total Billed Charges,77% of total billed charges,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.95,74,,,Percent of Total Billed Charges,74% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,123.03,69,,,Percent of Total Billed Charges,69% of total billed charges,149.78,84,,,Percent of Total Billed Charges,84% of total billed charges,146.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.7,89,,,Percent of total Billed Charges,89% of total Billed charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.3,77,,,Percent of total Billed charges,77% of total billed charges,151.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.58,158.7,
Estradiol 0.5mg Tablet,555089902,CDM,250,RC,,,Outpatient,,,10.16,5.08,,7.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.52,74,,,Percent of Total Billed Charges,74% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8.53,84,,,Percent of Total Billed Charges,84% of total billed charges,8.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.04,89,,,Percent of total Billed Charges,89% of total Billed charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,77,,,Percent of total Billed charges,77% of total billed charges,8.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.54,9.04,
Estradiol 0.5mg Tablet,555089902,CDM,250,RC,,,Outpatient,,,10.16,5.08,,7.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.52,74,,,Percent of Total Billed Charges,74% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8.53,84,,,Percent of Total Billed Charges,84% of total billed charges,8.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.04,89,,,Percent of total Billed Charges,89% of total Billed charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,77,,,Percent of total Billed charges,77% of total billed charges,8.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.54,9.04,
Estradiol 0.5mg Tablet,555089902,CDM,250,RC,,,Outpatient,,,10.16,5.08,,7.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.52,74,,,Percent of Total Billed Charges,74% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8.53,84,,,Percent of Total Billed Charges,84% of total billed charges,8.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.04,89,,,Percent of total Billed Charges,89% of total Billed charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,77,,,Percent of total Billed charges,77% of total billed charges,8.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.54,9.04,
Estradiol 0.5mg Tablet,555089902,CDM,250,RC,,,Outpatient,,,10.16,5.08,,7.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.52,74,,,Percent of Total Billed Charges,74% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8.53,84,,,Percent of Total Billed Charges,84% of total billed charges,8.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.04,89,,,Percent of total Billed Charges,89% of total Billed charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,77,,,Percent of total Billed charges,77% of total billed charges,8.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.54,9.04,
Estradiol 0.5mg Tablet,555089902,CDM,250,RC,,,Outpatient,,,10.16,5.08,,7.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.52,74,,,Percent of Total Billed Charges,74% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8.53,84,,,Percent of Total Billed Charges,84% of total billed charges,8.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.04,89,,,Percent of total Billed Charges,89% of total Billed charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,77,,,Percent of total Billed charges,77% of total billed charges,8.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.54,9.04,
Estradiol 0.5mg Tablet,555089902,CDM,250,RC,,,Outpatient,,,10.16,5.08,,7.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.52,74,,,Percent of Total Billed Charges,74% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,7.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8.53,84,,,Percent of Total Billed Charges,84% of total billed charges,8.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.04,89,,,Percent of total Billed Charges,89% of total Billed charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,77,,,Percent of total Billed charges,77% of total billed charges,8.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.54,9.04,
Conjugated Estrogens 25mg SDV,46074905,CDM,250,RC,,,Outpatient,,,1679.44,839.72,,1293.17,77,,,Percent of Total Billed Charges,77% of total billed charges,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1242.79,74,,,Percent of Total Billed Charges,74% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1410.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1377.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1494.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,77,,,Percent of total Billed charges,77% of total billed charges,1427.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,482.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,839.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.86,1494.7,
Conjugated Estrogens 25mg SDV,46074905,CDM,250,RC,,,Outpatient,,,1679.44,839.72,,1293.17,77,,,Percent of Total Billed Charges,77% of total billed charges,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1242.79,74,,,Percent of Total Billed Charges,74% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1410.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1377.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1494.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,77,,,Percent of total Billed charges,77% of total billed charges,1427.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,482.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,839.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.86,1494.7,
Conjugated Estrogens 25mg SDV,46074905,CDM,250,RC,,,Outpatient,,,1679.44,839.72,,1293.17,77,,,Percent of Total Billed Charges,77% of total billed charges,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1242.79,74,,,Percent of Total Billed Charges,74% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1410.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1377.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1494.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,77,,,Percent of total Billed charges,77% of total billed charges,1427.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,482.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,839.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.86,1494.7,
Conjugated Estrogens 25mg SDV,46074905,CDM,250,RC,,,Outpatient,,,1679.44,839.72,,1293.17,77,,,Percent of Total Billed Charges,77% of total billed charges,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1242.79,74,,,Percent of Total Billed Charges,74% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1410.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1377.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1494.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,77,,,Percent of total Billed charges,77% of total billed charges,1427.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,482.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,839.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.86,1494.7,
Conjugated Estrogens 25mg SDV,46074905,CDM,250,RC,,,Outpatient,,,1679.44,839.72,,1293.17,77,,,Percent of Total Billed Charges,77% of total billed charges,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1242.79,74,,,Percent of Total Billed Charges,74% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1410.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1377.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1494.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,77,,,Percent of total Billed charges,77% of total billed charges,1427.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,482.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,839.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.86,1494.7,
Conjugated Estrogens 25mg SDV,46074905,CDM,250,RC,,,Outpatient,,,1679.44,839.72,,1293.17,77,,,Percent of Total Billed Charges,77% of total billed charges,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,428.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,524.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1242.79,74,,,Percent of Total Billed Charges,74% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1158.81,69,,,Percent of Total Billed Charges,69% of total billed charges,1410.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1377.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1494.7,89,,,Percent of total Billed Charges,89% of total Billed charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1293.17,77,,,Percent of total Billed charges,77% of total billed charges,1427.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,482.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,839.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,685.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1494.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,419.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,419.86,1494.7,
Estrogen 0.625mg/gm Vaginal Cream w/Applicator 30gm,46087221,CDM,250,RC,,,Outpatient,,,1555.51,777.76,,1197.74,77,,,Percent of Total Billed Charges,77% of total billed charges,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1151.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.63,84,,,Percent of Total Billed Charges,84% of total billed charges,1275.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1384.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.74,77,,,Percent of total Billed charges,77% of total billed charges,1322.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,777.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.88,1384.4,
Estrogen 0.625mg/gm Vaginal Cream w/Applicator 30gm,46087221,CDM,250,RC,,,Outpatient,,,1555.51,777.76,,1197.74,77,,,Percent of Total Billed Charges,77% of total billed charges,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1151.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.63,84,,,Percent of Total Billed Charges,84% of total billed charges,1275.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1384.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.74,77,,,Percent of total Billed charges,77% of total billed charges,1322.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,777.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.88,1384.4,
Estrogen 0.625mg/gm Vaginal Cream w/Applicator 30gm,46087221,CDM,250,RC,,,Outpatient,,,1555.51,777.76,,1197.74,77,,,Percent of Total Billed Charges,77% of total billed charges,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1151.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.63,84,,,Percent of Total Billed Charges,84% of total billed charges,1275.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1384.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.74,77,,,Percent of total Billed charges,77% of total billed charges,1322.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,777.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.88,1384.4,
Estrogen 0.625mg/gm Vaginal Cream w/Applicator 30gm,46087221,CDM,250,RC,,,Outpatient,,,1555.51,777.76,,1197.74,77,,,Percent of Total Billed Charges,77% of total billed charges,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1151.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.63,84,,,Percent of Total Billed Charges,84% of total billed charges,1275.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1384.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.74,77,,,Percent of total Billed charges,77% of total billed charges,1322.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,777.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.88,1384.4,
Estrogen 0.625mg/gm Vaginal Cream w/Applicator 30gm,46087221,CDM,250,RC,,,Outpatient,,,1555.51,777.76,,1197.74,77,,,Percent of Total Billed Charges,77% of total billed charges,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1151.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.63,84,,,Percent of Total Billed Charges,84% of total billed charges,1275.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1384.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.74,77,,,Percent of total Billed charges,77% of total billed charges,1322.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,777.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.88,1384.4,
Estrogen 0.625mg/gm Vaginal Cream w/Applicator 30gm,46087221,CDM,250,RC,,,Outpatient,,,1555.51,777.76,,1197.74,77,,,Percent of Total Billed Charges,77% of total billed charges,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,396.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,486.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1151.08,74,,,Percent of Total Billed Charges,74% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1073.3,69,,,Percent of Total Billed Charges,69% of total billed charges,1306.63,84,,,Percent of Total Billed Charges,84% of total billed charges,1275.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,1384.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1197.74,77,,,Percent of total Billed charges,77% of total billed charges,1322.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,447.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,777.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,634.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1384.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,388.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,388.88,1384.4,
Ethambutol 400mg Tablet,,,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Ethambutol 400mg Tablet,,,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Ethambutol 400mg Tablet,,,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Ethambutol 400mg Tablet,,,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Ethambutol 400mg Tablet,,,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Ethambutol 400mg Tablet,,,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,93.38,46.69,,71.9,77,,,Percent of Total Billed Charges,77% of total billed charges,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.1,74,,,Percent of Total Billed Charges,74% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,78.44,84,,,Percent of Total Billed Charges,84% of total billed charges,76.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.11,89,,,Percent of total Billed Charges,89% of total Billed charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,77,,,Percent of total Billed charges,77% of total billed charges,79.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.11,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,211.66,105.83,,162.98,77,,,Percent of Total Billed Charges,77% of total billed charges,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.63,74,,,Percent of Total Billed Charges,74% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,177.79,84,,,Percent of Total Billed Charges,84% of total billed charges,173.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.38,89,,,Percent of total Billed Charges,89% of total Billed charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.98,77,,,Percent of total Billed charges,77% of total billed charges,179.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.92,188.38,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,93.38,46.69,,71.9,77,,,Percent of Total Billed Charges,77% of total billed charges,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.1,74,,,Percent of Total Billed Charges,74% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,78.44,84,,,Percent of Total Billed Charges,84% of total billed charges,76.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.11,89,,,Percent of total Billed Charges,89% of total Billed charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,77,,,Percent of total Billed charges,77% of total billed charges,79.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.11,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,211.66,105.83,,162.98,77,,,Percent of Total Billed Charges,77% of total billed charges,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.63,74,,,Percent of Total Billed Charges,74% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,177.79,84,,,Percent of Total Billed Charges,84% of total billed charges,173.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.38,89,,,Percent of total Billed Charges,89% of total Billed charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.98,77,,,Percent of total Billed charges,77% of total billed charges,179.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.92,188.38,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,93.38,46.69,,71.9,77,,,Percent of Total Billed Charges,77% of total billed charges,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.1,74,,,Percent of Total Billed Charges,74% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,78.44,84,,,Percent of Total Billed Charges,84% of total billed charges,76.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.11,89,,,Percent of total Billed Charges,89% of total Billed charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,77,,,Percent of total Billed charges,77% of total billed charges,79.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.11,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,211.66,105.83,,162.98,77,,,Percent of Total Billed Charges,77% of total billed charges,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.63,74,,,Percent of Total Billed Charges,74% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,177.79,84,,,Percent of Total Billed Charges,84% of total billed charges,173.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.38,89,,,Percent of total Billed Charges,89% of total Billed charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.98,77,,,Percent of total Billed charges,77% of total billed charges,179.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.92,188.38,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,93.38,46.69,,71.9,77,,,Percent of Total Billed Charges,77% of total billed charges,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.1,74,,,Percent of Total Billed Charges,74% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,78.44,84,,,Percent of Total Billed Charges,84% of total billed charges,76.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.11,89,,,Percent of total Billed Charges,89% of total Billed charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,77,,,Percent of total Billed charges,77% of total billed charges,79.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.11,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,211.66,105.83,,162.98,77,,,Percent of Total Billed Charges,77% of total billed charges,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.63,74,,,Percent of Total Billed Charges,74% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,177.79,84,,,Percent of Total Billed Charges,84% of total billed charges,173.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.38,89,,,Percent of total Billed Charges,89% of total Billed charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.98,77,,,Percent of total Billed charges,77% of total billed charges,179.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.92,188.38,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,93.38,46.69,,71.9,77,,,Percent of Total Billed Charges,77% of total billed charges,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.1,74,,,Percent of Total Billed Charges,74% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,78.44,84,,,Percent of Total Billed Charges,84% of total billed charges,76.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.11,89,,,Percent of total Billed Charges,89% of total Billed charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,77,,,Percent of total Billed charges,77% of total billed charges,79.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.11,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,211.66,105.83,,162.98,77,,,Percent of Total Billed Charges,77% of total billed charges,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.63,74,,,Percent of Total Billed Charges,74% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,177.79,84,,,Percent of Total Billed Charges,84% of total billed charges,173.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.38,89,,,Percent of total Billed Charges,89% of total Billed charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.98,77,,,Percent of total Billed charges,77% of total billed charges,179.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.92,188.38,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,93.38,46.69,,71.9,77,,,Percent of Total Billed Charges,77% of total billed charges,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.1,74,,,Percent of Total Billed Charges,74% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,64.43,69,,,Percent of Total Billed Charges,69% of total billed charges,78.44,84,,,Percent of Total Billed Charges,84% of total billed charges,76.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.11,89,,,Percent of total Billed Charges,89% of total Billed charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,77,,,Percent of total Billed charges,77% of total billed charges,79.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.11,
Etomidate 40mg/20ml SDV,409669502,CDM,250,RC,,,Outpatient,,,211.66,105.83,,162.98,77,,,Percent of Total Billed Charges,77% of total billed charges,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,156.63,74,,,Percent of Total Billed Charges,74% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,146.05,69,,,Percent of Total Billed Charges,69% of total billed charges,177.79,84,,,Percent of Total Billed Charges,84% of total billed charges,173.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,188.38,89,,,Percent of total Billed Charges,89% of total Billed charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,162.98,77,,,Percent of total Billed charges,77% of total billed charges,179.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,105.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,86.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.92,188.38,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1382.42,691.21,,1064.46,77,,,Percent of Total Billed Charges,77% of total billed charges,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1022.99,74,,,Percent of Total Billed Charges,74% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1161.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1133.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,1230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.46,77,,,Percent of total Billed charges,77% of total billed charges,1175.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,691.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.61,1230.35,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1351.3,675.65,,1040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.96,74,,,Percent of Total Billed Charges,74% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.09,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.5,77,,,Percent of total Billed charges,77% of total billed charges,1148.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.83,1202.66,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1382.42,691.21,,1064.46,77,,,Percent of Total Billed Charges,77% of total billed charges,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1022.99,74,,,Percent of Total Billed Charges,74% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1161.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1133.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,1230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.46,77,,,Percent of total Billed charges,77% of total billed charges,1175.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,691.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.61,1230.35,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1351.3,675.65,,1040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.96,74,,,Percent of Total Billed Charges,74% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.09,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.5,77,,,Percent of total Billed charges,77% of total billed charges,1148.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.83,1202.66,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1382.42,691.21,,1064.46,77,,,Percent of Total Billed Charges,77% of total billed charges,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1022.99,74,,,Percent of Total Billed Charges,74% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1161.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1133.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,1230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.46,77,,,Percent of total Billed charges,77% of total billed charges,1175.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,691.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.61,1230.35,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1351.3,675.65,,1040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.96,74,,,Percent of Total Billed Charges,74% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.09,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.5,77,,,Percent of total Billed charges,77% of total billed charges,1148.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.83,1202.66,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1382.42,691.21,,1064.46,77,,,Percent of Total Billed Charges,77% of total billed charges,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1022.99,74,,,Percent of Total Billed Charges,74% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1161.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1133.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,1230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.46,77,,,Percent of total Billed charges,77% of total billed charges,1175.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,691.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.61,1230.35,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1351.3,675.65,,1040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.96,74,,,Percent of Total Billed Charges,74% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.09,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.5,77,,,Percent of total Billed charges,77% of total billed charges,1148.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.83,1202.66,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1382.42,691.21,,1064.46,77,,,Percent of Total Billed Charges,77% of total billed charges,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1022.99,74,,,Percent of Total Billed Charges,74% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1161.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1133.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,1230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.46,77,,,Percent of total Billed charges,77% of total billed charges,1175.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,691.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.61,1230.35,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1351.3,675.65,,1040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.96,74,,,Percent of Total Billed Charges,74% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.09,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.5,77,,,Percent of total Billed charges,77% of total billed charges,1148.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.83,1202.66,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1382.42,691.21,,1064.46,77,,,Percent of Total Billed Charges,77% of total billed charges,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,432.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1022.99,74,,,Percent of Total Billed Charges,74% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,953.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1161.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1133.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,1230.35,89,,,Percent of total Billed Charges,89% of total Billed charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1064.46,77,,,Percent of total Billed charges,77% of total billed charges,1175.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,397.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,691.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,564.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1230.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,345.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,345.61,1230.35,
Etoposide Phosphate 100mg Powder SDV,61269041020,CDM,250,RC,,,Outpatient,,,1351.3,675.65,,1040.5,77,,,Percent of Total Billed Charges,77% of total billed charges,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.96,74,,,Percent of Total Billed Charges,74% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,932.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.09,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.66,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.5,77,,,Percent of total Billed charges,77% of total billed charges,1148.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.83,1202.66,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1350.9,675.45,,1040.19,77,,,Percent of Total Billed Charges,77% of total billed charges,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.67,74,,,Percent of Total Billed Charges,74% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1134.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1107.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.19,77,,,Percent of total Billed charges,77% of total billed charges,1148.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.73,1202.3,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1319.83,659.92,,1016.27,77,,,Percent of Total Billed Charges,77% of total billed charges,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,976.67,74,,,Percent of Total Billed Charges,74% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1108.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1082.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1016.27,77,,,Percent of total Billed charges,77% of total billed charges,1121.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,659.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.96,1174.65,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1350.9,675.45,,1040.19,77,,,Percent of Total Billed Charges,77% of total billed charges,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.67,74,,,Percent of Total Billed Charges,74% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1134.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1107.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.19,77,,,Percent of total Billed charges,77% of total billed charges,1148.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.73,1202.3,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1319.83,659.92,,1016.27,77,,,Percent of Total Billed Charges,77% of total billed charges,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,976.67,74,,,Percent of Total Billed Charges,74% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1108.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1082.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1016.27,77,,,Percent of total Billed charges,77% of total billed charges,1121.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,659.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.96,1174.65,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1350.9,675.45,,1040.19,77,,,Percent of Total Billed Charges,77% of total billed charges,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.67,74,,,Percent of Total Billed Charges,74% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1134.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1107.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.19,77,,,Percent of total Billed charges,77% of total billed charges,1148.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.73,1202.3,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1319.83,659.92,,1016.27,77,,,Percent of Total Billed Charges,77% of total billed charges,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,976.67,74,,,Percent of Total Billed Charges,74% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1108.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1082.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1016.27,77,,,Percent of total Billed charges,77% of total billed charges,1121.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,659.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.96,1174.65,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,852.84,426.42,,656.69,77,,,Percent of Total Billed Charges,77% of total billed charges,217.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.1,74,,,Percent of Total Billed Charges,74% of total billed charges,588.46,69,,,Percent of Total Billed Charges,69% of total billed charges,588.46,69,,,Percent of Total Billed Charges,69% of total billed charges,213.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.46,69,,,Percent of Total Billed Charges,69% of total billed charges,588.46,69,,,Percent of Total Billed Charges,69% of total billed charges,716.39,84,,,Percent of Total Billed Charges,84% of total billed charges,699.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.03,89,,,Percent of total Billed Charges,89% of total Billed charges,759.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,656.69,77,,,Percent of total Billed charges,77% of total billed charges,724.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.21,759.03,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1319.83,659.92,,1016.27,77,,,Percent of Total Billed Charges,77% of total billed charges,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,976.67,74,,,Percent of Total Billed Charges,74% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1108.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1082.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1016.27,77,,,Percent of total Billed charges,77% of total billed charges,1121.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,659.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.96,1174.65,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1350.9,675.45,,1040.19,77,,,Percent of Total Billed Charges,77% of total billed charges,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.67,74,,,Percent of Total Billed Charges,74% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1134.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1107.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.19,77,,,Percent of total Billed charges,77% of total billed charges,1148.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.73,1202.3,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1319.83,659.92,,1016.27,77,,,Percent of Total Billed Charges,77% of total billed charges,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,976.67,74,,,Percent of Total Billed Charges,74% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1108.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1082.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1016.27,77,,,Percent of total Billed charges,77% of total billed charges,1121.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,659.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.96,1174.65,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1350.9,675.45,,1040.19,77,,,Percent of Total Billed Charges,77% of total billed charges,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,999.67,74,,,Percent of Total Billed Charges,74% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,932.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1134.76,84,,,Percent of Total Billed Charges,84% of total billed charges,1107.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.3,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.19,77,,,Percent of total Billed charges,77% of total billed charges,1148.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.73,1202.3,
Etoposide 100mg/5ml Liquid MDV,16729011431,CDM,250,RC,,,Outpatient,,,1319.83,659.92,,1016.27,77,,,Percent of Total Billed Charges,77% of total billed charges,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,336.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,976.67,74,,,Percent of Total Billed Charges,74% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,910.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1108.66,84,,,Percent of Total Billed Charges,84% of total billed charges,1082.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,1174.65,89,,,Percent of total Billed Charges,89% of total Billed charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1016.27,77,,,Percent of total Billed charges,77% of total billed charges,1121.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,379.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,659.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,538.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1174.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.96,1174.65,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5497.06,2748.53,,4232.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1717.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4067.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4617.53,84,,,Percent of Total Billed Charges,84% of total billed charges,4507.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,4892.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.74,77,,,Percent of total Billed charges,77% of total billed charges,4672.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1580.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2748.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.27,4892.38,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5358.76,2679.38,,4126.25,77,,,Percent of Total Billed Charges,77% of total billed charges,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3965.48,74,,,Percent of Total Billed Charges,74% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4501.36,84,,,Percent of Total Billed Charges,84% of total billed charges,4394.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,4769.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4126.25,77,,,Percent of total Billed charges,77% of total billed charges,4554.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2679.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.69,4769.3,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5497.06,2748.53,,4232.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1717.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4067.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4617.53,84,,,Percent of Total Billed Charges,84% of total billed charges,4507.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,4892.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.74,77,,,Percent of total Billed charges,77% of total billed charges,4672.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1580.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2748.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.27,4892.38,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5358.76,2679.38,,4126.25,77,,,Percent of Total Billed Charges,77% of total billed charges,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3965.48,74,,,Percent of Total Billed Charges,74% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4501.36,84,,,Percent of Total Billed Charges,84% of total billed charges,4394.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,4769.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4126.25,77,,,Percent of total Billed charges,77% of total billed charges,4554.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2679.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.69,4769.3,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5497.06,2748.53,,4232.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1717.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4067.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4617.53,84,,,Percent of Total Billed Charges,84% of total billed charges,4507.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,4892.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.74,77,,,Percent of total Billed charges,77% of total billed charges,4672.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1580.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2748.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.27,4892.38,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5358.76,2679.38,,4126.25,77,,,Percent of Total Billed Charges,77% of total billed charges,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3965.48,74,,,Percent of Total Billed Charges,74% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4501.36,84,,,Percent of Total Billed Charges,84% of total billed charges,4394.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,4769.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4126.25,77,,,Percent of total Billed charges,77% of total billed charges,4554.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2679.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.69,4769.3,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5497.06,2748.53,,4232.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1717.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4067.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4617.53,84,,,Percent of Total Billed Charges,84% of total billed charges,4507.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,4892.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.74,77,,,Percent of total Billed charges,77% of total billed charges,4672.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1580.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2748.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.27,4892.38,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5358.76,2679.38,,4126.25,77,,,Percent of Total Billed Charges,77% of total billed charges,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3965.48,74,,,Percent of Total Billed Charges,74% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4501.36,84,,,Percent of Total Billed Charges,84% of total billed charges,4394.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,4769.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4126.25,77,,,Percent of total Billed charges,77% of total billed charges,4554.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2679.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.69,4769.3,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5497.06,2748.53,,4232.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1717.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4067.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4617.53,84,,,Percent of Total Billed Charges,84% of total billed charges,4507.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,4892.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.74,77,,,Percent of total Billed charges,77% of total billed charges,4672.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1580.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2748.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.27,4892.38,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5358.76,2679.38,,4126.25,77,,,Percent of Total Billed Charges,77% of total billed charges,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3965.48,74,,,Percent of Total Billed Charges,74% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4501.36,84,,,Percent of Total Billed Charges,84% of total billed charges,4394.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,4769.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4126.25,77,,,Percent of total Billed charges,77% of total billed charges,4554.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2679.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.69,4769.3,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5497.06,2748.53,,4232.74,77,,,Percent of Total Billed Charges,77% of total billed charges,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1401.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1717.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4067.82,74,,,Percent of Total Billed Charges,74% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3792.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4617.53,84,,,Percent of Total Billed Charges,84% of total billed charges,4507.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,4892.38,89,,,Percent of total Billed Charges,89% of total Billed charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.74,77,,,Percent of total Billed charges,77% of total billed charges,4672.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1580.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2748.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2242.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4892.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1374.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1374.27,4892.38,
Etoposide 500mg/25ml Liquid MDV,16729011408,CDM,250,RC,,,Outpatient,,,5358.76,2679.38,,4126.25,77,,,Percent of Total Billed Charges,77% of total billed charges,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3965.48,74,,,Percent of Total Billed Charges,74% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,3697.54,69,,,Percent of Total Billed Charges,69% of total billed charges,4501.36,84,,,Percent of Total Billed Charges,84% of total billed charges,4394.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,4769.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4126.25,77,,,Percent of total Billed charges,77% of total billed charges,4554.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2679.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2186.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4769.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.69,4769.3,
Evolocumab (Repatha) Sureclick 140mg/ml,72511076002,CDM,250,RC,,,Outpatient,,,2132.83,1066.42,,1642.28,77,,,Percent of Total Billed Charges,77% of total billed charges,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1578.29,74,,,Percent of Total Billed Charges,74% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1748.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1898.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.28,77,,,Percent of total Billed charges,77% of total billed charges,1812.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1066.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.21,1898.22,
Evolocumab (Repatha) Sureclick 140mg/ml,72511076002,CDM,250,RC,,,Outpatient,,,2132.83,1066.42,,1642.28,77,,,Percent of Total Billed Charges,77% of total billed charges,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1578.29,74,,,Percent of Total Billed Charges,74% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1748.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1898.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.28,77,,,Percent of total Billed charges,77% of total billed charges,1812.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1066.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.21,1898.22,
Evolocumab (Repatha) Sureclick 140mg/ml,72511076002,CDM,250,RC,,,Outpatient,,,2132.83,1066.42,,1642.28,77,,,Percent of Total Billed Charges,77% of total billed charges,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1578.29,74,,,Percent of Total Billed Charges,74% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1748.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1898.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.28,77,,,Percent of total Billed charges,77% of total billed charges,1812.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1066.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.21,1898.22,
Evolocumab (Repatha) Sureclick 140mg/ml,72511076002,CDM,250,RC,,,Outpatient,,,2132.83,1066.42,,1642.28,77,,,Percent of Total Billed Charges,77% of total billed charges,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1578.29,74,,,Percent of Total Billed Charges,74% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1748.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1898.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.28,77,,,Percent of total Billed charges,77% of total billed charges,1812.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1066.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.21,1898.22,
Evolocumab (Repatha) Sureclick 140mg/ml,72511076002,CDM,250,RC,,,Outpatient,,,2132.83,1066.42,,1642.28,77,,,Percent of Total Billed Charges,77% of total billed charges,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1578.29,74,,,Percent of Total Billed Charges,74% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1748.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1898.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.28,77,,,Percent of total Billed charges,77% of total billed charges,1812.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1066.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.21,1898.22,
Evolocumab (Repatha) Sureclick 140mg/ml,72511076002,CDM,250,RC,,,Outpatient,,,2132.83,1066.42,,1642.28,77,,,Percent of Total Billed Charges,77% of total billed charges,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,543.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1578.29,74,,,Percent of Total Billed Charges,74% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1471.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1791.58,84,,,Percent of Total Billed Charges,84% of total billed charges,1748.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1898.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1642.28,77,,,Percent of total Billed charges,77% of total billed charges,1812.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,613.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1066.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,870.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1898.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,533.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,533.21,1898.22,
Ezetimibe 10mg Tablet,,,250,RC,,,Outpatient,,,69.78,34.89,,53.73,77,,,Percent of Total Billed Charges,77% of total billed charges,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.64,74,,,Percent of Total Billed Charges,74% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,84,,,Percent of Total Billed Charges,84% of total billed charges,57.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.1,89,,,Percent of total Billed Charges,89% of total Billed charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.73,77,,,Percent of total Billed charges,77% of total billed charges,59.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.45,62.1,
Ezetimibe 10mg Tablet,,,250,RC,,,Outpatient,,,69.78,34.89,,53.73,77,,,Percent of Total Billed Charges,77% of total billed charges,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.64,74,,,Percent of Total Billed Charges,74% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,84,,,Percent of Total Billed Charges,84% of total billed charges,57.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.1,89,,,Percent of total Billed Charges,89% of total Billed charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.73,77,,,Percent of total Billed charges,77% of total billed charges,59.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.45,62.1,
Ezetimibe 10mg Tablet,,,250,RC,,,Outpatient,,,69.78,34.89,,53.73,77,,,Percent of Total Billed Charges,77% of total billed charges,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.64,74,,,Percent of Total Billed Charges,74% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,84,,,Percent of Total Billed Charges,84% of total billed charges,57.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.1,89,,,Percent of total Billed Charges,89% of total Billed charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.73,77,,,Percent of total Billed charges,77% of total billed charges,59.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.45,62.1,
Ezetimibe 10mg Tablet,,,250,RC,,,Outpatient,,,69.78,34.89,,53.73,77,,,Percent of Total Billed Charges,77% of total billed charges,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.64,74,,,Percent of Total Billed Charges,74% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,84,,,Percent of Total Billed Charges,84% of total billed charges,57.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.1,89,,,Percent of total Billed Charges,89% of total Billed charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.73,77,,,Percent of total Billed charges,77% of total billed charges,59.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.45,62.1,
Ezetimibe 10mg Tablet,,,250,RC,,,Outpatient,,,69.78,34.89,,53.73,77,,,Percent of Total Billed Charges,77% of total billed charges,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.64,74,,,Percent of Total Billed Charges,74% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,84,,,Percent of Total Billed Charges,84% of total billed charges,57.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.1,89,,,Percent of total Billed Charges,89% of total Billed charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.73,77,,,Percent of total Billed charges,77% of total billed charges,59.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.45,62.1,
Ezetimibe 10mg Tablet,,,250,RC,,,Outpatient,,,69.78,34.89,,53.73,77,,,Percent of Total Billed Charges,77% of total billed charges,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.64,74,,,Percent of Total Billed Charges,74% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,48.15,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,84,,,Percent of Total Billed Charges,84% of total billed charges,57.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.1,89,,,Percent of total Billed Charges,89% of total Billed charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.73,77,,,Percent of total Billed charges,77% of total billed charges,59.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.45,62.1,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,18389.59,9194.8,,14159.98,77,,,Percent of Total Billed Charges,77% of total billed charges,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5746.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13608.3,74,,,Percent of Total Billed Charges,74% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,15447.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16366.74,89,,,Percent of total Billed Charges,89% of total Billed charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14159.98,77,,,Percent of total Billed charges,77% of total billed charges,15631.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5287.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9194.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.4,16366.74,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,17918.63,8959.32,,13797.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5599.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13259.79,74,,,Percent of Total Billed Charges,74% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15051.65,84,,,Percent of Total Billed Charges,84% of total billed charges,14693.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,15947.58,89,,,Percent of total Billed Charges,89% of total Billed charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13797.35,77,,,Percent of total Billed charges,77% of total billed charges,15230.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5151.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8959.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4479.66,15947.58,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,18389.59,9194.8,,14159.98,77,,,Percent of Total Billed Charges,77% of total billed charges,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5746.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13608.3,74,,,Percent of Total Billed Charges,74% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,15447.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16366.74,89,,,Percent of total Billed Charges,89% of total Billed charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14159.98,77,,,Percent of total Billed charges,77% of total billed charges,15631.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5287.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9194.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.4,16366.74,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,17918.63,8959.32,,13797.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5599.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13259.79,74,,,Percent of Total Billed Charges,74% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15051.65,84,,,Percent of Total Billed Charges,84% of total billed charges,14693.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,15947.58,89,,,Percent of total Billed Charges,89% of total Billed charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13797.35,77,,,Percent of total Billed charges,77% of total billed charges,15230.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5151.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8959.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4479.66,15947.58,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,18389.59,9194.8,,14159.98,77,,,Percent of Total Billed Charges,77% of total billed charges,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5746.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13608.3,74,,,Percent of Total Billed Charges,74% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,15447.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16366.74,89,,,Percent of total Billed Charges,89% of total Billed charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14159.98,77,,,Percent of total Billed charges,77% of total billed charges,15631.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5287.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9194.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.4,16366.74,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,17918.63,8959.32,,13797.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5599.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13259.79,74,,,Percent of Total Billed Charges,74% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15051.65,84,,,Percent of Total Billed Charges,84% of total billed charges,14693.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,15947.58,89,,,Percent of total Billed Charges,89% of total Billed charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13797.35,77,,,Percent of total Billed charges,77% of total billed charges,15230.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5151.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8959.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4479.66,15947.58,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,18389.59,9194.8,,14159.98,77,,,Percent of Total Billed Charges,77% of total billed charges,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5746.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13608.3,74,,,Percent of Total Billed Charges,74% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,15447.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16366.74,89,,,Percent of total Billed Charges,89% of total Billed charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14159.98,77,,,Percent of total Billed charges,77% of total billed charges,15631.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5287.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9194.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.4,16366.74,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,17918.63,8959.32,,13797.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5599.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13259.79,74,,,Percent of Total Billed Charges,74% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15051.65,84,,,Percent of Total Billed Charges,84% of total billed charges,14693.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,15947.58,89,,,Percent of total Billed Charges,89% of total Billed charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13797.35,77,,,Percent of total Billed charges,77% of total billed charges,15230.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5151.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8959.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4479.66,15947.58,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,18389.59,9194.8,,14159.98,77,,,Percent of Total Billed Charges,77% of total billed charges,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5746.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13608.3,74,,,Percent of Total Billed Charges,74% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,15447.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16366.74,89,,,Percent of total Billed Charges,89% of total Billed charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14159.98,77,,,Percent of total Billed charges,77% of total billed charges,15631.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5287.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9194.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.4,16366.74,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,17918.63,8959.32,,13797.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5599.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13259.79,74,,,Percent of Total Billed Charges,74% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15051.65,84,,,Percent of Total Billed Charges,84% of total billed charges,14693.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,15947.58,89,,,Percent of total Billed Charges,89% of total Billed charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13797.35,77,,,Percent of total Billed charges,77% of total billed charges,15230.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5151.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8959.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4479.66,15947.58,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,18389.59,9194.8,,14159.98,77,,,Percent of Total Billed Charges,77% of total billed charges,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4689.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5746.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13608.3,74,,,Percent of Total Billed Charges,74% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,12688.82,69,,,Percent of Total Billed Charges,69% of total billed charges,15447.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16366.74,89,,,Percent of total Billed Charges,89% of total Billed charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14159.98,77,,,Percent of total Billed charges,77% of total billed charges,15631.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5287.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9194.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7502.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16366.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4597.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4597.4,16366.74,
Fam-Trastuzumab (Enhertu) 100mg/5ml Powder SDV,65597040601,CDM,250,RC,,,Outpatient,,,17918.63,8959.32,,13797.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4569.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5599.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13259.79,74,,,Percent of Total Billed Charges,74% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,12363.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15051.65,84,,,Percent of Total Billed Charges,84% of total billed charges,14693.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,15947.58,89,,,Percent of total Billed Charges,89% of total Billed charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13797.35,77,,,Percent of total Billed charges,77% of total billed charges,15230.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5151.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8959.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7310.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15947.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4479.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4479.66,15947.58,
Famotidine 20mg Tablet,51079096620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Famotidine 20mg Tablet,51079096620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Famotidine 20mg Tablet,51079096620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Famotidine 20mg Tablet,51079096620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Famotidine 20mg Tablet,51079096620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Famotidine 20mg Tablet,51079096620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Famotidine 20mg/2ml SDV,63323073912,CDM,250,RC,,,Outpatient,,,47.4,23.7,,36.5,77,,,Percent of Total Billed Charges,77% of total billed charges,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.08,74,,,Percent of Total Billed Charges,74% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,32.71,69,,,Percent of Total Billed Charges,69% of total billed charges,39.82,84,,,Percent of Total Billed Charges,84% of total billed charges,38.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.19,89,,,Percent of total Billed Charges,89% of total Billed charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.5,77,,,Percent of total Billed charges,77% of total billed charges,40.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.85,42.19,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Intralipid 20% (Soy) 250ml Bag,,,250,RC,,,Outpatient,,,293.63,146.82,,226.1,77,,,Percent of Total Billed Charges,77% of total billed charges,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.29,74,,,Percent of Total Billed Charges,74% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,202.6,69,,,Percent of Total Billed Charges,69% of total billed charges,246.65,84,,,Percent of Total Billed Charges,84% of total billed charges,240.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.33,89,,,Percent of total Billed Charges,89% of total Billed charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.1,77,,,Percent of total Billed charges,77% of total billed charges,249.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,146.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.41,261.33,
Febuxostat 40mg Tablet,72205002830,CDM,250,RC,,,Outpatient,,,76.14,38.07,,58.63,77,,,Percent of Total Billed Charges,77% of total billed charges,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.34,74,,,Percent of Total Billed Charges,74% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,63.96,84,,,Percent of Total Billed Charges,84% of total billed charges,62.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.76,89,,,Percent of total Billed Charges,89% of total Billed charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,77,,,Percent of total Billed charges,77% of total billed charges,64.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.04,67.76,
Febuxostat 40mg Tablet,72205002830,CDM,250,RC,,,Outpatient,,,76.14,38.07,,58.63,77,,,Percent of Total Billed Charges,77% of total billed charges,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.34,74,,,Percent of Total Billed Charges,74% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,63.96,84,,,Percent of Total Billed Charges,84% of total billed charges,62.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.76,89,,,Percent of total Billed Charges,89% of total Billed charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,77,,,Percent of total Billed charges,77% of total billed charges,64.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.04,67.76,
Febuxostat 40mg Tablet,72205002830,CDM,250,RC,,,Outpatient,,,76.14,38.07,,58.63,77,,,Percent of Total Billed Charges,77% of total billed charges,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.34,74,,,Percent of Total Billed Charges,74% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,63.96,84,,,Percent of Total Billed Charges,84% of total billed charges,62.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.76,89,,,Percent of total Billed Charges,89% of total Billed charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,77,,,Percent of total Billed charges,77% of total billed charges,64.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.04,67.76,
Febuxostat 40mg Tablet,72205002830,CDM,250,RC,,,Outpatient,,,76.14,38.07,,58.63,77,,,Percent of Total Billed Charges,77% of total billed charges,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.34,74,,,Percent of Total Billed Charges,74% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,63.96,84,,,Percent of Total Billed Charges,84% of total billed charges,62.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.76,89,,,Percent of total Billed Charges,89% of total Billed charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,77,,,Percent of total Billed charges,77% of total billed charges,64.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.04,67.76,
Febuxostat 40mg Tablet,72205002830,CDM,250,RC,,,Outpatient,,,76.14,38.07,,58.63,77,,,Percent of Total Billed Charges,77% of total billed charges,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.34,74,,,Percent of Total Billed Charges,74% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,63.96,84,,,Percent of Total Billed Charges,84% of total billed charges,62.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.76,89,,,Percent of total Billed Charges,89% of total Billed charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,77,,,Percent of total Billed charges,77% of total billed charges,64.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.04,67.76,
Febuxostat 40mg Tablet,72205002830,CDM,250,RC,,,Outpatient,,,76.14,38.07,,58.63,77,,,Percent of Total Billed Charges,77% of total billed charges,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.34,74,,,Percent of Total Billed Charges,74% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,52.54,69,,,Percent of Total Billed Charges,69% of total billed charges,63.96,84,,,Percent of Total Billed Charges,84% of total billed charges,62.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.76,89,,,Percent of total Billed Charges,89% of total Billed charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,77,,,Percent of total Billed charges,77% of total billed charges,64.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.04,67.76,
Fenofibrate 160mg Tablet,63304090190,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Fenofibrate 160mg Tablet,63304090190,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Fenofibrate 160mg Tablet,63304090190,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Fenofibrate 160mg Tablet,63304090190,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Fenofibrate 160mg Tablet,63304090190,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Fenofibrate 160mg Tablet,63304090190,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
fentaNYL 12mcg/hr Topical Patch,378911998,CDM,250,RC,,,Outpatient,,,171.96,85.98,,132.41,77,,,Percent of Total Billed Charges,77% of total billed charges,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.25,74,,,Percent of Total Billed Charges,74% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,144.45,84,,,Percent of Total Billed Charges,84% of total billed charges,141.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.04,89,,,Percent of total Billed Charges,89% of total Billed charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.41,77,,,Percent of total Billed charges,77% of total billed charges,146.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.99,153.04,
fentaNYL 12mcg/hr Topical Patch,378911998,CDM,250,RC,,,Outpatient,,,171.96,85.98,,132.41,77,,,Percent of Total Billed Charges,77% of total billed charges,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.25,74,,,Percent of Total Billed Charges,74% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,144.45,84,,,Percent of Total Billed Charges,84% of total billed charges,141.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.04,89,,,Percent of total Billed Charges,89% of total Billed charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.41,77,,,Percent of total Billed charges,77% of total billed charges,146.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.99,153.04,
fentaNYL 12mcg/hr Topical Patch,378911998,CDM,250,RC,,,Outpatient,,,171.96,85.98,,132.41,77,,,Percent of Total Billed Charges,77% of total billed charges,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.25,74,,,Percent of Total Billed Charges,74% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,144.45,84,,,Percent of Total Billed Charges,84% of total billed charges,141.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.04,89,,,Percent of total Billed Charges,89% of total Billed charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.41,77,,,Percent of total Billed charges,77% of total billed charges,146.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.99,153.04,
fentaNYL 12mcg/hr Topical Patch,378911998,CDM,250,RC,,,Outpatient,,,171.96,85.98,,132.41,77,,,Percent of Total Billed Charges,77% of total billed charges,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.25,74,,,Percent of Total Billed Charges,74% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,144.45,84,,,Percent of Total Billed Charges,84% of total billed charges,141.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.04,89,,,Percent of total Billed Charges,89% of total Billed charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.41,77,,,Percent of total Billed charges,77% of total billed charges,146.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.99,153.04,
fentaNYL 12mcg/hr Topical Patch,378911998,CDM,250,RC,,,Outpatient,,,171.96,85.98,,132.41,77,,,Percent of Total Billed Charges,77% of total billed charges,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.25,74,,,Percent of Total Billed Charges,74% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,144.45,84,,,Percent of Total Billed Charges,84% of total billed charges,141.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.04,89,,,Percent of total Billed Charges,89% of total Billed charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.41,77,,,Percent of total Billed charges,77% of total billed charges,146.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.99,153.04,
fentaNYL 12mcg/hr Topical Patch,378911998,CDM,250,RC,,,Outpatient,,,171.96,85.98,,132.41,77,,,Percent of Total Billed Charges,77% of total billed charges,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.25,74,,,Percent of Total Billed Charges,74% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,118.65,69,,,Percent of Total Billed Charges,69% of total billed charges,144.45,84,,,Percent of Total Billed Charges,84% of total billed charges,141.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.04,89,,,Percent of total Billed Charges,89% of total Billed charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.41,77,,,Percent of total Billed charges,77% of total billed charges,146.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.99,153.04,
fentaNYL 25mcg/hr Topical Patch,378912198,CDM,250,RC,,,Outpatient,,,123.6,61.8,,95.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.46,74,,,Percent of Total Billed Charges,74% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,103.82,84,,,Percent of Total Billed Charges,84% of total billed charges,101.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,110,89,,,Percent of total Billed Charges,89% of total Billed charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.17,77,,,Percent of total Billed charges,77% of total billed charges,105.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.9,110,
fentaNYL 25mcg/hr Topical Patch,378912198,CDM,250,RC,,,Outpatient,,,123.6,61.8,,95.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.46,74,,,Percent of Total Billed Charges,74% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,103.82,84,,,Percent of Total Billed Charges,84% of total billed charges,101.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,110,89,,,Percent of total Billed Charges,89% of total Billed charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.17,77,,,Percent of total Billed charges,77% of total billed charges,105.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.9,110,
fentaNYL 25mcg/hr Topical Patch,378912198,CDM,250,RC,,,Outpatient,,,123.6,61.8,,95.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.46,74,,,Percent of Total Billed Charges,74% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,103.82,84,,,Percent of Total Billed Charges,84% of total billed charges,101.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,110,89,,,Percent of total Billed Charges,89% of total Billed charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.17,77,,,Percent of total Billed charges,77% of total billed charges,105.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.9,110,
fentaNYL 25mcg/hr Topical Patch,378912198,CDM,250,RC,,,Outpatient,,,123.6,61.8,,95.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.46,74,,,Percent of Total Billed Charges,74% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,103.82,84,,,Percent of Total Billed Charges,84% of total billed charges,101.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,110,89,,,Percent of total Billed Charges,89% of total Billed charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.17,77,,,Percent of total Billed charges,77% of total billed charges,105.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.9,110,
fentaNYL 25mcg/hr Topical Patch,378912198,CDM,250,RC,,,Outpatient,,,123.6,61.8,,95.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.46,74,,,Percent of Total Billed Charges,74% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,103.82,84,,,Percent of Total Billed Charges,84% of total billed charges,101.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,110,89,,,Percent of total Billed Charges,89% of total Billed charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.17,77,,,Percent of total Billed charges,77% of total billed charges,105.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.9,110,
fentaNYL 25mcg/hr Topical Patch,378912198,CDM,250,RC,,,Outpatient,,,123.6,61.8,,95.17,77,,,Percent of Total Billed Charges,77% of total billed charges,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,91.46,74,,,Percent of Total Billed Charges,74% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,85.28,69,,,Percent of Total Billed Charges,69% of total billed charges,103.82,84,,,Percent of Total Billed Charges,84% of total billed charges,101.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,110,89,,,Percent of total Billed Charges,89% of total Billed charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.17,77,,,Percent of total Billed charges,77% of total billed charges,105.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,50.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.9,110,
fentaNYL 100mcg/hr Topical Patch,47781042847,CDM,250,RC,,,Outpatient,,,276.17,138.09,,212.65,77,,,Percent of Total Billed Charges,77% of total billed charges,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.37,74,,,Percent of Total Billed Charges,74% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,231.98,84,,,Percent of Total Billed Charges,84% of total billed charges,226.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.79,89,,,Percent of total Billed Charges,89% of total Billed charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.65,77,,,Percent of total Billed charges,77% of total billed charges,234.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.04,245.79,
fentaNYL 100mcg/hr Topical Patch,47781042847,CDM,250,RC,,,Outpatient,,,276.17,138.09,,212.65,77,,,Percent of Total Billed Charges,77% of total billed charges,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.37,74,,,Percent of Total Billed Charges,74% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,231.98,84,,,Percent of Total Billed Charges,84% of total billed charges,226.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.79,89,,,Percent of total Billed Charges,89% of total Billed charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.65,77,,,Percent of total Billed charges,77% of total billed charges,234.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.04,245.79,
fentaNYL 100mcg/hr Topical Patch,47781042847,CDM,250,RC,,,Outpatient,,,276.17,138.09,,212.65,77,,,Percent of Total Billed Charges,77% of total billed charges,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.37,74,,,Percent of Total Billed Charges,74% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,231.98,84,,,Percent of Total Billed Charges,84% of total billed charges,226.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.79,89,,,Percent of total Billed Charges,89% of total Billed charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.65,77,,,Percent of total Billed charges,77% of total billed charges,234.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.04,245.79,
fentaNYL 100mcg/hr Topical Patch,47781042847,CDM,250,RC,,,Outpatient,,,276.17,138.09,,212.65,77,,,Percent of Total Billed Charges,77% of total billed charges,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.37,74,,,Percent of Total Billed Charges,74% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,231.98,84,,,Percent of Total Billed Charges,84% of total billed charges,226.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.79,89,,,Percent of total Billed Charges,89% of total Billed charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.65,77,,,Percent of total Billed charges,77% of total billed charges,234.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.04,245.79,
fentaNYL 100mcg/hr Topical Patch,47781042847,CDM,250,RC,,,Outpatient,,,276.17,138.09,,212.65,77,,,Percent of Total Billed Charges,77% of total billed charges,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.37,74,,,Percent of Total Billed Charges,74% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,231.98,84,,,Percent of Total Billed Charges,84% of total billed charges,226.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.79,89,,,Percent of total Billed Charges,89% of total Billed charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.65,77,,,Percent of total Billed charges,77% of total billed charges,234.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.04,245.79,
fentaNYL 100mcg/hr Topical Patch,47781042847,CDM,250,RC,,,Outpatient,,,276.17,138.09,,212.65,77,,,Percent of Total Billed Charges,77% of total billed charges,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,86.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,204.37,74,,,Percent of Total Billed Charges,74% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,190.56,69,,,Percent of Total Billed Charges,69% of total billed charges,231.98,84,,,Percent of Total Billed Charges,84% of total billed charges,226.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,245.79,89,,,Percent of total Billed Charges,89% of total Billed charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.65,77,,,Percent of total Billed charges,77% of total billed charges,234.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,79.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,138.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,112.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.04,245.79,
fentaNYL 50mcg/hr Topical Patch,378912298,CDM,250,RC,,,Outpatient,,,130.06,65.03,,100.15,77,,,Percent of Total Billed Charges,77% of total billed charges,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.24,74,,,Percent of Total Billed Charges,74% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,109.25,84,,,Percent of Total Billed Charges,84% of total billed charges,106.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.75,89,,,Percent of total Billed Charges,89% of total Billed charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.15,77,,,Percent of total Billed charges,77% of total billed charges,110.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.52,115.75,
fentaNYL 50mcg/hr Topical Patch,378912298,CDM,250,RC,,,Outpatient,,,130.06,65.03,,100.15,77,,,Percent of Total Billed Charges,77% of total billed charges,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.24,74,,,Percent of Total Billed Charges,74% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,109.25,84,,,Percent of Total Billed Charges,84% of total billed charges,106.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.75,89,,,Percent of total Billed Charges,89% of total Billed charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.15,77,,,Percent of total Billed charges,77% of total billed charges,110.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.52,115.75,
fentaNYL 50mcg/hr Topical Patch,378912298,CDM,250,RC,,,Outpatient,,,130.06,65.03,,100.15,77,,,Percent of Total Billed Charges,77% of total billed charges,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.24,74,,,Percent of Total Billed Charges,74% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,109.25,84,,,Percent of Total Billed Charges,84% of total billed charges,106.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.75,89,,,Percent of total Billed Charges,89% of total Billed charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.15,77,,,Percent of total Billed charges,77% of total billed charges,110.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.52,115.75,
fentaNYL 50mcg/hr Topical Patch,378912298,CDM,250,RC,,,Outpatient,,,130.06,65.03,,100.15,77,,,Percent of Total Billed Charges,77% of total billed charges,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.24,74,,,Percent of Total Billed Charges,74% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,109.25,84,,,Percent of Total Billed Charges,84% of total billed charges,106.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.75,89,,,Percent of total Billed Charges,89% of total Billed charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.15,77,,,Percent of total Billed charges,77% of total billed charges,110.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.52,115.75,
fentaNYL 50mcg/hr Topical Patch,378912298,CDM,250,RC,,,Outpatient,,,130.06,65.03,,100.15,77,,,Percent of Total Billed Charges,77% of total billed charges,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.24,74,,,Percent of Total Billed Charges,74% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,109.25,84,,,Percent of Total Billed Charges,84% of total billed charges,106.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.75,89,,,Percent of total Billed Charges,89% of total Billed charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.15,77,,,Percent of total Billed charges,77% of total billed charges,110.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.52,115.75,
fentaNYL 50mcg/hr Topical Patch,378912298,CDM,250,RC,,,Outpatient,,,130.06,65.03,,100.15,77,,,Percent of Total Billed Charges,77% of total billed charges,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.24,74,,,Percent of Total Billed Charges,74% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,89.74,69,,,Percent of Total Billed Charges,69% of total billed charges,109.25,84,,,Percent of Total Billed Charges,84% of total billed charges,106.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.75,89,,,Percent of total Billed Charges,89% of total Billed charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.15,77,,,Percent of total Billed charges,77% of total billed charges,110.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.52,115.75,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 100mcg/2ml SDV,641602725,CDM,250,RC,,,Outpatient,,,57.44,28.72,,44.23,77,,,Percent of Total Billed Charges,77% of total billed charges,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.51,74,,,Percent of Total Billed Charges,74% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,39.63,69,,,Percent of Total Billed Charges,69% of total billed charges,48.25,84,,,Percent of Total Billed Charges,84% of total billed charges,47.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.12,89,,,Percent of total Billed Charges,89% of total Billed charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,77,,,Percent of total Billed charges,77% of total billed charges,48.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.36,51.12,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
fentaNYL 250mcg/5ml SDV,409909425,CDM,250,RC,,,Outpatient,,,59,29.5,,45.43,77,,,Percent of Total Billed Charges,77% of total billed charges,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.66,74,,,Percent of Total Billed Charges,74% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,40.71,69,,,Percent of Total Billed Charges,69% of total billed charges,49.56,84,,,Percent of Total Billed Charges,84% of total billed charges,48.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.51,89,,,Percent of total Billed Charges,89% of total Billed charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.43,77,,,Percent of total Billed charges,77% of total billed charges,50.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.75,52.51,
Ferrous Sulfate 220mg/5ml UDC,54838000180,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 220mg/5ml UDC,54838000180,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 220mg/5ml UDC,54838000180,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 220mg/5ml UDC,54838000180,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 220mg/5ml UDC,54838000180,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 220mg/5ml UDC,54838000180,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Gluconate 236mg Tablet (27mg Elemental Iron),40985022690,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Gluconate 236mg Tablet (27mg Elemental Iron),40985022690,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Gluconate 236mg Tablet (27mg Elemental Iron),40985022690,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Gluconate 236mg Tablet (27mg Elemental Iron),40985022690,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Gluconate 236mg Tablet (27mg Elemental Iron),40985022690,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Gluconate 236mg Tablet (27mg Elemental Iron),40985022690,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 325mg Tablet (65mg Elemental Iron),904759161,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 325mg Tablet (65mg Elemental Iron),904759161,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 325mg Tablet (65mg Elemental Iron),904759161,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 325mg Tablet (65mg Elemental Iron),904759161,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 325mg Tablet (65mg Elemental Iron),904759161,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferrous Sulfate 325mg Tablet (65mg Elemental Iron),904759161,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5356.86,2678.43,,4124.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3964.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4499.76,84,,,Percent of Total Billed Charges,84% of total billed charges,4392.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,4767.61,89,,,Percent of total Billed Charges,89% of total Billed charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4124.78,77,,,Percent of total Billed charges,77% of total billed charges,4553.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2678.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.22,4767.61,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5578.4,2789.2,,4295.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1743.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4685.86,84,,,Percent of Total Billed Charges,84% of total billed charges,4574.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,4964.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4295.37,77,,,Percent of total Billed charges,77% of total billed charges,4741.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1603.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2789.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.6,4964.78,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5356.86,2678.43,,4124.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3964.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4499.76,84,,,Percent of Total Billed Charges,84% of total billed charges,4392.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,4767.61,89,,,Percent of total Billed Charges,89% of total Billed charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4124.78,77,,,Percent of total Billed charges,77% of total billed charges,4553.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2678.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.22,4767.61,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5578.4,2789.2,,4295.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1743.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4685.86,84,,,Percent of Total Billed Charges,84% of total billed charges,4574.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,4964.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4295.37,77,,,Percent of total Billed charges,77% of total billed charges,4741.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1603.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2789.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.6,4964.78,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5356.86,2678.43,,4124.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3964.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4499.76,84,,,Percent of Total Billed Charges,84% of total billed charges,4392.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,4767.61,89,,,Percent of total Billed Charges,89% of total Billed charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4124.78,77,,,Percent of total Billed charges,77% of total billed charges,4553.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2678.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.22,4767.61,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5578.4,2789.2,,4295.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1743.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4685.86,84,,,Percent of Total Billed Charges,84% of total billed charges,4574.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,4964.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4295.37,77,,,Percent of total Billed charges,77% of total billed charges,4741.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1603.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2789.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.6,4964.78,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5356.86,2678.43,,4124.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3964.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4499.76,84,,,Percent of Total Billed Charges,84% of total billed charges,4392.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,4767.61,89,,,Percent of total Billed Charges,89% of total Billed charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4124.78,77,,,Percent of total Billed charges,77% of total billed charges,4553.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2678.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.22,4767.61,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5578.4,2789.2,,4295.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1743.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4685.86,84,,,Percent of Total Billed Charges,84% of total billed charges,4574.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,4964.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4295.37,77,,,Percent of total Billed charges,77% of total billed charges,4741.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1603.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2789.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.6,4964.78,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5356.86,2678.43,,4124.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3964.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4499.76,84,,,Percent of Total Billed Charges,84% of total billed charges,4392.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,4767.61,89,,,Percent of total Billed Charges,89% of total Billed charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4124.78,77,,,Percent of total Billed charges,77% of total billed charges,4553.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2678.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.22,4767.61,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5578.4,2789.2,,4295.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1743.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4685.86,84,,,Percent of Total Billed Charges,84% of total billed charges,4574.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,4964.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4295.37,77,,,Percent of total Billed charges,77% of total billed charges,4741.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1603.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2789.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.6,4964.78,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5356.86,2678.43,,4124.78,77,,,Percent of Total Billed Charges,77% of total billed charges,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1366,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1674.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3964.08,74,,,Percent of Total Billed Charges,74% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,3696.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4499.76,84,,,Percent of Total Billed Charges,84% of total billed charges,4392.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,4767.61,89,,,Percent of total Billed Charges,89% of total Billed charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4124.78,77,,,Percent of total Billed charges,77% of total billed charges,4553.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1540.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2678.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2185.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4767.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1339.22,4767.61,
Ferumoxytol (Feraheme) 510mg/17ml Liquid SDV,59338077501,CDM,250,RC,,,Outpatient,,,5578.4,2789.2,,4295.37,77,,,Percent of Total Billed Charges,77% of total billed charges,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1422.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1743.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4128.02,74,,,Percent of Total Billed Charges,74% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,3849.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4685.86,84,,,Percent of Total Billed Charges,84% of total billed charges,4574.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,4964.78,89,,,Percent of total Billed Charges,89% of total Billed charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4295.37,77,,,Percent of total Billed charges,77% of total billed charges,4741.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1603.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2789.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2275.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4964.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1394.6,4964.78,
Filgrastim-SNDZ (Zarxio) 300 mcg/0.5ml Syringe,61314031801,CDM,250,RC,,,Outpatient,,,1351.67,675.84,,1040.79,77,,,Percent of Total Billed Charges,77% of total billed charges,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.24,74,,,Percent of Total Billed Charges,74% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.79,77,,,Percent of total Billed charges,77% of total billed charges,1148.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.92,1202.99,
Filgrastim-SNDZ (Zarxio) 300 mcg/0.5ml Syringe,61314031801,CDM,250,RC,,,Outpatient,,,1351.67,675.84,,1040.79,77,,,Percent of Total Billed Charges,77% of total billed charges,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.24,74,,,Percent of Total Billed Charges,74% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.79,77,,,Percent of total Billed charges,77% of total billed charges,1148.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.92,1202.99,
Filgrastim-SNDZ (Zarxio) 300 mcg/0.5ml Syringe,61314031801,CDM,250,RC,,,Outpatient,,,1351.67,675.84,,1040.79,77,,,Percent of Total Billed Charges,77% of total billed charges,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.24,74,,,Percent of Total Billed Charges,74% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.79,77,,,Percent of total Billed charges,77% of total billed charges,1148.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.92,1202.99,
Filgrastim-SNDZ (Zarxio) 300 mcg/0.5ml Syringe,61314031801,CDM,250,RC,,,Outpatient,,,1351.67,675.84,,1040.79,77,,,Percent of Total Billed Charges,77% of total billed charges,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.24,74,,,Percent of Total Billed Charges,74% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.79,77,,,Percent of total Billed charges,77% of total billed charges,1148.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.92,1202.99,
Filgrastim-SNDZ (Zarxio) 300 mcg/0.5ml Syringe,61314031801,CDM,250,RC,,,Outpatient,,,1351.67,675.84,,1040.79,77,,,Percent of Total Billed Charges,77% of total billed charges,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.24,74,,,Percent of Total Billed Charges,74% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.79,77,,,Percent of total Billed charges,77% of total billed charges,1148.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.92,1202.99,
Filgrastim-SNDZ (Zarxio) 300 mcg/0.5ml Syringe,61314031801,CDM,250,RC,,,Outpatient,,,1351.67,675.84,,1040.79,77,,,Percent of Total Billed Charges,77% of total billed charges,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,344.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1000.24,74,,,Percent of Total Billed Charges,74% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,932.65,69,,,Percent of Total Billed Charges,69% of total billed charges,1135.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1108.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,1202.99,89,,,Percent of total Billed Charges,89% of total Billed charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1040.79,77,,,Percent of total Billed charges,77% of total billed charges,1148.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,388.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,675.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,551.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1202.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.92,1202.99,
Filgrastim (Neupogen) 300mcg/1ml SDV,55513053010,CDM,250,RC,,,Outpatient,,,1543.68,771.84,,1188.63,77,,,Percent of Total Billed Charges,77% of total billed charges,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1142.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1296.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1265.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1373.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.63,77,,,Percent of total Billed charges,77% of total billed charges,1312.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,771.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.92,1373.88,
Filgrastim (Neupogen) 300mcg/1ml SDV,55513053010,CDM,250,RC,,,Outpatient,,,1543.68,771.84,,1188.63,77,,,Percent of Total Billed Charges,77% of total billed charges,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1142.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1296.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1265.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1373.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.63,77,,,Percent of total Billed charges,77% of total billed charges,1312.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,771.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.92,1373.88,
Filgrastim (Neupogen) 300mcg/1ml SDV,55513053010,CDM,250,RC,,,Outpatient,,,1543.68,771.84,,1188.63,77,,,Percent of Total Billed Charges,77% of total billed charges,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1142.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1296.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1265.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1373.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.63,77,,,Percent of total Billed charges,77% of total billed charges,1312.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,771.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.92,1373.88,
Filgrastim (Neupogen) 300mcg/1ml SDV,55513053010,CDM,250,RC,,,Outpatient,,,1543.68,771.84,,1188.63,77,,,Percent of Total Billed Charges,77% of total billed charges,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1142.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1296.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1265.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1373.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.63,77,,,Percent of total Billed charges,77% of total billed charges,1312.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,771.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.92,1373.88,
Filgrastim (Neupogen) 300mcg/1ml SDV,55513053010,CDM,250,RC,,,Outpatient,,,1543.68,771.84,,1188.63,77,,,Percent of Total Billed Charges,77% of total billed charges,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1142.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1296.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1265.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1373.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.63,77,,,Percent of total Billed charges,77% of total billed charges,1312.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,771.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.92,1373.88,
Filgrastim (Neupogen) 300mcg/1ml SDV,55513053010,CDM,250,RC,,,Outpatient,,,1543.68,771.84,,1188.63,77,,,Percent of Total Billed Charges,77% of total billed charges,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,482.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1142.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1065.14,69,,,Percent of Total Billed Charges,69% of total billed charges,1296.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1265.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,1373.88,89,,,Percent of total Billed Charges,89% of total Billed charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1188.63,77,,,Percent of total Billed charges,77% of total billed charges,1312.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,771.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1373.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.92,1373.88,
Filgrastim (Neupogen) 480mcg/0.8ml Syringe,55513020991,CDM,250,RC,,,Outpatient,,,2571.32,1285.66,,1979.92,77,,,Percent of Total Billed Charges,77% of total billed charges,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1902.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2159.91,84,,,Percent of Total Billed Charges,84% of total billed charges,2108.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2288.47,89,,,Percent of total Billed Charges,89% of total Billed charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1979.92,77,,,Percent of total Billed charges,77% of total billed charges,2185.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1285.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.83,2288.47,
Filgrastim (Neupogen) 480mcg/0.8ml Syringe,55513020991,CDM,250,RC,,,Outpatient,,,2571.32,1285.66,,1979.92,77,,,Percent of Total Billed Charges,77% of total billed charges,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1902.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2159.91,84,,,Percent of Total Billed Charges,84% of total billed charges,2108.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2288.47,89,,,Percent of total Billed Charges,89% of total Billed charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1979.92,77,,,Percent of total Billed charges,77% of total billed charges,2185.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1285.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.83,2288.47,
Filgrastim (Neupogen) 480mcg/0.8ml Syringe,55513020991,CDM,250,RC,,,Outpatient,,,2571.32,1285.66,,1979.92,77,,,Percent of Total Billed Charges,77% of total billed charges,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1902.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2159.91,84,,,Percent of Total Billed Charges,84% of total billed charges,2108.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2288.47,89,,,Percent of total Billed Charges,89% of total Billed charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1979.92,77,,,Percent of total Billed charges,77% of total billed charges,2185.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1285.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.83,2288.47,
Filgrastim (Neupogen) 480mcg/0.8ml Syringe,55513020991,CDM,250,RC,,,Outpatient,,,2571.32,1285.66,,1979.92,77,,,Percent of Total Billed Charges,77% of total billed charges,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1902.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2159.91,84,,,Percent of Total Billed Charges,84% of total billed charges,2108.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2288.47,89,,,Percent of total Billed Charges,89% of total Billed charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1979.92,77,,,Percent of total Billed charges,77% of total billed charges,2185.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1285.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.83,2288.47,
Filgrastim (Neupogen) 480mcg/0.8ml Syringe,55513020991,CDM,250,RC,,,Outpatient,,,2571.32,1285.66,,1979.92,77,,,Percent of Total Billed Charges,77% of total billed charges,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1902.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2159.91,84,,,Percent of Total Billed Charges,84% of total billed charges,2108.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2288.47,89,,,Percent of total Billed Charges,89% of total Billed charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1979.92,77,,,Percent of total Billed charges,77% of total billed charges,2185.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1285.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.83,2288.47,
Filgrastim (Neupogen) 480mcg/0.8ml Syringe,55513020991,CDM,250,RC,,,Outpatient,,,2571.32,1285.66,,1979.92,77,,,Percent of Total Billed Charges,77% of total billed charges,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,655.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,803.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1902.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,1774.21,69,,,Percent of Total Billed Charges,69% of total billed charges,2159.91,84,,,Percent of Total Billed Charges,84% of total billed charges,2108.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,2288.47,89,,,Percent of total Billed Charges,89% of total Billed charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1979.92,77,,,Percent of total Billed charges,77% of total billed charges,2185.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,739.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1285.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1049.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2288.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,642.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,642.83,2288.47,
Finasteride 5mg Tablet,16729009001,CDM,250,RC,,,Outpatient,,,34.37,17.19,,26.46,77,,,Percent of Total Billed Charges,77% of total billed charges,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.43,74,,,Percent of Total Billed Charges,74% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,28.87,84,,,Percent of Total Billed Charges,84% of total billed charges,28.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.59,89,,,Percent of total Billed Charges,89% of total Billed charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.46,77,,,Percent of total Billed charges,77% of total billed charges,29.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.59,30.59,
Finasteride 5mg Tablet,16729009001,CDM,250,RC,,,Outpatient,,,34.37,17.19,,26.46,77,,,Percent of Total Billed Charges,77% of total billed charges,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.43,74,,,Percent of Total Billed Charges,74% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,28.87,84,,,Percent of Total Billed Charges,84% of total billed charges,28.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.59,89,,,Percent of total Billed Charges,89% of total Billed charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.46,77,,,Percent of total Billed charges,77% of total billed charges,29.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.59,30.59,
Finasteride 5mg Tablet,16729009001,CDM,250,RC,,,Outpatient,,,34.37,17.19,,26.46,77,,,Percent of Total Billed Charges,77% of total billed charges,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.43,74,,,Percent of Total Billed Charges,74% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,28.87,84,,,Percent of Total Billed Charges,84% of total billed charges,28.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.59,89,,,Percent of total Billed Charges,89% of total Billed charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.46,77,,,Percent of total Billed charges,77% of total billed charges,29.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.59,30.59,
Finasteride 5mg Tablet,16729009001,CDM,250,RC,,,Outpatient,,,34.37,17.19,,26.46,77,,,Percent of Total Billed Charges,77% of total billed charges,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.43,74,,,Percent of Total Billed Charges,74% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,28.87,84,,,Percent of Total Billed Charges,84% of total billed charges,28.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.59,89,,,Percent of total Billed Charges,89% of total Billed charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.46,77,,,Percent of total Billed charges,77% of total billed charges,29.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.59,30.59,
Finasteride 5mg Tablet,16729009001,CDM,250,RC,,,Outpatient,,,34.37,17.19,,26.46,77,,,Percent of Total Billed Charges,77% of total billed charges,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.43,74,,,Percent of Total Billed Charges,74% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,28.87,84,,,Percent of Total Billed Charges,84% of total billed charges,28.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.59,89,,,Percent of total Billed Charges,89% of total Billed charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.46,77,,,Percent of total Billed charges,77% of total billed charges,29.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.59,30.59,
Finasteride 5mg Tablet,16729009001,CDM,250,RC,,,Outpatient,,,34.37,17.19,,26.46,77,,,Percent of Total Billed Charges,77% of total billed charges,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.43,74,,,Percent of Total Billed Charges,74% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,23.72,69,,,Percent of Total Billed Charges,69% of total billed charges,28.87,84,,,Percent of Total Billed Charges,84% of total billed charges,28.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.59,89,,,Percent of total Billed Charges,89% of total Billed charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.46,77,,,Percent of total Billed charges,77% of total billed charges,29.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.59,30.59,
FlavoxATE 100mg Tablet,574011501,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
FlavoxATE 100mg Tablet,574011501,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
FlavoxATE 100mg Tablet,574011501,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
FlavoxATE 100mg Tablet,574011501,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
FlavoxATE 100mg Tablet,574011501,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
FlavoxATE 100mg Tablet,574011501,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Flecainide 50mg Tablet,54001021,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Flecainide 50mg Tablet,54001021,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Flecainide 50mg Tablet,54001021,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Flecainide 50mg Tablet,54001021,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Flecainide 50mg Tablet,54001021,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Flecainide 50mg Tablet,54001021,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Fluconazole 100mg Tablet,49342030,CDM,250,RC,,,Outpatient,,,15.6,7.8,,12.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.54,74,,,Percent of Total Billed Charges,74% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.88,89,,,Percent of total Billed Charges,89% of total Billed charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,77,,,Percent of total Billed charges,77% of total billed charges,13.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.9,13.88,
Fluconazole 100mg Tablet,49342030,CDM,250,RC,,,Outpatient,,,15.6,7.8,,12.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.54,74,,,Percent of Total Billed Charges,74% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.88,89,,,Percent of total Billed Charges,89% of total Billed charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,77,,,Percent of total Billed charges,77% of total billed charges,13.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.9,13.88,
Fluconazole 100mg Tablet,49342030,CDM,250,RC,,,Outpatient,,,15.6,7.8,,12.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.54,74,,,Percent of Total Billed Charges,74% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.88,89,,,Percent of total Billed Charges,89% of total Billed charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,77,,,Percent of total Billed charges,77% of total billed charges,13.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.9,13.88,
Fluconazole 100mg Tablet,49342030,CDM,250,RC,,,Outpatient,,,15.6,7.8,,12.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.54,74,,,Percent of Total Billed Charges,74% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.88,89,,,Percent of total Billed Charges,89% of total Billed charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,77,,,Percent of total Billed charges,77% of total billed charges,13.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.9,13.88,
Fluconazole 100mg Tablet,49342030,CDM,250,RC,,,Outpatient,,,15.6,7.8,,12.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.54,74,,,Percent of Total Billed Charges,74% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.88,89,,,Percent of total Billed Charges,89% of total Billed charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,77,,,Percent of total Billed charges,77% of total billed charges,13.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.9,13.88,
Fluconazole 100mg Tablet,49342030,CDM,250,RC,,,Outpatient,,,15.6,7.8,,12.01,77,,,Percent of Total Billed Charges,77% of total billed charges,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.54,74,,,Percent of Total Billed Charges,74% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.76,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.88,89,,,Percent of total Billed Charges,89% of total Billed charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.01,77,,,Percent of total Billed charges,77% of total billed charges,13.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.9,13.88,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fluconazole 200mg/100ml IV Bag,55390001201,CDM,250,RC,,,Outpatient,,,224.66,112.33,,172.99,77,,,Percent of Total Billed Charges,77% of total billed charges,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,166.25,74,,,Percent of Total Billed Charges,74% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,155.02,69,,,Percent of Total Billed Charges,69% of total billed charges,188.71,84,,,Percent of Total Billed Charges,84% of total billed charges,184.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.95,89,,,Percent of total Billed Charges,89% of total Billed charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.99,77,,,Percent of total Billed charges,77% of total billed charges,190.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.17,199.95,
Fludrocortisone 0.1mg Tablet,115703301,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Fludrocortisone 0.1mg Tablet,115703301,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Fludrocortisone 0.1mg Tablet,115703301,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Fludrocortisone 0.1mg Tablet,115703301,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Fludrocortisone 0.1mg Tablet,115703301,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Fludrocortisone 0.1mg Tablet,115703301,CDM,250,RC,,,Outpatient,,,12.04,6.02,,9.27,77,,,Percent of Total Billed Charges,77% of total billed charges,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.91,74,,,Percent of Total Billed Charges,74% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,8.31,69,,,Percent of Total Billed Charges,69% of total billed charges,10.11,84,,,Percent of Total Billed Charges,84% of total billed charges,9.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.72,89,,,Percent of total Billed Charges,89% of total Billed charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.27,77,,,Percent of total Billed charges,77% of total billed charges,10.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.01,10.72,
Flumazenil 0.5mg/5ml MDV,143968410,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Flumazenil 0.5mg/5ml MDV,143968410,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Flumazenil 0.5mg/5ml MDV,143968410,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Flumazenil 0.5mg/5ml MDV,143968410,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Flumazenil 0.5mg/5ml MDV,143968410,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Flumazenil 0.5mg/5ml MDV,143968410,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
FLUoxetine 10mg Capsule,,,250,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,26.17,
FLUoxetine 10mg Capsule,,,250,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,26.17,
FLUoxetine 10mg Capsule,,,250,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,26.17,
FLUoxetine 10mg Capsule,,,250,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,26.17,
FLUoxetine 10mg Capsule,,,250,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,26.17,
FLUoxetine 10mg Capsule,,,250,RC,,,Outpatient,,,29.4,14.7,,22.64,77,,,Percent of Total Billed Charges,77% of total billed charges,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.76,74,,,Percent of Total Billed Charges,74% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,20.29,69,,,Percent of Total Billed Charges,69% of total billed charges,24.7,84,,,Percent of Total Billed Charges,84% of total billed charges,24.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.17,89,,,Percent of total Billed Charges,89% of total Billed charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.64,77,,,Percent of total Billed charges,77% of total billed charges,24.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.35,26.17,
Fluorescein 1mg OPHTH Strip,17238090011,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Fluorescein 1mg OPHTH Strip,17238090011,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Fluorescein 1mg OPHTH Strip,17238090011,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Fluorescein 1mg OPHTH Strip,17238090011,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Fluorescein 1mg OPHTH Strip,17238090011,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Fluorescein 1mg OPHTH Strip,17238090011,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,872.24,436.12,,671.62,77,,,Percent of Total Billed Charges,77% of total billed charges,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.46,74,,,Percent of Total Billed Charges,74% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.68,84,,,Percent of Total Billed Charges,84% of total billed charges,715.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,776.29,89,,,Percent of total Billed Charges,89% of total Billed charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.62,77,,,Percent of total Billed charges,77% of total billed charges,741.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.06,776.29,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,853.55,426.78,,657.23,77,,,Percent of Total Billed Charges,77% of total billed charges,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.63,74,,,Percent of Total Billed Charges,74% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,716.98,84,,,Percent of Total Billed Charges,84% of total billed charges,699.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.66,89,,,Percent of total Billed Charges,89% of total Billed charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.23,77,,,Percent of total Billed charges,77% of total billed charges,725.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.39,759.66,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,872.24,436.12,,671.62,77,,,Percent of Total Billed Charges,77% of total billed charges,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.46,74,,,Percent of Total Billed Charges,74% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.68,84,,,Percent of Total Billed Charges,84% of total billed charges,715.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,776.29,89,,,Percent of total Billed Charges,89% of total Billed charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.62,77,,,Percent of total Billed charges,77% of total billed charges,741.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.06,776.29,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,853.55,426.78,,657.23,77,,,Percent of Total Billed Charges,77% of total billed charges,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.63,74,,,Percent of Total Billed Charges,74% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,716.98,84,,,Percent of Total Billed Charges,84% of total billed charges,699.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.66,89,,,Percent of total Billed Charges,89% of total Billed charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.23,77,,,Percent of total Billed charges,77% of total billed charges,725.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.39,759.66,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,872.24,436.12,,671.62,77,,,Percent of Total Billed Charges,77% of total billed charges,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.46,74,,,Percent of Total Billed Charges,74% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.68,84,,,Percent of Total Billed Charges,84% of total billed charges,715.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,776.29,89,,,Percent of total Billed Charges,89% of total Billed charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.62,77,,,Percent of total Billed charges,77% of total billed charges,741.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.06,776.29,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,853.55,426.78,,657.23,77,,,Percent of Total Billed Charges,77% of total billed charges,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.63,74,,,Percent of Total Billed Charges,74% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,716.98,84,,,Percent of Total Billed Charges,84% of total billed charges,699.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.66,89,,,Percent of total Billed Charges,89% of total Billed charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.23,77,,,Percent of total Billed charges,77% of total billed charges,725.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.39,759.66,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,872.24,436.12,,671.62,77,,,Percent of Total Billed Charges,77% of total billed charges,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.46,74,,,Percent of Total Billed Charges,74% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.68,84,,,Percent of Total Billed Charges,84% of total billed charges,715.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,776.29,89,,,Percent of total Billed Charges,89% of total Billed charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.62,77,,,Percent of total Billed charges,77% of total billed charges,741.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.06,776.29,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,853.55,426.78,,657.23,77,,,Percent of Total Billed Charges,77% of total billed charges,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.63,74,,,Percent of Total Billed Charges,74% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,716.98,84,,,Percent of Total Billed Charges,84% of total billed charges,699.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.66,89,,,Percent of total Billed Charges,89% of total Billed charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.23,77,,,Percent of total Billed charges,77% of total billed charges,725.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.39,759.66,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,872.24,436.12,,671.62,77,,,Percent of Total Billed Charges,77% of total billed charges,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.46,74,,,Percent of Total Billed Charges,74% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.68,84,,,Percent of Total Billed Charges,84% of total billed charges,715.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,776.29,89,,,Percent of total Billed Charges,89% of total Billed charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.62,77,,,Percent of total Billed charges,77% of total billed charges,741.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.06,776.29,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,853.55,426.78,,657.23,77,,,Percent of Total Billed Charges,77% of total billed charges,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.63,74,,,Percent of Total Billed Charges,74% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,716.98,84,,,Percent of Total Billed Charges,84% of total billed charges,699.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.66,89,,,Percent of total Billed Charges,89% of total Billed charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.23,77,,,Percent of total Billed charges,77% of total billed charges,725.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.39,759.66,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,872.24,436.12,,671.62,77,,,Percent of Total Billed Charges,77% of total billed charges,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,645.46,74,,,Percent of Total Billed Charges,74% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,601.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.68,84,,,Percent of Total Billed Charges,84% of total billed charges,715.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,776.29,89,,,Percent of total Billed Charges,89% of total Billed charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.62,77,,,Percent of total Billed charges,77% of total billed charges,741.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,250.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,436.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,355.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,776.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.06,776.29,
Fluorouracil 1000mg/20ml Liquid SDV,63323011720,CDM,250,RC,,,Outpatient,,,853.55,426.78,,657.23,77,,,Percent of Total Billed Charges,77% of total billed charges,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,631.63,74,,,Percent of Total Billed Charges,74% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,588.95,69,,,Percent of Total Billed Charges,69% of total billed charges,716.98,84,,,Percent of Total Billed Charges,84% of total billed charges,699.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,759.66,89,,,Percent of total Billed Charges,89% of total Billed charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,657.23,77,,,Percent of total Billed charges,77% of total billed charges,725.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,245.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,426.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,348.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,759.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.39,759.66,
Fluorescein (Fluorescite) 10% 500mg/5ml SDV,14789012207,CDM,250,RC,,,Outpatient,,,424.86,212.43,,327.14,77,,,Percent of Total Billed Charges,77% of total billed charges,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,314.4,74,,,Percent of Total Billed Charges,74% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,356.88,84,,,Percent of Total Billed Charges,84% of total billed charges,348.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.13,89,,,Percent of total Billed Charges,89% of total Billed charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.14,77,,,Percent of total Billed charges,77% of total billed charges,361.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,212.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.22,378.13,
Fluorescein (Fluorescite) 10% 500mg/5ml SDV,14789012207,CDM,250,RC,,,Outpatient,,,424.86,212.43,,327.14,77,,,Percent of Total Billed Charges,77% of total billed charges,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,314.4,74,,,Percent of Total Billed Charges,74% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,356.88,84,,,Percent of Total Billed Charges,84% of total billed charges,348.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.13,89,,,Percent of total Billed Charges,89% of total Billed charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.14,77,,,Percent of total Billed charges,77% of total billed charges,361.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,212.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.22,378.13,
Fluorescein (Fluorescite) 10% 500mg/5ml SDV,14789012207,CDM,250,RC,,,Outpatient,,,424.86,212.43,,327.14,77,,,Percent of Total Billed Charges,77% of total billed charges,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,314.4,74,,,Percent of Total Billed Charges,74% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,356.88,84,,,Percent of Total Billed Charges,84% of total billed charges,348.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.13,89,,,Percent of total Billed Charges,89% of total Billed charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.14,77,,,Percent of total Billed charges,77% of total billed charges,361.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,212.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.22,378.13,
Fluorescein (Fluorescite) 10% 500mg/5ml SDV,14789012207,CDM,250,RC,,,Outpatient,,,424.86,212.43,,327.14,77,,,Percent of Total Billed Charges,77% of total billed charges,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,314.4,74,,,Percent of Total Billed Charges,74% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,356.88,84,,,Percent of Total Billed Charges,84% of total billed charges,348.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.13,89,,,Percent of total Billed Charges,89% of total Billed charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.14,77,,,Percent of total Billed charges,77% of total billed charges,361.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,212.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.22,378.13,
Fluorescein (Fluorescite) 10% 500mg/5ml SDV,14789012207,CDM,250,RC,,,Outpatient,,,424.86,212.43,,327.14,77,,,Percent of Total Billed Charges,77% of total billed charges,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,314.4,74,,,Percent of Total Billed Charges,74% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,356.88,84,,,Percent of Total Billed Charges,84% of total billed charges,348.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.13,89,,,Percent of total Billed Charges,89% of total Billed charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.14,77,,,Percent of total Billed charges,77% of total billed charges,361.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,212.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.22,378.13,
Fluorescein (Fluorescite) 10% 500mg/5ml SDV,14789012207,CDM,250,RC,,,Outpatient,,,424.86,212.43,,327.14,77,,,Percent of Total Billed Charges,77% of total billed charges,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,314.4,74,,,Percent of Total Billed Charges,74% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,293.15,69,,,Percent of Total Billed Charges,69% of total billed charges,356.88,84,,,Percent of Total Billed Charges,84% of total billed charges,348.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,378.13,89,,,Percent of total Billed Charges,89% of total Billed charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,327.14,77,,,Percent of total Billed charges,77% of total billed charges,361.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,212.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,378.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.22,378.13,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,510.87,255.44,,393.37,77,,,Percent of Total Billed Charges,77% of total billed charges,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.04,74,,,Percent of Total Billed Charges,74% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,429.13,84,,,Percent of Total Billed Charges,84% of total billed charges,418.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.67,89,,,Percent of total Billed Charges,89% of total Billed charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.37,77,,,Percent of total Billed charges,77% of total billed charges,434.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.72,454.67,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,501.53,250.77,,386.18,77,,,Percent of Total Billed Charges,77% of total billed charges,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,371.13,74,,,Percent of Total Billed Charges,74% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,421.29,84,,,Percent of Total Billed Charges,84% of total billed charges,411.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.36,89,,,Percent of total Billed Charges,89% of total Billed charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.18,77,,,Percent of total Billed charges,77% of total billed charges,426.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.38,446.36,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,510.87,255.44,,393.37,77,,,Percent of Total Billed Charges,77% of total billed charges,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.04,74,,,Percent of Total Billed Charges,74% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,429.13,84,,,Percent of Total Billed Charges,84% of total billed charges,418.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.67,89,,,Percent of total Billed Charges,89% of total Billed charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.37,77,,,Percent of total Billed charges,77% of total billed charges,434.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.72,454.67,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,501.53,250.77,,386.18,77,,,Percent of Total Billed Charges,77% of total billed charges,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,371.13,74,,,Percent of Total Billed Charges,74% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,421.29,84,,,Percent of Total Billed Charges,84% of total billed charges,411.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.36,89,,,Percent of total Billed Charges,89% of total Billed charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.18,77,,,Percent of total Billed charges,77% of total billed charges,426.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.38,446.36,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,510.87,255.44,,393.37,77,,,Percent of Total Billed Charges,77% of total billed charges,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.04,74,,,Percent of Total Billed Charges,74% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,429.13,84,,,Percent of Total Billed Charges,84% of total billed charges,418.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.67,89,,,Percent of total Billed Charges,89% of total Billed charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.37,77,,,Percent of total Billed charges,77% of total billed charges,434.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.72,454.67,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,501.53,250.77,,386.18,77,,,Percent of Total Billed Charges,77% of total billed charges,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,371.13,74,,,Percent of Total Billed Charges,74% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,421.29,84,,,Percent of Total Billed Charges,84% of total billed charges,411.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.36,89,,,Percent of total Billed Charges,89% of total Billed charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.18,77,,,Percent of total Billed charges,77% of total billed charges,426.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.38,446.36,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,510.87,255.44,,393.37,77,,,Percent of Total Billed Charges,77% of total billed charges,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.04,74,,,Percent of Total Billed Charges,74% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,429.13,84,,,Percent of Total Billed Charges,84% of total billed charges,418.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.67,89,,,Percent of total Billed Charges,89% of total Billed charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.37,77,,,Percent of total Billed charges,77% of total billed charges,434.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.72,454.67,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,501.53,250.77,,386.18,77,,,Percent of Total Billed Charges,77% of total billed charges,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,371.13,74,,,Percent of Total Billed Charges,74% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,421.29,84,,,Percent of Total Billed Charges,84% of total billed charges,411.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.36,89,,,Percent of total Billed Charges,89% of total Billed charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.18,77,,,Percent of total Billed charges,77% of total billed charges,426.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.38,446.36,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,510.87,255.44,,393.37,77,,,Percent of Total Billed Charges,77% of total billed charges,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.04,74,,,Percent of Total Billed Charges,74% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,429.13,84,,,Percent of Total Billed Charges,84% of total billed charges,418.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.67,89,,,Percent of total Billed Charges,89% of total Billed charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.37,77,,,Percent of total Billed charges,77% of total billed charges,434.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.72,454.67,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,501.53,250.77,,386.18,77,,,Percent of Total Billed Charges,77% of total billed charges,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,371.13,74,,,Percent of Total Billed Charges,74% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,421.29,84,,,Percent of Total Billed Charges,84% of total billed charges,411.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.36,89,,,Percent of total Billed Charges,89% of total Billed charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.18,77,,,Percent of total Billed charges,77% of total billed charges,426.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.38,446.36,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,510.87,255.44,,393.37,77,,,Percent of Total Billed Charges,77% of total billed charges,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,378.04,74,,,Percent of Total Billed Charges,74% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,352.5,69,,,Percent of Total Billed Charges,69% of total billed charges,429.13,84,,,Percent of Total Billed Charges,84% of total billed charges,418.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.67,89,,,Percent of total Billed Charges,89% of total Billed charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.37,77,,,Percent of total Billed charges,77% of total billed charges,434.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.72,454.67,
Fluorouracil 500mg/10ml Liquid SDV,63323011710,CDM,250,RC,,,Outpatient,,,501.53,250.77,,386.18,77,,,Percent of Total Billed Charges,77% of total billed charges,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,127.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,156.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,371.13,74,,,Percent of Total Billed Charges,74% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,346.06,69,,,Percent of Total Billed Charges,69% of total billed charges,421.29,84,,,Percent of Total Billed Charges,84% of total billed charges,411.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,446.36,89,,,Percent of total Billed Charges,89% of total Billed charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,386.18,77,,,Percent of total Billed charges,77% of total billed charges,426.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,144.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,250.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,204.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,446.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.38,446.36,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,185.43,92.72,,142.78,77,,,Percent of Total Billed Charges,77% of total billed charges,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.22,74,,,Percent of Total Billed Charges,74% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,155.76,84,,,Percent of Total Billed Charges,84% of total billed charges,152.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.03,89,,,Percent of total Billed Charges,89% of total Billed charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.78,77,,,Percent of total Billed charges,77% of total billed charges,157.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.36,165.03,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,51.54,25.77,,39.69,77,,,Percent of Total Billed Charges,77% of total billed charges,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.14,74,,,Percent of Total Billed Charges,74% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,43.29,84,,,Percent of Total Billed Charges,84% of total billed charges,42.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.87,89,,,Percent of total Billed Charges,89% of total Billed charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,77,,,Percent of total Billed charges,77% of total billed charges,43.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,45.87,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,185.43,92.72,,142.78,77,,,Percent of Total Billed Charges,77% of total billed charges,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.22,74,,,Percent of Total Billed Charges,74% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,155.76,84,,,Percent of Total Billed Charges,84% of total billed charges,152.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.03,89,,,Percent of total Billed Charges,89% of total Billed charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.78,77,,,Percent of total Billed charges,77% of total billed charges,157.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.36,165.03,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,51.54,25.77,,39.69,77,,,Percent of Total Billed Charges,77% of total billed charges,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.14,74,,,Percent of Total Billed Charges,74% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,43.29,84,,,Percent of Total Billed Charges,84% of total billed charges,42.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.87,89,,,Percent of total Billed Charges,89% of total Billed charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,77,,,Percent of total Billed charges,77% of total billed charges,43.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,45.87,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,185.43,92.72,,142.78,77,,,Percent of Total Billed Charges,77% of total billed charges,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.22,74,,,Percent of Total Billed Charges,74% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,155.76,84,,,Percent of Total Billed Charges,84% of total billed charges,152.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.03,89,,,Percent of total Billed Charges,89% of total Billed charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.78,77,,,Percent of total Billed charges,77% of total billed charges,157.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.36,165.03,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,51.54,25.77,,39.69,77,,,Percent of Total Billed Charges,77% of total billed charges,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.14,74,,,Percent of Total Billed Charges,74% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,43.29,84,,,Percent of Total Billed Charges,84% of total billed charges,42.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.87,89,,,Percent of total Billed Charges,89% of total Billed charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,77,,,Percent of total Billed charges,77% of total billed charges,43.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,45.87,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,185.43,92.72,,142.78,77,,,Percent of Total Billed Charges,77% of total billed charges,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.22,74,,,Percent of Total Billed Charges,74% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,155.76,84,,,Percent of Total Billed Charges,84% of total billed charges,152.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.03,89,,,Percent of total Billed Charges,89% of total Billed charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.78,77,,,Percent of total Billed charges,77% of total billed charges,157.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.36,165.03,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,51.54,25.77,,39.69,77,,,Percent of Total Billed Charges,77% of total billed charges,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.14,74,,,Percent of Total Billed Charges,74% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,43.29,84,,,Percent of Total Billed Charges,84% of total billed charges,42.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.87,89,,,Percent of total Billed Charges,89% of total Billed charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,77,,,Percent of total Billed charges,77% of total billed charges,43.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,45.87,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,185.43,92.72,,142.78,77,,,Percent of Total Billed Charges,77% of total billed charges,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.22,74,,,Percent of Total Billed Charges,74% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,155.76,84,,,Percent of Total Billed Charges,84% of total billed charges,152.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.03,89,,,Percent of total Billed Charges,89% of total Billed charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.78,77,,,Percent of total Billed charges,77% of total billed charges,157.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.36,165.03,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,51.54,25.77,,39.69,77,,,Percent of Total Billed Charges,77% of total billed charges,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.14,74,,,Percent of Total Billed Charges,74% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,43.29,84,,,Percent of Total Billed Charges,84% of total billed charges,42.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.87,89,,,Percent of total Billed Charges,89% of total Billed charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,77,,,Percent of total Billed charges,77% of total billed charges,43.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,45.87,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,185.43,92.72,,142.78,77,,,Percent of Total Billed Charges,77% of total billed charges,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,137.22,74,,,Percent of Total Billed Charges,74% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,127.95,69,,,Percent of Total Billed Charges,69% of total billed charges,155.76,84,,,Percent of Total Billed Charges,84% of total billed charges,152.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,165.03,89,,,Percent of total Billed Charges,89% of total Billed charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.78,77,,,Percent of total Billed charges,77% of total billed charges,157.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.36,165.03,
Fluorouracil Premix Bag,,,250,RC,,,Outpatient,,,51.54,25.77,,39.69,77,,,Percent of Total Billed Charges,77% of total billed charges,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.14,74,,,Percent of Total Billed Charges,74% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,35.56,69,,,Percent of Total Billed Charges,69% of total billed charges,43.29,84,,,Percent of Total Billed Charges,84% of total billed charges,42.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.87,89,,,Percent of total Billed Charges,89% of total Billed charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,77,,,Percent of total Billed charges,77% of total billed charges,43.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,45.87,
Fluticasone Nasal Spray 16gm,60505082901,CDM,250,RC,,,Outpatient,,,298.74,149.37,,230.03,77,,,Percent of Total Billed Charges,77% of total billed charges,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.07,74,,,Percent of Total Billed Charges,74% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,250.94,84,,,Percent of Total Billed Charges,84% of total billed charges,244.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.88,89,,,Percent of total Billed Charges,89% of total Billed charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.03,77,,,Percent of total Billed charges,77% of total billed charges,253.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,265.88,
Fluticasone Nasal Spray 16gm,60505082901,CDM,250,RC,,,Outpatient,,,298.74,149.37,,230.03,77,,,Percent of Total Billed Charges,77% of total billed charges,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.07,74,,,Percent of Total Billed Charges,74% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,250.94,84,,,Percent of Total Billed Charges,84% of total billed charges,244.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.88,89,,,Percent of total Billed Charges,89% of total Billed charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.03,77,,,Percent of total Billed charges,77% of total billed charges,253.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,265.88,
Fluticasone Nasal Spray 16gm,60505082901,CDM,250,RC,,,Outpatient,,,298.74,149.37,,230.03,77,,,Percent of Total Billed Charges,77% of total billed charges,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.07,74,,,Percent of Total Billed Charges,74% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,250.94,84,,,Percent of Total Billed Charges,84% of total billed charges,244.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.88,89,,,Percent of total Billed Charges,89% of total Billed charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.03,77,,,Percent of total Billed charges,77% of total billed charges,253.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,265.88,
Fluticasone Nasal Spray 16gm,60505082901,CDM,250,RC,,,Outpatient,,,298.74,149.37,,230.03,77,,,Percent of Total Billed Charges,77% of total billed charges,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.07,74,,,Percent of Total Billed Charges,74% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,250.94,84,,,Percent of Total Billed Charges,84% of total billed charges,244.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.88,89,,,Percent of total Billed Charges,89% of total Billed charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.03,77,,,Percent of total Billed charges,77% of total billed charges,253.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,265.88,
Fluticasone Nasal Spray 16gm,60505082901,CDM,250,RC,,,Outpatient,,,298.74,149.37,,230.03,77,,,Percent of Total Billed Charges,77% of total billed charges,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.07,74,,,Percent of Total Billed Charges,74% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,250.94,84,,,Percent of Total Billed Charges,84% of total billed charges,244.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.88,89,,,Percent of total Billed Charges,89% of total Billed charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.03,77,,,Percent of total Billed charges,77% of total billed charges,253.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,265.88,
Fluticasone Nasal Spray 16gm,60505082901,CDM,250,RC,,,Outpatient,,,298.74,149.37,,230.03,77,,,Percent of Total Billed Charges,77% of total billed charges,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.07,74,,,Percent of Total Billed Charges,74% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,206.13,69,,,Percent of Total Billed Charges,69% of total billed charges,250.94,84,,,Percent of Total Billed Charges,84% of total billed charges,244.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,265.88,89,,,Percent of total Billed Charges,89% of total Billed charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.03,77,,,Percent of total Billed charges,77% of total billed charges,253.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,265.88,
Nephro-Vite Tablet,,,250,RC,,,Outpatient,,,6.31,3.16,,4.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5.3,84,,,Percent of Total Billed Charges,84% of total billed charges,5.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.62,89,,,Percent of total Billed Charges,89% of total Billed charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.86,77,,,Percent of total Billed charges,77% of total billed charges,5.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.58,5.62,
Nephro-Vite Tablet,,,250,RC,,,Outpatient,,,6.31,3.16,,4.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5.3,84,,,Percent of Total Billed Charges,84% of total billed charges,5.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.62,89,,,Percent of total Billed Charges,89% of total Billed charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.86,77,,,Percent of total Billed charges,77% of total billed charges,5.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.58,5.62,
Nephro-Vite Tablet,,,250,RC,,,Outpatient,,,6.31,3.16,,4.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5.3,84,,,Percent of Total Billed Charges,84% of total billed charges,5.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.62,89,,,Percent of total Billed Charges,89% of total Billed charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.86,77,,,Percent of total Billed charges,77% of total billed charges,5.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.58,5.62,
Nephro-Vite Tablet,,,250,RC,,,Outpatient,,,6.31,3.16,,4.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5.3,84,,,Percent of Total Billed Charges,84% of total billed charges,5.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.62,89,,,Percent of total Billed Charges,89% of total Billed charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.86,77,,,Percent of total Billed charges,77% of total billed charges,5.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.58,5.62,
Nephro-Vite Tablet,,,250,RC,,,Outpatient,,,6.31,3.16,,4.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5.3,84,,,Percent of Total Billed Charges,84% of total billed charges,5.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.62,89,,,Percent of total Billed Charges,89% of total Billed charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.86,77,,,Percent of total Billed charges,77% of total billed charges,5.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.58,5.62,
Nephro-Vite Tablet,,,250,RC,,,Outpatient,,,6.31,3.16,,4.86,77,,,Percent of Total Billed Charges,77% of total billed charges,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.67,74,,,Percent of Total Billed Charges,74% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.35,69,,,Percent of Total Billed Charges,69% of total billed charges,5.3,84,,,Percent of Total Billed Charges,84% of total billed charges,5.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.62,89,,,Percent of total Billed Charges,89% of total Billed charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.86,77,,,Percent of total Billed charges,77% of total billed charges,5.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.58,5.62,
Folic Acid 1mg Tablet,60687068111,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Folic Acid 1mg Tablet,60687068111,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Folic Acid 1mg Tablet,60687068111,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Folic Acid 1mg Tablet,60687068111,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Folic Acid 1mg Tablet,60687068111,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Folic Acid 1mg Tablet,60687068111,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Folic Acid 50mg/10ml MDV,63323018410,CDM,250,RC,,,Outpatient,,,371.06,185.53,,285.72,77,,,Percent of Total Billed Charges,77% of total billed charges,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,274.58,74,,,Percent of Total Billed Charges,74% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,256.03,69,,,Percent of Total Billed Charges,69% of total billed charges,311.69,84,,,Percent of Total Billed Charges,84% of total billed charges,304.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,330.24,89,,,Percent of total Billed Charges,89% of total Billed charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.72,77,,,Percent of total Billed charges,77% of total billed charges,315.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,330.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.77,330.24,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8057.92,4028.96,,6204.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2518.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5962.86,74,,,Percent of Total Billed Charges,74% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,6768.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6607.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7171.55,89,,,Percent of total Billed Charges,89% of total Billed charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6204.6,77,,,Percent of total Billed charges,77% of total billed charges,6849.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2316.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4028.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2014.48,7171.55,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8392,4196,,6461.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6210.08,74,,,Percent of Total Billed Charges,74% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,7049.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6881.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,7468.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6461.84,77,,,Percent of total Billed charges,77% of total billed charges,7133.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2412.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4196,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2098,7468.88,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8057.92,4028.96,,6204.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2518.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5962.86,74,,,Percent of Total Billed Charges,74% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,6768.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6607.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7171.55,89,,,Percent of total Billed Charges,89% of total Billed charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6204.6,77,,,Percent of total Billed charges,77% of total billed charges,6849.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2316.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4028.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2014.48,7171.55,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8392,4196,,6461.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6210.08,74,,,Percent of Total Billed Charges,74% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,7049.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6881.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,7468.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6461.84,77,,,Percent of total Billed charges,77% of total billed charges,7133.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2412.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4196,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2098,7468.88,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8057.92,4028.96,,6204.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2518.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5962.86,74,,,Percent of Total Billed Charges,74% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,6768.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6607.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7171.55,89,,,Percent of total Billed Charges,89% of total Billed charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6204.6,77,,,Percent of total Billed charges,77% of total billed charges,6849.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2316.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4028.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2014.48,7171.55,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8392,4196,,6461.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6210.08,74,,,Percent of Total Billed Charges,74% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,7049.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6881.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,7468.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6461.84,77,,,Percent of total Billed charges,77% of total billed charges,7133.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2412.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4196,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2098,7468.88,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8057.92,4028.96,,6204.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2518.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5962.86,74,,,Percent of Total Billed Charges,74% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,6768.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6607.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7171.55,89,,,Percent of total Billed Charges,89% of total Billed charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6204.6,77,,,Percent of total Billed charges,77% of total billed charges,6849.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2316.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4028.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2014.48,7171.55,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8392,4196,,6461.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6210.08,74,,,Percent of Total Billed Charges,74% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,7049.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6881.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,7468.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6461.84,77,,,Percent of total Billed charges,77% of total billed charges,7133.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2412.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4196,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2098,7468.88,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8057.92,4028.96,,6204.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2518.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5962.86,74,,,Percent of Total Billed Charges,74% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,6768.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6607.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7171.55,89,,,Percent of total Billed Charges,89% of total Billed charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6204.6,77,,,Percent of total Billed charges,77% of total billed charges,6849.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2316.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4028.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2014.48,7171.55,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8392,4196,,6461.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6210.08,74,,,Percent of Total Billed Charges,74% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,7049.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6881.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,7468.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6461.84,77,,,Percent of total Billed charges,77% of total billed charges,7133.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2412.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4196,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2098,7468.88,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8057.92,4028.96,,6204.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2054.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2518.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5962.86,74,,,Percent of Total Billed Charges,74% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5559.96,69,,,Percent of Total Billed Charges,69% of total billed charges,6768.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6607.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7171.55,89,,,Percent of total Billed Charges,89% of total Billed charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6204.6,77,,,Percent of total Billed charges,77% of total billed charges,6849.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2316.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4028.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3287.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7171.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2014.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2014.48,7171.55,
Fomepizole 1.5gm/1.5ml SDV,70710147801,CDM,250,RC,,,Outpatient,,,8392,4196,,6461.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2139.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2622.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6210.08,74,,,Percent of Total Billed Charges,74% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,5790.48,69,,,Percent of Total Billed Charges,69% of total billed charges,7049.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6881.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,7468.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6461.84,77,,,Percent of total Billed charges,77% of total billed charges,7133.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2412.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4196,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3423.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7468.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2098,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2098,7468.88,
Fondaparinux 7.5mg/0.6ml Syringe,55111068002,CDM,250,RC,,,Outpatient,,,644.91,322.46,,496.58,77,,,Percent of Total Billed Charges,77% of total billed charges,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,477.23,74,,,Percent of Total Billed Charges,74% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,541.72,84,,,Percent of Total Billed Charges,84% of total billed charges,528.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,573.97,89,,,Percent of total Billed Charges,89% of total Billed charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.58,77,,,Percent of total Billed charges,77% of total billed charges,548.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,322.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,573.97,
Fondaparinux 7.5mg/0.6ml Syringe,55111068002,CDM,250,RC,,,Outpatient,,,644.91,322.46,,496.58,77,,,Percent of Total Billed Charges,77% of total billed charges,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,477.23,74,,,Percent of Total Billed Charges,74% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,541.72,84,,,Percent of Total Billed Charges,84% of total billed charges,528.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,573.97,89,,,Percent of total Billed Charges,89% of total Billed charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.58,77,,,Percent of total Billed charges,77% of total billed charges,548.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,322.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,573.97,
Fondaparinux 7.5mg/0.6ml Syringe,55111068002,CDM,250,RC,,,Outpatient,,,644.91,322.46,,496.58,77,,,Percent of Total Billed Charges,77% of total billed charges,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,477.23,74,,,Percent of Total Billed Charges,74% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,541.72,84,,,Percent of Total Billed Charges,84% of total billed charges,528.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,573.97,89,,,Percent of total Billed Charges,89% of total Billed charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.58,77,,,Percent of total Billed charges,77% of total billed charges,548.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,322.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,573.97,
Fondaparinux 7.5mg/0.6ml Syringe,55111068002,CDM,250,RC,,,Outpatient,,,644.91,322.46,,496.58,77,,,Percent of Total Billed Charges,77% of total billed charges,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,477.23,74,,,Percent of Total Billed Charges,74% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,541.72,84,,,Percent of Total Billed Charges,84% of total billed charges,528.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,573.97,89,,,Percent of total Billed Charges,89% of total Billed charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.58,77,,,Percent of total Billed charges,77% of total billed charges,548.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,322.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,573.97,
Fondaparinux 7.5mg/0.6ml Syringe,55111068002,CDM,250,RC,,,Outpatient,,,644.91,322.46,,496.58,77,,,Percent of Total Billed Charges,77% of total billed charges,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,477.23,74,,,Percent of Total Billed Charges,74% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,541.72,84,,,Percent of Total Billed Charges,84% of total billed charges,528.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,573.97,89,,,Percent of total Billed Charges,89% of total Billed charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.58,77,,,Percent of total Billed charges,77% of total billed charges,548.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,322.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,573.97,
Fondaparinux 7.5mg/0.6ml Syringe,55111068002,CDM,250,RC,,,Outpatient,,,644.91,322.46,,496.58,77,,,Percent of Total Billed Charges,77% of total billed charges,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,477.23,74,,,Percent of Total Billed Charges,74% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,444.99,69,,,Percent of Total Billed Charges,69% of total billed charges,541.72,84,,,Percent of Total Billed Charges,84% of total billed charges,528.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,573.97,89,,,Percent of total Billed Charges,89% of total Billed charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.58,77,,,Percent of total Billed charges,77% of total billed charges,548.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,322.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,263.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,573.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,573.97,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosaprepitant 150mg/5ml Powder Vial,338000801,CDM,250,RC,,,Outpatient,,,234.53,117.27,,180.59,77,,,Percent of Total Billed Charges,77% of total billed charges,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,173.55,74,,,Percent of Total Billed Charges,74% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,161.83,69,,,Percent of Total Billed Charges,69% of total billed charges,197.01,84,,,Percent of Total Billed Charges,84% of total billed charges,192.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,208.73,89,,,Percent of total Billed Charges,89% of total Billed charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,180.59,77,,,Percent of total Billed charges,77% of total billed charges,199.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,67.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,117.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,95.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.63,208.73,
Fosfomycin 3gm Oral Packet,,,250,RC,,,Outpatient,,,220.06,110.03,,169.45,77,,,Percent of Total Billed Charges,77% of total billed charges,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.84,74,,,Percent of Total Billed Charges,74% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184.85,84,,,Percent of Total Billed Charges,84% of total billed charges,180.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.85,89,,,Percent of total Billed Charges,89% of total Billed charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.45,77,,,Percent of total Billed charges,77% of total billed charges,187.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.02,195.85,
Fosfomycin 3gm Oral Packet,,,250,RC,,,Outpatient,,,220.06,110.03,,169.45,77,,,Percent of Total Billed Charges,77% of total billed charges,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.84,74,,,Percent of Total Billed Charges,74% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184.85,84,,,Percent of Total Billed Charges,84% of total billed charges,180.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.85,89,,,Percent of total Billed Charges,89% of total Billed charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.45,77,,,Percent of total Billed charges,77% of total billed charges,187.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.02,195.85,
Fosfomycin 3gm Oral Packet,,,250,RC,,,Outpatient,,,220.06,110.03,,169.45,77,,,Percent of Total Billed Charges,77% of total billed charges,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.84,74,,,Percent of Total Billed Charges,74% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184.85,84,,,Percent of Total Billed Charges,84% of total billed charges,180.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.85,89,,,Percent of total Billed Charges,89% of total Billed charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.45,77,,,Percent of total Billed charges,77% of total billed charges,187.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.02,195.85,
Fosfomycin 3gm Oral Packet,,,250,RC,,,Outpatient,,,220.06,110.03,,169.45,77,,,Percent of Total Billed Charges,77% of total billed charges,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.84,74,,,Percent of Total Billed Charges,74% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184.85,84,,,Percent of Total Billed Charges,84% of total billed charges,180.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.85,89,,,Percent of total Billed Charges,89% of total Billed charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.45,77,,,Percent of total Billed charges,77% of total billed charges,187.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.02,195.85,
Fosfomycin 3gm Oral Packet,,,250,RC,,,Outpatient,,,220.06,110.03,,169.45,77,,,Percent of Total Billed Charges,77% of total billed charges,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.84,74,,,Percent of Total Billed Charges,74% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184.85,84,,,Percent of Total Billed Charges,84% of total billed charges,180.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.85,89,,,Percent of total Billed Charges,89% of total Billed charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.45,77,,,Percent of total Billed charges,77% of total billed charges,187.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.02,195.85,
Fosfomycin 3gm Oral Packet,,,250,RC,,,Outpatient,,,220.06,110.03,,169.45,77,,,Percent of Total Billed Charges,77% of total billed charges,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.84,74,,,Percent of Total Billed Charges,74% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,151.84,69,,,Percent of Total Billed Charges,69% of total billed charges,184.85,84,,,Percent of Total Billed Charges,84% of total billed charges,180.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.85,89,,,Percent of total Billed Charges,89% of total Billed charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.45,77,,,Percent of total Billed charges,77% of total billed charges,187.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.02,195.85,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fosphenytoin 100mg PE/2ml SDV,68462062154,CDM,250,RC,,,Outpatient,,,155.16,77.58,,119.47,77,,,Percent of Total Billed Charges,77% of total billed charges,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,114.82,74,,,Percent of Total Billed Charges,74% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,107.06,69,,,Percent of Total Billed Charges,69% of total billed charges,130.33,84,,,Percent of Total Billed Charges,84% of total billed charges,127.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,138.09,89,,,Percent of total Billed Charges,89% of total Billed charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.47,77,,,Percent of total Billed charges,77% of total billed charges,131.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,77.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.79,138.09,
Fulvestrant (Faslodex) 250mg/5ml Syringe (2 Pack),43598026202,CDM,250,RC,,,Outpatient,,,524.44,262.22,,403.82,77,,,Percent of Total Billed Charges,77% of total billed charges,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.09,74,,,Percent of Total Billed Charges,74% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,440.53,84,,,Percent of Total Billed Charges,84% of total billed charges,430.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.75,89,,,Percent of total Billed Charges,89% of total Billed charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.82,77,,,Percent of total Billed charges,77% of total billed charges,445.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,262.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.11,466.75,
Fulvestrant (Faslodex) 250mg/5ml Syringe (2 Pack),43598026202,CDM,250,RC,,,Outpatient,,,524.44,262.22,,403.82,77,,,Percent of Total Billed Charges,77% of total billed charges,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.09,74,,,Percent of Total Billed Charges,74% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,440.53,84,,,Percent of Total Billed Charges,84% of total billed charges,430.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.75,89,,,Percent of total Billed Charges,89% of total Billed charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.82,77,,,Percent of total Billed charges,77% of total billed charges,445.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,262.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.11,466.75,
Fulvestrant (Faslodex) 250mg/5ml Syringe (2 Pack),43598026202,CDM,250,RC,,,Outpatient,,,524.44,262.22,,403.82,77,,,Percent of Total Billed Charges,77% of total billed charges,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.09,74,,,Percent of Total Billed Charges,74% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,440.53,84,,,Percent of Total Billed Charges,84% of total billed charges,430.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.75,89,,,Percent of total Billed Charges,89% of total Billed charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.82,77,,,Percent of total Billed charges,77% of total billed charges,445.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,262.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.11,466.75,
Fulvestrant (Faslodex) 250mg/5ml Syringe (2 Pack),43598026202,CDM,250,RC,,,Outpatient,,,524.44,262.22,,403.82,77,,,Percent of Total Billed Charges,77% of total billed charges,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.09,74,,,Percent of Total Billed Charges,74% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,440.53,84,,,Percent of Total Billed Charges,84% of total billed charges,430.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.75,89,,,Percent of total Billed Charges,89% of total Billed charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.82,77,,,Percent of total Billed charges,77% of total billed charges,445.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,262.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.11,466.75,
Fulvestrant (Faslodex) 250mg/5ml Syringe (2 Pack),43598026202,CDM,250,RC,,,Outpatient,,,524.44,262.22,,403.82,77,,,Percent of Total Billed Charges,77% of total billed charges,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.09,74,,,Percent of Total Billed Charges,74% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,440.53,84,,,Percent of Total Billed Charges,84% of total billed charges,430.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.75,89,,,Percent of total Billed Charges,89% of total Billed charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.82,77,,,Percent of total Billed charges,77% of total billed charges,445.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,262.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.11,466.75,
Fulvestrant (Faslodex) 250mg/5ml Syringe (2 Pack),43598026202,CDM,250,RC,,,Outpatient,,,524.44,262.22,,403.82,77,,,Percent of Total Billed Charges,77% of total billed charges,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,163.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,388.09,74,,,Percent of Total Billed Charges,74% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,361.86,69,,,Percent of Total Billed Charges,69% of total billed charges,440.53,84,,,Percent of Total Billed Charges,84% of total billed charges,430.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,466.75,89,,,Percent of total Billed Charges,89% of total Billed charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,403.82,77,,,Percent of total Billed charges,77% of total billed charges,445.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,150.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,262.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,213.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,466.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.11,466.75,
Furosemide 40mg/4ml SDV,409610204,CDM,250,RC,,,Outpatient,,,64.1,32.05,,49.36,77,,,Percent of Total Billed Charges,77% of total billed charges,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.43,74,,,Percent of Total Billed Charges,74% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,53.84,84,,,Percent of Total Billed Charges,84% of total billed charges,52.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.05,89,,,Percent of total Billed Charges,89% of total Billed charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,77,,,Percent of total Billed charges,77% of total billed charges,54.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,57.05,
Furosemide 40mg/4ml SDV,409610204,CDM,250,RC,,,Outpatient,,,64.1,32.05,,49.36,77,,,Percent of Total Billed Charges,77% of total billed charges,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.43,74,,,Percent of Total Billed Charges,74% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,53.84,84,,,Percent of Total Billed Charges,84% of total billed charges,52.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.05,89,,,Percent of total Billed Charges,89% of total Billed charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,77,,,Percent of total Billed charges,77% of total billed charges,54.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,57.05,
Furosemide 40mg/4ml SDV,409610204,CDM,250,RC,,,Outpatient,,,64.1,32.05,,49.36,77,,,Percent of Total Billed Charges,77% of total billed charges,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.43,74,,,Percent of Total Billed Charges,74% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,53.84,84,,,Percent of Total Billed Charges,84% of total billed charges,52.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.05,89,,,Percent of total Billed Charges,89% of total Billed charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,77,,,Percent of total Billed charges,77% of total billed charges,54.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,57.05,
Furosemide 40mg/4ml SDV,409610204,CDM,250,RC,,,Outpatient,,,64.1,32.05,,49.36,77,,,Percent of Total Billed Charges,77% of total billed charges,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.43,74,,,Percent of Total Billed Charges,74% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,53.84,84,,,Percent of Total Billed Charges,84% of total billed charges,52.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.05,89,,,Percent of total Billed Charges,89% of total Billed charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,77,,,Percent of total Billed charges,77% of total billed charges,54.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,57.05,
Furosemide 40mg/4ml SDV,409610204,CDM,250,RC,,,Outpatient,,,64.1,32.05,,49.36,77,,,Percent of Total Billed Charges,77% of total billed charges,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.43,74,,,Percent of Total Billed Charges,74% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,53.84,84,,,Percent of Total Billed Charges,84% of total billed charges,52.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.05,89,,,Percent of total Billed Charges,89% of total Billed charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,77,,,Percent of total Billed charges,77% of total billed charges,54.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,57.05,
Furosemide 40mg/4ml SDV,409610204,CDM,250,RC,,,Outpatient,,,64.1,32.05,,49.36,77,,,Percent of Total Billed Charges,77% of total billed charges,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.43,74,,,Percent of Total Billed Charges,74% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,44.23,69,,,Percent of Total Billed Charges,69% of total billed charges,53.84,84,,,Percent of Total Billed Charges,84% of total billed charges,52.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.05,89,,,Percent of total Billed Charges,89% of total Billed charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,77,,,Percent of total Billed charges,77% of total billed charges,54.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.03,57.05,
Furosemide 20mg/2ml SDV,409610225,CDM,250,RC,,,Outpatient,,,68.13,34.07,,52.46,77,,,Percent of Total Billed Charges,77% of total billed charges,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.42,74,,,Percent of Total Billed Charges,74% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,57.23,84,,,Percent of Total Billed Charges,84% of total billed charges,55.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.64,89,,,Percent of total Billed Charges,89% of total Billed charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.46,77,,,Percent of total Billed charges,77% of total billed charges,57.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.03,60.64,
Furosemide 20mg/2ml SDV,409610225,CDM,250,RC,,,Outpatient,,,68.13,34.07,,52.46,77,,,Percent of Total Billed Charges,77% of total billed charges,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.42,74,,,Percent of Total Billed Charges,74% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,57.23,84,,,Percent of Total Billed Charges,84% of total billed charges,55.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.64,89,,,Percent of total Billed Charges,89% of total Billed charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.46,77,,,Percent of total Billed charges,77% of total billed charges,57.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.03,60.64,
Furosemide 20mg/2ml SDV,409610225,CDM,250,RC,,,Outpatient,,,68.13,34.07,,52.46,77,,,Percent of Total Billed Charges,77% of total billed charges,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.42,74,,,Percent of Total Billed Charges,74% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,57.23,84,,,Percent of Total Billed Charges,84% of total billed charges,55.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.64,89,,,Percent of total Billed Charges,89% of total Billed charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.46,77,,,Percent of total Billed charges,77% of total billed charges,57.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.03,60.64,
Furosemide 20mg/2ml SDV,409610225,CDM,250,RC,,,Outpatient,,,68.13,34.07,,52.46,77,,,Percent of Total Billed Charges,77% of total billed charges,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.42,74,,,Percent of Total Billed Charges,74% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,57.23,84,,,Percent of Total Billed Charges,84% of total billed charges,55.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.64,89,,,Percent of total Billed Charges,89% of total Billed charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.46,77,,,Percent of total Billed charges,77% of total billed charges,57.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.03,60.64,
Furosemide 20mg/2ml SDV,409610225,CDM,250,RC,,,Outpatient,,,68.13,34.07,,52.46,77,,,Percent of Total Billed Charges,77% of total billed charges,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.42,74,,,Percent of Total Billed Charges,74% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,57.23,84,,,Percent of Total Billed Charges,84% of total billed charges,55.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.64,89,,,Percent of total Billed Charges,89% of total Billed charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.46,77,,,Percent of total Billed charges,77% of total billed charges,57.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.03,60.64,
Furosemide 20mg/2ml SDV,409610225,CDM,250,RC,,,Outpatient,,,68.13,34.07,,52.46,77,,,Percent of Total Billed Charges,77% of total billed charges,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.42,74,,,Percent of Total Billed Charges,74% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,47.01,69,,,Percent of Total Billed Charges,69% of total billed charges,57.23,84,,,Percent of Total Billed Charges,84% of total billed charges,55.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.64,89,,,Percent of total Billed Charges,89% of total Billed charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.46,77,,,Percent of total Billed charges,77% of total billed charges,57.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.03,60.64,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 100mg/10ml SDV,409610227,CDM,250,RC,,,Outpatient,,,81.12,40.56,,62.46,77,,,Percent of Total Billed Charges,77% of total billed charges,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.03,74,,,Percent of Total Billed Charges,74% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,55.97,69,,,Percent of Total Billed Charges,69% of total billed charges,68.14,84,,,Percent of Total Billed Charges,84% of total billed charges,66.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.2,89,,,Percent of total Billed Charges,89% of total Billed charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.46,77,,,Percent of total Billed charges,77% of total billed charges,68.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.28,72.2,
Furosemide 20mg Tablet,,,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Furosemide 20mg Tablet,,,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Furosemide 20mg Tablet,,,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Furosemide 20mg Tablet,,,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Furosemide 20mg Tablet,,,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Furosemide 20mg Tablet,,,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Furosemide 40mg Tablet,,,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Furosemide 40mg Tablet,,,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Furosemide 40mg Tablet,,,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Furosemide 40mg Tablet,,,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Furosemide 40mg Tablet,,,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Furosemide 40mg Tablet,,,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Gabapentin 100mg Capsule,67877022201,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Gabapentin 100mg Capsule,67877022201,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Gabapentin 100mg Capsule,67877022201,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Gabapentin 100mg Capsule,67877022201,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Gabapentin 100mg Capsule,67877022201,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Gabapentin 100mg Capsule,67877022201,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Gabapentin 300mg Capsule,904666661,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Gabapentin 300mg Capsule,904666661,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Gabapentin 300mg Capsule,904666661,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Gabapentin 300mg Capsule,904666661,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Gabapentin 300mg Capsule,904666661,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Gabapentin 300mg Capsule,904666661,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Galantamine 4mg Tablet,68084072921,CDM,250,RC,,,Outpatient,,,44.41,22.21,,34.2,77,,,Percent of Total Billed Charges,77% of total billed charges,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.86,74,,,Percent of Total Billed Charges,74% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,37.3,84,,,Percent of Total Billed Charges,84% of total billed charges,36.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.52,89,,,Percent of total Billed Charges,89% of total Billed charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.2,77,,,Percent of total Billed charges,77% of total billed charges,37.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,39.52,
Galantamine 4mg Tablet,68084072921,CDM,250,RC,,,Outpatient,,,44.41,22.21,,34.2,77,,,Percent of Total Billed Charges,77% of total billed charges,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.86,74,,,Percent of Total Billed Charges,74% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,37.3,84,,,Percent of Total Billed Charges,84% of total billed charges,36.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.52,89,,,Percent of total Billed Charges,89% of total Billed charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.2,77,,,Percent of total Billed charges,77% of total billed charges,37.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,39.52,
Galantamine 4mg Tablet,68084072921,CDM,250,RC,,,Outpatient,,,44.41,22.21,,34.2,77,,,Percent of Total Billed Charges,77% of total billed charges,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.86,74,,,Percent of Total Billed Charges,74% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,37.3,84,,,Percent of Total Billed Charges,84% of total billed charges,36.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.52,89,,,Percent of total Billed Charges,89% of total Billed charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.2,77,,,Percent of total Billed charges,77% of total billed charges,37.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,39.52,
Galantamine 4mg Tablet,68084072921,CDM,250,RC,,,Outpatient,,,44.41,22.21,,34.2,77,,,Percent of Total Billed Charges,77% of total billed charges,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.86,74,,,Percent of Total Billed Charges,74% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,37.3,84,,,Percent of Total Billed Charges,84% of total billed charges,36.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.52,89,,,Percent of total Billed Charges,89% of total Billed charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.2,77,,,Percent of total Billed charges,77% of total billed charges,37.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,39.52,
Galantamine 4mg Tablet,68084072921,CDM,250,RC,,,Outpatient,,,44.41,22.21,,34.2,77,,,Percent of Total Billed Charges,77% of total billed charges,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.86,74,,,Percent of Total Billed Charges,74% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,37.3,84,,,Percent of Total Billed Charges,84% of total billed charges,36.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.52,89,,,Percent of total Billed Charges,89% of total Billed charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.2,77,,,Percent of total Billed charges,77% of total billed charges,37.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,39.52,
Galantamine 4mg Tablet,68084072921,CDM,250,RC,,,Outpatient,,,44.41,22.21,,34.2,77,,,Percent of Total Billed Charges,77% of total billed charges,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.86,74,,,Percent of Total Billed Charges,74% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,30.64,69,,,Percent of Total Billed Charges,69% of total billed charges,37.3,84,,,Percent of Total Billed Charges,84% of total billed charges,36.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.52,89,,,Percent of total Billed Charges,89% of total Billed charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.2,77,,,Percent of total Billed charges,77% of total billed charges,37.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.1,39.52,
Gatifloxacin OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,412.08,206.04,,317.3,77,,,Percent of Total Billed Charges,77% of total billed charges,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.94,74,,,Percent of Total Billed Charges,74% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,346.15,84,,,Percent of Total Billed Charges,84% of total billed charges,337.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.75,89,,,Percent of total Billed Charges,89% of total Billed charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.3,77,,,Percent of total Billed charges,77% of total billed charges,350.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.02,366.75,
Gatifloxacin OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,412.08,206.04,,317.3,77,,,Percent of Total Billed Charges,77% of total billed charges,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.94,74,,,Percent of Total Billed Charges,74% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,346.15,84,,,Percent of Total Billed Charges,84% of total billed charges,337.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.75,89,,,Percent of total Billed Charges,89% of total Billed charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.3,77,,,Percent of total Billed charges,77% of total billed charges,350.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.02,366.75,
Gatifloxacin OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,412.08,206.04,,317.3,77,,,Percent of Total Billed Charges,77% of total billed charges,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.94,74,,,Percent of Total Billed Charges,74% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,346.15,84,,,Percent of Total Billed Charges,84% of total billed charges,337.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.75,89,,,Percent of total Billed Charges,89% of total Billed charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.3,77,,,Percent of total Billed charges,77% of total billed charges,350.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.02,366.75,
Gatifloxacin OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,412.08,206.04,,317.3,77,,,Percent of Total Billed Charges,77% of total billed charges,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.94,74,,,Percent of Total Billed Charges,74% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,346.15,84,,,Percent of Total Billed Charges,84% of total billed charges,337.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.75,89,,,Percent of total Billed Charges,89% of total Billed charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.3,77,,,Percent of total Billed charges,77% of total billed charges,350.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.02,366.75,
Gatifloxacin OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,412.08,206.04,,317.3,77,,,Percent of Total Billed Charges,77% of total billed charges,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.94,74,,,Percent of Total Billed Charges,74% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,346.15,84,,,Percent of Total Billed Charges,84% of total billed charges,337.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.75,89,,,Percent of total Billed Charges,89% of total Billed charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.3,77,,,Percent of total Billed charges,77% of total billed charges,350.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.02,366.75,
Gatifloxacin OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,412.08,206.04,,317.3,77,,,Percent of Total Billed Charges,77% of total billed charges,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,304.94,74,,,Percent of Total Billed Charges,74% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,284.34,69,,,Percent of Total Billed Charges,69% of total billed charges,346.15,84,,,Percent of Total Billed Charges,84% of total billed charges,337.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.75,89,,,Percent of total Billed Charges,89% of total Billed charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.3,77,,,Percent of total Billed charges,77% of total billed charges,350.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.02,366.75,
Gelatin Sponge (size 100 sq/cm),9034201,CDM,250,RC,,,Outpatient,,,164.03,82.02,,126.3,77,,,Percent of Total Billed Charges,77% of total billed charges,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.38,74,,,Percent of Total Billed Charges,74% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,137.79,84,,,Percent of Total Billed Charges,84% of total billed charges,134.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.99,89,,,Percent of total Billed Charges,89% of total Billed charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.3,77,,,Percent of total Billed charges,77% of total billed charges,139.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.01,145.99,
Gelatin Sponge (size 100 sq/cm),9034201,CDM,250,RC,,,Outpatient,,,164.03,82.02,,126.3,77,,,Percent of Total Billed Charges,77% of total billed charges,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.38,74,,,Percent of Total Billed Charges,74% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,137.79,84,,,Percent of Total Billed Charges,84% of total billed charges,134.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.99,89,,,Percent of total Billed Charges,89% of total Billed charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.3,77,,,Percent of total Billed charges,77% of total billed charges,139.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.01,145.99,
Gelatin Sponge (size 100 sq/cm),9034201,CDM,250,RC,,,Outpatient,,,164.03,82.02,,126.3,77,,,Percent of Total Billed Charges,77% of total billed charges,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.38,74,,,Percent of Total Billed Charges,74% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,137.79,84,,,Percent of Total Billed Charges,84% of total billed charges,134.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.99,89,,,Percent of total Billed Charges,89% of total Billed charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.3,77,,,Percent of total Billed charges,77% of total billed charges,139.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.01,145.99,
Gelatin Sponge (size 100 sq/cm),9034201,CDM,250,RC,,,Outpatient,,,164.03,82.02,,126.3,77,,,Percent of Total Billed Charges,77% of total billed charges,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.38,74,,,Percent of Total Billed Charges,74% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,137.79,84,,,Percent of Total Billed Charges,84% of total billed charges,134.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.99,89,,,Percent of total Billed Charges,89% of total Billed charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.3,77,,,Percent of total Billed charges,77% of total billed charges,139.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.01,145.99,
Gelatin Sponge (size 100 sq/cm),9034201,CDM,250,RC,,,Outpatient,,,164.03,82.02,,126.3,77,,,Percent of Total Billed Charges,77% of total billed charges,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.38,74,,,Percent of Total Billed Charges,74% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,137.79,84,,,Percent of Total Billed Charges,84% of total billed charges,134.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.99,89,,,Percent of total Billed Charges,89% of total Billed charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.3,77,,,Percent of total Billed charges,77% of total billed charges,139.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.01,145.99,
Gelatin Sponge (size 100 sq/cm),9034201,CDM,250,RC,,,Outpatient,,,164.03,82.02,,126.3,77,,,Percent of Total Billed Charges,77% of total billed charges,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.38,74,,,Percent of Total Billed Charges,74% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,113.18,69,,,Percent of Total Billed Charges,69% of total billed charges,137.79,84,,,Percent of Total Billed Charges,84% of total billed charges,134.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,145.99,89,,,Percent of total Billed Charges,89% of total Billed charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.3,77,,,Percent of total Billed charges,77% of total billed charges,139.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,66.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.01,145.99,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4936.1,2468.05,,3800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1542.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3652.71,74,,,Percent of Total Billed Charges,74% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4146.32,84,,,Percent of Total Billed Charges,84% of total billed charges,4047.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,4393.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3800.8,77,,,Percent of total Billed charges,77% of total billed charges,4195.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1419.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2468.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.03,4393.13,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4812.31,2406.16,,3705.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1503.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3561.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4042.34,84,,,Percent of Total Billed Charges,84% of total billed charges,3946.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,4282.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3705.48,77,,,Percent of total Billed charges,77% of total billed charges,4090.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1383.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2406.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1203.08,4282.96,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4936.1,2468.05,,3800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1542.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3652.71,74,,,Percent of Total Billed Charges,74% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4146.32,84,,,Percent of Total Billed Charges,84% of total billed charges,4047.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,4393.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3800.8,77,,,Percent of total Billed charges,77% of total billed charges,4195.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1419.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2468.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.03,4393.13,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4812.31,2406.16,,3705.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1503.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3561.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4042.34,84,,,Percent of Total Billed Charges,84% of total billed charges,3946.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,4282.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3705.48,77,,,Percent of total Billed charges,77% of total billed charges,4090.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1383.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2406.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1203.08,4282.96,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4936.1,2468.05,,3800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1542.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3652.71,74,,,Percent of Total Billed Charges,74% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4146.32,84,,,Percent of Total Billed Charges,84% of total billed charges,4047.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,4393.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3800.8,77,,,Percent of total Billed charges,77% of total billed charges,4195.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1419.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2468.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.03,4393.13,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4812.31,2406.16,,3705.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1503.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3561.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4042.34,84,,,Percent of Total Billed Charges,84% of total billed charges,3946.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,4282.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3705.48,77,,,Percent of total Billed charges,77% of total billed charges,4090.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1383.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2406.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1203.08,4282.96,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4936.1,2468.05,,3800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1542.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3652.71,74,,,Percent of Total Billed Charges,74% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4146.32,84,,,Percent of Total Billed Charges,84% of total billed charges,4047.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,4393.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3800.8,77,,,Percent of total Billed charges,77% of total billed charges,4195.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1419.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2468.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.03,4393.13,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4812.31,2406.16,,3705.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1503.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3561.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4042.34,84,,,Percent of Total Billed Charges,84% of total billed charges,3946.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,4282.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3705.48,77,,,Percent of total Billed charges,77% of total billed charges,4090.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1383.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2406.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1203.08,4282.96,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4936.1,2468.05,,3800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1542.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3652.71,74,,,Percent of Total Billed Charges,74% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4146.32,84,,,Percent of Total Billed Charges,84% of total billed charges,4047.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,4393.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3800.8,77,,,Percent of total Billed charges,77% of total billed charges,4195.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1419.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2468.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.03,4393.13,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4812.31,2406.16,,3705.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1503.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3561.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4042.34,84,,,Percent of Total Billed Charges,84% of total billed charges,3946.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,4282.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3705.48,77,,,Percent of total Billed charges,77% of total billed charges,4090.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1383.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2406.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1203.08,4282.96,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4936.1,2468.05,,3800.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1258.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1542.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3652.71,74,,,Percent of Total Billed Charges,74% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3405.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4146.32,84,,,Percent of Total Billed Charges,84% of total billed charges,4047.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,4393.13,89,,,Percent of total Billed Charges,89% of total Billed charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3800.8,77,,,Percent of total Billed charges,77% of total billed charges,4195.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1419.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2468.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2013.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4393.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1234.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1234.03,4393.13,
Gemcitabine 1000mg/26.3ml Liquid SDV,409018125,CDM,250,RC,,,Outpatient,,,4812.31,2406.16,,3705.48,77,,,Percent of Total Billed Charges,77% of total billed charges,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1227.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1503.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3561.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,3320.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4042.34,84,,,Percent of Total Billed Charges,84% of total billed charges,3946.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,4282.96,89,,,Percent of total Billed Charges,89% of total Billed charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3705.48,77,,,Percent of total Billed charges,77% of total billed charges,4090.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1383.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2406.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1963.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4282.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1203.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1203.08,4282.96,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1135.35,567.68,,874.22,77,,,Percent of Total Billed Charges,77% of total billed charges,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,840.16,74,,,Percent of Total Billed Charges,74% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,953.69,84,,,Percent of Total Billed Charges,84% of total billed charges,930.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1010.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,874.22,77,,,Percent of total Billed charges,77% of total billed charges,965.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,567.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.84,1010.46,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1109.85,554.93,,854.58,77,,,Percent of Total Billed Charges,77% of total billed charges,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,821.29,74,,,Percent of Total Billed Charges,74% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,932.27,84,,,Percent of Total Billed Charges,84% of total billed charges,910.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,987.77,89,,,Percent of total Billed Charges,89% of total Billed charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.58,77,,,Percent of total Billed charges,77% of total billed charges,943.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,554.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.46,987.77,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1135.35,567.68,,874.22,77,,,Percent of Total Billed Charges,77% of total billed charges,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,840.16,74,,,Percent of Total Billed Charges,74% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,953.69,84,,,Percent of Total Billed Charges,84% of total billed charges,930.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1010.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,874.22,77,,,Percent of total Billed charges,77% of total billed charges,965.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,567.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.84,1010.46,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1109.85,554.93,,854.58,77,,,Percent of Total Billed Charges,77% of total billed charges,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,821.29,74,,,Percent of Total Billed Charges,74% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,932.27,84,,,Percent of Total Billed Charges,84% of total billed charges,910.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,987.77,89,,,Percent of total Billed Charges,89% of total Billed charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.58,77,,,Percent of total Billed charges,77% of total billed charges,943.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,554.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.46,987.77,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1135.35,567.68,,874.22,77,,,Percent of Total Billed Charges,77% of total billed charges,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,840.16,74,,,Percent of Total Billed Charges,74% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,953.69,84,,,Percent of Total Billed Charges,84% of total billed charges,930.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1010.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,874.22,77,,,Percent of total Billed charges,77% of total billed charges,965.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,567.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.84,1010.46,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1109.85,554.93,,854.58,77,,,Percent of Total Billed Charges,77% of total billed charges,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,821.29,74,,,Percent of Total Billed Charges,74% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,932.27,84,,,Percent of Total Billed Charges,84% of total billed charges,910.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,987.77,89,,,Percent of total Billed Charges,89% of total Billed charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.58,77,,,Percent of total Billed charges,77% of total billed charges,943.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,554.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.46,987.77,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1135.35,567.68,,874.22,77,,,Percent of Total Billed Charges,77% of total billed charges,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,840.16,74,,,Percent of Total Billed Charges,74% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,953.69,84,,,Percent of Total Billed Charges,84% of total billed charges,930.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1010.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,874.22,77,,,Percent of total Billed charges,77% of total billed charges,965.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,567.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.84,1010.46,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1109.85,554.93,,854.58,77,,,Percent of Total Billed Charges,77% of total billed charges,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,821.29,74,,,Percent of Total Billed Charges,74% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,932.27,84,,,Percent of Total Billed Charges,84% of total billed charges,910.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,987.77,89,,,Percent of total Billed Charges,89% of total Billed charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.58,77,,,Percent of total Billed charges,77% of total billed charges,943.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,554.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.46,987.77,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1135.35,567.68,,874.22,77,,,Percent of Total Billed Charges,77% of total billed charges,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,840.16,74,,,Percent of Total Billed Charges,74% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,953.69,84,,,Percent of Total Billed Charges,84% of total billed charges,930.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1010.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,874.22,77,,,Percent of total Billed charges,77% of total billed charges,965.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,567.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.84,1010.46,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1109.85,554.93,,854.58,77,,,Percent of Total Billed Charges,77% of total billed charges,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,821.29,74,,,Percent of Total Billed Charges,74% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,932.27,84,,,Percent of Total Billed Charges,84% of total billed charges,910.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,987.77,89,,,Percent of total Billed Charges,89% of total Billed charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.58,77,,,Percent of total Billed charges,77% of total billed charges,943.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,554.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.46,987.77,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1135.35,567.68,,874.22,77,,,Percent of Total Billed Charges,77% of total billed charges,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,289.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,354.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,840.16,74,,,Percent of Total Billed Charges,74% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,783.39,69,,,Percent of Total Billed Charges,69% of total billed charges,953.69,84,,,Percent of Total Billed Charges,84% of total billed charges,930.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,1010.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,874.22,77,,,Percent of total Billed charges,77% of total billed charges,965.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,326.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,567.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,463.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1010.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,283.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,283.84,1010.46,
Gemcitabine 200mg/5.26ml Liquid SDV,409018325,CDM,250,RC,,,Outpatient,,,1109.85,554.93,,854.58,77,,,Percent of Total Billed Charges,77% of total billed charges,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,283.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,346.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,821.29,74,,,Percent of Total Billed Charges,74% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,765.8,69,,,Percent of Total Billed Charges,69% of total billed charges,932.27,84,,,Percent of Total Billed Charges,84% of total billed charges,910.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,987.77,89,,,Percent of total Billed Charges,89% of total Billed charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.58,77,,,Percent of total Billed charges,77% of total billed charges,943.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,319.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,554.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,452.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,987.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.46,987.77,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3416.93,1708.47,,2631.04,77,,,Percent of Total Billed Charges,77% of total billed charges,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1067.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2528.53,74,,,Percent of Total Billed Charges,74% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.22,84,,,Percent of Total Billed Charges,84% of total billed charges,2801.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,3041.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2631.04,77,,,Percent of total Billed charges,77% of total billed charges,2904.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,982.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1708.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.23,3041.07,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3332.43,1666.22,,2565.97,77,,,Percent of Total Billed Charges,77% of total billed charges,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1041.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2466,74,,,Percent of Total Billed Charges,74% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2799.24,84,,,Percent of Total Billed Charges,84% of total billed charges,2732.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2965.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2565.97,77,,,Percent of total Billed charges,77% of total billed charges,2832.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,958.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1666.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.11,2965.86,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3416.93,1708.47,,2631.04,77,,,Percent of Total Billed Charges,77% of total billed charges,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1067.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2528.53,74,,,Percent of Total Billed Charges,74% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.22,84,,,Percent of Total Billed Charges,84% of total billed charges,2801.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,3041.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2631.04,77,,,Percent of total Billed charges,77% of total billed charges,2904.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,982.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1708.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.23,3041.07,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3332.43,1666.22,,2565.97,77,,,Percent of Total Billed Charges,77% of total billed charges,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1041.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2466,74,,,Percent of Total Billed Charges,74% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2799.24,84,,,Percent of Total Billed Charges,84% of total billed charges,2732.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2965.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2565.97,77,,,Percent of total Billed charges,77% of total billed charges,2832.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,958.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1666.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.11,2965.86,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3416.93,1708.47,,2631.04,77,,,Percent of Total Billed Charges,77% of total billed charges,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1067.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2528.53,74,,,Percent of Total Billed Charges,74% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.22,84,,,Percent of Total Billed Charges,84% of total billed charges,2801.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,3041.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2631.04,77,,,Percent of total Billed charges,77% of total billed charges,2904.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,982.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1708.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.23,3041.07,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3332.43,1666.22,,2565.97,77,,,Percent of Total Billed Charges,77% of total billed charges,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1041.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2466,74,,,Percent of Total Billed Charges,74% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2799.24,84,,,Percent of Total Billed Charges,84% of total billed charges,2732.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2965.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2565.97,77,,,Percent of total Billed charges,77% of total billed charges,2832.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,958.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1666.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.11,2965.86,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3416.93,1708.47,,2631.04,77,,,Percent of Total Billed Charges,77% of total billed charges,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1067.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2528.53,74,,,Percent of Total Billed Charges,74% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.22,84,,,Percent of Total Billed Charges,84% of total billed charges,2801.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,3041.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2631.04,77,,,Percent of total Billed charges,77% of total billed charges,2904.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,982.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1708.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.23,3041.07,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3332.43,1666.22,,2565.97,77,,,Percent of Total Billed Charges,77% of total billed charges,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1041.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2466,74,,,Percent of Total Billed Charges,74% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2799.24,84,,,Percent of Total Billed Charges,84% of total billed charges,2732.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2965.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2565.97,77,,,Percent of total Billed charges,77% of total billed charges,2832.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,958.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1666.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.11,2965.86,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3416.93,1708.47,,2631.04,77,,,Percent of Total Billed Charges,77% of total billed charges,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1067.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2528.53,74,,,Percent of Total Billed Charges,74% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.22,84,,,Percent of Total Billed Charges,84% of total billed charges,2801.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,3041.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2631.04,77,,,Percent of total Billed charges,77% of total billed charges,2904.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,982.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1708.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.23,3041.07,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3332.43,1666.22,,2565.97,77,,,Percent of Total Billed Charges,77% of total billed charges,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1041.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2466,74,,,Percent of Total Billed Charges,74% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2799.24,84,,,Percent of Total Billed Charges,84% of total billed charges,2732.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2965.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2565.97,77,,,Percent of total Billed charges,77% of total billed charges,2832.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,958.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1666.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.11,2965.86,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3416.93,1708.47,,2631.04,77,,,Percent of Total Billed Charges,77% of total billed charges,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,871.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1067.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2528.53,74,,,Percent of Total Billed Charges,74% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2357.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2870.22,84,,,Percent of Total Billed Charges,84% of total billed charges,2801.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,3041.07,89,,,Percent of total Billed Charges,89% of total Billed charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2631.04,77,,,Percent of total Billed charges,77% of total billed charges,2904.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,982.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1708.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1394.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3041.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,854.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,854.23,3041.07,
Gemcitabine 2000mg/52.6ml Liquid Vial,409018201,CDM,250,RC,,,Outpatient,,,3332.43,1666.22,,2565.97,77,,,Percent of Total Billed Charges,77% of total billed charges,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,849.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1041.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2466,74,,,Percent of Total Billed Charges,74% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2299.38,69,,,Percent of Total Billed Charges,69% of total billed charges,2799.24,84,,,Percent of Total Billed Charges,84% of total billed charges,2732.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,2965.86,89,,,Percent of total Billed Charges,89% of total Billed charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2565.97,77,,,Percent of total Billed charges,77% of total billed charges,2832.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,958.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1666.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1359.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2965.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,833.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.11,2965.86,
Gentamicin 0.1% Topical Ointment 15gm,45802004635,CDM,250,RC,,,Outpatient,,,192.4,96.2,,148.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.38,74,,,Percent of Total Billed Charges,74% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,161.62,84,,,Percent of Total Billed Charges,84% of total billed charges,157.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.15,77,,,Percent of total Billed charges,77% of total billed charges,163.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,171.24,
Gentamicin 0.1% Topical Ointment 15gm,45802004635,CDM,250,RC,,,Outpatient,,,192.4,96.2,,148.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.38,74,,,Percent of Total Billed Charges,74% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,161.62,84,,,Percent of Total Billed Charges,84% of total billed charges,157.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.15,77,,,Percent of total Billed charges,77% of total billed charges,163.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,171.24,
Gentamicin 0.1% Topical Ointment 15gm,45802004635,CDM,250,RC,,,Outpatient,,,192.4,96.2,,148.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.38,74,,,Percent of Total Billed Charges,74% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,161.62,84,,,Percent of Total Billed Charges,84% of total billed charges,157.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.15,77,,,Percent of total Billed charges,77% of total billed charges,163.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,171.24,
Gentamicin 0.1% Topical Ointment 15gm,45802004635,CDM,250,RC,,,Outpatient,,,192.4,96.2,,148.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.38,74,,,Percent of Total Billed Charges,74% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,161.62,84,,,Percent of Total Billed Charges,84% of total billed charges,157.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.15,77,,,Percent of total Billed charges,77% of total billed charges,163.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,171.24,
Gentamicin 0.1% Topical Ointment 15gm,45802004635,CDM,250,RC,,,Outpatient,,,192.4,96.2,,148.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.38,74,,,Percent of Total Billed Charges,74% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,161.62,84,,,Percent of Total Billed Charges,84% of total billed charges,157.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.15,77,,,Percent of total Billed charges,77% of total billed charges,163.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,171.24,
Gentamicin 0.1% Topical Ointment 15gm,45802004635,CDM,250,RC,,,Outpatient,,,192.4,96.2,,148.15,77,,,Percent of Total Billed Charges,77% of total billed charges,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,142.38,74,,,Percent of Total Billed Charges,74% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,132.76,69,,,Percent of Total Billed Charges,69% of total billed charges,161.62,84,,,Percent of Total Billed Charges,84% of total billed charges,157.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,171.24,89,,,Percent of total Billed Charges,89% of total Billed charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.15,77,,,Percent of total Billed charges,77% of total billed charges,163.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,96.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,78.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,171.24,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 20mg/2ml PEDIATRIC SDV,63323017302,CDM,250,RC,,,Outpatient,,,90.74,45.37,,69.87,77,,,Percent of Total Billed Charges,77% of total billed charges,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.15,74,,,Percent of Total Billed Charges,74% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,69,,,Percent of Total Billed Charges,69% of total billed charges,76.22,84,,,Percent of Total Billed Charges,84% of total billed charges,74.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.76,89,,,Percent of total Billed Charges,89% of total Billed charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.87,77,,,Percent of total Billed charges,77% of total billed charges,77.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.69,80.76,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 80mg/2ml MDV,409120703,CDM,250,RC,,,Outpatient,,,68.29,34.15,,52.58,77,,,Percent of Total Billed Charges,77% of total billed charges,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.53,74,,,Percent of Total Billed Charges,74% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,47.12,69,,,Percent of Total Billed Charges,69% of total billed charges,57.36,84,,,Percent of Total Billed Charges,84% of total billed charges,56,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.78,89,,,Percent of total Billed Charges,89% of total Billed charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.58,77,,,Percent of total Billed charges,77% of total billed charges,58.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.07,60.78,
Gentamicin 0.3% OPHTH Soln 5ml,61314063305,CDM,250,RC,,,Outpatient,,,183.47,91.74,,141.27,77,,,Percent of Total Billed Charges,77% of total billed charges,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.77,74,,,Percent of Total Billed Charges,74% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,154.11,84,,,Percent of Total Billed Charges,84% of total billed charges,150.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.29,89,,,Percent of total Billed Charges,89% of total Billed charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.27,77,,,Percent of total Billed charges,77% of total billed charges,155.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,163.29,
Gentamicin 0.3% OPHTH Soln 5ml,61314063305,CDM,250,RC,,,Outpatient,,,183.47,91.74,,141.27,77,,,Percent of Total Billed Charges,77% of total billed charges,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.77,74,,,Percent of Total Billed Charges,74% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,154.11,84,,,Percent of Total Billed Charges,84% of total billed charges,150.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.29,89,,,Percent of total Billed Charges,89% of total Billed charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.27,77,,,Percent of total Billed charges,77% of total billed charges,155.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,163.29,
Gentamicin 0.3% OPHTH Soln 5ml,61314063305,CDM,250,RC,,,Outpatient,,,183.47,91.74,,141.27,77,,,Percent of Total Billed Charges,77% of total billed charges,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.77,74,,,Percent of Total Billed Charges,74% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,154.11,84,,,Percent of Total Billed Charges,84% of total billed charges,150.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.29,89,,,Percent of total Billed Charges,89% of total Billed charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.27,77,,,Percent of total Billed charges,77% of total billed charges,155.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,163.29,
Gentamicin 0.3% OPHTH Soln 5ml,61314063305,CDM,250,RC,,,Outpatient,,,183.47,91.74,,141.27,77,,,Percent of Total Billed Charges,77% of total billed charges,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.77,74,,,Percent of Total Billed Charges,74% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,154.11,84,,,Percent of Total Billed Charges,84% of total billed charges,150.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.29,89,,,Percent of total Billed Charges,89% of total Billed charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.27,77,,,Percent of total Billed charges,77% of total billed charges,155.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,163.29,
Gentamicin 0.3% OPHTH Soln 5ml,61314063305,CDM,250,RC,,,Outpatient,,,183.47,91.74,,141.27,77,,,Percent of Total Billed Charges,77% of total billed charges,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.77,74,,,Percent of Total Billed Charges,74% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,154.11,84,,,Percent of Total Billed Charges,84% of total billed charges,150.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.29,89,,,Percent of total Billed Charges,89% of total Billed charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.27,77,,,Percent of total Billed charges,77% of total billed charges,155.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,163.29,
Gentamicin 0.3% OPHTH Soln 5ml,61314063305,CDM,250,RC,,,Outpatient,,,183.47,91.74,,141.27,77,,,Percent of Total Billed Charges,77% of total billed charges,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,135.77,74,,,Percent of Total Billed Charges,74% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,126.59,69,,,Percent of Total Billed Charges,69% of total billed charges,154.11,84,,,Percent of Total Billed Charges,84% of total billed charges,150.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,163.29,89,,,Percent of total Billed Charges,89% of total Billed charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,141.27,77,,,Percent of total Billed charges,77% of total billed charges,155.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,91.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,74.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,163.29,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Gentamicin 80mg/100ml IV Bag,338050348,CDM,250,RC,,,Outpatient,,,142.09,71.05,,109.41,77,,,Percent of Total Billed Charges,77% of total billed charges,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.15,74,,,Percent of Total Billed Charges,74% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,98.04,69,,,Percent of Total Billed Charges,69% of total billed charges,119.36,84,,,Percent of Total Billed Charges,84% of total billed charges,116.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.46,89,,,Percent of total Billed Charges,89% of total Billed charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.41,77,,,Percent of total Billed charges,77% of total billed charges,120.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.52,126.46,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1165.54,582.77,,897.47,77,,,Percent of Total Billed Charges,77% of total billed charges,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,862.5,74,,,Percent of Total Billed Charges,74% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,979.05,84,,,Percent of Total Billed Charges,84% of total billed charges,955.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1037.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.47,77,,,Percent of total Billed charges,77% of total billed charges,990.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,582.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.39,1037.33,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1212.44,606.22,,933.58,77,,,Percent of Total Billed Charges,77% of total billed charges,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,897.21,74,,,Percent of Total Billed Charges,74% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.45,84,,,Percent of Total Billed Charges,84% of total billed charges,994.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1079.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.58,77,,,Percent of total Billed charges,77% of total billed charges,1030.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,606.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.11,1079.07,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1165.54,582.77,,897.47,77,,,Percent of Total Billed Charges,77% of total billed charges,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,862.5,74,,,Percent of Total Billed Charges,74% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,979.05,84,,,Percent of Total Billed Charges,84% of total billed charges,955.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1037.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.47,77,,,Percent of total Billed charges,77% of total billed charges,990.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,582.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.39,1037.33,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1212.44,606.22,,933.58,77,,,Percent of Total Billed Charges,77% of total billed charges,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,897.21,74,,,Percent of Total Billed Charges,74% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.45,84,,,Percent of Total Billed Charges,84% of total billed charges,994.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1079.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.58,77,,,Percent of total Billed charges,77% of total billed charges,1030.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,606.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.11,1079.07,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1165.54,582.77,,897.47,77,,,Percent of Total Billed Charges,77% of total billed charges,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,862.5,74,,,Percent of Total Billed Charges,74% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,979.05,84,,,Percent of Total Billed Charges,84% of total billed charges,955.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1037.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.47,77,,,Percent of total Billed charges,77% of total billed charges,990.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,582.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.39,1037.33,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1212.44,606.22,,933.58,77,,,Percent of Total Billed Charges,77% of total billed charges,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,897.21,74,,,Percent of Total Billed Charges,74% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.45,84,,,Percent of Total Billed Charges,84% of total billed charges,994.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1079.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.58,77,,,Percent of total Billed charges,77% of total billed charges,1030.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,606.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.11,1079.07,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1165.54,582.77,,897.47,77,,,Percent of Total Billed Charges,77% of total billed charges,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,862.5,74,,,Percent of Total Billed Charges,74% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,979.05,84,,,Percent of Total Billed Charges,84% of total billed charges,955.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1037.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.47,77,,,Percent of total Billed charges,77% of total billed charges,990.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,582.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.39,1037.33,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1212.44,606.22,,933.58,77,,,Percent of Total Billed Charges,77% of total billed charges,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,897.21,74,,,Percent of Total Billed Charges,74% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.45,84,,,Percent of Total Billed Charges,84% of total billed charges,994.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1079.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.58,77,,,Percent of total Billed charges,77% of total billed charges,1030.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,606.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.11,1079.07,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1165.54,582.77,,897.47,77,,,Percent of Total Billed Charges,77% of total billed charges,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,862.5,74,,,Percent of Total Billed Charges,74% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,979.05,84,,,Percent of Total Billed Charges,84% of total billed charges,955.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1037.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.47,77,,,Percent of total Billed charges,77% of total billed charges,990.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,582.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.39,1037.33,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1212.44,606.22,,933.58,77,,,Percent of Total Billed Charges,77% of total billed charges,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,897.21,74,,,Percent of Total Billed Charges,74% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.45,84,,,Percent of Total Billed Charges,84% of total billed charges,994.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1079.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.58,77,,,Percent of total Billed charges,77% of total billed charges,1030.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,606.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.11,1079.07,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1165.54,582.77,,897.47,77,,,Percent of Total Billed Charges,77% of total billed charges,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,297.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,364.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,862.5,74,,,Percent of Total Billed Charges,74% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,804.22,69,,,Percent of Total Billed Charges,69% of total billed charges,979.05,84,,,Percent of Total Billed Charges,84% of total billed charges,955.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,1037.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,897.47,77,,,Percent of total Billed charges,77% of total billed charges,990.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,335.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,582.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,475.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1037.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,291.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.39,1037.33,
Glucagon 1mg SDV,63323059303,CDM,250,RC,,,Outpatient,,,1212.44,606.22,,933.58,77,,,Percent of Total Billed Charges,77% of total billed charges,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,309.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,378.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,897.21,74,,,Percent of Total Billed Charges,74% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,836.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1018.45,84,,,Percent of Total Billed Charges,84% of total billed charges,994.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,1079.07,89,,,Percent of total Billed Charges,89% of total Billed charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,933.58,77,,,Percent of total Billed charges,77% of total billed charges,1030.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,348.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,606.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,494.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,303.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,303.11,1079.07,
Glycopyrrolate 0.2mg/ml SDV,143968225,CDM,250,RC,,,Outpatient,,,61.38,30.69,,47.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.42,74,,,Percent of Total Billed Charges,74% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,84,,,Percent of Total Billed Charges,84% of total billed charges,50.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.63,89,,,Percent of total Billed Charges,89% of total Billed charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.26,77,,,Percent of total Billed charges,77% of total billed charges,52.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.35,54.63,
Glycopyrrolate 0.2mg/ml SDV,143968225,CDM,250,RC,,,Outpatient,,,61.38,30.69,,47.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.42,74,,,Percent of Total Billed Charges,74% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,84,,,Percent of Total Billed Charges,84% of total billed charges,50.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.63,89,,,Percent of total Billed Charges,89% of total Billed charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.26,77,,,Percent of total Billed charges,77% of total billed charges,52.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.35,54.63,
Glycopyrrolate 0.2mg/ml SDV,143968225,CDM,250,RC,,,Outpatient,,,61.38,30.69,,47.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.42,74,,,Percent of Total Billed Charges,74% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,84,,,Percent of Total Billed Charges,84% of total billed charges,50.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.63,89,,,Percent of total Billed Charges,89% of total Billed charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.26,77,,,Percent of total Billed charges,77% of total billed charges,52.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.35,54.63,
Glycopyrrolate 0.2mg/ml SDV,143968225,CDM,250,RC,,,Outpatient,,,61.38,30.69,,47.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.42,74,,,Percent of Total Billed Charges,74% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,84,,,Percent of Total Billed Charges,84% of total billed charges,50.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.63,89,,,Percent of total Billed Charges,89% of total Billed charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.26,77,,,Percent of total Billed charges,77% of total billed charges,52.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.35,54.63,
Glycopyrrolate 0.2mg/ml SDV,143968225,CDM,250,RC,,,Outpatient,,,61.38,30.69,,47.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.42,74,,,Percent of Total Billed Charges,74% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,84,,,Percent of Total Billed Charges,84% of total billed charges,50.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.63,89,,,Percent of total Billed Charges,89% of total Billed charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.26,77,,,Percent of total Billed charges,77% of total billed charges,52.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.35,54.63,
Glycopyrrolate 0.2mg/ml SDV,143968225,CDM,250,RC,,,Outpatient,,,61.38,30.69,,47.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.42,74,,,Percent of Total Billed Charges,74% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,42.35,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,84,,,Percent of Total Billed Charges,84% of total billed charges,50.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.63,89,,,Percent of total Billed Charges,89% of total Billed charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.26,77,,,Percent of total Billed charges,77% of total billed charges,52.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.35,54.63,
Artificial Tears OPHTH Soln 15ml,10119002003,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Artificial Tears OPHTH Soln 15ml,10119002003,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Artificial Tears OPHTH Soln 15ml,10119002003,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Artificial Tears OPHTH Soln 15ml,10119002003,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Artificial Tears OPHTH Soln 15ml,10119002003,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Artificial Tears OPHTH Soln 15ml,10119002003,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Glycerin Topical Soln 177ml Bottle,395103196,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Glycerin Topical Soln 177ml Bottle,395103196,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Glycerin Topical Soln 177ml Bottle,395103196,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Glycerin Topical Soln 177ml Bottle,395103196,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Glycerin Topical Soln 177ml Bottle,395103196,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Glycerin Topical Soln 177ml Bottle,395103196,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Glycerin 2gm Suppository 12/Jar,58980041012,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Glycerin 2gm Suppository 12/Jar,58980041012,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Glycerin 2gm Suppository 12/Jar,58980041012,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Glycerin 2gm Suppository 12/Jar,58980041012,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Glycerin 2gm Suppository 12/Jar,58980041012,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Glycerin 2gm Suppository 12/Jar,58980041012,CDM,250,RC,,,Outpatient,,,6.88,3.44,,5.3,77,,,Percent of Total Billed Charges,77% of total billed charges,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.09,74,,,Percent of Total Billed Charges,74% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,84,,,Percent of Total Billed Charges,84% of total billed charges,5.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.12,89,,,Percent of total Billed Charges,89% of total Billed charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.3,77,,,Percent of total Billed charges,77% of total billed charges,5.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.72,6.12,
Fleet Babylax Glycerin Suppository (Ages 2-5),132019012,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fleet Babylax Glycerin Suppository (Ages 2-5),132019012,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fleet Babylax Glycerin Suppository (Ages 2-5),132019012,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fleet Babylax Glycerin Suppository (Ages 2-5),132019012,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fleet Babylax Glycerin Suppository (Ages 2-5),132019012,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fleet Babylax Glycerin Suppository (Ages 2-5),132019012,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9634.46,4817.23,,7418.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3010.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7129.5,74,,,Percent of Total Billed Charges,74% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8092.95,84,,,Percent of Total Billed Charges,84% of total billed charges,7900.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8574.67,89,,,Percent of total Billed Charges,89% of total Billed charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7418.53,77,,,Percent of total Billed charges,77% of total billed charges,8189.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2769.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4817.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2408.62,8574.67,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9389.16,4694.58,,7229.65,77,,,Percent of Total Billed Charges,77% of total billed charges,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2934.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6947.98,74,,,Percent of Total Billed Charges,74% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7886.89,84,,,Percent of Total Billed Charges,84% of total billed charges,7699.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,8356.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7229.65,77,,,Percent of total Billed charges,77% of total billed charges,7980.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2699.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4694.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2347.29,8356.35,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9634.46,4817.23,,7418.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3010.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7129.5,74,,,Percent of Total Billed Charges,74% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8092.95,84,,,Percent of Total Billed Charges,84% of total billed charges,7900.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8574.67,89,,,Percent of total Billed Charges,89% of total Billed charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7418.53,77,,,Percent of total Billed charges,77% of total billed charges,8189.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2769.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4817.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2408.62,8574.67,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9389.16,4694.58,,7229.65,77,,,Percent of Total Billed Charges,77% of total billed charges,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2934.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6947.98,74,,,Percent of Total Billed Charges,74% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7886.89,84,,,Percent of Total Billed Charges,84% of total billed charges,7699.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,8356.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7229.65,77,,,Percent of total Billed charges,77% of total billed charges,7980.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2699.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4694.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2347.29,8356.35,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9634.46,4817.23,,7418.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3010.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7129.5,74,,,Percent of Total Billed Charges,74% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8092.95,84,,,Percent of Total Billed Charges,84% of total billed charges,7900.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8574.67,89,,,Percent of total Billed Charges,89% of total Billed charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7418.53,77,,,Percent of total Billed charges,77% of total billed charges,8189.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2769.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4817.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2408.62,8574.67,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9389.16,4694.58,,7229.65,77,,,Percent of Total Billed Charges,77% of total billed charges,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2934.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6947.98,74,,,Percent of Total Billed Charges,74% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7886.89,84,,,Percent of Total Billed Charges,84% of total billed charges,7699.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,8356.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7229.65,77,,,Percent of total Billed charges,77% of total billed charges,7980.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2699.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4694.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2347.29,8356.35,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9634.46,4817.23,,7418.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3010.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7129.5,74,,,Percent of Total Billed Charges,74% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8092.95,84,,,Percent of Total Billed Charges,84% of total billed charges,7900.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8574.67,89,,,Percent of total Billed Charges,89% of total Billed charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7418.53,77,,,Percent of total Billed charges,77% of total billed charges,8189.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2769.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4817.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2408.62,8574.67,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9389.16,4694.58,,7229.65,77,,,Percent of Total Billed Charges,77% of total billed charges,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2934.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6947.98,74,,,Percent of Total Billed Charges,74% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7886.89,84,,,Percent of Total Billed Charges,84% of total billed charges,7699.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,8356.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7229.65,77,,,Percent of total Billed charges,77% of total billed charges,7980.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2699.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4694.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2347.29,8356.35,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9634.46,4817.23,,7418.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3010.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7129.5,74,,,Percent of Total Billed Charges,74% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8092.95,84,,,Percent of Total Billed Charges,84% of total billed charges,7900.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8574.67,89,,,Percent of total Billed Charges,89% of total Billed charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7418.53,77,,,Percent of total Billed charges,77% of total billed charges,8189.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2769.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4817.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2408.62,8574.67,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9389.16,4694.58,,7229.65,77,,,Percent of Total Billed Charges,77% of total billed charges,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2934.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6947.98,74,,,Percent of Total Billed Charges,74% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7886.89,84,,,Percent of Total Billed Charges,84% of total billed charges,7699.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,8356.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7229.65,77,,,Percent of total Billed charges,77% of total billed charges,7980.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2699.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4694.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2347.29,8356.35,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9634.46,4817.23,,7418.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2456.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3010.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7129.5,74,,,Percent of Total Billed Charges,74% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,6647.78,69,,,Percent of Total Billed Charges,69% of total billed charges,8092.95,84,,,Percent of Total Billed Charges,84% of total billed charges,7900.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8574.67,89,,,Percent of total Billed Charges,89% of total Billed charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7418.53,77,,,Percent of total Billed charges,77% of total billed charges,8189.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2769.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4817.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3930.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8574.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2408.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2408.62,8574.67,
Golimumab (Simponi) 50mg/4ml Liquid SDV,57894035001,CDM,250,RC,,,Outpatient,,,9389.16,4694.58,,7229.65,77,,,Percent of Total Billed Charges,77% of total billed charges,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2394.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2934.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6947.98,74,,,Percent of Total Billed Charges,74% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,6478.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7886.89,84,,,Percent of Total Billed Charges,84% of total billed charges,7699.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,8356.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7229.65,77,,,Percent of total Billed charges,77% of total billed charges,7980.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2699.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4694.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3830.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8356.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2347.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2347.29,8356.35,
Goserelin Acetate 10.8mg Implant Kit,70720095130,CDM,250,RC,,,Outpatient,,,18199.67,9099.84,,14013.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5687.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13467.76,74,,,Percent of Total Billed Charges,74% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15287.72,84,,,Percent of Total Billed Charges,84% of total billed charges,14923.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,16197.71,89,,,Percent of total Billed Charges,89% of total Billed charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14013.75,77,,,Percent of total Billed charges,77% of total billed charges,15469.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5232.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9099.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4549.92,16197.71,
Goserelin Acetate 10.8mg Implant Kit,70720095130,CDM,250,RC,,,Outpatient,,,18199.67,9099.84,,14013.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5687.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13467.76,74,,,Percent of Total Billed Charges,74% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15287.72,84,,,Percent of Total Billed Charges,84% of total billed charges,14923.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,16197.71,89,,,Percent of total Billed Charges,89% of total Billed charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14013.75,77,,,Percent of total Billed charges,77% of total billed charges,15469.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5232.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9099.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4549.92,16197.71,
Goserelin Acetate 10.8mg Implant Kit,70720095130,CDM,250,RC,,,Outpatient,,,18199.67,9099.84,,14013.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5687.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13467.76,74,,,Percent of Total Billed Charges,74% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15287.72,84,,,Percent of Total Billed Charges,84% of total billed charges,14923.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,16197.71,89,,,Percent of total Billed Charges,89% of total Billed charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14013.75,77,,,Percent of total Billed charges,77% of total billed charges,15469.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5232.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9099.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4549.92,16197.71,
Goserelin Acetate 10.8mg Implant Kit,70720095130,CDM,250,RC,,,Outpatient,,,18199.67,9099.84,,14013.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5687.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13467.76,74,,,Percent of Total Billed Charges,74% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15287.72,84,,,Percent of Total Billed Charges,84% of total billed charges,14923.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,16197.71,89,,,Percent of total Billed Charges,89% of total Billed charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14013.75,77,,,Percent of total Billed charges,77% of total billed charges,15469.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5232.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9099.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4549.92,16197.71,
Goserelin Acetate 10.8mg Implant Kit,70720095130,CDM,250,RC,,,Outpatient,,,18199.67,9099.84,,14013.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5687.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13467.76,74,,,Percent of Total Billed Charges,74% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15287.72,84,,,Percent of Total Billed Charges,84% of total billed charges,14923.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,16197.71,89,,,Percent of total Billed Charges,89% of total Billed charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14013.75,77,,,Percent of total Billed charges,77% of total billed charges,15469.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5232.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9099.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4549.92,16197.71,
Goserelin Acetate 10.8mg Implant Kit,70720095130,CDM,250,RC,,,Outpatient,,,18199.67,9099.84,,14013.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4640.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5687.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13467.76,74,,,Percent of Total Billed Charges,74% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12557.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15287.72,84,,,Percent of Total Billed Charges,84% of total billed charges,14923.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,16197.71,89,,,Percent of total Billed Charges,89% of total Billed charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14013.75,77,,,Percent of total Billed charges,77% of total billed charges,15469.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5232.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9099.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7425.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16197.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4549.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4549.92,16197.71,
Goserelin Acetate 3.6mg Implant Kit,70720095036,CDM,250,RC,,,Outpatient,,,7163.18,3581.59,,5515.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2238.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5300.75,74,,,Percent of Total Billed Charges,74% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6017.07,84,,,Percent of Total Billed Charges,84% of total billed charges,5873.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,6375.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5515.65,77,,,Percent of total Billed charges,77% of total billed charges,6088.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2059.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3581.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.8,6375.23,
Goserelin Acetate 3.6mg Implant Kit,70720095036,CDM,250,RC,,,Outpatient,,,7163.18,3581.59,,5515.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2238.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5300.75,74,,,Percent of Total Billed Charges,74% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6017.07,84,,,Percent of Total Billed Charges,84% of total billed charges,5873.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,6375.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5515.65,77,,,Percent of total Billed charges,77% of total billed charges,6088.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2059.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3581.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.8,6375.23,
Goserelin Acetate 3.6mg Implant Kit,70720095036,CDM,250,RC,,,Outpatient,,,7163.18,3581.59,,5515.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2238.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5300.75,74,,,Percent of Total Billed Charges,74% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6017.07,84,,,Percent of Total Billed Charges,84% of total billed charges,5873.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,6375.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5515.65,77,,,Percent of total Billed charges,77% of total billed charges,6088.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2059.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3581.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.8,6375.23,
Goserelin Acetate 3.6mg Implant Kit,70720095036,CDM,250,RC,,,Outpatient,,,7163.18,3581.59,,5515.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2238.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5300.75,74,,,Percent of Total Billed Charges,74% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6017.07,84,,,Percent of Total Billed Charges,84% of total billed charges,5873.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,6375.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5515.65,77,,,Percent of total Billed charges,77% of total billed charges,6088.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2059.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3581.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.8,6375.23,
Goserelin Acetate 3.6mg Implant Kit,70720095036,CDM,250,RC,,,Outpatient,,,7163.18,3581.59,,5515.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2238.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5300.75,74,,,Percent of Total Billed Charges,74% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6017.07,84,,,Percent of Total Billed Charges,84% of total billed charges,5873.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,6375.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5515.65,77,,,Percent of total Billed charges,77% of total billed charges,6088.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2059.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3581.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.8,6375.23,
Goserelin Acetate 3.6mg Implant Kit,70720095036,CDM,250,RC,,,Outpatient,,,7163.18,3581.59,,5515.65,77,,,Percent of Total Billed Charges,77% of total billed charges,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1826.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2238.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5300.75,74,,,Percent of Total Billed Charges,74% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,4942.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6017.07,84,,,Percent of Total Billed Charges,84% of total billed charges,5873.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,6375.23,89,,,Percent of total Billed Charges,89% of total Billed charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5515.65,77,,,Percent of total Billed charges,77% of total billed charges,6088.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2059.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3581.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2922.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6375.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1790.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1790.8,6375.23,
guaiFENesin 200mg/10ml UDC,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 200mg/10ml UDC,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 200mg/10ml UDC,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 200mg/10ml UDC,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 200mg/10ml UDC,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 200mg/10ml UDC,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM Sugar Free 200-20mg/10ml UDC,60569006204,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM Sugar Free 200-20mg/10ml UDC,60569006204,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM Sugar Free 200-20mg/10ml UDC,60569006204,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM Sugar Free 200-20mg/10ml UDC,60569006204,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM Sugar Free 200-20mg/10ml UDC,60569006204,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM Sugar Free 200-20mg/10ml UDC,60569006204,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM 600/30mg Tablet,536116137,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM 600/30mg Tablet,536116137,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM 600/30mg Tablet,536116137,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM 600/30mg Tablet,536116137,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM 600/30mg Tablet,536116137,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin DM 600/30mg Tablet,536116137,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 400mg Immediate Release Tab,57896079401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 400mg Immediate Release Tab,57896079401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 400mg Immediate Release Tab,57896079401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 400mg Immediate Release Tab,57896079401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 400mg Immediate Release Tab,57896079401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin 400mg Immediate Release Tab,57896079401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin LA 600mg Tablet,63824000850,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin LA 600mg Tablet,63824000850,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin LA 600mg Tablet,63824000850,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin LA 600mg Tablet,63824000850,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin LA 600mg Tablet,63824000850,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guaiFENesin LA 600mg Tablet,63824000850,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
guanFACINE 1mg Tablet,378116001,CDM,250,RC,,,Outpatient,,,13.16,6.58,,10.13,77,,,Percent of Total Billed Charges,77% of total billed charges,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.74,74,,,Percent of Total Billed Charges,74% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,11.05,84,,,Percent of Total Billed Charges,84% of total billed charges,10.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.71,89,,,Percent of total Billed Charges,89% of total Billed charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,77,,,Percent of total Billed charges,77% of total billed charges,11.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.29,11.71,
guanFACINE 1mg Tablet,378116001,CDM,250,RC,,,Outpatient,,,13.16,6.58,,10.13,77,,,Percent of Total Billed Charges,77% of total billed charges,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.74,74,,,Percent of Total Billed Charges,74% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,11.05,84,,,Percent of Total Billed Charges,84% of total billed charges,10.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.71,89,,,Percent of total Billed Charges,89% of total Billed charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,77,,,Percent of total Billed charges,77% of total billed charges,11.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.29,11.71,
guanFACINE 1mg Tablet,378116001,CDM,250,RC,,,Outpatient,,,13.16,6.58,,10.13,77,,,Percent of Total Billed Charges,77% of total billed charges,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.74,74,,,Percent of Total Billed Charges,74% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,11.05,84,,,Percent of Total Billed Charges,84% of total billed charges,10.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.71,89,,,Percent of total Billed Charges,89% of total Billed charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,77,,,Percent of total Billed charges,77% of total billed charges,11.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.29,11.71,
guanFACINE 1mg Tablet,378116001,CDM,250,RC,,,Outpatient,,,13.16,6.58,,10.13,77,,,Percent of Total Billed Charges,77% of total billed charges,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.74,74,,,Percent of Total Billed Charges,74% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,11.05,84,,,Percent of Total Billed Charges,84% of total billed charges,10.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.71,89,,,Percent of total Billed Charges,89% of total Billed charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,77,,,Percent of total Billed charges,77% of total billed charges,11.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.29,11.71,
guanFACINE 1mg Tablet,378116001,CDM,250,RC,,,Outpatient,,,13.16,6.58,,10.13,77,,,Percent of Total Billed Charges,77% of total billed charges,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.74,74,,,Percent of Total Billed Charges,74% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,11.05,84,,,Percent of Total Billed Charges,84% of total billed charges,10.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.71,89,,,Percent of total Billed Charges,89% of total Billed charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,77,,,Percent of total Billed charges,77% of total billed charges,11.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.29,11.71,
guanFACINE 1mg Tablet,378116001,CDM,250,RC,,,Outpatient,,,13.16,6.58,,10.13,77,,,Percent of Total Billed Charges,77% of total billed charges,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.74,74,,,Percent of Total Billed Charges,74% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,9.08,69,,,Percent of Total Billed Charges,69% of total billed charges,11.05,84,,,Percent of Total Billed Charges,84% of total billed charges,10.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.71,89,,,Percent of total Billed Charges,89% of total Billed charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,77,,,Percent of total Billed charges,77% of total billed charges,11.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.29,11.71,
Haemophilus b Conjugate Vaccine (Hiberix) PF 0.5ml/Dose Vial,,,250,RC,,,Outpatient,,,139.1,69.55,,107.11,77,,,Percent of Total Billed Charges,77% of total billed charges,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.93,74,,,Percent of Total Billed Charges,74% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,116.84,84,,,Percent of Total Billed Charges,84% of total billed charges,114.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.8,89,,,Percent of total Billed Charges,89% of total Billed charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.11,77,,,Percent of total Billed charges,77% of total billed charges,118.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.78,123.8,
Haemophilus b Conjugate Vaccine (Hiberix) PF 0.5ml/Dose Vial,,,250,RC,,,Outpatient,,,139.1,69.55,,107.11,77,,,Percent of Total Billed Charges,77% of total billed charges,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.93,74,,,Percent of Total Billed Charges,74% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,116.84,84,,,Percent of Total Billed Charges,84% of total billed charges,114.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.8,89,,,Percent of total Billed Charges,89% of total Billed charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.11,77,,,Percent of total Billed charges,77% of total billed charges,118.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.78,123.8,
Haemophilus b Conjugate Vaccine (Hiberix) PF 0.5ml/Dose Vial,,,250,RC,,,Outpatient,,,139.1,69.55,,107.11,77,,,Percent of Total Billed Charges,77% of total billed charges,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.93,74,,,Percent of Total Billed Charges,74% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,116.84,84,,,Percent of Total Billed Charges,84% of total billed charges,114.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.8,89,,,Percent of total Billed Charges,89% of total Billed charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.11,77,,,Percent of total Billed charges,77% of total billed charges,118.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.78,123.8,
Haemophilus b Conjugate Vaccine (Hiberix) PF 0.5ml/Dose Vial,,,250,RC,,,Outpatient,,,139.1,69.55,,107.11,77,,,Percent of Total Billed Charges,77% of total billed charges,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.93,74,,,Percent of Total Billed Charges,74% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,116.84,84,,,Percent of Total Billed Charges,84% of total billed charges,114.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.8,89,,,Percent of total Billed Charges,89% of total Billed charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.11,77,,,Percent of total Billed charges,77% of total billed charges,118.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.78,123.8,
Haemophilus b Conjugate Vaccine (Hiberix) PF 0.5ml/Dose Vial,,,250,RC,,,Outpatient,,,139.1,69.55,,107.11,77,,,Percent of Total Billed Charges,77% of total billed charges,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.93,74,,,Percent of Total Billed Charges,74% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,116.84,84,,,Percent of Total Billed Charges,84% of total billed charges,114.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.8,89,,,Percent of total Billed Charges,89% of total Billed charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.11,77,,,Percent of total Billed charges,77% of total billed charges,118.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.78,123.8,
Haemophilus b Conjugate Vaccine (Hiberix) PF 0.5ml/Dose Vial,,,250,RC,,,Outpatient,,,139.1,69.55,,107.11,77,,,Percent of Total Billed Charges,77% of total billed charges,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.93,74,,,Percent of Total Billed Charges,74% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,95.98,69,,,Percent of Total Billed Charges,69% of total billed charges,116.84,84,,,Percent of Total Billed Charges,84% of total billed charges,114.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.8,89,,,Percent of total Billed Charges,89% of total Billed charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.11,77,,,Percent of total Billed charges,77% of total billed charges,118.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.78,123.8,
Haloperidol 1mg Tablet,58657070101,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Haloperidol 1mg Tablet,58657070101,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Haloperidol 1mg Tablet,58657070101,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Haloperidol 1mg Tablet,58657070101,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Haloperidol 1mg Tablet,58657070101,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Haloperidol 1mg Tablet,58657070101,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
Haloperidol 5mg Tablet,51079073620,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Haloperidol 5mg Tablet,51079073620,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Haloperidol 5mg Tablet,51079073620,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Haloperidol 5mg Tablet,51079073620,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Haloperidol 5mg Tablet,51079073620,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Haloperidol 5mg Tablet,51079073620,CDM,250,RC,,,Outpatient,,,15.23,7.62,,11.73,77,,,Percent of Total Billed Charges,77% of total billed charges,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.27,74,,,Percent of Total Billed Charges,74% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,69,,,Percent of Total Billed Charges,69% of total billed charges,12.79,84,,,Percent of Total Billed Charges,84% of total billed charges,12.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.55,89,,,Percent of total Billed Charges,89% of total Billed charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.73,77,,,Percent of total Billed charges,77% of total billed charges,12.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.81,13.55,
Haloperidol Lactate 5mg/ml SDV,63323047401,CDM,250,RC,,,Outpatient,,,89.26,44.63,,68.73,77,,,Percent of Total Billed Charges,77% of total billed charges,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.05,74,,,Percent of Total Billed Charges,74% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,74.98,84,,,Percent of Total Billed Charges,84% of total billed charges,73.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.44,89,,,Percent of total Billed Charges,89% of total Billed charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.73,77,,,Percent of total Billed charges,77% of total billed charges,75.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,79.44,
Haloperidol Lactate 5mg/ml SDV,63323047401,CDM,250,RC,,,Outpatient,,,89.26,44.63,,68.73,77,,,Percent of Total Billed Charges,77% of total billed charges,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.05,74,,,Percent of Total Billed Charges,74% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,74.98,84,,,Percent of Total Billed Charges,84% of total billed charges,73.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.44,89,,,Percent of total Billed Charges,89% of total Billed charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.73,77,,,Percent of total Billed charges,77% of total billed charges,75.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,79.44,
Haloperidol Lactate 5mg/ml SDV,63323047401,CDM,250,RC,,,Outpatient,,,89.26,44.63,,68.73,77,,,Percent of Total Billed Charges,77% of total billed charges,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.05,74,,,Percent of Total Billed Charges,74% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,74.98,84,,,Percent of Total Billed Charges,84% of total billed charges,73.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.44,89,,,Percent of total Billed Charges,89% of total Billed charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.73,77,,,Percent of total Billed charges,77% of total billed charges,75.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,79.44,
Haloperidol Lactate 5mg/ml SDV,63323047401,CDM,250,RC,,,Outpatient,,,89.26,44.63,,68.73,77,,,Percent of Total Billed Charges,77% of total billed charges,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.05,74,,,Percent of Total Billed Charges,74% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,74.98,84,,,Percent of Total Billed Charges,84% of total billed charges,73.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.44,89,,,Percent of total Billed Charges,89% of total Billed charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.73,77,,,Percent of total Billed charges,77% of total billed charges,75.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,79.44,
Haloperidol Lactate 5mg/ml SDV,63323047401,CDM,250,RC,,,Outpatient,,,89.26,44.63,,68.73,77,,,Percent of Total Billed Charges,77% of total billed charges,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.05,74,,,Percent of Total Billed Charges,74% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,74.98,84,,,Percent of Total Billed Charges,84% of total billed charges,73.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.44,89,,,Percent of total Billed Charges,89% of total Billed charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.73,77,,,Percent of total Billed charges,77% of total billed charges,75.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,79.44,
Haloperidol Lactate 5mg/ml SDV,63323047401,CDM,250,RC,,,Outpatient,,,89.26,44.63,,68.73,77,,,Percent of Total Billed Charges,77% of total billed charges,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.05,74,,,Percent of Total Billed Charges,74% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,61.59,69,,,Percent of Total Billed Charges,69% of total billed charges,74.98,84,,,Percent of Total Billed Charges,84% of total billed charges,73.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.44,89,,,Percent of total Billed Charges,89% of total Billed charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.73,77,,,Percent of total Billed charges,77% of total billed charges,75.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.32,79.44,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
"Heparin 10,000units/10ml MDV",63323054015,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
Flush-Heparin Pediatric 50unit/5ml (5ml in a 10ml) Syringe,8290306414,CDM,250,RC,,,Outpatient,,,46.58,23.29,,35.87,77,,,Percent of Total Billed Charges,77% of total billed charges,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.47,74,,,Percent of Total Billed Charges,74% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,39.13,84,,,Percent of Total Billed Charges,84% of total billed charges,38.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.46,89,,,Percent of total Billed Charges,89% of total Billed charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.87,77,,,Percent of total Billed charges,77% of total billed charges,39.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.65,41.46,
Flush-Heparin Pediatric 50unit/5ml (5ml in a 10ml) Syringe,8290306414,CDM,250,RC,,,Outpatient,,,46.58,23.29,,35.87,77,,,Percent of Total Billed Charges,77% of total billed charges,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.47,74,,,Percent of Total Billed Charges,74% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,39.13,84,,,Percent of Total Billed Charges,84% of total billed charges,38.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.46,89,,,Percent of total Billed Charges,89% of total Billed charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.87,77,,,Percent of total Billed charges,77% of total billed charges,39.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.65,41.46,
Flush-Heparin Pediatric 50unit/5ml (5ml in a 10ml) Syringe,8290306414,CDM,250,RC,,,Outpatient,,,46.58,23.29,,35.87,77,,,Percent of Total Billed Charges,77% of total billed charges,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.47,74,,,Percent of Total Billed Charges,74% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,39.13,84,,,Percent of Total Billed Charges,84% of total billed charges,38.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.46,89,,,Percent of total Billed Charges,89% of total Billed charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.87,77,,,Percent of total Billed charges,77% of total billed charges,39.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.65,41.46,
Flush-Heparin Pediatric 50unit/5ml (5ml in a 10ml) Syringe,8290306414,CDM,250,RC,,,Outpatient,,,46.58,23.29,,35.87,77,,,Percent of Total Billed Charges,77% of total billed charges,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.47,74,,,Percent of Total Billed Charges,74% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,39.13,84,,,Percent of Total Billed Charges,84% of total billed charges,38.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.46,89,,,Percent of total Billed Charges,89% of total Billed charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.87,77,,,Percent of total Billed charges,77% of total billed charges,39.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.65,41.46,
Flush-Heparin Pediatric 50unit/5ml (5ml in a 10ml) Syringe,8290306414,CDM,250,RC,,,Outpatient,,,46.58,23.29,,35.87,77,,,Percent of Total Billed Charges,77% of total billed charges,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.47,74,,,Percent of Total Billed Charges,74% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,39.13,84,,,Percent of Total Billed Charges,84% of total billed charges,38.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.46,89,,,Percent of total Billed Charges,89% of total Billed charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.87,77,,,Percent of total Billed charges,77% of total billed charges,39.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.65,41.46,
Flush-Heparin Pediatric 50unit/5ml (5ml in a 10ml) Syringe,8290306414,CDM,250,RC,,,Outpatient,,,46.58,23.29,,35.87,77,,,Percent of Total Billed Charges,77% of total billed charges,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.47,74,,,Percent of Total Billed Charges,74% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,32.14,69,,,Percent of Total Billed Charges,69% of total billed charges,39.13,84,,,Percent of Total Billed Charges,84% of total billed charges,38.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.46,89,,,Percent of total Billed Charges,89% of total Billed charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.87,77,,,Percent of total Billed charges,77% of total billed charges,39.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.65,41.46,
Hepatitis B Vaccine Pediatric 10mcg/0.5ml Syringe,58160082052,CDM,250,RC,,,Outpatient,,,219.42,109.71,,168.95,77,,,Percent of Total Billed Charges,77% of total billed charges,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.37,74,,,Percent of Total Billed Charges,74% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,184.31,84,,,Percent of Total Billed Charges,84% of total billed charges,179.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.28,89,,,Percent of total Billed Charges,89% of total Billed charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.95,77,,,Percent of total Billed charges,77% of total billed charges,186.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,195.28,
Hepatitis B Vaccine Pediatric 10mcg/0.5ml Syringe,58160082052,CDM,250,RC,,,Outpatient,,,219.42,109.71,,168.95,77,,,Percent of Total Billed Charges,77% of total billed charges,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.37,74,,,Percent of Total Billed Charges,74% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,184.31,84,,,Percent of Total Billed Charges,84% of total billed charges,179.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.28,89,,,Percent of total Billed Charges,89% of total Billed charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.95,77,,,Percent of total Billed charges,77% of total billed charges,186.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,195.28,
Hepatitis B Vaccine Pediatric 10mcg/0.5ml Syringe,58160082052,CDM,250,RC,,,Outpatient,,,219.42,109.71,,168.95,77,,,Percent of Total Billed Charges,77% of total billed charges,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.37,74,,,Percent of Total Billed Charges,74% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,184.31,84,,,Percent of Total Billed Charges,84% of total billed charges,179.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.28,89,,,Percent of total Billed Charges,89% of total Billed charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.95,77,,,Percent of total Billed charges,77% of total billed charges,186.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,195.28,
Hepatitis B Vaccine Pediatric 10mcg/0.5ml Syringe,58160082052,CDM,250,RC,,,Outpatient,,,219.42,109.71,,168.95,77,,,Percent of Total Billed Charges,77% of total billed charges,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.37,74,,,Percent of Total Billed Charges,74% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,184.31,84,,,Percent of Total Billed Charges,84% of total billed charges,179.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.28,89,,,Percent of total Billed Charges,89% of total Billed charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.95,77,,,Percent of total Billed charges,77% of total billed charges,186.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,195.28,
Hepatitis B Vaccine Pediatric 10mcg/0.5ml Syringe,58160082052,CDM,250,RC,,,Outpatient,,,219.42,109.71,,168.95,77,,,Percent of Total Billed Charges,77% of total billed charges,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.37,74,,,Percent of Total Billed Charges,74% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,184.31,84,,,Percent of Total Billed Charges,84% of total billed charges,179.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.28,89,,,Percent of total Billed Charges,89% of total Billed charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.95,77,,,Percent of total Billed charges,77% of total billed charges,186.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,195.28,
Hepatitis B Vaccine Pediatric 10mcg/0.5ml Syringe,58160082052,CDM,250,RC,,,Outpatient,,,219.42,109.71,,168.95,77,,,Percent of Total Billed Charges,77% of total billed charges,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.37,74,,,Percent of Total Billed Charges,74% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,151.4,69,,,Percent of Total Billed Charges,69% of total billed charges,184.31,84,,,Percent of Total Billed Charges,84% of total billed charges,179.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,195.28,89,,,Percent of total Billed Charges,89% of total Billed charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.95,77,,,Percent of total Billed charges,77% of total billed charges,186.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,195.28,
Hepatitis B Immune Globulin (Nabi-HB) 5ml SDV,69800420301,CDM,250,RC,,,Outpatient,,,3392.96,1696.48,,2612.58,77,,,Percent of Total Billed Charges,77% of total billed charges,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2510.79,74,,,Percent of Total Billed Charges,74% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.09,84,,,Percent of Total Billed Charges,84% of total billed charges,2782.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,3019.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2612.58,77,,,Percent of total Billed charges,77% of total billed charges,2884.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1696.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.24,3019.73,
Hepatitis B Immune Globulin (Nabi-HB) 5ml SDV,69800420301,CDM,250,RC,,,Outpatient,,,3392.96,1696.48,,2612.58,77,,,Percent of Total Billed Charges,77% of total billed charges,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2510.79,74,,,Percent of Total Billed Charges,74% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.09,84,,,Percent of Total Billed Charges,84% of total billed charges,2782.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,3019.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2612.58,77,,,Percent of total Billed charges,77% of total billed charges,2884.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1696.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.24,3019.73,
Hepatitis B Immune Globulin (Nabi-HB) 5ml SDV,69800420301,CDM,250,RC,,,Outpatient,,,3392.96,1696.48,,2612.58,77,,,Percent of Total Billed Charges,77% of total billed charges,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2510.79,74,,,Percent of Total Billed Charges,74% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.09,84,,,Percent of Total Billed Charges,84% of total billed charges,2782.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,3019.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2612.58,77,,,Percent of total Billed charges,77% of total billed charges,2884.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1696.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.24,3019.73,
Hepatitis B Immune Globulin (Nabi-HB) 5ml SDV,69800420301,CDM,250,RC,,,Outpatient,,,3392.96,1696.48,,2612.58,77,,,Percent of Total Billed Charges,77% of total billed charges,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2510.79,74,,,Percent of Total Billed Charges,74% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.09,84,,,Percent of Total Billed Charges,84% of total billed charges,2782.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,3019.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2612.58,77,,,Percent of total Billed charges,77% of total billed charges,2884.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1696.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.24,3019.73,
Hepatitis B Immune Globulin (Nabi-HB) 5ml SDV,69800420301,CDM,250,RC,,,Outpatient,,,3392.96,1696.48,,2612.58,77,,,Percent of Total Billed Charges,77% of total billed charges,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2510.79,74,,,Percent of Total Billed Charges,74% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.09,84,,,Percent of Total Billed Charges,84% of total billed charges,2782.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,3019.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2612.58,77,,,Percent of total Billed charges,77% of total billed charges,2884.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1696.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.24,3019.73,
Hepatitis B Immune Globulin (Nabi-HB) 5ml SDV,69800420301,CDM,250,RC,,,Outpatient,,,3392.96,1696.48,,2612.58,77,,,Percent of Total Billed Charges,77% of total billed charges,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1060.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2510.79,74,,,Percent of Total Billed Charges,74% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2341.14,69,,,Percent of Total Billed Charges,69% of total billed charges,2850.09,84,,,Percent of Total Billed Charges,84% of total billed charges,2782.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,3019.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2612.58,77,,,Percent of total Billed charges,77% of total billed charges,2884.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,975.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1696.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1384.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3019.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.24,3019.73,
Hepatitis B Vaccine/PF 20mcg/ml 1ml Vial,,,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Vaccine/PF 20mcg/ml 1ml Vial,,,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Vaccine/PF 20mcg/ml 1ml Vial,,,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Vaccine/PF 20mcg/ml 1ml Vial,,,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Vaccine/PF 20mcg/ml 1ml Vial,,,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Vaccine/PF 20mcg/ml 1ml Vial,,,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Virus Vaccine 20mcg/1ml (Adult),58160082111,CDM,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Virus Vaccine 20mcg/1ml (Adult),58160082111,CDM,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Virus Vaccine 20mcg/1ml (Adult),58160082111,CDM,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Virus Vaccine 20mcg/1ml (Adult),58160082111,CDM,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Virus Vaccine 20mcg/1ml (Adult),58160082111,CDM,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Hepatitis B Virus Vaccine 20mcg/1ml (Adult),58160082111,CDM,250,RC,,,Outpatient,,,445.87,222.94,,343.32,77,,,Percent of Total Billed Charges,77% of total billed charges,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,329.94,74,,,Percent of Total Billed Charges,74% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,307.65,69,,,Percent of Total Billed Charges,69% of total billed charges,374.53,84,,,Percent of Total Billed Charges,84% of total billed charges,365.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,396.82,89,,,Percent of total Billed Charges,89% of total Billed charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.32,77,,,Percent of total Billed charges,77% of total billed charges,378.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,222.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,396.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.47,396.82,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
Heparin in D5W 25000units/250ml (100units/ml) IV Bag,264958720,CDM,250,RC,,,Outpatient,,,219.05,109.53,,168.67,77,,,Percent of Total Billed Charges,77% of total billed charges,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,162.1,74,,,Percent of Total Billed Charges,74% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,151.14,69,,,Percent of Total Billed Charges,69% of total billed charges,184,84,,,Percent of Total Billed Charges,84% of total billed charges,179.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.95,89,,,Percent of total Billed Charges,89% of total Billed charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.67,77,,,Percent of total Billed charges,77% of total billed charges,186.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.76,194.95,
"Heparin 5,000units/ml SDV",71288040301,CDM,250,RC,,,Outpatient,,,74.21,37.11,,57.14,77,,,Percent of Total Billed Charges,77% of total billed charges,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.92,74,,,Percent of Total Billed Charges,74% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,62.34,84,,,Percent of Total Billed Charges,84% of total billed charges,60.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.05,89,,,Percent of total Billed Charges,89% of total Billed charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.14,77,,,Percent of total Billed charges,77% of total billed charges,63.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.55,66.05,
"Heparin 5,000units/ml SDV",71288040301,CDM,250,RC,,,Outpatient,,,74.21,37.11,,57.14,77,,,Percent of Total Billed Charges,77% of total billed charges,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.92,74,,,Percent of Total Billed Charges,74% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,62.34,84,,,Percent of Total Billed Charges,84% of total billed charges,60.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.05,89,,,Percent of total Billed Charges,89% of total Billed charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.14,77,,,Percent of total Billed charges,77% of total billed charges,63.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.55,66.05,
"Heparin 5,000units/ml SDV",71288040301,CDM,250,RC,,,Outpatient,,,74.21,37.11,,57.14,77,,,Percent of Total Billed Charges,77% of total billed charges,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.92,74,,,Percent of Total Billed Charges,74% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,62.34,84,,,Percent of Total Billed Charges,84% of total billed charges,60.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.05,89,,,Percent of total Billed Charges,89% of total Billed charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.14,77,,,Percent of total Billed charges,77% of total billed charges,63.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.55,66.05,
"Heparin 5,000units/ml SDV",71288040301,CDM,250,RC,,,Outpatient,,,74.21,37.11,,57.14,77,,,Percent of Total Billed Charges,77% of total billed charges,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.92,74,,,Percent of Total Billed Charges,74% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,62.34,84,,,Percent of Total Billed Charges,84% of total billed charges,60.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.05,89,,,Percent of total Billed Charges,89% of total Billed charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.14,77,,,Percent of total Billed charges,77% of total billed charges,63.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.55,66.05,
"Heparin 5,000units/ml SDV",71288040301,CDM,250,RC,,,Outpatient,,,74.21,37.11,,57.14,77,,,Percent of Total Billed Charges,77% of total billed charges,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.92,74,,,Percent of Total Billed Charges,74% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,62.34,84,,,Percent of Total Billed Charges,84% of total billed charges,60.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.05,89,,,Percent of total Billed Charges,89% of total Billed charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.14,77,,,Percent of total Billed charges,77% of total billed charges,63.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.55,66.05,
"Heparin 5,000units/ml SDV",71288040301,CDM,250,RC,,,Outpatient,,,74.21,37.11,,57.14,77,,,Percent of Total Billed Charges,77% of total billed charges,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.92,74,,,Percent of Total Billed Charges,74% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,51.2,69,,,Percent of Total Billed Charges,69% of total billed charges,62.34,84,,,Percent of Total Billed Charges,84% of total billed charges,60.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.05,89,,,Percent of total Billed Charges,89% of total Billed charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.14,77,,,Percent of total Billed charges,77% of total billed charges,63.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.55,66.05,
Flush-Heparin 500unit/5ml Syringe,64253033335,CDM,250,RC,,,Outpatient,,,45.51,22.76,,35.04,77,,,Percent of Total Billed Charges,77% of total billed charges,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.68,74,,,Percent of Total Billed Charges,74% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,38.23,84,,,Percent of Total Billed Charges,84% of total billed charges,37.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.5,89,,,Percent of total Billed Charges,89% of total Billed charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.04,77,,,Percent of total Billed charges,77% of total billed charges,38.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,40.5,
Flush-Heparin 500unit/5ml Syringe,64253033335,CDM,250,RC,,,Outpatient,,,45.51,22.76,,35.04,77,,,Percent of Total Billed Charges,77% of total billed charges,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.68,74,,,Percent of Total Billed Charges,74% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,38.23,84,,,Percent of Total Billed Charges,84% of total billed charges,37.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.5,89,,,Percent of total Billed Charges,89% of total Billed charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.04,77,,,Percent of total Billed charges,77% of total billed charges,38.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,40.5,
Flush-Heparin 500unit/5ml Syringe,64253033335,CDM,250,RC,,,Outpatient,,,45.51,22.76,,35.04,77,,,Percent of Total Billed Charges,77% of total billed charges,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.68,74,,,Percent of Total Billed Charges,74% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,38.23,84,,,Percent of Total Billed Charges,84% of total billed charges,37.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.5,89,,,Percent of total Billed Charges,89% of total Billed charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.04,77,,,Percent of total Billed charges,77% of total billed charges,38.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,40.5,
Flush-Heparin 500unit/5ml Syringe,64253033335,CDM,250,RC,,,Outpatient,,,45.51,22.76,,35.04,77,,,Percent of Total Billed Charges,77% of total billed charges,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.68,74,,,Percent of Total Billed Charges,74% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,38.23,84,,,Percent of Total Billed Charges,84% of total billed charges,37.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.5,89,,,Percent of total Billed Charges,89% of total Billed charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.04,77,,,Percent of total Billed charges,77% of total billed charges,38.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,40.5,
Flush-Heparin 500unit/5ml Syringe,64253033335,CDM,250,RC,,,Outpatient,,,45.51,22.76,,35.04,77,,,Percent of Total Billed Charges,77% of total billed charges,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.68,74,,,Percent of Total Billed Charges,74% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,38.23,84,,,Percent of Total Billed Charges,84% of total billed charges,37.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.5,89,,,Percent of total Billed Charges,89% of total Billed charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.04,77,,,Percent of total Billed charges,77% of total billed charges,38.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,40.5,
Flush-Heparin 500unit/5ml Syringe,64253033335,CDM,250,RC,,,Outpatient,,,45.51,22.76,,35.04,77,,,Percent of Total Billed Charges,77% of total billed charges,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.68,74,,,Percent of Total Billed Charges,74% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,31.4,69,,,Percent of Total Billed Charges,69% of total billed charges,38.23,84,,,Percent of Total Billed Charges,84% of total billed charges,37.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.5,89,,,Percent of total Billed Charges,89% of total Billed charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.04,77,,,Percent of total Billed charges,77% of total billed charges,38.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.38,40.5,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,188.17,94.09,,144.89,77,,,Percent of Total Billed Charges,77% of total billed charges,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.25,74,,,Percent of Total Billed Charges,74% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,158.06,84,,,Percent of Total Billed Charges,84% of total billed charges,154.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.47,89,,,Percent of total Billed Charges,89% of total Billed charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.89,77,,,Percent of total Billed charges,77% of total billed charges,159.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,167.47,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,266.57,133.29,,205.26,77,,,Percent of Total Billed Charges,77% of total billed charges,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.26,74,,,Percent of Total Billed Charges,74% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,223.92,84,,,Percent of Total Billed Charges,84% of total billed charges,218.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.25,89,,,Percent of total Billed Charges,89% of total Billed charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.26,77,,,Percent of total Billed charges,77% of total billed charges,226.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.64,237.25,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,188.17,94.09,,144.89,77,,,Percent of Total Billed Charges,77% of total billed charges,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.25,74,,,Percent of Total Billed Charges,74% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,158.06,84,,,Percent of Total Billed Charges,84% of total billed charges,154.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.47,89,,,Percent of total Billed Charges,89% of total Billed charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.89,77,,,Percent of total Billed charges,77% of total billed charges,159.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,167.47,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,266.57,133.29,,205.26,77,,,Percent of Total Billed Charges,77% of total billed charges,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.26,74,,,Percent of Total Billed Charges,74% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,223.92,84,,,Percent of Total Billed Charges,84% of total billed charges,218.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.25,89,,,Percent of total Billed Charges,89% of total Billed charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.26,77,,,Percent of total Billed charges,77% of total billed charges,226.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.64,237.25,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,188.17,94.09,,144.89,77,,,Percent of Total Billed Charges,77% of total billed charges,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.25,74,,,Percent of Total Billed Charges,74% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,158.06,84,,,Percent of Total Billed Charges,84% of total billed charges,154.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.47,89,,,Percent of total Billed Charges,89% of total Billed charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.89,77,,,Percent of total Billed charges,77% of total billed charges,159.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,167.47,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,266.57,133.29,,205.26,77,,,Percent of Total Billed Charges,77% of total billed charges,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.26,74,,,Percent of Total Billed Charges,74% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,223.92,84,,,Percent of Total Billed Charges,84% of total billed charges,218.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.25,89,,,Percent of total Billed Charges,89% of total Billed charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.26,77,,,Percent of total Billed charges,77% of total billed charges,226.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.64,237.25,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,188.17,94.09,,144.89,77,,,Percent of Total Billed Charges,77% of total billed charges,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.25,74,,,Percent of Total Billed Charges,74% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,158.06,84,,,Percent of Total Billed Charges,84% of total billed charges,154.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.47,89,,,Percent of total Billed Charges,89% of total Billed charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.89,77,,,Percent of total Billed charges,77% of total billed charges,159.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,167.47,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,266.57,133.29,,205.26,77,,,Percent of Total Billed Charges,77% of total billed charges,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.26,74,,,Percent of Total Billed Charges,74% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,223.92,84,,,Percent of Total Billed Charges,84% of total billed charges,218.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.25,89,,,Percent of total Billed Charges,89% of total Billed charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.26,77,,,Percent of total Billed charges,77% of total billed charges,226.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.64,237.25,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,188.17,94.09,,144.89,77,,,Percent of Total Billed Charges,77% of total billed charges,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.25,74,,,Percent of Total Billed Charges,74% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,158.06,84,,,Percent of Total Billed Charges,84% of total billed charges,154.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.47,89,,,Percent of total Billed Charges,89% of total Billed charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.89,77,,,Percent of total Billed charges,77% of total billed charges,159.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,167.47,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,266.57,133.29,,205.26,77,,,Percent of Total Billed Charges,77% of total billed charges,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.26,74,,,Percent of Total Billed Charges,74% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,223.92,84,,,Percent of Total Billed Charges,84% of total billed charges,218.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.25,89,,,Percent of total Billed Charges,89% of total Billed charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.26,77,,,Percent of total Billed charges,77% of total billed charges,226.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.64,237.25,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,188.17,94.09,,144.89,77,,,Percent of Total Billed Charges,77% of total billed charges,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.25,74,,,Percent of Total Billed Charges,74% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,129.84,69,,,Percent of Total Billed Charges,69% of total billed charges,158.06,84,,,Percent of Total Billed Charges,84% of total billed charges,154.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.47,89,,,Percent of total Billed Charges,89% of total Billed charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.89,77,,,Percent of total Billed charges,77% of total billed charges,159.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.04,167.47,
Hetastarch 6% 500ml IV Bag,,,250,RC,,,Outpatient,,,266.57,133.29,,205.26,77,,,Percent of Total Billed Charges,77% of total billed charges,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,197.26,74,,,Percent of Total Billed Charges,74% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,183.93,69,,,Percent of Total Billed Charges,69% of total billed charges,223.92,84,,,Percent of Total Billed Charges,84% of total billed charges,218.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,237.25,89,,,Percent of total Billed Charges,89% of total Billed charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,205.26,77,,,Percent of total Billed charges,77% of total billed charges,226.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,76.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,133.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,108.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.64,237.25,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13314.11,6657.06,,10251.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4160.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9852.44,74,,,Percent of Total Billed Charges,74% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11183.85,84,,,Percent of Total Billed Charges,84% of total billed charges,10917.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,11849.56,89,,,Percent of total Billed Charges,89% of total Billed charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10251.86,77,,,Percent of total Billed charges,77% of total billed charges,11316.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3827.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6657.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3328.53,11849.56,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13867.2,6933.6,,10677.74,77,,,Percent of Total Billed Charges,77% of total billed charges,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4333.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10261.73,74,,,Percent of Total Billed Charges,74% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11648.45,84,,,Percent of Total Billed Charges,84% of total billed charges,11371.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12341.81,89,,,Percent of total Billed Charges,89% of total Billed charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10677.74,77,,,Percent of total Billed charges,77% of total billed charges,11787.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3986.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6933.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.8,12341.81,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13314.11,6657.06,,10251.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4160.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9852.44,74,,,Percent of Total Billed Charges,74% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11183.85,84,,,Percent of Total Billed Charges,84% of total billed charges,10917.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,11849.56,89,,,Percent of total Billed Charges,89% of total Billed charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10251.86,77,,,Percent of total Billed charges,77% of total billed charges,11316.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3827.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6657.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3328.53,11849.56,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13867.2,6933.6,,10677.74,77,,,Percent of Total Billed Charges,77% of total billed charges,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4333.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10261.73,74,,,Percent of Total Billed Charges,74% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11648.45,84,,,Percent of Total Billed Charges,84% of total billed charges,11371.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12341.81,89,,,Percent of total Billed Charges,89% of total Billed charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10677.74,77,,,Percent of total Billed charges,77% of total billed charges,11787.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3986.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6933.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.8,12341.81,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13314.11,6657.06,,10251.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4160.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9852.44,74,,,Percent of Total Billed Charges,74% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11183.85,84,,,Percent of Total Billed Charges,84% of total billed charges,10917.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,11849.56,89,,,Percent of total Billed Charges,89% of total Billed charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10251.86,77,,,Percent of total Billed charges,77% of total billed charges,11316.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3827.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6657.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3328.53,11849.56,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13867.2,6933.6,,10677.74,77,,,Percent of Total Billed Charges,77% of total billed charges,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4333.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10261.73,74,,,Percent of Total Billed Charges,74% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11648.45,84,,,Percent of Total Billed Charges,84% of total billed charges,11371.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12341.81,89,,,Percent of total Billed Charges,89% of total Billed charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10677.74,77,,,Percent of total Billed charges,77% of total billed charges,11787.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3986.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6933.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.8,12341.81,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13314.11,6657.06,,10251.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4160.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9852.44,74,,,Percent of Total Billed Charges,74% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11183.85,84,,,Percent of Total Billed Charges,84% of total billed charges,10917.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,11849.56,89,,,Percent of total Billed Charges,89% of total Billed charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10251.86,77,,,Percent of total Billed charges,77% of total billed charges,11316.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3827.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6657.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3328.53,11849.56,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13867.2,6933.6,,10677.74,77,,,Percent of Total Billed Charges,77% of total billed charges,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4333.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10261.73,74,,,Percent of Total Billed Charges,74% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11648.45,84,,,Percent of Total Billed Charges,84% of total billed charges,11371.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12341.81,89,,,Percent of total Billed Charges,89% of total Billed charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10677.74,77,,,Percent of total Billed charges,77% of total billed charges,11787.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3986.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6933.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.8,12341.81,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13314.11,6657.06,,10251.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4160.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9852.44,74,,,Percent of Total Billed Charges,74% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11183.85,84,,,Percent of Total Billed Charges,84% of total billed charges,10917.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,11849.56,89,,,Percent of total Billed Charges,89% of total Billed charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10251.86,77,,,Percent of total Billed charges,77% of total billed charges,11316.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3827.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6657.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3328.53,11849.56,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13867.2,6933.6,,10677.74,77,,,Percent of Total Billed Charges,77% of total billed charges,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4333.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10261.73,74,,,Percent of Total Billed Charges,74% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11648.45,84,,,Percent of Total Billed Charges,84% of total billed charges,11371.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12341.81,89,,,Percent of total Billed Charges,89% of total Billed charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10677.74,77,,,Percent of total Billed charges,77% of total billed charges,11787.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3986.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6933.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.8,12341.81,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13314.11,6657.06,,10251.86,77,,,Percent of Total Billed Charges,77% of total billed charges,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3395.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4160.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9852.44,74,,,Percent of Total Billed Charges,74% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,9186.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11183.85,84,,,Percent of Total Billed Charges,84% of total billed charges,10917.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,11849.56,89,,,Percent of total Billed Charges,89% of total Billed charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10251.86,77,,,Percent of total Billed charges,77% of total billed charges,11316.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3827.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6657.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5432.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11849.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3328.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3328.53,11849.56,
Kcentra 1000unit/40ml Powder SDV,63833038702,CDM,250,RC,,,Outpatient,,,13867.2,6933.6,,10677.74,77,,,Percent of Total Billed Charges,77% of total billed charges,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3536.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4333.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10261.73,74,,,Percent of Total Billed Charges,74% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9568.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11648.45,84,,,Percent of Total Billed Charges,84% of total billed charges,11371.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12341.81,89,,,Percent of total Billed Charges,89% of total Billed charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10677.74,77,,,Percent of total Billed charges,77% of total billed charges,11787.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3986.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6933.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5657.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12341.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3466.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3466.8,12341.81,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6677.06,3338.53,,5141.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2086.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4941.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,5608.73,84,,,Percent of Total Billed Charges,84% of total billed charges,5475.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,5942.58,89,,,Percent of total Billed Charges,89% of total Billed charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5141.34,77,,,Percent of total Billed charges,77% of total billed charges,5675.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1919.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3338.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.27,5942.58,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6953.6,3476.8,,5354.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2173,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5145.66,74,,,Percent of Total Billed Charges,74% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5841.02,84,,,Percent of Total Billed Charges,84% of total billed charges,5701.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6188.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.27,77,,,Percent of total Billed charges,77% of total billed charges,5910.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1999.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3476.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1738.4,6188.7,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6677.06,3338.53,,5141.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2086.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4941.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,5608.73,84,,,Percent of Total Billed Charges,84% of total billed charges,5475.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,5942.58,89,,,Percent of total Billed Charges,89% of total Billed charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5141.34,77,,,Percent of total Billed charges,77% of total billed charges,5675.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1919.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3338.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.27,5942.58,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6953.6,3476.8,,5354.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2173,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5145.66,74,,,Percent of Total Billed Charges,74% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5841.02,84,,,Percent of Total Billed Charges,84% of total billed charges,5701.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6188.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.27,77,,,Percent of total Billed charges,77% of total billed charges,5910.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1999.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3476.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1738.4,6188.7,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6677.06,3338.53,,5141.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2086.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4941.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,5608.73,84,,,Percent of Total Billed Charges,84% of total billed charges,5475.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,5942.58,89,,,Percent of total Billed Charges,89% of total Billed charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5141.34,77,,,Percent of total Billed charges,77% of total billed charges,5675.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1919.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3338.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.27,5942.58,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6953.6,3476.8,,5354.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2173,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5145.66,74,,,Percent of Total Billed Charges,74% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5841.02,84,,,Percent of Total Billed Charges,84% of total billed charges,5701.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6188.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.27,77,,,Percent of total Billed charges,77% of total billed charges,5910.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1999.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3476.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1738.4,6188.7,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6677.06,3338.53,,5141.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2086.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4941.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,5608.73,84,,,Percent of Total Billed Charges,84% of total billed charges,5475.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,5942.58,89,,,Percent of total Billed Charges,89% of total Billed charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5141.34,77,,,Percent of total Billed charges,77% of total billed charges,5675.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1919.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3338.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.27,5942.58,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6953.6,3476.8,,5354.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2173,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5145.66,74,,,Percent of Total Billed Charges,74% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5841.02,84,,,Percent of Total Billed Charges,84% of total billed charges,5701.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6188.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.27,77,,,Percent of total Billed charges,77% of total billed charges,5910.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1999.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3476.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1738.4,6188.7,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6677.06,3338.53,,5141.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2086.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4941.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,5608.73,84,,,Percent of Total Billed Charges,84% of total billed charges,5475.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,5942.58,89,,,Percent of total Billed Charges,89% of total Billed charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5141.34,77,,,Percent of total Billed charges,77% of total billed charges,5675.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1919.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3338.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.27,5942.58,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6953.6,3476.8,,5354.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2173,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5145.66,74,,,Percent of Total Billed Charges,74% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5841.02,84,,,Percent of Total Billed Charges,84% of total billed charges,5701.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6188.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.27,77,,,Percent of total Billed charges,77% of total billed charges,5910.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1999.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3476.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1738.4,6188.7,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6677.06,3338.53,,5141.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1702.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2086.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4941.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,4607.17,69,,,Percent of Total Billed Charges,69% of total billed charges,5608.73,84,,,Percent of Total Billed Charges,84% of total billed charges,5475.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,5942.58,89,,,Percent of total Billed Charges,89% of total Billed charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5141.34,77,,,Percent of total Billed charges,77% of total billed charges,5675.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1919.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3338.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2724.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5942.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1669.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1669.27,5942.58,
Kcentra 500unit/20ml Powder SDV,63833038602,CDM,250,RC,,,Outpatient,,,6953.6,3476.8,,5354.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1773.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2173,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5145.66,74,,,Percent of Total Billed Charges,74% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,4797.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5841.02,84,,,Percent of Total Billed Charges,84% of total billed charges,5701.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6188.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5354.27,77,,,Percent of total Billed charges,77% of total billed charges,5910.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1999.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3476.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2837.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6188.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1738.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1738.4,6188.7,
Hyaluronidase 150unit/ml SDV,18657011704,CDM,250,RC,,,Outpatient,,,369.47,184.74,,284.49,77,,,Percent of Total Billed Charges,77% of total billed charges,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.41,74,,,Percent of Total Billed Charges,74% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,310.35,84,,,Percent of Total Billed Charges,84% of total billed charges,302.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.83,89,,,Percent of total Billed Charges,89% of total Billed charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.49,77,,,Percent of total Billed charges,77% of total billed charges,314.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.37,328.83,
Hyaluronidase 150unit/ml SDV,18657011704,CDM,250,RC,,,Outpatient,,,369.47,184.74,,284.49,77,,,Percent of Total Billed Charges,77% of total billed charges,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.41,74,,,Percent of Total Billed Charges,74% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,310.35,84,,,Percent of Total Billed Charges,84% of total billed charges,302.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.83,89,,,Percent of total Billed Charges,89% of total Billed charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.49,77,,,Percent of total Billed charges,77% of total billed charges,314.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.37,328.83,
Hyaluronidase 150unit/ml SDV,18657011704,CDM,250,RC,,,Outpatient,,,369.47,184.74,,284.49,77,,,Percent of Total Billed Charges,77% of total billed charges,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.41,74,,,Percent of Total Billed Charges,74% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,310.35,84,,,Percent of Total Billed Charges,84% of total billed charges,302.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.83,89,,,Percent of total Billed Charges,89% of total Billed charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.49,77,,,Percent of total Billed charges,77% of total billed charges,314.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.37,328.83,
Hyaluronidase 150unit/ml SDV,18657011704,CDM,250,RC,,,Outpatient,,,369.47,184.74,,284.49,77,,,Percent of Total Billed Charges,77% of total billed charges,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.41,74,,,Percent of Total Billed Charges,74% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,310.35,84,,,Percent of Total Billed Charges,84% of total billed charges,302.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.83,89,,,Percent of total Billed Charges,89% of total Billed charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.49,77,,,Percent of total Billed charges,77% of total billed charges,314.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.37,328.83,
Hyaluronidase 150unit/ml SDV,18657011704,CDM,250,RC,,,Outpatient,,,369.47,184.74,,284.49,77,,,Percent of Total Billed Charges,77% of total billed charges,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.41,74,,,Percent of Total Billed Charges,74% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,310.35,84,,,Percent of Total Billed Charges,84% of total billed charges,302.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.83,89,,,Percent of total Billed Charges,89% of total Billed charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.49,77,,,Percent of total Billed charges,77% of total billed charges,314.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.37,328.83,
Hyaluronidase 150unit/ml SDV,18657011704,CDM,250,RC,,,Outpatient,,,369.47,184.74,,284.49,77,,,Percent of Total Billed Charges,77% of total billed charges,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.41,74,,,Percent of Total Billed Charges,74% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,254.93,69,,,Percent of Total Billed Charges,69% of total billed charges,310.35,84,,,Percent of Total Billed Charges,84% of total billed charges,302.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,328.83,89,,,Percent of total Billed Charges,89% of total Billed charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.49,77,,,Percent of total Billed charges,77% of total billed charges,314.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,184.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,150.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.37,328.83,
HYDROcod/APAP 10-325mg Tablet,68084088409,CDM,250,RC,,,Outpatient,,,15.32,7.66,,11.8,77,,,Percent of Total Billed Charges,77% of total billed charges,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.34,74,,,Percent of Total Billed Charges,74% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,12.87,84,,,Percent of Total Billed Charges,84% of total billed charges,12.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.63,89,,,Percent of total Billed Charges,89% of total Billed charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,77,,,Percent of total Billed charges,77% of total billed charges,13.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.83,13.63,
HYDROcod/APAP 10-325mg Tablet,68084088409,CDM,250,RC,,,Outpatient,,,15.32,7.66,,11.8,77,,,Percent of Total Billed Charges,77% of total billed charges,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.34,74,,,Percent of Total Billed Charges,74% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,12.87,84,,,Percent of Total Billed Charges,84% of total billed charges,12.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.63,89,,,Percent of total Billed Charges,89% of total Billed charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,77,,,Percent of total Billed charges,77% of total billed charges,13.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.83,13.63,
HYDROcod/APAP 10-325mg Tablet,68084088409,CDM,250,RC,,,Outpatient,,,15.32,7.66,,11.8,77,,,Percent of Total Billed Charges,77% of total billed charges,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.34,74,,,Percent of Total Billed Charges,74% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,12.87,84,,,Percent of Total Billed Charges,84% of total billed charges,12.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.63,89,,,Percent of total Billed Charges,89% of total Billed charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,77,,,Percent of total Billed charges,77% of total billed charges,13.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.83,13.63,
HYDROcod/APAP 10-325mg Tablet,68084088409,CDM,250,RC,,,Outpatient,,,15.32,7.66,,11.8,77,,,Percent of Total Billed Charges,77% of total billed charges,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.34,74,,,Percent of Total Billed Charges,74% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,12.87,84,,,Percent of Total Billed Charges,84% of total billed charges,12.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.63,89,,,Percent of total Billed Charges,89% of total Billed charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,77,,,Percent of total Billed charges,77% of total billed charges,13.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.83,13.63,
HYDROcod/APAP 10-325mg Tablet,68084088409,CDM,250,RC,,,Outpatient,,,15.32,7.66,,11.8,77,,,Percent of Total Billed Charges,77% of total billed charges,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.34,74,,,Percent of Total Billed Charges,74% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,12.87,84,,,Percent of Total Billed Charges,84% of total billed charges,12.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.63,89,,,Percent of total Billed Charges,89% of total Billed charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,77,,,Percent of total Billed charges,77% of total billed charges,13.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.83,13.63,
HYDROcod/APAP 10-325mg Tablet,68084088409,CDM,250,RC,,,Outpatient,,,15.32,7.66,,11.8,77,,,Percent of Total Billed Charges,77% of total billed charges,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.34,74,,,Percent of Total Billed Charges,74% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.57,69,,,Percent of Total Billed Charges,69% of total billed charges,12.87,84,,,Percent of Total Billed Charges,84% of total billed charges,12.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.63,89,,,Percent of total Billed Charges,89% of total Billed charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,77,,,Percent of total Billed charges,77% of total billed charges,13.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.83,13.63,
Duoderm CGF 4x4 Dressing,68455010697,CDM,250,RC,,,Outpatient,,,63.09,31.55,,48.58,77,,,Percent of Total Billed Charges,77% of total billed charges,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.69,74,,,Percent of Total Billed Charges,74% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,53,84,,,Percent of Total Billed Charges,84% of total billed charges,51.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.15,89,,,Percent of total Billed Charges,89% of total Billed charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.58,77,,,Percent of total Billed charges,77% of total billed charges,53.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.77,56.15,
Duoderm CGF 4x4 Dressing,68455010697,CDM,250,RC,,,Outpatient,,,63.09,31.55,,48.58,77,,,Percent of Total Billed Charges,77% of total billed charges,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.69,74,,,Percent of Total Billed Charges,74% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,53,84,,,Percent of Total Billed Charges,84% of total billed charges,51.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.15,89,,,Percent of total Billed Charges,89% of total Billed charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.58,77,,,Percent of total Billed charges,77% of total billed charges,53.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.77,56.15,
Duoderm CGF 4x4 Dressing,68455010697,CDM,250,RC,,,Outpatient,,,63.09,31.55,,48.58,77,,,Percent of Total Billed Charges,77% of total billed charges,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.69,74,,,Percent of Total Billed Charges,74% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,53,84,,,Percent of Total Billed Charges,84% of total billed charges,51.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.15,89,,,Percent of total Billed Charges,89% of total Billed charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.58,77,,,Percent of total Billed charges,77% of total billed charges,53.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.77,56.15,
Duoderm CGF 4x4 Dressing,68455010697,CDM,250,RC,,,Outpatient,,,63.09,31.55,,48.58,77,,,Percent of Total Billed Charges,77% of total billed charges,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.69,74,,,Percent of Total Billed Charges,74% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,53,84,,,Percent of Total Billed Charges,84% of total billed charges,51.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.15,89,,,Percent of total Billed Charges,89% of total Billed charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.58,77,,,Percent of total Billed charges,77% of total billed charges,53.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.77,56.15,
Duoderm CGF 4x4 Dressing,68455010697,CDM,250,RC,,,Outpatient,,,63.09,31.55,,48.58,77,,,Percent of Total Billed Charges,77% of total billed charges,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.69,74,,,Percent of Total Billed Charges,74% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,53,84,,,Percent of Total Billed Charges,84% of total billed charges,51.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.15,89,,,Percent of total Billed Charges,89% of total Billed charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.58,77,,,Percent of total Billed charges,77% of total billed charges,53.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.77,56.15,
Duoderm CGF 4x4 Dressing,68455010697,CDM,250,RC,,,Outpatient,,,63.09,31.55,,48.58,77,,,Percent of Total Billed Charges,77% of total billed charges,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.69,74,,,Percent of Total Billed Charges,74% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,43.53,69,,,Percent of Total Billed Charges,69% of total billed charges,53,84,,,Percent of Total Billed Charges,84% of total billed charges,51.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.15,89,,,Percent of total Billed Charges,89% of total Billed charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.58,77,,,Percent of total Billed charges,77% of total billed charges,53.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.77,56.15,
HYDROmorphone 0.5mg/0.5ml Syringe,76045000905,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
HYDROmorphone 0.5mg/0.5ml Syringe,76045000905,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
HYDROmorphone 0.5mg/0.5ml Syringe,76045000905,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
HYDROmorphone 0.5mg/0.5ml Syringe,76045000905,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
HYDROmorphone 0.5mg/0.5ml Syringe,76045000905,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
HYDROmorphone 0.5mg/0.5ml Syringe,76045000905,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
Hydrocortisone Sodium Succinate 100mg/2ml SDV,9001103,CDM,250,RC,,,Outpatient,,,178.9,89.45,,137.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,132.39,74,,,Percent of Total Billed Charges,74% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,123.44,69,,,Percent of Total Billed Charges,69% of total billed charges,150.28,84,,,Percent of Total Billed Charges,84% of total billed charges,146.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,159.22,89,,,Percent of total Billed Charges,89% of total Billed charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,137.75,77,,,Percent of total Billed charges,77% of total billed charges,152.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,89.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,159.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.73,159.22,
HYDROcod/APAP 5-217mg/10ml UDC,121154440,CDM,250,RC,,,Outpatient,,,84.76,42.38,,65.27,77,,,Percent of Total Billed Charges,77% of total billed charges,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.72,74,,,Percent of Total Billed Charges,74% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,71.2,84,,,Percent of Total Billed Charges,84% of total billed charges,69.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.44,89,,,Percent of total Billed Charges,89% of total Billed charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.27,77,,,Percent of total Billed charges,77% of total billed charges,72.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,75.44,
HYDROcod/APAP 5-217mg/10ml UDC,121154440,CDM,250,RC,,,Outpatient,,,84.76,42.38,,65.27,77,,,Percent of Total Billed Charges,77% of total billed charges,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.72,74,,,Percent of Total Billed Charges,74% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,71.2,84,,,Percent of Total Billed Charges,84% of total billed charges,69.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.44,89,,,Percent of total Billed Charges,89% of total Billed charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.27,77,,,Percent of total Billed charges,77% of total billed charges,72.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,75.44,
HYDROcod/APAP 5-217mg/10ml UDC,121154440,CDM,250,RC,,,Outpatient,,,84.76,42.38,,65.27,77,,,Percent of Total Billed Charges,77% of total billed charges,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.72,74,,,Percent of Total Billed Charges,74% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,71.2,84,,,Percent of Total Billed Charges,84% of total billed charges,69.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.44,89,,,Percent of total Billed Charges,89% of total Billed charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.27,77,,,Percent of total Billed charges,77% of total billed charges,72.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,75.44,
HYDROcod/APAP 5-217mg/10ml UDC,121154440,CDM,250,RC,,,Outpatient,,,84.76,42.38,,65.27,77,,,Percent of Total Billed Charges,77% of total billed charges,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.72,74,,,Percent of Total Billed Charges,74% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,71.2,84,,,Percent of Total Billed Charges,84% of total billed charges,69.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.44,89,,,Percent of total Billed Charges,89% of total Billed charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.27,77,,,Percent of total Billed charges,77% of total billed charges,72.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,75.44,
HYDROcod/APAP 5-217mg/10ml UDC,121154440,CDM,250,RC,,,Outpatient,,,84.76,42.38,,65.27,77,,,Percent of Total Billed Charges,77% of total billed charges,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.72,74,,,Percent of Total Billed Charges,74% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,71.2,84,,,Percent of Total Billed Charges,84% of total billed charges,69.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.44,89,,,Percent of total Billed Charges,89% of total Billed charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.27,77,,,Percent of total Billed charges,77% of total billed charges,72.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,75.44,
HYDROcod/APAP 5-217mg/10ml UDC,121154440,CDM,250,RC,,,Outpatient,,,84.76,42.38,,65.27,77,,,Percent of Total Billed Charges,77% of total billed charges,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.72,74,,,Percent of Total Billed Charges,74% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,58.48,69,,,Percent of Total Billed Charges,69% of total billed charges,71.2,84,,,Percent of Total Billed Charges,84% of total billed charges,69.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.44,89,,,Percent of total Billed Charges,89% of total Billed charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.27,77,,,Percent of total Billed charges,77% of total billed charges,72.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,75.44,
hydrOXYzine 10mg Tablet,93506001,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
hydrOXYzine 10mg Tablet,93506001,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
hydrOXYzine 10mg Tablet,93506001,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
hydrOXYzine 10mg Tablet,93506001,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
hydrOXYzine 10mg Tablet,93506001,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
hydrOXYzine 10mg Tablet,93506001,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
hydrALAZINE 10mg Tablet,,,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
hydrALAZINE 10mg Tablet,,,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
hydrALAZINE 10mg Tablet,,,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
hydrALAZINE 10mg Tablet,,,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
hydrALAZINE 10mg Tablet,,,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
hydrALAZINE 10mg Tablet,,,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
HYDROcod/APAP 5-325mg Tablet,406012362,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
HYDROcod/APAP 5-325mg Tablet,406012362,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
HYDROcod/APAP 5-325mg Tablet,406012362,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
HYDROcod/APAP 5-325mg Tablet,406012362,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
HYDROcod/APAP 5-325mg Tablet,406012362,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
HYDROcod/APAP 5-325mg Tablet,406012362,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
HYDROcod/APAP 7.5-325mg Tablet,406012462,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
HYDROcod/APAP 7.5-325mg Tablet,406012462,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
HYDROcod/APAP 7.5-325mg Tablet,406012462,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
HYDROcod/APAP 7.5-325mg Tablet,406012462,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
HYDROcod/APAP 7.5-325mg Tablet,406012462,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
HYDROcod/APAP 7.5-325mg Tablet,406012462,CDM,250,RC,,,Outpatient,,,13.35,6.68,,10.28,77,,,Percent of Total Billed Charges,77% of total billed charges,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.88,74,,,Percent of Total Billed Charges,74% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.21,69,,,Percent of Total Billed Charges,69% of total billed charges,11.21,84,,,Percent of Total Billed Charges,84% of total billed charges,10.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.88,89,,,Percent of total Billed Charges,89% of total Billed charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.28,77,,,Percent of total Billed charges,77% of total billed charges,11.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.34,11.88,
HYDROmorphone 1mg/ml SDV,63323085225,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
HYDROmorphone 1mg/ml SDV,63323085225,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
HYDROmorphone 1mg/ml SDV,63323085225,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
HYDROmorphone 1mg/ml SDV,63323085225,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
HYDROmorphone 1mg/ml SDV,63323085225,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
HYDROmorphone 1mg/ml SDV,63323085225,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Hydroxychloroquine 200mg Tablet,68084026901,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Hydroxychloroquine 200mg Tablet,68084026901,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Hydroxychloroquine 200mg Tablet,68084026901,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Hydroxychloroquine 200mg Tablet,68084026901,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Hydroxychloroquine 200mg Tablet,68084026901,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Hydroxychloroquine 200mg Tablet,68084026901,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
hydrALAZINE 20mg/ml SDV,63323061401,CDM,250,RC,,,Outpatient,,,157.77,78.89,,121.48,77,,,Percent of Total Billed Charges,77% of total billed charges,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.75,74,,,Percent of Total Billed Charges,74% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,132.53,84,,,Percent of Total Billed Charges,84% of total billed charges,129.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.42,89,,,Percent of total Billed Charges,89% of total Billed charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.48,77,,,Percent of total Billed charges,77% of total billed charges,134.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.44,140.42,
hydrALAZINE 20mg/ml SDV,63323061401,CDM,250,RC,,,Outpatient,,,157.77,78.89,,121.48,77,,,Percent of Total Billed Charges,77% of total billed charges,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.75,74,,,Percent of Total Billed Charges,74% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,132.53,84,,,Percent of Total Billed Charges,84% of total billed charges,129.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.42,89,,,Percent of total Billed Charges,89% of total Billed charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.48,77,,,Percent of total Billed charges,77% of total billed charges,134.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.44,140.42,
hydrALAZINE 20mg/ml SDV,63323061401,CDM,250,RC,,,Outpatient,,,157.77,78.89,,121.48,77,,,Percent of Total Billed Charges,77% of total billed charges,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.75,74,,,Percent of Total Billed Charges,74% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,132.53,84,,,Percent of Total Billed Charges,84% of total billed charges,129.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.42,89,,,Percent of total Billed Charges,89% of total Billed charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.48,77,,,Percent of total Billed charges,77% of total billed charges,134.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.44,140.42,
hydrALAZINE 20mg/ml SDV,63323061401,CDM,250,RC,,,Outpatient,,,157.77,78.89,,121.48,77,,,Percent of Total Billed Charges,77% of total billed charges,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.75,74,,,Percent of Total Billed Charges,74% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,132.53,84,,,Percent of Total Billed Charges,84% of total billed charges,129.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.42,89,,,Percent of total Billed Charges,89% of total Billed charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.48,77,,,Percent of total Billed charges,77% of total billed charges,134.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.44,140.42,
hydrALAZINE 20mg/ml SDV,63323061401,CDM,250,RC,,,Outpatient,,,157.77,78.89,,121.48,77,,,Percent of Total Billed Charges,77% of total billed charges,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.75,74,,,Percent of Total Billed Charges,74% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,132.53,84,,,Percent of Total Billed Charges,84% of total billed charges,129.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.42,89,,,Percent of total Billed Charges,89% of total Billed charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.48,77,,,Percent of total Billed charges,77% of total billed charges,134.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.44,140.42,
hydrALAZINE 20mg/ml SDV,63323061401,CDM,250,RC,,,Outpatient,,,157.77,78.89,,121.48,77,,,Percent of Total Billed Charges,77% of total billed charges,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.75,74,,,Percent of Total Billed Charges,74% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,108.86,69,,,Percent of Total Billed Charges,69% of total billed charges,132.53,84,,,Percent of Total Billed Charges,84% of total billed charges,129.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.42,89,,,Percent of total Billed Charges,89% of total Billed charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.48,77,,,Percent of total Billed charges,77% of total billed charges,134.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.44,140.42,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone Sodium Succinate 250mg/2ml SDV,9001305,CDM,250,RC,,,Outpatient,,,297.04,148.52,,228.72,77,,,Percent of Total Billed Charges,77% of total billed charges,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,92.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,219.81,74,,,Percent of Total Billed Charges,74% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,204.96,69,,,Percent of Total Billed Charges,69% of total billed charges,249.51,84,,,Percent of Total Billed Charges,84% of total billed charges,243.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,264.37,89,,,Percent of total Billed Charges,89% of total Billed charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,228.72,77,,,Percent of total Billed charges,77% of total billed charges,252.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,85.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,148.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,121.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,264.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.26,264.37,
Hydrocortisone 25mg Rectal Suppository,713050312,CDM,250,RC,,,Outpatient,,,165.01,82.51,,127.06,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.11,74,,,Percent of Total Billed Charges,74% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,138.61,84,,,Percent of Total Billed Charges,84% of total billed charges,135.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.06,77,,,Percent of total Billed charges,77% of total billed charges,140.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.86,
Hydrocortisone 25mg Rectal Suppository,713050312,CDM,250,RC,,,Outpatient,,,165.01,82.51,,127.06,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.11,74,,,Percent of Total Billed Charges,74% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,138.61,84,,,Percent of Total Billed Charges,84% of total billed charges,135.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.06,77,,,Percent of total Billed charges,77% of total billed charges,140.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.86,
Hydrocortisone 25mg Rectal Suppository,713050312,CDM,250,RC,,,Outpatient,,,165.01,82.51,,127.06,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.11,74,,,Percent of Total Billed Charges,74% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,138.61,84,,,Percent of Total Billed Charges,84% of total billed charges,135.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.06,77,,,Percent of total Billed charges,77% of total billed charges,140.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.86,
Hydrocortisone 25mg Rectal Suppository,713050312,CDM,250,RC,,,Outpatient,,,165.01,82.51,,127.06,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.11,74,,,Percent of Total Billed Charges,74% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,138.61,84,,,Percent of Total Billed Charges,84% of total billed charges,135.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.06,77,,,Percent of total Billed charges,77% of total billed charges,140.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.86,
Hydrocortisone 25mg Rectal Suppository,713050312,CDM,250,RC,,,Outpatient,,,165.01,82.51,,127.06,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.11,74,,,Percent of Total Billed Charges,74% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,138.61,84,,,Percent of Total Billed Charges,84% of total billed charges,135.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.06,77,,,Percent of total Billed charges,77% of total billed charges,140.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.86,
Hydrocortisone 25mg Rectal Suppository,713050312,CDM,250,RC,,,Outpatient,,,165.01,82.51,,127.06,77,,,Percent of Total Billed Charges,77% of total billed charges,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.11,74,,,Percent of Total Billed Charges,74% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,113.86,69,,,Percent of Total Billed Charges,69% of total billed charges,138.61,84,,,Percent of Total Billed Charges,84% of total billed charges,135.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.86,89,,,Percent of total Billed Charges,89% of total Billed charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.06,77,,,Percent of total Billed charges,77% of total billed charges,140.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.25,146.86,
hydroCHLOROthiazide 25mg Tablet,16729018301,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
hydroCHLOROthiazide 25mg Tablet,16729018301,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
hydroCHLOROthiazide 25mg Tablet,16729018301,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
hydroCHLOROthiazide 25mg Tablet,16729018301,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
hydroCHLOROthiazide 25mg Tablet,16729018301,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
hydroCHLOROthiazide 25mg Tablet,16729018301,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
hydrALAZINE 25mg Tablet,,,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
hydrALAZINE 25mg Tablet,,,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
hydrALAZINE 25mg Tablet,,,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
hydrALAZINE 25mg Tablet,,,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
hydrALAZINE 25mg Tablet,,,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
hydrALAZINE 25mg Tablet,,,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
hydrOXYzine 25mg Tablet,904661761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
hydrOXYzine 25mg Tablet,904661761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
hydrOXYzine 25mg Tablet,904661761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
hydrOXYzine 25mg Tablet,904661761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
hydrOXYzine 25mg Tablet,904661761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
hydrOXYzine 25mg Tablet,904661761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Hydrocortisone Rectal Cream 1% 30gm,62559043001,CDM,250,RC,,,Outpatient,,,223.36,111.68,,171.99,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.29,74,,,Percent of Total Billed Charges,74% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187.62,84,,,Percent of Total Billed Charges,84% of total billed charges,183.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.79,89,,,Percent of total Billed Charges,89% of total Billed charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.99,77,,,Percent of total Billed charges,77% of total billed charges,189.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.84,198.79,
Hydrocortisone Rectal Cream 1% 30gm,62559043001,CDM,250,RC,,,Outpatient,,,223.36,111.68,,171.99,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.29,74,,,Percent of Total Billed Charges,74% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187.62,84,,,Percent of Total Billed Charges,84% of total billed charges,183.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.79,89,,,Percent of total Billed Charges,89% of total Billed charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.99,77,,,Percent of total Billed charges,77% of total billed charges,189.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.84,198.79,
Hydrocortisone Rectal Cream 1% 30gm,62559043001,CDM,250,RC,,,Outpatient,,,223.36,111.68,,171.99,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.29,74,,,Percent of Total Billed Charges,74% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187.62,84,,,Percent of Total Billed Charges,84% of total billed charges,183.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.79,89,,,Percent of total Billed Charges,89% of total Billed charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.99,77,,,Percent of total Billed charges,77% of total billed charges,189.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.84,198.79,
Hydrocortisone Rectal Cream 1% 30gm,62559043001,CDM,250,RC,,,Outpatient,,,223.36,111.68,,171.99,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.29,74,,,Percent of Total Billed Charges,74% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187.62,84,,,Percent of Total Billed Charges,84% of total billed charges,183.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.79,89,,,Percent of total Billed Charges,89% of total Billed charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.99,77,,,Percent of total Billed charges,77% of total billed charges,189.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.84,198.79,
Hydrocortisone Rectal Cream 1% 30gm,62559043001,CDM,250,RC,,,Outpatient,,,223.36,111.68,,171.99,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.29,74,,,Percent of Total Billed Charges,74% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187.62,84,,,Percent of Total Billed Charges,84% of total billed charges,183.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.79,89,,,Percent of total Billed Charges,89% of total Billed charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.99,77,,,Percent of total Billed charges,77% of total billed charges,189.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.84,198.79,
Hydrocortisone Rectal Cream 1% 30gm,62559043001,CDM,250,RC,,,Outpatient,,,223.36,111.68,,171.99,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.29,74,,,Percent of Total Billed Charges,74% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.12,69,,,Percent of Total Billed Charges,69% of total billed charges,187.62,84,,,Percent of Total Billed Charges,84% of total billed charges,183.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.79,89,,,Percent of total Billed Charges,89% of total Billed charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,171.99,77,,,Percent of total Billed charges,77% of total billed charges,189.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.84,198.79,
Hydrocortisone 1% Cream 30 gm,472032126,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Hydrocortisone 1% Cream 30 gm,472032126,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Hydrocortisone 1% Cream 30 gm,472032126,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Hydrocortisone 1% Cream 30 gm,472032126,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Hydrocortisone 1% Cream 30 gm,472032126,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Hydrocortisone 1% Cream 30 gm,472032126,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
HYDROmorphone 2mg Tablet,406324301,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
HYDROmorphone 2mg Tablet,406324301,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
HYDROmorphone 2mg Tablet,406324301,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
HYDROmorphone 2mg Tablet,406324301,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
HYDROmorphone 2mg Tablet,406324301,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
HYDROmorphone 2mg Tablet,406324301,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Hydrocortisone 2.5% Cream 30gm,168008031,CDM,250,RC,,,Outpatient,,,35.97,17.99,,27.7,77,,,Percent of Total Billed Charges,77% of total billed charges,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.62,74,,,Percent of Total Billed Charges,74% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,30.21,84,,,Percent of Total Billed Charges,84% of total billed charges,29.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.01,89,,,Percent of total Billed Charges,89% of total Billed charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.7,77,,,Percent of total Billed charges,77% of total billed charges,30.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.99,32.01,
Hydrocortisone 2.5% Cream 30gm,168008031,CDM,250,RC,,,Outpatient,,,35.97,17.99,,27.7,77,,,Percent of Total Billed Charges,77% of total billed charges,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.62,74,,,Percent of Total Billed Charges,74% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,30.21,84,,,Percent of Total Billed Charges,84% of total billed charges,29.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.01,89,,,Percent of total Billed Charges,89% of total Billed charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.7,77,,,Percent of total Billed charges,77% of total billed charges,30.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.99,32.01,
Hydrocortisone 2.5% Cream 30gm,168008031,CDM,250,RC,,,Outpatient,,,35.97,17.99,,27.7,77,,,Percent of Total Billed Charges,77% of total billed charges,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.62,74,,,Percent of Total Billed Charges,74% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,30.21,84,,,Percent of Total Billed Charges,84% of total billed charges,29.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.01,89,,,Percent of total Billed Charges,89% of total Billed charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.7,77,,,Percent of total Billed charges,77% of total billed charges,30.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.99,32.01,
Hydrocortisone 2.5% Cream 30gm,168008031,CDM,250,RC,,,Outpatient,,,35.97,17.99,,27.7,77,,,Percent of Total Billed Charges,77% of total billed charges,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.62,74,,,Percent of Total Billed Charges,74% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,30.21,84,,,Percent of Total Billed Charges,84% of total billed charges,29.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.01,89,,,Percent of total Billed Charges,89% of total Billed charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.7,77,,,Percent of total Billed charges,77% of total billed charges,30.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.99,32.01,
Hydrocortisone 2.5% Cream 30gm,168008031,CDM,250,RC,,,Outpatient,,,35.97,17.99,,27.7,77,,,Percent of Total Billed Charges,77% of total billed charges,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.62,74,,,Percent of Total Billed Charges,74% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,30.21,84,,,Percent of Total Billed Charges,84% of total billed charges,29.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.01,89,,,Percent of total Billed Charges,89% of total Billed charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.7,77,,,Percent of total Billed charges,77% of total billed charges,30.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.99,32.01,
Hydrocortisone 2.5% Cream 30gm,168008031,CDM,250,RC,,,Outpatient,,,35.97,17.99,,27.7,77,,,Percent of Total Billed Charges,77% of total billed charges,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.62,74,,,Percent of Total Billed Charges,74% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24.82,69,,,Percent of Total Billed Charges,69% of total billed charges,30.21,84,,,Percent of Total Billed Charges,84% of total billed charges,29.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.01,89,,,Percent of total Billed Charges,89% of total Billed charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.7,77,,,Percent of total Billed charges,77% of total billed charges,30.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.99,32.01,
Hydroxyurea 500mg Capsule,49884072401,CDM,250,RC,,,Outpatient,,,17.01,8.51,,13.1,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.59,74,,,Percent of Total Billed Charges,74% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.14,89,,,Percent of total Billed Charges,89% of total Billed charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,77,,,Percent of total Billed charges,77% of total billed charges,14.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.14,
Hydroxyurea 500mg Capsule,49884072401,CDM,250,RC,,,Outpatient,,,17.01,8.51,,13.1,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.59,74,,,Percent of Total Billed Charges,74% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.14,89,,,Percent of total Billed Charges,89% of total Billed charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,77,,,Percent of total Billed charges,77% of total billed charges,14.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.14,
Hydroxyurea 500mg Capsule,49884072401,CDM,250,RC,,,Outpatient,,,17.01,8.51,,13.1,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.59,74,,,Percent of Total Billed Charges,74% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.14,89,,,Percent of total Billed Charges,89% of total Billed charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,77,,,Percent of total Billed charges,77% of total billed charges,14.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.14,
Hydroxyurea 500mg Capsule,49884072401,CDM,250,RC,,,Outpatient,,,17.01,8.51,,13.1,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.59,74,,,Percent of Total Billed Charges,74% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.14,89,,,Percent of total Billed Charges,89% of total Billed charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,77,,,Percent of total Billed charges,77% of total billed charges,14.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.14,
Hydroxyurea 500mg Capsule,49884072401,CDM,250,RC,,,Outpatient,,,17.01,8.51,,13.1,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.59,74,,,Percent of Total Billed Charges,74% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.14,89,,,Percent of total Billed Charges,89% of total Billed charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,77,,,Percent of total Billed charges,77% of total billed charges,14.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.14,
Hydroxyurea 500mg Capsule,49884072401,CDM,250,RC,,,Outpatient,,,17.01,8.51,,13.1,77,,,Percent of Total Billed Charges,77% of total billed charges,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.59,74,,,Percent of Total Billed Charges,74% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,11.74,69,,,Percent of Total Billed Charges,69% of total billed charges,14.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.14,89,,,Percent of total Billed Charges,89% of total Billed charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,77,,,Percent of total Billed charges,77% of total billed charges,14.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.25,15.14,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
Hydrocortisone Sodium Succinate 500mg/4ml SDV,9001612,CDM,250,RC,,,Outpatient,,,508.28,254.14,,391.38,77,,,Percent of Total Billed Charges,77% of total billed charges,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,129.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,158.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,376.13,74,,,Percent of Total Billed Charges,74% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,350.71,69,,,Percent of Total Billed Charges,69% of total billed charges,426.96,84,,,Percent of Total Billed Charges,84% of total billed charges,416.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,452.37,89,,,Percent of total Billed Charges,89% of total Billed charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.38,77,,,Percent of total Billed charges,77% of total billed charges,432.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,254.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,207.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,452.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.07,452.37,
hydrOXYzine 50mg/ml SDV,517560125,CDM,250,RC,,,Outpatient,,,240.17,120.09,,184.93,77,,,Percent of Total Billed Charges,77% of total billed charges,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.73,74,,,Percent of Total Billed Charges,74% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,201.74,84,,,Percent of Total Billed Charges,84% of total billed charges,196.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.75,89,,,Percent of total Billed Charges,89% of total Billed charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.93,77,,,Percent of total Billed charges,77% of total billed charges,204.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.04,213.75,
hydrOXYzine 50mg/ml SDV,517560125,CDM,250,RC,,,Outpatient,,,240.17,120.09,,184.93,77,,,Percent of Total Billed Charges,77% of total billed charges,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.73,74,,,Percent of Total Billed Charges,74% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,201.74,84,,,Percent of Total Billed Charges,84% of total billed charges,196.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.75,89,,,Percent of total Billed Charges,89% of total Billed charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.93,77,,,Percent of total Billed charges,77% of total billed charges,204.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.04,213.75,
hydrOXYzine 50mg/ml SDV,517560125,CDM,250,RC,,,Outpatient,,,240.17,120.09,,184.93,77,,,Percent of Total Billed Charges,77% of total billed charges,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.73,74,,,Percent of Total Billed Charges,74% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,201.74,84,,,Percent of Total Billed Charges,84% of total billed charges,196.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.75,89,,,Percent of total Billed Charges,89% of total Billed charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.93,77,,,Percent of total Billed charges,77% of total billed charges,204.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.04,213.75,
hydrOXYzine 50mg/ml SDV,517560125,CDM,250,RC,,,Outpatient,,,240.17,120.09,,184.93,77,,,Percent of Total Billed Charges,77% of total billed charges,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.73,74,,,Percent of Total Billed Charges,74% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,201.74,84,,,Percent of Total Billed Charges,84% of total billed charges,196.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.75,89,,,Percent of total Billed Charges,89% of total Billed charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.93,77,,,Percent of total Billed charges,77% of total billed charges,204.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.04,213.75,
hydrOXYzine 50mg/ml SDV,517560125,CDM,250,RC,,,Outpatient,,,240.17,120.09,,184.93,77,,,Percent of Total Billed Charges,77% of total billed charges,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.73,74,,,Percent of Total Billed Charges,74% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,201.74,84,,,Percent of Total Billed Charges,84% of total billed charges,196.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.75,89,,,Percent of total Billed Charges,89% of total Billed charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.93,77,,,Percent of total Billed charges,77% of total billed charges,204.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.04,213.75,
hydrOXYzine 50mg/ml SDV,517560125,CDM,250,RC,,,Outpatient,,,240.17,120.09,,184.93,77,,,Percent of Total Billed Charges,77% of total billed charges,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,177.73,74,,,Percent of Total Billed Charges,74% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,165.72,69,,,Percent of Total Billed Charges,69% of total billed charges,201.74,84,,,Percent of Total Billed Charges,84% of total billed charges,196.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,213.75,89,,,Percent of total Billed Charges,89% of total Billed charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,184.93,77,,,Percent of total Billed charges,77% of total billed charges,204.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,213.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.04,213.75,
Hydrocortisone 5mg Tablet,9001201,CDM,250,RC,,,Outpatient,,,14.48,7.24,,11.15,77,,,Percent of Total Billed Charges,77% of total billed charges,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.72,74,,,Percent of Total Billed Charges,74% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,84,,,Percent of Total Billed Charges,84% of total billed charges,11.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.89,89,,,Percent of total Billed Charges,89% of total Billed charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,77,,,Percent of total Billed charges,77% of total billed charges,12.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.62,12.89,
Hydrocortisone 5mg Tablet,9001201,CDM,250,RC,,,Outpatient,,,14.48,7.24,,11.15,77,,,Percent of Total Billed Charges,77% of total billed charges,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.72,74,,,Percent of Total Billed Charges,74% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,84,,,Percent of Total Billed Charges,84% of total billed charges,11.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.89,89,,,Percent of total Billed Charges,89% of total Billed charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,77,,,Percent of total Billed charges,77% of total billed charges,12.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.62,12.89,
Hydrocortisone 5mg Tablet,9001201,CDM,250,RC,,,Outpatient,,,14.48,7.24,,11.15,77,,,Percent of Total Billed Charges,77% of total billed charges,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.72,74,,,Percent of Total Billed Charges,74% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,84,,,Percent of Total Billed Charges,84% of total billed charges,11.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.89,89,,,Percent of total Billed Charges,89% of total Billed charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,77,,,Percent of total Billed charges,77% of total billed charges,12.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.62,12.89,
Hydrocortisone 5mg Tablet,9001201,CDM,250,RC,,,Outpatient,,,14.48,7.24,,11.15,77,,,Percent of Total Billed Charges,77% of total billed charges,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.72,74,,,Percent of Total Billed Charges,74% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,84,,,Percent of Total Billed Charges,84% of total billed charges,11.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.89,89,,,Percent of total Billed Charges,89% of total Billed charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,77,,,Percent of total Billed charges,77% of total billed charges,12.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.62,12.89,
Hydrocortisone 5mg Tablet,9001201,CDM,250,RC,,,Outpatient,,,14.48,7.24,,11.15,77,,,Percent of Total Billed Charges,77% of total billed charges,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.72,74,,,Percent of Total Billed Charges,74% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,84,,,Percent of Total Billed Charges,84% of total billed charges,11.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.89,89,,,Percent of total Billed Charges,89% of total Billed charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,77,,,Percent of total Billed charges,77% of total billed charges,12.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.62,12.89,
Hydrocortisone 5mg Tablet,9001201,CDM,250,RC,,,Outpatient,,,14.48,7.24,,11.15,77,,,Percent of Total Billed Charges,77% of total billed charges,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.72,74,,,Percent of Total Billed Charges,74% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9.99,69,,,Percent of Total Billed Charges,69% of total billed charges,12.16,84,,,Percent of Total Billed Charges,84% of total billed charges,11.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.89,89,,,Percent of total Billed Charges,89% of total Billed charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,77,,,Percent of total Billed charges,77% of total billed charges,12.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.62,12.89,
Hyoscyamine 0.125mg Tablet,,,250,RC,,,Outpatient,,,12.98,6.49,,9.99,77,,,Percent of Total Billed Charges,77% of total billed charges,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.61,74,,,Percent of Total Billed Charges,74% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.9,84,,,Percent of Total Billed Charges,84% of total billed charges,10.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.55,89,,,Percent of total Billed Charges,89% of total Billed charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,77,,,Percent of total Billed charges,77% of total billed charges,11.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.55,
Hyoscyamine 0.125mg Tablet,,,250,RC,,,Outpatient,,,12.98,6.49,,9.99,77,,,Percent of Total Billed Charges,77% of total billed charges,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.61,74,,,Percent of Total Billed Charges,74% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.9,84,,,Percent of Total Billed Charges,84% of total billed charges,10.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.55,89,,,Percent of total Billed Charges,89% of total Billed charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,77,,,Percent of total Billed charges,77% of total billed charges,11.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.55,
Hyoscyamine 0.125mg Tablet,,,250,RC,,,Outpatient,,,12.98,6.49,,9.99,77,,,Percent of Total Billed Charges,77% of total billed charges,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.61,74,,,Percent of Total Billed Charges,74% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.9,84,,,Percent of Total Billed Charges,84% of total billed charges,10.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.55,89,,,Percent of total Billed Charges,89% of total Billed charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,77,,,Percent of total Billed charges,77% of total billed charges,11.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.55,
Hyoscyamine 0.125mg Tablet,,,250,RC,,,Outpatient,,,12.98,6.49,,9.99,77,,,Percent of Total Billed Charges,77% of total billed charges,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.61,74,,,Percent of Total Billed Charges,74% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.9,84,,,Percent of Total Billed Charges,84% of total billed charges,10.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.55,89,,,Percent of total Billed Charges,89% of total Billed charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,77,,,Percent of total Billed charges,77% of total billed charges,11.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.55,
Hyoscyamine 0.125mg Tablet,,,250,RC,,,Outpatient,,,12.98,6.49,,9.99,77,,,Percent of Total Billed Charges,77% of total billed charges,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.61,74,,,Percent of Total Billed Charges,74% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.9,84,,,Percent of Total Billed Charges,84% of total billed charges,10.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.55,89,,,Percent of total Billed Charges,89% of total Billed charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,77,,,Percent of total Billed charges,77% of total billed charges,11.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.55,
Hyoscyamine 0.125mg Tablet,,,250,RC,,,Outpatient,,,12.98,6.49,,9.99,77,,,Percent of Total Billed Charges,77% of total billed charges,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.61,74,,,Percent of Total Billed Charges,74% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,8.96,69,,,Percent of Total Billed Charges,69% of total billed charges,10.9,84,,,Percent of Total Billed Charges,84% of total billed charges,10.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.55,89,,,Percent of total Billed Charges,89% of total Billed charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.99,77,,,Percent of total Billed charges,77% of total billed charges,11.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.25,11.55,
Hyoscyamine 0.125mg/ml Oral Drops 15ml,,,250,RC,,,Outpatient,,,194.73,97.37,,149.94,77,,,Percent of Total Billed Charges,77% of total billed charges,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.1,74,,,Percent of Total Billed Charges,74% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,163.57,84,,,Percent of Total Billed Charges,84% of total billed charges,159.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.31,89,,,Percent of total Billed Charges,89% of total Billed charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.94,77,,,Percent of total Billed charges,77% of total billed charges,165.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.68,173.31,
Hyoscyamine 0.125mg/ml Oral Drops 15ml,,,250,RC,,,Outpatient,,,194.73,97.37,,149.94,77,,,Percent of Total Billed Charges,77% of total billed charges,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.1,74,,,Percent of Total Billed Charges,74% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,163.57,84,,,Percent of Total Billed Charges,84% of total billed charges,159.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.31,89,,,Percent of total Billed Charges,89% of total Billed charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.94,77,,,Percent of total Billed charges,77% of total billed charges,165.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.68,173.31,
Hyoscyamine 0.125mg/ml Oral Drops 15ml,,,250,RC,,,Outpatient,,,194.73,97.37,,149.94,77,,,Percent of Total Billed Charges,77% of total billed charges,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.1,74,,,Percent of Total Billed Charges,74% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,163.57,84,,,Percent of Total Billed Charges,84% of total billed charges,159.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.31,89,,,Percent of total Billed Charges,89% of total Billed charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.94,77,,,Percent of total Billed charges,77% of total billed charges,165.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.68,173.31,
Hyoscyamine 0.125mg/ml Oral Drops 15ml,,,250,RC,,,Outpatient,,,194.73,97.37,,149.94,77,,,Percent of Total Billed Charges,77% of total billed charges,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.1,74,,,Percent of Total Billed Charges,74% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,163.57,84,,,Percent of Total Billed Charges,84% of total billed charges,159.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.31,89,,,Percent of total Billed Charges,89% of total Billed charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.94,77,,,Percent of total Billed charges,77% of total billed charges,165.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.68,173.31,
Hyoscyamine 0.125mg/ml Oral Drops 15ml,,,250,RC,,,Outpatient,,,194.73,97.37,,149.94,77,,,Percent of Total Billed Charges,77% of total billed charges,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.1,74,,,Percent of Total Billed Charges,74% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,163.57,84,,,Percent of Total Billed Charges,84% of total billed charges,159.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.31,89,,,Percent of total Billed Charges,89% of total Billed charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.94,77,,,Percent of total Billed charges,77% of total billed charges,165.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.68,173.31,
Hyoscyamine 0.125mg/ml Oral Drops 15ml,,,250,RC,,,Outpatient,,,194.73,97.37,,149.94,77,,,Percent of Total Billed Charges,77% of total billed charges,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.1,74,,,Percent of Total Billed Charges,74% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,134.36,69,,,Percent of Total Billed Charges,69% of total billed charges,163.57,84,,,Percent of Total Billed Charges,84% of total billed charges,159.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,173.31,89,,,Percent of total Billed Charges,89% of total Billed charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.94,77,,,Percent of total Billed charges,77% of total billed charges,165.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,55.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.68,173.31,
Hyoscyamine 0.125mg/5ml Oral Soln UDC,,,250,RC,,,Outpatient,,,15.51,7.76,,11.94,77,,,Percent of Total Billed Charges,77% of total billed charges,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.48,74,,,Percent of Total Billed Charges,74% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,13.03,84,,,Percent of Total Billed Charges,84% of total billed charges,12.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.8,89,,,Percent of total Billed Charges,89% of total Billed charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.94,77,,,Percent of total Billed charges,77% of total billed charges,13.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.88,13.8,
Hyoscyamine 0.125mg/5ml Oral Soln UDC,,,250,RC,,,Outpatient,,,15.51,7.76,,11.94,77,,,Percent of Total Billed Charges,77% of total billed charges,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.48,74,,,Percent of Total Billed Charges,74% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,13.03,84,,,Percent of Total Billed Charges,84% of total billed charges,12.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.8,89,,,Percent of total Billed Charges,89% of total Billed charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.94,77,,,Percent of total Billed charges,77% of total billed charges,13.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.88,13.8,
Hyoscyamine 0.125mg/5ml Oral Soln UDC,,,250,RC,,,Outpatient,,,15.51,7.76,,11.94,77,,,Percent of Total Billed Charges,77% of total billed charges,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.48,74,,,Percent of Total Billed Charges,74% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,13.03,84,,,Percent of Total Billed Charges,84% of total billed charges,12.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.8,89,,,Percent of total Billed Charges,89% of total Billed charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.94,77,,,Percent of total Billed charges,77% of total billed charges,13.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.88,13.8,
Hyoscyamine 0.125mg/5ml Oral Soln UDC,,,250,RC,,,Outpatient,,,15.51,7.76,,11.94,77,,,Percent of Total Billed Charges,77% of total billed charges,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.48,74,,,Percent of Total Billed Charges,74% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,13.03,84,,,Percent of Total Billed Charges,84% of total billed charges,12.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.8,89,,,Percent of total Billed Charges,89% of total Billed charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.94,77,,,Percent of total Billed charges,77% of total billed charges,13.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.88,13.8,
Hyoscyamine 0.125mg/5ml Oral Soln UDC,,,250,RC,,,Outpatient,,,15.51,7.76,,11.94,77,,,Percent of Total Billed Charges,77% of total billed charges,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.48,74,,,Percent of Total Billed Charges,74% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,13.03,84,,,Percent of Total Billed Charges,84% of total billed charges,12.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.8,89,,,Percent of total Billed Charges,89% of total Billed charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.94,77,,,Percent of total Billed charges,77% of total billed charges,13.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.88,13.8,
Hyoscyamine 0.125mg/5ml Oral Soln UDC,,,250,RC,,,Outpatient,,,15.51,7.76,,11.94,77,,,Percent of Total Billed Charges,77% of total billed charges,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.48,74,,,Percent of Total Billed Charges,74% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.7,69,,,Percent of Total Billed Charges,69% of total billed charges,13.03,84,,,Percent of Total Billed Charges,84% of total billed charges,12.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.8,89,,,Percent of total Billed Charges,89% of total Billed charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.94,77,,,Percent of total Billed charges,77% of total billed charges,13.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.88,13.8,
Ibandronate 3mg/3ml Liquid Vial,62756021840,CDM,250,RC,,,Outpatient,,,1915.3,957.65,,1474.78,77,,,Percent of Total Billed Charges,77% of total billed charges,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1417.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1608.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1570.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1704.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.78,77,,,Percent of total Billed charges,77% of total billed charges,1628.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,550.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,957.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.83,1704.62,
Ibandronate 3mg/3ml Liquid Vial,62756021840,CDM,250,RC,,,Outpatient,,,1915.3,957.65,,1474.78,77,,,Percent of Total Billed Charges,77% of total billed charges,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1417.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1608.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1570.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1704.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.78,77,,,Percent of total Billed charges,77% of total billed charges,1628.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,550.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,957.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.83,1704.62,
Ibandronate 3mg/3ml Liquid Vial,62756021840,CDM,250,RC,,,Outpatient,,,1915.3,957.65,,1474.78,77,,,Percent of Total Billed Charges,77% of total billed charges,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1417.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1608.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1570.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1704.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.78,77,,,Percent of total Billed charges,77% of total billed charges,1628.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,550.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,957.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.83,1704.62,
Ibandronate 3mg/3ml Liquid Vial,62756021840,CDM,250,RC,,,Outpatient,,,1915.3,957.65,,1474.78,77,,,Percent of Total Billed Charges,77% of total billed charges,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1417.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1608.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1570.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1704.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.78,77,,,Percent of total Billed charges,77% of total billed charges,1628.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,550.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,957.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.83,1704.62,
Ibandronate 3mg/3ml Liquid Vial,62756021840,CDM,250,RC,,,Outpatient,,,1915.3,957.65,,1474.78,77,,,Percent of Total Billed Charges,77% of total billed charges,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1417.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1608.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1570.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1704.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.78,77,,,Percent of total Billed charges,77% of total billed charges,1628.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,550.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,957.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.83,1704.62,
Ibandronate 3mg/3ml Liquid Vial,62756021840,CDM,250,RC,,,Outpatient,,,1915.3,957.65,,1474.78,77,,,Percent of Total Billed Charges,77% of total billed charges,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,598.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1417.32,74,,,Percent of Total Billed Charges,74% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.56,69,,,Percent of Total Billed Charges,69% of total billed charges,1608.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1570.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,1704.62,89,,,Percent of total Billed Charges,89% of total Billed charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.78,77,,,Percent of total Billed charges,77% of total billed charges,1628.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,550.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,957.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,781.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,478.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,478.83,1704.62,
Ibuprofen 100mg/5ml Oral UDC,68094049462,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 100mg/5ml Oral UDC,68094049462,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 100mg/5ml Oral UDC,68094049462,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 100mg/5ml Oral UDC,68094049462,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 100mg/5ml Oral UDC,68094049462,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 100mg/5ml Oral UDC,68094049462,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 200mg Tablet,904791461,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 200mg Tablet,904791461,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 200mg Tablet,904791461,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 200mg Tablet,904791461,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 200mg Tablet,904791461,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 200mg Tablet,904791461,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ibuprofen 400mg Tablet,904585361,CDM,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Ibuprofen 400mg Tablet,904585361,CDM,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Ibuprofen 400mg Tablet,904585361,CDM,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Ibuprofen 400mg Tablet,904585361,CDM,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Ibuprofen 400mg Tablet,904585361,CDM,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Ibuprofen 400mg Tablet,904585361,CDM,250,RC,,,Outpatient,,,5.66,2.83,,4.36,77,,,Percent of Total Billed Charges,77% of total billed charges,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.19,74,,,Percent of Total Billed Charges,74% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,3.91,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,84,,,Percent of Total Billed Charges,84% of total billed charges,4.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.04,89,,,Percent of total Billed Charges,89% of total Billed charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.36,77,,,Percent of total Billed charges,77% of total billed charges,4.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,5.04,
Ibuprofen 600mg Tablet,904585461,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Ibuprofen 600mg Tablet,904585461,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Ibuprofen 600mg Tablet,904585461,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Ibuprofen 600mg Tablet,904585461,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Ibuprofen 600mg Tablet,904585461,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Ibuprofen 600mg Tablet,904585461,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
idaruCIZUmab PF 2.5gram/50ml SDV,597019705,CDM,250,RC,,,Outpatient,,,10615.91,5307.96,,8174.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2707.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3317.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7855.77,74,,,Percent of Total Billed Charges,74% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7324.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8917.36,84,,,Percent of Total Billed Charges,84% of total billed charges,8705.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9448.16,89,,,Percent of total Billed Charges,89% of total Billed charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8174.25,77,,,Percent of total Billed charges,77% of total billed charges,9023.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3052.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5307.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4331.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9448.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2653.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2653.98,9448.16,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,589.09,294.55,,453.6,77,,,Percent of Total Billed Charges,77% of total billed charges,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.93,74,,,Percent of Total Billed Charges,74% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,494.84,84,,,Percent of Total Billed Charges,84% of total billed charges,483.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.29,89,,,Percent of total Billed Charges,89% of total Billed charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.6,77,,,Percent of total Billed charges,77% of total billed charges,500.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,294.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.27,524.29,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,578.48,289.24,,445.43,77,,,Percent of Total Billed Charges,77% of total billed charges,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.08,74,,,Percent of Total Billed Charges,74% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,485.92,84,,,Percent of Total Billed Charges,84% of total billed charges,474.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.85,89,,,Percent of total Billed Charges,89% of total Billed charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.43,77,,,Percent of total Billed charges,77% of total billed charges,491.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.62,514.85,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,589.09,294.55,,453.6,77,,,Percent of Total Billed Charges,77% of total billed charges,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.93,74,,,Percent of Total Billed Charges,74% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,494.84,84,,,Percent of Total Billed Charges,84% of total billed charges,483.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.29,89,,,Percent of total Billed Charges,89% of total Billed charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.6,77,,,Percent of total Billed charges,77% of total billed charges,500.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,294.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.27,524.29,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,578.48,289.24,,445.43,77,,,Percent of Total Billed Charges,77% of total billed charges,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.08,74,,,Percent of Total Billed Charges,74% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,485.92,84,,,Percent of Total Billed Charges,84% of total billed charges,474.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.85,89,,,Percent of total Billed Charges,89% of total Billed charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.43,77,,,Percent of total Billed charges,77% of total billed charges,491.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.62,514.85,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,589.09,294.55,,453.6,77,,,Percent of Total Billed Charges,77% of total billed charges,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.93,74,,,Percent of Total Billed Charges,74% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,494.84,84,,,Percent of Total Billed Charges,84% of total billed charges,483.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.29,89,,,Percent of total Billed Charges,89% of total Billed charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.6,77,,,Percent of total Billed charges,77% of total billed charges,500.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,294.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.27,524.29,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,578.48,289.24,,445.43,77,,,Percent of Total Billed Charges,77% of total billed charges,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.08,74,,,Percent of Total Billed Charges,74% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,485.92,84,,,Percent of Total Billed Charges,84% of total billed charges,474.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.85,89,,,Percent of total Billed Charges,89% of total Billed charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.43,77,,,Percent of total Billed charges,77% of total billed charges,491.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.62,514.85,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,589.09,294.55,,453.6,77,,,Percent of Total Billed Charges,77% of total billed charges,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.93,74,,,Percent of Total Billed Charges,74% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,494.84,84,,,Percent of Total Billed Charges,84% of total billed charges,483.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.29,89,,,Percent of total Billed Charges,89% of total Billed charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.6,77,,,Percent of total Billed charges,77% of total billed charges,500.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,294.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.27,524.29,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,578.48,289.24,,445.43,77,,,Percent of Total Billed Charges,77% of total billed charges,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.08,74,,,Percent of Total Billed Charges,74% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,485.92,84,,,Percent of Total Billed Charges,84% of total billed charges,474.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.85,89,,,Percent of total Billed Charges,89% of total Billed charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.43,77,,,Percent of total Billed charges,77% of total billed charges,491.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.62,514.85,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,589.09,294.55,,453.6,77,,,Percent of Total Billed Charges,77% of total billed charges,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.93,74,,,Percent of Total Billed Charges,74% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,494.84,84,,,Percent of Total Billed Charges,84% of total billed charges,483.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.29,89,,,Percent of total Billed Charges,89% of total Billed charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.6,77,,,Percent of total Billed charges,77% of total billed charges,500.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,294.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.27,524.29,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,578.48,289.24,,445.43,77,,,Percent of Total Billed Charges,77% of total billed charges,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.08,74,,,Percent of Total Billed Charges,74% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,485.92,84,,,Percent of Total Billed Charges,84% of total billed charges,474.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.85,89,,,Percent of total Billed Charges,89% of total Billed charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.43,77,,,Percent of total Billed charges,77% of total billed charges,491.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.62,514.85,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,589.09,294.55,,453.6,77,,,Percent of Total Billed Charges,77% of total billed charges,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,150.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,184.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,435.93,74,,,Percent of Total Billed Charges,74% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,406.47,69,,,Percent of Total Billed Charges,69% of total billed charges,494.84,84,,,Percent of Total Billed Charges,84% of total billed charges,483.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,524.29,89,,,Percent of total Billed Charges,89% of total Billed charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,453.6,77,,,Percent of total Billed charges,77% of total billed charges,500.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,169.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,294.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,240.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,524.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,147.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,147.27,524.29,
Ifosfamide 1000mg/20mg Powder SDV,63323014210,CDM,250,RC,,,Outpatient,,,578.48,289.24,,445.43,77,,,Percent of Total Billed Charges,77% of total billed charges,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,428.08,74,,,Percent of Total Billed Charges,74% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,399.15,69,,,Percent of Total Billed Charges,69% of total billed charges,485.92,84,,,Percent of Total Billed Charges,84% of total billed charges,474.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.85,89,,,Percent of total Billed Charges,89% of total Billed charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.43,77,,,Percent of total Billed charges,77% of total billed charges,491.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,236.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.62,514.85,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,938.71,469.36,,722.81,77,,,Percent of Total Billed Charges,77% of total billed charges,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.65,74,,,Percent of Total Billed Charges,74% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,788.52,84,,,Percent of Total Billed Charges,84% of total billed charges,769.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,835.45,89,,,Percent of total Billed Charges,89% of total Billed charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.81,77,,,Percent of total Billed charges,77% of total billed charges,797.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.68,835.45,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,919.06,459.53,,707.68,77,,,Percent of Total Billed Charges,77% of total billed charges,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.1,74,,,Percent of Total Billed Charges,74% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,772.01,84,,,Percent of Total Billed Charges,84% of total billed charges,753.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.96,89,,,Percent of total Billed Charges,89% of total Billed charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.68,77,,,Percent of total Billed charges,77% of total billed charges,781.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.77,817.96,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,938.71,469.36,,722.81,77,,,Percent of Total Billed Charges,77% of total billed charges,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.65,74,,,Percent of Total Billed Charges,74% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,788.52,84,,,Percent of Total Billed Charges,84% of total billed charges,769.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,835.45,89,,,Percent of total Billed Charges,89% of total Billed charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.81,77,,,Percent of total Billed charges,77% of total billed charges,797.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.68,835.45,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,919.06,459.53,,707.68,77,,,Percent of Total Billed Charges,77% of total billed charges,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.1,74,,,Percent of Total Billed Charges,74% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,772.01,84,,,Percent of Total Billed Charges,84% of total billed charges,753.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.96,89,,,Percent of total Billed Charges,89% of total Billed charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.68,77,,,Percent of total Billed charges,77% of total billed charges,781.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.77,817.96,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,938.71,469.36,,722.81,77,,,Percent of Total Billed Charges,77% of total billed charges,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.65,74,,,Percent of Total Billed Charges,74% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,788.52,84,,,Percent of Total Billed Charges,84% of total billed charges,769.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,835.45,89,,,Percent of total Billed Charges,89% of total Billed charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.81,77,,,Percent of total Billed charges,77% of total billed charges,797.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.68,835.45,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,919.06,459.53,,707.68,77,,,Percent of Total Billed Charges,77% of total billed charges,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.1,74,,,Percent of Total Billed Charges,74% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,772.01,84,,,Percent of Total Billed Charges,84% of total billed charges,753.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.96,89,,,Percent of total Billed Charges,89% of total Billed charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.68,77,,,Percent of total Billed charges,77% of total billed charges,781.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.77,817.96,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,938.71,469.36,,722.81,77,,,Percent of Total Billed Charges,77% of total billed charges,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.65,74,,,Percent of Total Billed Charges,74% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,788.52,84,,,Percent of Total Billed Charges,84% of total billed charges,769.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,835.45,89,,,Percent of total Billed Charges,89% of total Billed charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.81,77,,,Percent of total Billed charges,77% of total billed charges,797.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.68,835.45,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,919.06,459.53,,707.68,77,,,Percent of Total Billed Charges,77% of total billed charges,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.1,74,,,Percent of Total Billed Charges,74% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,772.01,84,,,Percent of Total Billed Charges,84% of total billed charges,753.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.96,89,,,Percent of total Billed Charges,89% of total Billed charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.68,77,,,Percent of total Billed charges,77% of total billed charges,781.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.77,817.96,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,938.71,469.36,,722.81,77,,,Percent of Total Billed Charges,77% of total billed charges,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.65,74,,,Percent of Total Billed Charges,74% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,788.52,84,,,Percent of Total Billed Charges,84% of total billed charges,769.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,835.45,89,,,Percent of total Billed Charges,89% of total Billed charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.81,77,,,Percent of total Billed charges,77% of total billed charges,797.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.68,835.45,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,919.06,459.53,,707.68,77,,,Percent of Total Billed Charges,77% of total billed charges,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.1,74,,,Percent of Total Billed Charges,74% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,772.01,84,,,Percent of Total Billed Charges,84% of total billed charges,753.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.96,89,,,Percent of total Billed Charges,89% of total Billed charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.68,77,,,Percent of total Billed charges,77% of total billed charges,781.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.77,817.96,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,938.71,469.36,,722.81,77,,,Percent of Total Billed Charges,77% of total billed charges,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,694.65,74,,,Percent of Total Billed Charges,74% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,647.71,69,,,Percent of Total Billed Charges,69% of total billed charges,788.52,84,,,Percent of Total Billed Charges,84% of total billed charges,769.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,835.45,89,,,Percent of total Billed Charges,89% of total Billed charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,722.81,77,,,Percent of total Billed charges,77% of total billed charges,797.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,269.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,382.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,835.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.68,835.45,
Ifosfamide 3000mg/60ml Powder SDV,10019092602,CDM,250,RC,,,Outpatient,,,919.06,459.53,,707.68,77,,,Percent of Total Billed Charges,77% of total billed charges,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,680.1,74,,,Percent of Total Billed Charges,74% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,634.15,69,,,Percent of Total Billed Charges,69% of total billed charges,772.01,84,,,Percent of Total Billed Charges,84% of total billed charges,753.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,817.96,89,,,Percent of total Billed Charges,89% of total Billed charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,707.68,77,,,Percent of total Billed charges,77% of total billed charges,781.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,459.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,374.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,229.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.77,817.96,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 250mg SDV,63323034993,CDM,250,RC,,,Outpatient,,,93.46,46.73,,71.96,77,,,Percent of Total Billed Charges,77% of total billed charges,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.16,74,,,Percent of Total Billed Charges,74% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,64.49,69,,,Percent of Total Billed Charges,69% of total billed charges,78.51,84,,,Percent of Total Billed Charges,84% of total billed charges,76.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.18,89,,,Percent of total Billed Charges,89% of total Billed charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.96,77,,,Percent of total Billed charges,77% of total billed charges,79.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.37,83.18,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Imipenem-Cilastatin 500mg SDV,6351659,CDM,250,RC,,,Outpatient,,,251.72,125.86,,193.82,77,,,Percent of Total Billed Charges,77% of total billed charges,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,186.27,74,,,Percent of Total Billed Charges,74% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,173.69,69,,,Percent of Total Billed Charges,69% of total billed charges,211.44,84,,,Percent of Total Billed Charges,84% of total billed charges,206.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,224.03,89,,,Percent of total Billed Charges,89% of total Billed charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.82,77,,,Percent of total Billed charges,77% of total billed charges,213.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,224.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.93,224.03,
Immune Globulin (Gammagard) 10% 10gm/100ml SDV,944270005,CDM,250,RC,,,Outpatient,,,7530.42,3765.21,,5798.42,77,,,Percent of Total Billed Charges,77% of total billed charges,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2353.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5572.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6325.55,84,,,Percent of Total Billed Charges,84% of total billed charges,6174.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,6702.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5798.42,77,,,Percent of total Billed charges,77% of total billed charges,6400.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2165,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3765.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1882.61,6702.07,
Immune Globulin (Gammagard) 10% 10gm/100ml SDV,944270005,CDM,250,RC,,,Outpatient,,,7530.42,3765.21,,5798.42,77,,,Percent of Total Billed Charges,77% of total billed charges,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2353.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5572.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6325.55,84,,,Percent of Total Billed Charges,84% of total billed charges,6174.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,6702.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5798.42,77,,,Percent of total Billed charges,77% of total billed charges,6400.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2165,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3765.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1882.61,6702.07,
Immune Globulin (Gammagard) 10% 10gm/100ml SDV,944270005,CDM,250,RC,,,Outpatient,,,7530.42,3765.21,,5798.42,77,,,Percent of Total Billed Charges,77% of total billed charges,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2353.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5572.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6325.55,84,,,Percent of Total Billed Charges,84% of total billed charges,6174.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,6702.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5798.42,77,,,Percent of total Billed charges,77% of total billed charges,6400.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2165,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3765.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1882.61,6702.07,
Immune Globulin (Gammagard) 10% 10gm/100ml SDV,944270005,CDM,250,RC,,,Outpatient,,,7530.42,3765.21,,5798.42,77,,,Percent of Total Billed Charges,77% of total billed charges,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2353.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5572.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6325.55,84,,,Percent of Total Billed Charges,84% of total billed charges,6174.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,6702.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5798.42,77,,,Percent of total Billed charges,77% of total billed charges,6400.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2165,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3765.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1882.61,6702.07,
Immune Globulin (Gammagard) 10% 10gm/100ml SDV,944270005,CDM,250,RC,,,Outpatient,,,7530.42,3765.21,,5798.42,77,,,Percent of Total Billed Charges,77% of total billed charges,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2353.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5572.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6325.55,84,,,Percent of Total Billed Charges,84% of total billed charges,6174.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,6702.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5798.42,77,,,Percent of total Billed charges,77% of total billed charges,6400.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2165,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3765.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1882.61,6702.07,
Immune Globulin (Gammagard) 10% 10gm/100ml SDV,944270005,CDM,250,RC,,,Outpatient,,,7530.42,3765.21,,5798.42,77,,,Percent of Total Billed Charges,77% of total billed charges,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1920.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2353.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5572.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,5195.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6325.55,84,,,Percent of Total Billed Charges,84% of total billed charges,6174.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,6702.07,89,,,Percent of total Billed Charges,89% of total Billed charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5798.42,77,,,Percent of total Billed charges,77% of total billed charges,6400.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2165,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3765.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3072.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6702.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1882.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1882.61,6702.07,
Immune Globulin (Gammagard) 10% 20gm/200ml SDV,944270006,CDM,250,RC,,,Outpatient,,,15060.83,7530.42,,11596.84,77,,,Percent of Total Billed Charges,77% of total billed charges,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4706.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11145.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12651.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12349.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13404.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11596.84,77,,,Percent of total Billed charges,77% of total billed charges,12801.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4329.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7530.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3765.21,13404.14,
Immune Globulin (Gammagard) 10% 20gm/200ml SDV,944270006,CDM,250,RC,,,Outpatient,,,15060.83,7530.42,,11596.84,77,,,Percent of Total Billed Charges,77% of total billed charges,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4706.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11145.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12651.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12349.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13404.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11596.84,77,,,Percent of total Billed charges,77% of total billed charges,12801.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4329.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7530.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3765.21,13404.14,
Immune Globulin (Gammagard) 10% 20gm/200ml SDV,944270006,CDM,250,RC,,,Outpatient,,,15060.83,7530.42,,11596.84,77,,,Percent of Total Billed Charges,77% of total billed charges,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4706.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11145.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12651.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12349.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13404.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11596.84,77,,,Percent of total Billed charges,77% of total billed charges,12801.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4329.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7530.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3765.21,13404.14,
Immune Globulin (Gammagard) 10% 20gm/200ml SDV,944270006,CDM,250,RC,,,Outpatient,,,15060.83,7530.42,,11596.84,77,,,Percent of Total Billed Charges,77% of total billed charges,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4706.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11145.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12651.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12349.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13404.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11596.84,77,,,Percent of total Billed charges,77% of total billed charges,12801.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4329.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7530.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3765.21,13404.14,
Immune Globulin (Gammagard) 10% 20gm/200ml SDV,944270006,CDM,250,RC,,,Outpatient,,,15060.83,7530.42,,11596.84,77,,,Percent of Total Billed Charges,77% of total billed charges,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4706.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11145.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12651.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12349.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13404.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11596.84,77,,,Percent of total Billed charges,77% of total billed charges,12801.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4329.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7530.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3765.21,13404.14,
Immune Globulin (Gammagard) 10% 20gm/200ml SDV,944270006,CDM,250,RC,,,Outpatient,,,15060.83,7530.42,,11596.84,77,,,Percent of Total Billed Charges,77% of total billed charges,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3840.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4706.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11145.01,74,,,Percent of Total Billed Charges,74% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,10391.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12651.1,84,,,Percent of Total Billed Charges,84% of total billed charges,12349.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13404.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11596.84,77,,,Percent of total Billed charges,77% of total billed charges,12801.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4329.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7530.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6144.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13404.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3765.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3765.21,13404.14,
Immune Globulin (Gammagard) 10% 30gm/300ml SDV,944270007,CDM,250,RC,,,Outpatient,,,22591.25,11295.63,,17395.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7059.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16717.53,74,,,Percent of Total Billed Charges,74% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,18976.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,20106.21,89,,,Percent of total Billed Charges,89% of total Billed charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17395.26,77,,,Percent of total Billed charges,77% of total billed charges,19202.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6494.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11295.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.81,20106.21,
Immune Globulin (Gammagard) 10% 30gm/300ml SDV,944270007,CDM,250,RC,,,Outpatient,,,22591.25,11295.63,,17395.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7059.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16717.53,74,,,Percent of Total Billed Charges,74% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,18976.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,20106.21,89,,,Percent of total Billed Charges,89% of total Billed charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17395.26,77,,,Percent of total Billed charges,77% of total billed charges,19202.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6494.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11295.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.81,20106.21,
Immune Globulin (Gammagard) 10% 30gm/300ml SDV,944270007,CDM,250,RC,,,Outpatient,,,22591.25,11295.63,,17395.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7059.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16717.53,74,,,Percent of Total Billed Charges,74% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,18976.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,20106.21,89,,,Percent of total Billed Charges,89% of total Billed charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17395.26,77,,,Percent of total Billed charges,77% of total billed charges,19202.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6494.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11295.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.81,20106.21,
Immune Globulin (Gammagard) 10% 30gm/300ml SDV,944270007,CDM,250,RC,,,Outpatient,,,22591.25,11295.63,,17395.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7059.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16717.53,74,,,Percent of Total Billed Charges,74% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,18976.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,20106.21,89,,,Percent of total Billed Charges,89% of total Billed charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17395.26,77,,,Percent of total Billed charges,77% of total billed charges,19202.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6494.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11295.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.81,20106.21,
Immune Globulin (Gammagard) 10% 30gm/300ml SDV,944270007,CDM,250,RC,,,Outpatient,,,22591.25,11295.63,,17395.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7059.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16717.53,74,,,Percent of Total Billed Charges,74% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,18976.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,20106.21,89,,,Percent of total Billed Charges,89% of total Billed charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17395.26,77,,,Percent of total Billed charges,77% of total billed charges,19202.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6494.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11295.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.81,20106.21,
Immune Globulin (Gammagard) 10% 30gm/300ml SDV,944270007,CDM,250,RC,,,Outpatient,,,22591.25,11295.63,,17395.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5760.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7059.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16717.53,74,,,Percent of Total Billed Charges,74% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,15587.96,69,,,Percent of Total Billed Charges,69% of total billed charges,18976.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,20106.21,89,,,Percent of total Billed Charges,89% of total Billed charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17395.26,77,,,Percent of total Billed charges,77% of total billed charges,19202.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6494.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11295.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9217.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20106.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5647.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5647.81,20106.21,
Immune Globulin (Gammagard) 10% 5gm/50ml SDV,944270004,CDM,250,RC,,,Outpatient,,,3765.21,1882.61,,2899.21,77,,,Percent of Total Billed Charges,77% of total billed charges,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1176.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2786.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3162.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3087.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,3351.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2899.21,77,,,Percent of total Billed charges,77% of total billed charges,3200.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1082.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1882.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.3,3351.04,
Immune Globulin (Gammagard) 10% 5gm/50ml SDV,944270004,CDM,250,RC,,,Outpatient,,,3765.21,1882.61,,2899.21,77,,,Percent of Total Billed Charges,77% of total billed charges,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1176.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2786.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3162.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3087.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,3351.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2899.21,77,,,Percent of total Billed charges,77% of total billed charges,3200.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1082.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1882.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.3,3351.04,
Immune Globulin (Gammagard) 10% 5gm/50ml SDV,944270004,CDM,250,RC,,,Outpatient,,,3765.21,1882.61,,2899.21,77,,,Percent of Total Billed Charges,77% of total billed charges,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1176.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2786.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3162.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3087.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,3351.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2899.21,77,,,Percent of total Billed charges,77% of total billed charges,3200.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1082.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1882.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.3,3351.04,
Immune Globulin (Gammagard) 10% 5gm/50ml SDV,944270004,CDM,250,RC,,,Outpatient,,,3765.21,1882.61,,2899.21,77,,,Percent of Total Billed Charges,77% of total billed charges,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1176.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2786.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3162.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3087.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,3351.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2899.21,77,,,Percent of total Billed charges,77% of total billed charges,3200.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1082.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1882.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.3,3351.04,
Immune Globulin (Gammagard) 10% 5gm/50ml SDV,944270004,CDM,250,RC,,,Outpatient,,,3765.21,1882.61,,2899.21,77,,,Percent of Total Billed Charges,77% of total billed charges,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1176.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2786.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3162.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3087.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,3351.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2899.21,77,,,Percent of total Billed charges,77% of total billed charges,3200.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1082.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1882.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.3,3351.04,
Immune Globulin (Gammagard) 10% 5gm/50ml SDV,944270004,CDM,250,RC,,,Outpatient,,,3765.21,1882.61,,2899.21,77,,,Percent of Total Billed Charges,77% of total billed charges,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,960.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1176.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2786.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2597.99,69,,,Percent of Total Billed Charges,69% of total billed charges,3162.78,84,,,Percent of Total Billed Charges,84% of total billed charges,3087.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,3351.04,89,,,Percent of total Billed Charges,89% of total Billed charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2899.21,77,,,Percent of total Billed charges,77% of total billed charges,3200.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1082.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1882.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1536.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3351.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,941.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,941.3,3351.04,
Inclisiran (Leqvio) Syringe 284mg/1.5ml,78100060,CDM,250,RC,,,Outpatient,,,16254.88,8127.44,,12516.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5079.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12028.61,74,,,Percent of Total Billed Charges,74% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,13654.1,84,,,Percent of Total Billed Charges,84% of total billed charges,13329,82,,,Percent of Total Billed Charges,82% of total billed charges ,14466.84,89,,,Percent of total Billed Charges,89% of total Billed charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12516.26,77,,,Percent of total Billed charges,77% of total billed charges,13816.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4673.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8127.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4063.72,14466.84,
Inclisiran (Leqvio) Syringe 284mg/1.5ml,78100060,CDM,250,RC,,,Outpatient,,,16254.88,8127.44,,12516.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5079.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12028.61,74,,,Percent of Total Billed Charges,74% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,13654.1,84,,,Percent of Total Billed Charges,84% of total billed charges,13329,82,,,Percent of Total Billed Charges,82% of total billed charges ,14466.84,89,,,Percent of total Billed Charges,89% of total Billed charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12516.26,77,,,Percent of total Billed charges,77% of total billed charges,13816.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4673.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8127.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4063.72,14466.84,
Inclisiran (Leqvio) Syringe 284mg/1.5ml,78100060,CDM,250,RC,,,Outpatient,,,16254.88,8127.44,,12516.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5079.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12028.61,74,,,Percent of Total Billed Charges,74% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,13654.1,84,,,Percent of Total Billed Charges,84% of total billed charges,13329,82,,,Percent of Total Billed Charges,82% of total billed charges ,14466.84,89,,,Percent of total Billed Charges,89% of total Billed charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12516.26,77,,,Percent of total Billed charges,77% of total billed charges,13816.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4673.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8127.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4063.72,14466.84,
Inclisiran (Leqvio) Syringe 284mg/1.5ml,78100060,CDM,250,RC,,,Outpatient,,,16254.88,8127.44,,12516.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5079.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12028.61,74,,,Percent of Total Billed Charges,74% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,13654.1,84,,,Percent of Total Billed Charges,84% of total billed charges,13329,82,,,Percent of Total Billed Charges,82% of total billed charges ,14466.84,89,,,Percent of total Billed Charges,89% of total Billed charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12516.26,77,,,Percent of total Billed charges,77% of total billed charges,13816.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4673.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8127.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4063.72,14466.84,
Inclisiran (Leqvio) Syringe 284mg/1.5ml,78100060,CDM,250,RC,,,Outpatient,,,16254.88,8127.44,,12516.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5079.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12028.61,74,,,Percent of Total Billed Charges,74% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,13654.1,84,,,Percent of Total Billed Charges,84% of total billed charges,13329,82,,,Percent of Total Billed Charges,82% of total billed charges ,14466.84,89,,,Percent of total Billed Charges,89% of total Billed charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12516.26,77,,,Percent of total Billed charges,77% of total billed charges,13816.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4673.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8127.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4063.72,14466.84,
Inclisiran (Leqvio) Syringe 284mg/1.5ml,78100060,CDM,250,RC,,,Outpatient,,,16254.88,8127.44,,12516.26,77,,,Percent of Total Billed Charges,77% of total billed charges,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4144.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5079.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12028.61,74,,,Percent of Total Billed Charges,74% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,11215.87,69,,,Percent of Total Billed Charges,69% of total billed charges,13654.1,84,,,Percent of Total Billed Charges,84% of total billed charges,13329,82,,,Percent of Total Billed Charges,82% of total billed charges ,14466.84,89,,,Percent of total Billed Charges,89% of total Billed charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12516.26,77,,,Percent of total Billed charges,77% of total billed charges,13816.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4673.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8127.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6631.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14466.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4063.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4063.72,14466.84,
Indigotindisulfonate (Bludigo) 40mg/5ml Ampule,81284031505,CDM,250,RC,,,Outpatient,,,2178.11,1089.06,,1677.14,77,,,Percent of Total Billed Charges,77% of total billed charges,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1611.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.61,84,,,Percent of Total Billed Charges,84% of total billed charges,1786.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1938.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1677.14,77,,,Percent of total Billed charges,77% of total billed charges,1851.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1089.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.53,1938.52,
Indigotindisulfonate (Bludigo) 40mg/5ml Ampule,81284031505,CDM,250,RC,,,Outpatient,,,2178.11,1089.06,,1677.14,77,,,Percent of Total Billed Charges,77% of total billed charges,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1611.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.61,84,,,Percent of Total Billed Charges,84% of total billed charges,1786.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1938.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1677.14,77,,,Percent of total Billed charges,77% of total billed charges,1851.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1089.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.53,1938.52,
Indigotindisulfonate (Bludigo) 40mg/5ml Ampule,81284031505,CDM,250,RC,,,Outpatient,,,2178.11,1089.06,,1677.14,77,,,Percent of Total Billed Charges,77% of total billed charges,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1611.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.61,84,,,Percent of Total Billed Charges,84% of total billed charges,1786.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1938.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1677.14,77,,,Percent of total Billed charges,77% of total billed charges,1851.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1089.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.53,1938.52,
Indigotindisulfonate (Bludigo) 40mg/5ml Ampule,81284031505,CDM,250,RC,,,Outpatient,,,2178.11,1089.06,,1677.14,77,,,Percent of Total Billed Charges,77% of total billed charges,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1611.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.61,84,,,Percent of Total Billed Charges,84% of total billed charges,1786.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1938.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1677.14,77,,,Percent of total Billed charges,77% of total billed charges,1851.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1089.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.53,1938.52,
Indigotindisulfonate (Bludigo) 40mg/5ml Ampule,81284031505,CDM,250,RC,,,Outpatient,,,2178.11,1089.06,,1677.14,77,,,Percent of Total Billed Charges,77% of total billed charges,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1611.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.61,84,,,Percent of Total Billed Charges,84% of total billed charges,1786.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1938.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1677.14,77,,,Percent of total Billed charges,77% of total billed charges,1851.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1089.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.53,1938.52,
Indigotindisulfonate (Bludigo) 40mg/5ml Ampule,81284031505,CDM,250,RC,,,Outpatient,,,2178.11,1089.06,,1677.14,77,,,Percent of Total Billed Charges,77% of total billed charges,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,680.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1611.8,74,,,Percent of Total Billed Charges,74% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1502.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1829.61,84,,,Percent of Total Billed Charges,84% of total billed charges,1786.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1938.52,89,,,Percent of total Billed Charges,89% of total Billed charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1677.14,77,,,Percent of total Billed charges,77% of total billed charges,1851.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,626.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1089.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,888.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1938.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,544.53,1938.52,
Indomethacin 25mg Capsule,68462040601,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Indomethacin 25mg Capsule,68462040601,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Indomethacin 25mg Capsule,68462040601,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Indomethacin 25mg Capsule,68462040601,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Indomethacin 25mg Capsule,68462040601,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
Indomethacin 25mg Capsule,68462040601,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3711.2,1855.6,,2857.62,77,,,Percent of Total Billed Charges,77% of total billed charges,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1159.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3117.41,84,,,Percent of Total Billed Charges,84% of total billed charges,3043.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,3302.97,89,,,Percent of total Billed Charges,89% of total Billed charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2857.62,77,,,Percent of total Billed charges,77% of total billed charges,3154.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1066.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1855.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,927.8,3302.97,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3619.85,1809.93,,2787.28,77,,,Percent of Total Billed Charges,77% of total billed charges,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2678.69,74,,,Percent of Total Billed Charges,74% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2968.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3221.67,89,,,Percent of total Billed Charges,89% of total Billed charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2787.28,77,,,Percent of total Billed charges,77% of total billed charges,3076.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1040.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1809.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.96,3221.67,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3711.2,1855.6,,2857.62,77,,,Percent of Total Billed Charges,77% of total billed charges,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1159.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3117.41,84,,,Percent of Total Billed Charges,84% of total billed charges,3043.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,3302.97,89,,,Percent of total Billed Charges,89% of total Billed charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2857.62,77,,,Percent of total Billed charges,77% of total billed charges,3154.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1066.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1855.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,927.8,3302.97,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3619.85,1809.93,,2787.28,77,,,Percent of Total Billed Charges,77% of total billed charges,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2678.69,74,,,Percent of Total Billed Charges,74% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2968.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3221.67,89,,,Percent of total Billed Charges,89% of total Billed charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2787.28,77,,,Percent of total Billed charges,77% of total billed charges,3076.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1040.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1809.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.96,3221.67,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3711.2,1855.6,,2857.62,77,,,Percent of Total Billed Charges,77% of total billed charges,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1159.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3117.41,84,,,Percent of Total Billed Charges,84% of total billed charges,3043.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,3302.97,89,,,Percent of total Billed Charges,89% of total Billed charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2857.62,77,,,Percent of total Billed charges,77% of total billed charges,3154.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1066.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1855.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,927.8,3302.97,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3619.85,1809.93,,2787.28,77,,,Percent of Total Billed Charges,77% of total billed charges,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2678.69,74,,,Percent of Total Billed Charges,74% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2968.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3221.67,89,,,Percent of total Billed Charges,89% of total Billed charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2787.28,77,,,Percent of total Billed charges,77% of total billed charges,3076.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1040.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1809.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.96,3221.67,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3711.2,1855.6,,2857.62,77,,,Percent of Total Billed Charges,77% of total billed charges,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1159.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3117.41,84,,,Percent of Total Billed Charges,84% of total billed charges,3043.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,3302.97,89,,,Percent of total Billed Charges,89% of total Billed charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2857.62,77,,,Percent of total Billed charges,77% of total billed charges,3154.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1066.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1855.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,927.8,3302.97,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3619.85,1809.93,,2787.28,77,,,Percent of Total Billed Charges,77% of total billed charges,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2678.69,74,,,Percent of Total Billed Charges,74% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2968.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3221.67,89,,,Percent of total Billed Charges,89% of total Billed charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2787.28,77,,,Percent of total Billed charges,77% of total billed charges,3076.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1040.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1809.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.96,3221.67,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3711.2,1855.6,,2857.62,77,,,Percent of Total Billed Charges,77% of total billed charges,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1159.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3117.41,84,,,Percent of Total Billed Charges,84% of total billed charges,3043.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,3302.97,89,,,Percent of total Billed Charges,89% of total Billed charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2857.62,77,,,Percent of total Billed charges,77% of total billed charges,3154.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1066.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1855.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,927.8,3302.97,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3619.85,1809.93,,2787.28,77,,,Percent of Total Billed Charges,77% of total billed charges,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2678.69,74,,,Percent of Total Billed Charges,74% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2968.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3221.67,89,,,Percent of total Billed Charges,89% of total Billed charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2787.28,77,,,Percent of total Billed charges,77% of total billed charges,3076.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1040.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1809.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.96,3221.67,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3711.2,1855.6,,2857.62,77,,,Percent of Total Billed Charges,77% of total billed charges,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,946.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1159.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2746.29,74,,,Percent of Total Billed Charges,74% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2560.73,69,,,Percent of Total Billed Charges,69% of total billed charges,3117.41,84,,,Percent of Total Billed Charges,84% of total billed charges,3043.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,3302.97,89,,,Percent of total Billed Charges,89% of total Billed charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2857.62,77,,,Percent of total Billed charges,77% of total billed charges,3154.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1066.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1855.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1514.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3302.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,927.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,927.8,3302.97,
inFLIXimab-AXXQ (Avsola) 100mg/10ml Powder SDV,55513067001,CDM,250,RC,,,Outpatient,,,3619.85,1809.93,,2787.28,77,,,Percent of Total Billed Charges,77% of total billed charges,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,923.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1131.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2678.69,74,,,Percent of Total Billed Charges,74% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,2497.7,69,,,Percent of Total Billed Charges,69% of total billed charges,3040.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2968.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,3221.67,89,,,Percent of total Billed Charges,89% of total Billed charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2787.28,77,,,Percent of total Billed charges,77% of total billed charges,3076.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1040.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1809.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1476.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3221.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,904.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,904.96,3221.67,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8428.95,4214.48,,6490.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2634.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6237.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7080.32,84,,,Percent of Total Billed Charges,84% of total billed charges,6911.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,7501.77,89,,,Percent of total Billed Charges,89% of total Billed charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6490.29,77,,,Percent of total Billed charges,77% of total billed charges,7164.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2423.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4214.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.24,7501.77,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8215.59,4107.8,,6326,77,,,Percent of Total Billed Charges,77% of total billed charges,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2567.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6079.54,74,,,Percent of Total Billed Charges,74% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6901.1,84,,,Percent of Total Billed Charges,84% of total billed charges,6736.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,7311.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6326,77,,,Percent of total Billed charges,77% of total billed charges,6983.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2361.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4107.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.9,7311.88,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8428.95,4214.48,,6490.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2634.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6237.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7080.32,84,,,Percent of Total Billed Charges,84% of total billed charges,6911.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,7501.77,89,,,Percent of total Billed Charges,89% of total Billed charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6490.29,77,,,Percent of total Billed charges,77% of total billed charges,7164.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2423.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4214.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.24,7501.77,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8215.59,4107.8,,6326,77,,,Percent of Total Billed Charges,77% of total billed charges,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2567.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6079.54,74,,,Percent of Total Billed Charges,74% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6901.1,84,,,Percent of Total Billed Charges,84% of total billed charges,6736.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,7311.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6326,77,,,Percent of total Billed charges,77% of total billed charges,6983.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2361.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4107.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.9,7311.88,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8428.95,4214.48,,6490.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2634.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6237.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7080.32,84,,,Percent of Total Billed Charges,84% of total billed charges,6911.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,7501.77,89,,,Percent of total Billed Charges,89% of total Billed charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6490.29,77,,,Percent of total Billed charges,77% of total billed charges,7164.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2423.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4214.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.24,7501.77,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8215.59,4107.8,,6326,77,,,Percent of Total Billed Charges,77% of total billed charges,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2567.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6079.54,74,,,Percent of Total Billed Charges,74% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6901.1,84,,,Percent of Total Billed Charges,84% of total billed charges,6736.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,7311.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6326,77,,,Percent of total Billed charges,77% of total billed charges,6983.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2361.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4107.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.9,7311.88,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8428.95,4214.48,,6490.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2634.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6237.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7080.32,84,,,Percent of Total Billed Charges,84% of total billed charges,6911.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,7501.77,89,,,Percent of total Billed Charges,89% of total Billed charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6490.29,77,,,Percent of total Billed charges,77% of total billed charges,7164.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2423.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4214.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.24,7501.77,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8215.59,4107.8,,6326,77,,,Percent of Total Billed Charges,77% of total billed charges,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2567.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6079.54,74,,,Percent of Total Billed Charges,74% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6901.1,84,,,Percent of Total Billed Charges,84% of total billed charges,6736.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,7311.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6326,77,,,Percent of total Billed charges,77% of total billed charges,6983.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2361.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4107.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.9,7311.88,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8428.95,4214.48,,6490.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2634.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6237.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7080.32,84,,,Percent of Total Billed Charges,84% of total billed charges,6911.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,7501.77,89,,,Percent of total Billed Charges,89% of total Billed charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6490.29,77,,,Percent of total Billed charges,77% of total billed charges,7164.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2423.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4214.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.24,7501.77,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8215.59,4107.8,,6326,77,,,Percent of Total Billed Charges,77% of total billed charges,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2567.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6079.54,74,,,Percent of Total Billed Charges,74% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6901.1,84,,,Percent of Total Billed Charges,84% of total billed charges,6736.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,7311.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6326,77,,,Percent of total Billed charges,77% of total billed charges,6983.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2361.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4107.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.9,7311.88,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8428.95,4214.48,,6490.29,77,,,Percent of Total Billed Charges,77% of total billed charges,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2149.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2634.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6237.42,74,,,Percent of Total Billed Charges,74% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5815.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7080.32,84,,,Percent of Total Billed Charges,84% of total billed charges,6911.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,7501.77,89,,,Percent of total Billed Charges,89% of total Billed charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6490.29,77,,,Percent of total Billed charges,77% of total billed charges,7164.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2423.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4214.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3439.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7501.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2107.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2107.24,7501.77,
inFLIXimab (Remicade) 100mg/10ml Powder SDV,57894003001,CDM,250,RC,,,Outpatient,,,8215.59,4107.8,,6326,77,,,Percent of Total Billed Charges,77% of total billed charges,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2094.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2567.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6079.54,74,,,Percent of Total Billed Charges,74% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5668.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6901.1,84,,,Percent of Total Billed Charges,84% of total billed charges,6736.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,7311.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6326,77,,,Percent of total Billed charges,77% of total billed charges,6983.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2361.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4107.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3351.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7311.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2053.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2053.9,7311.88,
inFLIXimab 100mg/10ml Powder SDV,57894016001,CDM,250,RC,,,Outpatient,,,3447.81,1723.91,,2654.81,77,,,Percent of Total Billed Charges,77% of total billed charges,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1077.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2551.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.16,84,,,Percent of Total Billed Charges,84% of total billed charges,2827.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,3068.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2654.81,77,,,Percent of total Billed charges,77% of total billed charges,2930.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,991.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1723.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.95,3068.55,
inFLIXimab 100mg/10ml Powder SDV,57894016001,CDM,250,RC,,,Outpatient,,,3447.81,1723.91,,2654.81,77,,,Percent of Total Billed Charges,77% of total billed charges,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1077.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2551.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.16,84,,,Percent of Total Billed Charges,84% of total billed charges,2827.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,3068.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2654.81,77,,,Percent of total Billed charges,77% of total billed charges,2930.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,991.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1723.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.95,3068.55,
inFLIXimab 100mg/10ml Powder SDV,57894016001,CDM,250,RC,,,Outpatient,,,3447.81,1723.91,,2654.81,77,,,Percent of Total Billed Charges,77% of total billed charges,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1077.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2551.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.16,84,,,Percent of Total Billed Charges,84% of total billed charges,2827.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,3068.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2654.81,77,,,Percent of total Billed charges,77% of total billed charges,2930.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,991.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1723.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.95,3068.55,
inFLIXimab 100mg/10ml Powder SDV,57894016001,CDM,250,RC,,,Outpatient,,,3447.81,1723.91,,2654.81,77,,,Percent of Total Billed Charges,77% of total billed charges,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1077.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2551.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.16,84,,,Percent of Total Billed Charges,84% of total billed charges,2827.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,3068.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2654.81,77,,,Percent of total Billed charges,77% of total billed charges,2930.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,991.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1723.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.95,3068.55,
inFLIXimab 100mg/10ml Powder SDV,57894016001,CDM,250,RC,,,Outpatient,,,3447.81,1723.91,,2654.81,77,,,Percent of Total Billed Charges,77% of total billed charges,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1077.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2551.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.16,84,,,Percent of Total Billed Charges,84% of total billed charges,2827.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,3068.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2654.81,77,,,Percent of total Billed charges,77% of total billed charges,2930.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,991.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1723.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.95,3068.55,
inFLIXimab 100mg/10ml Powder SDV,57894016001,CDM,250,RC,,,Outpatient,,,3447.81,1723.91,,2654.81,77,,,Percent of Total Billed Charges,77% of total billed charges,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,879.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1077.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2551.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2378.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.16,84,,,Percent of Total Billed Charges,84% of total billed charges,2827.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,3068.55,89,,,Percent of total Billed Charges,89% of total Billed charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2654.81,77,,,Percent of total Billed charges,77% of total billed charges,2930.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,991.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1723.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1406.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3068.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,861.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,861.95,3068.55,
Insulin-NPH/REG 70/30 3ml Pen,,,250,RC,,,Outpatient,,,84.96,42.48,,65.42,77,,,Percent of Total Billed Charges,77% of total billed charges,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.87,74,,,Percent of Total Billed Charges,74% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,71.37,84,,,Percent of Total Billed Charges,84% of total billed charges,69.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.61,89,,,Percent of total Billed Charges,89% of total Billed charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,77,,,Percent of total Billed charges,77% of total billed charges,72.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.24,75.61,
Insulin-NPH/REG 70/30 3ml Pen,,,250,RC,,,Outpatient,,,84.96,42.48,,65.42,77,,,Percent of Total Billed Charges,77% of total billed charges,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.87,74,,,Percent of Total Billed Charges,74% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,71.37,84,,,Percent of Total Billed Charges,84% of total billed charges,69.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.61,89,,,Percent of total Billed Charges,89% of total Billed charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,77,,,Percent of total Billed charges,77% of total billed charges,72.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.24,75.61,
Insulin-NPH/REG 70/30 3ml Pen,,,250,RC,,,Outpatient,,,84.96,42.48,,65.42,77,,,Percent of Total Billed Charges,77% of total billed charges,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.87,74,,,Percent of Total Billed Charges,74% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,71.37,84,,,Percent of Total Billed Charges,84% of total billed charges,69.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.61,89,,,Percent of total Billed Charges,89% of total Billed charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,77,,,Percent of total Billed charges,77% of total billed charges,72.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.24,75.61,
Insulin-NPH/REG 70/30 3ml Pen,,,250,RC,,,Outpatient,,,84.96,42.48,,65.42,77,,,Percent of Total Billed Charges,77% of total billed charges,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.87,74,,,Percent of Total Billed Charges,74% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,71.37,84,,,Percent of Total Billed Charges,84% of total billed charges,69.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.61,89,,,Percent of total Billed Charges,89% of total Billed charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,77,,,Percent of total Billed charges,77% of total billed charges,72.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.24,75.61,
Insulin-NPH/REG 70/30 3ml Pen,,,250,RC,,,Outpatient,,,84.96,42.48,,65.42,77,,,Percent of Total Billed Charges,77% of total billed charges,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.87,74,,,Percent of Total Billed Charges,74% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,71.37,84,,,Percent of Total Billed Charges,84% of total billed charges,69.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.61,89,,,Percent of total Billed Charges,89% of total Billed charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,77,,,Percent of total Billed charges,77% of total billed charges,72.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.24,75.61,
Insulin-NPH/REG 70/30 3ml Pen,,,250,RC,,,Outpatient,,,84.96,42.48,,65.42,77,,,Percent of Total Billed Charges,77% of total billed charges,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.87,74,,,Percent of Total Billed Charges,74% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,58.62,69,,,Percent of Total Billed Charges,69% of total billed charges,71.37,84,,,Percent of Total Billed Charges,84% of total billed charges,69.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,75.61,89,,,Percent of total Billed Charges,89% of total Billed charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.42,77,,,Percent of total Billed charges,77% of total billed charges,72.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.24,75.61,
Insulin-Glargine (Lantus) 300units/3ml Solostar Pen,88221905,CDM,250,RC,,,Outpatient,,,57.92,28.96,,44.6,77,,,Percent of Total Billed Charges,77% of total billed charges,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.86,74,,,Percent of Total Billed Charges,74% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,84,,,Percent of Total Billed Charges,84% of total billed charges,47.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.55,89,,,Percent of total Billed Charges,89% of total Billed charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.6,77,,,Percent of total Billed charges,77% of total billed charges,49.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,51.55,
Insulin-Glargine (Lantus) 300units/3ml Solostar Pen,88221905,CDM,250,RC,,,Outpatient,,,57.92,28.96,,44.6,77,,,Percent of Total Billed Charges,77% of total billed charges,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.86,74,,,Percent of Total Billed Charges,74% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,84,,,Percent of Total Billed Charges,84% of total billed charges,47.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.55,89,,,Percent of total Billed Charges,89% of total Billed charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.6,77,,,Percent of total Billed charges,77% of total billed charges,49.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,51.55,
Insulin-Glargine (Lantus) 300units/3ml Solostar Pen,88221905,CDM,250,RC,,,Outpatient,,,57.92,28.96,,44.6,77,,,Percent of Total Billed Charges,77% of total billed charges,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.86,74,,,Percent of Total Billed Charges,74% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,84,,,Percent of Total Billed Charges,84% of total billed charges,47.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.55,89,,,Percent of total Billed Charges,89% of total Billed charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.6,77,,,Percent of total Billed charges,77% of total billed charges,49.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,51.55,
Insulin-Glargine (Lantus) 300units/3ml Solostar Pen,88221905,CDM,250,RC,,,Outpatient,,,57.92,28.96,,44.6,77,,,Percent of Total Billed Charges,77% of total billed charges,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.86,74,,,Percent of Total Billed Charges,74% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,84,,,Percent of Total Billed Charges,84% of total billed charges,47.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.55,89,,,Percent of total Billed Charges,89% of total Billed charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.6,77,,,Percent of total Billed charges,77% of total billed charges,49.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,51.55,
Insulin-Glargine (Lantus) 300units/3ml Solostar Pen,88221905,CDM,250,RC,,,Outpatient,,,57.92,28.96,,44.6,77,,,Percent of Total Billed Charges,77% of total billed charges,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.86,74,,,Percent of Total Billed Charges,74% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,84,,,Percent of Total Billed Charges,84% of total billed charges,47.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.55,89,,,Percent of total Billed Charges,89% of total Billed charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.6,77,,,Percent of total Billed charges,77% of total billed charges,49.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,51.55,
Insulin-Glargine (Lantus) 300units/3ml Solostar Pen,88221905,CDM,250,RC,,,Outpatient,,,57.92,28.96,,44.6,77,,,Percent of Total Billed Charges,77% of total billed charges,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,42.86,74,,,Percent of Total Billed Charges,74% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,39.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.65,84,,,Percent of Total Billed Charges,84% of total billed charges,47.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,51.55,89,,,Percent of total Billed Charges,89% of total Billed charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.6,77,,,Percent of total Billed charges,77% of total billed charges,49.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,51.55,
Insulin-NPH (N) 300unit/3ml FlexPen,169300425,CDM,250,RC,,,Outpatient,,,54.74,27.37,,42.15,77,,,Percent of Total Billed Charges,77% of total billed charges,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.51,74,,,Percent of Total Billed Charges,74% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,45.98,84,,,Percent of Total Billed Charges,84% of total billed charges,44.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.72,89,,,Percent of total Billed Charges,89% of total Billed charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,77,,,Percent of total Billed charges,77% of total billed charges,46.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,48.72,
Insulin-NPH (N) 300unit/3ml FlexPen,169300425,CDM,250,RC,,,Outpatient,,,54.74,27.37,,42.15,77,,,Percent of Total Billed Charges,77% of total billed charges,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.51,74,,,Percent of Total Billed Charges,74% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,45.98,84,,,Percent of Total Billed Charges,84% of total billed charges,44.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.72,89,,,Percent of total Billed Charges,89% of total Billed charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,77,,,Percent of total Billed charges,77% of total billed charges,46.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,48.72,
Insulin-NPH (N) 300unit/3ml FlexPen,169300425,CDM,250,RC,,,Outpatient,,,54.74,27.37,,42.15,77,,,Percent of Total Billed Charges,77% of total billed charges,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.51,74,,,Percent of Total Billed Charges,74% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,45.98,84,,,Percent of Total Billed Charges,84% of total billed charges,44.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.72,89,,,Percent of total Billed Charges,89% of total Billed charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,77,,,Percent of total Billed charges,77% of total billed charges,46.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,48.72,
Insulin-NPH (N) 300unit/3ml FlexPen,169300425,CDM,250,RC,,,Outpatient,,,54.74,27.37,,42.15,77,,,Percent of Total Billed Charges,77% of total billed charges,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.51,74,,,Percent of Total Billed Charges,74% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,45.98,84,,,Percent of Total Billed Charges,84% of total billed charges,44.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.72,89,,,Percent of total Billed Charges,89% of total Billed charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,77,,,Percent of total Billed charges,77% of total billed charges,46.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,48.72,
Insulin-NPH (N) 300unit/3ml FlexPen,169300425,CDM,250,RC,,,Outpatient,,,54.74,27.37,,42.15,77,,,Percent of Total Billed Charges,77% of total billed charges,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.51,74,,,Percent of Total Billed Charges,74% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,45.98,84,,,Percent of Total Billed Charges,84% of total billed charges,44.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.72,89,,,Percent of total Billed Charges,89% of total Billed charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,77,,,Percent of total Billed charges,77% of total billed charges,46.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,48.72,
Insulin-NPH (N) 300unit/3ml FlexPen,169300425,CDM,250,RC,,,Outpatient,,,54.74,27.37,,42.15,77,,,Percent of Total Billed Charges,77% of total billed charges,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.51,74,,,Percent of Total Billed Charges,74% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.77,69,,,Percent of Total Billed Charges,69% of total billed charges,45.98,84,,,Percent of Total Billed Charges,84% of total billed charges,44.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.72,89,,,Percent of total Billed Charges,89% of total Billed charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.15,77,,,Percent of total Billed charges,77% of total billed charges,46.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.69,48.72,
Insulin-Aspart (NovoLOG) 300units/3ml FlexPen,169633910,CDM,250,RC,,,Outpatient,,,83.94,41.97,,64.63,77,,,Percent of Total Billed Charges,77% of total billed charges,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.12,74,,,Percent of Total Billed Charges,74% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,70.51,84,,,Percent of Total Billed Charges,84% of total billed charges,68.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.71,89,,,Percent of total Billed Charges,89% of total Billed charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.63,77,,,Percent of total Billed charges,77% of total billed charges,71.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,74.71,
Insulin-Aspart (NovoLOG) 300units/3ml FlexPen,169633910,CDM,250,RC,,,Outpatient,,,83.94,41.97,,64.63,77,,,Percent of Total Billed Charges,77% of total billed charges,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.12,74,,,Percent of Total Billed Charges,74% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,70.51,84,,,Percent of Total Billed Charges,84% of total billed charges,68.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.71,89,,,Percent of total Billed Charges,89% of total Billed charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.63,77,,,Percent of total Billed charges,77% of total billed charges,71.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,74.71,
Insulin-Aspart (NovoLOG) 300units/3ml FlexPen,169633910,CDM,250,RC,,,Outpatient,,,83.94,41.97,,64.63,77,,,Percent of Total Billed Charges,77% of total billed charges,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.12,74,,,Percent of Total Billed Charges,74% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,70.51,84,,,Percent of Total Billed Charges,84% of total billed charges,68.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.71,89,,,Percent of total Billed Charges,89% of total Billed charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.63,77,,,Percent of total Billed charges,77% of total billed charges,71.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,74.71,
Insulin-Aspart (NovoLOG) 300units/3ml FlexPen,169633910,CDM,250,RC,,,Outpatient,,,83.94,41.97,,64.63,77,,,Percent of Total Billed Charges,77% of total billed charges,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.12,74,,,Percent of Total Billed Charges,74% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,70.51,84,,,Percent of Total Billed Charges,84% of total billed charges,68.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.71,89,,,Percent of total Billed Charges,89% of total Billed charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.63,77,,,Percent of total Billed charges,77% of total billed charges,71.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,74.71,
Insulin-Aspart (NovoLOG) 300units/3ml FlexPen,169633910,CDM,250,RC,,,Outpatient,,,83.94,41.97,,64.63,77,,,Percent of Total Billed Charges,77% of total billed charges,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.12,74,,,Percent of Total Billed Charges,74% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,70.51,84,,,Percent of Total Billed Charges,84% of total billed charges,68.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.71,89,,,Percent of total Billed Charges,89% of total Billed charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.63,77,,,Percent of total Billed charges,77% of total billed charges,71.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,74.71,
Insulin-Aspart (NovoLOG) 300units/3ml FlexPen,169633910,CDM,250,RC,,,Outpatient,,,83.94,41.97,,64.63,77,,,Percent of Total Billed Charges,77% of total billed charges,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.12,74,,,Percent of Total Billed Charges,74% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,57.92,69,,,Percent of Total Billed Charges,69% of total billed charges,70.51,84,,,Percent of Total Billed Charges,84% of total billed charges,68.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.71,89,,,Percent of total Billed Charges,89% of total Billed charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.63,77,,,Percent of total Billed charges,77% of total billed charges,71.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,74.71,
Insulin-Detemir (Levemir) 300unit/3ml FlexTouch Pen,169643210,CDM,250,RC,,,Outpatient,,,97.19,48.6,,74.84,77,,,Percent of Total Billed Charges,77% of total billed charges,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.92,74,,,Percent of Total Billed Charges,74% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,81.64,84,,,Percent of Total Billed Charges,84% of total billed charges,79.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.5,89,,,Percent of total Billed Charges,89% of total Billed charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.84,77,,,Percent of total Billed charges,77% of total billed charges,82.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,86.5,
Insulin-Detemir (Levemir) 300unit/3ml FlexTouch Pen,169643210,CDM,250,RC,,,Outpatient,,,97.19,48.6,,74.84,77,,,Percent of Total Billed Charges,77% of total billed charges,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.92,74,,,Percent of Total Billed Charges,74% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,81.64,84,,,Percent of Total Billed Charges,84% of total billed charges,79.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.5,89,,,Percent of total Billed Charges,89% of total Billed charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.84,77,,,Percent of total Billed charges,77% of total billed charges,82.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,86.5,
Insulin-Detemir (Levemir) 300unit/3ml FlexTouch Pen,169643210,CDM,250,RC,,,Outpatient,,,97.19,48.6,,74.84,77,,,Percent of Total Billed Charges,77% of total billed charges,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.92,74,,,Percent of Total Billed Charges,74% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,81.64,84,,,Percent of Total Billed Charges,84% of total billed charges,79.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.5,89,,,Percent of total Billed Charges,89% of total Billed charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.84,77,,,Percent of total Billed charges,77% of total billed charges,82.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,86.5,
Insulin-Detemir (Levemir) 300unit/3ml FlexTouch Pen,169643210,CDM,250,RC,,,Outpatient,,,97.19,48.6,,74.84,77,,,Percent of Total Billed Charges,77% of total billed charges,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.92,74,,,Percent of Total Billed Charges,74% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,81.64,84,,,Percent of Total Billed Charges,84% of total billed charges,79.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.5,89,,,Percent of total Billed Charges,89% of total Billed charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.84,77,,,Percent of total Billed charges,77% of total billed charges,82.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,86.5,
Insulin-Detemir (Levemir) 300unit/3ml FlexTouch Pen,169643210,CDM,250,RC,,,Outpatient,,,97.19,48.6,,74.84,77,,,Percent of Total Billed Charges,77% of total billed charges,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.92,74,,,Percent of Total Billed Charges,74% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,81.64,84,,,Percent of Total Billed Charges,84% of total billed charges,79.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.5,89,,,Percent of total Billed Charges,89% of total Billed charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.84,77,,,Percent of total Billed charges,77% of total billed charges,82.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,86.5,
Insulin-Detemir (Levemir) 300unit/3ml FlexTouch Pen,169643210,CDM,250,RC,,,Outpatient,,,97.19,48.6,,74.84,77,,,Percent of Total Billed Charges,77% of total billed charges,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.92,74,,,Percent of Total Billed Charges,74% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,67.06,69,,,Percent of Total Billed Charges,69% of total billed charges,81.64,84,,,Percent of Total Billed Charges,84% of total billed charges,79.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.5,89,,,Percent of total Billed Charges,89% of total Billed charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.84,77,,,Percent of total Billed charges,77% of total billed charges,82.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.3,86.5,
Insulin-Aspart (NovoLOG) 100units/ml MDV (ER Area Only),169210011,CDM,250,RC,,,Outpatient,,,217.34,108.67,,167.35,77,,,Percent of Total Billed Charges,77% of total billed charges,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.83,74,,,Percent of Total Billed Charges,74% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,182.57,84,,,Percent of Total Billed Charges,84% of total billed charges,178.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.43,89,,,Percent of total Billed Charges,89% of total Billed charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.35,77,,,Percent of total Billed charges,77% of total billed charges,184.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.34,193.43,
Insulin-Aspart (NovoLOG) 100units/ml MDV (ER Area Only),169210011,CDM,250,RC,,,Outpatient,,,217.34,108.67,,167.35,77,,,Percent of Total Billed Charges,77% of total billed charges,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.83,74,,,Percent of Total Billed Charges,74% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,182.57,84,,,Percent of Total Billed Charges,84% of total billed charges,178.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.43,89,,,Percent of total Billed Charges,89% of total Billed charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.35,77,,,Percent of total Billed charges,77% of total billed charges,184.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.34,193.43,
Insulin-Aspart (NovoLOG) 100units/ml MDV (ER Area Only),169210011,CDM,250,RC,,,Outpatient,,,217.34,108.67,,167.35,77,,,Percent of Total Billed Charges,77% of total billed charges,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.83,74,,,Percent of Total Billed Charges,74% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,182.57,84,,,Percent of Total Billed Charges,84% of total billed charges,178.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.43,89,,,Percent of total Billed Charges,89% of total Billed charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.35,77,,,Percent of total Billed charges,77% of total billed charges,184.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.34,193.43,
Insulin-Aspart (NovoLOG) 100units/ml MDV (ER Area Only),169210011,CDM,250,RC,,,Outpatient,,,217.34,108.67,,167.35,77,,,Percent of Total Billed Charges,77% of total billed charges,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.83,74,,,Percent of Total Billed Charges,74% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,182.57,84,,,Percent of Total Billed Charges,84% of total billed charges,178.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.43,89,,,Percent of total Billed Charges,89% of total Billed charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.35,77,,,Percent of total Billed charges,77% of total billed charges,184.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.34,193.43,
Insulin-Aspart (NovoLOG) 100units/ml MDV (ER Area Only),169210011,CDM,250,RC,,,Outpatient,,,217.34,108.67,,167.35,77,,,Percent of Total Billed Charges,77% of total billed charges,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.83,74,,,Percent of Total Billed Charges,74% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,182.57,84,,,Percent of Total Billed Charges,84% of total billed charges,178.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.43,89,,,Percent of total Billed Charges,89% of total Billed charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.35,77,,,Percent of total Billed charges,77% of total billed charges,184.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.34,193.43,
Insulin-Aspart (NovoLOG) 100units/ml MDV (ER Area Only),169210011,CDM,250,RC,,,Outpatient,,,217.34,108.67,,167.35,77,,,Percent of Total Billed Charges,77% of total billed charges,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.83,74,,,Percent of Total Billed Charges,74% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,149.96,69,,,Percent of Total Billed Charges,69% of total billed charges,182.57,84,,,Percent of Total Billed Charges,84% of total billed charges,178.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.43,89,,,Percent of total Billed Charges,89% of total Billed charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.35,77,,,Percent of total Billed charges,77% of total billed charges,184.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.34,193.43,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,134.03,67.02,,103.2,77,,,Percent of Total Billed Charges,77% of total billed charges,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.18,74,,,Percent of Total Billed Charges,74% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,112.59,84,,,Percent of Total Billed Charges,84% of total billed charges,109.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.29,89,,,Percent of total Billed Charges,89% of total Billed charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.2,77,,,Percent of total Billed charges,77% of total billed charges,113.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.51,119.29,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,303.4,151.7,,233.62,77,,,Percent of Total Billed Charges,77% of total billed charges,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.52,74,,,Percent of Total Billed Charges,74% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,254.86,84,,,Percent of Total Billed Charges,84% of total billed charges,248.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.03,89,,,Percent of total Billed Charges,89% of total Billed charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.62,77,,,Percent of total Billed charges,77% of total billed charges,257.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,270.03,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,134.03,67.02,,103.2,77,,,Percent of Total Billed Charges,77% of total billed charges,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.18,74,,,Percent of Total Billed Charges,74% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,112.59,84,,,Percent of Total Billed Charges,84% of total billed charges,109.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.29,89,,,Percent of total Billed Charges,89% of total Billed charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.2,77,,,Percent of total Billed charges,77% of total billed charges,113.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.51,119.29,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,303.4,151.7,,233.62,77,,,Percent of Total Billed Charges,77% of total billed charges,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.52,74,,,Percent of Total Billed Charges,74% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,254.86,84,,,Percent of Total Billed Charges,84% of total billed charges,248.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.03,89,,,Percent of total Billed Charges,89% of total Billed charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.62,77,,,Percent of total Billed charges,77% of total billed charges,257.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,270.03,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,134.03,67.02,,103.2,77,,,Percent of Total Billed Charges,77% of total billed charges,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.18,74,,,Percent of Total Billed Charges,74% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,112.59,84,,,Percent of Total Billed Charges,84% of total billed charges,109.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.29,89,,,Percent of total Billed Charges,89% of total Billed charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.2,77,,,Percent of total Billed charges,77% of total billed charges,113.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.51,119.29,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,303.4,151.7,,233.62,77,,,Percent of Total Billed Charges,77% of total billed charges,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.52,74,,,Percent of Total Billed Charges,74% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,254.86,84,,,Percent of Total Billed Charges,84% of total billed charges,248.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.03,89,,,Percent of total Billed Charges,89% of total Billed charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.62,77,,,Percent of total Billed charges,77% of total billed charges,257.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,270.03,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,134.03,67.02,,103.2,77,,,Percent of Total Billed Charges,77% of total billed charges,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.18,74,,,Percent of Total Billed Charges,74% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,112.59,84,,,Percent of Total Billed Charges,84% of total billed charges,109.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.29,89,,,Percent of total Billed Charges,89% of total Billed charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.2,77,,,Percent of total Billed charges,77% of total billed charges,113.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.51,119.29,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,303.4,151.7,,233.62,77,,,Percent of Total Billed Charges,77% of total billed charges,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.52,74,,,Percent of Total Billed Charges,74% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,254.86,84,,,Percent of Total Billed Charges,84% of total billed charges,248.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.03,89,,,Percent of total Billed Charges,89% of total Billed charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.62,77,,,Percent of total Billed charges,77% of total billed charges,257.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,270.03,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,134.03,67.02,,103.2,77,,,Percent of Total Billed Charges,77% of total billed charges,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.18,74,,,Percent of Total Billed Charges,74% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,112.59,84,,,Percent of Total Billed Charges,84% of total billed charges,109.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.29,89,,,Percent of total Billed Charges,89% of total Billed charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.2,77,,,Percent of total Billed charges,77% of total billed charges,113.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.51,119.29,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,303.4,151.7,,233.62,77,,,Percent of Total Billed Charges,77% of total billed charges,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.52,74,,,Percent of Total Billed Charges,74% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,254.86,84,,,Percent of Total Billed Charges,84% of total billed charges,248.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.03,89,,,Percent of total Billed Charges,89% of total Billed charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.62,77,,,Percent of total Billed charges,77% of total billed charges,257.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,270.03,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,134.03,67.02,,103.2,77,,,Percent of Total Billed Charges,77% of total billed charges,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.18,74,,,Percent of Total Billed Charges,74% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,92.48,69,,,Percent of Total Billed Charges,69% of total billed charges,112.59,84,,,Percent of Total Billed Charges,84% of total billed charges,109.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.29,89,,,Percent of total Billed Charges,89% of total Billed charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.2,77,,,Percent of total Billed charges,77% of total billed charges,113.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.51,119.29,
Insulin-Regular (R) 1000unit/10ml MDV,2821501,CDM,250,RC,,,Outpatient,,,303.4,151.7,,233.62,77,,,Percent of Total Billed Charges,77% of total billed charges,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.52,74,,,Percent of Total Billed Charges,74% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,209.35,69,,,Percent of Total Billed Charges,69% of total billed charges,254.86,84,,,Percent of Total Billed Charges,84% of total billed charges,248.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.03,89,,,Percent of total Billed Charges,89% of total Billed charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.62,77,,,Percent of total Billed charges,77% of total billed charges,257.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.85,270.03,
Ipilimumab (Yervoy) 200mg/40ml Liquid SDV,3232822,CDM,250,RC,,,Outpatient,,,146908.62,73454.31,,113119.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45908.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108712.38,74,,,Percent of Total Billed Charges,74% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,123403.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,130748.67,89,,,Percent of total Billed Charges,89% of total Billed charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113119.64,77,,,Percent of total Billed charges,77% of total billed charges,124872.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42236.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73454.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,130748.67,
Ipilimumab (Yervoy) 200mg/40ml Liquid SDV,3232822,CDM,250,RC,,,Outpatient,,,146908.62,73454.31,,113119.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45908.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108712.38,74,,,Percent of Total Billed Charges,74% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,123403.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,130748.67,89,,,Percent of total Billed Charges,89% of total Billed charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113119.64,77,,,Percent of total Billed charges,77% of total billed charges,124872.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42236.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73454.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,130748.67,
Ipilimumab (Yervoy) 200mg/40ml Liquid SDV,3232822,CDM,250,RC,,,Outpatient,,,146908.62,73454.31,,113119.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45908.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108712.38,74,,,Percent of Total Billed Charges,74% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,123403.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,130748.67,89,,,Percent of total Billed Charges,89% of total Billed charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113119.64,77,,,Percent of total Billed charges,77% of total billed charges,124872.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42236.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73454.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,130748.67,
Ipilimumab (Yervoy) 200mg/40ml Liquid SDV,3232822,CDM,250,RC,,,Outpatient,,,146908.62,73454.31,,113119.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45908.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108712.38,74,,,Percent of Total Billed Charges,74% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,123403.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,130748.67,89,,,Percent of total Billed Charges,89% of total Billed charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113119.64,77,,,Percent of total Billed charges,77% of total billed charges,124872.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42236.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73454.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,130748.67,
Ipilimumab (Yervoy) 200mg/40ml Liquid SDV,3232822,CDM,250,RC,,,Outpatient,,,146908.62,73454.31,,113119.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45908.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108712.38,74,,,Percent of Total Billed Charges,74% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,123403.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,130748.67,89,,,Percent of total Billed Charges,89% of total Billed charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113119.64,77,,,Percent of total Billed charges,77% of total billed charges,124872.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42236.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73454.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,130748.67,
Ipilimumab (Yervoy) 200mg/40ml Liquid SDV,3232822,CDM,250,RC,,,Outpatient,,,146908.62,73454.31,,113119.64,77,,,Percent of Total Billed Charges,77% of total billed charges,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37461.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45908.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,108712.38,74,,,Percent of Total Billed Charges,74% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,101366.95,69,,,Percent of Total Billed Charges,69% of total billed charges,123403.24,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,130748.67,89,,,Percent of total Billed Charges,89% of total Billed charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113119.64,77,,,Percent of total Billed charges,77% of total billed charges,124872.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42236.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,73454.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59938.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130748.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36727.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,130748.67,
Ipilimumab (Yervoy) 50mg/10ml Liquid SDV,3232711,CDM,250,RC,,,Outpatient,,,36727.25,18363.63,,28279.98,77,,,Percent of Total Billed Charges,77% of total billed charges,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11477.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27178.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30850.89,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32687.25,89,,,Percent of total Billed Charges,89% of total Billed charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28279.98,77,,,Percent of total Billed charges,77% of total billed charges,31218.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10559.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18363.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9181.81,32687.25,
Ipilimumab (Yervoy) 50mg/10ml Liquid SDV,3232711,CDM,250,RC,,,Outpatient,,,36727.25,18363.63,,28279.98,77,,,Percent of Total Billed Charges,77% of total billed charges,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11477.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27178.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30850.89,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32687.25,89,,,Percent of total Billed Charges,89% of total Billed charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28279.98,77,,,Percent of total Billed charges,77% of total billed charges,31218.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10559.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18363.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9181.81,32687.25,
Ipilimumab (Yervoy) 50mg/10ml Liquid SDV,3232711,CDM,250,RC,,,Outpatient,,,36727.25,18363.63,,28279.98,77,,,Percent of Total Billed Charges,77% of total billed charges,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11477.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27178.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30850.89,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32687.25,89,,,Percent of total Billed Charges,89% of total Billed charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28279.98,77,,,Percent of total Billed charges,77% of total billed charges,31218.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10559.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18363.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9181.81,32687.25,
Ipilimumab (Yervoy) 50mg/10ml Liquid SDV,3232711,CDM,250,RC,,,Outpatient,,,36727.25,18363.63,,28279.98,77,,,Percent of Total Billed Charges,77% of total billed charges,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11477.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27178.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30850.89,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32687.25,89,,,Percent of total Billed Charges,89% of total Billed charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28279.98,77,,,Percent of total Billed charges,77% of total billed charges,31218.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10559.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18363.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9181.81,32687.25,
Ipilimumab (Yervoy) 50mg/10ml Liquid SDV,3232711,CDM,250,RC,,,Outpatient,,,36727.25,18363.63,,28279.98,77,,,Percent of Total Billed Charges,77% of total billed charges,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11477.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27178.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30850.89,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32687.25,89,,,Percent of total Billed Charges,89% of total Billed charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28279.98,77,,,Percent of total Billed charges,77% of total billed charges,31218.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10559.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18363.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9181.81,32687.25,
Ipilimumab (Yervoy) 50mg/10ml Liquid SDV,3232711,CDM,250,RC,,,Outpatient,,,36727.25,18363.63,,28279.98,77,,,Percent of Total Billed Charges,77% of total billed charges,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9365.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11477.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27178.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,25341.8,69,,,Percent of Total Billed Charges,69% of total billed charges,30850.89,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32687.25,89,,,Percent of total Billed Charges,89% of total Billed charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28279.98,77,,,Percent of total Billed charges,77% of total billed charges,31218.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10559.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18363.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14984.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32687.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9181.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9181.81,32687.25,
Ipratropium HFA Inhaler 12.9gm,597008717,CDM,250,RC,,,Outpatient,,,1631.34,815.67,,1256.13,77,,,Percent of Total Billed Charges,77% of total billed charges,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1207.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.13,77,,,Percent of total Billed charges,77% of total billed charges,1386.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.84,1451.89,
Ipratropium HFA Inhaler 12.9gm,597008717,CDM,250,RC,,,Outpatient,,,1631.34,815.67,,1256.13,77,,,Percent of Total Billed Charges,77% of total billed charges,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1207.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.13,77,,,Percent of total Billed charges,77% of total billed charges,1386.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.84,1451.89,
Ipratropium HFA Inhaler 12.9gm,597008717,CDM,250,RC,,,Outpatient,,,1631.34,815.67,,1256.13,77,,,Percent of Total Billed Charges,77% of total billed charges,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1207.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.13,77,,,Percent of total Billed charges,77% of total billed charges,1386.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.84,1451.89,
Ipratropium HFA Inhaler 12.9gm,597008717,CDM,250,RC,,,Outpatient,,,1631.34,815.67,,1256.13,77,,,Percent of Total Billed Charges,77% of total billed charges,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1207.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.13,77,,,Percent of total Billed charges,77% of total billed charges,1386.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.84,1451.89,
Ipratropium HFA Inhaler 12.9gm,597008717,CDM,250,RC,,,Outpatient,,,1631.34,815.67,,1256.13,77,,,Percent of Total Billed Charges,77% of total billed charges,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1207.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.13,77,,,Percent of total Billed charges,77% of total billed charges,1386.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.84,1451.89,
Ipratropium HFA Inhaler 12.9gm,597008717,CDM,250,RC,,,Outpatient,,,1631.34,815.67,,1256.13,77,,,Percent of Total Billed Charges,77% of total billed charges,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1207.19,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.62,69,,,Percent of Total Billed Charges,69% of total billed charges,1370.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.89,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1256.13,77,,,Percent of total Billed charges,77% of total billed charges,1386.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,469.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.84,1451.89,
Albuterol/Ipratropium 20mcg/100mcg Inhaler,597002402,CDM,250,RC,,,Outpatient,,,1690.87,845.44,,1301.97,77,,,Percent of Total Billed Charges,77% of total billed charges,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1251.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1420.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1386.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1504.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.97,77,,,Percent of total Billed charges,77% of total billed charges,1437.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,486.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,845.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.72,1504.87,
Albuterol/Ipratropium 20mcg/100mcg Inhaler,597002402,CDM,250,RC,,,Outpatient,,,1690.87,845.44,,1301.97,77,,,Percent of Total Billed Charges,77% of total billed charges,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1251.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1420.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1386.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1504.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.97,77,,,Percent of total Billed charges,77% of total billed charges,1437.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,486.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,845.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.72,1504.87,
Albuterol/Ipratropium 20mcg/100mcg Inhaler,597002402,CDM,250,RC,,,Outpatient,,,1690.87,845.44,,1301.97,77,,,Percent of Total Billed Charges,77% of total billed charges,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1251.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1420.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1386.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1504.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.97,77,,,Percent of total Billed charges,77% of total billed charges,1437.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,486.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,845.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.72,1504.87,
Albuterol/Ipratropium 20mcg/100mcg Inhaler,597002402,CDM,250,RC,,,Outpatient,,,1690.87,845.44,,1301.97,77,,,Percent of Total Billed Charges,77% of total billed charges,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1251.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1420.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1386.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1504.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.97,77,,,Percent of total Billed charges,77% of total billed charges,1437.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,486.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,845.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.72,1504.87,
Albuterol/Ipratropium 20mcg/100mcg Inhaler,597002402,CDM,250,RC,,,Outpatient,,,1690.87,845.44,,1301.97,77,,,Percent of Total Billed Charges,77% of total billed charges,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1251.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1420.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1386.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1504.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.97,77,,,Percent of total Billed charges,77% of total billed charges,1437.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,486.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,845.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.72,1504.87,
Albuterol/Ipratropium 20mcg/100mcg Inhaler,597002402,CDM,250,RC,,,Outpatient,,,1690.87,845.44,,1301.97,77,,,Percent of Total Billed Charges,77% of total billed charges,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,431.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,528.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1251.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1166.7,69,,,Percent of Total Billed Charges,69% of total billed charges,1420.33,84,,,Percent of Total Billed Charges,84% of total billed charges,1386.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,1504.87,89,,,Percent of total Billed Charges,89% of total Billed charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.97,77,,,Percent of total Billed charges,77% of total billed charges,1437.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,486.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,845.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,689.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1504.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,422.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,422.72,1504.87,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2470.95,1235.48,,1902.63,77,,,Percent of Total Billed Charges,77% of total billed charges,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1828.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2075.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2026.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2199.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1902.63,77,,,Percent of total Billed charges,77% of total billed charges,2100.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1235.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.74,2199.15,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2410.91,1205.46,,1856.4,77,,,Percent of Total Billed Charges,77% of total billed charges,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,753.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1784.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2025.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1976.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.71,89,,,Percent of total Billed Charges,89% of total Billed charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1856.4,77,,,Percent of total Billed charges,77% of total billed charges,2049.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,693.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1205.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.73,2145.71,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2470.95,1235.48,,1902.63,77,,,Percent of Total Billed Charges,77% of total billed charges,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1828.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2075.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2026.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2199.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1902.63,77,,,Percent of total Billed charges,77% of total billed charges,2100.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1235.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.74,2199.15,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2410.91,1205.46,,1856.4,77,,,Percent of Total Billed Charges,77% of total billed charges,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,753.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1784.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2025.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1976.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.71,89,,,Percent of total Billed Charges,89% of total Billed charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1856.4,77,,,Percent of total Billed charges,77% of total billed charges,2049.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,693.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1205.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.73,2145.71,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2470.95,1235.48,,1902.63,77,,,Percent of Total Billed Charges,77% of total billed charges,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1828.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2075.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2026.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2199.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1902.63,77,,,Percent of total Billed charges,77% of total billed charges,2100.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1235.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.74,2199.15,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2410.91,1205.46,,1856.4,77,,,Percent of Total Billed Charges,77% of total billed charges,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,753.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1784.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2025.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1976.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.71,89,,,Percent of total Billed Charges,89% of total Billed charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1856.4,77,,,Percent of total Billed charges,77% of total billed charges,2049.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,693.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1205.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.73,2145.71,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2470.95,1235.48,,1902.63,77,,,Percent of Total Billed Charges,77% of total billed charges,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1828.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2075.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2026.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2199.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1902.63,77,,,Percent of total Billed charges,77% of total billed charges,2100.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1235.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.74,2199.15,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2410.91,1205.46,,1856.4,77,,,Percent of Total Billed Charges,77% of total billed charges,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,753.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1784.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2025.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1976.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.71,89,,,Percent of total Billed Charges,89% of total Billed charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1856.4,77,,,Percent of total Billed charges,77% of total billed charges,2049.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,693.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1205.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.73,2145.71,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2470.95,1235.48,,1902.63,77,,,Percent of Total Billed Charges,77% of total billed charges,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1828.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2075.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2026.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2199.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1902.63,77,,,Percent of total Billed charges,77% of total billed charges,2100.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1235.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.74,2199.15,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2410.91,1205.46,,1856.4,77,,,Percent of Total Billed Charges,77% of total billed charges,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,753.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1784.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2025.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1976.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.71,89,,,Percent of total Billed Charges,89% of total Billed charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1856.4,77,,,Percent of total Billed charges,77% of total billed charges,2049.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,693.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1205.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.73,2145.71,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2470.95,1235.48,,1902.63,77,,,Percent of Total Billed Charges,77% of total billed charges,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,630.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,772.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1828.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,1704.96,69,,,Percent of Total Billed Charges,69% of total billed charges,2075.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2026.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,2199.15,89,,,Percent of total Billed Charges,89% of total Billed charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1902.63,77,,,Percent of total Billed charges,77% of total billed charges,2100.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,710.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1235.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1008.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2199.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,617.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,617.74,2199.15,
Irinotecan 100mg/5ml Liquid SDV,61703034909,CDM,250,RC,,,Outpatient,,,2410.91,1205.46,,1856.4,77,,,Percent of Total Billed Charges,77% of total billed charges,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,614.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,753.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1784.07,74,,,Percent of Total Billed Charges,74% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2025.16,84,,,Percent of Total Billed Charges,84% of total billed charges,1976.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,2145.71,89,,,Percent of total Billed Charges,89% of total Billed charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1856.4,77,,,Percent of total Billed charges,77% of total billed charges,2049.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,693.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1205.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,983.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2145.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,602.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,602.73,2145.71,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4477.23,2238.62,,3447.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3313.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3760.87,84,,,Percent of Total Billed Charges,84% of total billed charges,3671.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3984.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3447.47,77,,,Percent of total Billed charges,77% of total billed charges,3805.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2238.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.31,3984.73,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4365.3,2182.65,,3361.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1364.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3230.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3666.85,84,,,Percent of Total Billed Charges,84% of total billed charges,3579.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,3885.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3361.28,77,,,Percent of total Billed charges,77% of total billed charges,3710.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1255.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2182.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.33,3885.12,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4477.23,2238.62,,3447.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3313.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3760.87,84,,,Percent of Total Billed Charges,84% of total billed charges,3671.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3984.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3447.47,77,,,Percent of total Billed charges,77% of total billed charges,3805.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2238.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.31,3984.73,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4365.3,2182.65,,3361.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1364.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3230.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3666.85,84,,,Percent of Total Billed Charges,84% of total billed charges,3579.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,3885.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3361.28,77,,,Percent of total Billed charges,77% of total billed charges,3710.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1255.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2182.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.33,3885.12,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4477.23,2238.62,,3447.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3313.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3760.87,84,,,Percent of Total Billed Charges,84% of total billed charges,3671.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3984.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3447.47,77,,,Percent of total Billed charges,77% of total billed charges,3805.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2238.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.31,3984.73,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4365.3,2182.65,,3361.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1364.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3230.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3666.85,84,,,Percent of Total Billed Charges,84% of total billed charges,3579.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,3885.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3361.28,77,,,Percent of total Billed charges,77% of total billed charges,3710.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1255.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2182.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.33,3885.12,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4477.23,2238.62,,3447.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3313.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3760.87,84,,,Percent of Total Billed Charges,84% of total billed charges,3671.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3984.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3447.47,77,,,Percent of total Billed charges,77% of total billed charges,3805.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2238.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.31,3984.73,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4365.3,2182.65,,3361.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1364.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3230.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3666.85,84,,,Percent of Total Billed Charges,84% of total billed charges,3579.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,3885.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3361.28,77,,,Percent of total Billed charges,77% of total billed charges,3710.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1255.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2182.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.33,3885.12,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4477.23,2238.62,,3447.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3313.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3760.87,84,,,Percent of Total Billed Charges,84% of total billed charges,3671.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3984.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3447.47,77,,,Percent of total Billed charges,77% of total billed charges,3805.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2238.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.31,3984.73,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4365.3,2182.65,,3361.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1364.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3230.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3666.85,84,,,Percent of Total Billed Charges,84% of total billed charges,3579.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,3885.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3361.28,77,,,Percent of total Billed charges,77% of total billed charges,3710.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1255.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2182.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.33,3885.12,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4477.23,2238.62,,3447.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1141.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1399.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3313.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3089.29,69,,,Percent of Total Billed Charges,69% of total billed charges,3760.87,84,,,Percent of Total Billed Charges,84% of total billed charges,3671.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3984.73,89,,,Percent of total Billed Charges,89% of total Billed charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3447.47,77,,,Percent of total Billed charges,77% of total billed charges,3805.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1287.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2238.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1826.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3984.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1119.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1119.31,3984.73,
Irinotecan 300mg/15ml Liquid SDV,55150035401,CDM,250,RC,,,Outpatient,,,4365.3,2182.65,,3361.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1113.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1364.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3230.32,74,,,Percent of Total Billed Charges,74% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3012.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3666.85,84,,,Percent of Total Billed Charges,84% of total billed charges,3579.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,3885.12,89,,,Percent of total Billed Charges,89% of total Billed charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3361.28,77,,,Percent of total Billed charges,77% of total billed charges,3710.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1255.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2182.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1781.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3885.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1091.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1091.33,3885.12,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1656.27,828.14,,1275.33,77,,,Percent of Total Billed Charges,77% of total billed charges,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.33,77,,,Percent of total Billed charges,77% of total billed charges,1407.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,828.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.07,1474.08,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1617.31,808.66,,1245.33,77,,,Percent of Total Billed Charges,77% of total billed charges,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1326.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1439.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.33,77,,,Percent of total Billed charges,77% of total billed charges,1374.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,808.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.33,1439.41,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1656.27,828.14,,1275.33,77,,,Percent of Total Billed Charges,77% of total billed charges,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.33,77,,,Percent of total Billed charges,77% of total billed charges,1407.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,828.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.07,1474.08,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1617.31,808.66,,1245.33,77,,,Percent of Total Billed Charges,77% of total billed charges,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1326.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1439.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.33,77,,,Percent of total Billed charges,77% of total billed charges,1374.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,808.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.33,1439.41,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1656.27,828.14,,1275.33,77,,,Percent of Total Billed Charges,77% of total billed charges,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.33,77,,,Percent of total Billed charges,77% of total billed charges,1407.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,828.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.07,1474.08,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1617.31,808.66,,1245.33,77,,,Percent of Total Billed Charges,77% of total billed charges,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1326.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1439.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.33,77,,,Percent of total Billed charges,77% of total billed charges,1374.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,808.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.33,1439.41,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1656.27,828.14,,1275.33,77,,,Percent of Total Billed Charges,77% of total billed charges,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.33,77,,,Percent of total Billed charges,77% of total billed charges,1407.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,828.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.07,1474.08,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1617.31,808.66,,1245.33,77,,,Percent of Total Billed Charges,77% of total billed charges,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1326.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1439.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.33,77,,,Percent of total Billed charges,77% of total billed charges,1374.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,808.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.33,1439.41,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1656.27,828.14,,1275.33,77,,,Percent of Total Billed Charges,77% of total billed charges,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.33,77,,,Percent of total Billed charges,77% of total billed charges,1407.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,828.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.07,1474.08,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1617.31,808.66,,1245.33,77,,,Percent of Total Billed Charges,77% of total billed charges,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1326.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1439.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.33,77,,,Percent of total Billed charges,77% of total billed charges,1374.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,808.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.33,1439.41,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1656.27,828.14,,1275.33,77,,,Percent of Total Billed Charges,77% of total billed charges,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,422.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1225.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1142.83,69,,,Percent of Total Billed Charges,69% of total billed charges,1391.27,84,,,Percent of Total Billed Charges,84% of total billed charges,1358.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,1474.08,89,,,Percent of total Billed Charges,89% of total Billed charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1275.33,77,,,Percent of total Billed charges,77% of total billed charges,1407.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,476.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,828.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,675.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1474.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.07,1474.08,
Irinotecan 40mg/2ml Liquid SDV,61703034916,CDM,250,RC,,,Outpatient,,,1617.31,808.66,,1245.33,77,,,Percent of Total Billed Charges,77% of total billed charges,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,412.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,505.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1196.81,74,,,Percent of Total Billed Charges,74% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1115.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1358.54,84,,,Percent of Total Billed Charges,84% of total billed charges,1326.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1439.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1245.33,77,,,Percent of total Billed charges,77% of total billed charges,1374.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,464.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,808.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,659.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.33,1439.41,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18993.17,9496.59,,14624.74,77,,,Percent of Total Billed Charges,77% of total billed charges,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5935.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14054.95,74,,,Percent of Total Billed Charges,74% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,15954.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16903.92,89,,,Percent of total Billed Charges,89% of total Billed charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14624.74,77,,,Percent of total Billed charges,77% of total billed charges,16144.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5460.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9496.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4748.29,16903.92,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18505.83,9252.92,,14249.49,77,,,Percent of Total Billed Charges,77% of total billed charges,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5783.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13694.31,74,,,Percent of Total Billed Charges,74% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,15544.9,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16470.19,89,,,Percent of total Billed Charges,89% of total Billed charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14249.49,77,,,Percent of total Billed charges,77% of total billed charges,15729.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5320.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9252.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4626.46,16470.19,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18993.17,9496.59,,14624.74,77,,,Percent of Total Billed Charges,77% of total billed charges,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5935.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14054.95,74,,,Percent of Total Billed Charges,74% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,15954.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16903.92,89,,,Percent of total Billed Charges,89% of total Billed charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14624.74,77,,,Percent of total Billed charges,77% of total billed charges,16144.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5460.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9496.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4748.29,16903.92,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18505.83,9252.92,,14249.49,77,,,Percent of Total Billed Charges,77% of total billed charges,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5783.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13694.31,74,,,Percent of Total Billed Charges,74% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,15544.9,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16470.19,89,,,Percent of total Billed Charges,89% of total Billed charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14249.49,77,,,Percent of total Billed charges,77% of total billed charges,15729.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5320.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9252.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4626.46,16470.19,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18993.17,9496.59,,14624.74,77,,,Percent of Total Billed Charges,77% of total billed charges,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5935.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14054.95,74,,,Percent of Total Billed Charges,74% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,15954.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16903.92,89,,,Percent of total Billed Charges,89% of total Billed charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14624.74,77,,,Percent of total Billed charges,77% of total billed charges,16144.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5460.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9496.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4748.29,16903.92,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18505.83,9252.92,,14249.49,77,,,Percent of Total Billed Charges,77% of total billed charges,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5783.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13694.31,74,,,Percent of Total Billed Charges,74% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,15544.9,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16470.19,89,,,Percent of total Billed Charges,89% of total Billed charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14249.49,77,,,Percent of total Billed charges,77% of total billed charges,15729.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5320.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9252.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4626.46,16470.19,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18993.17,9496.59,,14624.74,77,,,Percent of Total Billed Charges,77% of total billed charges,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5935.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14054.95,74,,,Percent of Total Billed Charges,74% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,15954.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16903.92,89,,,Percent of total Billed Charges,89% of total Billed charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14624.74,77,,,Percent of total Billed charges,77% of total billed charges,16144.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5460.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9496.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4748.29,16903.92,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18505.83,9252.92,,14249.49,77,,,Percent of Total Billed Charges,77% of total billed charges,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5783.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13694.31,74,,,Percent of Total Billed Charges,74% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,15544.9,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16470.19,89,,,Percent of total Billed Charges,89% of total Billed charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14249.49,77,,,Percent of total Billed charges,77% of total billed charges,15729.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5320.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9252.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4626.46,16470.19,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18993.17,9496.59,,14624.74,77,,,Percent of Total Billed Charges,77% of total billed charges,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5935.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14054.95,74,,,Percent of Total Billed Charges,74% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,15954.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16903.92,89,,,Percent of total Billed Charges,89% of total Billed charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14624.74,77,,,Percent of total Billed charges,77% of total billed charges,16144.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5460.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9496.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4748.29,16903.92,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18505.83,9252.92,,14249.49,77,,,Percent of Total Billed Charges,77% of total billed charges,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5783.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13694.31,74,,,Percent of Total Billed Charges,74% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,15544.9,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16470.19,89,,,Percent of total Billed Charges,89% of total Billed charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14249.49,77,,,Percent of total Billed charges,77% of total billed charges,15729.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5320.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9252.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4626.46,16470.19,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18993.17,9496.59,,14624.74,77,,,Percent of Total Billed Charges,77% of total billed charges,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4843.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5935.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14054.95,74,,,Percent of Total Billed Charges,74% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,13105.29,69,,,Percent of Total Billed Charges,69% of total billed charges,15954.26,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16903.92,89,,,Percent of total Billed Charges,89% of total Billed charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14624.74,77,,,Percent of total Billed charges,77% of total billed charges,16144.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5460.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9496.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7749.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16903.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4748.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4748.29,16903.92,
Irinotecan Liposomal (Onivyde) 43mg/10ml Liquid SDV,15054004301,CDM,250,RC,,,Outpatient,,,18505.83,9252.92,,14249.49,77,,,Percent of Total Billed Charges,77% of total billed charges,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4718.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5783.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13694.31,74,,,Percent of Total Billed Charges,74% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,12769.02,69,,,Percent of Total Billed Charges,69% of total billed charges,15544.9,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16470.19,89,,,Percent of total Billed Charges,89% of total Billed charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14249.49,77,,,Percent of total Billed charges,77% of total billed charges,15729.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5320.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9252.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7550.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16470.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4626.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4626.46,16470.19,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Dextran 100mg/2ml SDV,23608210,CDM,250,RC,,,Outpatient,,,270.26,135.13,,208.1,77,,,Percent of Total Billed Charges,77% of total billed charges,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,199.99,74,,,Percent of Total Billed Charges,74% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,186.48,69,,,Percent of Total Billed Charges,69% of total billed charges,227.02,84,,,Percent of Total Billed Charges,84% of total billed charges,221.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,240.53,89,,,Percent of total Billed Charges,89% of total Billed charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.1,77,,,Percent of total Billed charges,77% of total billed charges,229.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.57,240.53,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Sucrose (Venofer) 100mg/5ml SDV,517234010,CDM,250,RC,,,Outpatient,,,412.33,206.17,,317.49,77,,,Percent of Total Billed Charges,77% of total billed charges,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,128.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,305.12,74,,,Percent of Total Billed Charges,74% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,284.51,69,,,Percent of Total Billed Charges,69% of total billed charges,346.36,84,,,Percent of Total Billed Charges,84% of total billed charges,338.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,366.97,89,,,Percent of total Billed Charges,89% of total Billed charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,317.49,77,,,Percent of total Billed charges,77% of total billed charges,350.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,118.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,206.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,168.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,366.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.08,366.97,
Iron Polysaccharide Complex 150mg Capsule,51991020311,CDM,250,RC,,,Outpatient,,,7.63,3.82,,5.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.65,74,,,Percent of Total Billed Charges,74% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6.41,84,,,Percent of Total Billed Charges,84% of total billed charges,6.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.79,89,,,Percent of total Billed Charges,89% of total Billed charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.88,77,,,Percent of total Billed charges,77% of total billed charges,6.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.91,6.79,
Iron Polysaccharide Complex 150mg Capsule,51991020311,CDM,250,RC,,,Outpatient,,,7.63,3.82,,5.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.65,74,,,Percent of Total Billed Charges,74% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6.41,84,,,Percent of Total Billed Charges,84% of total billed charges,6.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.79,89,,,Percent of total Billed Charges,89% of total Billed charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.88,77,,,Percent of total Billed charges,77% of total billed charges,6.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.91,6.79,
Iron Polysaccharide Complex 150mg Capsule,51991020311,CDM,250,RC,,,Outpatient,,,7.63,3.82,,5.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.65,74,,,Percent of Total Billed Charges,74% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6.41,84,,,Percent of Total Billed Charges,84% of total billed charges,6.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.79,89,,,Percent of total Billed Charges,89% of total Billed charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.88,77,,,Percent of total Billed charges,77% of total billed charges,6.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.91,6.79,
Iron Polysaccharide Complex 150mg Capsule,51991020311,CDM,250,RC,,,Outpatient,,,7.63,3.82,,5.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.65,74,,,Percent of Total Billed Charges,74% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6.41,84,,,Percent of Total Billed Charges,84% of total billed charges,6.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.79,89,,,Percent of total Billed Charges,89% of total Billed charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.88,77,,,Percent of total Billed charges,77% of total billed charges,6.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.91,6.79,
Iron Polysaccharide Complex 150mg Capsule,51991020311,CDM,250,RC,,,Outpatient,,,7.63,3.82,,5.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.65,74,,,Percent of Total Billed Charges,74% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6.41,84,,,Percent of Total Billed Charges,84% of total billed charges,6.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.79,89,,,Percent of total Billed Charges,89% of total Billed charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.88,77,,,Percent of total Billed charges,77% of total billed charges,6.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.91,6.79,
Iron Polysaccharide Complex 150mg Capsule,51991020311,CDM,250,RC,,,Outpatient,,,7.63,3.82,,5.88,77,,,Percent of Total Billed Charges,77% of total billed charges,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.65,74,,,Percent of Total Billed Charges,74% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,69,,,Percent of Total Billed Charges,69% of total billed charges,6.41,84,,,Percent of Total Billed Charges,84% of total billed charges,6.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.79,89,,,Percent of total Billed Charges,89% of total Billed charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.88,77,,,Percent of total Billed charges,77% of total billed charges,6.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.91,6.79,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,601.7,300.85,,463.31,77,,,Percent of Total Billed Charges,77% of total billed charges,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,445.26,74,,,Percent of Total Billed Charges,74% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,505.43,84,,,Percent of Total Billed Charges,84% of total billed charges,493.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,535.51,89,,,Percent of total Billed Charges,89% of total Billed charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.31,77,,,Percent of total Billed charges,77% of total billed charges,511.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,300.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.43,535.51,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,625.1,312.55,,481.33,77,,,Percent of Total Billed Charges,77% of total billed charges,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.57,74,,,Percent of Total Billed Charges,74% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,525.08,84,,,Percent of Total Billed Charges,84% of total billed charges,512.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,556.34,89,,,Percent of total Billed Charges,89% of total Billed charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.33,77,,,Percent of total Billed charges,77% of total billed charges,531.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,312.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.28,556.34,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,601.7,300.85,,463.31,77,,,Percent of Total Billed Charges,77% of total billed charges,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,445.26,74,,,Percent of Total Billed Charges,74% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,505.43,84,,,Percent of Total Billed Charges,84% of total billed charges,493.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,535.51,89,,,Percent of total Billed Charges,89% of total Billed charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.31,77,,,Percent of total Billed charges,77% of total billed charges,511.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,300.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.43,535.51,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,625.1,312.55,,481.33,77,,,Percent of Total Billed Charges,77% of total billed charges,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.57,74,,,Percent of Total Billed Charges,74% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,525.08,84,,,Percent of Total Billed Charges,84% of total billed charges,512.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,556.34,89,,,Percent of total Billed Charges,89% of total Billed charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.33,77,,,Percent of total Billed charges,77% of total billed charges,531.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,312.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.28,556.34,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,601.7,300.85,,463.31,77,,,Percent of Total Billed Charges,77% of total billed charges,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,445.26,74,,,Percent of Total Billed Charges,74% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,505.43,84,,,Percent of Total Billed Charges,84% of total billed charges,493.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,535.51,89,,,Percent of total Billed Charges,89% of total Billed charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.31,77,,,Percent of total Billed charges,77% of total billed charges,511.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,300.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.43,535.51,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,625.1,312.55,,481.33,77,,,Percent of Total Billed Charges,77% of total billed charges,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.57,74,,,Percent of Total Billed Charges,74% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,525.08,84,,,Percent of Total Billed Charges,84% of total billed charges,512.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,556.34,89,,,Percent of total Billed Charges,89% of total Billed charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.33,77,,,Percent of total Billed charges,77% of total billed charges,531.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,312.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.28,556.34,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,601.7,300.85,,463.31,77,,,Percent of Total Billed Charges,77% of total billed charges,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,445.26,74,,,Percent of Total Billed Charges,74% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,505.43,84,,,Percent of Total Billed Charges,84% of total billed charges,493.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,535.51,89,,,Percent of total Billed Charges,89% of total Billed charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.31,77,,,Percent of total Billed charges,77% of total billed charges,511.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,300.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.43,535.51,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,625.1,312.55,,481.33,77,,,Percent of Total Billed Charges,77% of total billed charges,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.57,74,,,Percent of Total Billed Charges,74% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,525.08,84,,,Percent of Total Billed Charges,84% of total billed charges,512.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,556.34,89,,,Percent of total Billed Charges,89% of total Billed charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.33,77,,,Percent of total Billed charges,77% of total billed charges,531.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,312.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.28,556.34,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,601.7,300.85,,463.31,77,,,Percent of Total Billed Charges,77% of total billed charges,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,445.26,74,,,Percent of Total Billed Charges,74% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,505.43,84,,,Percent of Total Billed Charges,84% of total billed charges,493.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,535.51,89,,,Percent of total Billed Charges,89% of total Billed charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.31,77,,,Percent of total Billed charges,77% of total billed charges,511.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,300.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.43,535.51,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,625.1,312.55,,481.33,77,,,Percent of Total Billed Charges,77% of total billed charges,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.57,74,,,Percent of Total Billed Charges,74% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,525.08,84,,,Percent of Total Billed Charges,84% of total billed charges,512.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,556.34,89,,,Percent of total Billed Charges,89% of total Billed charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.33,77,,,Percent of total Billed charges,77% of total billed charges,531.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,312.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.28,556.34,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,601.7,300.85,,463.31,77,,,Percent of Total Billed Charges,77% of total billed charges,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,188.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,445.26,74,,,Percent of Total Billed Charges,74% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,415.17,69,,,Percent of Total Billed Charges,69% of total billed charges,505.43,84,,,Percent of Total Billed Charges,84% of total billed charges,493.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,535.51,89,,,Percent of total Billed Charges,89% of total Billed charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,463.31,77,,,Percent of total Billed charges,77% of total billed charges,511.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,172.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,300.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,245.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,535.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.43,535.51,
Iron Sucrose (Venofer) 200mg/10ml SDV,517231005,CDM,250,RC,,,Outpatient,,,625.1,312.55,,481.33,77,,,Percent of Total Billed Charges,77% of total billed charges,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,195.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,462.57,74,,,Percent of Total Billed Charges,74% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,431.32,69,,,Percent of Total Billed Charges,69% of total billed charges,525.08,84,,,Percent of Total Billed Charges,84% of total billed charges,512.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,556.34,89,,,Percent of total Billed Charges,89% of total Billed charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,481.33,77,,,Percent of total Billed charges,77% of total billed charges,531.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,179.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,312.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,255.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,556.34,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,156.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.28,556.34,
Isoniazid 300mg Tablet,51079008320,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Isoniazid 300mg Tablet,51079008320,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Isoniazid 300mg Tablet,51079008320,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Isoniazid 300mg Tablet,51079008320,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Isoniazid 300mg Tablet,51079008320,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Isoniazid 300mg Tablet,51079008320,CDM,250,RC,,,Outpatient,,,17.11,8.56,,13.17,77,,,Percent of Total Billed Charges,77% of total billed charges,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,11.81,69,,,Percent of Total Billed Charges,69% of total billed charges,14.37,84,,,Percent of Total Billed Charges,84% of total billed charges,14.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.23,89,,,Percent of total Billed Charges,89% of total Billed charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.17,77,,,Percent of total Billed charges,77% of total billed charges,14.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,15.23,
Isosorbide DInitrate 20mg Tablet,904662061,CDM,250,RC,,,Outpatient,,,11.66,5.83,,8.98,77,,,Percent of Total Billed Charges,77% of total billed charges,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.63,74,,,Percent of Total Billed Charges,74% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,9.79,84,,,Percent of Total Billed Charges,84% of total billed charges,9.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.38,89,,,Percent of total Billed Charges,89% of total Billed charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.98,77,,,Percent of total Billed charges,77% of total billed charges,9.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.92,10.38,
Isosorbide DInitrate 20mg Tablet,904662061,CDM,250,RC,,,Outpatient,,,11.66,5.83,,8.98,77,,,Percent of Total Billed Charges,77% of total billed charges,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.63,74,,,Percent of Total Billed Charges,74% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,9.79,84,,,Percent of Total Billed Charges,84% of total billed charges,9.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.38,89,,,Percent of total Billed Charges,89% of total Billed charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.98,77,,,Percent of total Billed charges,77% of total billed charges,9.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.92,10.38,
Isosorbide DInitrate 20mg Tablet,904662061,CDM,250,RC,,,Outpatient,,,11.66,5.83,,8.98,77,,,Percent of Total Billed Charges,77% of total billed charges,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.63,74,,,Percent of Total Billed Charges,74% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,9.79,84,,,Percent of Total Billed Charges,84% of total billed charges,9.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.38,89,,,Percent of total Billed Charges,89% of total Billed charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.98,77,,,Percent of total Billed charges,77% of total billed charges,9.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.92,10.38,
Isosorbide DInitrate 20mg Tablet,904662061,CDM,250,RC,,,Outpatient,,,11.66,5.83,,8.98,77,,,Percent of Total Billed Charges,77% of total billed charges,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.63,74,,,Percent of Total Billed Charges,74% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,9.79,84,,,Percent of Total Billed Charges,84% of total billed charges,9.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.38,89,,,Percent of total Billed Charges,89% of total Billed charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.98,77,,,Percent of total Billed charges,77% of total billed charges,9.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.92,10.38,
Isosorbide DInitrate 20mg Tablet,904662061,CDM,250,RC,,,Outpatient,,,11.66,5.83,,8.98,77,,,Percent of Total Billed Charges,77% of total billed charges,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.63,74,,,Percent of Total Billed Charges,74% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,9.79,84,,,Percent of Total Billed Charges,84% of total billed charges,9.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.38,89,,,Percent of total Billed Charges,89% of total Billed charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.98,77,,,Percent of total Billed charges,77% of total billed charges,9.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.92,10.38,
Isosorbide DInitrate 20mg Tablet,904662061,CDM,250,RC,,,Outpatient,,,11.66,5.83,,8.98,77,,,Percent of Total Billed Charges,77% of total billed charges,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.63,74,,,Percent of Total Billed Charges,74% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,8.05,69,,,Percent of Total Billed Charges,69% of total billed charges,9.79,84,,,Percent of Total Billed Charges,84% of total billed charges,9.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.38,89,,,Percent of total Billed Charges,89% of total Billed charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.98,77,,,Percent of total Billed charges,77% of total billed charges,9.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.92,10.38,
Isosorbide MONOnitrate 30mg Tablet,23155051901,CDM,250,RC,,,Outpatient,,,36.44,18.22,,28.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.97,74,,,Percent of Total Billed Charges,74% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,30.61,84,,,Percent of Total Billed Charges,84% of total billed charges,29.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.43,89,,,Percent of total Billed Charges,89% of total Billed charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.06,77,,,Percent of total Billed charges,77% of total billed charges,30.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.11,32.43,
Isosorbide MONOnitrate 30mg Tablet,23155051901,CDM,250,RC,,,Outpatient,,,36.44,18.22,,28.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.97,74,,,Percent of Total Billed Charges,74% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,30.61,84,,,Percent of Total Billed Charges,84% of total billed charges,29.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.43,89,,,Percent of total Billed Charges,89% of total Billed charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.06,77,,,Percent of total Billed charges,77% of total billed charges,30.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.11,32.43,
Isosorbide MONOnitrate 30mg Tablet,23155051901,CDM,250,RC,,,Outpatient,,,36.44,18.22,,28.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.97,74,,,Percent of Total Billed Charges,74% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,30.61,84,,,Percent of Total Billed Charges,84% of total billed charges,29.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.43,89,,,Percent of total Billed Charges,89% of total Billed charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.06,77,,,Percent of total Billed charges,77% of total billed charges,30.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.11,32.43,
Isosorbide MONOnitrate 30mg Tablet,23155051901,CDM,250,RC,,,Outpatient,,,36.44,18.22,,28.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.97,74,,,Percent of Total Billed Charges,74% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,30.61,84,,,Percent of Total Billed Charges,84% of total billed charges,29.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.43,89,,,Percent of total Billed Charges,89% of total Billed charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.06,77,,,Percent of total Billed charges,77% of total billed charges,30.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.11,32.43,
Isosorbide MONOnitrate 30mg Tablet,23155051901,CDM,250,RC,,,Outpatient,,,36.44,18.22,,28.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.97,74,,,Percent of Total Billed Charges,74% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,30.61,84,,,Percent of Total Billed Charges,84% of total billed charges,29.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.43,89,,,Percent of total Billed Charges,89% of total Billed charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.06,77,,,Percent of total Billed charges,77% of total billed charges,30.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.11,32.43,
Isosorbide MONOnitrate 30mg Tablet,23155051901,CDM,250,RC,,,Outpatient,,,36.44,18.22,,28.06,77,,,Percent of Total Billed Charges,77% of total billed charges,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26.97,74,,,Percent of Total Billed Charges,74% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,25.14,69,,,Percent of Total Billed Charges,69% of total billed charges,30.61,84,,,Percent of Total Billed Charges,84% of total billed charges,29.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.43,89,,,Percent of total Billed Charges,89% of total Billed charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.06,77,,,Percent of total Billed charges,77% of total billed charges,30.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.11,32.43,
Isosorbide MONOnitrate 60mg Tablet,904645061,CDM,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
Isosorbide MONOnitrate 60mg Tablet,904645061,CDM,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
Isosorbide MONOnitrate 60mg Tablet,904645061,CDM,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
Isosorbide MONOnitrate 60mg Tablet,904645061,CDM,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
Isosorbide MONOnitrate 60mg Tablet,904645061,CDM,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
Isosorbide MONOnitrate 60mg Tablet,904645061,CDM,250,RC,,,Outpatient,,,8.85,4.43,,6.81,77,,,Percent of Total Billed Charges,77% of total billed charges,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.55,74,,,Percent of Total Billed Charges,74% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.43,84,,,Percent of Total Billed Charges,84% of total billed charges,7.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.88,89,,,Percent of total Billed Charges,89% of total Billed charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.81,77,,,Percent of total Billed charges,77% of total billed charges,7.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.21,7.88,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 500mg/5ml MDV,409004010,CDM,250,RC,,,Outpatient,,,108.34,54.17,,83.42,77,,,Percent of Total Billed Charges,77% of total billed charges,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.17,74,,,Percent of Total Billed Charges,74% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,74.75,69,,,Percent of Total Billed Charges,69% of total billed charges,91.01,84,,,Percent of Total Billed Charges,84% of total billed charges,88.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.42,89,,,Percent of total Billed Charges,89% of total Billed charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.42,77,,,Percent of total Billed charges,77% of total billed charges,92.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.09,96.42,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 200mg/20ml MDV,42023011310,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketamine 500mg/10ml MDV,143950810,CDM,250,RC,,,Outpatient,,,92.64,46.32,,71.33,77,,,Percent of Total Billed Charges,77% of total billed charges,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.55,74,,,Percent of Total Billed Charges,74% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,63.92,69,,,Percent of Total Billed Charges,69% of total billed charges,77.82,84,,,Percent of Total Billed Charges,84% of total billed charges,75.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.45,89,,,Percent of total Billed Charges,89% of total Billed charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.33,77,,,Percent of total Billed charges,77% of total billed charges,78.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,82.45,
Ketorolac 10mg Tablet,93031401,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Ketorolac 10mg Tablet,93031401,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Ketorolac 10mg Tablet,93031401,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Ketorolac 10mg Tablet,93031401,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Ketorolac 10mg Tablet,93031401,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Ketorolac 10mg Tablet,93031401,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Ketoconazole 2% Shampoo 120ml,45802046564,CDM,250,RC,,,Outpatient,,,148.52,74.26,,114.36,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.9,74,,,Percent of Total Billed Charges,74% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,124.76,84,,,Percent of Total Billed Charges,84% of total billed charges,121.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.18,89,,,Percent of total Billed Charges,89% of total Billed charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.36,77,,,Percent of total Billed charges,77% of total billed charges,126.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.13,132.18,
Ketoconazole 2% Shampoo 120ml,45802046564,CDM,250,RC,,,Outpatient,,,148.52,74.26,,114.36,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.9,74,,,Percent of Total Billed Charges,74% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,124.76,84,,,Percent of Total Billed Charges,84% of total billed charges,121.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.18,89,,,Percent of total Billed Charges,89% of total Billed charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.36,77,,,Percent of total Billed charges,77% of total billed charges,126.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.13,132.18,
Ketoconazole 2% Shampoo 120ml,45802046564,CDM,250,RC,,,Outpatient,,,148.52,74.26,,114.36,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.9,74,,,Percent of Total Billed Charges,74% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,124.76,84,,,Percent of Total Billed Charges,84% of total billed charges,121.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.18,89,,,Percent of total Billed Charges,89% of total Billed charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.36,77,,,Percent of total Billed charges,77% of total billed charges,126.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.13,132.18,
Ketoconazole 2% Shampoo 120ml,45802046564,CDM,250,RC,,,Outpatient,,,148.52,74.26,,114.36,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.9,74,,,Percent of Total Billed Charges,74% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,124.76,84,,,Percent of Total Billed Charges,84% of total billed charges,121.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.18,89,,,Percent of total Billed Charges,89% of total Billed charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.36,77,,,Percent of total Billed charges,77% of total billed charges,126.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.13,132.18,
Ketoconazole 2% Shampoo 120ml,45802046564,CDM,250,RC,,,Outpatient,,,148.52,74.26,,114.36,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.9,74,,,Percent of Total Billed Charges,74% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,124.76,84,,,Percent of Total Billed Charges,84% of total billed charges,121.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.18,89,,,Percent of total Billed Charges,89% of total Billed charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.36,77,,,Percent of total Billed charges,77% of total billed charges,126.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.13,132.18,
Ketoconazole 2% Shampoo 120ml,45802046564,CDM,250,RC,,,Outpatient,,,148.52,74.26,,114.36,77,,,Percent of Total Billed Charges,77% of total billed charges,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.9,74,,,Percent of Total Billed Charges,74% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,102.48,69,,,Percent of Total Billed Charges,69% of total billed charges,124.76,84,,,Percent of Total Billed Charges,84% of total billed charges,121.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,132.18,89,,,Percent of total Billed Charges,89% of total Billed charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.36,77,,,Percent of total Billed charges,77% of total billed charges,126.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.13,132.18,
Ketoconazole 2% Cream 15gm,168009915,CDM,250,RC,,,Outpatient,,,151.6,75.8,,116.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.18,74,,,Percent of Total Billed Charges,74% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,127.34,84,,,Percent of Total Billed Charges,84% of total billed charges,124.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.92,89,,,Percent of total Billed Charges,89% of total Billed charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.73,77,,,Percent of total Billed charges,77% of total billed charges,128.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.9,134.92,
Ketoconazole 2% Cream 15gm,168009915,CDM,250,RC,,,Outpatient,,,151.6,75.8,,116.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.18,74,,,Percent of Total Billed Charges,74% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,127.34,84,,,Percent of Total Billed Charges,84% of total billed charges,124.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.92,89,,,Percent of total Billed Charges,89% of total Billed charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.73,77,,,Percent of total Billed charges,77% of total billed charges,128.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.9,134.92,
Ketoconazole 2% Cream 15gm,168009915,CDM,250,RC,,,Outpatient,,,151.6,75.8,,116.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.18,74,,,Percent of Total Billed Charges,74% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,127.34,84,,,Percent of Total Billed Charges,84% of total billed charges,124.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.92,89,,,Percent of total Billed Charges,89% of total Billed charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.73,77,,,Percent of total Billed charges,77% of total billed charges,128.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.9,134.92,
Ketoconazole 2% Cream 15gm,168009915,CDM,250,RC,,,Outpatient,,,151.6,75.8,,116.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.18,74,,,Percent of Total Billed Charges,74% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,127.34,84,,,Percent of Total Billed Charges,84% of total billed charges,124.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.92,89,,,Percent of total Billed Charges,89% of total Billed charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.73,77,,,Percent of total Billed charges,77% of total billed charges,128.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.9,134.92,
Ketoconazole 2% Cream 15gm,168009915,CDM,250,RC,,,Outpatient,,,151.6,75.8,,116.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.18,74,,,Percent of Total Billed Charges,74% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,127.34,84,,,Percent of Total Billed Charges,84% of total billed charges,124.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.92,89,,,Percent of total Billed Charges,89% of total Billed charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.73,77,,,Percent of total Billed charges,77% of total billed charges,128.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.9,134.92,
Ketoconazole 2% Cream 15gm,168009915,CDM,250,RC,,,Outpatient,,,151.6,75.8,,116.73,77,,,Percent of Total Billed Charges,77% of total billed charges,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.18,74,,,Percent of Total Billed Charges,74% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,104.6,69,,,Percent of Total Billed Charges,69% of total billed charges,127.34,84,,,Percent of Total Billed Charges,84% of total billed charges,124.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.92,89,,,Percent of total Billed Charges,89% of total Billed charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.73,77,,,Percent of total Billed charges,77% of total billed charges,128.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.9,134.92,
Ketorolac 30mg/ml SDV,63323016201,CDM,250,RC,,,Outpatient,,,86.88,43.44,,66.9,77,,,Percent of Total Billed Charges,77% of total billed charges,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.29,74,,,Percent of Total Billed Charges,74% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,72.98,84,,,Percent of Total Billed Charges,84% of total billed charges,71.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.32,89,,,Percent of total Billed Charges,89% of total Billed charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.9,77,,,Percent of total Billed charges,77% of total billed charges,73.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.72,77.32,
Ketorolac 30mg/ml SDV,63323016201,CDM,250,RC,,,Outpatient,,,86.88,43.44,,66.9,77,,,Percent of Total Billed Charges,77% of total billed charges,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.29,74,,,Percent of Total Billed Charges,74% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,72.98,84,,,Percent of Total Billed Charges,84% of total billed charges,71.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.32,89,,,Percent of total Billed Charges,89% of total Billed charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.9,77,,,Percent of total Billed charges,77% of total billed charges,73.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.72,77.32,
Ketorolac 30mg/ml SDV,63323016201,CDM,250,RC,,,Outpatient,,,86.88,43.44,,66.9,77,,,Percent of Total Billed Charges,77% of total billed charges,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.29,74,,,Percent of Total Billed Charges,74% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,72.98,84,,,Percent of Total Billed Charges,84% of total billed charges,71.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.32,89,,,Percent of total Billed Charges,89% of total Billed charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.9,77,,,Percent of total Billed charges,77% of total billed charges,73.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.72,77.32,
Ketorolac 30mg/ml SDV,63323016201,CDM,250,RC,,,Outpatient,,,86.88,43.44,,66.9,77,,,Percent of Total Billed Charges,77% of total billed charges,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.29,74,,,Percent of Total Billed Charges,74% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,72.98,84,,,Percent of Total Billed Charges,84% of total billed charges,71.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.32,89,,,Percent of total Billed Charges,89% of total Billed charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.9,77,,,Percent of total Billed charges,77% of total billed charges,73.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.72,77.32,
Ketorolac 30mg/ml SDV,63323016201,CDM,250,RC,,,Outpatient,,,86.88,43.44,,66.9,77,,,Percent of Total Billed Charges,77% of total billed charges,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.29,74,,,Percent of Total Billed Charges,74% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,72.98,84,,,Percent of Total Billed Charges,84% of total billed charges,71.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.32,89,,,Percent of total Billed Charges,89% of total Billed charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.9,77,,,Percent of total Billed charges,77% of total billed charges,73.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.72,77.32,
Ketorolac 30mg/ml SDV,63323016201,CDM,250,RC,,,Outpatient,,,86.88,43.44,,66.9,77,,,Percent of Total Billed Charges,77% of total billed charges,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.29,74,,,Percent of Total Billed Charges,74% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,59.95,69,,,Percent of Total Billed Charges,69% of total billed charges,72.98,84,,,Percent of Total Billed Charges,84% of total billed charges,71.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.32,89,,,Percent of total Billed Charges,89% of total Billed charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.9,77,,,Percent of total Billed charges,77% of total billed charges,73.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.72,77.32,
Ketorolac 0.5% OPHTH Soln 5ml,42571013725,CDM,250,RC,,,Outpatient,,,370.19,185.1,,285.05,77,,,Percent of Total Billed Charges,77% of total billed charges,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.94,74,,,Percent of Total Billed Charges,74% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,310.96,84,,,Percent of Total Billed Charges,84% of total billed charges,303.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.47,89,,,Percent of total Billed Charges,89% of total Billed charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.05,77,,,Percent of total Billed charges,77% of total billed charges,314.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.55,329.47,
Ketorolac 0.5% OPHTH Soln 5ml,42571013725,CDM,250,RC,,,Outpatient,,,370.19,185.1,,285.05,77,,,Percent of Total Billed Charges,77% of total billed charges,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.94,74,,,Percent of Total Billed Charges,74% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,310.96,84,,,Percent of Total Billed Charges,84% of total billed charges,303.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.47,89,,,Percent of total Billed Charges,89% of total Billed charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.05,77,,,Percent of total Billed charges,77% of total billed charges,314.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.55,329.47,
Ketorolac 0.5% OPHTH Soln 5ml,42571013725,CDM,250,RC,,,Outpatient,,,370.19,185.1,,285.05,77,,,Percent of Total Billed Charges,77% of total billed charges,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.94,74,,,Percent of Total Billed Charges,74% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,310.96,84,,,Percent of Total Billed Charges,84% of total billed charges,303.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.47,89,,,Percent of total Billed Charges,89% of total Billed charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.05,77,,,Percent of total Billed charges,77% of total billed charges,314.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.55,329.47,
Ketorolac 0.5% OPHTH Soln 5ml,42571013725,CDM,250,RC,,,Outpatient,,,370.19,185.1,,285.05,77,,,Percent of Total Billed Charges,77% of total billed charges,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.94,74,,,Percent of Total Billed Charges,74% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,310.96,84,,,Percent of Total Billed Charges,84% of total billed charges,303.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.47,89,,,Percent of total Billed Charges,89% of total Billed charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.05,77,,,Percent of total Billed charges,77% of total billed charges,314.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.55,329.47,
Ketorolac 0.5% OPHTH Soln 5ml,42571013725,CDM,250,RC,,,Outpatient,,,370.19,185.1,,285.05,77,,,Percent of Total Billed Charges,77% of total billed charges,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.94,74,,,Percent of Total Billed Charges,74% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,310.96,84,,,Percent of Total Billed Charges,84% of total billed charges,303.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.47,89,,,Percent of total Billed Charges,89% of total Billed charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.05,77,,,Percent of total Billed charges,77% of total billed charges,314.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.55,329.47,
Ketorolac 0.5% OPHTH Soln 5ml,42571013725,CDM,250,RC,,,Outpatient,,,370.19,185.1,,285.05,77,,,Percent of Total Billed Charges,77% of total billed charges,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,273.94,74,,,Percent of Total Billed Charges,74% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,255.43,69,,,Percent of Total Billed Charges,69% of total billed charges,310.96,84,,,Percent of Total Billed Charges,84% of total billed charges,303.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,329.47,89,,,Percent of total Billed Charges,89% of total Billed charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,285.05,77,,,Percent of total Billed charges,77% of total billed charges,314.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,106.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,185.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,151.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,329.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.55,329.47,
Ketotifen 0.025% OPHTH Soln 5ml,536125240,CDM,250,RC,,,Outpatient,,,92.18,46.09,,70.98,77,,,Percent of Total Billed Charges,77% of total billed charges,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.21,74,,,Percent of Total Billed Charges,74% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,77.43,84,,,Percent of Total Billed Charges,84% of total billed charges,75.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.04,89,,,Percent of total Billed Charges,89% of total Billed charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.98,77,,,Percent of total Billed charges,77% of total billed charges,78.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.05,82.04,
Ketotifen 0.025% OPHTH Soln 5ml,536125240,CDM,250,RC,,,Outpatient,,,92.18,46.09,,70.98,77,,,Percent of Total Billed Charges,77% of total billed charges,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.21,74,,,Percent of Total Billed Charges,74% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,77.43,84,,,Percent of Total Billed Charges,84% of total billed charges,75.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.04,89,,,Percent of total Billed Charges,89% of total Billed charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.98,77,,,Percent of total Billed charges,77% of total billed charges,78.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.05,82.04,
Ketotifen 0.025% OPHTH Soln 5ml,536125240,CDM,250,RC,,,Outpatient,,,92.18,46.09,,70.98,77,,,Percent of Total Billed Charges,77% of total billed charges,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.21,74,,,Percent of Total Billed Charges,74% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,77.43,84,,,Percent of Total Billed Charges,84% of total billed charges,75.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.04,89,,,Percent of total Billed Charges,89% of total Billed charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.98,77,,,Percent of total Billed charges,77% of total billed charges,78.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.05,82.04,
Ketotifen 0.025% OPHTH Soln 5ml,536125240,CDM,250,RC,,,Outpatient,,,92.18,46.09,,70.98,77,,,Percent of Total Billed Charges,77% of total billed charges,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.21,74,,,Percent of Total Billed Charges,74% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,77.43,84,,,Percent of Total Billed Charges,84% of total billed charges,75.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.04,89,,,Percent of total Billed Charges,89% of total Billed charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.98,77,,,Percent of total Billed charges,77% of total billed charges,78.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.05,82.04,
Ketotifen 0.025% OPHTH Soln 5ml,536125240,CDM,250,RC,,,Outpatient,,,92.18,46.09,,70.98,77,,,Percent of Total Billed Charges,77% of total billed charges,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.21,74,,,Percent of Total Billed Charges,74% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,77.43,84,,,Percent of Total Billed Charges,84% of total billed charges,75.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.04,89,,,Percent of total Billed Charges,89% of total Billed charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.98,77,,,Percent of total Billed charges,77% of total billed charges,78.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.05,82.04,
Ketotifen 0.025% OPHTH Soln 5ml,536125240,CDM,250,RC,,,Outpatient,,,92.18,46.09,,70.98,77,,,Percent of Total Billed Charges,77% of total billed charges,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.21,74,,,Percent of Total Billed Charges,74% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,63.6,69,,,Percent of Total Billed Charges,69% of total billed charges,77.43,84,,,Percent of Total Billed Charges,84% of total billed charges,75.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.04,89,,,Percent of total Billed Charges,89% of total Billed charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.98,77,,,Percent of total Billed charges,77% of total billed charges,78.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.05,82.04,
Ketorolac 60mg/2ml SDV,63323016202,CDM,250,RC,,,Outpatient,,,107.44,53.72,,82.73,77,,,Percent of Total Billed Charges,77% of total billed charges,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.51,74,,,Percent of Total Billed Charges,74% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,84,,,Percent of Total Billed Charges,84% of total billed charges,88.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.62,89,,,Percent of total Billed Charges,89% of total Billed charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.73,77,,,Percent of total Billed charges,77% of total billed charges,91.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.86,95.62,
Ketorolac 60mg/2ml SDV,63323016202,CDM,250,RC,,,Outpatient,,,107.44,53.72,,82.73,77,,,Percent of Total Billed Charges,77% of total billed charges,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.51,74,,,Percent of Total Billed Charges,74% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,84,,,Percent of Total Billed Charges,84% of total billed charges,88.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.62,89,,,Percent of total Billed Charges,89% of total Billed charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.73,77,,,Percent of total Billed charges,77% of total billed charges,91.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.86,95.62,
Ketorolac 60mg/2ml SDV,63323016202,CDM,250,RC,,,Outpatient,,,107.44,53.72,,82.73,77,,,Percent of Total Billed Charges,77% of total billed charges,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.51,74,,,Percent of Total Billed Charges,74% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,84,,,Percent of Total Billed Charges,84% of total billed charges,88.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.62,89,,,Percent of total Billed Charges,89% of total Billed charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.73,77,,,Percent of total Billed charges,77% of total billed charges,91.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.86,95.62,
Ketorolac 60mg/2ml SDV,63323016202,CDM,250,RC,,,Outpatient,,,107.44,53.72,,82.73,77,,,Percent of Total Billed Charges,77% of total billed charges,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.51,74,,,Percent of Total Billed Charges,74% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,84,,,Percent of Total Billed Charges,84% of total billed charges,88.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.62,89,,,Percent of total Billed Charges,89% of total Billed charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.73,77,,,Percent of total Billed charges,77% of total billed charges,91.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.86,95.62,
Ketorolac 60mg/2ml SDV,63323016202,CDM,250,RC,,,Outpatient,,,107.44,53.72,,82.73,77,,,Percent of Total Billed Charges,77% of total billed charges,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.51,74,,,Percent of Total Billed Charges,74% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,84,,,Percent of Total Billed Charges,84% of total billed charges,88.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.62,89,,,Percent of total Billed Charges,89% of total Billed charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.73,77,,,Percent of total Billed charges,77% of total billed charges,91.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.86,95.62,
Ketorolac 60mg/2ml SDV,63323016202,CDM,250,RC,,,Outpatient,,,107.44,53.72,,82.73,77,,,Percent of Total Billed Charges,77% of total billed charges,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.51,74,,,Percent of Total Billed Charges,74% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,74.13,69,,,Percent of Total Billed Charges,69% of total billed charges,90.25,84,,,Percent of Total Billed Charges,84% of total billed charges,88.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.62,89,,,Percent of total Billed Charges,89% of total Billed charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.73,77,,,Percent of total Billed charges,77% of total billed charges,91.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.86,95.62,
Lidocaine/Epi/Tetracaine Top 3 ml Solution,,,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
Lidocaine/Epi/Tetracaine Top 3 ml Solution,,,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
Lidocaine/Epi/Tetracaine Top 3 ml Solution,,,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
Lidocaine/Epi/Tetracaine Top 3 ml Solution,,,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
Lidocaine/Epi/Tetracaine Top 3 ml Solution,,,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
Lidocaine/Epi/Tetracaine Top 3 ml Solution,,,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
Labetalol 100mg Tablet,51079092820,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Labetalol 100mg Tablet,51079092820,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Labetalol 100mg Tablet,51079092820,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Labetalol 100mg Tablet,51079092820,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Labetalol 100mg Tablet,51079092820,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Labetalol 100mg Tablet,51079092820,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Labetalol 20mg/4ml Syringe (ER-OR USE),409233934,CDM,250,RC,,,Outpatient,,,114.68,57.34,,88.3,77,,,Percent of Total Billed Charges,77% of total billed charges,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.86,74,,,Percent of Total Billed Charges,74% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,96.33,84,,,Percent of Total Billed Charges,84% of total billed charges,94.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.07,89,,,Percent of total Billed Charges,89% of total Billed charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.3,77,,,Percent of total Billed charges,77% of total billed charges,97.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.67,102.07,
Labetalol 20mg/4ml Syringe (ER-OR USE),409233934,CDM,250,RC,,,Outpatient,,,114.68,57.34,,88.3,77,,,Percent of Total Billed Charges,77% of total billed charges,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.86,74,,,Percent of Total Billed Charges,74% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,96.33,84,,,Percent of Total Billed Charges,84% of total billed charges,94.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.07,89,,,Percent of total Billed Charges,89% of total Billed charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.3,77,,,Percent of total Billed charges,77% of total billed charges,97.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.67,102.07,
Labetalol 20mg/4ml Syringe (ER-OR USE),409233934,CDM,250,RC,,,Outpatient,,,114.68,57.34,,88.3,77,,,Percent of Total Billed Charges,77% of total billed charges,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.86,74,,,Percent of Total Billed Charges,74% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,96.33,84,,,Percent of Total Billed Charges,84% of total billed charges,94.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.07,89,,,Percent of total Billed Charges,89% of total Billed charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.3,77,,,Percent of total Billed charges,77% of total billed charges,97.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.67,102.07,
Labetalol 20mg/4ml Syringe (ER-OR USE),409233934,CDM,250,RC,,,Outpatient,,,114.68,57.34,,88.3,77,,,Percent of Total Billed Charges,77% of total billed charges,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.86,74,,,Percent of Total Billed Charges,74% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,96.33,84,,,Percent of Total Billed Charges,84% of total billed charges,94.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.07,89,,,Percent of total Billed Charges,89% of total Billed charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.3,77,,,Percent of total Billed charges,77% of total billed charges,97.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.67,102.07,
Labetalol 20mg/4ml Syringe (ER-OR USE),409233934,CDM,250,RC,,,Outpatient,,,114.68,57.34,,88.3,77,,,Percent of Total Billed Charges,77% of total billed charges,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.86,74,,,Percent of Total Billed Charges,74% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,96.33,84,,,Percent of Total Billed Charges,84% of total billed charges,94.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.07,89,,,Percent of total Billed Charges,89% of total Billed charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.3,77,,,Percent of total Billed charges,77% of total billed charges,97.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.67,102.07,
Labetalol 20mg/4ml Syringe (ER-OR USE),409233934,CDM,250,RC,,,Outpatient,,,114.68,57.34,,88.3,77,,,Percent of Total Billed Charges,77% of total billed charges,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.86,74,,,Percent of Total Billed Charges,74% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,79.13,69,,,Percent of Total Billed Charges,69% of total billed charges,96.33,84,,,Percent of Total Billed Charges,84% of total billed charges,94.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,102.07,89,,,Percent of total Billed Charges,89% of total Billed charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.3,77,,,Percent of total Billed charges,77% of total billed charges,97.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.67,102.07,
Labetalol 300mg Tablet,60687046101,CDM,250,RC,,,Outpatient,,,16.17,8.09,,12.45,77,,,Percent of Total Billed Charges,77% of total billed charges,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.97,74,,,Percent of Total Billed Charges,74% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.58,84,,,Percent of Total Billed Charges,84% of total billed charges,13.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.39,89,,,Percent of total Billed Charges,89% of total Billed charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.45,77,,,Percent of total Billed charges,77% of total billed charges,13.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.04,14.39,
Labetalol 300mg Tablet,60687046101,CDM,250,RC,,,Outpatient,,,16.17,8.09,,12.45,77,,,Percent of Total Billed Charges,77% of total billed charges,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.97,74,,,Percent of Total Billed Charges,74% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.58,84,,,Percent of Total Billed Charges,84% of total billed charges,13.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.39,89,,,Percent of total Billed Charges,89% of total Billed charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.45,77,,,Percent of total Billed charges,77% of total billed charges,13.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.04,14.39,
Labetalol 300mg Tablet,60687046101,CDM,250,RC,,,Outpatient,,,16.17,8.09,,12.45,77,,,Percent of Total Billed Charges,77% of total billed charges,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.97,74,,,Percent of Total Billed Charges,74% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.58,84,,,Percent of Total Billed Charges,84% of total billed charges,13.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.39,89,,,Percent of total Billed Charges,89% of total Billed charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.45,77,,,Percent of total Billed charges,77% of total billed charges,13.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.04,14.39,
Labetalol 300mg Tablet,60687046101,CDM,250,RC,,,Outpatient,,,16.17,8.09,,12.45,77,,,Percent of Total Billed Charges,77% of total billed charges,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.97,74,,,Percent of Total Billed Charges,74% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.58,84,,,Percent of Total Billed Charges,84% of total billed charges,13.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.39,89,,,Percent of total Billed Charges,89% of total Billed charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.45,77,,,Percent of total Billed charges,77% of total billed charges,13.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.04,14.39,
Labetalol 300mg Tablet,60687046101,CDM,250,RC,,,Outpatient,,,16.17,8.09,,12.45,77,,,Percent of Total Billed Charges,77% of total billed charges,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.97,74,,,Percent of Total Billed Charges,74% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.58,84,,,Percent of Total Billed Charges,84% of total billed charges,13.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.39,89,,,Percent of total Billed Charges,89% of total Billed charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.45,77,,,Percent of total Billed charges,77% of total billed charges,13.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.04,14.39,
Labetalol 300mg Tablet,60687046101,CDM,250,RC,,,Outpatient,,,16.17,8.09,,12.45,77,,,Percent of Total Billed Charges,77% of total billed charges,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.97,74,,,Percent of Total Billed Charges,74% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,11.16,69,,,Percent of Total Billed Charges,69% of total billed charges,13.58,84,,,Percent of Total Billed Charges,84% of total billed charges,13.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.39,89,,,Percent of total Billed Charges,89% of total Billed charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.45,77,,,Percent of total Billed charges,77% of total billed charges,13.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.04,14.39,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Labetalol 200mg/40ml MDV,72266010301,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Lacosamide 100mg Tablet,131247860,CDM,250,RC,,,Outpatient,,,148.12,74.06,,114.05,77,,,Percent of Total Billed Charges,77% of total billed charges,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.61,74,,,Percent of Total Billed Charges,74% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,124.42,84,,,Percent of Total Billed Charges,84% of total billed charges,121.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.83,89,,,Percent of total Billed Charges,89% of total Billed charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.05,77,,,Percent of total Billed charges,77% of total billed charges,125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.03,131.83,
Lacosamide 100mg Tablet,131247860,CDM,250,RC,,,Outpatient,,,148.12,74.06,,114.05,77,,,Percent of Total Billed Charges,77% of total billed charges,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.61,74,,,Percent of Total Billed Charges,74% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,124.42,84,,,Percent of Total Billed Charges,84% of total billed charges,121.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.83,89,,,Percent of total Billed Charges,89% of total Billed charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.05,77,,,Percent of total Billed charges,77% of total billed charges,125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.03,131.83,
Lacosamide 100mg Tablet,131247860,CDM,250,RC,,,Outpatient,,,148.12,74.06,,114.05,77,,,Percent of Total Billed Charges,77% of total billed charges,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.61,74,,,Percent of Total Billed Charges,74% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,124.42,84,,,Percent of Total Billed Charges,84% of total billed charges,121.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.83,89,,,Percent of total Billed Charges,89% of total Billed charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.05,77,,,Percent of total Billed charges,77% of total billed charges,125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.03,131.83,
Lacosamide 100mg Tablet,131247860,CDM,250,RC,,,Outpatient,,,148.12,74.06,,114.05,77,,,Percent of Total Billed Charges,77% of total billed charges,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.61,74,,,Percent of Total Billed Charges,74% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,124.42,84,,,Percent of Total Billed Charges,84% of total billed charges,121.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.83,89,,,Percent of total Billed Charges,89% of total Billed charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.05,77,,,Percent of total Billed charges,77% of total billed charges,125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.03,131.83,
Lacosamide 100mg Tablet,131247860,CDM,250,RC,,,Outpatient,,,148.12,74.06,,114.05,77,,,Percent of Total Billed Charges,77% of total billed charges,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.61,74,,,Percent of Total Billed Charges,74% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,124.42,84,,,Percent of Total Billed Charges,84% of total billed charges,121.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.83,89,,,Percent of total Billed Charges,89% of total Billed charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.05,77,,,Percent of total Billed charges,77% of total billed charges,125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.03,131.83,
Lacosamide 100mg Tablet,131247860,CDM,250,RC,,,Outpatient,,,148.12,74.06,,114.05,77,,,Percent of Total Billed Charges,77% of total billed charges,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.61,74,,,Percent of Total Billed Charges,74% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,102.2,69,,,Percent of Total Billed Charges,69% of total billed charges,124.42,84,,,Percent of Total Billed Charges,84% of total billed charges,121.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.83,89,,,Percent of total Billed Charges,89% of total Billed charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.05,77,,,Percent of total Billed charges,77% of total billed charges,125.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.03,131.83,
Lacosamide 50mg Tablet,131247760,CDM,250,RC,,,Outpatient,,,96.55,48.28,,74.34,77,,,Percent of Total Billed Charges,77% of total billed charges,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.45,74,,,Percent of Total Billed Charges,74% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,81.1,84,,,Percent of Total Billed Charges,84% of total billed charges,79.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.93,89,,,Percent of total Billed Charges,89% of total Billed charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.34,77,,,Percent of total Billed charges,77% of total billed charges,82.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.14,85.93,
Lacosamide 50mg Tablet,131247760,CDM,250,RC,,,Outpatient,,,96.55,48.28,,74.34,77,,,Percent of Total Billed Charges,77% of total billed charges,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.45,74,,,Percent of Total Billed Charges,74% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,81.1,84,,,Percent of Total Billed Charges,84% of total billed charges,79.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.93,89,,,Percent of total Billed Charges,89% of total Billed charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.34,77,,,Percent of total Billed charges,77% of total billed charges,82.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.14,85.93,
Lacosamide 50mg Tablet,131247760,CDM,250,RC,,,Outpatient,,,96.55,48.28,,74.34,77,,,Percent of Total Billed Charges,77% of total billed charges,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.45,74,,,Percent of Total Billed Charges,74% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,81.1,84,,,Percent of Total Billed Charges,84% of total billed charges,79.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.93,89,,,Percent of total Billed Charges,89% of total Billed charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.34,77,,,Percent of total Billed charges,77% of total billed charges,82.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.14,85.93,
Lacosamide 50mg Tablet,131247760,CDM,250,RC,,,Outpatient,,,96.55,48.28,,74.34,77,,,Percent of Total Billed Charges,77% of total billed charges,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.45,74,,,Percent of Total Billed Charges,74% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,81.1,84,,,Percent of Total Billed Charges,84% of total billed charges,79.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.93,89,,,Percent of total Billed Charges,89% of total Billed charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.34,77,,,Percent of total Billed charges,77% of total billed charges,82.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.14,85.93,
Lacosamide 50mg Tablet,131247760,CDM,250,RC,,,Outpatient,,,96.55,48.28,,74.34,77,,,Percent of Total Billed Charges,77% of total billed charges,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.45,74,,,Percent of Total Billed Charges,74% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,81.1,84,,,Percent of Total Billed Charges,84% of total billed charges,79.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.93,89,,,Percent of total Billed Charges,89% of total Billed charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.34,77,,,Percent of total Billed charges,77% of total billed charges,82.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.14,85.93,
Lacosamide 50mg Tablet,131247760,CDM,250,RC,,,Outpatient,,,96.55,48.28,,74.34,77,,,Percent of Total Billed Charges,77% of total billed charges,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.45,74,,,Percent of Total Billed Charges,74% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,66.62,69,,,Percent of Total Billed Charges,69% of total billed charges,81.1,84,,,Percent of Total Billed Charges,84% of total billed charges,79.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,85.93,89,,,Percent of total Billed Charges,89% of total Billed charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.34,77,,,Percent of total Billed charges,77% of total billed charges,82.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.14,85.93,
Lactulose 20gm/30ml Oral Soln UDC,121115440,CDM,250,RC,,,Outpatient,,,23.49,11.75,,18.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.73,84,,,Percent of Total Billed Charges,84% of total billed charges,19.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.91,89,,,Percent of total Billed Charges,89% of total Billed charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.09,77,,,Percent of total Billed charges,77% of total billed charges,19.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,20.91,
Lactulose 20gm/30ml Oral Soln UDC,121115440,CDM,250,RC,,,Outpatient,,,23.49,11.75,,18.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.73,84,,,Percent of Total Billed Charges,84% of total billed charges,19.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.91,89,,,Percent of total Billed Charges,89% of total Billed charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.09,77,,,Percent of total Billed charges,77% of total billed charges,19.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,20.91,
Lactulose 20gm/30ml Oral Soln UDC,121115440,CDM,250,RC,,,Outpatient,,,23.49,11.75,,18.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.73,84,,,Percent of Total Billed Charges,84% of total billed charges,19.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.91,89,,,Percent of total Billed Charges,89% of total Billed charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.09,77,,,Percent of total Billed charges,77% of total billed charges,19.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,20.91,
Lactulose 20gm/30ml Oral Soln UDC,121115440,CDM,250,RC,,,Outpatient,,,23.49,11.75,,18.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.73,84,,,Percent of Total Billed Charges,84% of total billed charges,19.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.91,89,,,Percent of total Billed Charges,89% of total Billed charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.09,77,,,Percent of total Billed charges,77% of total billed charges,19.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,20.91,
Lactulose 20gm/30ml Oral Soln UDC,121115440,CDM,250,RC,,,Outpatient,,,23.49,11.75,,18.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.73,84,,,Percent of Total Billed Charges,84% of total billed charges,19.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.91,89,,,Percent of total Billed Charges,89% of total Billed charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.09,77,,,Percent of total Billed charges,77% of total billed charges,19.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,20.91,
Lactulose 20gm/30ml Oral Soln UDC,121115440,CDM,250,RC,,,Outpatient,,,23.49,11.75,,18.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.38,74,,,Percent of Total Billed Charges,74% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,16.21,69,,,Percent of Total Billed Charges,69% of total billed charges,19.73,84,,,Percent of Total Billed Charges,84% of total billed charges,19.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.91,89,,,Percent of total Billed Charges,89% of total Billed charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.09,77,,,Percent of total Billed charges,77% of total billed charges,19.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,20.91,
lamoTRIgine 100mg Tablet,173064255,CDM,250,RC,,,Outpatient,,,83.34,41.67,,64.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.67,74,,,Percent of Total Billed Charges,74% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,70.01,84,,,Percent of Total Billed Charges,84% of total billed charges,68.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.17,89,,,Percent of total Billed Charges,89% of total Billed charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,77,,,Percent of total Billed charges,77% of total billed charges,70.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.84,74.17,
lamoTRIgine 100mg Tablet,173064255,CDM,250,RC,,,Outpatient,,,83.34,41.67,,64.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.67,74,,,Percent of Total Billed Charges,74% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,70.01,84,,,Percent of Total Billed Charges,84% of total billed charges,68.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.17,89,,,Percent of total Billed Charges,89% of total Billed charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,77,,,Percent of total Billed charges,77% of total billed charges,70.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.84,74.17,
lamoTRIgine 100mg Tablet,173064255,CDM,250,RC,,,Outpatient,,,83.34,41.67,,64.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.67,74,,,Percent of Total Billed Charges,74% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,70.01,84,,,Percent of Total Billed Charges,84% of total billed charges,68.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.17,89,,,Percent of total Billed Charges,89% of total Billed charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,77,,,Percent of total Billed charges,77% of total billed charges,70.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.84,74.17,
lamoTRIgine 100mg Tablet,173064255,CDM,250,RC,,,Outpatient,,,83.34,41.67,,64.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.67,74,,,Percent of Total Billed Charges,74% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,70.01,84,,,Percent of Total Billed Charges,84% of total billed charges,68.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.17,89,,,Percent of total Billed Charges,89% of total Billed charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,77,,,Percent of total Billed charges,77% of total billed charges,70.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.84,74.17,
lamoTRIgine 100mg Tablet,173064255,CDM,250,RC,,,Outpatient,,,83.34,41.67,,64.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.67,74,,,Percent of Total Billed Charges,74% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,70.01,84,,,Percent of Total Billed Charges,84% of total billed charges,68.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.17,89,,,Percent of total Billed Charges,89% of total Billed charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,77,,,Percent of total Billed charges,77% of total billed charges,70.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.84,74.17,
lamoTRIgine 100mg Tablet,173064255,CDM,250,RC,,,Outpatient,,,83.34,41.67,,64.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61.67,74,,,Percent of Total Billed Charges,74% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,57.5,69,,,Percent of Total Billed Charges,69% of total billed charges,70.01,84,,,Percent of Total Billed Charges,84% of total billed charges,68.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.17,89,,,Percent of total Billed Charges,89% of total Billed charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.17,77,,,Percent of total Billed charges,77% of total billed charges,70.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.84,74.17,
lamoTRIgine 25mg Tablet,904700761,CDM,250,RC,,,Outpatient,,,6.6,3.3,,5.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5.54,84,,,Percent of Total Billed Charges,84% of total billed charges,5.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.87,89,,,Percent of total Billed Charges,89% of total Billed charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.08,77,,,Percent of total Billed charges,77% of total billed charges,5.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.65,5.87,
lamoTRIgine 25mg Tablet,904700761,CDM,250,RC,,,Outpatient,,,6.6,3.3,,5.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5.54,84,,,Percent of Total Billed Charges,84% of total billed charges,5.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.87,89,,,Percent of total Billed Charges,89% of total Billed charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.08,77,,,Percent of total Billed charges,77% of total billed charges,5.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.65,5.87,
lamoTRIgine 25mg Tablet,904700761,CDM,250,RC,,,Outpatient,,,6.6,3.3,,5.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5.54,84,,,Percent of Total Billed Charges,84% of total billed charges,5.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.87,89,,,Percent of total Billed Charges,89% of total Billed charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.08,77,,,Percent of total Billed charges,77% of total billed charges,5.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.65,5.87,
lamoTRIgine 25mg Tablet,904700761,CDM,250,RC,,,Outpatient,,,6.6,3.3,,5.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5.54,84,,,Percent of Total Billed Charges,84% of total billed charges,5.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.87,89,,,Percent of total Billed Charges,89% of total Billed charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.08,77,,,Percent of total Billed charges,77% of total billed charges,5.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.65,5.87,
lamoTRIgine 25mg Tablet,904700761,CDM,250,RC,,,Outpatient,,,6.6,3.3,,5.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5.54,84,,,Percent of Total Billed Charges,84% of total billed charges,5.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.87,89,,,Percent of total Billed Charges,89% of total Billed charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.08,77,,,Percent of total Billed charges,77% of total billed charges,5.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.65,5.87,
lamoTRIgine 25mg Tablet,904700761,CDM,250,RC,,,Outpatient,,,6.6,3.3,,5.08,77,,,Percent of Total Billed Charges,77% of total billed charges,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.88,74,,,Percent of Total Billed Charges,74% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.55,69,,,Percent of Total Billed Charges,69% of total billed charges,5.54,84,,,Percent of Total Billed Charges,84% of total billed charges,5.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.87,89,,,Percent of total Billed Charges,89% of total Billed charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.08,77,,,Percent of total Billed charges,77% of total billed charges,5.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.65,5.87,
Hydrocerin (Eucerin) Cream 4oz,72140000022,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Hydrocerin (Eucerin) Cream 4oz,72140000022,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Hydrocerin (Eucerin) Cream 4oz,72140000022,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Hydrocerin (Eucerin) Cream 4oz,72140000022,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Hydrocerin (Eucerin) Cream 4oz,72140000022,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Hydrocerin (Eucerin) Cream 4oz,72140000022,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Latanoprost 0.005% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,332.29,166.15,,255.86,77,,,Percent of Total Billed Charges,77% of total billed charges,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.89,74,,,Percent of Total Billed Charges,74% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,279.12,84,,,Percent of Total Billed Charges,84% of total billed charges,272.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.74,89,,,Percent of total Billed Charges,89% of total Billed charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.86,77,,,Percent of total Billed charges,77% of total billed charges,282.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,295.74,
Latanoprost 0.005% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,332.29,166.15,,255.86,77,,,Percent of Total Billed Charges,77% of total billed charges,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.89,74,,,Percent of Total Billed Charges,74% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,279.12,84,,,Percent of Total Billed Charges,84% of total billed charges,272.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.74,89,,,Percent of total Billed Charges,89% of total Billed charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.86,77,,,Percent of total Billed charges,77% of total billed charges,282.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,295.74,
Latanoprost 0.005% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,332.29,166.15,,255.86,77,,,Percent of Total Billed Charges,77% of total billed charges,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.89,74,,,Percent of Total Billed Charges,74% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,279.12,84,,,Percent of Total Billed Charges,84% of total billed charges,272.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.74,89,,,Percent of total Billed Charges,89% of total Billed charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.86,77,,,Percent of total Billed charges,77% of total billed charges,282.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,295.74,
Latanoprost 0.005% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,332.29,166.15,,255.86,77,,,Percent of Total Billed Charges,77% of total billed charges,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.89,74,,,Percent of Total Billed Charges,74% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,279.12,84,,,Percent of Total Billed Charges,84% of total billed charges,272.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.74,89,,,Percent of total Billed Charges,89% of total Billed charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.86,77,,,Percent of total Billed charges,77% of total billed charges,282.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,295.74,
Latanoprost 0.005% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,332.29,166.15,,255.86,77,,,Percent of Total Billed Charges,77% of total billed charges,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.89,74,,,Percent of Total Billed Charges,74% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,279.12,84,,,Percent of Total Billed Charges,84% of total billed charges,272.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.74,89,,,Percent of total Billed Charges,89% of total Billed charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.86,77,,,Percent of total Billed charges,77% of total billed charges,282.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,295.74,
Latanoprost 0.005% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,332.29,166.15,,255.86,77,,,Percent of Total Billed Charges,77% of total billed charges,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,103.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,245.89,74,,,Percent of Total Billed Charges,74% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,229.28,69,,,Percent of Total Billed Charges,69% of total billed charges,279.12,84,,,Percent of Total Billed Charges,84% of total billed charges,272.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,295.74,89,,,Percent of total Billed Charges,89% of total Billed charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,255.86,77,,,Percent of total Billed charges,77% of total billed charges,282.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,95.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,166.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,135.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,295.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.07,295.74,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1601.35,800.68,,1233.04,77,,,Percent of Total Billed Charges,77% of total billed charges,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1185,74,,,Percent of Total Billed Charges,74% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1345.13,84,,,Percent of Total Billed Charges,84% of total billed charges,1313.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1425.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.04,77,,,Percent of total Billed charges,77% of total billed charges,1361.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,800.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.34,1425.2,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1564.56,782.28,,1204.71,77,,,Percent of Total Billed Charges,77% of total billed charges,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1392.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.71,77,,,Percent of total Billed charges,77% of total billed charges,1329.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.14,1392.46,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1601.35,800.68,,1233.04,77,,,Percent of Total Billed Charges,77% of total billed charges,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1185,74,,,Percent of Total Billed Charges,74% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1345.13,84,,,Percent of Total Billed Charges,84% of total billed charges,1313.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1425.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.04,77,,,Percent of total Billed charges,77% of total billed charges,1361.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,800.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.34,1425.2,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1564.56,782.28,,1204.71,77,,,Percent of Total Billed Charges,77% of total billed charges,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1392.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.71,77,,,Percent of total Billed charges,77% of total billed charges,1329.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.14,1392.46,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1601.35,800.68,,1233.04,77,,,Percent of Total Billed Charges,77% of total billed charges,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1185,74,,,Percent of Total Billed Charges,74% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1345.13,84,,,Percent of Total Billed Charges,84% of total billed charges,1313.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1425.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.04,77,,,Percent of total Billed charges,77% of total billed charges,1361.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,800.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.34,1425.2,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1564.56,782.28,,1204.71,77,,,Percent of Total Billed Charges,77% of total billed charges,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1392.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.71,77,,,Percent of total Billed charges,77% of total billed charges,1329.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.14,1392.46,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1601.35,800.68,,1233.04,77,,,Percent of Total Billed Charges,77% of total billed charges,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1185,74,,,Percent of Total Billed Charges,74% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1345.13,84,,,Percent of Total Billed Charges,84% of total billed charges,1313.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1425.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.04,77,,,Percent of total Billed charges,77% of total billed charges,1361.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,800.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.34,1425.2,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1564.56,782.28,,1204.71,77,,,Percent of Total Billed Charges,77% of total billed charges,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1392.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.71,77,,,Percent of total Billed charges,77% of total billed charges,1329.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.14,1392.46,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1601.35,800.68,,1233.04,77,,,Percent of Total Billed Charges,77% of total billed charges,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1185,74,,,Percent of Total Billed Charges,74% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1345.13,84,,,Percent of Total Billed Charges,84% of total billed charges,1313.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1425.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.04,77,,,Percent of total Billed charges,77% of total billed charges,1361.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,800.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.34,1425.2,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1564.56,782.28,,1204.71,77,,,Percent of Total Billed Charges,77% of total billed charges,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1392.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.71,77,,,Percent of total Billed charges,77% of total billed charges,1329.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.14,1392.46,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1601.35,800.68,,1233.04,77,,,Percent of Total Billed Charges,77% of total billed charges,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,408.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,500.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1185,74,,,Percent of Total Billed Charges,74% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1104.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1345.13,84,,,Percent of Total Billed Charges,84% of total billed charges,1313.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,1425.2,89,,,Percent of total Billed Charges,89% of total Billed charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1233.04,77,,,Percent of total Billed charges,77% of total billed charges,1361.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,460.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,800.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,653.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1425.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.34,1425.2,
Leucovorin 100mg/10ml Powder SDV,67457052810,CDM,250,RC,,,Outpatient,,,1564.56,782.28,,1204.71,77,,,Percent of Total Billed Charges,77% of total billed charges,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,398.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,488.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1157.77,74,,,Percent of Total Billed Charges,74% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1079.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1314.23,84,,,Percent of Total Billed Charges,84% of total billed charges,1282.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,1392.46,89,,,Percent of total Billed Charges,89% of total Billed charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1204.71,77,,,Percent of total Billed charges,77% of total billed charges,1329.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,449.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,782.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,638.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1392.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,391.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,391.14,1392.46,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 200mg/20ml Powder SDV,143936801,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,2028.05,1014.03,,1561.6,77,,,Percent of Total Billed Charges,77% of total billed charges,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1500.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1703.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1663,82,,,Percent of Total Billed Charges,82% of total billed charges ,1804.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1561.6,77,,,Percent of total Billed charges,77% of total billed charges,1723.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,583.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1014.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.01,1804.96,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,1980.23,990.12,,1524.78,77,,,Percent of Total Billed Charges,77% of total billed charges,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.39,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.78,77,,,Percent of total Billed charges,77% of total billed charges,1683.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.06,1762.4,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,2028.05,1014.03,,1561.6,77,,,Percent of Total Billed Charges,77% of total billed charges,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1500.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1703.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1663,82,,,Percent of Total Billed Charges,82% of total billed charges ,1804.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1561.6,77,,,Percent of total Billed charges,77% of total billed charges,1723.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,583.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1014.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.01,1804.96,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,1980.23,990.12,,1524.78,77,,,Percent of Total Billed Charges,77% of total billed charges,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.39,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.78,77,,,Percent of total Billed charges,77% of total billed charges,1683.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.06,1762.4,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,2028.05,1014.03,,1561.6,77,,,Percent of Total Billed Charges,77% of total billed charges,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1500.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1703.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1663,82,,,Percent of Total Billed Charges,82% of total billed charges ,1804.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1561.6,77,,,Percent of total Billed charges,77% of total billed charges,1723.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,583.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1014.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.01,1804.96,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,1980.23,990.12,,1524.78,77,,,Percent of Total Billed Charges,77% of total billed charges,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.39,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.78,77,,,Percent of total Billed charges,77% of total billed charges,1683.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.06,1762.4,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,2028.05,1014.03,,1561.6,77,,,Percent of Total Billed Charges,77% of total billed charges,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1500.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1703.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1663,82,,,Percent of Total Billed Charges,82% of total billed charges ,1804.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1561.6,77,,,Percent of total Billed charges,77% of total billed charges,1723.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,583.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1014.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.01,1804.96,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,1980.23,990.12,,1524.78,77,,,Percent of Total Billed Charges,77% of total billed charges,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.39,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.78,77,,,Percent of total Billed charges,77% of total billed charges,1683.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.06,1762.4,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,2028.05,1014.03,,1561.6,77,,,Percent of Total Billed Charges,77% of total billed charges,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1500.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1703.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1663,82,,,Percent of Total Billed Charges,82% of total billed charges ,1804.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1561.6,77,,,Percent of total Billed charges,77% of total billed charges,1723.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,583.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1014.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.01,1804.96,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,1980.23,990.12,,1524.78,77,,,Percent of Total Billed Charges,77% of total billed charges,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.39,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.78,77,,,Percent of total Billed charges,77% of total billed charges,1683.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.06,1762.4,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,2028.05,1014.03,,1561.6,77,,,Percent of Total Billed Charges,77% of total billed charges,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,517.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,633.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1500.76,74,,,Percent of Total Billed Charges,74% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1399.35,69,,,Percent of Total Billed Charges,69% of total billed charges,1703.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1663,82,,,Percent of Total Billed Charges,82% of total billed charges ,1804.96,89,,,Percent of total Billed Charges,89% of total Billed charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1561.6,77,,,Percent of total Billed charges,77% of total billed charges,1723.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,583.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1014.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,827.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,507.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.01,1804.96,
Leucovorin 350mg/17.5ml Powder SDV,67457053035,CDM,250,RC,,,Outpatient,,,1980.23,990.12,,1524.78,77,,,Percent of Total Billed Charges,77% of total billed charges,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,504.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,618.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1465.37,74,,,Percent of Total Billed Charges,74% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1366.36,69,,,Percent of Total Billed Charges,69% of total billed charges,1663.39,84,,,Percent of Total Billed Charges,84% of total billed charges,1623.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1762.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1524.78,77,,,Percent of total Billed charges,77% of total billed charges,1683.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,569.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,990.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,807.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1762.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.06,1762.4,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5287,2643.5,,4070.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1652.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3912.38,74,,,Percent of Total Billed Charges,74% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4441.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4335.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4705.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4070.99,77,,,Percent of total Billed charges,77% of total billed charges,4493.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1520.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2643.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.75,4705.43,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5154.9,2577.45,,3969.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3814.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4330.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4227.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4587.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3969.27,77,,,Percent of total Billed charges,77% of total billed charges,4381.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2577.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288.73,4587.86,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5287,2643.5,,4070.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1652.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3912.38,74,,,Percent of Total Billed Charges,74% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4441.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4335.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4705.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4070.99,77,,,Percent of total Billed charges,77% of total billed charges,4493.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1520.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2643.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.75,4705.43,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5154.9,2577.45,,3969.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3814.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4330.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4227.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4587.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3969.27,77,,,Percent of total Billed charges,77% of total billed charges,4381.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2577.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288.73,4587.86,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5287,2643.5,,4070.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1652.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3912.38,74,,,Percent of Total Billed Charges,74% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4441.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4335.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4705.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4070.99,77,,,Percent of total Billed charges,77% of total billed charges,4493.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1520.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2643.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.75,4705.43,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5154.9,2577.45,,3969.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3814.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4330.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4227.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4587.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3969.27,77,,,Percent of total Billed charges,77% of total billed charges,4381.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2577.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288.73,4587.86,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5287,2643.5,,4070.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1652.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3912.38,74,,,Percent of Total Billed Charges,74% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4441.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4335.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4705.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4070.99,77,,,Percent of total Billed charges,77% of total billed charges,4493.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1520.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2643.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.75,4705.43,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5154.9,2577.45,,3969.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3814.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4330.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4227.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4587.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3969.27,77,,,Percent of total Billed charges,77% of total billed charges,4381.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2577.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288.73,4587.86,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5287,2643.5,,4070.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1652.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3912.38,74,,,Percent of Total Billed Charges,74% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4441.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4335.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4705.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4070.99,77,,,Percent of total Billed charges,77% of total billed charges,4493.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1520.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2643.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.75,4705.43,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5154.9,2577.45,,3969.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3814.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4330.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4227.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4587.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3969.27,77,,,Percent of total Billed charges,77% of total billed charges,4381.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2577.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288.73,4587.86,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5287,2643.5,,4070.99,77,,,Percent of Total Billed Charges,77% of total billed charges,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1348.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1652.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3912.38,74,,,Percent of Total Billed Charges,74% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,3648.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4441.08,84,,,Percent of Total Billed Charges,84% of total billed charges,4335.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,4705.43,89,,,Percent of total Billed Charges,89% of total Billed charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4070.99,77,,,Percent of total Billed charges,77% of total billed charges,4493.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1520.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2643.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2157.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4705.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1321.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1321.75,4705.43,
Leucovorin 500mg/50ml Powder SDV,63323071100,CDM,250,RC,,,Outpatient,,,5154.9,2577.45,,3969.27,77,,,Percent of Total Billed Charges,77% of total billed charges,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1314.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1610.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3814.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,3556.88,69,,,Percent of Total Billed Charges,69% of total billed charges,4330.12,84,,,Percent of Total Billed Charges,84% of total billed charges,4227.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,4587.86,89,,,Percent of total Billed Charges,89% of total Billed charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3969.27,77,,,Percent of total Billed charges,77% of total billed charges,4381.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1482.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2577.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2103.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4587.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1288.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1288.73,4587.86,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,771.64,385.82,,594.16,77,,,Percent of Total Billed Charges,77% of total billed charges,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,196.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,241.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,571.01,74,,,Percent of Total Billed Charges,74% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,532.43,69,,,Percent of Total Billed Charges,69% of total billed charges,648.18,84,,,Percent of Total Billed Charges,84% of total billed charges,632.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,686.76,89,,,Percent of total Billed Charges,89% of total Billed charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,594.16,77,,,Percent of total Billed charges,77% of total billed charges,655.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,221.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,385.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,314.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,686.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,192.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.91,686.76,
Leucovorin 50mg/5ml Powder SDV,25021081310,CDM,250,RC,,,Outpatient,,,756.32,378.16,,582.37,77,,,Percent of Total Billed Charges,77% of total billed charges,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,236.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,559.68,74,,,Percent of Total Billed Charges,74% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,521.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.31,84,,,Percent of Total Billed Charges,84% of total billed charges,620.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,673.12,89,,,Percent of total Billed Charges,89% of total Billed charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,582.37,77,,,Percent of total Billed charges,77% of total billed charges,642.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,217.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,378.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,308.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,673.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,189.08,673.12,
Leuprolide (Lupron) 11.25mg (3month) Syringe,74366303,CDM,250,RC,,,Outpatient,,,24465.01,12232.51,,18838.06,77,,,Percent of Total Billed Charges,77% of total billed charges,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7645.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18104.11,74,,,Percent of Total Billed Charges,74% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20550.61,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21773.86,89,,,Percent of total Billed Charges,89% of total Billed charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18838.06,77,,,Percent of total Billed charges,77% of total billed charges,20795.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7033.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12232.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6116.25,21773.86,
Leuprolide (Lupron) 11.25mg (3month) Syringe,74366303,CDM,250,RC,,,Outpatient,,,24465.01,12232.51,,18838.06,77,,,Percent of Total Billed Charges,77% of total billed charges,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7645.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18104.11,74,,,Percent of Total Billed Charges,74% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20550.61,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21773.86,89,,,Percent of total Billed Charges,89% of total Billed charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18838.06,77,,,Percent of total Billed charges,77% of total billed charges,20795.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7033.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12232.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6116.25,21773.86,
Leuprolide (Lupron) 11.25mg (3month) Syringe,74366303,CDM,250,RC,,,Outpatient,,,24465.01,12232.51,,18838.06,77,,,Percent of Total Billed Charges,77% of total billed charges,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7645.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18104.11,74,,,Percent of Total Billed Charges,74% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20550.61,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21773.86,89,,,Percent of total Billed Charges,89% of total Billed charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18838.06,77,,,Percent of total Billed charges,77% of total billed charges,20795.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7033.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12232.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6116.25,21773.86,
Leuprolide (Lupron) 11.25mg (3month) Syringe,74366303,CDM,250,RC,,,Outpatient,,,24465.01,12232.51,,18838.06,77,,,Percent of Total Billed Charges,77% of total billed charges,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7645.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18104.11,74,,,Percent of Total Billed Charges,74% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20550.61,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21773.86,89,,,Percent of total Billed Charges,89% of total Billed charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18838.06,77,,,Percent of total Billed charges,77% of total billed charges,20795.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7033.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12232.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6116.25,21773.86,
Leuprolide (Lupron) 11.25mg (3month) Syringe,74366303,CDM,250,RC,,,Outpatient,,,24465.01,12232.51,,18838.06,77,,,Percent of Total Billed Charges,77% of total billed charges,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7645.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18104.11,74,,,Percent of Total Billed Charges,74% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20550.61,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21773.86,89,,,Percent of total Billed Charges,89% of total Billed charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18838.06,77,,,Percent of total Billed charges,77% of total billed charges,20795.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7033.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12232.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6116.25,21773.86,
Leuprolide (Lupron) 11.25mg (3month) Syringe,74366303,CDM,250,RC,,,Outpatient,,,24465.01,12232.51,,18838.06,77,,,Percent of Total Billed Charges,77% of total billed charges,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6238.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7645.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18104.11,74,,,Percent of Total Billed Charges,74% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16880.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20550.61,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21773.86,89,,,Percent of total Billed Charges,89% of total Billed charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18838.06,77,,,Percent of total Billed charges,77% of total billed charges,20795.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7033.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12232.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9981.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21773.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6116.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6116.25,21773.86,
Leuprolide (Lupron) 22.5mg (3month) Syringe,74334603,CDM,250,RC,,,Outpatient,,,29143.94,14571.97,,22440.83,77,,,Percent of Total Billed Charges,77% of total billed charges,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9107.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21566.52,74,,,Percent of Total Billed Charges,74% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,24480.91,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25938.11,89,,,Percent of total Billed Charges,89% of total Billed charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22440.83,77,,,Percent of total Billed charges,77% of total billed charges,24772.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8378.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14571.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7285.99,25938.11,
Leuprolide (Lupron) 22.5mg (3month) Syringe,74334603,CDM,250,RC,,,Outpatient,,,29143.94,14571.97,,22440.83,77,,,Percent of Total Billed Charges,77% of total billed charges,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9107.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21566.52,74,,,Percent of Total Billed Charges,74% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,24480.91,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25938.11,89,,,Percent of total Billed Charges,89% of total Billed charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22440.83,77,,,Percent of total Billed charges,77% of total billed charges,24772.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8378.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14571.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7285.99,25938.11,
Leuprolide (Lupron) 22.5mg (3month) Syringe,74334603,CDM,250,RC,,,Outpatient,,,29143.94,14571.97,,22440.83,77,,,Percent of Total Billed Charges,77% of total billed charges,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9107.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21566.52,74,,,Percent of Total Billed Charges,74% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,24480.91,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25938.11,89,,,Percent of total Billed Charges,89% of total Billed charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22440.83,77,,,Percent of total Billed charges,77% of total billed charges,24772.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8378.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14571.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7285.99,25938.11,
Leuprolide (Lupron) 22.5mg (3month) Syringe,74334603,CDM,250,RC,,,Outpatient,,,29143.94,14571.97,,22440.83,77,,,Percent of Total Billed Charges,77% of total billed charges,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9107.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21566.52,74,,,Percent of Total Billed Charges,74% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,24480.91,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25938.11,89,,,Percent of total Billed Charges,89% of total Billed charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22440.83,77,,,Percent of total Billed charges,77% of total billed charges,24772.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8378.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14571.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7285.99,25938.11,
Leuprolide (Lupron) 22.5mg (3month) Syringe,74334603,CDM,250,RC,,,Outpatient,,,29143.94,14571.97,,22440.83,77,,,Percent of Total Billed Charges,77% of total billed charges,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9107.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21566.52,74,,,Percent of Total Billed Charges,74% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,24480.91,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25938.11,89,,,Percent of total Billed Charges,89% of total Billed charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22440.83,77,,,Percent of total Billed charges,77% of total billed charges,24772.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8378.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14571.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7285.99,25938.11,
Leuprolide (Lupron) 22.5mg (3month) Syringe,74334603,CDM,250,RC,,,Outpatient,,,29143.94,14571.97,,22440.83,77,,,Percent of Total Billed Charges,77% of total billed charges,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7431.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9107.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21566.52,74,,,Percent of Total Billed Charges,74% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,20109.32,69,,,Percent of Total Billed Charges,69% of total billed charges,24480.91,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25938.11,89,,,Percent of total Billed Charges,89% of total Billed charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22440.83,77,,,Percent of total Billed charges,77% of total billed charges,24772.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8378.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14571.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11890.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25938.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7285.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7285.99,25938.11,
Leuprolide (Eligard) 22.5mg (3month) Injection,62935022305,CDM,250,RC,,,Outpatient,,,5853.25,2926.63,,4507,77,,,Percent of Total Billed Charges,77% of total billed charges,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1829.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4331.41,74,,,Percent of Total Billed Charges,74% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4916.73,84,,,Percent of Total Billed Charges,84% of total billed charges,4799.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,5209.39,89,,,Percent of total Billed Charges,89% of total Billed charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4507,77,,,Percent of total Billed charges,77% of total billed charges,4975.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1682.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2926.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.31,5209.39,
Leuprolide (Eligard) 22.5mg (3month) Injection,62935022305,CDM,250,RC,,,Outpatient,,,5853.25,2926.63,,4507,77,,,Percent of Total Billed Charges,77% of total billed charges,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1829.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4331.41,74,,,Percent of Total Billed Charges,74% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4916.73,84,,,Percent of Total Billed Charges,84% of total billed charges,4799.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,5209.39,89,,,Percent of total Billed Charges,89% of total Billed charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4507,77,,,Percent of total Billed charges,77% of total billed charges,4975.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1682.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2926.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.31,5209.39,
Leuprolide (Eligard) 22.5mg (3month) Injection,62935022305,CDM,250,RC,,,Outpatient,,,5853.25,2926.63,,4507,77,,,Percent of Total Billed Charges,77% of total billed charges,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1829.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4331.41,74,,,Percent of Total Billed Charges,74% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4916.73,84,,,Percent of Total Billed Charges,84% of total billed charges,4799.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,5209.39,89,,,Percent of total Billed Charges,89% of total Billed charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4507,77,,,Percent of total Billed charges,77% of total billed charges,4975.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1682.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2926.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.31,5209.39,
Leuprolide (Eligard) 22.5mg (3month) Injection,62935022305,CDM,250,RC,,,Outpatient,,,5853.25,2926.63,,4507,77,,,Percent of Total Billed Charges,77% of total billed charges,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1829.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4331.41,74,,,Percent of Total Billed Charges,74% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4916.73,84,,,Percent of Total Billed Charges,84% of total billed charges,4799.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,5209.39,89,,,Percent of total Billed Charges,89% of total Billed charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4507,77,,,Percent of total Billed charges,77% of total billed charges,4975.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1682.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2926.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.31,5209.39,
Leuprolide (Eligard) 22.5mg (3month) Injection,62935022305,CDM,250,RC,,,Outpatient,,,5853.25,2926.63,,4507,77,,,Percent of Total Billed Charges,77% of total billed charges,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1829.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4331.41,74,,,Percent of Total Billed Charges,74% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4916.73,84,,,Percent of Total Billed Charges,84% of total billed charges,4799.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,5209.39,89,,,Percent of total Billed Charges,89% of total Billed charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4507,77,,,Percent of total Billed charges,77% of total billed charges,4975.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1682.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2926.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.31,5209.39,
Leuprolide (Eligard) 22.5mg (3month) Injection,62935022305,CDM,250,RC,,,Outpatient,,,5853.25,2926.63,,4507,77,,,Percent of Total Billed Charges,77% of total billed charges,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1492.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1829.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4331.41,74,,,Percent of Total Billed Charges,74% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4038.74,69,,,Percent of Total Billed Charges,69% of total billed charges,4916.73,84,,,Percent of Total Billed Charges,84% of total billed charges,4799.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,5209.39,89,,,Percent of total Billed Charges,89% of total Billed charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4507,77,,,Percent of total Billed charges,77% of total billed charges,4975.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1682.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2926.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2388.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5209.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1463.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1463.31,5209.39,
Leuprolide (Lupron) 3.75mg (1month) Syringe,74364171,CDM,250,RC,,,Outpatient,,,9538.8,4769.4,,7344.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.71,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.53,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.88,77,,,Percent of total Billed charges,77% of total billed charges,8107.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.7,8489.53,
Leuprolide (Lupron) 3.75mg (1month) Syringe,74364171,CDM,250,RC,,,Outpatient,,,9538.8,4769.4,,7344.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.71,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.53,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.88,77,,,Percent of total Billed charges,77% of total billed charges,8107.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.7,8489.53,
Leuprolide (Lupron) 3.75mg (1month) Syringe,74364171,CDM,250,RC,,,Outpatient,,,9538.8,4769.4,,7344.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.71,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.53,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.88,77,,,Percent of total Billed charges,77% of total billed charges,8107.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.7,8489.53,
Leuprolide (Lupron) 3.75mg (1month) Syringe,74364171,CDM,250,RC,,,Outpatient,,,9538.8,4769.4,,7344.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.71,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.53,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.88,77,,,Percent of total Billed charges,77% of total billed charges,8107.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.7,8489.53,
Leuprolide (Lupron) 3.75mg (1month) Syringe,74364171,CDM,250,RC,,,Outpatient,,,9538.8,4769.4,,7344.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.71,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.53,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.88,77,,,Percent of total Billed charges,77% of total billed charges,8107.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.7,8489.53,
Leuprolide (Lupron) 3.75mg (1month) Syringe,74364171,CDM,250,RC,,,Outpatient,,,9538.8,4769.4,,7344.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.71,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.77,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.53,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.88,77,,,Percent of total Billed charges,77% of total billed charges,8107.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.7,8489.53,
Leuprolide (Lupron) 30mg (4month) Syringe,74368303,CDM,250,RC,,,Outpatient,,,38842.02,19421.01,,29908.36,77,,,Percent of Total Billed Charges,77% of total billed charges,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28743.09,74,,,Percent of Total Billed Charges,74% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,32627.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34569.4,89,,,Percent of total Billed Charges,89% of total Billed charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29908.36,77,,,Percent of total Billed charges,77% of total billed charges,33015.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11167.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19421.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9710.51,34569.4,
Leuprolide (Lupron) 30mg (4month) Syringe,74368303,CDM,250,RC,,,Outpatient,,,38842.02,19421.01,,29908.36,77,,,Percent of Total Billed Charges,77% of total billed charges,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28743.09,74,,,Percent of Total Billed Charges,74% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,32627.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34569.4,89,,,Percent of total Billed Charges,89% of total Billed charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29908.36,77,,,Percent of total Billed charges,77% of total billed charges,33015.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11167.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19421.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9710.51,34569.4,
Leuprolide (Lupron) 30mg (4month) Syringe,74368303,CDM,250,RC,,,Outpatient,,,38842.02,19421.01,,29908.36,77,,,Percent of Total Billed Charges,77% of total billed charges,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28743.09,74,,,Percent of Total Billed Charges,74% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,32627.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34569.4,89,,,Percent of total Billed Charges,89% of total Billed charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29908.36,77,,,Percent of total Billed charges,77% of total billed charges,33015.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11167.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19421.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9710.51,34569.4,
Leuprolide (Lupron) 30mg (4month) Syringe,74368303,CDM,250,RC,,,Outpatient,,,38842.02,19421.01,,29908.36,77,,,Percent of Total Billed Charges,77% of total billed charges,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28743.09,74,,,Percent of Total Billed Charges,74% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,32627.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34569.4,89,,,Percent of total Billed Charges,89% of total Billed charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29908.36,77,,,Percent of total Billed charges,77% of total billed charges,33015.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11167.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19421.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9710.51,34569.4,
Leuprolide (Lupron) 30mg (4month) Syringe,74368303,CDM,250,RC,,,Outpatient,,,38842.02,19421.01,,29908.36,77,,,Percent of Total Billed Charges,77% of total billed charges,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28743.09,74,,,Percent of Total Billed Charges,74% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,32627.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34569.4,89,,,Percent of total Billed Charges,89% of total Billed charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29908.36,77,,,Percent of total Billed charges,77% of total billed charges,33015.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11167.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19421.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9710.51,34569.4,
Leuprolide (Lupron) 30mg (4month) Syringe,74368303,CDM,250,RC,,,Outpatient,,,38842.02,19421.01,,29908.36,77,,,Percent of Total Billed Charges,77% of total billed charges,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9904.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12138.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28743.09,74,,,Percent of Total Billed Charges,74% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,26800.99,69,,,Percent of Total Billed Charges,69% of total billed charges,32627.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,34569.4,89,,,Percent of total Billed Charges,89% of total Billed charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29908.36,77,,,Percent of total Billed charges,77% of total billed charges,33015.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11167.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19421.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15847.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34569.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9710.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9710.51,34569.4,
Leuprolide (Eligard) 30mg (4month) Injection,62935030330,CDM,250,RC,,,Outpatient,,,7799.58,3899.79,,6005.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2437.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5771.69,74,,,Percent of Total Billed Charges,74% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6551.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6395.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6941.63,89,,,Percent of total Billed Charges,89% of total Billed charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6005.68,77,,,Percent of total Billed charges,77% of total billed charges,6629.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2242.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3899.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1949.9,6941.63,
Leuprolide (Eligard) 30mg (4month) Injection,62935030330,CDM,250,RC,,,Outpatient,,,7799.58,3899.79,,6005.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2437.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5771.69,74,,,Percent of Total Billed Charges,74% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6551.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6395.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6941.63,89,,,Percent of total Billed Charges,89% of total Billed charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6005.68,77,,,Percent of total Billed charges,77% of total billed charges,6629.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2242.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3899.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1949.9,6941.63,
Leuprolide (Eligard) 30mg (4month) Injection,62935030330,CDM,250,RC,,,Outpatient,,,7799.58,3899.79,,6005.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2437.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5771.69,74,,,Percent of Total Billed Charges,74% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6551.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6395.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6941.63,89,,,Percent of total Billed Charges,89% of total Billed charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6005.68,77,,,Percent of total Billed charges,77% of total billed charges,6629.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2242.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3899.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1949.9,6941.63,
Leuprolide (Eligard) 30mg (4month) Injection,62935030330,CDM,250,RC,,,Outpatient,,,7799.58,3899.79,,6005.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2437.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5771.69,74,,,Percent of Total Billed Charges,74% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6551.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6395.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6941.63,89,,,Percent of total Billed Charges,89% of total Billed charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6005.68,77,,,Percent of total Billed charges,77% of total billed charges,6629.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2242.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3899.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1949.9,6941.63,
Leuprolide (Eligard) 30mg (4month) Injection,62935030330,CDM,250,RC,,,Outpatient,,,7799.58,3899.79,,6005.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2437.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5771.69,74,,,Percent of Total Billed Charges,74% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6551.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6395.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6941.63,89,,,Percent of total Billed Charges,89% of total Billed charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6005.68,77,,,Percent of total Billed charges,77% of total billed charges,6629.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2242.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3899.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1949.9,6941.63,
Leuprolide (Eligard) 30mg (4month) Injection,62935030330,CDM,250,RC,,,Outpatient,,,7799.58,3899.79,,6005.68,77,,,Percent of Total Billed Charges,77% of total billed charges,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1988.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2437.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5771.69,74,,,Percent of Total Billed Charges,74% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,5381.71,69,,,Percent of Total Billed Charges,69% of total billed charges,6551.65,84,,,Percent of Total Billed Charges,84% of total billed charges,6395.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,6941.63,89,,,Percent of total Billed Charges,89% of total Billed charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6005.68,77,,,Percent of total Billed charges,77% of total billed charges,6629.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2242.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3899.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3182.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6941.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1949.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1949.9,6941.63,
Leuprolide (Lupron) 45mg (6month) Syringe,74347303,CDM,250,RC,,,Outpatient,,,58238.88,29119.44,,44843.94,77,,,Percent of Total Billed Charges,77% of total billed charges,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18199.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43096.77,74,,,Percent of Total Billed Charges,74% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,48920.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,51832.6,89,,,Percent of total Billed Charges,89% of total Billed charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44843.94,77,,,Percent of total Billed charges,77% of total billed charges,49503.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16743.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29119.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14559.72,51832.6,
Leuprolide (Lupron) 45mg (6month) Syringe,74347303,CDM,250,RC,,,Outpatient,,,58238.88,29119.44,,44843.94,77,,,Percent of Total Billed Charges,77% of total billed charges,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18199.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43096.77,74,,,Percent of Total Billed Charges,74% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,48920.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,51832.6,89,,,Percent of total Billed Charges,89% of total Billed charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44843.94,77,,,Percent of total Billed charges,77% of total billed charges,49503.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16743.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29119.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14559.72,51832.6,
Leuprolide (Lupron) 45mg (6month) Syringe,74347303,CDM,250,RC,,,Outpatient,,,58238.88,29119.44,,44843.94,77,,,Percent of Total Billed Charges,77% of total billed charges,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18199.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43096.77,74,,,Percent of Total Billed Charges,74% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,48920.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,51832.6,89,,,Percent of total Billed Charges,89% of total Billed charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44843.94,77,,,Percent of total Billed charges,77% of total billed charges,49503.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16743.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29119.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14559.72,51832.6,
Leuprolide (Lupron) 45mg (6month) Syringe,74347303,CDM,250,RC,,,Outpatient,,,58238.88,29119.44,,44843.94,77,,,Percent of Total Billed Charges,77% of total billed charges,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18199.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43096.77,74,,,Percent of Total Billed Charges,74% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,48920.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,51832.6,89,,,Percent of total Billed Charges,89% of total Billed charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44843.94,77,,,Percent of total Billed charges,77% of total billed charges,49503.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16743.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29119.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14559.72,51832.6,
Leuprolide (Lupron) 45mg (6month) Syringe,74347303,CDM,250,RC,,,Outpatient,,,58238.88,29119.44,,44843.94,77,,,Percent of Total Billed Charges,77% of total billed charges,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18199.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43096.77,74,,,Percent of Total Billed Charges,74% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,48920.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,51832.6,89,,,Percent of total Billed Charges,89% of total Billed charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44843.94,77,,,Percent of total Billed charges,77% of total billed charges,49503.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16743.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29119.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14559.72,51832.6,
Leuprolide (Lupron) 45mg (6month) Syringe,74347303,CDM,250,RC,,,Outpatient,,,58238.88,29119.44,,44843.94,77,,,Percent of Total Billed Charges,77% of total billed charges,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14850.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18199.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43096.77,74,,,Percent of Total Billed Charges,74% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40184.83,69,,,Percent of Total Billed Charges,69% of total billed charges,48920.66,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,51832.6,89,,,Percent of total Billed Charges,89% of total Billed charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44843.94,77,,,Percent of total Billed charges,77% of total billed charges,49503.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16743.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29119.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23761.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51832.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14559.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14559.72,51832.6,
Leuprolide (Eligard) 45mg (6month) Injection,62935045345,CDM,250,RC,,,Outpatient,,,11666.46,5833.23,,8983.17,77,,,Percent of Total Billed Charges,77% of total billed charges,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3645.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8633.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9799.83,84,,,Percent of Total Billed Charges,84% of total billed charges,9566.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,10383.15,89,,,Percent of total Billed Charges,89% of total Billed charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8983.17,77,,,Percent of total Billed charges,77% of total billed charges,9916.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3354.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5833.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2916.62,10383.15,
Leuprolide (Eligard) 45mg (6month) Injection,62935045345,CDM,250,RC,,,Outpatient,,,11666.46,5833.23,,8983.17,77,,,Percent of Total Billed Charges,77% of total billed charges,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3645.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8633.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9799.83,84,,,Percent of Total Billed Charges,84% of total billed charges,9566.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,10383.15,89,,,Percent of total Billed Charges,89% of total Billed charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8983.17,77,,,Percent of total Billed charges,77% of total billed charges,9916.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3354.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5833.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2916.62,10383.15,
Leuprolide (Eligard) 45mg (6month) Injection,62935045345,CDM,250,RC,,,Outpatient,,,11666.46,5833.23,,8983.17,77,,,Percent of Total Billed Charges,77% of total billed charges,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3645.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8633.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9799.83,84,,,Percent of Total Billed Charges,84% of total billed charges,9566.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,10383.15,89,,,Percent of total Billed Charges,89% of total Billed charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8983.17,77,,,Percent of total Billed charges,77% of total billed charges,9916.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3354.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5833.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2916.62,10383.15,
Leuprolide (Eligard) 45mg (6month) Injection,62935045345,CDM,250,RC,,,Outpatient,,,11666.46,5833.23,,8983.17,77,,,Percent of Total Billed Charges,77% of total billed charges,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3645.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8633.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9799.83,84,,,Percent of Total Billed Charges,84% of total billed charges,9566.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,10383.15,89,,,Percent of total Billed Charges,89% of total Billed charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8983.17,77,,,Percent of total Billed charges,77% of total billed charges,9916.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3354.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5833.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2916.62,10383.15,
Leuprolide (Eligard) 45mg (6month) Injection,62935045345,CDM,250,RC,,,Outpatient,,,11666.46,5833.23,,8983.17,77,,,Percent of Total Billed Charges,77% of total billed charges,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3645.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8633.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9799.83,84,,,Percent of Total Billed Charges,84% of total billed charges,9566.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,10383.15,89,,,Percent of total Billed Charges,89% of total Billed charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8983.17,77,,,Percent of total Billed charges,77% of total billed charges,9916.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3354.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5833.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2916.62,10383.15,
Leuprolide (Eligard) 45mg (6month) Injection,62935045345,CDM,250,RC,,,Outpatient,,,11666.46,5833.23,,8983.17,77,,,Percent of Total Billed Charges,77% of total billed charges,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2974.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3645.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8633.18,74,,,Percent of Total Billed Charges,74% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,8049.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9799.83,84,,,Percent of Total Billed Charges,84% of total billed charges,9566.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,10383.15,89,,,Percent of total Billed Charges,89% of total Billed charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8983.17,77,,,Percent of total Billed charges,77% of total billed charges,9916.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3354.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5833.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4759.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10383.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2916.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2916.62,10383.15,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 1000mg/100ml IV Bag,44567050210,CDM,250,RC,,,Outpatient,,,203.73,101.87,,156.87,77,,,Percent of Total Billed Charges,77% of total billed charges,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.76,74,,,Percent of Total Billed Charges,74% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,140.57,69,,,Percent of Total Billed Charges,69% of total billed charges,171.13,84,,,Percent of Total Billed Charges,84% of total billed charges,167.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.32,89,,,Percent of total Billed Charges,89% of total Billed charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.87,77,,,Percent of total Billed charges,77% of total billed charges,173.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.93,181.32,
levETIRAcetam 250mg Tablet,50474059440,CDM,250,RC,,,Outpatient,,,62.08,31.04,,47.8,77,,,Percent of Total Billed Charges,77% of total billed charges,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.94,74,,,Percent of Total Billed Charges,74% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,52.15,84,,,Percent of Total Billed Charges,84% of total billed charges,50.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.25,89,,,Percent of total Billed Charges,89% of total Billed charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.8,77,,,Percent of total Billed charges,77% of total billed charges,52.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.52,55.25,
levETIRAcetam 250mg Tablet,50474059440,CDM,250,RC,,,Outpatient,,,62.08,31.04,,47.8,77,,,Percent of Total Billed Charges,77% of total billed charges,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.94,74,,,Percent of Total Billed Charges,74% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,52.15,84,,,Percent of Total Billed Charges,84% of total billed charges,50.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.25,89,,,Percent of total Billed Charges,89% of total Billed charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.8,77,,,Percent of total Billed charges,77% of total billed charges,52.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.52,55.25,
levETIRAcetam 250mg Tablet,50474059440,CDM,250,RC,,,Outpatient,,,62.08,31.04,,47.8,77,,,Percent of Total Billed Charges,77% of total billed charges,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.94,74,,,Percent of Total Billed Charges,74% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,52.15,84,,,Percent of Total Billed Charges,84% of total billed charges,50.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.25,89,,,Percent of total Billed Charges,89% of total Billed charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.8,77,,,Percent of total Billed charges,77% of total billed charges,52.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.52,55.25,
levETIRAcetam 250mg Tablet,50474059440,CDM,250,RC,,,Outpatient,,,62.08,31.04,,47.8,77,,,Percent of Total Billed Charges,77% of total billed charges,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.94,74,,,Percent of Total Billed Charges,74% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,52.15,84,,,Percent of Total Billed Charges,84% of total billed charges,50.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.25,89,,,Percent of total Billed Charges,89% of total Billed charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.8,77,,,Percent of total Billed charges,77% of total billed charges,52.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.52,55.25,
levETIRAcetam 250mg Tablet,50474059440,CDM,250,RC,,,Outpatient,,,62.08,31.04,,47.8,77,,,Percent of Total Billed Charges,77% of total billed charges,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.94,74,,,Percent of Total Billed Charges,74% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,52.15,84,,,Percent of Total Billed Charges,84% of total billed charges,50.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.25,89,,,Percent of total Billed Charges,89% of total Billed charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.8,77,,,Percent of total Billed charges,77% of total billed charges,52.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.52,55.25,
levETIRAcetam 250mg Tablet,50474059440,CDM,250,RC,,,Outpatient,,,62.08,31.04,,47.8,77,,,Percent of Total Billed Charges,77% of total billed charges,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.94,74,,,Percent of Total Billed Charges,74% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,42.84,69,,,Percent of Total Billed Charges,69% of total billed charges,52.15,84,,,Percent of Total Billed Charges,84% of total billed charges,50.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.25,89,,,Percent of total Billed Charges,89% of total Billed charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.8,77,,,Percent of total Billed charges,77% of total billed charges,52.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.52,55.25,
levETIRAcetam 500mg Tablet,50474059540,CDM,250,RC,,,Outpatient,,,74.73,37.37,,57.54,77,,,Percent of Total Billed Charges,77% of total billed charges,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.3,74,,,Percent of Total Billed Charges,74% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,62.77,84,,,Percent of Total Billed Charges,84% of total billed charges,61.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.51,89,,,Percent of total Billed Charges,89% of total Billed charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.54,77,,,Percent of total Billed charges,77% of total billed charges,63.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.68,66.51,
levETIRAcetam 500mg Tablet,50474059540,CDM,250,RC,,,Outpatient,,,74.73,37.37,,57.54,77,,,Percent of Total Billed Charges,77% of total billed charges,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.3,74,,,Percent of Total Billed Charges,74% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,62.77,84,,,Percent of Total Billed Charges,84% of total billed charges,61.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.51,89,,,Percent of total Billed Charges,89% of total Billed charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.54,77,,,Percent of total Billed charges,77% of total billed charges,63.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.68,66.51,
levETIRAcetam 500mg Tablet,50474059540,CDM,250,RC,,,Outpatient,,,74.73,37.37,,57.54,77,,,Percent of Total Billed Charges,77% of total billed charges,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.3,74,,,Percent of Total Billed Charges,74% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,62.77,84,,,Percent of Total Billed Charges,84% of total billed charges,61.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.51,89,,,Percent of total Billed Charges,89% of total Billed charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.54,77,,,Percent of total Billed charges,77% of total billed charges,63.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.68,66.51,
levETIRAcetam 500mg Tablet,50474059540,CDM,250,RC,,,Outpatient,,,74.73,37.37,,57.54,77,,,Percent of Total Billed Charges,77% of total billed charges,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.3,74,,,Percent of Total Billed Charges,74% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,62.77,84,,,Percent of Total Billed Charges,84% of total billed charges,61.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.51,89,,,Percent of total Billed Charges,89% of total Billed charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.54,77,,,Percent of total Billed charges,77% of total billed charges,63.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.68,66.51,
levETIRAcetam 500mg Tablet,50474059540,CDM,250,RC,,,Outpatient,,,74.73,37.37,,57.54,77,,,Percent of Total Billed Charges,77% of total billed charges,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.3,74,,,Percent of Total Billed Charges,74% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,62.77,84,,,Percent of Total Billed Charges,84% of total billed charges,61.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.51,89,,,Percent of total Billed Charges,89% of total Billed charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.54,77,,,Percent of total Billed charges,77% of total billed charges,63.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.68,66.51,
levETIRAcetam 500mg Tablet,50474059540,CDM,250,RC,,,Outpatient,,,74.73,37.37,,57.54,77,,,Percent of Total Billed Charges,77% of total billed charges,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.3,74,,,Percent of Total Billed Charges,74% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,51.56,69,,,Percent of Total Billed Charges,69% of total billed charges,62.77,84,,,Percent of Total Billed Charges,84% of total billed charges,61.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,66.51,89,,,Percent of total Billed Charges,89% of total Billed charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.54,77,,,Percent of total Billed charges,77% of total billed charges,63.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.68,66.51,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
levETIRAcetam 500mg/5ml SDV,50474000263,CDM,250,RC,,,Outpatient,,,433,216.5,,333.41,77,,,Percent of Total Billed Charges,77% of total billed charges,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,135.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,320.42,74,,,Percent of Total Billed Charges,74% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,298.77,69,,,Percent of Total Billed Charges,69% of total billed charges,363.72,84,,,Percent of Total Billed Charges,84% of total billed charges,355.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,385.37,89,,,Percent of total Billed Charges,89% of total Billed charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.41,77,,,Percent of total Billed charges,77% of total billed charges,368.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,216.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,176.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,385.37,
Levothyroxine 100mcg Tablet,74662411,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 100mcg Tablet,74662411,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 100mcg Tablet,74662411,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 100mcg Tablet,74662411,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 100mcg Tablet,74662411,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 100mcg Tablet,74662411,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 100mcg SDV,63323064907,CDM,250,RC,,,Outpatient,,,510.3,255.15,,392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.62,74,,,Percent of Total Billed Charges,74% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,428.65,84,,,Percent of Total Billed Charges,84% of total billed charges,418.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.17,89,,,Percent of total Billed Charges,89% of total Billed charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.93,77,,,Percent of total Billed charges,77% of total billed charges,433.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.58,454.17,
Levothyroxine 100mcg SDV,63323064907,CDM,250,RC,,,Outpatient,,,510.3,255.15,,392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.62,74,,,Percent of Total Billed Charges,74% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,428.65,84,,,Percent of Total Billed Charges,84% of total billed charges,418.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.17,89,,,Percent of total Billed Charges,89% of total Billed charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.93,77,,,Percent of total Billed charges,77% of total billed charges,433.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.58,454.17,
Levothyroxine 100mcg SDV,63323064907,CDM,250,RC,,,Outpatient,,,510.3,255.15,,392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.62,74,,,Percent of Total Billed Charges,74% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,428.65,84,,,Percent of Total Billed Charges,84% of total billed charges,418.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.17,89,,,Percent of total Billed Charges,89% of total Billed charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.93,77,,,Percent of total Billed charges,77% of total billed charges,433.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.58,454.17,
Levothyroxine 100mcg SDV,63323064907,CDM,250,RC,,,Outpatient,,,510.3,255.15,,392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.62,74,,,Percent of Total Billed Charges,74% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,428.65,84,,,Percent of Total Billed Charges,84% of total billed charges,418.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.17,89,,,Percent of total Billed Charges,89% of total Billed charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.93,77,,,Percent of total Billed charges,77% of total billed charges,433.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.58,454.17,
Levothyroxine 100mcg SDV,63323064907,CDM,250,RC,,,Outpatient,,,510.3,255.15,,392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.62,74,,,Percent of Total Billed Charges,74% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,428.65,84,,,Percent of Total Billed Charges,84% of total billed charges,418.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.17,89,,,Percent of total Billed Charges,89% of total Billed charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.93,77,,,Percent of total Billed charges,77% of total billed charges,433.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.58,454.17,
Levothyroxine 100mcg SDV,63323064907,CDM,250,RC,,,Outpatient,,,510.3,255.15,,392.93,77,,,Percent of Total Billed Charges,77% of total billed charges,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,130.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,159.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,377.62,74,,,Percent of Total Billed Charges,74% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,352.11,69,,,Percent of Total Billed Charges,69% of total billed charges,428.65,84,,,Percent of Total Billed Charges,84% of total billed charges,418.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,454.17,89,,,Percent of total Billed Charges,89% of total Billed charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,392.93,77,,,Percent of total Billed charges,77% of total billed charges,433.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,146.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,255.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,208.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,454.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.58,454.17,
levonorgestreL 1 EACH IUD,50419042301,CDM,250,RC,,,Outpatient,,,4628.34,2314.17,,3563.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1446.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3424.97,74,,,Percent of Total Billed Charges,74% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.81,84,,,Percent of Total Billed Charges,84% of total billed charges,3795.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,4119.22,89,,,Percent of total Billed Charges,89% of total Billed charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3563.82,77,,,Percent of total Billed charges,77% of total billed charges,3934.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1330.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2314.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1157.09,4119.22,
levonorgestreL 1 EACH IUD,50419042301,CDM,250,RC,,,Outpatient,,,4628.34,2314.17,,3563.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1446.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3424.97,74,,,Percent of Total Billed Charges,74% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.81,84,,,Percent of Total Billed Charges,84% of total billed charges,3795.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,4119.22,89,,,Percent of total Billed Charges,89% of total Billed charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3563.82,77,,,Percent of total Billed charges,77% of total billed charges,3934.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1330.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2314.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1157.09,4119.22,
levonorgestreL 1 EACH IUD,50419042301,CDM,250,RC,,,Outpatient,,,4628.34,2314.17,,3563.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1446.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3424.97,74,,,Percent of Total Billed Charges,74% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.81,84,,,Percent of Total Billed Charges,84% of total billed charges,3795.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,4119.22,89,,,Percent of total Billed Charges,89% of total Billed charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3563.82,77,,,Percent of total Billed charges,77% of total billed charges,3934.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1330.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2314.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1157.09,4119.22,
levonorgestreL 1 EACH IUD,50419042301,CDM,250,RC,,,Outpatient,,,4628.34,2314.17,,3563.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1446.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3424.97,74,,,Percent of Total Billed Charges,74% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.81,84,,,Percent of Total Billed Charges,84% of total billed charges,3795.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,4119.22,89,,,Percent of total Billed Charges,89% of total Billed charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3563.82,77,,,Percent of total Billed charges,77% of total billed charges,3934.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1330.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2314.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1157.09,4119.22,
levonorgestreL 1 EACH IUD,50419042301,CDM,250,RC,,,Outpatient,,,4628.34,2314.17,,3563.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1446.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3424.97,74,,,Percent of Total Billed Charges,74% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.81,84,,,Percent of Total Billed Charges,84% of total billed charges,3795.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,4119.22,89,,,Percent of total Billed Charges,89% of total Billed charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3563.82,77,,,Percent of total Billed charges,77% of total billed charges,3934.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1330.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2314.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1157.09,4119.22,
levonorgestreL 1 EACH IUD,50419042301,CDM,250,RC,,,Outpatient,,,4628.34,2314.17,,3563.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1180.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1446.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3424.97,74,,,Percent of Total Billed Charges,74% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3193.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3887.81,84,,,Percent of Total Billed Charges,84% of total billed charges,3795.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,4119.22,89,,,Percent of total Billed Charges,89% of total Billed charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3563.82,77,,,Percent of total Billed charges,77% of total billed charges,3934.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1330.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2314.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1888.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4119.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1157.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1157.09,4119.22,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levOCARNitine 1 gm/5ml SDV,54482014701,CDM,250,RC,,,Outpatient,,,286.08,143.04,,220.28,77,,,Percent of Total Billed Charges,77% of total billed charges,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,211.7,74,,,Percent of Total Billed Charges,74% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,197.4,69,,,Percent of Total Billed Charges,69% of total billed charges,240.31,84,,,Percent of Total Billed Charges,84% of total billed charges,234.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,254.61,89,,,Percent of total Billed Charges,89% of total Billed charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,77,,,Percent of total Billed charges,77% of total billed charges,243.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,82.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,143.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,116.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,254.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.52,254.61,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg/50ml IV Bag,36000004624,CDM,250,RC,,,Outpatient,,,142.15,71.08,,109.46,77,,,Percent of Total Billed Charges,77% of total billed charges,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.19,74,,,Percent of Total Billed Charges,74% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,98.08,69,,,Percent of Total Billed Charges,69% of total billed charges,119.41,84,,,Percent of Total Billed Charges,84% of total billed charges,116.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.51,89,,,Percent of total Billed Charges,89% of total Billed charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.46,77,,,Percent of total Billed charges,77% of total billed charges,120.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,71.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.54,126.51,
levoFLOXacin 250mg Tablet,904635161,CDM,250,RC,,,Outpatient,,,7.06,3.53,,5.44,77,,,Percent of Total Billed Charges,77% of total billed charges,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.22,74,,,Percent of Total Billed Charges,74% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.93,84,,,Percent of Total Billed Charges,84% of total billed charges,5.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.28,89,,,Percent of total Billed Charges,89% of total Billed charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,77,,,Percent of total Billed charges,77% of total billed charges,6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.77,6.28,
levoFLOXacin 250mg Tablet,904635161,CDM,250,RC,,,Outpatient,,,7.06,3.53,,5.44,77,,,Percent of Total Billed Charges,77% of total billed charges,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.22,74,,,Percent of Total Billed Charges,74% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.93,84,,,Percent of Total Billed Charges,84% of total billed charges,5.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.28,89,,,Percent of total Billed Charges,89% of total Billed charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,77,,,Percent of total Billed charges,77% of total billed charges,6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.77,6.28,
levoFLOXacin 250mg Tablet,904635161,CDM,250,RC,,,Outpatient,,,7.06,3.53,,5.44,77,,,Percent of Total Billed Charges,77% of total billed charges,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.22,74,,,Percent of Total Billed Charges,74% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.93,84,,,Percent of Total Billed Charges,84% of total billed charges,5.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.28,89,,,Percent of total Billed Charges,89% of total Billed charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,77,,,Percent of total Billed charges,77% of total billed charges,6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.77,6.28,
levoFLOXacin 250mg Tablet,904635161,CDM,250,RC,,,Outpatient,,,7.06,3.53,,5.44,77,,,Percent of Total Billed Charges,77% of total billed charges,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.22,74,,,Percent of Total Billed Charges,74% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.93,84,,,Percent of Total Billed Charges,84% of total billed charges,5.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.28,89,,,Percent of total Billed Charges,89% of total Billed charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,77,,,Percent of total Billed charges,77% of total billed charges,6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.77,6.28,
levoFLOXacin 250mg Tablet,904635161,CDM,250,RC,,,Outpatient,,,7.06,3.53,,5.44,77,,,Percent of Total Billed Charges,77% of total billed charges,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.22,74,,,Percent of Total Billed Charges,74% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.93,84,,,Percent of Total Billed Charges,84% of total billed charges,5.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.28,89,,,Percent of total Billed Charges,89% of total Billed charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,77,,,Percent of total Billed charges,77% of total billed charges,6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.77,6.28,
levoFLOXacin 250mg Tablet,904635161,CDM,250,RC,,,Outpatient,,,7.06,3.53,,5.44,77,,,Percent of Total Billed Charges,77% of total billed charges,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.22,74,,,Percent of Total Billed Charges,74% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,4.87,69,,,Percent of Total Billed Charges,69% of total billed charges,5.93,84,,,Percent of Total Billed Charges,84% of total billed charges,5.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.28,89,,,Percent of total Billed Charges,89% of total Billed charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.44,77,,,Percent of total Billed charges,77% of total billed charges,6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.77,6.28,
Levothyroxine 25mcg Tablet,74434190,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 25mcg Tablet,74434190,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 25mcg Tablet,74434190,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 25mcg Tablet,74434190,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 25mcg Tablet,74434190,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 25mcg Tablet,74434190,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
levOCARNitine 330mg Tablet,54482014407,CDM,250,RC,,,Outpatient,,,16.45,8.23,,12.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.17,74,,,Percent of Total Billed Charges,74% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.82,84,,,Percent of Total Billed Charges,84% of total billed charges,13.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.64,89,,,Percent of total Billed Charges,89% of total Billed charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.67,77,,,Percent of total Billed charges,77% of total billed charges,13.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.11,14.64,
levOCARNitine 330mg Tablet,54482014407,CDM,250,RC,,,Outpatient,,,16.45,8.23,,12.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.17,74,,,Percent of Total Billed Charges,74% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.82,84,,,Percent of Total Billed Charges,84% of total billed charges,13.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.64,89,,,Percent of total Billed Charges,89% of total Billed charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.67,77,,,Percent of total Billed charges,77% of total billed charges,13.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.11,14.64,
levOCARNitine 330mg Tablet,54482014407,CDM,250,RC,,,Outpatient,,,16.45,8.23,,12.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.17,74,,,Percent of Total Billed Charges,74% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.82,84,,,Percent of Total Billed Charges,84% of total billed charges,13.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.64,89,,,Percent of total Billed Charges,89% of total Billed charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.67,77,,,Percent of total Billed charges,77% of total billed charges,13.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.11,14.64,
levOCARNitine 330mg Tablet,54482014407,CDM,250,RC,,,Outpatient,,,16.45,8.23,,12.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.17,74,,,Percent of Total Billed Charges,74% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.82,84,,,Percent of Total Billed Charges,84% of total billed charges,13.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.64,89,,,Percent of total Billed Charges,89% of total Billed charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.67,77,,,Percent of total Billed charges,77% of total billed charges,13.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.11,14.64,
levOCARNitine 330mg Tablet,54482014407,CDM,250,RC,,,Outpatient,,,16.45,8.23,,12.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.17,74,,,Percent of Total Billed Charges,74% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.82,84,,,Percent of Total Billed Charges,84% of total billed charges,13.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.64,89,,,Percent of total Billed Charges,89% of total Billed charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.67,77,,,Percent of total Billed charges,77% of total billed charges,13.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.11,14.64,
levOCARNitine 330mg Tablet,54482014407,CDM,250,RC,,,Outpatient,,,16.45,8.23,,12.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.17,74,,,Percent of Total Billed Charges,74% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.82,84,,,Percent of Total Billed Charges,84% of total billed charges,13.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,14.64,89,,,Percent of total Billed Charges,89% of total Billed charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.67,77,,,Percent of total Billed charges,77% of total billed charges,13.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.11,14.64,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
levoFLOXacin 500mg/100ml IV Bag,25021013282,CDM,250,RC,,,Outpatient,,,188.35,94.18,,145.03,77,,,Percent of Total Billed Charges,77% of total billed charges,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,139.38,74,,,Percent of Total Billed Charges,74% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,129.96,69,,,Percent of Total Billed Charges,69% of total billed charges,158.21,84,,,Percent of Total Billed Charges,84% of total billed charges,154.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,167.63,89,,,Percent of total Billed Charges,89% of total Billed charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,145.03,77,,,Percent of total Billed charges,77% of total billed charges,160.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,94.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,76.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.09,167.63,
Levothyroxine 50mcg Tablet,74455211,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 50mcg Tablet,74455211,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 50mcg Tablet,74455211,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 50mcg Tablet,74455211,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 50mcg Tablet,74455211,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levothyroxine 50mcg Tablet,74455211,CDM,250,RC,,,Outpatient,,,19.83,9.92,,15.27,77,,,Percent of Total Billed Charges,77% of total billed charges,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.67,74,,,Percent of Total Billed Charges,74% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.68,69,,,Percent of Total Billed Charges,69% of total billed charges,16.66,84,,,Percent of Total Billed Charges,84% of total billed charges,16.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.65,89,,,Percent of total Billed Charges,89% of total Billed charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.27,77,,,Percent of total Billed charges,77% of total billed charges,16.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.96,17.65,
Levobunolol 0.5% OPHTH Soln 5ml,24208050505,CDM,250,RC,,,Outpatient,,,203.87,101.94,,156.98,77,,,Percent of Total Billed Charges,77% of total billed charges,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.86,74,,,Percent of Total Billed Charges,74% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,171.25,84,,,Percent of Total Billed Charges,84% of total billed charges,167.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.44,89,,,Percent of total Billed Charges,89% of total Billed charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.98,77,,,Percent of total Billed charges,77% of total billed charges,173.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.97,181.44,
Levobunolol 0.5% OPHTH Soln 5ml,24208050505,CDM,250,RC,,,Outpatient,,,203.87,101.94,,156.98,77,,,Percent of Total Billed Charges,77% of total billed charges,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.86,74,,,Percent of Total Billed Charges,74% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,171.25,84,,,Percent of Total Billed Charges,84% of total billed charges,167.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.44,89,,,Percent of total Billed Charges,89% of total Billed charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.98,77,,,Percent of total Billed charges,77% of total billed charges,173.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.97,181.44,
Levobunolol 0.5% OPHTH Soln 5ml,24208050505,CDM,250,RC,,,Outpatient,,,203.87,101.94,,156.98,77,,,Percent of Total Billed Charges,77% of total billed charges,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.86,74,,,Percent of Total Billed Charges,74% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,171.25,84,,,Percent of Total Billed Charges,84% of total billed charges,167.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.44,89,,,Percent of total Billed Charges,89% of total Billed charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.98,77,,,Percent of total Billed charges,77% of total billed charges,173.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.97,181.44,
Levobunolol 0.5% OPHTH Soln 5ml,24208050505,CDM,250,RC,,,Outpatient,,,203.87,101.94,,156.98,77,,,Percent of Total Billed Charges,77% of total billed charges,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.86,74,,,Percent of Total Billed Charges,74% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,171.25,84,,,Percent of Total Billed Charges,84% of total billed charges,167.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.44,89,,,Percent of total Billed Charges,89% of total Billed charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.98,77,,,Percent of total Billed charges,77% of total billed charges,173.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.97,181.44,
Levobunolol 0.5% OPHTH Soln 5ml,24208050505,CDM,250,RC,,,Outpatient,,,203.87,101.94,,156.98,77,,,Percent of Total Billed Charges,77% of total billed charges,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.86,74,,,Percent of Total Billed Charges,74% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,171.25,84,,,Percent of Total Billed Charges,84% of total billed charges,167.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.44,89,,,Percent of total Billed Charges,89% of total Billed charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.98,77,,,Percent of total Billed charges,77% of total billed charges,173.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.97,181.44,
Levobunolol 0.5% OPHTH Soln 5ml,24208050505,CDM,250,RC,,,Outpatient,,,203.87,101.94,,156.98,77,,,Percent of Total Billed Charges,77% of total billed charges,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,150.86,74,,,Percent of Total Billed Charges,74% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,140.67,69,,,Percent of Total Billed Charges,69% of total billed charges,171.25,84,,,Percent of Total Billed Charges,84% of total billed charges,167.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,181.44,89,,,Percent of total Billed Charges,89% of total Billed charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.98,77,,,Percent of total Billed charges,77% of total billed charges,173.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,83.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,181.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.97,181.44,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
levoFLOXacin 750mg/150ml IV Bag,63323035560,CDM,250,RC,,,Outpatient,,,201.56,100.78,,155.2,77,,,Percent of Total Billed Charges,77% of total billed charges,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.15,74,,,Percent of Total Billed Charges,74% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,139.08,69,,,Percent of Total Billed Charges,69% of total billed charges,169.31,84,,,Percent of Total Billed Charges,84% of total billed charges,165.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.39,89,,,Percent of total Billed Charges,89% of total Billed charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.2,77,,,Percent of total Billed charges,77% of total billed charges,171.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.39,179.39,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,23.58,11.79,,18.16,77,,,Percent of Total Billed Charges,77% of total billed charges,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.45,74,,,Percent of Total Billed Charges,74% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,19.81,84,,,Percent of Total Billed Charges,84% of total billed charges,19.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.99,89,,,Percent of total Billed Charges,89% of total Billed charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.16,77,,,Percent of total Billed charges,77% of total billed charges,20.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.9,20.99,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,41.58,20.79,,32.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.77,74,,,Percent of Total Billed Charges,74% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,34.93,84,,,Percent of Total Billed Charges,84% of total billed charges,34.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.01,89,,,Percent of total Billed Charges,89% of total Billed charges,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.02,77,,,Percent of total Billed charges,77% of total billed charges,35.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.01,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,23.58,11.79,,18.16,77,,,Percent of Total Billed Charges,77% of total billed charges,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.45,74,,,Percent of Total Billed Charges,74% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,19.81,84,,,Percent of Total Billed Charges,84% of total billed charges,19.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.99,89,,,Percent of total Billed Charges,89% of total Billed charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.16,77,,,Percent of total Billed charges,77% of total billed charges,20.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.9,20.99,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,23.58,11.79,,18.16,77,,,Percent of Total Billed Charges,77% of total billed charges,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.45,74,,,Percent of Total Billed Charges,74% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,19.81,84,,,Percent of Total Billed Charges,84% of total billed charges,19.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.99,89,,,Percent of total Billed Charges,89% of total Billed charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.16,77,,,Percent of total Billed charges,77% of total billed charges,20.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.9,20.99,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,41.58,20.79,,32.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.77,74,,,Percent of Total Billed Charges,74% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,34.93,84,,,Percent of Total Billed Charges,84% of total billed charges,34.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.01,89,,,Percent of total Billed Charges,89% of total Billed charges,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.02,77,,,Percent of total Billed charges,77% of total billed charges,35.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.01,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,23.58,11.79,,18.16,77,,,Percent of Total Billed Charges,77% of total billed charges,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.45,74,,,Percent of Total Billed Charges,74% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,19.81,84,,,Percent of Total Billed Charges,84% of total billed charges,19.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.99,89,,,Percent of total Billed Charges,89% of total Billed charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.16,77,,,Percent of total Billed charges,77% of total billed charges,20.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.9,20.99,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,23.58,11.79,,18.16,77,,,Percent of Total Billed Charges,77% of total billed charges,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.45,74,,,Percent of Total Billed Charges,74% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,19.81,84,,,Percent of Total Billed Charges,84% of total billed charges,19.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.99,89,,,Percent of total Billed Charges,89% of total Billed charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.16,77,,,Percent of total Billed charges,77% of total billed charges,20.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.9,20.99,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,41.58,20.79,,32.02,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.77,74,,,Percent of Total Billed Charges,74% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,28.69,69,,,Percent of Total Billed Charges,69% of total billed charges,34.93,84,,,Percent of Total Billed Charges,84% of total billed charges,34.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.01,89,,,Percent of total Billed Charges,89% of total Billed charges,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.02,77,,,Percent of total Billed charges,77% of total billed charges,35.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.01,
Lidocaine Viscous 2% 15ml Oral UDC BTL,54350049,CDM,250,RC,,,Outpatient,,,23.58,11.79,,18.16,77,,,Percent of Total Billed Charges,77% of total billed charges,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.45,74,,,Percent of Total Billed Charges,74% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,16.27,69,,,Percent of Total Billed Charges,69% of total billed charges,19.81,84,,,Percent of Total Billed Charges,84% of total billed charges,19.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.99,89,,,Percent of total Billed Charges,89% of total Billed charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.16,77,,,Percent of total Billed charges,77% of total billed charges,20.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.9,20.99,
Lidocaine PF 2% 100mg/5ml Syringe,409132305,CDM,250,RC,,,Outpatient,,,89.43,44.72,,68.86,77,,,Percent of Total Billed Charges,77% of total billed charges,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.18,74,,,Percent of Total Billed Charges,74% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,75.12,84,,,Percent of Total Billed Charges,84% of total billed charges,73.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.59,89,,,Percent of total Billed Charges,89% of total Billed charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,77,,,Percent of total Billed charges,77% of total billed charges,76.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.36,79.59,
Lidocaine PF 2% 100mg/5ml Syringe,409132305,CDM,250,RC,,,Outpatient,,,89.43,44.72,,68.86,77,,,Percent of Total Billed Charges,77% of total billed charges,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.18,74,,,Percent of Total Billed Charges,74% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,75.12,84,,,Percent of Total Billed Charges,84% of total billed charges,73.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.59,89,,,Percent of total Billed Charges,89% of total Billed charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,77,,,Percent of total Billed charges,77% of total billed charges,76.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.36,79.59,
Lidocaine PF 2% 100mg/5ml Syringe,409132305,CDM,250,RC,,,Outpatient,,,89.43,44.72,,68.86,77,,,Percent of Total Billed Charges,77% of total billed charges,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.18,74,,,Percent of Total Billed Charges,74% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,75.12,84,,,Percent of Total Billed Charges,84% of total billed charges,73.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.59,89,,,Percent of total Billed Charges,89% of total Billed charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,77,,,Percent of total Billed charges,77% of total billed charges,76.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.36,79.59,
Lidocaine PF 2% 100mg/5ml Syringe,409132305,CDM,250,RC,,,Outpatient,,,89.43,44.72,,68.86,77,,,Percent of Total Billed Charges,77% of total billed charges,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.18,74,,,Percent of Total Billed Charges,74% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,75.12,84,,,Percent of Total Billed Charges,84% of total billed charges,73.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.59,89,,,Percent of total Billed Charges,89% of total Billed charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,77,,,Percent of total Billed charges,77% of total billed charges,76.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.36,79.59,
Lidocaine PF 2% 100mg/5ml Syringe,409132305,CDM,250,RC,,,Outpatient,,,89.43,44.72,,68.86,77,,,Percent of Total Billed Charges,77% of total billed charges,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.18,74,,,Percent of Total Billed Charges,74% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,75.12,84,,,Percent of Total Billed Charges,84% of total billed charges,73.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.59,89,,,Percent of total Billed Charges,89% of total Billed charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,77,,,Percent of total Billed charges,77% of total billed charges,76.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.36,79.59,
Lidocaine PF 2% 100mg/5ml Syringe,409132305,CDM,250,RC,,,Outpatient,,,89.43,44.72,,68.86,77,,,Percent of Total Billed Charges,77% of total billed charges,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.18,74,,,Percent of Total Billed Charges,74% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,61.71,69,,,Percent of Total Billed Charges,69% of total billed charges,75.12,84,,,Percent of Total Billed Charges,84% of total billed charges,73.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.59,89,,,Percent of total Billed Charges,89% of total Billed charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,77,,,Percent of total Billed charges,77% of total billed charges,76.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.36,79.59,
Lidocaine 2% 20mg/ml Jelly Urojet,76329301305,CDM,250,RC,,,Outpatient,,,97.9,48.95,,75.38,77,,,Percent of Total Billed Charges,77% of total billed charges,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.45,74,,,Percent of Total Billed Charges,74% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,82.24,84,,,Percent of Total Billed Charges,84% of total billed charges,80.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.13,89,,,Percent of total Billed Charges,89% of total Billed charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,77,,,Percent of total Billed charges,77% of total billed charges,83.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.48,87.13,
Lidocaine 2% 20mg/ml Jelly Urojet,76329301305,CDM,250,RC,,,Outpatient,,,97.9,48.95,,75.38,77,,,Percent of Total Billed Charges,77% of total billed charges,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.45,74,,,Percent of Total Billed Charges,74% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,82.24,84,,,Percent of Total Billed Charges,84% of total billed charges,80.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.13,89,,,Percent of total Billed Charges,89% of total Billed charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,77,,,Percent of total Billed charges,77% of total billed charges,83.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.48,87.13,
Lidocaine 2% 20mg/ml Jelly Urojet,76329301305,CDM,250,RC,,,Outpatient,,,97.9,48.95,,75.38,77,,,Percent of Total Billed Charges,77% of total billed charges,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.45,74,,,Percent of Total Billed Charges,74% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,82.24,84,,,Percent of Total Billed Charges,84% of total billed charges,80.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.13,89,,,Percent of total Billed Charges,89% of total Billed charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,77,,,Percent of total Billed charges,77% of total billed charges,83.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.48,87.13,
Lidocaine 2% 20mg/ml Jelly Urojet,76329301305,CDM,250,RC,,,Outpatient,,,97.9,48.95,,75.38,77,,,Percent of Total Billed Charges,77% of total billed charges,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.45,74,,,Percent of Total Billed Charges,74% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,82.24,84,,,Percent of Total Billed Charges,84% of total billed charges,80.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.13,89,,,Percent of total Billed Charges,89% of total Billed charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,77,,,Percent of total Billed charges,77% of total billed charges,83.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.48,87.13,
Lidocaine 2% 20mg/ml Jelly Urojet,76329301305,CDM,250,RC,,,Outpatient,,,97.9,48.95,,75.38,77,,,Percent of Total Billed Charges,77% of total billed charges,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.45,74,,,Percent of Total Billed Charges,74% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,82.24,84,,,Percent of Total Billed Charges,84% of total billed charges,80.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.13,89,,,Percent of total Billed Charges,89% of total Billed charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,77,,,Percent of total Billed charges,77% of total billed charges,83.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.48,87.13,
Lidocaine 2% 20mg/ml Jelly Urojet,76329301305,CDM,250,RC,,,Outpatient,,,97.9,48.95,,75.38,77,,,Percent of Total Billed Charges,77% of total billed charges,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,72.45,74,,,Percent of Total Billed Charges,74% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,67.55,69,,,Percent of Total Billed Charges,69% of total billed charges,82.24,84,,,Percent of Total Billed Charges,84% of total billed charges,80.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,87.13,89,,,Percent of total Billed Charges,89% of total Billed charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.38,77,,,Percent of total Billed charges,77% of total billed charges,83.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.48,87.13,
Lidocaine 1%+EPI 1:100000 10ml MDV,63323048217,CDM,250,RC,,,Outpatient,,,68.54,34.27,,52.78,77,,,Percent of Total Billed Charges,77% of total billed charges,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.72,74,,,Percent of Total Billed Charges,74% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,57.57,84,,,Percent of Total Billed Charges,84% of total billed charges,56.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,61,89,,,Percent of total Billed Charges,89% of total Billed charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,77,,,Percent of total Billed charges,77% of total billed charges,58.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.14,61,
Lidocaine 1%+EPI 1:100000 10ml MDV,63323048217,CDM,250,RC,,,Outpatient,,,68.54,34.27,,52.78,77,,,Percent of Total Billed Charges,77% of total billed charges,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.72,74,,,Percent of Total Billed Charges,74% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,57.57,84,,,Percent of Total Billed Charges,84% of total billed charges,56.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,61,89,,,Percent of total Billed Charges,89% of total Billed charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,77,,,Percent of total Billed charges,77% of total billed charges,58.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.14,61,
Lidocaine 1%+EPI 1:100000 10ml MDV,63323048217,CDM,250,RC,,,Outpatient,,,68.54,34.27,,52.78,77,,,Percent of Total Billed Charges,77% of total billed charges,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.72,74,,,Percent of Total Billed Charges,74% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,57.57,84,,,Percent of Total Billed Charges,84% of total billed charges,56.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,61,89,,,Percent of total Billed Charges,89% of total Billed charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,77,,,Percent of total Billed charges,77% of total billed charges,58.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.14,61,
Lidocaine 1%+EPI 1:100000 10ml MDV,63323048217,CDM,250,RC,,,Outpatient,,,68.54,34.27,,52.78,77,,,Percent of Total Billed Charges,77% of total billed charges,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.72,74,,,Percent of Total Billed Charges,74% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,57.57,84,,,Percent of Total Billed Charges,84% of total billed charges,56.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,61,89,,,Percent of total Billed Charges,89% of total Billed charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,77,,,Percent of total Billed charges,77% of total billed charges,58.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.14,61,
Lidocaine 1%+EPI 1:100000 10ml MDV,63323048217,CDM,250,RC,,,Outpatient,,,68.54,34.27,,52.78,77,,,Percent of Total Billed Charges,77% of total billed charges,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.72,74,,,Percent of Total Billed Charges,74% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,57.57,84,,,Percent of Total Billed Charges,84% of total billed charges,56.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,61,89,,,Percent of total Billed Charges,89% of total Billed charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,77,,,Percent of total Billed charges,77% of total billed charges,58.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.14,61,
Lidocaine 1%+EPI 1:100000 10ml MDV,63323048217,CDM,250,RC,,,Outpatient,,,68.54,34.27,,52.78,77,,,Percent of Total Billed Charges,77% of total billed charges,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.72,74,,,Percent of Total Billed Charges,74% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,47.29,69,,,Percent of Total Billed Charges,69% of total billed charges,57.57,84,,,Percent of Total Billed Charges,84% of total billed charges,56.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,61,89,,,Percent of total Billed Charges,89% of total Billed charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,77,,,Percent of total Billed charges,77% of total billed charges,58.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.14,61,
Lidocaine MPF 1% 10mg/ml 5ml SDV,63323049257,CDM,250,RC,,,Outpatient,,,72.32,36.16,,55.69,77,,,Percent of Total Billed Charges,77% of total billed charges,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.52,74,,,Percent of Total Billed Charges,74% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,84,,,Percent of Total Billed Charges,84% of total billed charges,59.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.36,89,,,Percent of total Billed Charges,89% of total Billed charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.69,77,,,Percent of total Billed charges,77% of total billed charges,61.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.08,64.36,
Lidocaine MPF 1% 10mg/ml 5ml SDV,63323049257,CDM,250,RC,,,Outpatient,,,72.32,36.16,,55.69,77,,,Percent of Total Billed Charges,77% of total billed charges,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.52,74,,,Percent of Total Billed Charges,74% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,84,,,Percent of Total Billed Charges,84% of total billed charges,59.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.36,89,,,Percent of total Billed Charges,89% of total Billed charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.69,77,,,Percent of total Billed charges,77% of total billed charges,61.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.08,64.36,
Lidocaine MPF 1% 10mg/ml 5ml SDV,63323049257,CDM,250,RC,,,Outpatient,,,72.32,36.16,,55.69,77,,,Percent of Total Billed Charges,77% of total billed charges,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.52,74,,,Percent of Total Billed Charges,74% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,84,,,Percent of Total Billed Charges,84% of total billed charges,59.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.36,89,,,Percent of total Billed Charges,89% of total Billed charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.69,77,,,Percent of total Billed charges,77% of total billed charges,61.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.08,64.36,
Lidocaine MPF 1% 10mg/ml 5ml SDV,63323049257,CDM,250,RC,,,Outpatient,,,72.32,36.16,,55.69,77,,,Percent of Total Billed Charges,77% of total billed charges,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.52,74,,,Percent of Total Billed Charges,74% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,84,,,Percent of Total Billed Charges,84% of total billed charges,59.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.36,89,,,Percent of total Billed Charges,89% of total Billed charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.69,77,,,Percent of total Billed charges,77% of total billed charges,61.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.08,64.36,
Lidocaine MPF 1% 10mg/ml 5ml SDV,63323049257,CDM,250,RC,,,Outpatient,,,72.32,36.16,,55.69,77,,,Percent of Total Billed Charges,77% of total billed charges,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.52,74,,,Percent of Total Billed Charges,74% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,84,,,Percent of Total Billed Charges,84% of total billed charges,59.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.36,89,,,Percent of total Billed Charges,89% of total Billed charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.69,77,,,Percent of total Billed charges,77% of total billed charges,61.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.08,64.36,
Lidocaine MPF 1% 10mg/ml 5ml SDV,63323049257,CDM,250,RC,,,Outpatient,,,72.32,36.16,,55.69,77,,,Percent of Total Billed Charges,77% of total billed charges,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.52,74,,,Percent of Total Billed Charges,74% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,49.9,69,,,Percent of Total Billed Charges,69% of total billed charges,60.75,84,,,Percent of Total Billed Charges,84% of total billed charges,59.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.36,89,,,Percent of total Billed Charges,89% of total Billed charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.69,77,,,Percent of total Billed charges,77% of total billed charges,61.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.08,64.36,
Lidocaine 1% 10mg/ml 20ml MDV,409427601,CDM,250,RC,,,Outpatient,,,53.08,26.54,,40.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.28,74,,,Percent of Total Billed Charges,74% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,44.59,84,,,Percent of Total Billed Charges,84% of total billed charges,43.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.24,89,,,Percent of total Billed Charges,89% of total Billed charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.87,77,,,Percent of total Billed charges,77% of total billed charges,45.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.27,47.24,
Lidocaine 1% 10mg/ml 20ml MDV,409427601,CDM,250,RC,,,Outpatient,,,53.08,26.54,,40.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.28,74,,,Percent of Total Billed Charges,74% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,44.59,84,,,Percent of Total Billed Charges,84% of total billed charges,43.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.24,89,,,Percent of total Billed Charges,89% of total Billed charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.87,77,,,Percent of total Billed charges,77% of total billed charges,45.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.27,47.24,
Lidocaine 1% 10mg/ml 20ml MDV,409427601,CDM,250,RC,,,Outpatient,,,53.08,26.54,,40.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.28,74,,,Percent of Total Billed Charges,74% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,44.59,84,,,Percent of Total Billed Charges,84% of total billed charges,43.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.24,89,,,Percent of total Billed Charges,89% of total Billed charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.87,77,,,Percent of total Billed charges,77% of total billed charges,45.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.27,47.24,
Lidocaine 1% 10mg/ml 20ml MDV,409427601,CDM,250,RC,,,Outpatient,,,53.08,26.54,,40.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.28,74,,,Percent of Total Billed Charges,74% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,44.59,84,,,Percent of Total Billed Charges,84% of total billed charges,43.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.24,89,,,Percent of total Billed Charges,89% of total Billed charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.87,77,,,Percent of total Billed charges,77% of total billed charges,45.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.27,47.24,
Lidocaine 1% 10mg/ml 20ml MDV,409427601,CDM,250,RC,,,Outpatient,,,53.08,26.54,,40.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.28,74,,,Percent of Total Billed Charges,74% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,44.59,84,,,Percent of Total Billed Charges,84% of total billed charges,43.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.24,89,,,Percent of total Billed Charges,89% of total Billed charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.87,77,,,Percent of total Billed charges,77% of total billed charges,45.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.27,47.24,
Lidocaine 1% 10mg/ml 20ml MDV,409427601,CDM,250,RC,,,Outpatient,,,53.08,26.54,,40.87,77,,,Percent of Total Billed Charges,77% of total billed charges,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.28,74,,,Percent of Total Billed Charges,74% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,36.63,69,,,Percent of Total Billed Charges,69% of total billed charges,44.59,84,,,Percent of Total Billed Charges,84% of total billed charges,43.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.24,89,,,Percent of total Billed Charges,89% of total Billed charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.87,77,,,Percent of total Billed charges,77% of total billed charges,45.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.27,47.24,
Lidocaine 5% Patch,63481068706,CDM,250,RC,,,Outpatient,,,130.77,65.39,,100.69,77,,,Percent of Total Billed Charges,77% of total billed charges,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.77,74,,,Percent of Total Billed Charges,74% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,109.85,84,,,Percent of Total Billed Charges,84% of total billed charges,107.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.39,89,,,Percent of total Billed Charges,89% of total Billed charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.69,77,,,Percent of total Billed charges,77% of total billed charges,111.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.69,116.39,
Lidocaine 5% Patch,63481068706,CDM,250,RC,,,Outpatient,,,130.77,65.39,,100.69,77,,,Percent of Total Billed Charges,77% of total billed charges,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.77,74,,,Percent of Total Billed Charges,74% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,109.85,84,,,Percent of Total Billed Charges,84% of total billed charges,107.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.39,89,,,Percent of total Billed Charges,89% of total Billed charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.69,77,,,Percent of total Billed charges,77% of total billed charges,111.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.69,116.39,
Lidocaine 5% Patch,63481068706,CDM,250,RC,,,Outpatient,,,130.77,65.39,,100.69,77,,,Percent of Total Billed Charges,77% of total billed charges,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.77,74,,,Percent of Total Billed Charges,74% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,109.85,84,,,Percent of Total Billed Charges,84% of total billed charges,107.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.39,89,,,Percent of total Billed Charges,89% of total Billed charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.69,77,,,Percent of total Billed charges,77% of total billed charges,111.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.69,116.39,
Lidocaine 5% Patch,63481068706,CDM,250,RC,,,Outpatient,,,130.77,65.39,,100.69,77,,,Percent of Total Billed Charges,77% of total billed charges,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.77,74,,,Percent of Total Billed Charges,74% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,109.85,84,,,Percent of Total Billed Charges,84% of total billed charges,107.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.39,89,,,Percent of total Billed Charges,89% of total Billed charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.69,77,,,Percent of total Billed charges,77% of total billed charges,111.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.69,116.39,
Lidocaine 5% Patch,63481068706,CDM,250,RC,,,Outpatient,,,130.77,65.39,,100.69,77,,,Percent of Total Billed Charges,77% of total billed charges,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.77,74,,,Percent of Total Billed Charges,74% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,109.85,84,,,Percent of Total Billed Charges,84% of total billed charges,107.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.39,89,,,Percent of total Billed Charges,89% of total Billed charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.69,77,,,Percent of total Billed charges,77% of total billed charges,111.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.69,116.39,
Lidocaine 5% Patch,63481068706,CDM,250,RC,,,Outpatient,,,130.77,65.39,,100.69,77,,,Percent of Total Billed Charges,77% of total billed charges,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.77,74,,,Percent of Total Billed Charges,74% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,90.23,69,,,Percent of Total Billed Charges,69% of total billed charges,109.85,84,,,Percent of Total Billed Charges,84% of total billed charges,107.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.39,89,,,Percent of total Billed Charges,89% of total Billed charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.69,77,,,Percent of total Billed charges,77% of total billed charges,111.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.69,116.39,
Lidocaine MPF 2% 20mg/ml 10ml Ampule,63323049697,CDM,250,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
Lidocaine MPF 2% 20mg/ml 10ml Ampule,63323049697,CDM,250,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
Lidocaine MPF 2% 20mg/ml 10ml Ampule,63323049697,CDM,250,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
Lidocaine MPF 2% 20mg/ml 10ml Ampule,63323049697,CDM,250,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
Lidocaine MPF 2% 20mg/ml 10ml Ampule,63323049697,CDM,250,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
Lidocaine MPF 2% 20mg/ml 10ml Ampule,63323049697,CDM,250,RC,,,Outpatient,,,97,48.5,,74.69,77,,,Percent of Total Billed Charges,77% of total billed charges,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,71.78,74,,,Percent of Total Billed Charges,74% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,66.93,69,,,Percent of Total Billed Charges,69% of total billed charges,81.48,84,,,Percent of Total Billed Charges,84% of total billed charges,79.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,86.33,89,,,Percent of total Billed Charges,89% of total Billed charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.69,77,,,Percent of total Billed charges,77% of total billed charges,82.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,48.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,39.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.25,86.33,
Lidocaine 2% 20mg/ml 20ml MDV,409427701,CDM,250,RC,,,Outpatient,,,59.25,29.63,,45.62,77,,,Percent of Total Billed Charges,77% of total billed charges,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.85,74,,,Percent of Total Billed Charges,74% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,49.77,84,,,Percent of Total Billed Charges,84% of total billed charges,48.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.73,89,,,Percent of total Billed Charges,89% of total Billed charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.62,77,,,Percent of total Billed charges,77% of total billed charges,50.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.81,52.73,
Lidocaine 2% 20mg/ml 20ml MDV,409427701,CDM,250,RC,,,Outpatient,,,59.25,29.63,,45.62,77,,,Percent of Total Billed Charges,77% of total billed charges,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.85,74,,,Percent of Total Billed Charges,74% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,49.77,84,,,Percent of Total Billed Charges,84% of total billed charges,48.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.73,89,,,Percent of total Billed Charges,89% of total Billed charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.62,77,,,Percent of total Billed charges,77% of total billed charges,50.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.81,52.73,
Lidocaine 2% 20mg/ml 20ml MDV,409427701,CDM,250,RC,,,Outpatient,,,59.25,29.63,,45.62,77,,,Percent of Total Billed Charges,77% of total billed charges,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.85,74,,,Percent of Total Billed Charges,74% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,49.77,84,,,Percent of Total Billed Charges,84% of total billed charges,48.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.73,89,,,Percent of total Billed Charges,89% of total Billed charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.62,77,,,Percent of total Billed charges,77% of total billed charges,50.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.81,52.73,
Lidocaine 2% 20mg/ml 20ml MDV,409427701,CDM,250,RC,,,Outpatient,,,59.25,29.63,,45.62,77,,,Percent of Total Billed Charges,77% of total billed charges,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.85,74,,,Percent of Total Billed Charges,74% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,49.77,84,,,Percent of Total Billed Charges,84% of total billed charges,48.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.73,89,,,Percent of total Billed Charges,89% of total Billed charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.62,77,,,Percent of total Billed charges,77% of total billed charges,50.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.81,52.73,
Lidocaine 2% 20mg/ml 20ml MDV,409427701,CDM,250,RC,,,Outpatient,,,59.25,29.63,,45.62,77,,,Percent of Total Billed Charges,77% of total billed charges,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.85,74,,,Percent of Total Billed Charges,74% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,49.77,84,,,Percent of Total Billed Charges,84% of total billed charges,48.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.73,89,,,Percent of total Billed Charges,89% of total Billed charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.62,77,,,Percent of total Billed charges,77% of total billed charges,50.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.81,52.73,
Lidocaine 2% 20mg/ml 20ml MDV,409427701,CDM,250,RC,,,Outpatient,,,59.25,29.63,,45.62,77,,,Percent of Total Billed Charges,77% of total billed charges,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,43.85,74,,,Percent of Total Billed Charges,74% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,40.88,69,,,Percent of Total Billed Charges,69% of total billed charges,49.77,84,,,Percent of Total Billed Charges,84% of total billed charges,48.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.73,89,,,Percent of total Billed Charges,89% of total Billed charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.62,77,,,Percent of total Billed charges,77% of total billed charges,50.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.81,52.73,
Lidocaine 2%+EPI 1:100000 20ml MDV,63323048327,CDM,250,RC,,,Outpatient,,,80.96,40.48,,62.34,77,,,Percent of Total Billed Charges,77% of total billed charges,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.91,74,,,Percent of Total Billed Charges,74% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.01,84,,,Percent of Total Billed Charges,84% of total billed charges,66.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.05,89,,,Percent of total Billed Charges,89% of total Billed charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.34,77,,,Percent of total Billed charges,77% of total billed charges,68.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,72.05,
Lidocaine 2%+EPI 1:100000 20ml MDV,63323048327,CDM,250,RC,,,Outpatient,,,80.96,40.48,,62.34,77,,,Percent of Total Billed Charges,77% of total billed charges,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.91,74,,,Percent of Total Billed Charges,74% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.01,84,,,Percent of Total Billed Charges,84% of total billed charges,66.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.05,89,,,Percent of total Billed Charges,89% of total Billed charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.34,77,,,Percent of total Billed charges,77% of total billed charges,68.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,72.05,
Lidocaine 2%+EPI 1:100000 20ml MDV,63323048327,CDM,250,RC,,,Outpatient,,,80.96,40.48,,62.34,77,,,Percent of Total Billed Charges,77% of total billed charges,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.91,74,,,Percent of Total Billed Charges,74% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.01,84,,,Percent of Total Billed Charges,84% of total billed charges,66.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.05,89,,,Percent of total Billed Charges,89% of total Billed charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.34,77,,,Percent of total Billed charges,77% of total billed charges,68.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,72.05,
Lidocaine 2%+EPI 1:100000 20ml MDV,63323048327,CDM,250,RC,,,Outpatient,,,80.96,40.48,,62.34,77,,,Percent of Total Billed Charges,77% of total billed charges,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.91,74,,,Percent of Total Billed Charges,74% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.01,84,,,Percent of Total Billed Charges,84% of total billed charges,66.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.05,89,,,Percent of total Billed Charges,89% of total Billed charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.34,77,,,Percent of total Billed charges,77% of total billed charges,68.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,72.05,
Lidocaine 2%+EPI 1:100000 20ml MDV,63323048327,CDM,250,RC,,,Outpatient,,,80.96,40.48,,62.34,77,,,Percent of Total Billed Charges,77% of total billed charges,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.91,74,,,Percent of Total Billed Charges,74% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.01,84,,,Percent of Total Billed Charges,84% of total billed charges,66.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.05,89,,,Percent of total Billed Charges,89% of total Billed charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.34,77,,,Percent of total Billed charges,77% of total billed charges,68.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,72.05,
Lidocaine 2%+EPI 1:100000 20ml MDV,63323048327,CDM,250,RC,,,Outpatient,,,80.96,40.48,,62.34,77,,,Percent of Total Billed Charges,77% of total billed charges,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.91,74,,,Percent of Total Billed Charges,74% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,55.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.01,84,,,Percent of Total Billed Charges,84% of total billed charges,66.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,72.05,89,,,Percent of total Billed Charges,89% of total Billed charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.34,77,,,Percent of total Billed charges,77% of total billed charges,68.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.24,72.05,
Lidocaine 2%+EPI 1:200000 20ml SDV,63323048927,CDM,250,RC,,,Outpatient,,,173.64,86.82,,133.7,77,,,Percent of Total Billed Charges,77% of total billed charges,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.49,74,,,Percent of Total Billed Charges,74% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,145.86,84,,,Percent of Total Billed Charges,84% of total billed charges,142.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.54,89,,,Percent of total Billed Charges,89% of total Billed charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.7,77,,,Percent of total Billed charges,77% of total billed charges,147.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.41,154.54,
Lidocaine 2%+EPI 1:200000 20ml SDV,63323048927,CDM,250,RC,,,Outpatient,,,173.64,86.82,,133.7,77,,,Percent of Total Billed Charges,77% of total billed charges,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.49,74,,,Percent of Total Billed Charges,74% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,145.86,84,,,Percent of Total Billed Charges,84% of total billed charges,142.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.54,89,,,Percent of total Billed Charges,89% of total Billed charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.7,77,,,Percent of total Billed charges,77% of total billed charges,147.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.41,154.54,
Lidocaine 2%+EPI 1:200000 20ml SDV,63323048927,CDM,250,RC,,,Outpatient,,,173.64,86.82,,133.7,77,,,Percent of Total Billed Charges,77% of total billed charges,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.49,74,,,Percent of Total Billed Charges,74% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,145.86,84,,,Percent of Total Billed Charges,84% of total billed charges,142.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.54,89,,,Percent of total Billed Charges,89% of total Billed charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.7,77,,,Percent of total Billed charges,77% of total billed charges,147.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.41,154.54,
Lidocaine 2%+EPI 1:200000 20ml SDV,63323048927,CDM,250,RC,,,Outpatient,,,173.64,86.82,,133.7,77,,,Percent of Total Billed Charges,77% of total billed charges,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.49,74,,,Percent of Total Billed Charges,74% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,145.86,84,,,Percent of Total Billed Charges,84% of total billed charges,142.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.54,89,,,Percent of total Billed Charges,89% of total Billed charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.7,77,,,Percent of total Billed charges,77% of total billed charges,147.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.41,154.54,
Lidocaine 2%+EPI 1:200000 20ml SDV,63323048927,CDM,250,RC,,,Outpatient,,,173.64,86.82,,133.7,77,,,Percent of Total Billed Charges,77% of total billed charges,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.49,74,,,Percent of Total Billed Charges,74% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,145.86,84,,,Percent of Total Billed Charges,84% of total billed charges,142.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.54,89,,,Percent of total Billed Charges,89% of total Billed charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.7,77,,,Percent of total Billed charges,77% of total billed charges,147.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.41,154.54,
Lidocaine 2%+EPI 1:200000 20ml SDV,63323048927,CDM,250,RC,,,Outpatient,,,173.64,86.82,,133.7,77,,,Percent of Total Billed Charges,77% of total billed charges,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.49,74,,,Percent of Total Billed Charges,74% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,119.81,69,,,Percent of Total Billed Charges,69% of total billed charges,145.86,84,,,Percent of Total Billed Charges,84% of total billed charges,142.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.54,89,,,Percent of total Billed Charges,89% of total Billed charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.7,77,,,Percent of total Billed charges,77% of total billed charges,147.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.85,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.41,154.54,
Lidocaine 1%+EPI 1:100000 20ml MDV,409317801,CDM,250,RC,,,Outpatient,,,59.57,29.79,,45.87,77,,,Percent of Total Billed Charges,77% of total billed charges,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.08,74,,,Percent of Total Billed Charges,74% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,50.04,84,,,Percent of Total Billed Charges,84% of total billed charges,48.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.02,89,,,Percent of total Billed Charges,89% of total Billed charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,77,,,Percent of total Billed charges,77% of total billed charges,50.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.89,53.02,
Lidocaine 1%+EPI 1:100000 20ml MDV,409317801,CDM,250,RC,,,Outpatient,,,59.57,29.79,,45.87,77,,,Percent of Total Billed Charges,77% of total billed charges,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.08,74,,,Percent of Total Billed Charges,74% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,50.04,84,,,Percent of Total Billed Charges,84% of total billed charges,48.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.02,89,,,Percent of total Billed Charges,89% of total Billed charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,77,,,Percent of total Billed charges,77% of total billed charges,50.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.89,53.02,
Lidocaine 1%+EPI 1:100000 20ml MDV,409317801,CDM,250,RC,,,Outpatient,,,59.57,29.79,,45.87,77,,,Percent of Total Billed Charges,77% of total billed charges,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.08,74,,,Percent of Total Billed Charges,74% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,50.04,84,,,Percent of Total Billed Charges,84% of total billed charges,48.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.02,89,,,Percent of total Billed Charges,89% of total Billed charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,77,,,Percent of total Billed charges,77% of total billed charges,50.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.89,53.02,
Lidocaine 1%+EPI 1:100000 20ml MDV,409317801,CDM,250,RC,,,Outpatient,,,59.57,29.79,,45.87,77,,,Percent of Total Billed Charges,77% of total billed charges,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.08,74,,,Percent of Total Billed Charges,74% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,50.04,84,,,Percent of Total Billed Charges,84% of total billed charges,48.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.02,89,,,Percent of total Billed Charges,89% of total Billed charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,77,,,Percent of total Billed charges,77% of total billed charges,50.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.89,53.02,
Lidocaine 1%+EPI 1:100000 20ml MDV,409317801,CDM,250,RC,,,Outpatient,,,59.57,29.79,,45.87,77,,,Percent of Total Billed Charges,77% of total billed charges,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.08,74,,,Percent of Total Billed Charges,74% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,50.04,84,,,Percent of Total Billed Charges,84% of total billed charges,48.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.02,89,,,Percent of total Billed Charges,89% of total Billed charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,77,,,Percent of total Billed charges,77% of total billed charges,50.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.89,53.02,
Lidocaine 1%+EPI 1:100000 20ml MDV,409317801,CDM,250,RC,,,Outpatient,,,59.57,29.79,,45.87,77,,,Percent of Total Billed Charges,77% of total billed charges,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.08,74,,,Percent of Total Billed Charges,74% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,41.1,69,,,Percent of Total Billed Charges,69% of total billed charges,50.04,84,,,Percent of Total Billed Charges,84% of total billed charges,48.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.02,89,,,Percent of total Billed Charges,89% of total Billed charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.87,77,,,Percent of total Billed charges,77% of total billed charges,50.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.89,53.02,
Lidocaine 5% Oint 35gm,52565000814,CDM,250,RC,,,Outpatient,,,1082.42,541.21,,833.46,77,,,Percent of Total Billed Charges,77% of total billed charges,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,800.99,74,,,Percent of Total Billed Charges,74% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,909.23,84,,,Percent of Total Billed Charges,84% of total billed charges,887.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,963.35,89,,,Percent of total Billed Charges,89% of total Billed charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.46,77,,,Percent of total Billed charges,77% of total billed charges,920.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,541.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.61,963.35,
Lidocaine 5% Oint 35gm,52565000814,CDM,250,RC,,,Outpatient,,,1082.42,541.21,,833.46,77,,,Percent of Total Billed Charges,77% of total billed charges,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,800.99,74,,,Percent of Total Billed Charges,74% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,909.23,84,,,Percent of Total Billed Charges,84% of total billed charges,887.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,963.35,89,,,Percent of total Billed Charges,89% of total Billed charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.46,77,,,Percent of total Billed charges,77% of total billed charges,920.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,541.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.61,963.35,
Lidocaine 5% Oint 35gm,52565000814,CDM,250,RC,,,Outpatient,,,1082.42,541.21,,833.46,77,,,Percent of Total Billed Charges,77% of total billed charges,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,800.99,74,,,Percent of Total Billed Charges,74% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,909.23,84,,,Percent of Total Billed Charges,84% of total billed charges,887.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,963.35,89,,,Percent of total Billed Charges,89% of total Billed charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.46,77,,,Percent of total Billed charges,77% of total billed charges,920.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,541.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.61,963.35,
Lidocaine 5% Oint 35gm,52565000814,CDM,250,RC,,,Outpatient,,,1082.42,541.21,,833.46,77,,,Percent of Total Billed Charges,77% of total billed charges,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,800.99,74,,,Percent of Total Billed Charges,74% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,909.23,84,,,Percent of Total Billed Charges,84% of total billed charges,887.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,963.35,89,,,Percent of total Billed Charges,89% of total Billed charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.46,77,,,Percent of total Billed charges,77% of total billed charges,920.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,541.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.61,963.35,
Lidocaine 5% Oint 35gm,52565000814,CDM,250,RC,,,Outpatient,,,1082.42,541.21,,833.46,77,,,Percent of Total Billed Charges,77% of total billed charges,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,800.99,74,,,Percent of Total Billed Charges,74% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,909.23,84,,,Percent of Total Billed Charges,84% of total billed charges,887.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,963.35,89,,,Percent of total Billed Charges,89% of total Billed charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.46,77,,,Percent of total Billed charges,77% of total billed charges,920.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,541.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.61,963.35,
Lidocaine 5% Oint 35gm,52565000814,CDM,250,RC,,,Outpatient,,,1082.42,541.21,,833.46,77,,,Percent of Total Billed Charges,77% of total billed charges,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,800.99,74,,,Percent of Total Billed Charges,74% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,746.87,69,,,Percent of Total Billed Charges,69% of total billed charges,909.23,84,,,Percent of Total Billed Charges,84% of total billed charges,887.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,963.35,89,,,Percent of total Billed Charges,89% of total Billed charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,833.46,77,,,Percent of total Billed charges,77% of total billed charges,920.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,541.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,441.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,963.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.61,963.35,
Lidocaine MPF 4% 40mg/ml Topical/Retrobulbar 5ml Ampule,409428301,CDM,250,RC,,,Outpatient,,,79.72,39.86,,61.38,77,,,Percent of Total Billed Charges,77% of total billed charges,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.99,74,,,Percent of Total Billed Charges,74% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,66.96,84,,,Percent of Total Billed Charges,84% of total billed charges,65.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.95,89,,,Percent of total Billed Charges,89% of total Billed charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,77,,,Percent of total Billed charges,77% of total billed charges,67.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.93,70.95,
Lidocaine MPF 4% 40mg/ml Topical/Retrobulbar 5ml Ampule,409428301,CDM,250,RC,,,Outpatient,,,79.72,39.86,,61.38,77,,,Percent of Total Billed Charges,77% of total billed charges,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.99,74,,,Percent of Total Billed Charges,74% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,66.96,84,,,Percent of Total Billed Charges,84% of total billed charges,65.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.95,89,,,Percent of total Billed Charges,89% of total Billed charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,77,,,Percent of total Billed charges,77% of total billed charges,67.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.93,70.95,
Lidocaine MPF 4% 40mg/ml Topical/Retrobulbar 5ml Ampule,409428301,CDM,250,RC,,,Outpatient,,,79.72,39.86,,61.38,77,,,Percent of Total Billed Charges,77% of total billed charges,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.99,74,,,Percent of Total Billed Charges,74% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,66.96,84,,,Percent of Total Billed Charges,84% of total billed charges,65.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.95,89,,,Percent of total Billed Charges,89% of total Billed charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,77,,,Percent of total Billed charges,77% of total billed charges,67.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.93,70.95,
Lidocaine MPF 4% 40mg/ml Topical/Retrobulbar 5ml Ampule,409428301,CDM,250,RC,,,Outpatient,,,79.72,39.86,,61.38,77,,,Percent of Total Billed Charges,77% of total billed charges,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.99,74,,,Percent of Total Billed Charges,74% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,66.96,84,,,Percent of Total Billed Charges,84% of total billed charges,65.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.95,89,,,Percent of total Billed Charges,89% of total Billed charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,77,,,Percent of total Billed charges,77% of total billed charges,67.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.93,70.95,
Lidocaine MPF 4% 40mg/ml Topical/Retrobulbar 5ml Ampule,409428301,CDM,250,RC,,,Outpatient,,,79.72,39.86,,61.38,77,,,Percent of Total Billed Charges,77% of total billed charges,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.99,74,,,Percent of Total Billed Charges,74% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,66.96,84,,,Percent of Total Billed Charges,84% of total billed charges,65.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.95,89,,,Percent of total Billed Charges,89% of total Billed charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,77,,,Percent of total Billed charges,77% of total billed charges,67.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.93,70.95,
Lidocaine MPF 4% 40mg/ml Topical/Retrobulbar 5ml Ampule,409428301,CDM,250,RC,,,Outpatient,,,79.72,39.86,,61.38,77,,,Percent of Total Billed Charges,77% of total billed charges,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.99,74,,,Percent of Total Billed Charges,74% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,55.01,69,,,Percent of Total Billed Charges,69% of total billed charges,66.96,84,,,Percent of Total Billed Charges,84% of total billed charges,65.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.95,89,,,Percent of total Billed Charges,89% of total Billed charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.38,77,,,Percent of total Billed charges,77% of total billed charges,67.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.93,70.95,
Lidocaine 4% Topical Solution (50ml),54350547,CDM,250,RC,,,Outpatient,,,170.37,85.19,,131.18,77,,,Percent of Total Billed Charges,77% of total billed charges,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.07,74,,,Percent of Total Billed Charges,74% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,143.11,84,,,Percent of Total Billed Charges,84% of total billed charges,139.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.63,89,,,Percent of total Billed Charges,89% of total Billed charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.18,77,,,Percent of total Billed charges,77% of total billed charges,144.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.59,151.63,
Lidocaine 4% Topical Solution (50ml),54350547,CDM,250,RC,,,Outpatient,,,170.37,85.19,,131.18,77,,,Percent of Total Billed Charges,77% of total billed charges,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.07,74,,,Percent of Total Billed Charges,74% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,143.11,84,,,Percent of Total Billed Charges,84% of total billed charges,139.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.63,89,,,Percent of total Billed Charges,89% of total Billed charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.18,77,,,Percent of total Billed charges,77% of total billed charges,144.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.59,151.63,
Lidocaine 4% Topical Solution (50ml),54350547,CDM,250,RC,,,Outpatient,,,170.37,85.19,,131.18,77,,,Percent of Total Billed Charges,77% of total billed charges,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.07,74,,,Percent of Total Billed Charges,74% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,143.11,84,,,Percent of Total Billed Charges,84% of total billed charges,139.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.63,89,,,Percent of total Billed Charges,89% of total Billed charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.18,77,,,Percent of total Billed charges,77% of total billed charges,144.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.59,151.63,
Lidocaine 4% Topical Solution (50ml),54350547,CDM,250,RC,,,Outpatient,,,170.37,85.19,,131.18,77,,,Percent of Total Billed Charges,77% of total billed charges,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.07,74,,,Percent of Total Billed Charges,74% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,143.11,84,,,Percent of Total Billed Charges,84% of total billed charges,139.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.63,89,,,Percent of total Billed Charges,89% of total Billed charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.18,77,,,Percent of total Billed charges,77% of total billed charges,144.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.59,151.63,
Lidocaine 4% Topical Solution (50ml),54350547,CDM,250,RC,,,Outpatient,,,170.37,85.19,,131.18,77,,,Percent of Total Billed Charges,77% of total billed charges,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.07,74,,,Percent of Total Billed Charges,74% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,143.11,84,,,Percent of Total Billed Charges,84% of total billed charges,139.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.63,89,,,Percent of total Billed Charges,89% of total Billed charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.18,77,,,Percent of total Billed charges,77% of total billed charges,144.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.59,151.63,
Lidocaine 4% Topical Solution (50ml),54350547,CDM,250,RC,,,Outpatient,,,170.37,85.19,,131.18,77,,,Percent of Total Billed Charges,77% of total billed charges,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.07,74,,,Percent of Total Billed Charges,74% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,117.56,69,,,Percent of Total Billed Charges,69% of total billed charges,143.11,84,,,Percent of Total Billed Charges,84% of total billed charges,139.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.63,89,,,Percent of total Billed Charges,89% of total Billed charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.18,77,,,Percent of total Billed charges,77% of total billed charges,144.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.59,151.63,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine 2000mg/500ml (4mg/ml) D5W IV Bag,338040903,CDM,250,RC,,,Outpatient,,,160.63,80.32,,123.69,77,,,Percent of Total Billed Charges,77% of total billed charges,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,118.87,74,,,Percent of Total Billed Charges,74% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,110.83,69,,,Percent of Total Billed Charges,69% of total billed charges,134.93,84,,,Percent of Total Billed Charges,84% of total billed charges,131.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,142.96,89,,,Percent of total Billed Charges,89% of total Billed charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.69,77,,,Percent of total Billed charges,77% of total billed charges,136.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.16,142.96,
Lidocaine PF 1% 50mg/5ml Syringe,409913705,CDM,250,RC,,,Outpatient,,,141.9,70.95,,109.26,77,,,Percent of Total Billed Charges,77% of total billed charges,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.01,74,,,Percent of Total Billed Charges,74% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,119.2,84,,,Percent of Total Billed Charges,84% of total billed charges,116.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.29,89,,,Percent of total Billed Charges,89% of total Billed charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.26,77,,,Percent of total Billed charges,77% of total billed charges,120.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.48,126.29,
Lidocaine PF 1% 50mg/5ml Syringe,409913705,CDM,250,RC,,,Outpatient,,,141.9,70.95,,109.26,77,,,Percent of Total Billed Charges,77% of total billed charges,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.01,74,,,Percent of Total Billed Charges,74% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,119.2,84,,,Percent of Total Billed Charges,84% of total billed charges,116.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.29,89,,,Percent of total Billed Charges,89% of total Billed charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.26,77,,,Percent of total Billed charges,77% of total billed charges,120.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.48,126.29,
Lidocaine PF 1% 50mg/5ml Syringe,409913705,CDM,250,RC,,,Outpatient,,,141.9,70.95,,109.26,77,,,Percent of Total Billed Charges,77% of total billed charges,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.01,74,,,Percent of Total Billed Charges,74% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,119.2,84,,,Percent of Total Billed Charges,84% of total billed charges,116.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.29,89,,,Percent of total Billed Charges,89% of total Billed charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.26,77,,,Percent of total Billed charges,77% of total billed charges,120.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.48,126.29,
Lidocaine PF 1% 50mg/5ml Syringe,409913705,CDM,250,RC,,,Outpatient,,,141.9,70.95,,109.26,77,,,Percent of Total Billed Charges,77% of total billed charges,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.01,74,,,Percent of Total Billed Charges,74% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,119.2,84,,,Percent of Total Billed Charges,84% of total billed charges,116.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.29,89,,,Percent of total Billed Charges,89% of total Billed charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.26,77,,,Percent of total Billed charges,77% of total billed charges,120.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.48,126.29,
Lidocaine PF 1% 50mg/5ml Syringe,409913705,CDM,250,RC,,,Outpatient,,,141.9,70.95,,109.26,77,,,Percent of Total Billed Charges,77% of total billed charges,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.01,74,,,Percent of Total Billed Charges,74% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,119.2,84,,,Percent of Total Billed Charges,84% of total billed charges,116.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.29,89,,,Percent of total Billed Charges,89% of total Billed charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.26,77,,,Percent of total Billed charges,77% of total billed charges,120.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.48,126.29,
Lidocaine PF 1% 50mg/5ml Syringe,409913705,CDM,250,RC,,,Outpatient,,,141.9,70.95,,109.26,77,,,Percent of Total Billed Charges,77% of total billed charges,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,105.01,74,,,Percent of Total Billed Charges,74% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,97.91,69,,,Percent of Total Billed Charges,69% of total billed charges,119.2,84,,,Percent of Total Billed Charges,84% of total billed charges,116.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,126.29,89,,,Percent of total Billed Charges,89% of total Billed charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.26,77,,,Percent of total Billed charges,77% of total billed charges,120.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.95,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.48,126.29,
Lidocaine/Prilocaine 2.5% Cream 5gm,168035705,CDM,250,RC,,,Outpatient,,,80.45,40.23,,61.95,77,,,Percent of Total Billed Charges,77% of total billed charges,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.53,74,,,Percent of Total Billed Charges,74% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,67.58,84,,,Percent of Total Billed Charges,84% of total billed charges,65.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.6,89,,,Percent of total Billed Charges,89% of total Billed charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,77,,,Percent of total Billed charges,77% of total billed charges,68.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.11,71.6,
Lidocaine/Prilocaine 2.5% Cream 5gm,168035705,CDM,250,RC,,,Outpatient,,,80.45,40.23,,61.95,77,,,Percent of Total Billed Charges,77% of total billed charges,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.53,74,,,Percent of Total Billed Charges,74% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,67.58,84,,,Percent of Total Billed Charges,84% of total billed charges,65.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.6,89,,,Percent of total Billed Charges,89% of total Billed charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,77,,,Percent of total Billed charges,77% of total billed charges,68.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.11,71.6,
Lidocaine/Prilocaine 2.5% Cream 5gm,168035705,CDM,250,RC,,,Outpatient,,,80.45,40.23,,61.95,77,,,Percent of Total Billed Charges,77% of total billed charges,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.53,74,,,Percent of Total Billed Charges,74% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,67.58,84,,,Percent of Total Billed Charges,84% of total billed charges,65.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.6,89,,,Percent of total Billed Charges,89% of total Billed charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,77,,,Percent of total Billed charges,77% of total billed charges,68.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.11,71.6,
Lidocaine/Prilocaine 2.5% Cream 5gm,168035705,CDM,250,RC,,,Outpatient,,,80.45,40.23,,61.95,77,,,Percent of Total Billed Charges,77% of total billed charges,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.53,74,,,Percent of Total Billed Charges,74% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,67.58,84,,,Percent of Total Billed Charges,84% of total billed charges,65.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.6,89,,,Percent of total Billed Charges,89% of total Billed charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,77,,,Percent of total Billed charges,77% of total billed charges,68.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.11,71.6,
Lidocaine/Prilocaine 2.5% Cream 5gm,168035705,CDM,250,RC,,,Outpatient,,,80.45,40.23,,61.95,77,,,Percent of Total Billed Charges,77% of total billed charges,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.53,74,,,Percent of Total Billed Charges,74% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,67.58,84,,,Percent of Total Billed Charges,84% of total billed charges,65.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.6,89,,,Percent of total Billed Charges,89% of total Billed charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,77,,,Percent of total Billed charges,77% of total billed charges,68.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.11,71.6,
Lidocaine/Prilocaine 2.5% Cream 5gm,168035705,CDM,250,RC,,,Outpatient,,,80.45,40.23,,61.95,77,,,Percent of Total Billed Charges,77% of total billed charges,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.53,74,,,Percent of Total Billed Charges,74% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,55.51,69,,,Percent of Total Billed Charges,69% of total billed charges,67.58,84,,,Percent of Total Billed Charges,84% of total billed charges,65.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.6,89,,,Percent of total Billed Charges,89% of total Billed charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,77,,,Percent of total Billed charges,77% of total billed charges,68.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.11,71.6,
Lidocaine MPF 0.5% 5mg/ml 50ml SDV,409427801,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Lidocaine MPF 0.5% 5mg/ml 50ml SDV,409427801,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Lidocaine MPF 0.5% 5mg/ml 50ml SDV,409427801,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Lidocaine MPF 0.5% 5mg/ml 50ml SDV,409427801,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Lidocaine MPF 0.5% 5mg/ml 50ml SDV,409427801,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Lidocaine MPF 0.5% 5mg/ml 50ml SDV,409427801,CDM,250,RC,,,Outpatient,,,75.53,37.77,,58.16,77,,,Percent of Total Billed Charges,77% of total billed charges,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,55.89,74,,,Percent of Total Billed Charges,74% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,52.12,69,,,Percent of Total Billed Charges,69% of total billed charges,63.45,84,,,Percent of Total Billed Charges,84% of total billed charges,61.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,67.22,89,,,Percent of total Billed Charges,89% of total Billed charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.16,77,,,Percent of total Billed charges,77% of total billed charges,64.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,37.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.88,67.22,
Lidocaine 2% 20mg/ml Topical Jelly 6ml Syringe,25021067376,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Lidocaine 2% 20mg/ml Topical Jelly 6ml Syringe,25021067376,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Lidocaine 2% 20mg/ml Topical Jelly 6ml Syringe,25021067376,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Lidocaine 2% 20mg/ml Topical Jelly 6ml Syringe,25021067376,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Lidocaine 2% 20mg/ml Topical Jelly 6ml Syringe,25021067376,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Lidocaine 2% 20mg/ml Topical Jelly 6ml Syringe,25021067376,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 2000mg/250ml (8mg/ml) D5W IV Bag-PEDIATRIC,338041102,CDM,250,RC,,,Outpatient,,,172.84,86.42,,133.09,77,,,Percent of Total Billed Charges,77% of total billed charges,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.9,74,,,Percent of Total Billed Charges,74% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,119.26,69,,,Percent of Total Billed Charges,69% of total billed charges,145.19,84,,,Percent of Total Billed Charges,84% of total billed charges,141.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,153.83,89,,,Percent of total Billed Charges,89% of total Billed charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.09,77,,,Percent of total Billed charges,77% of total billed charges,146.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,153.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,153.83,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,33.04,16.52,,25.44,77,,,Percent of Total Billed Charges,77% of total billed charges,8.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.45,74,,,Percent of Total Billed Charges,74% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.75,84,,,Percent of Total Billed Charges,84% of total billed charges,27.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.41,89,,,Percent of total Billed Charges,89% of total Billed charges,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.44,77,,,Percent of total Billed charges,77% of total billed charges,28.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.26,29.41,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,33.04,16.52,,25.44,77,,,Percent of Total Billed Charges,77% of total billed charges,8.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.45,74,,,Percent of Total Billed Charges,74% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.75,84,,,Percent of Total Billed Charges,84% of total billed charges,27.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.41,89,,,Percent of total Billed Charges,89% of total Billed charges,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.44,77,,,Percent of total Billed charges,77% of total billed charges,28.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.26,29.41,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,33.04,16.52,,25.44,77,,,Percent of Total Billed Charges,77% of total billed charges,8.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.45,74,,,Percent of Total Billed Charges,74% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,22.8,69,,,Percent of Total Billed Charges,69% of total billed charges,27.75,84,,,Percent of Total Billed Charges,84% of total billed charges,27.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.41,89,,,Percent of total Billed Charges,89% of total Billed charges,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.44,77,,,Percent of total Billed charges,77% of total billed charges,28.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.26,29.41,
Lidocaine 1%+EPI 1:100K 20ml MDV for BUFFERED LIDOCAINE (OE-N),,,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg/300ml IV Bag,9514001,CDM,250,RC,,,Outpatient,,,643.78,321.89,,495.71,77,,,Percent of Total Billed Charges,77% of total billed charges,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,164.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,201.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,476.4,74,,,Percent of Total Billed Charges,74% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,444.21,69,,,Percent of Total Billed Charges,69% of total billed charges,540.78,84,,,Percent of Total Billed Charges,84% of total billed charges,527.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,572.96,89,,,Percent of total Billed Charges,89% of total Billed charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.71,77,,,Percent of total Billed charges,77% of total billed charges,547.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,185.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,321.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,262.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,572.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.95,572.96,
Linezolid 600mg Tablet,904655304,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Linezolid 600mg Tablet,904655304,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Linezolid 600mg Tablet,904655304,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Linezolid 600mg Tablet,904655304,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Linezolid 600mg Tablet,904655304,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Linezolid 600mg Tablet,904655304,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
"Amylase/Lipase/Protease-10,000",73562011001,CDM,250,RC,,,Outpatient,,,43.29,21.65,,33.33,77,,,Percent of Total Billed Charges,77% of total billed charges,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.03,74,,,Percent of Total Billed Charges,74% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,36.36,84,,,Percent of Total Billed Charges,84% of total billed charges,35.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.53,89,,,Percent of total Billed Charges,89% of total Billed charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.33,77,,,Percent of total Billed charges,77% of total billed charges,36.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.82,38.53,
"Amylase/Lipase/Protease-10,000",73562011001,CDM,250,RC,,,Outpatient,,,43.29,21.65,,33.33,77,,,Percent of Total Billed Charges,77% of total billed charges,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.03,74,,,Percent of Total Billed Charges,74% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,36.36,84,,,Percent of Total Billed Charges,84% of total billed charges,35.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.53,89,,,Percent of total Billed Charges,89% of total Billed charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.33,77,,,Percent of total Billed charges,77% of total billed charges,36.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.82,38.53,
"Amylase/Lipase/Protease-10,000",73562011001,CDM,250,RC,,,Outpatient,,,43.29,21.65,,33.33,77,,,Percent of Total Billed Charges,77% of total billed charges,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.03,74,,,Percent of Total Billed Charges,74% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,36.36,84,,,Percent of Total Billed Charges,84% of total billed charges,35.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.53,89,,,Percent of total Billed Charges,89% of total Billed charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.33,77,,,Percent of total Billed charges,77% of total billed charges,36.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.82,38.53,
"Amylase/Lipase/Protease-10,000",73562011001,CDM,250,RC,,,Outpatient,,,43.29,21.65,,33.33,77,,,Percent of Total Billed Charges,77% of total billed charges,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.03,74,,,Percent of Total Billed Charges,74% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,36.36,84,,,Percent of Total Billed Charges,84% of total billed charges,35.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.53,89,,,Percent of total Billed Charges,89% of total Billed charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.33,77,,,Percent of total Billed charges,77% of total billed charges,36.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.82,38.53,
"Amylase/Lipase/Protease-10,000",73562011001,CDM,250,RC,,,Outpatient,,,43.29,21.65,,33.33,77,,,Percent of Total Billed Charges,77% of total billed charges,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.03,74,,,Percent of Total Billed Charges,74% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,36.36,84,,,Percent of Total Billed Charges,84% of total billed charges,35.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.53,89,,,Percent of total Billed Charges,89% of total Billed charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.33,77,,,Percent of total Billed charges,77% of total billed charges,36.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.82,38.53,
"Amylase/Lipase/Protease-10,000",73562011001,CDM,250,RC,,,Outpatient,,,43.29,21.65,,33.33,77,,,Percent of Total Billed Charges,77% of total billed charges,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.03,74,,,Percent of Total Billed Charges,74% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,29.87,69,,,Percent of Total Billed Charges,69% of total billed charges,36.36,84,,,Percent of Total Billed Charges,84% of total billed charges,35.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.53,89,,,Percent of total Billed Charges,89% of total Billed charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.33,77,,,Percent of total Billed charges,77% of total billed charges,36.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.53,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.82,38.53,
"Amylase/Lipase/Protease-5,000",73562011501,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
"Amylase/Lipase/Protease-5,000",73562011501,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
"Amylase/Lipase/Protease-5,000",73562011501,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
"Amylase/Lipase/Protease-5,000",73562011501,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
"Amylase/Lipase/Protease-5,000",73562011501,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
"Amylase/Lipase/Protease-5,000",73562011501,CDM,250,RC,,,Outpatient,,,24.43,12.22,,18.81,77,,,Percent of Total Billed Charges,77% of total billed charges,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.08,74,,,Percent of Total Billed Charges,74% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,16.86,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,84,,,Percent of Total Billed Charges,84% of total billed charges,20.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.74,89,,,Percent of total Billed Charges,89% of total Billed charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.81,77,,,Percent of total Billed charges,77% of total billed charges,20.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.11,21.74,
Lisinopril 10mg Tablet,904679861,CDM,250,RC,,,Outpatient,,,5.47,2.74,,4.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.59,84,,,Percent of Total Billed Charges,84% of total billed charges,4.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.87,89,,,Percent of total Billed Charges,89% of total Billed charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.21,77,,,Percent of total Billed charges,77% of total billed charges,4.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.37,4.87,
Lisinopril 10mg Tablet,904679861,CDM,250,RC,,,Outpatient,,,5.47,2.74,,4.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.59,84,,,Percent of Total Billed Charges,84% of total billed charges,4.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.87,89,,,Percent of total Billed Charges,89% of total Billed charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.21,77,,,Percent of total Billed charges,77% of total billed charges,4.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.37,4.87,
Lisinopril 10mg Tablet,904679861,CDM,250,RC,,,Outpatient,,,5.47,2.74,,4.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.59,84,,,Percent of Total Billed Charges,84% of total billed charges,4.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.87,89,,,Percent of total Billed Charges,89% of total Billed charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.21,77,,,Percent of total Billed charges,77% of total billed charges,4.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.37,4.87,
Lisinopril 10mg Tablet,904679861,CDM,250,RC,,,Outpatient,,,5.47,2.74,,4.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.59,84,,,Percent of Total Billed Charges,84% of total billed charges,4.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.87,89,,,Percent of total Billed Charges,89% of total Billed charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.21,77,,,Percent of total Billed charges,77% of total billed charges,4.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.37,4.87,
Lisinopril 10mg Tablet,904679861,CDM,250,RC,,,Outpatient,,,5.47,2.74,,4.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.59,84,,,Percent of Total Billed Charges,84% of total billed charges,4.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.87,89,,,Percent of total Billed Charges,89% of total Billed charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.21,77,,,Percent of total Billed charges,77% of total billed charges,4.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.37,4.87,
Lisinopril 10mg Tablet,904679861,CDM,250,RC,,,Outpatient,,,5.47,2.74,,4.21,77,,,Percent of Total Billed Charges,77% of total billed charges,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.05,74,,,Percent of Total Billed Charges,74% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,3.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.59,84,,,Percent of Total Billed Charges,84% of total billed charges,4.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.87,89,,,Percent of total Billed Charges,89% of total Billed charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.21,77,,,Percent of total Billed charges,77% of total billed charges,4.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.37,4.87,
Lisinopril 2.5mg Tablet,68180051201,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Lisinopril 2.5mg Tablet,68180051201,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Lisinopril 2.5mg Tablet,68180051201,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Lisinopril 2.5mg Tablet,68180051201,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Lisinopril 2.5mg Tablet,68180051201,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Lisinopril 2.5mg Tablet,68180051201,CDM,250,RC,,,Outpatient,,,11.1,5.55,,8.55,77,,,Percent of Total Billed Charges,77% of total billed charges,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.21,74,,,Percent of Total Billed Charges,74% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,69,,,Percent of Total Billed Charges,69% of total billed charges,9.32,84,,,Percent of Total Billed Charges,84% of total billed charges,9.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.88,89,,,Percent of total Billed Charges,89% of total Billed charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.55,77,,,Percent of total Billed charges,77% of total billed charges,9.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.78,9.88,
Lisinopril 20mg Tablet,60687033301,CDM,250,RC,,,Outpatient,,,6.41,3.21,,4.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.74,74,,,Percent of Total Billed Charges,74% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,84,,,Percent of Total Billed Charges,84% of total billed charges,5.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.7,89,,,Percent of total Billed Charges,89% of total Billed charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,77,,,Percent of total Billed charges,77% of total billed charges,5.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.6,5.7,
Lisinopril 20mg Tablet,60687033301,CDM,250,RC,,,Outpatient,,,6.41,3.21,,4.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.74,74,,,Percent of Total Billed Charges,74% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,84,,,Percent of Total Billed Charges,84% of total billed charges,5.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.7,89,,,Percent of total Billed Charges,89% of total Billed charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,77,,,Percent of total Billed charges,77% of total billed charges,5.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.6,5.7,
Lisinopril 20mg Tablet,60687033301,CDM,250,RC,,,Outpatient,,,6.41,3.21,,4.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.74,74,,,Percent of Total Billed Charges,74% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,84,,,Percent of Total Billed Charges,84% of total billed charges,5.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.7,89,,,Percent of total Billed Charges,89% of total Billed charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,77,,,Percent of total Billed charges,77% of total billed charges,5.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.6,5.7,
Lisinopril 20mg Tablet,60687033301,CDM,250,RC,,,Outpatient,,,6.41,3.21,,4.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.74,74,,,Percent of Total Billed Charges,74% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,84,,,Percent of Total Billed Charges,84% of total billed charges,5.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.7,89,,,Percent of total Billed Charges,89% of total Billed charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,77,,,Percent of total Billed charges,77% of total billed charges,5.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.6,5.7,
Lisinopril 20mg Tablet,60687033301,CDM,250,RC,,,Outpatient,,,6.41,3.21,,4.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.74,74,,,Percent of Total Billed Charges,74% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,84,,,Percent of Total Billed Charges,84% of total billed charges,5.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.7,89,,,Percent of total Billed Charges,89% of total Billed charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,77,,,Percent of total Billed charges,77% of total billed charges,5.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.6,5.7,
Lisinopril 20mg Tablet,60687033301,CDM,250,RC,,,Outpatient,,,6.41,3.21,,4.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.74,74,,,Percent of Total Billed Charges,74% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4.42,69,,,Percent of Total Billed Charges,69% of total billed charges,5.38,84,,,Percent of Total Billed Charges,84% of total billed charges,5.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.7,89,,,Percent of total Billed Charges,89% of total Billed charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.94,77,,,Percent of total Billed charges,77% of total billed charges,5.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.6,5.7,
Lisinopril 5mg Tablet,904679761,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Lisinopril 5mg Tablet,904679761,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Lisinopril 5mg Tablet,904679761,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Lisinopril 5mg Tablet,904679761,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Lisinopril 5mg Tablet,904679761,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Lisinopril 5mg Tablet,904679761,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Lithium 300mg Capsule,54852725,CDM,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Lithium 300mg Capsule,54852725,CDM,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Lithium 300mg Capsule,54852725,CDM,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Lithium 300mg Capsule,54852725,CDM,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Lithium 300mg Capsule,54852725,CDM,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Lithium 300mg Capsule,54852725,CDM,250,RC,,,Outpatient,,,8.47,4.24,,6.52,77,,,Percent of Total Billed Charges,77% of total billed charges,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.27,74,,,Percent of Total Billed Charges,74% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5.84,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,84,,,Percent of Total Billed Charges,84% of total billed charges,6.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.54,89,,,Percent of total Billed Charges,89% of total Billed charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.52,77,,,Percent of total Billed charges,77% of total billed charges,7.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.12,7.54,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,128388.15,64194.08,,98858.88,77,,,Percent of Total Billed Charges,77% of total billed charges,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40121.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95007.23,74,,,Percent of Total Billed Charges,74% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,107846.05,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,114265.45,89,,,Percent of total Billed Charges,89% of total Billed charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98858.88,77,,,Percent of total Billed charges,77% of total billed charges,109129.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36911.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64194.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,114265.45,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,125072.4,62536.2,,96305.75,77,,,Percent of Total Billed Charges,77% of total billed charges,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39085.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92553.58,74,,,Percent of Total Billed Charges,74% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,105060.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,111314.44,89,,,Percent of total Billed Charges,89% of total Billed charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96305.75,77,,,Percent of total Billed charges,77% of total billed charges,106311.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35958.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62536.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,111314.44,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,128388.15,64194.08,,98858.88,77,,,Percent of Total Billed Charges,77% of total billed charges,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40121.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95007.23,74,,,Percent of Total Billed Charges,74% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,107846.05,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,114265.45,89,,,Percent of total Billed Charges,89% of total Billed charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98858.88,77,,,Percent of total Billed charges,77% of total billed charges,109129.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36911.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64194.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,114265.45,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,125072.4,62536.2,,96305.75,77,,,Percent of Total Billed Charges,77% of total billed charges,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39085.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92553.58,74,,,Percent of Total Billed Charges,74% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,105060.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,111314.44,89,,,Percent of total Billed Charges,89% of total Billed charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96305.75,77,,,Percent of total Billed charges,77% of total billed charges,106311.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35958.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62536.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,111314.44,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,128388.15,64194.08,,98858.88,77,,,Percent of Total Billed Charges,77% of total billed charges,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40121.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95007.23,74,,,Percent of Total Billed Charges,74% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,107846.05,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,114265.45,89,,,Percent of total Billed Charges,89% of total Billed charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98858.88,77,,,Percent of total Billed charges,77% of total billed charges,109129.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36911.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64194.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,114265.45,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,125072.4,62536.2,,96305.75,77,,,Percent of Total Billed Charges,77% of total billed charges,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39085.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92553.58,74,,,Percent of Total Billed Charges,74% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,105060.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,111314.44,89,,,Percent of total Billed Charges,89% of total Billed charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96305.75,77,,,Percent of total Billed charges,77% of total billed charges,106311.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35958.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62536.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,111314.44,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,128388.15,64194.08,,98858.88,77,,,Percent of Total Billed Charges,77% of total billed charges,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40121.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95007.23,74,,,Percent of Total Billed Charges,74% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,107846.05,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,114265.45,89,,,Percent of total Billed Charges,89% of total Billed charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98858.88,77,,,Percent of total Billed charges,77% of total billed charges,109129.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36911.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64194.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,114265.45,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,125072.4,62536.2,,96305.75,77,,,Percent of Total Billed Charges,77% of total billed charges,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39085.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92553.58,74,,,Percent of Total Billed Charges,74% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,105060.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,111314.44,89,,,Percent of total Billed Charges,89% of total Billed charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96305.75,77,,,Percent of total Billed charges,77% of total billed charges,106311.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35958.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62536.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,111314.44,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,128388.15,64194.08,,98858.88,77,,,Percent of Total Billed Charges,77% of total billed charges,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40121.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95007.23,74,,,Percent of Total Billed Charges,74% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,107846.05,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,114265.45,89,,,Percent of total Billed Charges,89% of total Billed charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98858.88,77,,,Percent of total Billed charges,77% of total billed charges,109129.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36911.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64194.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,114265.45,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,125072.4,62536.2,,96305.75,77,,,Percent of Total Billed Charges,77% of total billed charges,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39085.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92553.58,74,,,Percent of Total Billed Charges,74% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,105060.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,111314.44,89,,,Percent of total Billed Charges,89% of total Billed charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96305.75,77,,,Percent of total Billed charges,77% of total billed charges,106311.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35958.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62536.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,111314.44,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,128388.15,64194.08,,98858.88,77,,,Percent of Total Billed Charges,77% of total billed charges,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32738.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40121.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95007.23,74,,,Percent of Total Billed Charges,74% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,88587.82,69,,,Percent of Total Billed Charges,69% of total billed charges,107846.05,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,114265.45,89,,,Percent of total Billed Charges,89% of total Billed charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98858.88,77,,,Percent of total Billed charges,77% of total billed charges,109129.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36911.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64194.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52382.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114265.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32097.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,114265.45,
Loncastuximab Tesirine-LPYL (Zynlonta) 10mg/2ml Powder SDV,79952011001,CDM,250,RC,,,Outpatient,,,125072.4,62536.2,,96305.75,77,,,Percent of Total Billed Charges,77% of total billed charges,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31893.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39085.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,92553.58,74,,,Percent of Total Billed Charges,74% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,86299.96,69,,,Percent of Total Billed Charges,69% of total billed charges,105060.82,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,111314.44,89,,,Percent of total Billed Charges,89% of total Billed charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96305.75,77,,,Percent of total Billed charges,77% of total billed charges,106311.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35958.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62536.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51029.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111314.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31268.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,111314.44,
Loperamide 2mg Capsule,51079069020,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loperamide 2mg Capsule,51079069020,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loperamide 2mg Capsule,51079069020,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loperamide 2mg Capsule,51079069020,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loperamide 2mg Capsule,51079069020,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loperamide 2mg Capsule,51079069020,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine 10mg Tablet,51079024620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine 10mg Tablet,51079024620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine 10mg Tablet,51079024620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine 10mg Tablet,51079024620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine 10mg Tablet,51079024620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine 10mg Tablet,51079024620,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
LORazepam 1mg Tablet,69315090501,CDM,250,RC,,,Outpatient,,,12.88,6.44,,9.92,77,,,Percent of Total Billed Charges,77% of total billed charges,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.53,74,,,Percent of Total Billed Charges,74% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,84,,,Percent of Total Billed Charges,84% of total billed charges,10.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.46,89,,,Percent of total Billed Charges,89% of total Billed charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,77,,,Percent of total Billed charges,77% of total billed charges,10.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.22,11.46,
LORazepam 1mg Tablet,69315090501,CDM,250,RC,,,Outpatient,,,12.88,6.44,,9.92,77,,,Percent of Total Billed Charges,77% of total billed charges,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.53,74,,,Percent of Total Billed Charges,74% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,84,,,Percent of Total Billed Charges,84% of total billed charges,10.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.46,89,,,Percent of total Billed Charges,89% of total Billed charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,77,,,Percent of total Billed charges,77% of total billed charges,10.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.22,11.46,
LORazepam 1mg Tablet,69315090501,CDM,250,RC,,,Outpatient,,,12.88,6.44,,9.92,77,,,Percent of Total Billed Charges,77% of total billed charges,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.53,74,,,Percent of Total Billed Charges,74% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,84,,,Percent of Total Billed Charges,84% of total billed charges,10.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.46,89,,,Percent of total Billed Charges,89% of total Billed charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,77,,,Percent of total Billed charges,77% of total billed charges,10.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.22,11.46,
LORazepam 1mg Tablet,69315090501,CDM,250,RC,,,Outpatient,,,12.88,6.44,,9.92,77,,,Percent of Total Billed Charges,77% of total billed charges,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.53,74,,,Percent of Total Billed Charges,74% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,84,,,Percent of Total Billed Charges,84% of total billed charges,10.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.46,89,,,Percent of total Billed Charges,89% of total Billed charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,77,,,Percent of total Billed charges,77% of total billed charges,10.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.22,11.46,
LORazepam 1mg Tablet,69315090501,CDM,250,RC,,,Outpatient,,,12.88,6.44,,9.92,77,,,Percent of Total Billed Charges,77% of total billed charges,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.53,74,,,Percent of Total Billed Charges,74% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,84,,,Percent of Total Billed Charges,84% of total billed charges,10.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.46,89,,,Percent of total Billed Charges,89% of total Billed charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,77,,,Percent of total Billed charges,77% of total billed charges,10.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.22,11.46,
LORazepam 1mg Tablet,69315090501,CDM,250,RC,,,Outpatient,,,12.88,6.44,,9.92,77,,,Percent of Total Billed Charges,77% of total billed charges,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.53,74,,,Percent of Total Billed Charges,74% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,8.89,69,,,Percent of Total Billed Charges,69% of total billed charges,10.82,84,,,Percent of Total Billed Charges,84% of total billed charges,10.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.46,89,,,Percent of total Billed Charges,89% of total Billed charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,77,,,Percent of total Billed charges,77% of total billed charges,10.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.22,11.46,
LORazepam 0.5mg Tablet,51079041720,CDM,250,RC,,,Outpatient,,,11.57,5.79,,8.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.56,74,,,Percent of Total Billed Charges,74% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,84,,,Percent of Total Billed Charges,84% of total billed charges,9.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.3,89,,,Percent of total Billed Charges,89% of total Billed charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.91,77,,,Percent of total Billed charges,77% of total billed charges,9.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,10.3,
LORazepam 0.5mg Tablet,51079041720,CDM,250,RC,,,Outpatient,,,11.57,5.79,,8.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.56,74,,,Percent of Total Billed Charges,74% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,84,,,Percent of Total Billed Charges,84% of total billed charges,9.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.3,89,,,Percent of total Billed Charges,89% of total Billed charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.91,77,,,Percent of total Billed charges,77% of total billed charges,9.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,10.3,
LORazepam 0.5mg Tablet,51079041720,CDM,250,RC,,,Outpatient,,,11.57,5.79,,8.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.56,74,,,Percent of Total Billed Charges,74% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,84,,,Percent of Total Billed Charges,84% of total billed charges,9.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.3,89,,,Percent of total Billed Charges,89% of total Billed charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.91,77,,,Percent of total Billed charges,77% of total billed charges,9.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,10.3,
LORazepam 0.5mg Tablet,51079041720,CDM,250,RC,,,Outpatient,,,11.57,5.79,,8.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.56,74,,,Percent of Total Billed Charges,74% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,84,,,Percent of Total Billed Charges,84% of total billed charges,9.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.3,89,,,Percent of total Billed Charges,89% of total Billed charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.91,77,,,Percent of total Billed charges,77% of total billed charges,9.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,10.3,
LORazepam 0.5mg Tablet,51079041720,CDM,250,RC,,,Outpatient,,,11.57,5.79,,8.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.56,74,,,Percent of Total Billed Charges,74% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,84,,,Percent of Total Billed Charges,84% of total billed charges,9.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.3,89,,,Percent of total Billed Charges,89% of total Billed charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.91,77,,,Percent of total Billed charges,77% of total billed charges,9.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,10.3,
LORazepam 0.5mg Tablet,51079041720,CDM,250,RC,,,Outpatient,,,11.57,5.79,,8.91,77,,,Percent of Total Billed Charges,77% of total billed charges,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.56,74,,,Percent of Total Billed Charges,74% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,84,,,Percent of Total Billed Charges,84% of total billed charges,9.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.3,89,,,Percent of total Billed Charges,89% of total Billed charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.91,77,,,Percent of total Billed charges,77% of total billed charges,9.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.89,10.3,
LORazepam Intensol Conc 2 mg/ml 30ml,54353244,CDM,250,RC,,,Outpatient,,,177.16,88.58,,136.41,77,,,Percent of Total Billed Charges,77% of total billed charges,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.1,74,,,Percent of Total Billed Charges,74% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,148.81,84,,,Percent of Total Billed Charges,84% of total billed charges,145.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.67,89,,,Percent of total Billed Charges,89% of total Billed charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,77,,,Percent of total Billed charges,77% of total billed charges,150.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.29,157.67,
LORazepam Intensol Conc 2 mg/ml 30ml,54353244,CDM,250,RC,,,Outpatient,,,177.16,88.58,,136.41,77,,,Percent of Total Billed Charges,77% of total billed charges,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.1,74,,,Percent of Total Billed Charges,74% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,148.81,84,,,Percent of Total Billed Charges,84% of total billed charges,145.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.67,89,,,Percent of total Billed Charges,89% of total Billed charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,77,,,Percent of total Billed charges,77% of total billed charges,150.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.29,157.67,
LORazepam Intensol Conc 2 mg/ml 30ml,54353244,CDM,250,RC,,,Outpatient,,,177.16,88.58,,136.41,77,,,Percent of Total Billed Charges,77% of total billed charges,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.1,74,,,Percent of Total Billed Charges,74% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,148.81,84,,,Percent of Total Billed Charges,84% of total billed charges,145.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.67,89,,,Percent of total Billed Charges,89% of total Billed charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,77,,,Percent of total Billed charges,77% of total billed charges,150.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.29,157.67,
LORazepam Intensol Conc 2 mg/ml 30ml,54353244,CDM,250,RC,,,Outpatient,,,177.16,88.58,,136.41,77,,,Percent of Total Billed Charges,77% of total billed charges,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.1,74,,,Percent of Total Billed Charges,74% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,148.81,84,,,Percent of Total Billed Charges,84% of total billed charges,145.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.67,89,,,Percent of total Billed Charges,89% of total Billed charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,77,,,Percent of total Billed charges,77% of total billed charges,150.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.29,157.67,
LORazepam Intensol Conc 2 mg/ml 30ml,54353244,CDM,250,RC,,,Outpatient,,,177.16,88.58,,136.41,77,,,Percent of Total Billed Charges,77% of total billed charges,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.1,74,,,Percent of Total Billed Charges,74% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,148.81,84,,,Percent of Total Billed Charges,84% of total billed charges,145.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.67,89,,,Percent of total Billed Charges,89% of total Billed charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,77,,,Percent of total Billed charges,77% of total billed charges,150.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.29,157.67,
LORazepam Intensol Conc 2 mg/ml 30ml,54353244,CDM,250,RC,,,Outpatient,,,177.16,88.58,,136.41,77,,,Percent of Total Billed Charges,77% of total billed charges,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.1,74,,,Percent of Total Billed Charges,74% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,122.24,69,,,Percent of Total Billed Charges,69% of total billed charges,148.81,84,,,Percent of Total Billed Charges,84% of total billed charges,145.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.67,89,,,Percent of total Billed Charges,89% of total Billed charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.41,77,,,Percent of total Billed charges,77% of total billed charges,150.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.29,157.67,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
LORazepam 2mg/ml SDV,641604825,CDM,250,RC,,,Outpatient,,,50.61,25.31,,38.97,77,,,Percent of Total Billed Charges,77% of total billed charges,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.45,74,,,Percent of Total Billed Charges,74% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,34.92,69,,,Percent of Total Billed Charges,69% of total billed charges,42.51,84,,,Percent of Total Billed Charges,84% of total billed charges,41.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.04,89,,,Percent of total Billed Charges,89% of total Billed charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.97,77,,,Percent of total Billed charges,77% of total billed charges,43.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.65,45.04,
Loratadine Liquid 5mg/ml UDC,51672213108,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine Liquid 5mg/ml UDC,51672213108,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine Liquid 5mg/ml UDC,51672213108,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine Liquid 5mg/ml UDC,51672213108,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine Liquid 5mg/ml UDC,51672213108,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Loratadine Liquid 5mg/ml UDC,51672213108,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Losartan 25mg Tablet,68084034601,CDM,250,RC,,,Outpatient,,,20.77,10.39,,15.99,77,,,Percent of Total Billed Charges,77% of total billed charges,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.37,74,,,Percent of Total Billed Charges,74% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,84,,,Percent of Total Billed Charges,84% of total billed charges,17.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.99,77,,,Percent of total Billed charges,77% of total billed charges,17.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.19,18.49,
Losartan 25mg Tablet,68084034601,CDM,250,RC,,,Outpatient,,,20.77,10.39,,15.99,77,,,Percent of Total Billed Charges,77% of total billed charges,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.37,74,,,Percent of Total Billed Charges,74% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,84,,,Percent of Total Billed Charges,84% of total billed charges,17.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.99,77,,,Percent of total Billed charges,77% of total billed charges,17.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.19,18.49,
Losartan 25mg Tablet,68084034601,CDM,250,RC,,,Outpatient,,,20.77,10.39,,15.99,77,,,Percent of Total Billed Charges,77% of total billed charges,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.37,74,,,Percent of Total Billed Charges,74% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,84,,,Percent of Total Billed Charges,84% of total billed charges,17.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.99,77,,,Percent of total Billed charges,77% of total billed charges,17.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.19,18.49,
Losartan 25mg Tablet,68084034601,CDM,250,RC,,,Outpatient,,,20.77,10.39,,15.99,77,,,Percent of Total Billed Charges,77% of total billed charges,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.37,74,,,Percent of Total Billed Charges,74% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,84,,,Percent of Total Billed Charges,84% of total billed charges,17.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.99,77,,,Percent of total Billed charges,77% of total billed charges,17.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.19,18.49,
Losartan 25mg Tablet,68084034601,CDM,250,RC,,,Outpatient,,,20.77,10.39,,15.99,77,,,Percent of Total Billed Charges,77% of total billed charges,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.37,74,,,Percent of Total Billed Charges,74% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,84,,,Percent of Total Billed Charges,84% of total billed charges,17.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.99,77,,,Percent of total Billed charges,77% of total billed charges,17.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.19,18.49,
Losartan 25mg Tablet,68084034601,CDM,250,RC,,,Outpatient,,,20.77,10.39,,15.99,77,,,Percent of Total Billed Charges,77% of total billed charges,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.37,74,,,Percent of Total Billed Charges,74% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,14.33,69,,,Percent of Total Billed Charges,69% of total billed charges,17.45,84,,,Percent of Total Billed Charges,84% of total billed charges,17.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.99,77,,,Percent of total Billed charges,77% of total billed charges,17.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.19,18.49,
Losartan 50mg Tablet,63739068610,CDM,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Losartan 50mg Tablet,63739068610,CDM,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Losartan 50mg Tablet,63739068610,CDM,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Losartan 50mg Tablet,63739068610,CDM,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Losartan 50mg Tablet,63739068610,CDM,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Losartan 50mg Tablet,63739068610,CDM,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Lactated Ringers 250ml IV Bag CMP,77777777777,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 250ml IV Bag CMP,77777777777,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 250ml IV Bag CMP,77777777777,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 250ml IV Bag CMP,77777777777,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 250ml IV Bag CMP,77777777777,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 250ml IV Bag CMP,77777777777,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lubiprostone 8mcg Capsule,64764008060,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Lubiprostone 8mcg Capsule,64764008060,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Lubiprostone 8mcg Capsule,64764008060,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Lubiprostone 8mcg Capsule,64764008060,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Lubiprostone 8mcg Capsule,64764008060,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Lubiprostone 8mcg Capsule,64764008060,CDM,250,RC,,,Outpatient,,,59.5,29.75,,45.82,77,,,Percent of Total Billed Charges,77% of total billed charges,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.03,74,,,Percent of Total Billed Charges,74% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,41.06,69,,,Percent of Total Billed Charges,69% of total billed charges,49.98,84,,,Percent of Total Billed Charges,84% of total billed charges,48.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,52.96,89,,,Percent of total Billed Charges,89% of total Billed charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.82,77,,,Percent of total Billed charges,77% of total billed charges,50.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.88,52.96,
Luspatercept-AAMT (Reblozyl) 25mg/0.5ml Powder SDV,59572071101,CDM,250,RC,,,Outpatient,,,18806.61,9403.31,,14481.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5877.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13916.89,74,,,Percent of Total Billed Charges,74% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15797.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16737.88,89,,,Percent of total Billed Charges,89% of total Billed charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14481.09,77,,,Percent of total Billed charges,77% of total billed charges,15985.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5406.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9403.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.65,16737.88,
Luspatercept-AAMT (Reblozyl) 25mg/0.5ml Powder SDV,59572071101,CDM,250,RC,,,Outpatient,,,18806.61,9403.31,,14481.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5877.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13916.89,74,,,Percent of Total Billed Charges,74% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15797.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16737.88,89,,,Percent of total Billed Charges,89% of total Billed charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14481.09,77,,,Percent of total Billed charges,77% of total billed charges,15985.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5406.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9403.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.65,16737.88,
Luspatercept-AAMT (Reblozyl) 25mg/0.5ml Powder SDV,59572071101,CDM,250,RC,,,Outpatient,,,18806.61,9403.31,,14481.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5877.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13916.89,74,,,Percent of Total Billed Charges,74% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15797.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16737.88,89,,,Percent of total Billed Charges,89% of total Billed charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14481.09,77,,,Percent of total Billed charges,77% of total billed charges,15985.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5406.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9403.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.65,16737.88,
Luspatercept-AAMT (Reblozyl) 25mg/0.5ml Powder SDV,59572071101,CDM,250,RC,,,Outpatient,,,18806.61,9403.31,,14481.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5877.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13916.89,74,,,Percent of Total Billed Charges,74% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15797.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16737.88,89,,,Percent of total Billed Charges,89% of total Billed charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14481.09,77,,,Percent of total Billed charges,77% of total billed charges,15985.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5406.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9403.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.65,16737.88,
Luspatercept-AAMT (Reblozyl) 25mg/0.5ml Powder SDV,59572071101,CDM,250,RC,,,Outpatient,,,18806.61,9403.31,,14481.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5877.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13916.89,74,,,Percent of Total Billed Charges,74% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15797.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16737.88,89,,,Percent of total Billed Charges,89% of total Billed charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14481.09,77,,,Percent of total Billed charges,77% of total billed charges,15985.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5406.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9403.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.65,16737.88,
Luspatercept-AAMT (Reblozyl) 25mg/0.5ml Powder SDV,59572071101,CDM,250,RC,,,Outpatient,,,18806.61,9403.31,,14481.09,77,,,Percent of Total Billed Charges,77% of total billed charges,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4795.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5877.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13916.89,74,,,Percent of Total Billed Charges,74% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,12976.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15797.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,16737.88,89,,,Percent of total Billed Charges,89% of total Billed charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14481.09,77,,,Percent of total Billed charges,77% of total billed charges,15985.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5406.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9403.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7673.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16737.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4701.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4701.65,16737.88,
Luspatercept-AAMT (Reblozyl) 75mg/1.5ml Powder SDV,59572077501,CDM,250,RC,,,Outpatient,,,56319.63,28159.82,,43366.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17599.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41676.53,74,,,Percent of Total Billed Charges,74% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,47308.49,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,50124.47,89,,,Percent of total Billed Charges,89% of total Billed charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43366.12,77,,,Percent of total Billed charges,77% of total billed charges,47871.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16191.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28159.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14079.91,50124.47,
Luspatercept-AAMT (Reblozyl) 75mg/1.5ml Powder SDV,59572077501,CDM,250,RC,,,Outpatient,,,56319.63,28159.82,,43366.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17599.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41676.53,74,,,Percent of Total Billed Charges,74% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,47308.49,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,50124.47,89,,,Percent of total Billed Charges,89% of total Billed charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43366.12,77,,,Percent of total Billed charges,77% of total billed charges,47871.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16191.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28159.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14079.91,50124.47,
Luspatercept-AAMT (Reblozyl) 75mg/1.5ml Powder SDV,59572077501,CDM,250,RC,,,Outpatient,,,56319.63,28159.82,,43366.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17599.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41676.53,74,,,Percent of Total Billed Charges,74% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,47308.49,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,50124.47,89,,,Percent of total Billed Charges,89% of total Billed charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43366.12,77,,,Percent of total Billed charges,77% of total billed charges,47871.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16191.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28159.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14079.91,50124.47,
Luspatercept-AAMT (Reblozyl) 75mg/1.5ml Powder SDV,59572077501,CDM,250,RC,,,Outpatient,,,56319.63,28159.82,,43366.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17599.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41676.53,74,,,Percent of Total Billed Charges,74% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,47308.49,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,50124.47,89,,,Percent of total Billed Charges,89% of total Billed charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43366.12,77,,,Percent of total Billed charges,77% of total billed charges,47871.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16191.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28159.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14079.91,50124.47,
Luspatercept-AAMT (Reblozyl) 75mg/1.5ml Powder SDV,59572077501,CDM,250,RC,,,Outpatient,,,56319.63,28159.82,,43366.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17599.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41676.53,74,,,Percent of Total Billed Charges,74% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,47308.49,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,50124.47,89,,,Percent of total Billed Charges,89% of total Billed charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43366.12,77,,,Percent of total Billed charges,77% of total billed charges,47871.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16191.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28159.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14079.91,50124.47,
Luspatercept-AAMT (Reblozyl) 75mg/1.5ml Powder SDV,59572077501,CDM,250,RC,,,Outpatient,,,56319.63,28159.82,,43366.12,77,,,Percent of Total Billed Charges,77% of total billed charges,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14361.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17599.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41676.53,74,,,Percent of Total Billed Charges,74% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,38860.54,69,,,Percent of Total Billed Charges,69% of total billed charges,47308.49,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,50124.47,89,,,Percent of total Billed Charges,89% of total Billed charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43366.12,77,,,Percent of total Billed charges,77% of total billed charges,47871.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16191.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28159.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22978.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50124.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14079.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14079.91,50124.47,
Aluminum/Mag/Simeth 2400/2400/240mg per 30ml UDC,121176230,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Aluminum/Mag/Simeth 2400/2400/240mg per 30ml UDC,121176230,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Aluminum/Mag/Simeth 2400/2400/240mg per 30ml UDC,121176230,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Aluminum/Mag/Simeth 2400/2400/240mg per 30ml UDC,121176230,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Aluminum/Mag/Simeth 2400/2400/240mg per 30ml UDC,121176230,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Aluminum/Mag/Simeth 2400/2400/240mg per 30ml UDC,121176230,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Sulfate 1gm/100ml IV Bag,67457056700,CDM,250,RC,,,Outpatient,,,168.42,84.21,,129.68,77,,,Percent of Total Billed Charges,77% of total billed charges,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.63,74,,,Percent of Total Billed Charges,74% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,116.21,69,,,Percent of Total Billed Charges,69% of total billed charges,141.47,84,,,Percent of Total Billed Charges,84% of total billed charges,138.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.89,89,,,Percent of total Billed Charges,89% of total Billed charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.68,77,,,Percent of total Billed charges,77% of total billed charges,143.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.11,149.89,
Magnesium Citrate 296ml Bottle,869066738,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Citrate 296ml Bottle,869066738,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Citrate 296ml Bottle,869066738,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Citrate 296ml Bottle,869066738,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Citrate 296ml Bottle,869066738,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Citrate 296ml Bottle,869066738,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
Magnesium Sulfate 2000mg/50ml IV Bag-PEDIATRIC,44567042024,CDM,250,RC,,,Outpatient,,,169.48,84.74,,130.5,77,,,Percent of Total Billed Charges,77% of total billed charges,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.42,74,,,Percent of Total Billed Charges,74% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,116.94,69,,,Percent of Total Billed Charges,69% of total billed charges,142.36,84,,,Percent of Total Billed Charges,84% of total billed charges,138.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.84,89,,,Percent of total Billed Charges,89% of total Billed charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.5,77,,,Percent of total Billed charges,77% of total billed charges,144.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.37,150.84,
"Milk of Magnesium 2,400/30ml UDC",121043130,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Milk of Magnesium 2,400/30ml UDC",121043130,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Milk of Magnesium 2,400/30ml UDC",121043130,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Milk of Magnesium 2,400/30ml UDC",121043130,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Milk of Magnesium 2,400/30ml UDC",121043130,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
"Milk of Magnesium 2,400/30ml UDC",121043130,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Oxide 400mg Tablet,64980033990,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Oxide 400mg Tablet,64980033990,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Oxide 400mg Tablet,64980033990,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Oxide 400mg Tablet,64980033990,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Oxide 400mg Tablet,64980033990,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Oxide 400mg Tablet,64980033990,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 40gm/1000ml IV Bag (OB),,,250,RC,,,Outpatient,,,171.33,85.67,,131.92,77,,,Percent of Total Billed Charges,77% of total billed charges,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.78,74,,,Percent of Total Billed Charges,74% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,118.22,69,,,Percent of Total Billed Charges,69% of total billed charges,143.92,84,,,Percent of Total Billed Charges,84% of total billed charges,140.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.48,89,,,Percent of total Billed Charges,89% of total Billed charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.92,77,,,Percent of total Billed charges,77% of total billed charges,145.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.83,152.48,
Magnesium Sulfate 5gm Granules (UD Pack),70000002101,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Magnesium Sulfate 5gm Granules (UD Pack),70000002101,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Magnesium Sulfate 5gm Granules (UD Pack),70000002101,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Magnesium Sulfate 5gm Granules (UD Pack),70000002101,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Magnesium Sulfate 5gm Granules (UD Pack),70000002101,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Magnesium Sulfate 5gm Granules (UD Pack),70000002101,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 20ml SDV,63323064220,CDM,250,RC,,,Outpatient,,,114.43,57.22,,88.11,77,,,Percent of Total Billed Charges,77% of total billed charges,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.68,74,,,Percent of Total Billed Charges,74% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96.12,84,,,Percent of Total Billed Charges,84% of total billed charges,93.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.84,89,,,Percent of total Billed Charges,89% of total Billed charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.11,77,,,Percent of total Billed charges,77% of total billed charges,97.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.61,101.84,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 20ml SDV,63323064220,CDM,250,RC,,,Outpatient,,,114.43,57.22,,88.11,77,,,Percent of Total Billed Charges,77% of total billed charges,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.68,74,,,Percent of Total Billed Charges,74% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96.12,84,,,Percent of Total Billed Charges,84% of total billed charges,93.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.84,89,,,Percent of total Billed Charges,89% of total Billed charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.11,77,,,Percent of total Billed charges,77% of total billed charges,97.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.61,101.84,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 20ml SDV,63323064220,CDM,250,RC,,,Outpatient,,,114.43,57.22,,88.11,77,,,Percent of Total Billed Charges,77% of total billed charges,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.68,74,,,Percent of Total Billed Charges,74% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96.12,84,,,Percent of Total Billed Charges,84% of total billed charges,93.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.84,89,,,Percent of total Billed Charges,89% of total Billed charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.11,77,,,Percent of total Billed charges,77% of total billed charges,97.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.61,101.84,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 20ml SDV,63323064220,CDM,250,RC,,,Outpatient,,,114.43,57.22,,88.11,77,,,Percent of Total Billed Charges,77% of total billed charges,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.68,74,,,Percent of Total Billed Charges,74% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96.12,84,,,Percent of Total Billed Charges,84% of total billed charges,93.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.84,89,,,Percent of total Billed Charges,89% of total Billed charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.11,77,,,Percent of total Billed charges,77% of total billed charges,97.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.61,101.84,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 20ml SDV,63323064220,CDM,250,RC,,,Outpatient,,,114.43,57.22,,88.11,77,,,Percent of Total Billed Charges,77% of total billed charges,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.68,74,,,Percent of Total Billed Charges,74% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96.12,84,,,Percent of Total Billed Charges,84% of total billed charges,93.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.84,89,,,Percent of total Billed Charges,89% of total Billed charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.11,77,,,Percent of total Billed charges,77% of total billed charges,97.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.61,101.84,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 20ml SDV,63323064220,CDM,250,RC,,,Outpatient,,,114.43,57.22,,88.11,77,,,Percent of Total Billed Charges,77% of total billed charges,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.68,74,,,Percent of Total Billed Charges,74% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,78.96,69,,,Percent of Total Billed Charges,69% of total billed charges,96.12,84,,,Percent of Total Billed Charges,84% of total billed charges,93.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.84,89,,,Percent of total Billed Charges,89% of total Billed charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.11,77,,,Percent of total Billed charges,77% of total billed charges,97.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,57.22,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.61,101.84,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Magnesium Sulfate 500mg/ml (4.06mEq/ml) 2ml SDV,63323006402,CDM,250,RC,,,Outpatient,,,52.99,26.5,,40.8,77,,,Percent of Total Billed Charges,77% of total billed charges,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.21,74,,,Percent of Total Billed Charges,74% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,36.56,69,,,Percent of Total Billed Charges,69% of total billed charges,44.51,84,,,Percent of Total Billed Charges,84% of total billed charges,43.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.16,89,,,Percent of total Billed Charges,89% of total Billed charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.8,77,,,Percent of total Billed charges,77% of total billed charges,45.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.25,47.16,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 20% 100gm/500ml IV Bag,990771503,CDM,250,RC,,,Outpatient,,,241.49,120.75,,185.95,77,,,Percent of Total Billed Charges,77% of total billed charges,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,178.7,74,,,Percent of Total Billed Charges,74% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,166.63,69,,,Percent of Total Billed Charges,69% of total billed charges,202.85,84,,,Percent of Total Billed Charges,84% of total billed charges,198.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,214.93,89,,,Percent of total Billed Charges,89% of total Billed charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.95,77,,,Percent of total Billed charges,77% of total billed charges,205.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,120.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,98.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,214.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.37,214.93,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,59.74,29.87,,46,77,,,Percent of Total Billed Charges,77% of total billed charges,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.21,74,,,Percent of Total Billed Charges,74% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,41.22,69,,,Percent of Total Billed Charges,69% of total billed charges,50.18,84,,,Percent of Total Billed Charges,84% of total billed charges,48.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.17,89,,,Percent of total Billed Charges,89% of total Billed charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,77,,,Percent of total Billed charges,77% of total billed charges,50.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.94,53.17,
Mannitol 25% 12.5gm/50ml SDV - Pediatric,409403116,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15465.46,7732.73,,11908.4,77,,,Percent of Total Billed Charges,77% of total billed charges,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4832.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11444.44,74,,,Percent of Total Billed Charges,74% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,12990.99,84,,,Percent of Total Billed Charges,84% of total billed charges,12681.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,13764.26,89,,,Percent of total Billed Charges,89% of total Billed charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11908.4,77,,,Percent of total Billed charges,77% of total billed charges,13145.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4446.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7732.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3866.37,13764.26,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15069.36,7534.68,,11603.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4709.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12658.26,84,,,Percent of Total Billed Charges,84% of total billed charges,12356.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13411.73,89,,,Percent of total Billed Charges,89% of total Billed charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11603.41,77,,,Percent of total Billed charges,77% of total billed charges,12808.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4332.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7534.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3767.34,13411.73,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15465.46,7732.73,,11908.4,77,,,Percent of Total Billed Charges,77% of total billed charges,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4832.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11444.44,74,,,Percent of Total Billed Charges,74% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,12990.99,84,,,Percent of Total Billed Charges,84% of total billed charges,12681.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,13764.26,89,,,Percent of total Billed Charges,89% of total Billed charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11908.4,77,,,Percent of total Billed charges,77% of total billed charges,13145.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4446.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7732.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3866.37,13764.26,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15069.36,7534.68,,11603.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4709.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12658.26,84,,,Percent of Total Billed Charges,84% of total billed charges,12356.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13411.73,89,,,Percent of total Billed Charges,89% of total Billed charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11603.41,77,,,Percent of total Billed charges,77% of total billed charges,12808.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4332.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7534.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3767.34,13411.73,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15465.46,7732.73,,11908.4,77,,,Percent of Total Billed Charges,77% of total billed charges,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4832.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11444.44,74,,,Percent of Total Billed Charges,74% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,12990.99,84,,,Percent of Total Billed Charges,84% of total billed charges,12681.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,13764.26,89,,,Percent of total Billed Charges,89% of total Billed charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11908.4,77,,,Percent of total Billed charges,77% of total billed charges,13145.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4446.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7732.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3866.37,13764.26,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15069.36,7534.68,,11603.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4709.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12658.26,84,,,Percent of Total Billed Charges,84% of total billed charges,12356.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13411.73,89,,,Percent of total Billed Charges,89% of total Billed charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11603.41,77,,,Percent of total Billed charges,77% of total billed charges,12808.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4332.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7534.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3767.34,13411.73,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15465.46,7732.73,,11908.4,77,,,Percent of Total Billed Charges,77% of total billed charges,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4832.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11444.44,74,,,Percent of Total Billed Charges,74% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,12990.99,84,,,Percent of Total Billed Charges,84% of total billed charges,12681.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,13764.26,89,,,Percent of total Billed Charges,89% of total Billed charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11908.4,77,,,Percent of total Billed charges,77% of total billed charges,13145.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4446.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7732.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3866.37,13764.26,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15069.36,7534.68,,11603.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4709.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12658.26,84,,,Percent of Total Billed Charges,84% of total billed charges,12356.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13411.73,89,,,Percent of total Billed Charges,89% of total Billed charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11603.41,77,,,Percent of total Billed charges,77% of total billed charges,12808.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4332.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7534.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3767.34,13411.73,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15465.46,7732.73,,11908.4,77,,,Percent of Total Billed Charges,77% of total billed charges,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4832.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11444.44,74,,,Percent of Total Billed Charges,74% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,12990.99,84,,,Percent of Total Billed Charges,84% of total billed charges,12681.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,13764.26,89,,,Percent of total Billed Charges,89% of total Billed charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11908.4,77,,,Percent of total Billed charges,77% of total billed charges,13145.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4446.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7732.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3866.37,13764.26,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15069.36,7534.68,,11603.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4709.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12658.26,84,,,Percent of Total Billed Charges,84% of total billed charges,12356.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13411.73,89,,,Percent of total Billed Charges,89% of total Billed charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11603.41,77,,,Percent of total Billed charges,77% of total billed charges,12808.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4332.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7534.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3767.34,13411.73,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15465.46,7732.73,,11908.4,77,,,Percent of Total Billed Charges,77% of total billed charges,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3943.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4832.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11444.44,74,,,Percent of Total Billed Charges,74% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,10671.17,69,,,Percent of Total Billed Charges,69% of total billed charges,12990.99,84,,,Percent of Total Billed Charges,84% of total billed charges,12681.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,13764.26,89,,,Percent of total Billed Charges,89% of total Billed charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11908.4,77,,,Percent of total Billed charges,77% of total billed charges,13145.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4446.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7732.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6309.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13764.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3866.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3866.37,13764.26,
Margetuximab-CMKB (Margenza) 250mg/10ml Liquid Vial,74527002202,CDM,250,RC,,,Outpatient,,,15069.36,7534.68,,11603.41,77,,,Percent of Total Billed Charges,77% of total billed charges,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3842.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4709.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11151.33,74,,,Percent of Total Billed Charges,74% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,10397.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12658.26,84,,,Percent of Total Billed Charges,84% of total billed charges,12356.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,13411.73,89,,,Percent of total Billed Charges,89% of total Billed charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11603.41,77,,,Percent of total Billed charges,77% of total billed charges,12808.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4332.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7534.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6148.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13411.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3767.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3767.34,13411.73,
"Measles, Mumps, Rubella PF Vaccine 12,500 Units/0.5ml + Diluent SDV",6468100,CDM,250,RC,,,Outpatient,,,454.04,227.02,,349.61,77,,,Percent of Total Billed Charges,77% of total billed charges,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,335.99,74,,,Percent of Total Billed Charges,74% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,381.39,84,,,Percent of Total Billed Charges,84% of total billed charges,372.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.1,89,,,Percent of total Billed Charges,89% of total Billed charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.61,77,,,Percent of total Billed charges,77% of total billed charges,385.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,404.1,
"Measles, Mumps, Rubella PF Vaccine 12,500 Units/0.5ml + Diluent SDV",6468100,CDM,250,RC,,,Outpatient,,,454.04,227.02,,349.61,77,,,Percent of Total Billed Charges,77% of total billed charges,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,335.99,74,,,Percent of Total Billed Charges,74% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,381.39,84,,,Percent of Total Billed Charges,84% of total billed charges,372.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.1,89,,,Percent of total Billed Charges,89% of total Billed charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.61,77,,,Percent of total Billed charges,77% of total billed charges,385.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,404.1,
"Measles, Mumps, Rubella PF Vaccine 12,500 Units/0.5ml + Diluent SDV",6468100,CDM,250,RC,,,Outpatient,,,454.04,227.02,,349.61,77,,,Percent of Total Billed Charges,77% of total billed charges,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,335.99,74,,,Percent of Total Billed Charges,74% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,381.39,84,,,Percent of Total Billed Charges,84% of total billed charges,372.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.1,89,,,Percent of total Billed Charges,89% of total Billed charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.61,77,,,Percent of total Billed charges,77% of total billed charges,385.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,404.1,
"Measles, Mumps, Rubella PF Vaccine 12,500 Units/0.5ml + Diluent SDV",6468100,CDM,250,RC,,,Outpatient,,,454.04,227.02,,349.61,77,,,Percent of Total Billed Charges,77% of total billed charges,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,335.99,74,,,Percent of Total Billed Charges,74% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,381.39,84,,,Percent of Total Billed Charges,84% of total billed charges,372.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.1,89,,,Percent of total Billed Charges,89% of total Billed charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.61,77,,,Percent of total Billed charges,77% of total billed charges,385.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,404.1,
"Measles, Mumps, Rubella PF Vaccine 12,500 Units/0.5ml + Diluent SDV",6468100,CDM,250,RC,,,Outpatient,,,454.04,227.02,,349.61,77,,,Percent of Total Billed Charges,77% of total billed charges,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,335.99,74,,,Percent of Total Billed Charges,74% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,381.39,84,,,Percent of Total Billed Charges,84% of total billed charges,372.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.1,89,,,Percent of total Billed Charges,89% of total Billed charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.61,77,,,Percent of total Billed charges,77% of total billed charges,385.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,404.1,
"Measles, Mumps, Rubella PF Vaccine 12,500 Units/0.5ml + Diluent SDV",6468100,CDM,250,RC,,,Outpatient,,,454.04,227.02,,349.61,77,,,Percent of Total Billed Charges,77% of total billed charges,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,115.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,335.99,74,,,Percent of Total Billed Charges,74% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,313.29,69,,,Percent of Total Billed Charges,69% of total billed charges,381.39,84,,,Percent of Total Billed Charges,84% of total billed charges,372.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,404.1,89,,,Percent of total Billed Charges,89% of total Billed charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.61,77,,,Percent of total Billed charges,77% of total billed charges,385.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,130.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,227.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,185.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,404.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,113.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.51,404.1,
Meclizine 25mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Meclizine 25mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Meclizine 25mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Meclizine 25mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Meclizine 25mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Meclizine 25mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
medroxyPROGESTERone 5mg Tablet,555087302,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
medroxyPROGESTERone 5mg Tablet,555087302,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
medroxyPROGESTERone 5mg Tablet,555087302,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
medroxyPROGESTERone 5mg Tablet,555087302,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
medroxyPROGESTERone 5mg Tablet,555087302,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
medroxyPROGESTERone 5mg Tablet,555087302,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
Megestrol 400mg/10ml UDC,121094510,CDM,250,RC,,,Outpatient,,,44.88,22.44,,34.56,77,,,Percent of Total Billed Charges,77% of total billed charges,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.21,74,,,Percent of Total Billed Charges,74% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,37.7,84,,,Percent of Total Billed Charges,84% of total billed charges,36.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.94,89,,,Percent of total Billed Charges,89% of total Billed charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.56,77,,,Percent of total Billed charges,77% of total billed charges,38.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,39.94,
Megestrol 400mg/10ml UDC,121094510,CDM,250,RC,,,Outpatient,,,44.88,22.44,,34.56,77,,,Percent of Total Billed Charges,77% of total billed charges,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.21,74,,,Percent of Total Billed Charges,74% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,37.7,84,,,Percent of Total Billed Charges,84% of total billed charges,36.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.94,89,,,Percent of total Billed Charges,89% of total Billed charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.56,77,,,Percent of total Billed charges,77% of total billed charges,38.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,39.94,
Megestrol 400mg/10ml UDC,121094510,CDM,250,RC,,,Outpatient,,,44.88,22.44,,34.56,77,,,Percent of Total Billed Charges,77% of total billed charges,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.21,74,,,Percent of Total Billed Charges,74% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,37.7,84,,,Percent of Total Billed Charges,84% of total billed charges,36.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.94,89,,,Percent of total Billed Charges,89% of total Billed charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.56,77,,,Percent of total Billed charges,77% of total billed charges,38.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,39.94,
Megestrol 400mg/10ml UDC,121094510,CDM,250,RC,,,Outpatient,,,44.88,22.44,,34.56,77,,,Percent of Total Billed Charges,77% of total billed charges,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.21,74,,,Percent of Total Billed Charges,74% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,37.7,84,,,Percent of Total Billed Charges,84% of total billed charges,36.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.94,89,,,Percent of total Billed Charges,89% of total Billed charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.56,77,,,Percent of total Billed charges,77% of total billed charges,38.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,39.94,
Megestrol 400mg/10ml UDC,121094510,CDM,250,RC,,,Outpatient,,,44.88,22.44,,34.56,77,,,Percent of Total Billed Charges,77% of total billed charges,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.21,74,,,Percent of Total Billed Charges,74% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,37.7,84,,,Percent of Total Billed Charges,84% of total billed charges,36.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.94,89,,,Percent of total Billed Charges,89% of total Billed charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.56,77,,,Percent of total Billed charges,77% of total billed charges,38.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,39.94,
Megestrol 400mg/10ml UDC,121094510,CDM,250,RC,,,Outpatient,,,44.88,22.44,,34.56,77,,,Percent of Total Billed Charges,77% of total billed charges,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.21,74,,,Percent of Total Billed Charges,74% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,30.97,69,,,Percent of Total Billed Charges,69% of total billed charges,37.7,84,,,Percent of Total Billed Charges,84% of total billed charges,36.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.94,89,,,Percent of total Billed Charges,89% of total Billed charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.56,77,,,Percent of total Billed charges,77% of total billed charges,38.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.22,39.94,
Megestrol 40mg Tablet,555060702,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Megestrol 40mg Tablet,555060702,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Megestrol 40mg Tablet,555060702,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Megestrol 40mg Tablet,555060702,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Megestrol 40mg Tablet,555060702,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Megestrol 40mg Tablet,555060702,CDM,250,RC,,,Outpatient,,,21.05,10.53,,16.21,77,,,Percent of Total Billed Charges,77% of total billed charges,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.58,74,,,Percent of Total Billed Charges,74% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,69,,,Percent of Total Billed Charges,69% of total billed charges,17.68,84,,,Percent of Total Billed Charges,84% of total billed charges,17.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.73,89,,,Percent of total Billed Charges,89% of total Billed charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.21,77,,,Percent of total Billed charges,77% of total billed charges,17.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.26,18.73,
Melatonin 3mg Tablet,50268052415,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Melatonin 3mg Tablet,50268052415,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Melatonin 3mg Tablet,50268052415,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Melatonin 3mg Tablet,50268052415,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Melatonin 3mg Tablet,50268052415,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Melatonin 3mg Tablet,50268052415,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Meloxicam 7.5mg Tablet,69097015807,CDM,250,RC,,,Outpatient,,,34.75,17.38,,26.76,77,,,Percent of Total Billed Charges,77% of total billed charges,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.72,74,,,Percent of Total Billed Charges,74% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,29.19,84,,,Percent of Total Billed Charges,84% of total billed charges,28.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.93,89,,,Percent of total Billed Charges,89% of total Billed charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,77,,,Percent of total Billed charges,77% of total billed charges,29.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,30.93,
Meloxicam 7.5mg Tablet,69097015807,CDM,250,RC,,,Outpatient,,,34.75,17.38,,26.76,77,,,Percent of Total Billed Charges,77% of total billed charges,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.72,74,,,Percent of Total Billed Charges,74% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,29.19,84,,,Percent of Total Billed Charges,84% of total billed charges,28.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.93,89,,,Percent of total Billed Charges,89% of total Billed charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,77,,,Percent of total Billed charges,77% of total billed charges,29.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,30.93,
Meloxicam 7.5mg Tablet,69097015807,CDM,250,RC,,,Outpatient,,,34.75,17.38,,26.76,77,,,Percent of Total Billed Charges,77% of total billed charges,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.72,74,,,Percent of Total Billed Charges,74% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,29.19,84,,,Percent of Total Billed Charges,84% of total billed charges,28.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.93,89,,,Percent of total Billed Charges,89% of total Billed charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,77,,,Percent of total Billed charges,77% of total billed charges,29.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,30.93,
Meloxicam 7.5mg Tablet,69097015807,CDM,250,RC,,,Outpatient,,,34.75,17.38,,26.76,77,,,Percent of Total Billed Charges,77% of total billed charges,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.72,74,,,Percent of Total Billed Charges,74% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,29.19,84,,,Percent of Total Billed Charges,84% of total billed charges,28.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.93,89,,,Percent of total Billed Charges,89% of total Billed charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,77,,,Percent of total Billed charges,77% of total billed charges,29.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,30.93,
Meloxicam 7.5mg Tablet,69097015807,CDM,250,RC,,,Outpatient,,,34.75,17.38,,26.76,77,,,Percent of Total Billed Charges,77% of total billed charges,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.72,74,,,Percent of Total Billed Charges,74% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,29.19,84,,,Percent of Total Billed Charges,84% of total billed charges,28.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.93,89,,,Percent of total Billed Charges,89% of total Billed charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,77,,,Percent of total Billed charges,77% of total billed charges,29.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,30.93,
Meloxicam 7.5mg Tablet,69097015807,CDM,250,RC,,,Outpatient,,,34.75,17.38,,26.76,77,,,Percent of Total Billed Charges,77% of total billed charges,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25.72,74,,,Percent of Total Billed Charges,74% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,23.98,69,,,Percent of Total Billed Charges,69% of total billed charges,29.19,84,,,Percent of Total Billed Charges,84% of total billed charges,28.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,30.93,89,,,Percent of total Billed Charges,89% of total Billed charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.76,77,,,Percent of total Billed charges,77% of total billed charges,29.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.69,30.93,
Memantine 10mg Tablet,,,250,RC,,,Outpatient,,,70.24,35.12,,54.08,77,,,Percent of Total Billed Charges,77% of total billed charges,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.98,74,,,Percent of Total Billed Charges,74% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,59,84,,,Percent of Total Billed Charges,84% of total billed charges,57.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.51,89,,,Percent of total Billed Charges,89% of total Billed charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.08,77,,,Percent of total Billed charges,77% of total billed charges,59.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,62.51,
Memantine 10mg Tablet,,,250,RC,,,Outpatient,,,70.24,35.12,,54.08,77,,,Percent of Total Billed Charges,77% of total billed charges,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.98,74,,,Percent of Total Billed Charges,74% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,59,84,,,Percent of Total Billed Charges,84% of total billed charges,57.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.51,89,,,Percent of total Billed Charges,89% of total Billed charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.08,77,,,Percent of total Billed charges,77% of total billed charges,59.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,62.51,
Memantine 10mg Tablet,,,250,RC,,,Outpatient,,,70.24,35.12,,54.08,77,,,Percent of Total Billed Charges,77% of total billed charges,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.98,74,,,Percent of Total Billed Charges,74% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,59,84,,,Percent of Total Billed Charges,84% of total billed charges,57.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.51,89,,,Percent of total Billed Charges,89% of total Billed charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.08,77,,,Percent of total Billed charges,77% of total billed charges,59.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,62.51,
Memantine 10mg Tablet,,,250,RC,,,Outpatient,,,70.24,35.12,,54.08,77,,,Percent of Total Billed Charges,77% of total billed charges,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.98,74,,,Percent of Total Billed Charges,74% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,59,84,,,Percent of Total Billed Charges,84% of total billed charges,57.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.51,89,,,Percent of total Billed Charges,89% of total Billed charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.08,77,,,Percent of total Billed charges,77% of total billed charges,59.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,62.51,
Memantine 10mg Tablet,,,250,RC,,,Outpatient,,,70.24,35.12,,54.08,77,,,Percent of Total Billed Charges,77% of total billed charges,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.98,74,,,Percent of Total Billed Charges,74% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,59,84,,,Percent of Total Billed Charges,84% of total billed charges,57.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.51,89,,,Percent of total Billed Charges,89% of total Billed charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.08,77,,,Percent of total Billed charges,77% of total billed charges,59.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,62.51,
Memantine 10mg Tablet,,,250,RC,,,Outpatient,,,70.24,35.12,,54.08,77,,,Percent of Total Billed Charges,77% of total billed charges,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.98,74,,,Percent of Total Billed Charges,74% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,48.47,69,,,Percent of Total Billed Charges,69% of total billed charges,59,84,,,Percent of Total Billed Charges,84% of total billed charges,57.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.51,89,,,Percent of total Billed Charges,89% of total Billed charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.08,77,,,Percent of total Billed charges,77% of total billed charges,59.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,62.51,
Analgesic Balm 57gm,74300008197,CDM,250,RC,,,Outpatient,,,39.44,19.72,,30.37,77,,,Percent of Total Billed Charges,77% of total billed charges,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.19,74,,,Percent of Total Billed Charges,74% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,84,,,Percent of Total Billed Charges,84% of total billed charges,32.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,89,,,Percent of total Billed Charges,89% of total Billed charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.37,77,,,Percent of total Billed charges,77% of total billed charges,33.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,35.1,
Analgesic Balm 57gm,74300008197,CDM,250,RC,,,Outpatient,,,39.44,19.72,,30.37,77,,,Percent of Total Billed Charges,77% of total billed charges,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.19,74,,,Percent of Total Billed Charges,74% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,84,,,Percent of Total Billed Charges,84% of total billed charges,32.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,89,,,Percent of total Billed Charges,89% of total Billed charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.37,77,,,Percent of total Billed charges,77% of total billed charges,33.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,35.1,
Analgesic Balm 57gm,74300008197,CDM,250,RC,,,Outpatient,,,39.44,19.72,,30.37,77,,,Percent of Total Billed Charges,77% of total billed charges,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.19,74,,,Percent of Total Billed Charges,74% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,84,,,Percent of Total Billed Charges,84% of total billed charges,32.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,89,,,Percent of total Billed Charges,89% of total Billed charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.37,77,,,Percent of total Billed charges,77% of total billed charges,33.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,35.1,
Analgesic Balm 57gm,74300008197,CDM,250,RC,,,Outpatient,,,39.44,19.72,,30.37,77,,,Percent of Total Billed Charges,77% of total billed charges,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.19,74,,,Percent of Total Billed Charges,74% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,84,,,Percent of Total Billed Charges,84% of total billed charges,32.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,89,,,Percent of total Billed Charges,89% of total Billed charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.37,77,,,Percent of total Billed charges,77% of total billed charges,33.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,35.1,
Analgesic Balm 57gm,74300008197,CDM,250,RC,,,Outpatient,,,39.44,19.72,,30.37,77,,,Percent of Total Billed Charges,77% of total billed charges,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.19,74,,,Percent of Total Billed Charges,74% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,84,,,Percent of Total Billed Charges,84% of total billed charges,32.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,89,,,Percent of total Billed Charges,89% of total Billed charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.37,77,,,Percent of total Billed charges,77% of total billed charges,33.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,35.1,
Analgesic Balm 57gm,74300008197,CDM,250,RC,,,Outpatient,,,39.44,19.72,,30.37,77,,,Percent of Total Billed Charges,77% of total billed charges,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.19,74,,,Percent of Total Billed Charges,74% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,27.21,69,,,Percent of Total Billed Charges,69% of total billed charges,33.13,84,,,Percent of Total Billed Charges,84% of total billed charges,32.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.1,89,,,Percent of total Billed Charges,89% of total Billed charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.37,77,,,Percent of total Billed charges,77% of total billed charges,33.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,35.1,
Meperidine 25mg SDV,641605225,CDM,250,RC,,,Outpatient,,,60.89,30.45,,46.89,77,,,Percent of Total Billed Charges,77% of total billed charges,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.06,74,,,Percent of Total Billed Charges,74% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,51.15,84,,,Percent of Total Billed Charges,84% of total billed charges,49.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.19,89,,,Percent of total Billed Charges,89% of total Billed charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.89,77,,,Percent of total Billed charges,77% of total billed charges,51.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.22,54.19,
Meperidine 25mg SDV,641605225,CDM,250,RC,,,Outpatient,,,60.89,30.45,,46.89,77,,,Percent of Total Billed Charges,77% of total billed charges,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.06,74,,,Percent of Total Billed Charges,74% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,51.15,84,,,Percent of Total Billed Charges,84% of total billed charges,49.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.19,89,,,Percent of total Billed Charges,89% of total Billed charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.89,77,,,Percent of total Billed charges,77% of total billed charges,51.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.22,54.19,
Meperidine 25mg SDV,641605225,CDM,250,RC,,,Outpatient,,,60.89,30.45,,46.89,77,,,Percent of Total Billed Charges,77% of total billed charges,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.06,74,,,Percent of Total Billed Charges,74% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,51.15,84,,,Percent of Total Billed Charges,84% of total billed charges,49.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.19,89,,,Percent of total Billed Charges,89% of total Billed charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.89,77,,,Percent of total Billed charges,77% of total billed charges,51.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.22,54.19,
Meperidine 25mg SDV,641605225,CDM,250,RC,,,Outpatient,,,60.89,30.45,,46.89,77,,,Percent of Total Billed Charges,77% of total billed charges,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.06,74,,,Percent of Total Billed Charges,74% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,51.15,84,,,Percent of Total Billed Charges,84% of total billed charges,49.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.19,89,,,Percent of total Billed Charges,89% of total Billed charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.89,77,,,Percent of total Billed charges,77% of total billed charges,51.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.22,54.19,
Meperidine 25mg SDV,641605225,CDM,250,RC,,,Outpatient,,,60.89,30.45,,46.89,77,,,Percent of Total Billed Charges,77% of total billed charges,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.06,74,,,Percent of Total Billed Charges,74% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,51.15,84,,,Percent of Total Billed Charges,84% of total billed charges,49.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.19,89,,,Percent of total Billed Charges,89% of total Billed charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.89,77,,,Percent of total Billed charges,77% of total billed charges,51.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.22,54.19,
Meperidine 25mg SDV,641605225,CDM,250,RC,,,Outpatient,,,60.89,30.45,,46.89,77,,,Percent of Total Billed Charges,77% of total billed charges,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.06,74,,,Percent of Total Billed Charges,74% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,42.01,69,,,Percent of Total Billed Charges,69% of total billed charges,51.15,84,,,Percent of Total Billed Charges,84% of total billed charges,49.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.19,89,,,Percent of total Billed Charges,89% of total Billed charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.89,77,,,Percent of total Billed charges,77% of total billed charges,51.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.22,54.19,
Meperidine 50mg SDV,641605325,CDM,250,RC,,,Outpatient,,,61.71,30.86,,47.52,77,,,Percent of Total Billed Charges,77% of total billed charges,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.67,74,,,Percent of Total Billed Charges,74% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,51.84,84,,,Percent of Total Billed Charges,84% of total billed charges,50.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.92,89,,,Percent of total Billed Charges,89% of total Billed charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.52,77,,,Percent of total Billed charges,77% of total billed charges,52.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,54.92,
Meperidine 50mg SDV,641605325,CDM,250,RC,,,Outpatient,,,61.71,30.86,,47.52,77,,,Percent of Total Billed Charges,77% of total billed charges,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.67,74,,,Percent of Total Billed Charges,74% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,51.84,84,,,Percent of Total Billed Charges,84% of total billed charges,50.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.92,89,,,Percent of total Billed Charges,89% of total Billed charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.52,77,,,Percent of total Billed charges,77% of total billed charges,52.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,54.92,
Meperidine 50mg SDV,641605325,CDM,250,RC,,,Outpatient,,,61.71,30.86,,47.52,77,,,Percent of Total Billed Charges,77% of total billed charges,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.67,74,,,Percent of Total Billed Charges,74% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,51.84,84,,,Percent of Total Billed Charges,84% of total billed charges,50.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.92,89,,,Percent of total Billed Charges,89% of total Billed charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.52,77,,,Percent of total Billed charges,77% of total billed charges,52.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,54.92,
Meperidine 50mg SDV,641605325,CDM,250,RC,,,Outpatient,,,61.71,30.86,,47.52,77,,,Percent of Total Billed Charges,77% of total billed charges,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.67,74,,,Percent of Total Billed Charges,74% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,51.84,84,,,Percent of Total Billed Charges,84% of total billed charges,50.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.92,89,,,Percent of total Billed Charges,89% of total Billed charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.52,77,,,Percent of total Billed charges,77% of total billed charges,52.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,54.92,
Meperidine 50mg SDV,641605325,CDM,250,RC,,,Outpatient,,,61.71,30.86,,47.52,77,,,Percent of Total Billed Charges,77% of total billed charges,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.67,74,,,Percent of Total Billed Charges,74% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,51.84,84,,,Percent of Total Billed Charges,84% of total billed charges,50.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.92,89,,,Percent of total Billed Charges,89% of total Billed charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.52,77,,,Percent of total Billed charges,77% of total billed charges,52.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,54.92,
Meperidine 50mg SDV,641605325,CDM,250,RC,,,Outpatient,,,61.71,30.86,,47.52,77,,,Percent of Total Billed Charges,77% of total billed charges,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.67,74,,,Percent of Total Billed Charges,74% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,42.58,69,,,Percent of Total Billed Charges,69% of total billed charges,51.84,84,,,Percent of Total Billed Charges,84% of total billed charges,50.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,54.92,89,,,Percent of total Billed Charges,89% of total Billed charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.52,77,,,Percent of total Billed charges,77% of total billed charges,52.45,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.74,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.43,54.92,
Mepivacaine PF 2% 20mg/ml 20ml SDV,63323029427,CDM,250,RC,,,Outpatient,,,129.15,64.58,,99.45,77,,,Percent of Total Billed Charges,77% of total billed charges,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.57,74,,,Percent of Total Billed Charges,74% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,108.49,84,,,Percent of Total Billed Charges,84% of total billed charges,105.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.94,89,,,Percent of total Billed Charges,89% of total Billed charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.45,77,,,Percent of total Billed charges,77% of total billed charges,109.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.29,114.94,
Mepivacaine PF 2% 20mg/ml 20ml SDV,63323029427,CDM,250,RC,,,Outpatient,,,129.15,64.58,,99.45,77,,,Percent of Total Billed Charges,77% of total billed charges,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.57,74,,,Percent of Total Billed Charges,74% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,108.49,84,,,Percent of Total Billed Charges,84% of total billed charges,105.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.94,89,,,Percent of total Billed Charges,89% of total Billed charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.45,77,,,Percent of total Billed charges,77% of total billed charges,109.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.29,114.94,
Mepivacaine PF 2% 20mg/ml 20ml SDV,63323029427,CDM,250,RC,,,Outpatient,,,129.15,64.58,,99.45,77,,,Percent of Total Billed Charges,77% of total billed charges,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.57,74,,,Percent of Total Billed Charges,74% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,108.49,84,,,Percent of Total Billed Charges,84% of total billed charges,105.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.94,89,,,Percent of total Billed Charges,89% of total Billed charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.45,77,,,Percent of total Billed charges,77% of total billed charges,109.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.29,114.94,
Mepivacaine PF 2% 20mg/ml 20ml SDV,63323029427,CDM,250,RC,,,Outpatient,,,129.15,64.58,,99.45,77,,,Percent of Total Billed Charges,77% of total billed charges,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.57,74,,,Percent of Total Billed Charges,74% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,108.49,84,,,Percent of Total Billed Charges,84% of total billed charges,105.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.94,89,,,Percent of total Billed Charges,89% of total Billed charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.45,77,,,Percent of total Billed charges,77% of total billed charges,109.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.29,114.94,
Mepivacaine PF 2% 20mg/ml 20ml SDV,63323029427,CDM,250,RC,,,Outpatient,,,129.15,64.58,,99.45,77,,,Percent of Total Billed Charges,77% of total billed charges,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.57,74,,,Percent of Total Billed Charges,74% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,108.49,84,,,Percent of Total Billed Charges,84% of total billed charges,105.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.94,89,,,Percent of total Billed Charges,89% of total Billed charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.45,77,,,Percent of total Billed charges,77% of total billed charges,109.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.29,114.94,
Mepivacaine PF 2% 20mg/ml 20ml SDV,63323029427,CDM,250,RC,,,Outpatient,,,129.15,64.58,,99.45,77,,,Percent of Total Billed Charges,77% of total billed charges,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.57,74,,,Percent of Total Billed Charges,74% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,89.11,69,,,Percent of Total Billed Charges,69% of total billed charges,108.49,84,,,Percent of Total Billed Charges,84% of total billed charges,105.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.94,89,,,Percent of total Billed Charges,89% of total Billed charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.45,77,,,Percent of total Billed charges,77% of total billed charges,109.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.29,114.94,
Mepolizumab (Nucala) 100mg Powder Vial SDV,173088101,CDM,250,RC,,,Outpatient,,,16929.48,8464.74,,13035.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5290.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12527.82,74,,,Percent of Total Billed Charges,74% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,14220.76,84,,,Percent of Total Billed Charges,84% of total billed charges,13882.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,15067.24,89,,,Percent of total Billed Charges,89% of total Billed charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13035.7,77,,,Percent of total Billed charges,77% of total billed charges,14390.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4867.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8464.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.37,15067.24,
Mepolizumab (Nucala) 100mg Powder Vial SDV,173088101,CDM,250,RC,,,Outpatient,,,16929.48,8464.74,,13035.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5290.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12527.82,74,,,Percent of Total Billed Charges,74% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,14220.76,84,,,Percent of Total Billed Charges,84% of total billed charges,13882.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,15067.24,89,,,Percent of total Billed Charges,89% of total Billed charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13035.7,77,,,Percent of total Billed charges,77% of total billed charges,14390.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4867.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8464.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.37,15067.24,
Mepolizumab (Nucala) 100mg Powder Vial SDV,173088101,CDM,250,RC,,,Outpatient,,,16929.48,8464.74,,13035.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5290.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12527.82,74,,,Percent of Total Billed Charges,74% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,14220.76,84,,,Percent of Total Billed Charges,84% of total billed charges,13882.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,15067.24,89,,,Percent of total Billed Charges,89% of total Billed charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13035.7,77,,,Percent of total Billed charges,77% of total billed charges,14390.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4867.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8464.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.37,15067.24,
Mepolizumab (Nucala) 100mg Powder Vial SDV,173088101,CDM,250,RC,,,Outpatient,,,16929.48,8464.74,,13035.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5290.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12527.82,74,,,Percent of Total Billed Charges,74% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,14220.76,84,,,Percent of Total Billed Charges,84% of total billed charges,13882.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,15067.24,89,,,Percent of total Billed Charges,89% of total Billed charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13035.7,77,,,Percent of total Billed charges,77% of total billed charges,14390.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4867.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8464.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.37,15067.24,
Mepolizumab (Nucala) 100mg Powder Vial SDV,173088101,CDM,250,RC,,,Outpatient,,,16929.48,8464.74,,13035.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5290.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12527.82,74,,,Percent of Total Billed Charges,74% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,14220.76,84,,,Percent of Total Billed Charges,84% of total billed charges,13882.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,15067.24,89,,,Percent of total Billed Charges,89% of total Billed charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13035.7,77,,,Percent of total Billed charges,77% of total billed charges,14390.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4867.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8464.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.37,15067.24,
Mepolizumab (Nucala) 100mg Powder Vial SDV,173088101,CDM,250,RC,,,Outpatient,,,16929.48,8464.74,,13035.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4317.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5290.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12527.82,74,,,Percent of Total Billed Charges,74% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11681.34,69,,,Percent of Total Billed Charges,69% of total billed charges,14220.76,84,,,Percent of Total Billed Charges,84% of total billed charges,13882.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,15067.24,89,,,Percent of total Billed Charges,89% of total Billed charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13035.7,77,,,Percent of total Billed charges,77% of total billed charges,14390.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4867.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8464.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6907.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15067.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4232.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4232.37,15067.24,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 1000mg SDV,63323050831,CDM,250,RC,,,Outpatient,,,88.52,44.26,,68.16,77,,,Percent of Total Billed Charges,77% of total billed charges,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,65.5,74,,,Percent of Total Billed Charges,74% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,61.08,69,,,Percent of Total Billed Charges,69% of total billed charges,74.36,84,,,Percent of Total Billed Charges,84% of total billed charges,72.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,78.78,89,,,Percent of total Billed Charges,89% of total Billed charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.16,77,,,Percent of total Billed charges,77% of total billed charges,75.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.13,78.78,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Meropenem 500mg SDV,63323050721,CDM,250,RC,,,Outpatient,,,64.67,32.34,,49.8,77,,,Percent of Total Billed Charges,77% of total billed charges,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.86,74,,,Percent of Total Billed Charges,74% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.62,69,,,Percent of Total Billed Charges,69% of total billed charges,54.32,84,,,Percent of Total Billed Charges,84% of total billed charges,53.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.56,89,,,Percent of total Billed Charges,89% of total Billed charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.8,77,,,Percent of total Billed charges,77% of total billed charges,54.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.17,57.56,
Mesalamine 400mg Capsule,23585318,CDM,250,RC,,,Outpatient,,,41.41,20.71,,31.89,77,,,Percent of Total Billed Charges,77% of total billed charges,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.64,74,,,Percent of Total Billed Charges,74% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,84,,,Percent of Total Billed Charges,84% of total billed charges,33.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.85,89,,,Percent of total Billed Charges,89% of total Billed charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.89,77,,,Percent of total Billed charges,77% of total billed charges,35.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,36.85,
Mesalamine 400mg Capsule,23585318,CDM,250,RC,,,Outpatient,,,41.41,20.71,,31.89,77,,,Percent of Total Billed Charges,77% of total billed charges,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.64,74,,,Percent of Total Billed Charges,74% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,84,,,Percent of Total Billed Charges,84% of total billed charges,33.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.85,89,,,Percent of total Billed Charges,89% of total Billed charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.89,77,,,Percent of total Billed charges,77% of total billed charges,35.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,36.85,
Mesalamine 400mg Capsule,23585318,CDM,250,RC,,,Outpatient,,,41.41,20.71,,31.89,77,,,Percent of Total Billed Charges,77% of total billed charges,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.64,74,,,Percent of Total Billed Charges,74% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,84,,,Percent of Total Billed Charges,84% of total billed charges,33.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.85,89,,,Percent of total Billed Charges,89% of total Billed charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.89,77,,,Percent of total Billed charges,77% of total billed charges,35.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,36.85,
Mesalamine 400mg Capsule,23585318,CDM,250,RC,,,Outpatient,,,41.41,20.71,,31.89,77,,,Percent of Total Billed Charges,77% of total billed charges,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.64,74,,,Percent of Total Billed Charges,74% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,84,,,Percent of Total Billed Charges,84% of total billed charges,33.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.85,89,,,Percent of total Billed Charges,89% of total Billed charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.89,77,,,Percent of total Billed charges,77% of total billed charges,35.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,36.85,
Mesalamine 400mg Capsule,23585318,CDM,250,RC,,,Outpatient,,,41.41,20.71,,31.89,77,,,Percent of Total Billed Charges,77% of total billed charges,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.64,74,,,Percent of Total Billed Charges,74% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,84,,,Percent of Total Billed Charges,84% of total billed charges,33.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.85,89,,,Percent of total Billed Charges,89% of total Billed charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.89,77,,,Percent of total Billed charges,77% of total billed charges,35.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,36.85,
Mesalamine 400mg Capsule,23585318,CDM,250,RC,,,Outpatient,,,41.41,20.71,,31.89,77,,,Percent of Total Billed Charges,77% of total billed charges,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.64,74,,,Percent of Total Billed Charges,74% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,28.57,69,,,Percent of Total Billed Charges,69% of total billed charges,34.78,84,,,Percent of Total Billed Charges,84% of total billed charges,33.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.85,89,,,Percent of total Billed Charges,89% of total Billed charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.89,77,,,Percent of total Billed charges,77% of total billed charges,35.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.35,36.85,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
Mesna 1000mg/10ml Liquid MDV,338130501,CDM,250,RC,,,Outpatient,,,202.11,101.06,,155.62,77,,,Percent of Total Billed Charges,77% of total billed charges,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,149.56,74,,,Percent of Total Billed Charges,74% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,139.46,69,,,Percent of Total Billed Charges,69% of total billed charges,169.77,84,,,Percent of Total Billed Charges,84% of total billed charges,165.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.88,89,,,Percent of total Billed Charges,89% of total Billed charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,155.62,77,,,Percent of total Billed charges,77% of total billed charges,171.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,58.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,101.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.53,179.88,
metFORMIN Extended Release 500mg Tablet-OB use only,62756014201,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
metFORMIN Extended Release 500mg Tablet-OB use only,62756014201,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
metFORMIN Extended Release 500mg Tablet-OB use only,62756014201,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
metFORMIN Extended Release 500mg Tablet-OB use only,62756014201,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
metFORMIN Extended Release 500mg Tablet-OB use only,62756014201,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
metFORMIN Extended Release 500mg Tablet-OB use only,62756014201,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Methocarbamol 750mg Tablet,70010077001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Methocarbamol 750mg Tablet,70010077001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Methocarbamol 750mg Tablet,70010077001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Methocarbamol 750mg Tablet,70010077001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Methocarbamol 750mg Tablet,70010077001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Methocarbamol 750mg Tablet,70010077001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Methylergonovine 0.2mg Tablet,,,250,RC,,,Outpatient,,,259.38,129.69,,199.72,77,,,Percent of Total Billed Charges,77% of total billed charges,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.94,74,,,Percent of Total Billed Charges,74% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,217.88,84,,,Percent of Total Billed Charges,84% of total billed charges,212.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.85,89,,,Percent of total Billed Charges,89% of total Billed charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.72,77,,,Percent of total Billed charges,77% of total billed charges,220.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.85,230.85,
Methylergonovine 0.2mg Tablet,,,250,RC,,,Outpatient,,,259.38,129.69,,199.72,77,,,Percent of Total Billed Charges,77% of total billed charges,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.94,74,,,Percent of Total Billed Charges,74% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,217.88,84,,,Percent of Total Billed Charges,84% of total billed charges,212.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.85,89,,,Percent of total Billed Charges,89% of total Billed charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.72,77,,,Percent of total Billed charges,77% of total billed charges,220.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.85,230.85,
Methylergonovine 0.2mg Tablet,,,250,RC,,,Outpatient,,,259.38,129.69,,199.72,77,,,Percent of Total Billed Charges,77% of total billed charges,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.94,74,,,Percent of Total Billed Charges,74% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,217.88,84,,,Percent of Total Billed Charges,84% of total billed charges,212.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.85,89,,,Percent of total Billed Charges,89% of total Billed charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.72,77,,,Percent of total Billed charges,77% of total billed charges,220.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.85,230.85,
Methylergonovine 0.2mg Tablet,,,250,RC,,,Outpatient,,,259.38,129.69,,199.72,77,,,Percent of Total Billed Charges,77% of total billed charges,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.94,74,,,Percent of Total Billed Charges,74% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,217.88,84,,,Percent of Total Billed Charges,84% of total billed charges,212.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.85,89,,,Percent of total Billed Charges,89% of total Billed charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.72,77,,,Percent of total Billed charges,77% of total billed charges,220.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.85,230.85,
Methylergonovine 0.2mg Tablet,,,250,RC,,,Outpatient,,,259.38,129.69,,199.72,77,,,Percent of Total Billed Charges,77% of total billed charges,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.94,74,,,Percent of Total Billed Charges,74% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,217.88,84,,,Percent of Total Billed Charges,84% of total billed charges,212.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.85,89,,,Percent of total Billed Charges,89% of total Billed charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.72,77,,,Percent of total Billed charges,77% of total billed charges,220.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.85,230.85,
Methylergonovine 0.2mg Tablet,,,250,RC,,,Outpatient,,,259.38,129.69,,199.72,77,,,Percent of Total Billed Charges,77% of total billed charges,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,66.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,191.94,74,,,Percent of Total Billed Charges,74% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,178.97,69,,,Percent of Total Billed Charges,69% of total billed charges,217.88,84,,,Percent of Total Billed Charges,84% of total billed charges,212.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,230.85,89,,,Percent of total Billed Charges,89% of total Billed charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.72,77,,,Percent of total Billed charges,77% of total billed charges,220.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,74.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,129.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,105.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.85,230.85,
Methylergonovine 0.2mg/ml SDV,517074020,CDM,250,RC,,,Outpatient,,,236.93,118.47,,182.44,77,,,Percent of Total Billed Charges,77% of total billed charges,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.33,74,,,Percent of Total Billed Charges,74% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,199.02,84,,,Percent of Total Billed Charges,84% of total billed charges,194.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.87,89,,,Percent of total Billed Charges,89% of total Billed charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.44,77,,,Percent of total Billed charges,77% of total billed charges,201.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.23,210.87,
Methylergonovine 0.2mg/ml SDV,517074020,CDM,250,RC,,,Outpatient,,,236.93,118.47,,182.44,77,,,Percent of Total Billed Charges,77% of total billed charges,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.33,74,,,Percent of Total Billed Charges,74% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,199.02,84,,,Percent of Total Billed Charges,84% of total billed charges,194.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.87,89,,,Percent of total Billed Charges,89% of total Billed charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.44,77,,,Percent of total Billed charges,77% of total billed charges,201.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.23,210.87,
Methylergonovine 0.2mg/ml SDV,517074020,CDM,250,RC,,,Outpatient,,,236.93,118.47,,182.44,77,,,Percent of Total Billed Charges,77% of total billed charges,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.33,74,,,Percent of Total Billed Charges,74% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,199.02,84,,,Percent of Total Billed Charges,84% of total billed charges,194.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.87,89,,,Percent of total Billed Charges,89% of total Billed charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.44,77,,,Percent of total Billed charges,77% of total billed charges,201.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.23,210.87,
Methylergonovine 0.2mg/ml SDV,517074020,CDM,250,RC,,,Outpatient,,,236.93,118.47,,182.44,77,,,Percent of Total Billed Charges,77% of total billed charges,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.33,74,,,Percent of Total Billed Charges,74% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,199.02,84,,,Percent of Total Billed Charges,84% of total billed charges,194.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.87,89,,,Percent of total Billed Charges,89% of total Billed charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.44,77,,,Percent of total Billed charges,77% of total billed charges,201.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.23,210.87,
Methylergonovine 0.2mg/ml SDV,517074020,CDM,250,RC,,,Outpatient,,,236.93,118.47,,182.44,77,,,Percent of Total Billed Charges,77% of total billed charges,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.33,74,,,Percent of Total Billed Charges,74% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,199.02,84,,,Percent of Total Billed Charges,84% of total billed charges,194.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.87,89,,,Percent of total Billed Charges,89% of total Billed charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.44,77,,,Percent of total Billed charges,77% of total billed charges,201.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.23,210.87,
Methylergonovine 0.2mg/ml SDV,517074020,CDM,250,RC,,,Outpatient,,,236.93,118.47,,182.44,77,,,Percent of Total Billed Charges,77% of total billed charges,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,175.33,74,,,Percent of Total Billed Charges,74% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,163.48,69,,,Percent of Total Billed Charges,69% of total billed charges,199.02,84,,,Percent of Total Billed Charges,84% of total billed charges,194.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,210.87,89,,,Percent of total Billed Charges,89% of total Billed charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,182.44,77,,,Percent of total Billed charges,77% of total billed charges,201.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,118.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,96.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,210.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.23,210.87,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
methylPREDNISolone Sodium Succinate 1000mg/16ml MDV,9001820,CDM,250,RC,,,Outpatient,,,446.93,223.47,,344.14,77,,,Percent of Total Billed Charges,77% of total billed charges,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,139.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,330.73,74,,,Percent of Total Billed Charges,74% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,308.38,69,,,Percent of Total Billed Charges,69% of total billed charges,375.42,84,,,Percent of Total Billed Charges,84% of total billed charges,366.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,397.77,89,,,Percent of total Billed Charges,89% of total Billed charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,344.14,77,,,Percent of total Billed charges,77% of total billed charges,379.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,128.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,223.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,182.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,397.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.73,397.77,
Methadone 10mg Tablet,406577162,CDM,250,RC,,,Outpatient,,,9.88,4.94,,7.61,77,,,Percent of Total Billed Charges,77% of total billed charges,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.31,74,,,Percent of Total Billed Charges,74% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.3,84,,,Percent of Total Billed Charges,84% of total billed charges,8.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.79,89,,,Percent of total Billed Charges,89% of total Billed charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.61,77,,,Percent of total Billed charges,77% of total billed charges,8.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,8.79,
Methadone 10mg Tablet,406577162,CDM,250,RC,,,Outpatient,,,9.88,4.94,,7.61,77,,,Percent of Total Billed Charges,77% of total billed charges,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.31,74,,,Percent of Total Billed Charges,74% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.3,84,,,Percent of Total Billed Charges,84% of total billed charges,8.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.79,89,,,Percent of total Billed Charges,89% of total Billed charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.61,77,,,Percent of total Billed charges,77% of total billed charges,8.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,8.79,
Methadone 10mg Tablet,406577162,CDM,250,RC,,,Outpatient,,,9.88,4.94,,7.61,77,,,Percent of Total Billed Charges,77% of total billed charges,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.31,74,,,Percent of Total Billed Charges,74% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.3,84,,,Percent of Total Billed Charges,84% of total billed charges,8.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.79,89,,,Percent of total Billed Charges,89% of total Billed charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.61,77,,,Percent of total Billed charges,77% of total billed charges,8.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,8.79,
Methadone 10mg Tablet,406577162,CDM,250,RC,,,Outpatient,,,9.88,4.94,,7.61,77,,,Percent of Total Billed Charges,77% of total billed charges,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.31,74,,,Percent of Total Billed Charges,74% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.3,84,,,Percent of Total Billed Charges,84% of total billed charges,8.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.79,89,,,Percent of total Billed Charges,89% of total Billed charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.61,77,,,Percent of total Billed charges,77% of total billed charges,8.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,8.79,
Methadone 10mg Tablet,406577162,CDM,250,RC,,,Outpatient,,,9.88,4.94,,7.61,77,,,Percent of Total Billed Charges,77% of total billed charges,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.31,74,,,Percent of Total Billed Charges,74% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.3,84,,,Percent of Total Billed Charges,84% of total billed charges,8.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.79,89,,,Percent of total Billed Charges,89% of total Billed charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.61,77,,,Percent of total Billed charges,77% of total billed charges,8.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,8.79,
Methadone 10mg Tablet,406577162,CDM,250,RC,,,Outpatient,,,9.88,4.94,,7.61,77,,,Percent of Total Billed Charges,77% of total billed charges,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.31,74,,,Percent of Total Billed Charges,74% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,6.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8.3,84,,,Percent of Total Billed Charges,84% of total billed charges,8.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.79,89,,,Percent of total Billed Charges,89% of total Billed charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.61,77,,,Percent of total Billed charges,77% of total billed charges,8.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.47,8.79,
methIMAzole 10mg Tablet,23155007101,CDM,250,RC,,,Outpatient,,,12.23,6.12,,9.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.05,74,,,Percent of Total Billed Charges,74% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,10.27,84,,,Percent of Total Billed Charges,84% of total billed charges,10.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.88,89,,,Percent of total Billed Charges,89% of total Billed charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.42,77,,,Percent of total Billed charges,77% of total billed charges,10.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.06,10.88,
methIMAzole 10mg Tablet,23155007101,CDM,250,RC,,,Outpatient,,,12.23,6.12,,9.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.05,74,,,Percent of Total Billed Charges,74% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,10.27,84,,,Percent of Total Billed Charges,84% of total billed charges,10.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.88,89,,,Percent of total Billed Charges,89% of total Billed charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.42,77,,,Percent of total Billed charges,77% of total billed charges,10.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.06,10.88,
methIMAzole 10mg Tablet,23155007101,CDM,250,RC,,,Outpatient,,,12.23,6.12,,9.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.05,74,,,Percent of Total Billed Charges,74% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,10.27,84,,,Percent of Total Billed Charges,84% of total billed charges,10.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.88,89,,,Percent of total Billed Charges,89% of total Billed charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.42,77,,,Percent of total Billed charges,77% of total billed charges,10.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.06,10.88,
methIMAzole 10mg Tablet,23155007101,CDM,250,RC,,,Outpatient,,,12.23,6.12,,9.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.05,74,,,Percent of Total Billed Charges,74% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,10.27,84,,,Percent of Total Billed Charges,84% of total billed charges,10.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.88,89,,,Percent of total Billed Charges,89% of total Billed charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.42,77,,,Percent of total Billed charges,77% of total billed charges,10.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.06,10.88,
methIMAzole 10mg Tablet,23155007101,CDM,250,RC,,,Outpatient,,,12.23,6.12,,9.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.05,74,,,Percent of Total Billed Charges,74% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,10.27,84,,,Percent of Total Billed Charges,84% of total billed charges,10.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.88,89,,,Percent of total Billed Charges,89% of total Billed charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.42,77,,,Percent of total Billed charges,77% of total billed charges,10.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.06,10.88,
methIMAzole 10mg Tablet,23155007101,CDM,250,RC,,,Outpatient,,,12.23,6.12,,9.42,77,,,Percent of Total Billed Charges,77% of total billed charges,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.05,74,,,Percent of Total Billed Charges,74% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,8.44,69,,,Percent of Total Billed Charges,69% of total billed charges,10.27,84,,,Percent of Total Billed Charges,84% of total billed charges,10.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.88,89,,,Percent of total Billed Charges,89% of total Billed charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.42,77,,,Percent of total Billed charges,77% of total billed charges,10.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.06,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.06,10.88,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
methylPREDNISolone Sodium Succinate 125mg/2ml SDV,9004726,CDM,250,RC,,,Outpatient,,,125.7,62.85,,96.79,77,,,Percent of Total Billed Charges,77% of total billed charges,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,93.02,74,,,Percent of Total Billed Charges,74% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,86.73,69,,,Percent of Total Billed Charges,69% of total billed charges,105.59,84,,,Percent of Total Billed Charges,84% of total billed charges,103.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,111.87,89,,,Percent of total Billed Charges,89% of total Billed charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.79,77,,,Percent of total Billed charges,77% of total billed charges,106.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,62.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,51.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.43,111.87,
Methylnaltrexone 12mg/0.6mg SDV,65649055102,CDM,250,RC,,,Outpatient,,,754.08,377.04,,580.64,77,,,Percent of Total Billed Charges,77% of total billed charges,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,558.02,74,,,Percent of Total Billed Charges,74% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,633.43,84,,,Percent of Total Billed Charges,84% of total billed charges,618.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,671.13,89,,,Percent of total Billed Charges,89% of total Billed charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.64,77,,,Percent of total Billed charges,77% of total billed charges,640.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,377.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.52,671.13,
Methylnaltrexone 12mg/0.6mg SDV,65649055102,CDM,250,RC,,,Outpatient,,,754.08,377.04,,580.64,77,,,Percent of Total Billed Charges,77% of total billed charges,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,558.02,74,,,Percent of Total Billed Charges,74% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,633.43,84,,,Percent of Total Billed Charges,84% of total billed charges,618.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,671.13,89,,,Percent of total Billed Charges,89% of total Billed charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.64,77,,,Percent of total Billed charges,77% of total billed charges,640.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,377.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.52,671.13,
Methylnaltrexone 12mg/0.6mg SDV,65649055102,CDM,250,RC,,,Outpatient,,,754.08,377.04,,580.64,77,,,Percent of Total Billed Charges,77% of total billed charges,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,558.02,74,,,Percent of Total Billed Charges,74% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,633.43,84,,,Percent of Total Billed Charges,84% of total billed charges,618.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,671.13,89,,,Percent of total Billed Charges,89% of total Billed charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.64,77,,,Percent of total Billed charges,77% of total billed charges,640.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,377.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.52,671.13,
Methylnaltrexone 12mg/0.6mg SDV,65649055102,CDM,250,RC,,,Outpatient,,,754.08,377.04,,580.64,77,,,Percent of Total Billed Charges,77% of total billed charges,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,558.02,74,,,Percent of Total Billed Charges,74% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,633.43,84,,,Percent of Total Billed Charges,84% of total billed charges,618.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,671.13,89,,,Percent of total Billed Charges,89% of total Billed charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.64,77,,,Percent of total Billed charges,77% of total billed charges,640.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,377.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.52,671.13,
Methylnaltrexone 12mg/0.6mg SDV,65649055102,CDM,250,RC,,,Outpatient,,,754.08,377.04,,580.64,77,,,Percent of Total Billed Charges,77% of total billed charges,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,558.02,74,,,Percent of Total Billed Charges,74% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,633.43,84,,,Percent of Total Billed Charges,84% of total billed charges,618.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,671.13,89,,,Percent of total Billed Charges,89% of total Billed charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.64,77,,,Percent of total Billed charges,77% of total billed charges,640.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,377.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.52,671.13,
Methylnaltrexone 12mg/0.6mg SDV,65649055102,CDM,250,RC,,,Outpatient,,,754.08,377.04,,580.64,77,,,Percent of Total Billed Charges,77% of total billed charges,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,235.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,558.02,74,,,Percent of Total Billed Charges,74% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,520.32,69,,,Percent of Total Billed Charges,69% of total billed charges,633.43,84,,,Percent of Total Billed Charges,84% of total billed charges,618.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,671.13,89,,,Percent of total Billed Charges,89% of total Billed charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,580.64,77,,,Percent of total Billed charges,77% of total billed charges,640.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,216.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,377.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,307.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,671.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,188.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.52,671.13,
Meth/Me Blue/Sod Phos/Phen/Hyos Capsule,58657045601,CDM,250,RC,,,Outpatient,,,29.31,14.66,,22.57,77,,,Percent of Total Billed Charges,77% of total billed charges,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.69,74,,,Percent of Total Billed Charges,74% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,24.62,84,,,Percent of Total Billed Charges,84% of total billed charges,24.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.09,89,,,Percent of total Billed Charges,89% of total Billed charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,77,,,Percent of total Billed charges,77% of total billed charges,24.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,26.09,
Meth/Me Blue/Sod Phos/Phen/Hyos Capsule,58657045601,CDM,250,RC,,,Outpatient,,,29.31,14.66,,22.57,77,,,Percent of Total Billed Charges,77% of total billed charges,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.69,74,,,Percent of Total Billed Charges,74% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,24.62,84,,,Percent of Total Billed Charges,84% of total billed charges,24.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.09,89,,,Percent of total Billed Charges,89% of total Billed charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,77,,,Percent of total Billed charges,77% of total billed charges,24.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,26.09,
Meth/Me Blue/Sod Phos/Phen/Hyos Capsule,58657045601,CDM,250,RC,,,Outpatient,,,29.31,14.66,,22.57,77,,,Percent of Total Billed Charges,77% of total billed charges,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.69,74,,,Percent of Total Billed Charges,74% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,24.62,84,,,Percent of Total Billed Charges,84% of total billed charges,24.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.09,89,,,Percent of total Billed Charges,89% of total Billed charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,77,,,Percent of total Billed charges,77% of total billed charges,24.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,26.09,
Meth/Me Blue/Sod Phos/Phen/Hyos Capsule,58657045601,CDM,250,RC,,,Outpatient,,,29.31,14.66,,22.57,77,,,Percent of Total Billed Charges,77% of total billed charges,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.69,74,,,Percent of Total Billed Charges,74% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,24.62,84,,,Percent of Total Billed Charges,84% of total billed charges,24.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.09,89,,,Percent of total Billed Charges,89% of total Billed charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,77,,,Percent of total Billed charges,77% of total billed charges,24.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,26.09,
Meth/Me Blue/Sod Phos/Phen/Hyos Capsule,58657045601,CDM,250,RC,,,Outpatient,,,29.31,14.66,,22.57,77,,,Percent of Total Billed Charges,77% of total billed charges,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.69,74,,,Percent of Total Billed Charges,74% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,24.62,84,,,Percent of Total Billed Charges,84% of total billed charges,24.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.09,89,,,Percent of total Billed Charges,89% of total Billed charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,77,,,Percent of total Billed charges,77% of total billed charges,24.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,26.09,
Meth/Me Blue/Sod Phos/Phen/Hyos Capsule,58657045601,CDM,250,RC,,,Outpatient,,,29.31,14.66,,22.57,77,,,Percent of Total Billed Charges,77% of total billed charges,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.16,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.69,74,,,Percent of Total Billed Charges,74% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,20.22,69,,,Percent of Total Billed Charges,69% of total billed charges,24.62,84,,,Percent of Total Billed Charges,84% of total billed charges,24.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,26.09,89,,,Percent of total Billed Charges,89% of total Billed charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,77,,,Percent of total Billed charges,77% of total billed charges,24.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.33,26.09,
methoTREXate 2.5mg Tablet,51079067005,CDM,250,RC,,,Outpatient,,,59.94,29.97,,46.15,77,,,Percent of Total Billed Charges,77% of total billed charges,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.36,74,,,Percent of Total Billed Charges,74% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,50.35,84,,,Percent of Total Billed Charges,84% of total billed charges,49.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.35,89,,,Percent of total Billed Charges,89% of total Billed charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.15,77,,,Percent of total Billed charges,77% of total billed charges,50.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.99,53.35,
methoTREXate 2.5mg Tablet,51079067005,CDM,250,RC,,,Outpatient,,,59.94,29.97,,46.15,77,,,Percent of Total Billed Charges,77% of total billed charges,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.36,74,,,Percent of Total Billed Charges,74% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,50.35,84,,,Percent of Total Billed Charges,84% of total billed charges,49.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.35,89,,,Percent of total Billed Charges,89% of total Billed charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.15,77,,,Percent of total Billed charges,77% of total billed charges,50.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.99,53.35,
methoTREXate 2.5mg Tablet,51079067005,CDM,250,RC,,,Outpatient,,,59.94,29.97,,46.15,77,,,Percent of Total Billed Charges,77% of total billed charges,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.36,74,,,Percent of Total Billed Charges,74% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,50.35,84,,,Percent of Total Billed Charges,84% of total billed charges,49.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.35,89,,,Percent of total Billed Charges,89% of total Billed charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.15,77,,,Percent of total Billed charges,77% of total billed charges,50.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.99,53.35,
methoTREXate 2.5mg Tablet,51079067005,CDM,250,RC,,,Outpatient,,,59.94,29.97,,46.15,77,,,Percent of Total Billed Charges,77% of total billed charges,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.36,74,,,Percent of Total Billed Charges,74% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,50.35,84,,,Percent of Total Billed Charges,84% of total billed charges,49.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.35,89,,,Percent of total Billed Charges,89% of total Billed charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.15,77,,,Percent of total Billed charges,77% of total billed charges,50.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.99,53.35,
methoTREXate 2.5mg Tablet,51079067005,CDM,250,RC,,,Outpatient,,,59.94,29.97,,46.15,77,,,Percent of Total Billed Charges,77% of total billed charges,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.36,74,,,Percent of Total Billed Charges,74% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,50.35,84,,,Percent of Total Billed Charges,84% of total billed charges,49.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.35,89,,,Percent of total Billed Charges,89% of total Billed charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.15,77,,,Percent of total Billed charges,77% of total billed charges,50.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.99,53.35,
methoTREXate 2.5mg Tablet,51079067005,CDM,250,RC,,,Outpatient,,,59.94,29.97,,46.15,77,,,Percent of Total Billed Charges,77% of total billed charges,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.36,74,,,Percent of Total Billed Charges,74% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,41.36,69,,,Percent of Total Billed Charges,69% of total billed charges,50.35,84,,,Percent of Total Billed Charges,84% of total billed charges,49.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.35,89,,,Percent of total Billed Charges,89% of total Billed charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.15,77,,,Percent of total Billed charges,77% of total billed charges,50.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,29.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.99,53.35,
methoTREXate 50mg/2ml MDV,61703035038,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
methoTREXate 50mg/2ml MDV,61703035038,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
methoTREXate 50mg/2ml MDV,61703035038,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
methoTREXate 50mg/2ml MDV,61703035038,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
methoTREXate 50mg/2ml MDV,61703035038,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
methoTREXate 50mg/2ml MDV,61703035038,CDM,250,RC,,,Outpatient,,,99.79,49.9,,76.84,77,,,Percent of Total Billed Charges,77% of total billed charges,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,73.84,74,,,Percent of Total Billed Charges,74% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,68.86,69,,,Percent of Total Billed Charges,69% of total billed charges,83.82,84,,,Percent of Total Billed Charges,84% of total billed charges,81.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,88.81,89,,,Percent of total Billed Charges,89% of total Billed charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.84,77,,,Percent of total Billed charges,77% of total billed charges,84.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,28.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,49.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,40.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.95,88.81,
MethylPREDNISolone Acetate 40mg/ml SDV,9307301,CDM,250,RC,,,Outpatient,,,133.43,66.72,,102.74,77,,,Percent of Total Billed Charges,77% of total billed charges,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.74,74,,,Percent of Total Billed Charges,74% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,112.08,84,,,Percent of Total Billed Charges,84% of total billed charges,109.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.75,89,,,Percent of total Billed Charges,89% of total Billed charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,77,,,Percent of total Billed charges,77% of total billed charges,113.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.36,118.75,
MethylPREDNISolone Acetate 40mg/ml SDV,9307301,CDM,250,RC,,,Outpatient,,,133.43,66.72,,102.74,77,,,Percent of Total Billed Charges,77% of total billed charges,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.74,74,,,Percent of Total Billed Charges,74% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,112.08,84,,,Percent of Total Billed Charges,84% of total billed charges,109.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.75,89,,,Percent of total Billed Charges,89% of total Billed charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,77,,,Percent of total Billed charges,77% of total billed charges,113.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.36,118.75,
MethylPREDNISolone Acetate 40mg/ml SDV,9307301,CDM,250,RC,,,Outpatient,,,133.43,66.72,,102.74,77,,,Percent of Total Billed Charges,77% of total billed charges,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.74,74,,,Percent of Total Billed Charges,74% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,112.08,84,,,Percent of Total Billed Charges,84% of total billed charges,109.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.75,89,,,Percent of total Billed Charges,89% of total Billed charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,77,,,Percent of total Billed charges,77% of total billed charges,113.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.36,118.75,
MethylPREDNISolone Acetate 40mg/ml SDV,9307301,CDM,250,RC,,,Outpatient,,,133.43,66.72,,102.74,77,,,Percent of Total Billed Charges,77% of total billed charges,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.74,74,,,Percent of Total Billed Charges,74% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,112.08,84,,,Percent of Total Billed Charges,84% of total billed charges,109.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.75,89,,,Percent of total Billed Charges,89% of total Billed charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,77,,,Percent of total Billed charges,77% of total billed charges,113.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.36,118.75,
MethylPREDNISolone Acetate 40mg/ml SDV,9307301,CDM,250,RC,,,Outpatient,,,133.43,66.72,,102.74,77,,,Percent of Total Billed Charges,77% of total billed charges,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.74,74,,,Percent of Total Billed Charges,74% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,112.08,84,,,Percent of Total Billed Charges,84% of total billed charges,109.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.75,89,,,Percent of total Billed Charges,89% of total Billed charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,77,,,Percent of total Billed charges,77% of total billed charges,113.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.36,118.75,
MethylPREDNISolone Acetate 40mg/ml SDV,9307301,CDM,250,RC,,,Outpatient,,,133.43,66.72,,102.74,77,,,Percent of Total Billed Charges,77% of total billed charges,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,98.74,74,,,Percent of Total Billed Charges,74% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,92.07,69,,,Percent of Total Billed Charges,69% of total billed charges,112.08,84,,,Percent of Total Billed Charges,84% of total billed charges,109.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,118.75,89,,,Percent of total Billed Charges,89% of total Billed charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.74,77,,,Percent of total Billed charges,77% of total billed charges,113.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,66.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.36,118.75,
methylPREDNISolone Sodium Succinate 40mg/ml SDV,9003928,CDM,250,RC,,,Outpatient,,,93.21,46.61,,71.77,77,,,Percent of Total Billed Charges,77% of total billed charges,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.98,74,,,Percent of Total Billed Charges,74% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,78.3,84,,,Percent of Total Billed Charges,84% of total billed charges,76.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.96,89,,,Percent of total Billed Charges,89% of total Billed charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.77,77,,,Percent of total Billed charges,77% of total billed charges,79.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.3,82.96,
methylPREDNISolone Sodium Succinate 40mg/ml SDV,9003928,CDM,250,RC,,,Outpatient,,,93.21,46.61,,71.77,77,,,Percent of Total Billed Charges,77% of total billed charges,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.98,74,,,Percent of Total Billed Charges,74% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,78.3,84,,,Percent of Total Billed Charges,84% of total billed charges,76.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.96,89,,,Percent of total Billed Charges,89% of total Billed charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.77,77,,,Percent of total Billed charges,77% of total billed charges,79.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.3,82.96,
methylPREDNISolone Sodium Succinate 40mg/ml SDV,9003928,CDM,250,RC,,,Outpatient,,,93.21,46.61,,71.77,77,,,Percent of Total Billed Charges,77% of total billed charges,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.98,74,,,Percent of Total Billed Charges,74% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,78.3,84,,,Percent of Total Billed Charges,84% of total billed charges,76.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.96,89,,,Percent of total Billed Charges,89% of total Billed charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.77,77,,,Percent of total Billed charges,77% of total billed charges,79.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.3,82.96,
methylPREDNISolone Sodium Succinate 40mg/ml SDV,9003928,CDM,250,RC,,,Outpatient,,,93.21,46.61,,71.77,77,,,Percent of Total Billed Charges,77% of total billed charges,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.98,74,,,Percent of Total Billed Charges,74% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,78.3,84,,,Percent of Total Billed Charges,84% of total billed charges,76.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.96,89,,,Percent of total Billed Charges,89% of total Billed charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.77,77,,,Percent of total Billed charges,77% of total billed charges,79.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.3,82.96,
methylPREDNISolone Sodium Succinate 40mg/ml SDV,9003928,CDM,250,RC,,,Outpatient,,,93.21,46.61,,71.77,77,,,Percent of Total Billed Charges,77% of total billed charges,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.98,74,,,Percent of Total Billed Charges,74% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,78.3,84,,,Percent of Total Billed Charges,84% of total billed charges,76.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.96,89,,,Percent of total Billed Charges,89% of total Billed charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.77,77,,,Percent of total Billed charges,77% of total billed charges,79.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.3,82.96,
methylPREDNISolone Sodium Succinate 40mg/ml SDV,9003928,CDM,250,RC,,,Outpatient,,,93.21,46.61,,71.77,77,,,Percent of Total Billed Charges,77% of total billed charges,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.98,74,,,Percent of Total Billed Charges,74% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,64.31,69,,,Percent of Total Billed Charges,69% of total billed charges,78.3,84,,,Percent of Total Billed Charges,84% of total billed charges,76.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.96,89,,,Percent of total Billed Charges,89% of total Billed charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.77,77,,,Percent of total Billed charges,77% of total billed charges,79.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.3,82.96,
methylPREDNISolone 4mg Dosepack #21 Tablets,59746000103,CDM,250,RC,,,Outpatient,,,169.35,84.68,,130.4,77,,,Percent of Total Billed Charges,77% of total billed charges,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.32,74,,,Percent of Total Billed Charges,74% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,142.25,84,,,Percent of Total Billed Charges,84% of total billed charges,138.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.72,89,,,Percent of total Billed Charges,89% of total Billed charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.4,77,,,Percent of total Billed charges,77% of total billed charges,143.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.34,150.72,
methylPREDNISolone 4mg Dosepack #21 Tablets,59746000103,CDM,250,RC,,,Outpatient,,,169.35,84.68,,130.4,77,,,Percent of Total Billed Charges,77% of total billed charges,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.32,74,,,Percent of Total Billed Charges,74% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,142.25,84,,,Percent of Total Billed Charges,84% of total billed charges,138.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.72,89,,,Percent of total Billed Charges,89% of total Billed charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.4,77,,,Percent of total Billed charges,77% of total billed charges,143.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.34,150.72,
methylPREDNISolone 4mg Dosepack #21 Tablets,59746000103,CDM,250,RC,,,Outpatient,,,169.35,84.68,,130.4,77,,,Percent of Total Billed Charges,77% of total billed charges,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.32,74,,,Percent of Total Billed Charges,74% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,142.25,84,,,Percent of Total Billed Charges,84% of total billed charges,138.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.72,89,,,Percent of total Billed Charges,89% of total Billed charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.4,77,,,Percent of total Billed charges,77% of total billed charges,143.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.34,150.72,
methylPREDNISolone 4mg Dosepack #21 Tablets,59746000103,CDM,250,RC,,,Outpatient,,,169.35,84.68,,130.4,77,,,Percent of Total Billed Charges,77% of total billed charges,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.32,74,,,Percent of Total Billed Charges,74% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,142.25,84,,,Percent of Total Billed Charges,84% of total billed charges,138.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.72,89,,,Percent of total Billed Charges,89% of total Billed charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.4,77,,,Percent of total Billed charges,77% of total billed charges,143.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.34,150.72,
methylPREDNISolone 4mg Dosepack #21 Tablets,59746000103,CDM,250,RC,,,Outpatient,,,169.35,84.68,,130.4,77,,,Percent of Total Billed Charges,77% of total billed charges,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.32,74,,,Percent of Total Billed Charges,74% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,142.25,84,,,Percent of Total Billed Charges,84% of total billed charges,138.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.72,89,,,Percent of total Billed Charges,89% of total Billed charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.4,77,,,Percent of total Billed charges,77% of total billed charges,143.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.34,150.72,
methylPREDNISolone 4mg Dosepack #21 Tablets,59746000103,CDM,250,RC,,,Outpatient,,,169.35,84.68,,130.4,77,,,Percent of Total Billed Charges,77% of total billed charges,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.32,74,,,Percent of Total Billed Charges,74% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,116.85,69,,,Percent of Total Billed Charges,69% of total billed charges,142.25,84,,,Percent of Total Billed Charges,84% of total billed charges,138.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,150.72,89,,,Percent of total Billed Charges,89% of total Billed charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.4,77,,,Percent of total Billed charges,77% of total billed charges,143.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.34,150.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
methylPREDNISolone Sodium Succinate 500mg/8ml MDV,9075801,CDM,250,RC,,,Outpatient,,,197.44,98.72,,152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.11,74,,,Percent of Total Billed Charges,74% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,136.23,69,,,Percent of Total Billed Charges,69% of total billed charges,165.85,84,,,Percent of Total Billed Charges,84% of total billed charges,161.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,175.72,89,,,Percent of total Billed Charges,89% of total Billed charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.03,77,,,Percent of total Billed charges,77% of total billed charges,167.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,175.72,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1084.07,542.04,,834.73,77,,,Percent of Total Billed Charges,77% of total billed charges,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,802.21,74,,,Percent of Total Billed Charges,74% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,910.62,84,,,Percent of Total Billed Charges,84% of total billed charges,888.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,964.82,89,,,Percent of total Billed Charges,89% of total Billed charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,834.73,77,,,Percent of total Billed charges,77% of total billed charges,921.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,542.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.02,964.82,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1127.57,563.79,,868.23,77,,,Percent of Total Billed Charges,77% of total billed charges,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,834.4,74,,,Percent of Total Billed Charges,74% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,947.16,84,,,Percent of Total Billed Charges,84% of total billed charges,924.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1003.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,868.23,77,,,Percent of total Billed charges,77% of total billed charges,958.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.89,1003.54,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1084.07,542.04,,834.73,77,,,Percent of Total Billed Charges,77% of total billed charges,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,802.21,74,,,Percent of Total Billed Charges,74% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,910.62,84,,,Percent of Total Billed Charges,84% of total billed charges,888.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,964.82,89,,,Percent of total Billed Charges,89% of total Billed charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,834.73,77,,,Percent of total Billed charges,77% of total billed charges,921.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,542.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.02,964.82,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1127.57,563.79,,868.23,77,,,Percent of Total Billed Charges,77% of total billed charges,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,834.4,74,,,Percent of Total Billed Charges,74% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,947.16,84,,,Percent of Total Billed Charges,84% of total billed charges,924.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1003.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,868.23,77,,,Percent of total Billed charges,77% of total billed charges,958.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.89,1003.54,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1084.07,542.04,,834.73,77,,,Percent of Total Billed Charges,77% of total billed charges,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,802.21,74,,,Percent of Total Billed Charges,74% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,910.62,84,,,Percent of Total Billed Charges,84% of total billed charges,888.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,964.82,89,,,Percent of total Billed Charges,89% of total Billed charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,834.73,77,,,Percent of total Billed charges,77% of total billed charges,921.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,542.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.02,964.82,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1127.57,563.79,,868.23,77,,,Percent of Total Billed Charges,77% of total billed charges,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,834.4,74,,,Percent of Total Billed Charges,74% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,947.16,84,,,Percent of Total Billed Charges,84% of total billed charges,924.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1003.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,868.23,77,,,Percent of total Billed charges,77% of total billed charges,958.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.89,1003.54,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1084.07,542.04,,834.73,77,,,Percent of Total Billed Charges,77% of total billed charges,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,802.21,74,,,Percent of Total Billed Charges,74% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,910.62,84,,,Percent of Total Billed Charges,84% of total billed charges,888.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,964.82,89,,,Percent of total Billed Charges,89% of total Billed charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,834.73,77,,,Percent of total Billed charges,77% of total billed charges,921.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,542.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.02,964.82,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1127.57,563.79,,868.23,77,,,Percent of Total Billed Charges,77% of total billed charges,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,834.4,74,,,Percent of Total Billed Charges,74% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,947.16,84,,,Percent of Total Billed Charges,84% of total billed charges,924.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1003.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,868.23,77,,,Percent of total Billed charges,77% of total billed charges,958.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.89,1003.54,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1084.07,542.04,,834.73,77,,,Percent of Total Billed Charges,77% of total billed charges,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,802.21,74,,,Percent of Total Billed Charges,74% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,910.62,84,,,Percent of Total Billed Charges,84% of total billed charges,888.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,964.82,89,,,Percent of total Billed Charges,89% of total Billed charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,834.73,77,,,Percent of total Billed charges,77% of total billed charges,921.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,542.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.02,964.82,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1127.57,563.79,,868.23,77,,,Percent of Total Billed Charges,77% of total billed charges,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,834.4,74,,,Percent of Total Billed Charges,74% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,947.16,84,,,Percent of Total Billed Charges,84% of total billed charges,924.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1003.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,868.23,77,,,Percent of total Billed charges,77% of total billed charges,958.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.89,1003.54,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1084.07,542.04,,834.73,77,,,Percent of Total Billed Charges,77% of total billed charges,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,276.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,338.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,802.21,74,,,Percent of Total Billed Charges,74% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,748.01,69,,,Percent of Total Billed Charges,69% of total billed charges,910.62,84,,,Percent of Total Billed Charges,84% of total billed charges,888.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,964.82,89,,,Percent of total Billed Charges,89% of total Billed charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,834.73,77,,,Percent of total Billed charges,77% of total billed charges,921.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,311.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,542.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,442.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,964.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,271.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.02,964.82,
Methylene Blue 50mg/10ml Ampule,517037405,CDM,250,RC,,,Outpatient,,,1127.57,563.79,,868.23,77,,,Percent of Total Billed Charges,77% of total billed charges,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,834.4,74,,,Percent of Total Billed Charges,74% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,778.02,69,,,Percent of Total Billed Charges,69% of total billed charges,947.16,84,,,Percent of Total Billed Charges,84% of total billed charges,924.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,1003.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,868.23,77,,,Percent of total Billed charges,77% of total billed charges,958.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,324.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,460.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1003.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.89,1003.54,
MethylPREDNISolone Acetate 80mg/ml SDV,9347501,CDM,250,RC,,,Outpatient,,,167.87,83.94,,129.26,77,,,Percent of Total Billed Charges,77% of total billed charges,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.22,74,,,Percent of Total Billed Charges,74% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,141.01,84,,,Percent of Total Billed Charges,84% of total billed charges,137.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.4,89,,,Percent of total Billed Charges,89% of total Billed charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.26,77,,,Percent of total Billed charges,77% of total billed charges,142.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,149.4,
MethylPREDNISolone Acetate 80mg/ml SDV,9347501,CDM,250,RC,,,Outpatient,,,167.87,83.94,,129.26,77,,,Percent of Total Billed Charges,77% of total billed charges,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.22,74,,,Percent of Total Billed Charges,74% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,141.01,84,,,Percent of Total Billed Charges,84% of total billed charges,137.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.4,89,,,Percent of total Billed Charges,89% of total Billed charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.26,77,,,Percent of total Billed charges,77% of total billed charges,142.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,149.4,
MethylPREDNISolone Acetate 80mg/ml SDV,9347501,CDM,250,RC,,,Outpatient,,,167.87,83.94,,129.26,77,,,Percent of Total Billed Charges,77% of total billed charges,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.22,74,,,Percent of Total Billed Charges,74% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,141.01,84,,,Percent of Total Billed Charges,84% of total billed charges,137.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.4,89,,,Percent of total Billed Charges,89% of total Billed charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.26,77,,,Percent of total Billed charges,77% of total billed charges,142.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,149.4,
MethylPREDNISolone Acetate 80mg/ml SDV,9347501,CDM,250,RC,,,Outpatient,,,167.87,83.94,,129.26,77,,,Percent of Total Billed Charges,77% of total billed charges,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.22,74,,,Percent of Total Billed Charges,74% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,141.01,84,,,Percent of Total Billed Charges,84% of total billed charges,137.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.4,89,,,Percent of total Billed Charges,89% of total Billed charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.26,77,,,Percent of total Billed charges,77% of total billed charges,142.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,149.4,
MethylPREDNISolone Acetate 80mg/ml SDV,9347501,CDM,250,RC,,,Outpatient,,,167.87,83.94,,129.26,77,,,Percent of Total Billed Charges,77% of total billed charges,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.22,74,,,Percent of Total Billed Charges,74% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,141.01,84,,,Percent of Total Billed Charges,84% of total billed charges,137.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.4,89,,,Percent of total Billed Charges,89% of total Billed charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.26,77,,,Percent of total Billed charges,77% of total billed charges,142.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,149.4,
MethylPREDNISolone Acetate 80mg/ml SDV,9347501,CDM,250,RC,,,Outpatient,,,167.87,83.94,,129.26,77,,,Percent of Total Billed Charges,77% of total billed charges,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.22,74,,,Percent of Total Billed Charges,74% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,115.83,69,,,Percent of Total Billed Charges,69% of total billed charges,141.01,84,,,Percent of Total Billed Charges,84% of total billed charges,137.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.4,89,,,Percent of total Billed Charges,89% of total Billed charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.26,77,,,Percent of total Billed charges,77% of total billed charges,142.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.97,149.4,
Metoclopramide 10mg Tablet,60687063111,CDM,250,RC,,,Outpatient,,,11.76,5.88,,9.06,77,,,Percent of Total Billed Charges,77% of total billed charges,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.7,74,,,Percent of Total Billed Charges,74% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,9.88,84,,,Percent of Total Billed Charges,84% of total billed charges,9.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.47,89,,,Percent of total Billed Charges,89% of total Billed charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,77,,,Percent of total Billed charges,77% of total billed charges,10,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.94,10.47,
Metoclopramide 10mg Tablet,60687063111,CDM,250,RC,,,Outpatient,,,11.76,5.88,,9.06,77,,,Percent of Total Billed Charges,77% of total billed charges,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.7,74,,,Percent of Total Billed Charges,74% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,9.88,84,,,Percent of Total Billed Charges,84% of total billed charges,9.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.47,89,,,Percent of total Billed Charges,89% of total Billed charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,77,,,Percent of total Billed charges,77% of total billed charges,10,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.94,10.47,
Metoclopramide 10mg Tablet,60687063111,CDM,250,RC,,,Outpatient,,,11.76,5.88,,9.06,77,,,Percent of Total Billed Charges,77% of total billed charges,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.7,74,,,Percent of Total Billed Charges,74% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,9.88,84,,,Percent of Total Billed Charges,84% of total billed charges,9.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.47,89,,,Percent of total Billed Charges,89% of total Billed charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,77,,,Percent of total Billed charges,77% of total billed charges,10,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.94,10.47,
Metoclopramide 10mg Tablet,60687063111,CDM,250,RC,,,Outpatient,,,11.76,5.88,,9.06,77,,,Percent of Total Billed Charges,77% of total billed charges,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.7,74,,,Percent of Total Billed Charges,74% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,9.88,84,,,Percent of Total Billed Charges,84% of total billed charges,9.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.47,89,,,Percent of total Billed Charges,89% of total Billed charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,77,,,Percent of total Billed charges,77% of total billed charges,10,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.94,10.47,
Metoclopramide 10mg Tablet,60687063111,CDM,250,RC,,,Outpatient,,,11.76,5.88,,9.06,77,,,Percent of Total Billed Charges,77% of total billed charges,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.7,74,,,Percent of Total Billed Charges,74% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,9.88,84,,,Percent of Total Billed Charges,84% of total billed charges,9.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.47,89,,,Percent of total Billed Charges,89% of total Billed charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,77,,,Percent of total Billed charges,77% of total billed charges,10,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.94,10.47,
Metoclopramide 10mg Tablet,60687063111,CDM,250,RC,,,Outpatient,,,11.76,5.88,,9.06,77,,,Percent of Total Billed Charges,77% of total billed charges,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.7,74,,,Percent of Total Billed Charges,74% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.11,69,,,Percent of Total Billed Charges,69% of total billed charges,9.88,84,,,Percent of Total Billed Charges,84% of total billed charges,9.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.47,89,,,Percent of total Billed Charges,89% of total Billed charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.06,77,,,Percent of total Billed charges,77% of total billed charges,10,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.94,10.47,
metOLazone 2.5mg Tablet,378617201,CDM,250,RC,,,Outpatient,,,29.21,14.61,,22.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.62,74,,,Percent of Total Billed Charges,74% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.54,84,,,Percent of Total Billed Charges,84% of total billed charges,23.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,26,89,,,Percent of total Billed Charges,89% of total Billed charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,77,,,Percent of total Billed charges,77% of total billed charges,24.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.3,26,
metOLazone 2.5mg Tablet,378617201,CDM,250,RC,,,Outpatient,,,29.21,14.61,,22.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.62,74,,,Percent of Total Billed Charges,74% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.54,84,,,Percent of Total Billed Charges,84% of total billed charges,23.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,26,89,,,Percent of total Billed Charges,89% of total Billed charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,77,,,Percent of total Billed charges,77% of total billed charges,24.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.3,26,
metOLazone 2.5mg Tablet,378617201,CDM,250,RC,,,Outpatient,,,29.21,14.61,,22.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.62,74,,,Percent of Total Billed Charges,74% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.54,84,,,Percent of Total Billed Charges,84% of total billed charges,23.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,26,89,,,Percent of total Billed Charges,89% of total Billed charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,77,,,Percent of total Billed charges,77% of total billed charges,24.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.3,26,
metOLazone 2.5mg Tablet,378617201,CDM,250,RC,,,Outpatient,,,29.21,14.61,,22.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.62,74,,,Percent of Total Billed Charges,74% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.54,84,,,Percent of Total Billed Charges,84% of total billed charges,23.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,26,89,,,Percent of total Billed Charges,89% of total Billed charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,77,,,Percent of total Billed charges,77% of total billed charges,24.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.3,26,
metOLazone 2.5mg Tablet,378617201,CDM,250,RC,,,Outpatient,,,29.21,14.61,,22.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.62,74,,,Percent of Total Billed Charges,74% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.54,84,,,Percent of Total Billed Charges,84% of total billed charges,23.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,26,89,,,Percent of total Billed Charges,89% of total Billed charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,77,,,Percent of total Billed charges,77% of total billed charges,24.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.3,26,
metOLazone 2.5mg Tablet,378617201,CDM,250,RC,,,Outpatient,,,29.21,14.61,,22.49,77,,,Percent of Total Billed Charges,77% of total billed charges,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.62,74,,,Percent of Total Billed Charges,74% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,20.15,69,,,Percent of Total Billed Charges,69% of total billed charges,24.54,84,,,Percent of Total Billed Charges,84% of total billed charges,23.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,26,89,,,Percent of total Billed Charges,89% of total Billed charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,77,,,Percent of total Billed charges,77% of total billed charges,24.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.3,26,
Metoprolol Tartrate 25mg Tablet,51079025520,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Metoprolol Tartrate 25mg Tablet,51079025520,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Metoprolol Tartrate 25mg Tablet,51079025520,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Metoprolol Tartrate 25mg Tablet,51079025520,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Metoprolol Tartrate 25mg Tablet,51079025520,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Metoprolol Tartrate 25mg Tablet,51079025520,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
Metoprolol Succinate 25mg Tablet (XL),904632261,CDM,250,RC,,,Outpatient,,,13.26,6.63,,10.21,77,,,Percent of Total Billed Charges,77% of total billed charges,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.81,74,,,Percent of Total Billed Charges,74% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,11.14,84,,,Percent of Total Billed Charges,84% of total billed charges,10.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.8,89,,,Percent of total Billed Charges,89% of total Billed charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,77,,,Percent of total Billed charges,77% of total billed charges,11.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.32,11.8,
Metoprolol Succinate 25mg Tablet (XL),904632261,CDM,250,RC,,,Outpatient,,,13.26,6.63,,10.21,77,,,Percent of Total Billed Charges,77% of total billed charges,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.81,74,,,Percent of Total Billed Charges,74% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,11.14,84,,,Percent of Total Billed Charges,84% of total billed charges,10.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.8,89,,,Percent of total Billed Charges,89% of total Billed charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,77,,,Percent of total Billed charges,77% of total billed charges,11.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.32,11.8,
Metoprolol Succinate 25mg Tablet (XL),904632261,CDM,250,RC,,,Outpatient,,,13.26,6.63,,10.21,77,,,Percent of Total Billed Charges,77% of total billed charges,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.81,74,,,Percent of Total Billed Charges,74% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,11.14,84,,,Percent of Total Billed Charges,84% of total billed charges,10.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.8,89,,,Percent of total Billed Charges,89% of total Billed charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,77,,,Percent of total Billed charges,77% of total billed charges,11.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.32,11.8,
Metoprolol Succinate 25mg Tablet (XL),904632261,CDM,250,RC,,,Outpatient,,,13.26,6.63,,10.21,77,,,Percent of Total Billed Charges,77% of total billed charges,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.81,74,,,Percent of Total Billed Charges,74% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,11.14,84,,,Percent of Total Billed Charges,84% of total billed charges,10.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.8,89,,,Percent of total Billed Charges,89% of total Billed charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,77,,,Percent of total Billed charges,77% of total billed charges,11.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.32,11.8,
Metoprolol Succinate 25mg Tablet (XL),904632261,CDM,250,RC,,,Outpatient,,,13.26,6.63,,10.21,77,,,Percent of Total Billed Charges,77% of total billed charges,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.81,74,,,Percent of Total Billed Charges,74% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,11.14,84,,,Percent of Total Billed Charges,84% of total billed charges,10.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.8,89,,,Percent of total Billed Charges,89% of total Billed charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,77,,,Percent of total Billed charges,77% of total billed charges,11.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.32,11.8,
Metoprolol Succinate 25mg Tablet (XL),904632261,CDM,250,RC,,,Outpatient,,,13.26,6.63,,10.21,77,,,Percent of Total Billed Charges,77% of total billed charges,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.81,74,,,Percent of Total Billed Charges,74% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,9.15,69,,,Percent of Total Billed Charges,69% of total billed charges,11.14,84,,,Percent of Total Billed Charges,84% of total billed charges,10.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.8,89,,,Percent of total Billed Charges,89% of total Billed charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.21,77,,,Percent of total Billed charges,77% of total billed charges,11.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.32,11.8,
Metoprolol Succinate 50mg Tablet (XL),904632361,CDM,250,RC,,,Outpatient,,,14.85,7.43,,11.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.99,74,,,Percent of Total Billed Charges,74% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,12.47,84,,,Percent of Total Billed Charges,84% of total billed charges,12.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.22,89,,,Percent of total Billed Charges,89% of total Billed charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.43,77,,,Percent of total Billed charges,77% of total billed charges,12.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,13.22,
Metoprolol Succinate 50mg Tablet (XL),904632361,CDM,250,RC,,,Outpatient,,,14.85,7.43,,11.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.99,74,,,Percent of Total Billed Charges,74% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,12.47,84,,,Percent of Total Billed Charges,84% of total billed charges,12.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.22,89,,,Percent of total Billed Charges,89% of total Billed charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.43,77,,,Percent of total Billed charges,77% of total billed charges,12.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,13.22,
Metoprolol Succinate 50mg Tablet (XL),904632361,CDM,250,RC,,,Outpatient,,,14.85,7.43,,11.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.99,74,,,Percent of Total Billed Charges,74% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,12.47,84,,,Percent of Total Billed Charges,84% of total billed charges,12.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.22,89,,,Percent of total Billed Charges,89% of total Billed charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.43,77,,,Percent of total Billed charges,77% of total billed charges,12.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,13.22,
Metoprolol Succinate 50mg Tablet (XL),904632361,CDM,250,RC,,,Outpatient,,,14.85,7.43,,11.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.99,74,,,Percent of Total Billed Charges,74% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,12.47,84,,,Percent of Total Billed Charges,84% of total billed charges,12.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.22,89,,,Percent of total Billed Charges,89% of total Billed charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.43,77,,,Percent of total Billed charges,77% of total billed charges,12.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,13.22,
Metoprolol Succinate 50mg Tablet (XL),904632361,CDM,250,RC,,,Outpatient,,,14.85,7.43,,11.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.99,74,,,Percent of Total Billed Charges,74% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,12.47,84,,,Percent of Total Billed Charges,84% of total billed charges,12.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.22,89,,,Percent of total Billed Charges,89% of total Billed charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.43,77,,,Percent of total Billed charges,77% of total billed charges,12.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,13.22,
Metoprolol Succinate 50mg Tablet (XL),904632361,CDM,250,RC,,,Outpatient,,,14.85,7.43,,11.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.99,74,,,Percent of Total Billed Charges,74% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,10.25,69,,,Percent of Total Billed Charges,69% of total billed charges,12.47,84,,,Percent of Total Billed Charges,84% of total billed charges,12.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.22,89,,,Percent of total Billed Charges,89% of total Billed charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.43,77,,,Percent of total Billed charges,77% of total billed charges,12.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,13.22,
Metoprolol Tartrate 50mg Tablet,,,250,RC,,,Outpatient,,,10.26,5.13,,7.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.59,74,,,Percent of Total Billed Charges,74% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8.62,84,,,Percent of Total Billed Charges,84% of total billed charges,8.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.13,89,,,Percent of total Billed Charges,89% of total Billed charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.9,77,,,Percent of total Billed charges,77% of total billed charges,8.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.57,9.13,
Metoprolol Tartrate 50mg Tablet,,,250,RC,,,Outpatient,,,10.26,5.13,,7.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.59,74,,,Percent of Total Billed Charges,74% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8.62,84,,,Percent of Total Billed Charges,84% of total billed charges,8.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.13,89,,,Percent of total Billed Charges,89% of total Billed charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.9,77,,,Percent of total Billed charges,77% of total billed charges,8.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.57,9.13,
Metoprolol Tartrate 50mg Tablet,,,250,RC,,,Outpatient,,,10.26,5.13,,7.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.59,74,,,Percent of Total Billed Charges,74% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8.62,84,,,Percent of Total Billed Charges,84% of total billed charges,8.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.13,89,,,Percent of total Billed Charges,89% of total Billed charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.9,77,,,Percent of total Billed charges,77% of total billed charges,8.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.57,9.13,
Metoprolol Tartrate 50mg Tablet,,,250,RC,,,Outpatient,,,10.26,5.13,,7.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.59,74,,,Percent of Total Billed Charges,74% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8.62,84,,,Percent of Total Billed Charges,84% of total billed charges,8.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.13,89,,,Percent of total Billed Charges,89% of total Billed charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.9,77,,,Percent of total Billed charges,77% of total billed charges,8.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.57,9.13,
Metoprolol Tartrate 50mg Tablet,,,250,RC,,,Outpatient,,,10.26,5.13,,7.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.59,74,,,Percent of Total Billed Charges,74% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8.62,84,,,Percent of Total Billed Charges,84% of total billed charges,8.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.13,89,,,Percent of total Billed Charges,89% of total Billed charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.9,77,,,Percent of total Billed charges,77% of total billed charges,8.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.57,9.13,
Metoprolol Tartrate 50mg Tablet,,,250,RC,,,Outpatient,,,10.26,5.13,,7.9,77,,,Percent of Total Billed Charges,77% of total billed charges,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.59,74,,,Percent of Total Billed Charges,74% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,7.08,69,,,Percent of Total Billed Charges,69% of total billed charges,8.62,84,,,Percent of Total Billed Charges,84% of total billed charges,8.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.13,89,,,Percent of total Billed Charges,89% of total Billed charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.9,77,,,Percent of total Billed charges,77% of total billed charges,8.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.57,9.13,
Metoclopramide 5mg Tablet,51079088620,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Metoclopramide 5mg Tablet,51079088620,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Metoclopramide 5mg Tablet,51079088620,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Metoclopramide 5mg Tablet,51079088620,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Metoclopramide 5mg Tablet,51079088620,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Metoclopramide 5mg Tablet,51079088620,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Metoprolol Tartrate 5mg/5ml SDV,55390007310,CDM,250,RC,,,Outpatient,,,56.45,28.23,,43.47,77,,,Percent of Total Billed Charges,77% of total billed charges,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.77,74,,,Percent of Total Billed Charges,74% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,47.42,84,,,Percent of Total Billed Charges,84% of total billed charges,46.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.24,89,,,Percent of total Billed Charges,89% of total Billed charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,77,,,Percent of total Billed charges,77% of total billed charges,47.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,50.24,
Metoprolol Tartrate 5mg/5ml SDV,55390007310,CDM,250,RC,,,Outpatient,,,56.45,28.23,,43.47,77,,,Percent of Total Billed Charges,77% of total billed charges,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.77,74,,,Percent of Total Billed Charges,74% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,47.42,84,,,Percent of Total Billed Charges,84% of total billed charges,46.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.24,89,,,Percent of total Billed Charges,89% of total Billed charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,77,,,Percent of total Billed charges,77% of total billed charges,47.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,50.24,
Metoprolol Tartrate 5mg/5ml SDV,55390007310,CDM,250,RC,,,Outpatient,,,56.45,28.23,,43.47,77,,,Percent of Total Billed Charges,77% of total billed charges,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.77,74,,,Percent of Total Billed Charges,74% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,47.42,84,,,Percent of Total Billed Charges,84% of total billed charges,46.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.24,89,,,Percent of total Billed Charges,89% of total Billed charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,77,,,Percent of total Billed charges,77% of total billed charges,47.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,50.24,
Metoprolol Tartrate 5mg/5ml SDV,55390007310,CDM,250,RC,,,Outpatient,,,56.45,28.23,,43.47,77,,,Percent of Total Billed Charges,77% of total billed charges,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.77,74,,,Percent of Total Billed Charges,74% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,47.42,84,,,Percent of Total Billed Charges,84% of total billed charges,46.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.24,89,,,Percent of total Billed Charges,89% of total Billed charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,77,,,Percent of total Billed charges,77% of total billed charges,47.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,50.24,
Metoprolol Tartrate 5mg/5ml SDV,55390007310,CDM,250,RC,,,Outpatient,,,56.45,28.23,,43.47,77,,,Percent of Total Billed Charges,77% of total billed charges,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.77,74,,,Percent of Total Billed Charges,74% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,47.42,84,,,Percent of Total Billed Charges,84% of total billed charges,46.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.24,89,,,Percent of total Billed Charges,89% of total Billed charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,77,,,Percent of total Billed charges,77% of total billed charges,47.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,50.24,
Metoprolol Tartrate 5mg/5ml SDV,55390007310,CDM,250,RC,,,Outpatient,,,56.45,28.23,,43.47,77,,,Percent of Total Billed Charges,77% of total billed charges,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.77,74,,,Percent of Total Billed Charges,74% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,38.95,69,,,Percent of Total Billed Charges,69% of total billed charges,47.42,84,,,Percent of Total Billed Charges,84% of total billed charges,46.29,82,,,Percent of Total Billed Charges,82% of total billed charges ,50.24,89,,,Percent of total Billed Charges,89% of total Billed charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.47,77,,,Percent of total Billed charges,77% of total billed charges,47.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,16.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,28.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,23.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.11,50.24,
Metoclopramide IV 10mg/2ml SDV,,,250,RC,,,Outpatient,,,50.2,25.1,,38.65,77,,,Percent of Total Billed Charges,77% of total billed charges,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.15,74,,,Percent of Total Billed Charges,74% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.17,84,,,Percent of Total Billed Charges,84% of total billed charges,41.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.68,89,,,Percent of total Billed Charges,89% of total Billed charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.65,77,,,Percent of total Billed charges,77% of total billed charges,42.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,44.68,
Metoclopramide IV 10mg/2ml SDV,,,250,RC,,,Outpatient,,,50.2,25.1,,38.65,77,,,Percent of Total Billed Charges,77% of total billed charges,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.15,74,,,Percent of Total Billed Charges,74% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.17,84,,,Percent of Total Billed Charges,84% of total billed charges,41.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.68,89,,,Percent of total Billed Charges,89% of total Billed charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.65,77,,,Percent of total Billed charges,77% of total billed charges,42.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,44.68,
Metoclopramide IV 10mg/2ml SDV,,,250,RC,,,Outpatient,,,50.2,25.1,,38.65,77,,,Percent of Total Billed Charges,77% of total billed charges,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.15,74,,,Percent of Total Billed Charges,74% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.17,84,,,Percent of Total Billed Charges,84% of total billed charges,41.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.68,89,,,Percent of total Billed Charges,89% of total Billed charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.65,77,,,Percent of total Billed charges,77% of total billed charges,42.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,44.68,
Metoclopramide IV 10mg/2ml SDV,,,250,RC,,,Outpatient,,,50.2,25.1,,38.65,77,,,Percent of Total Billed Charges,77% of total billed charges,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.15,74,,,Percent of Total Billed Charges,74% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.17,84,,,Percent of Total Billed Charges,84% of total billed charges,41.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.68,89,,,Percent of total Billed Charges,89% of total Billed charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.65,77,,,Percent of total Billed charges,77% of total billed charges,42.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,44.68,
Metoclopramide IV 10mg/2ml SDV,,,250,RC,,,Outpatient,,,50.2,25.1,,38.65,77,,,Percent of Total Billed Charges,77% of total billed charges,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.15,74,,,Percent of Total Billed Charges,74% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.17,84,,,Percent of Total Billed Charges,84% of total billed charges,41.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.68,89,,,Percent of total Billed Charges,89% of total Billed charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.65,77,,,Percent of total Billed charges,77% of total billed charges,42.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,44.68,
Metoclopramide IV 10mg/2ml SDV,,,250,RC,,,Outpatient,,,50.2,25.1,,38.65,77,,,Percent of Total Billed Charges,77% of total billed charges,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.15,74,,,Percent of Total Billed Charges,74% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.17,84,,,Percent of Total Billed Charges,84% of total billed charges,41.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.68,89,,,Percent of total Billed Charges,89% of total Billed charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.65,77,,,Percent of total Billed charges,77% of total billed charges,42.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.55,44.68,
metroNIDAZOLE 250mg Tablet,904715661,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
metroNIDAZOLE 250mg Tablet,904715661,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
metroNIDAZOLE 250mg Tablet,904715661,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
metroNIDAZOLE 250mg Tablet,904715661,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
metroNIDAZOLE 250mg Tablet,904715661,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
metroNIDAZOLE 250mg Tablet,904715661,CDM,250,RC,,,Outpatient,,,8.75,4.38,,6.74,77,,,Percent of Total Billed Charges,77% of total billed charges,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,6.04,69,,,Percent of Total Billed Charges,69% of total billed charges,7.35,84,,,Percent of Total Billed Charges,84% of total billed charges,7.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.79,89,,,Percent of total Billed Charges,89% of total Billed charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.74,77,,,Percent of total Billed charges,77% of total billed charges,7.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.19,7.79,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
metroNIDAZOLE 500mg/100ml IV Bag,338105548,CDM,250,RC,,,Outpatient,,,130.86,65.43,,100.76,77,,,Percent of Total Billed Charges,77% of total billed charges,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.84,74,,,Percent of Total Billed Charges,74% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,90.29,69,,,Percent of Total Billed Charges,69% of total billed charges,109.92,84,,,Percent of Total Billed Charges,84% of total billed charges,107.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.47,89,,,Percent of total Billed Charges,89% of total Billed charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.76,77,,,Percent of total Billed charges,77% of total billed charges,111.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.72,116.47,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Micafungin 100mg SDV,63323072910,CDM,250,RC,,,Outpatient,,,323.41,161.71,,249.03,77,,,Percent of Total Billed Charges,77% of total billed charges,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,82.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,101.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,239.32,74,,,Percent of Total Billed Charges,74% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,223.15,69,,,Percent of Total Billed Charges,69% of total billed charges,271.66,84,,,Percent of Total Billed Charges,84% of total billed charges,265.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,287.83,89,,,Percent of total Billed Charges,89% of total Billed charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,249.03,77,,,Percent of total Billed charges,77% of total billed charges,274.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,92.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,161.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,131.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,287.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.85,287.83,
Miconazole 2% Vaginal Cream with Applicator 45gm,51672203506,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Miconazole 2% Vaginal Cream with Applicator 45gm,51672203506,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Miconazole 2% Vaginal Cream with Applicator 45gm,51672203506,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Miconazole 2% Vaginal Cream with Applicator 45gm,51672203506,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Miconazole 2% Vaginal Cream with Applicator 45gm,51672203506,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Miconazole 2% Vaginal Cream with Applicator 45gm,51672203506,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Miconazole 2% Powder 85gm,53329016979,CDM,250,RC,,,Outpatient,,,84.02,42.01,,64.7,77,,,Percent of Total Billed Charges,77% of total billed charges,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.17,74,,,Percent of Total Billed Charges,74% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,70.58,84,,,Percent of Total Billed Charges,84% of total billed charges,68.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.78,89,,,Percent of total Billed Charges,89% of total Billed charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.7,77,,,Percent of total Billed charges,77% of total billed charges,71.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.01,74.78,
Miconazole 2% Powder 85gm,53329016979,CDM,250,RC,,,Outpatient,,,84.02,42.01,,64.7,77,,,Percent of Total Billed Charges,77% of total billed charges,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.17,74,,,Percent of Total Billed Charges,74% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,70.58,84,,,Percent of Total Billed Charges,84% of total billed charges,68.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.78,89,,,Percent of total Billed Charges,89% of total Billed charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.7,77,,,Percent of total Billed charges,77% of total billed charges,71.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.01,74.78,
Miconazole 2% Powder 85gm,53329016979,CDM,250,RC,,,Outpatient,,,84.02,42.01,,64.7,77,,,Percent of Total Billed Charges,77% of total billed charges,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.17,74,,,Percent of Total Billed Charges,74% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,70.58,84,,,Percent of Total Billed Charges,84% of total billed charges,68.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.78,89,,,Percent of total Billed Charges,89% of total Billed charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.7,77,,,Percent of total Billed charges,77% of total billed charges,71.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.01,74.78,
Miconazole 2% Powder 85gm,53329016979,CDM,250,RC,,,Outpatient,,,84.02,42.01,,64.7,77,,,Percent of Total Billed Charges,77% of total billed charges,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.17,74,,,Percent of Total Billed Charges,74% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,70.58,84,,,Percent of Total Billed Charges,84% of total billed charges,68.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.78,89,,,Percent of total Billed Charges,89% of total Billed charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.7,77,,,Percent of total Billed charges,77% of total billed charges,71.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.01,74.78,
Miconazole 2% Powder 85gm,53329016979,CDM,250,RC,,,Outpatient,,,84.02,42.01,,64.7,77,,,Percent of Total Billed Charges,77% of total billed charges,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.17,74,,,Percent of Total Billed Charges,74% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,70.58,84,,,Percent of Total Billed Charges,84% of total billed charges,68.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.78,89,,,Percent of total Billed Charges,89% of total Billed charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.7,77,,,Percent of total Billed charges,77% of total billed charges,71.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.01,74.78,
Miconazole 2% Powder 85gm,53329016979,CDM,250,RC,,,Outpatient,,,84.02,42.01,,64.7,77,,,Percent of Total Billed Charges,77% of total billed charges,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,62.17,74,,,Percent of Total Billed Charges,74% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,57.97,69,,,Percent of Total Billed Charges,69% of total billed charges,70.58,84,,,Percent of Total Billed Charges,84% of total billed charges,68.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,74.78,89,,,Percent of total Billed Charges,89% of total Billed charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.7,77,,,Percent of total Billed charges,77% of total billed charges,71.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.01,74.78,
Midazolam 10mg/5ml Oral Soln 5ml UDC,68094076462,CDM,250,RC,,,Outpatient,,,69.54,34.77,,53.55,77,,,Percent of Total Billed Charges,77% of total billed charges,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.46,74,,,Percent of Total Billed Charges,74% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,58.41,84,,,Percent of Total Billed Charges,84% of total billed charges,57.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.89,89,,,Percent of total Billed Charges,89% of total Billed charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.55,77,,,Percent of total Billed charges,77% of total billed charges,59.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.39,61.89,
Midazolam 10mg/5ml Oral Soln 5ml UDC,68094076462,CDM,250,RC,,,Outpatient,,,69.54,34.77,,53.55,77,,,Percent of Total Billed Charges,77% of total billed charges,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.46,74,,,Percent of Total Billed Charges,74% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,58.41,84,,,Percent of Total Billed Charges,84% of total billed charges,57.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.89,89,,,Percent of total Billed Charges,89% of total Billed charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.55,77,,,Percent of total Billed charges,77% of total billed charges,59.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.39,61.89,
Midazolam 10mg/5ml Oral Soln 5ml UDC,68094076462,CDM,250,RC,,,Outpatient,,,69.54,34.77,,53.55,77,,,Percent of Total Billed Charges,77% of total billed charges,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.46,74,,,Percent of Total Billed Charges,74% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,58.41,84,,,Percent of Total Billed Charges,84% of total billed charges,57.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.89,89,,,Percent of total Billed Charges,89% of total Billed charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.55,77,,,Percent of total Billed charges,77% of total billed charges,59.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.39,61.89,
Midazolam 10mg/5ml Oral Soln 5ml UDC,68094076462,CDM,250,RC,,,Outpatient,,,69.54,34.77,,53.55,77,,,Percent of Total Billed Charges,77% of total billed charges,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.46,74,,,Percent of Total Billed Charges,74% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,58.41,84,,,Percent of Total Billed Charges,84% of total billed charges,57.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.89,89,,,Percent of total Billed Charges,89% of total Billed charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.55,77,,,Percent of total Billed charges,77% of total billed charges,59.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.39,61.89,
Midazolam 10mg/5ml Oral Soln 5ml UDC,68094076462,CDM,250,RC,,,Outpatient,,,69.54,34.77,,53.55,77,,,Percent of Total Billed Charges,77% of total billed charges,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.46,74,,,Percent of Total Billed Charges,74% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,58.41,84,,,Percent of Total Billed Charges,84% of total billed charges,57.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.89,89,,,Percent of total Billed Charges,89% of total Billed charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.55,77,,,Percent of total Billed charges,77% of total billed charges,59.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.39,61.89,
Midazolam 10mg/5ml Oral Soln 5ml UDC,68094076462,CDM,250,RC,,,Outpatient,,,69.54,34.77,,53.55,77,,,Percent of Total Billed Charges,77% of total billed charges,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.46,74,,,Percent of Total Billed Charges,74% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,47.98,69,,,Percent of Total Billed Charges,69% of total billed charges,58.41,84,,,Percent of Total Billed Charges,84% of total billed charges,57.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.89,89,,,Percent of total Billed Charges,89% of total Billed charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.55,77,,,Percent of total Billed charges,77% of total billed charges,59.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.39,61.89,
Midazolam PF 2mg/2ml SDV,409230517,CDM,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Midazolam PF 2mg/2ml SDV,409230517,CDM,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Midazolam PF 2mg/2ml SDV,409230517,CDM,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Midazolam PF 2mg/2ml SDV,409230517,CDM,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Midazolam PF 2mg/2ml SDV,409230517,CDM,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Midazolam PF 2mg/2ml SDV,409230517,CDM,250,RC,,,Outpatient,,,48.8,24.4,,37.58,77,,,Percent of Total Billed Charges,77% of total billed charges,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,36.11,74,,,Percent of Total Billed Charges,74% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.67,69,,,Percent of Total Billed Charges,69% of total billed charges,40.99,84,,,Percent of Total Billed Charges,84% of total billed charges,40.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.43,89,,,Percent of total Billed Charges,89% of total Billed charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.58,77,,,Percent of total Billed charges,77% of total billed charges,41.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.2,43.43,
Midazolam 5mg/1ml SDV (Seizure IM/Nasal),63323041225,CDM,250,RC,,,Outpatient,,,66.81,33.41,,51.44,77,,,Percent of Total Billed Charges,77% of total billed charges,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.44,74,,,Percent of Total Billed Charges,74% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,56.12,84,,,Percent of Total Billed Charges,84% of total billed charges,54.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.46,89,,,Percent of total Billed Charges,89% of total Billed charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.44,77,,,Percent of total Billed charges,77% of total billed charges,56.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.7,59.46,
Midazolam 5mg/1ml SDV (Seizure IM/Nasal),63323041225,CDM,250,RC,,,Outpatient,,,66.81,33.41,,51.44,77,,,Percent of Total Billed Charges,77% of total billed charges,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.44,74,,,Percent of Total Billed Charges,74% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,56.12,84,,,Percent of Total Billed Charges,84% of total billed charges,54.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.46,89,,,Percent of total Billed Charges,89% of total Billed charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.44,77,,,Percent of total Billed charges,77% of total billed charges,56.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.7,59.46,
Midazolam 5mg/1ml SDV (Seizure IM/Nasal),63323041225,CDM,250,RC,,,Outpatient,,,66.81,33.41,,51.44,77,,,Percent of Total Billed Charges,77% of total billed charges,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.44,74,,,Percent of Total Billed Charges,74% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,56.12,84,,,Percent of Total Billed Charges,84% of total billed charges,54.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.46,89,,,Percent of total Billed Charges,89% of total Billed charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.44,77,,,Percent of total Billed charges,77% of total billed charges,56.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.7,59.46,
Midazolam 5mg/1ml SDV (Seizure IM/Nasal),63323041225,CDM,250,RC,,,Outpatient,,,66.81,33.41,,51.44,77,,,Percent of Total Billed Charges,77% of total billed charges,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.44,74,,,Percent of Total Billed Charges,74% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,56.12,84,,,Percent of Total Billed Charges,84% of total billed charges,54.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.46,89,,,Percent of total Billed Charges,89% of total Billed charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.44,77,,,Percent of total Billed charges,77% of total billed charges,56.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.7,59.46,
Midazolam 5mg/1ml SDV (Seizure IM/Nasal),63323041225,CDM,250,RC,,,Outpatient,,,66.81,33.41,,51.44,77,,,Percent of Total Billed Charges,77% of total billed charges,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.44,74,,,Percent of Total Billed Charges,74% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,56.12,84,,,Percent of Total Billed Charges,84% of total billed charges,54.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.46,89,,,Percent of total Billed Charges,89% of total Billed charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.44,77,,,Percent of total Billed charges,77% of total billed charges,56.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.7,59.46,
Midazolam 5mg/1ml SDV (Seizure IM/Nasal),63323041225,CDM,250,RC,,,Outpatient,,,66.81,33.41,,51.44,77,,,Percent of Total Billed Charges,77% of total billed charges,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,49.44,74,,,Percent of Total Billed Charges,74% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,46.1,69,,,Percent of Total Billed Charges,69% of total billed charges,56.12,84,,,Percent of Total Billed Charges,84% of total billed charges,54.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,59.46,89,,,Percent of total Billed Charges,89% of total Billed charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,51.44,77,,,Percent of total Billed charges,77% of total billed charges,56.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.26,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.7,59.46,
Midodrine 5mg Tablet,245021211,CDM,250,RC,,,Outpatient,,,44.04,22.02,,33.91,77,,,Percent of Total Billed Charges,77% of total billed charges,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.59,74,,,Percent of Total Billed Charges,74% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,36.99,84,,,Percent of Total Billed Charges,84% of total billed charges,36.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,89,,,Percent of total Billed Charges,89% of total Billed charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,77,,,Percent of total Billed charges,77% of total billed charges,37.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.01,39.2,
Midodrine 5mg Tablet,245021211,CDM,250,RC,,,Outpatient,,,44.04,22.02,,33.91,77,,,Percent of Total Billed Charges,77% of total billed charges,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.59,74,,,Percent of Total Billed Charges,74% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,36.99,84,,,Percent of Total Billed Charges,84% of total billed charges,36.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,89,,,Percent of total Billed Charges,89% of total Billed charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,77,,,Percent of total Billed charges,77% of total billed charges,37.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.01,39.2,
Midodrine 5mg Tablet,245021211,CDM,250,RC,,,Outpatient,,,44.04,22.02,,33.91,77,,,Percent of Total Billed Charges,77% of total billed charges,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.59,74,,,Percent of Total Billed Charges,74% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,36.99,84,,,Percent of Total Billed Charges,84% of total billed charges,36.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,89,,,Percent of total Billed Charges,89% of total Billed charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,77,,,Percent of total Billed charges,77% of total billed charges,37.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.01,39.2,
Midodrine 5mg Tablet,245021211,CDM,250,RC,,,Outpatient,,,44.04,22.02,,33.91,77,,,Percent of Total Billed Charges,77% of total billed charges,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.59,74,,,Percent of Total Billed Charges,74% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,36.99,84,,,Percent of Total Billed Charges,84% of total billed charges,36.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,89,,,Percent of total Billed Charges,89% of total Billed charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,77,,,Percent of total Billed charges,77% of total billed charges,37.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.01,39.2,
Midodrine 5mg Tablet,245021211,CDM,250,RC,,,Outpatient,,,44.04,22.02,,33.91,77,,,Percent of Total Billed Charges,77% of total billed charges,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.59,74,,,Percent of Total Billed Charges,74% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,36.99,84,,,Percent of Total Billed Charges,84% of total billed charges,36.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,89,,,Percent of total Billed Charges,89% of total Billed charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,77,,,Percent of total Billed charges,77% of total billed charges,37.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.01,39.2,
Midodrine 5mg Tablet,245021211,CDM,250,RC,,,Outpatient,,,44.04,22.02,,33.91,77,,,Percent of Total Billed Charges,77% of total billed charges,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.59,74,,,Percent of Total Billed Charges,74% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,30.39,69,,,Percent of Total Billed Charges,69% of total billed charges,36.99,84,,,Percent of Total Billed Charges,84% of total billed charges,36.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.2,89,,,Percent of total Billed Charges,89% of total Billed charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.91,77,,,Percent of total Billed charges,77% of total billed charges,37.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.66,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.01,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.01,39.2,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Milrinone 10mg/10ml (1000mcg/ml) SDV,143971010,CDM,250,RC,,,Outpatient,,,91.4,45.7,,70.38,77,,,Percent of Total Billed Charges,77% of total billed charges,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.64,74,,,Percent of Total Billed Charges,74% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,63.07,69,,,Percent of Total Billed Charges,69% of total billed charges,76.78,84,,,Percent of Total Billed Charges,84% of total billed charges,74.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.35,89,,,Percent of total Billed Charges,89% of total Billed charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.38,77,,,Percent of total Billed charges,77% of total billed charges,77.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.85,81.35,
Artificial Tears OPHTH Oint 3.5gm,904648838,CDM,250,RC,,,Outpatient,,,55.58,27.79,,42.8,77,,,Percent of Total Billed Charges,77% of total billed charges,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.13,74,,,Percent of Total Billed Charges,74% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,84,,,Percent of Total Billed Charges,84% of total billed charges,45.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.47,89,,,Percent of total Billed Charges,89% of total Billed charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.8,77,,,Percent of total Billed charges,77% of total billed charges,47.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,49.47,
Artificial Tears OPHTH Oint 3.5gm,904648838,CDM,250,RC,,,Outpatient,,,55.58,27.79,,42.8,77,,,Percent of Total Billed Charges,77% of total billed charges,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.13,74,,,Percent of Total Billed Charges,74% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,84,,,Percent of Total Billed Charges,84% of total billed charges,45.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.47,89,,,Percent of total Billed Charges,89% of total Billed charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.8,77,,,Percent of total Billed charges,77% of total billed charges,47.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,49.47,
Artificial Tears OPHTH Oint 3.5gm,904648838,CDM,250,RC,,,Outpatient,,,55.58,27.79,,42.8,77,,,Percent of Total Billed Charges,77% of total billed charges,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.13,74,,,Percent of Total Billed Charges,74% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,84,,,Percent of Total Billed Charges,84% of total billed charges,45.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.47,89,,,Percent of total Billed Charges,89% of total Billed charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.8,77,,,Percent of total Billed charges,77% of total billed charges,47.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,49.47,
Artificial Tears OPHTH Oint 3.5gm,904648838,CDM,250,RC,,,Outpatient,,,55.58,27.79,,42.8,77,,,Percent of Total Billed Charges,77% of total billed charges,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.13,74,,,Percent of Total Billed Charges,74% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,84,,,Percent of Total Billed Charges,84% of total billed charges,45.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.47,89,,,Percent of total Billed Charges,89% of total Billed charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.8,77,,,Percent of total Billed charges,77% of total billed charges,47.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,49.47,
Artificial Tears OPHTH Oint 3.5gm,904648838,CDM,250,RC,,,Outpatient,,,55.58,27.79,,42.8,77,,,Percent of Total Billed Charges,77% of total billed charges,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.13,74,,,Percent of Total Billed Charges,74% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,84,,,Percent of Total Billed Charges,84% of total billed charges,45.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.47,89,,,Percent of total Billed Charges,89% of total Billed charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.8,77,,,Percent of total Billed charges,77% of total billed charges,47.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,49.47,
Artificial Tears OPHTH Oint 3.5gm,904648838,CDM,250,RC,,,Outpatient,,,55.58,27.79,,42.8,77,,,Percent of Total Billed Charges,77% of total billed charges,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.13,74,,,Percent of Total Billed Charges,74% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,38.35,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,84,,,Percent of Total Billed Charges,84% of total billed charges,45.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.47,89,,,Percent of total Billed Charges,89% of total Billed charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.8,77,,,Percent of total Billed charges,77% of total billed charges,47.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.9,49.47,
Mineral Oil 30ml UDC,48433020230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Mineral Oil 30ml UDC,48433020230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Mineral Oil 30ml UDC,48433020230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Mineral Oil 30ml UDC,48433020230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Mineral Oil 30ml UDC,48433020230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Mineral Oil 30ml UDC,48433020230,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Mirabegron ER 25mg Tablet,70710115903,CDM,250,RC,,,Outpatient,,,122.06,61.03,,93.99,77,,,Percent of Total Billed Charges,77% of total billed charges,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.32,74,,,Percent of Total Billed Charges,74% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,102.53,84,,,Percent of Total Billed Charges,84% of total billed charges,100.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.63,89,,,Percent of total Billed Charges,89% of total Billed charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.99,77,,,Percent of total Billed charges,77% of total billed charges,103.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.52,108.63,
Mirabegron ER 25mg Tablet,70710115903,CDM,250,RC,,,Outpatient,,,122.06,61.03,,93.99,77,,,Percent of Total Billed Charges,77% of total billed charges,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.32,74,,,Percent of Total Billed Charges,74% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,102.53,84,,,Percent of Total Billed Charges,84% of total billed charges,100.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.63,89,,,Percent of total Billed Charges,89% of total Billed charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.99,77,,,Percent of total Billed charges,77% of total billed charges,103.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.52,108.63,
Mirabegron ER 25mg Tablet,70710115903,CDM,250,RC,,,Outpatient,,,122.06,61.03,,93.99,77,,,Percent of Total Billed Charges,77% of total billed charges,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.32,74,,,Percent of Total Billed Charges,74% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,102.53,84,,,Percent of Total Billed Charges,84% of total billed charges,100.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.63,89,,,Percent of total Billed Charges,89% of total Billed charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.99,77,,,Percent of total Billed charges,77% of total billed charges,103.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.52,108.63,
Mirabegron ER 25mg Tablet,70710115903,CDM,250,RC,,,Outpatient,,,122.06,61.03,,93.99,77,,,Percent of Total Billed Charges,77% of total billed charges,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.32,74,,,Percent of Total Billed Charges,74% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,102.53,84,,,Percent of Total Billed Charges,84% of total billed charges,100.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.63,89,,,Percent of total Billed Charges,89% of total Billed charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.99,77,,,Percent of total Billed charges,77% of total billed charges,103.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.52,108.63,
Mirabegron ER 25mg Tablet,70710115903,CDM,250,RC,,,Outpatient,,,122.06,61.03,,93.99,77,,,Percent of Total Billed Charges,77% of total billed charges,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.32,74,,,Percent of Total Billed Charges,74% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,102.53,84,,,Percent of Total Billed Charges,84% of total billed charges,100.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.63,89,,,Percent of total Billed Charges,89% of total Billed charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.99,77,,,Percent of total Billed charges,77% of total billed charges,103.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.52,108.63,
Mirabegron ER 25mg Tablet,70710115903,CDM,250,RC,,,Outpatient,,,122.06,61.03,,93.99,77,,,Percent of Total Billed Charges,77% of total billed charges,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.32,74,,,Percent of Total Billed Charges,74% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,84.22,69,,,Percent of Total Billed Charges,69% of total billed charges,102.53,84,,,Percent of Total Billed Charges,84% of total billed charges,100.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.63,89,,,Percent of total Billed Charges,89% of total Billed charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.99,77,,,Percent of total Billed charges,77% of total billed charges,103.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.52,108.63,
Mirtazapine 15mg Tablet,51079008620,CDM,250,RC,,,Outpatient,,,30.53,15.27,,23.51,77,,,Percent of Total Billed Charges,77% of total billed charges,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.59,74,,,Percent of Total Billed Charges,74% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.65,84,,,Percent of Total Billed Charges,84% of total billed charges,25.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.17,89,,,Percent of total Billed Charges,89% of total Billed charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.51,77,,,Percent of total Billed charges,77% of total billed charges,25.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.17,
Mirtazapine 15mg Tablet,51079008620,CDM,250,RC,,,Outpatient,,,30.53,15.27,,23.51,77,,,Percent of Total Billed Charges,77% of total billed charges,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.59,74,,,Percent of Total Billed Charges,74% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.65,84,,,Percent of Total Billed Charges,84% of total billed charges,25.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.17,89,,,Percent of total Billed Charges,89% of total Billed charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.51,77,,,Percent of total Billed charges,77% of total billed charges,25.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.17,
Mirtazapine 15mg Tablet,51079008620,CDM,250,RC,,,Outpatient,,,30.53,15.27,,23.51,77,,,Percent of Total Billed Charges,77% of total billed charges,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.59,74,,,Percent of Total Billed Charges,74% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.65,84,,,Percent of Total Billed Charges,84% of total billed charges,25.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.17,89,,,Percent of total Billed Charges,89% of total Billed charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.51,77,,,Percent of total Billed charges,77% of total billed charges,25.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.17,
Mirtazapine 15mg Tablet,51079008620,CDM,250,RC,,,Outpatient,,,30.53,15.27,,23.51,77,,,Percent of Total Billed Charges,77% of total billed charges,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.59,74,,,Percent of Total Billed Charges,74% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.65,84,,,Percent of Total Billed Charges,84% of total billed charges,25.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.17,89,,,Percent of total Billed Charges,89% of total Billed charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.51,77,,,Percent of total Billed charges,77% of total billed charges,25.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.17,
Mirtazapine 15mg Tablet,51079008620,CDM,250,RC,,,Outpatient,,,30.53,15.27,,23.51,77,,,Percent of Total Billed Charges,77% of total billed charges,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.59,74,,,Percent of Total Billed Charges,74% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.65,84,,,Percent of Total Billed Charges,84% of total billed charges,25.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.17,89,,,Percent of total Billed Charges,89% of total Billed charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.51,77,,,Percent of total Billed charges,77% of total billed charges,25.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.17,
Mirtazapine 15mg Tablet,51079008620,CDM,250,RC,,,Outpatient,,,30.53,15.27,,23.51,77,,,Percent of Total Billed Charges,77% of total billed charges,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.59,74,,,Percent of Total Billed Charges,74% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,21.07,69,,,Percent of Total Billed Charges,69% of total billed charges,25.65,84,,,Percent of Total Billed Charges,84% of total billed charges,25.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.17,89,,,Percent of total Billed Charges,89% of total Billed charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.51,77,,,Percent of total Billed charges,77% of total billed charges,25.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,27.17,
miSOPROStol 100mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 100mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 100mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 100mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 100mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 100mcg Tablet,,,250,RC,,,Outpatient,,,14.2,7.1,,10.93,77,,,Percent of Total Billed Charges,77% of total billed charges,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.62,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.51,74,,,Percent of Total Billed Charges,74% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,9.8,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,84,,,Percent of Total Billed Charges,84% of total billed charges,11.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.64,89,,,Percent of total Billed Charges,89% of total Billed charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.93,77,,,Percent of total Billed charges,77% of total billed charges,12.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,12.64,
miSOPROStol 200mcg Tablet,,,250,RC,,,Outpatient,,,30.62,15.31,,23.58,77,,,Percent of Total Billed Charges,77% of total billed charges,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.66,74,,,Percent of Total Billed Charges,74% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,25.72,84,,,Percent of Total Billed Charges,84% of total billed charges,25.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.25,89,,,Percent of total Billed Charges,89% of total Billed charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.58,77,,,Percent of total Billed charges,77% of total billed charges,26.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,27.25,
miSOPROStol 200mcg Tablet,,,250,RC,,,Outpatient,,,30.62,15.31,,23.58,77,,,Percent of Total Billed Charges,77% of total billed charges,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.66,74,,,Percent of Total Billed Charges,74% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,25.72,84,,,Percent of Total Billed Charges,84% of total billed charges,25.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.25,89,,,Percent of total Billed Charges,89% of total Billed charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.58,77,,,Percent of total Billed charges,77% of total billed charges,26.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,27.25,
miSOPROStol 200mcg Tablet,,,250,RC,,,Outpatient,,,30.62,15.31,,23.58,77,,,Percent of Total Billed Charges,77% of total billed charges,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.66,74,,,Percent of Total Billed Charges,74% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,25.72,84,,,Percent of Total Billed Charges,84% of total billed charges,25.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.25,89,,,Percent of total Billed Charges,89% of total Billed charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.58,77,,,Percent of total Billed charges,77% of total billed charges,26.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,27.25,
miSOPROStol 200mcg Tablet,,,250,RC,,,Outpatient,,,30.62,15.31,,23.58,77,,,Percent of Total Billed Charges,77% of total billed charges,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.66,74,,,Percent of Total Billed Charges,74% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,25.72,84,,,Percent of Total Billed Charges,84% of total billed charges,25.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.25,89,,,Percent of total Billed Charges,89% of total Billed charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.58,77,,,Percent of total Billed charges,77% of total billed charges,26.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,27.25,
miSOPROStol 200mcg Tablet,,,250,RC,,,Outpatient,,,30.62,15.31,,23.58,77,,,Percent of Total Billed Charges,77% of total billed charges,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.66,74,,,Percent of Total Billed Charges,74% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,25.72,84,,,Percent of Total Billed Charges,84% of total billed charges,25.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.25,89,,,Percent of total Billed Charges,89% of total Billed charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.58,77,,,Percent of total Billed charges,77% of total billed charges,26.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,27.25,
miSOPROStol 200mcg Tablet,,,250,RC,,,Outpatient,,,30.62,15.31,,23.58,77,,,Percent of Total Billed Charges,77% of total billed charges,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.66,74,,,Percent of Total Billed Charges,74% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,21.13,69,,,Percent of Total Billed Charges,69% of total billed charges,25.72,84,,,Percent of Total Billed Charges,84% of total billed charges,25.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.25,89,,,Percent of total Billed Charges,89% of total Billed charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.58,77,,,Percent of total Billed charges,77% of total billed charges,26.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.66,27.25,
Lanolin Cream 37gm,44677010020,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Lanolin Cream 37gm,44677010020,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Lanolin Cream 37gm,44677010020,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Lanolin Cream 37gm,44677010020,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Lanolin Cream 37gm,44677010020,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Lanolin Cream 37gm,44677010020,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Montelukast 10mg Tablet,68084087501,CDM,250,RC,,,Outpatient,,,53.51,26.76,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.6,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.95,84,,,Percent of Total Billed Charges,84% of total billed charges,43.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,47.62,
Montelukast 10mg Tablet,68084087501,CDM,250,RC,,,Outpatient,,,53.51,26.76,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.6,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.95,84,,,Percent of Total Billed Charges,84% of total billed charges,43.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,47.62,
Montelukast 10mg Tablet,68084087501,CDM,250,RC,,,Outpatient,,,53.51,26.76,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.6,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.95,84,,,Percent of Total Billed Charges,84% of total billed charges,43.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,47.62,
Montelukast 10mg Tablet,68084087501,CDM,250,RC,,,Outpatient,,,53.51,26.76,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.6,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.95,84,,,Percent of Total Billed Charges,84% of total billed charges,43.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,47.62,
Montelukast 10mg Tablet,68084087501,CDM,250,RC,,,Outpatient,,,53.51,26.76,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.6,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.95,84,,,Percent of Total Billed Charges,84% of total billed charges,43.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,47.62,
Montelukast 10mg Tablet,68084087501,CDM,250,RC,,,Outpatient,,,53.51,26.76,,41.2,77,,,Percent of Total Billed Charges,77% of total billed charges,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.6,74,,,Percent of Total Billed Charges,74% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.92,69,,,Percent of Total Billed Charges,69% of total billed charges,44.95,84,,,Percent of Total Billed Charges,84% of total billed charges,43.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.62,89,,,Percent of total Billed Charges,89% of total Billed charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.2,77,,,Percent of total Billed charges,77% of total billed charges,45.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.38,47.62,
Morphine Concentrated Drops 20mg/ml 15ml,54051741,CDM,250,RC,,,Outpatient,,,108.63,54.32,,83.65,77,,,Percent of Total Billed Charges,77% of total billed charges,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,74,,,Percent of Total Billed Charges,74% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,84,,,Percent of Total Billed Charges,84% of total billed charges,89.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.68,89,,,Percent of total Billed Charges,89% of total Billed charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.65,77,,,Percent of total Billed charges,77% of total billed charges,92.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.16,96.68,
Morphine Concentrated Drops 20mg/ml 15ml,54051741,CDM,250,RC,,,Outpatient,,,108.63,54.32,,83.65,77,,,Percent of Total Billed Charges,77% of total billed charges,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,74,,,Percent of Total Billed Charges,74% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,84,,,Percent of Total Billed Charges,84% of total billed charges,89.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.68,89,,,Percent of total Billed Charges,89% of total Billed charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.65,77,,,Percent of total Billed charges,77% of total billed charges,92.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.16,96.68,
Morphine Concentrated Drops 20mg/ml 15ml,54051741,CDM,250,RC,,,Outpatient,,,108.63,54.32,,83.65,77,,,Percent of Total Billed Charges,77% of total billed charges,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,74,,,Percent of Total Billed Charges,74% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,84,,,Percent of Total Billed Charges,84% of total billed charges,89.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.68,89,,,Percent of total Billed Charges,89% of total Billed charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.65,77,,,Percent of total Billed charges,77% of total billed charges,92.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.16,96.68,
Morphine Concentrated Drops 20mg/ml 15ml,54051741,CDM,250,RC,,,Outpatient,,,108.63,54.32,,83.65,77,,,Percent of Total Billed Charges,77% of total billed charges,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,74,,,Percent of Total Billed Charges,74% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,84,,,Percent of Total Billed Charges,84% of total billed charges,89.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.68,89,,,Percent of total Billed Charges,89% of total Billed charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.65,77,,,Percent of total Billed charges,77% of total billed charges,92.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.16,96.68,
Morphine Concentrated Drops 20mg/ml 15ml,54051741,CDM,250,RC,,,Outpatient,,,108.63,54.32,,83.65,77,,,Percent of Total Billed Charges,77% of total billed charges,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,74,,,Percent of Total Billed Charges,74% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,84,,,Percent of Total Billed Charges,84% of total billed charges,89.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.68,89,,,Percent of total Billed Charges,89% of total Billed charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.65,77,,,Percent of total Billed charges,77% of total billed charges,92.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.16,96.68,
Morphine Concentrated Drops 20mg/ml 15ml,54051741,CDM,250,RC,,,Outpatient,,,108.63,54.32,,83.65,77,,,Percent of Total Billed Charges,77% of total billed charges,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,80.39,74,,,Percent of Total Billed Charges,74% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,74.95,69,,,Percent of Total Billed Charges,69% of total billed charges,91.25,84,,,Percent of Total Billed Charges,84% of total billed charges,89.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,96.68,89,,,Percent of total Billed Charges,89% of total Billed charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.65,77,,,Percent of total Billed charges,77% of total billed charges,92.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,54.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,44.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.16,96.68,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 10mg/ml SDV,641612701,CDM,250,RC,,,Outpatient,,,55.46,27.73,,42.7,77,,,Percent of Total Billed Charges,77% of total billed charges,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.04,74,,,Percent of Total Billed Charges,74% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,38.27,69,,,Percent of Total Billed Charges,69% of total billed charges,46.59,84,,,Percent of Total Billed Charges,84% of total billed charges,45.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.36,89,,,Percent of total Billed Charges,89% of total Billed charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.7,77,,,Percent of total Billed charges,77% of total billed charges,47.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.87,49.36,
Morphine 15mg Immediate Release Tablet,54023524,CDM,250,RC,,,Outpatient,,,13.54,6.77,,10.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.02,74,,,Percent of Total Billed Charges,74% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11.37,84,,,Percent of Total Billed Charges,84% of total billed charges,11.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.05,89,,,Percent of total Billed Charges,89% of total Billed charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.43,77,,,Percent of total Billed charges,77% of total billed charges,11.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.39,12.05,
Morphine 15mg Immediate Release Tablet,54023524,CDM,250,RC,,,Outpatient,,,13.54,6.77,,10.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.02,74,,,Percent of Total Billed Charges,74% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11.37,84,,,Percent of Total Billed Charges,84% of total billed charges,11.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.05,89,,,Percent of total Billed Charges,89% of total Billed charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.43,77,,,Percent of total Billed charges,77% of total billed charges,11.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.39,12.05,
Morphine 15mg Immediate Release Tablet,54023524,CDM,250,RC,,,Outpatient,,,13.54,6.77,,10.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.02,74,,,Percent of Total Billed Charges,74% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11.37,84,,,Percent of Total Billed Charges,84% of total billed charges,11.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.05,89,,,Percent of total Billed Charges,89% of total Billed charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.43,77,,,Percent of total Billed charges,77% of total billed charges,11.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.39,12.05,
Morphine 15mg Immediate Release Tablet,54023524,CDM,250,RC,,,Outpatient,,,13.54,6.77,,10.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.02,74,,,Percent of Total Billed Charges,74% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11.37,84,,,Percent of Total Billed Charges,84% of total billed charges,11.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.05,89,,,Percent of total Billed Charges,89% of total Billed charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.43,77,,,Percent of total Billed charges,77% of total billed charges,11.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.39,12.05,
Morphine 15mg Immediate Release Tablet,54023524,CDM,250,RC,,,Outpatient,,,13.54,6.77,,10.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.02,74,,,Percent of Total Billed Charges,74% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11.37,84,,,Percent of Total Billed Charges,84% of total billed charges,11.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.05,89,,,Percent of total Billed Charges,89% of total Billed charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.43,77,,,Percent of total Billed charges,77% of total billed charges,11.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.39,12.05,
Morphine 15mg Immediate Release Tablet,54023524,CDM,250,RC,,,Outpatient,,,13.54,6.77,,10.43,77,,,Percent of Total Billed Charges,77% of total billed charges,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.02,74,,,Percent of Total Billed Charges,74% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.34,69,,,Percent of Total Billed Charges,69% of total billed charges,11.37,84,,,Percent of Total Billed Charges,84% of total billed charges,11.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.05,89,,,Percent of total Billed Charges,89% of total Billed charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.43,77,,,Percent of total Billed charges,77% of total billed charges,11.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.39,12.05,
Morphine 15mg Controlled Release Tablet,406831562,CDM,250,RC,,,Outpatient,,,22.55,11.28,,17.36,77,,,Percent of Total Billed Charges,77% of total billed charges,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.69,74,,,Percent of Total Billed Charges,74% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.94,84,,,Percent of Total Billed Charges,84% of total billed charges,18.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.07,89,,,Percent of total Billed Charges,89% of total Billed charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,77,,,Percent of total Billed charges,77% of total billed charges,19.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.64,20.07,
Morphine 15mg Controlled Release Tablet,406831562,CDM,250,RC,,,Outpatient,,,22.55,11.28,,17.36,77,,,Percent of Total Billed Charges,77% of total billed charges,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.69,74,,,Percent of Total Billed Charges,74% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.94,84,,,Percent of Total Billed Charges,84% of total billed charges,18.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.07,89,,,Percent of total Billed Charges,89% of total Billed charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,77,,,Percent of total Billed charges,77% of total billed charges,19.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.64,20.07,
Morphine 15mg Controlled Release Tablet,406831562,CDM,250,RC,,,Outpatient,,,22.55,11.28,,17.36,77,,,Percent of Total Billed Charges,77% of total billed charges,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.69,74,,,Percent of Total Billed Charges,74% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.94,84,,,Percent of Total Billed Charges,84% of total billed charges,18.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.07,89,,,Percent of total Billed Charges,89% of total Billed charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,77,,,Percent of total Billed charges,77% of total billed charges,19.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.64,20.07,
Morphine 15mg Controlled Release Tablet,406831562,CDM,250,RC,,,Outpatient,,,22.55,11.28,,17.36,77,,,Percent of Total Billed Charges,77% of total billed charges,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.69,74,,,Percent of Total Billed Charges,74% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.94,84,,,Percent of Total Billed Charges,84% of total billed charges,18.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.07,89,,,Percent of total Billed Charges,89% of total Billed charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,77,,,Percent of total Billed charges,77% of total billed charges,19.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.64,20.07,
Morphine 15mg Controlled Release Tablet,406831562,CDM,250,RC,,,Outpatient,,,22.55,11.28,,17.36,77,,,Percent of Total Billed Charges,77% of total billed charges,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.69,74,,,Percent of Total Billed Charges,74% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.94,84,,,Percent of Total Billed Charges,84% of total billed charges,18.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.07,89,,,Percent of total Billed Charges,89% of total Billed charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,77,,,Percent of total Billed charges,77% of total billed charges,19.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.64,20.07,
Morphine 15mg Controlled Release Tablet,406831562,CDM,250,RC,,,Outpatient,,,22.55,11.28,,17.36,77,,,Percent of Total Billed Charges,77% of total billed charges,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.69,74,,,Percent of Total Billed Charges,74% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,15.56,69,,,Percent of Total Billed Charges,69% of total billed charges,18.94,84,,,Percent of Total Billed Charges,84% of total billed charges,18.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.07,89,,,Percent of total Billed Charges,89% of total Billed charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.36,77,,,Percent of total Billed charges,77% of total billed charges,19.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.64,20.07,
Morphine 10mg/10ml Ampule,641601910,CDM,250,RC,,,Outpatient,,,227.79,113.9,,175.4,77,,,Percent of Total Billed Charges,77% of total billed charges,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.56,74,,,Percent of Total Billed Charges,74% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,191.34,84,,,Percent of Total Billed Charges,84% of total billed charges,186.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.73,89,,,Percent of total Billed Charges,89% of total Billed charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.4,77,,,Percent of total Billed charges,77% of total billed charges,193.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.95,202.73,
Morphine 10mg/10ml Ampule,641601910,CDM,250,RC,,,Outpatient,,,227.79,113.9,,175.4,77,,,Percent of Total Billed Charges,77% of total billed charges,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.56,74,,,Percent of Total Billed Charges,74% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,191.34,84,,,Percent of Total Billed Charges,84% of total billed charges,186.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.73,89,,,Percent of total Billed Charges,89% of total Billed charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.4,77,,,Percent of total Billed charges,77% of total billed charges,193.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.95,202.73,
Morphine 10mg/10ml Ampule,641601910,CDM,250,RC,,,Outpatient,,,227.79,113.9,,175.4,77,,,Percent of Total Billed Charges,77% of total billed charges,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.56,74,,,Percent of Total Billed Charges,74% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,191.34,84,,,Percent of Total Billed Charges,84% of total billed charges,186.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.73,89,,,Percent of total Billed Charges,89% of total Billed charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.4,77,,,Percent of total Billed charges,77% of total billed charges,193.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.95,202.73,
Morphine 10mg/10ml Ampule,641601910,CDM,250,RC,,,Outpatient,,,227.79,113.9,,175.4,77,,,Percent of Total Billed Charges,77% of total billed charges,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.56,74,,,Percent of Total Billed Charges,74% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,191.34,84,,,Percent of Total Billed Charges,84% of total billed charges,186.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.73,89,,,Percent of total Billed Charges,89% of total Billed charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.4,77,,,Percent of total Billed charges,77% of total billed charges,193.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.95,202.73,
Morphine 10mg/10ml Ampule,641601910,CDM,250,RC,,,Outpatient,,,227.79,113.9,,175.4,77,,,Percent of Total Billed Charges,77% of total billed charges,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.56,74,,,Percent of Total Billed Charges,74% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,191.34,84,,,Percent of Total Billed Charges,84% of total billed charges,186.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.73,89,,,Percent of total Billed Charges,89% of total Billed charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.4,77,,,Percent of total Billed charges,77% of total billed charges,193.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.95,202.73,
Morphine 10mg/10ml Ampule,641601910,CDM,250,RC,,,Outpatient,,,227.79,113.9,,175.4,77,,,Percent of Total Billed Charges,77% of total billed charges,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,58.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,168.56,74,,,Percent of Total Billed Charges,74% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,157.18,69,,,Percent of Total Billed Charges,69% of total billed charges,191.34,84,,,Percent of Total Billed Charges,84% of total billed charges,186.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,202.73,89,,,Percent of total Billed Charges,89% of total Billed charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.4,77,,,Percent of total Billed charges,77% of total billed charges,193.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.95,202.73,
Morphine 30mg Controlled Release Tablet,406833062,CDM,250,RC,,,Outpatient,,,36.72,18.36,,28.27,77,,,Percent of Total Billed Charges,77% of total billed charges,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,30.84,84,,,Percent of Total Billed Charges,84% of total billed charges,30.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.68,89,,,Percent of total Billed Charges,89% of total Billed charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.27,77,,,Percent of total Billed charges,77% of total billed charges,31.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.18,32.68,
Morphine 30mg Controlled Release Tablet,406833062,CDM,250,RC,,,Outpatient,,,36.72,18.36,,28.27,77,,,Percent of Total Billed Charges,77% of total billed charges,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,30.84,84,,,Percent of Total Billed Charges,84% of total billed charges,30.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.68,89,,,Percent of total Billed Charges,89% of total Billed charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.27,77,,,Percent of total Billed charges,77% of total billed charges,31.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.18,32.68,
Morphine 30mg Controlled Release Tablet,406833062,CDM,250,RC,,,Outpatient,,,36.72,18.36,,28.27,77,,,Percent of Total Billed Charges,77% of total billed charges,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,30.84,84,,,Percent of Total Billed Charges,84% of total billed charges,30.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.68,89,,,Percent of total Billed Charges,89% of total Billed charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.27,77,,,Percent of total Billed charges,77% of total billed charges,31.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.18,32.68,
Morphine 30mg Controlled Release Tablet,406833062,CDM,250,RC,,,Outpatient,,,36.72,18.36,,28.27,77,,,Percent of Total Billed Charges,77% of total billed charges,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,30.84,84,,,Percent of Total Billed Charges,84% of total billed charges,30.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.68,89,,,Percent of total Billed Charges,89% of total Billed charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.27,77,,,Percent of total Billed charges,77% of total billed charges,31.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.18,32.68,
Morphine 30mg Controlled Release Tablet,406833062,CDM,250,RC,,,Outpatient,,,36.72,18.36,,28.27,77,,,Percent of Total Billed Charges,77% of total billed charges,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,30.84,84,,,Percent of Total Billed Charges,84% of total billed charges,30.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.68,89,,,Percent of total Billed Charges,89% of total Billed charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.27,77,,,Percent of total Billed charges,77% of total billed charges,31.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.18,32.68,
Morphine 30mg Controlled Release Tablet,406833062,CDM,250,RC,,,Outpatient,,,36.72,18.36,,28.27,77,,,Percent of Total Billed Charges,77% of total billed charges,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,27.17,74,,,Percent of Total Billed Charges,74% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,25.34,69,,,Percent of Total Billed Charges,69% of total billed charges,30.84,84,,,Percent of Total Billed Charges,84% of total billed charges,30.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,32.68,89,,,Percent of total Billed Charges,89% of total Billed charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.27,77,,,Percent of total Billed charges,77% of total billed charges,31.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.68,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.18,32.68,
Morphine 4mg/ml SDV,641612525,CDM,250,RC,,,Outpatient,,,60.56,30.28,,46.63,77,,,Percent of Total Billed Charges,77% of total billed charges,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.81,74,,,Percent of Total Billed Charges,74% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,50.87,84,,,Percent of Total Billed Charges,84% of total billed charges,49.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.9,89,,,Percent of total Billed Charges,89% of total Billed charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.63,77,,,Percent of total Billed charges,77% of total billed charges,51.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,53.9,
Morphine 4mg/ml SDV,641612525,CDM,250,RC,,,Outpatient,,,60.56,30.28,,46.63,77,,,Percent of Total Billed Charges,77% of total billed charges,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.81,74,,,Percent of Total Billed Charges,74% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,50.87,84,,,Percent of Total Billed Charges,84% of total billed charges,49.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.9,89,,,Percent of total Billed Charges,89% of total Billed charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.63,77,,,Percent of total Billed charges,77% of total billed charges,51.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,53.9,
Morphine 4mg/ml SDV,641612525,CDM,250,RC,,,Outpatient,,,60.56,30.28,,46.63,77,,,Percent of Total Billed Charges,77% of total billed charges,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.81,74,,,Percent of Total Billed Charges,74% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,50.87,84,,,Percent of Total Billed Charges,84% of total billed charges,49.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.9,89,,,Percent of total Billed Charges,89% of total Billed charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.63,77,,,Percent of total Billed charges,77% of total billed charges,51.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,53.9,
Morphine 4mg/ml SDV,641612525,CDM,250,RC,,,Outpatient,,,60.56,30.28,,46.63,77,,,Percent of Total Billed Charges,77% of total billed charges,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.81,74,,,Percent of Total Billed Charges,74% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,50.87,84,,,Percent of Total Billed Charges,84% of total billed charges,49.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.9,89,,,Percent of total Billed Charges,89% of total Billed charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.63,77,,,Percent of total Billed charges,77% of total billed charges,51.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,53.9,
Morphine 4mg/ml SDV,641612525,CDM,250,RC,,,Outpatient,,,60.56,30.28,,46.63,77,,,Percent of Total Billed Charges,77% of total billed charges,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.81,74,,,Percent of Total Billed Charges,74% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,50.87,84,,,Percent of Total Billed Charges,84% of total billed charges,49.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.9,89,,,Percent of total Billed Charges,89% of total Billed charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.63,77,,,Percent of total Billed charges,77% of total billed charges,51.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,53.9,
Morphine 4mg/ml SDV,641612525,CDM,250,RC,,,Outpatient,,,60.56,30.28,,46.63,77,,,Percent of Total Billed Charges,77% of total billed charges,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.81,74,,,Percent of Total Billed Charges,74% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,41.79,69,,,Percent of Total Billed Charges,69% of total billed charges,50.87,84,,,Percent of Total Billed Charges,84% of total billed charges,49.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.9,89,,,Percent of total Billed Charges,89% of total Billed charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.63,77,,,Percent of total Billed charges,77% of total billed charges,51.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.14,53.9,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin IV 10ml (2x5ml per Dose) SDV,54643564901,CDM,250,RC,,,Outpatient,,,166.49,83.25,,128.2,77,,,Percent of Total Billed Charges,77% of total billed charges,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,123.2,74,,,Percent of Total Billed Charges,74% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,114.88,69,,,Percent of Total Billed Charges,69% of total billed charges,139.85,84,,,Percent of Total Billed Charges,84% of total billed charges,136.52,82,,,Percent of Total Billed Charges,82% of total billed charges ,148.18,89,,,Percent of total Billed Charges,89% of total Billed charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.2,77,,,Percent of total Billed charges,77% of total billed charges,141.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.62,148.18,
Multivitamin Tablet,904053961,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Multivitamin Tablet,904053961,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Multivitamin Tablet,904053961,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Multivitamin Tablet,904053961,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Multivitamin Tablet,904053961,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Multivitamin Tablet,904053961,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Multivitamin Liquid 15ml UDC (OE-N),68094012061,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Multivitamin Liquid 15ml UDC (OE-N),68094012061,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Multivitamin Liquid 15ml UDC (OE-N),68094012061,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Multivitamin Liquid 15ml UDC (OE-N),68094012061,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Multivitamin Liquid 15ml UDC (OE-N),68094012061,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Multivitamin Liquid 15ml UDC (OE-N),68094012061,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Mupirocin 2% Cream 15gm,68462056417,CDM,250,RC,,,Outpatient,,,849.63,424.82,,654.22,77,,,Percent of Total Billed Charges,77% of total billed charges,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.73,74,,,Percent of Total Billed Charges,74% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,713.69,84,,,Percent of Total Billed Charges,84% of total billed charges,696.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.17,89,,,Percent of total Billed Charges,89% of total Billed charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.22,77,,,Percent of total Billed charges,77% of total billed charges,722.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.41,756.17,
Mupirocin 2% Cream 15gm,68462056417,CDM,250,RC,,,Outpatient,,,849.63,424.82,,654.22,77,,,Percent of Total Billed Charges,77% of total billed charges,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.73,74,,,Percent of Total Billed Charges,74% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,713.69,84,,,Percent of Total Billed Charges,84% of total billed charges,696.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.17,89,,,Percent of total Billed Charges,89% of total Billed charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.22,77,,,Percent of total Billed charges,77% of total billed charges,722.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.41,756.17,
Mupirocin 2% Cream 15gm,68462056417,CDM,250,RC,,,Outpatient,,,849.63,424.82,,654.22,77,,,Percent of Total Billed Charges,77% of total billed charges,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.73,74,,,Percent of Total Billed Charges,74% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,713.69,84,,,Percent of Total Billed Charges,84% of total billed charges,696.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.17,89,,,Percent of total Billed Charges,89% of total Billed charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.22,77,,,Percent of total Billed charges,77% of total billed charges,722.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.41,756.17,
Mupirocin 2% Cream 15gm,68462056417,CDM,250,RC,,,Outpatient,,,849.63,424.82,,654.22,77,,,Percent of Total Billed Charges,77% of total billed charges,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.73,74,,,Percent of Total Billed Charges,74% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,713.69,84,,,Percent of Total Billed Charges,84% of total billed charges,696.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.17,89,,,Percent of total Billed Charges,89% of total Billed charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.22,77,,,Percent of total Billed charges,77% of total billed charges,722.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.41,756.17,
Mupirocin 2% Cream 15gm,68462056417,CDM,250,RC,,,Outpatient,,,849.63,424.82,,654.22,77,,,Percent of Total Billed Charges,77% of total billed charges,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.73,74,,,Percent of Total Billed Charges,74% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,713.69,84,,,Percent of Total Billed Charges,84% of total billed charges,696.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.17,89,,,Percent of total Billed Charges,89% of total Billed charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.22,77,,,Percent of total Billed charges,77% of total billed charges,722.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.41,756.17,
Mupirocin 2% Cream 15gm,68462056417,CDM,250,RC,,,Outpatient,,,849.63,424.82,,654.22,77,,,Percent of Total Billed Charges,77% of total billed charges,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,216.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,628.73,74,,,Percent of Total Billed Charges,74% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,586.24,69,,,Percent of Total Billed Charges,69% of total billed charges,713.69,84,,,Percent of Total Billed Charges,84% of total billed charges,696.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,756.17,89,,,Percent of total Billed Charges,89% of total Billed charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.22,77,,,Percent of total Billed charges,77% of total billed charges,722.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,424.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,346.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,756.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.41,756.17,
Mupirocin 2% Ointment 22gm,45802011222,CDM,250,RC,,,Outpatient,,,79.02,39.51,,60.85,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.47,74,,,Percent of Total Billed Charges,74% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,84,,,Percent of Total Billed Charges,84% of total billed charges,64.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.33,89,,,Percent of total Billed Charges,89% of total Billed charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.85,77,,,Percent of total Billed charges,77% of total billed charges,67.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.76,70.33,
Mupirocin 2% Ointment 22gm,45802011222,CDM,250,RC,,,Outpatient,,,79.02,39.51,,60.85,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.47,74,,,Percent of Total Billed Charges,74% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,84,,,Percent of Total Billed Charges,84% of total billed charges,64.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.33,89,,,Percent of total Billed Charges,89% of total Billed charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.85,77,,,Percent of total Billed charges,77% of total billed charges,67.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.76,70.33,
Mupirocin 2% Ointment 22gm,45802011222,CDM,250,RC,,,Outpatient,,,79.02,39.51,,60.85,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.47,74,,,Percent of Total Billed Charges,74% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,84,,,Percent of Total Billed Charges,84% of total billed charges,64.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.33,89,,,Percent of total Billed Charges,89% of total Billed charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.85,77,,,Percent of total Billed charges,77% of total billed charges,67.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.76,70.33,
Mupirocin 2% Ointment 22gm,45802011222,CDM,250,RC,,,Outpatient,,,79.02,39.51,,60.85,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.47,74,,,Percent of Total Billed Charges,74% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,84,,,Percent of Total Billed Charges,84% of total billed charges,64.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.33,89,,,Percent of total Billed Charges,89% of total Billed charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.85,77,,,Percent of total Billed charges,77% of total billed charges,67.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.76,70.33,
Mupirocin 2% Ointment 22gm,45802011222,CDM,250,RC,,,Outpatient,,,79.02,39.51,,60.85,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.47,74,,,Percent of Total Billed Charges,74% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,84,,,Percent of Total Billed Charges,84% of total billed charges,64.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.33,89,,,Percent of total Billed Charges,89% of total Billed charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.85,77,,,Percent of total Billed charges,77% of total billed charges,67.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.76,70.33,
Mupirocin 2% Ointment 22gm,45802011222,CDM,250,RC,,,Outpatient,,,79.02,39.51,,60.85,77,,,Percent of Total Billed Charges,77% of total billed charges,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,58.47,74,,,Percent of Total Billed Charges,74% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,54.52,69,,,Percent of Total Billed Charges,69% of total billed charges,66.38,84,,,Percent of Total Billed Charges,84% of total billed charges,64.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.33,89,,,Percent of total Billed Charges,89% of total Billed charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.85,77,,,Percent of total Billed charges,77% of total billed charges,67.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.76,70.33,
Nadolol 40mg Tablet,,,250,RC,,,Outpatient,,,38.88,19.44,,29.94,77,,,Percent of Total Billed Charges,77% of total billed charges,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.77,74,,,Percent of Total Billed Charges,74% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,32.66,84,,,Percent of Total Billed Charges,84% of total billed charges,31.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.6,89,,,Percent of total Billed Charges,89% of total Billed charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.94,77,,,Percent of total Billed charges,77% of total billed charges,33.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.72,34.6,
Nadolol 40mg Tablet,,,250,RC,,,Outpatient,,,38.88,19.44,,29.94,77,,,Percent of Total Billed Charges,77% of total billed charges,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.77,74,,,Percent of Total Billed Charges,74% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,32.66,84,,,Percent of Total Billed Charges,84% of total billed charges,31.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.6,89,,,Percent of total Billed Charges,89% of total Billed charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.94,77,,,Percent of total Billed charges,77% of total billed charges,33.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.72,34.6,
Nadolol 40mg Tablet,,,250,RC,,,Outpatient,,,38.88,19.44,,29.94,77,,,Percent of Total Billed Charges,77% of total billed charges,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.77,74,,,Percent of Total Billed Charges,74% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,32.66,84,,,Percent of Total Billed Charges,84% of total billed charges,31.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.6,89,,,Percent of total Billed Charges,89% of total Billed charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.94,77,,,Percent of total Billed charges,77% of total billed charges,33.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.72,34.6,
Nadolol 40mg Tablet,,,250,RC,,,Outpatient,,,38.88,19.44,,29.94,77,,,Percent of Total Billed Charges,77% of total billed charges,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.77,74,,,Percent of Total Billed Charges,74% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,32.66,84,,,Percent of Total Billed Charges,84% of total billed charges,31.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.6,89,,,Percent of total Billed Charges,89% of total Billed charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.94,77,,,Percent of total Billed charges,77% of total billed charges,33.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.72,34.6,
Nadolol 40mg Tablet,,,250,RC,,,Outpatient,,,38.88,19.44,,29.94,77,,,Percent of Total Billed Charges,77% of total billed charges,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.77,74,,,Percent of Total Billed Charges,74% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,32.66,84,,,Percent of Total Billed Charges,84% of total billed charges,31.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.6,89,,,Percent of total Billed Charges,89% of total Billed charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.94,77,,,Percent of total Billed charges,77% of total billed charges,33.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.72,34.6,
Nadolol 40mg Tablet,,,250,RC,,,Outpatient,,,38.88,19.44,,29.94,77,,,Percent of Total Billed Charges,77% of total billed charges,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.77,74,,,Percent of Total Billed Charges,74% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,26.83,69,,,Percent of Total Billed Charges,69% of total billed charges,32.66,84,,,Percent of Total Billed Charges,84% of total billed charges,31.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.6,89,,,Percent of total Billed Charges,89% of total Billed charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.94,77,,,Percent of total Billed charges,77% of total billed charges,33.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.86,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.72,34.6,
Nalbuphine 10mg/ml Ampule,409146301,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Nalbuphine 10mg/ml Ampule,409146301,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Nalbuphine 10mg/ml Ampule,409146301,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Nalbuphine 10mg/ml Ampule,409146301,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Nalbuphine 10mg/ml Ampule,409146301,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Nalbuphine 10mg/ml Ampule,409146301,CDM,250,RC,,,Outpatient,,,76.68,38.34,,59.04,77,,,Percent of Total Billed Charges,77% of total billed charges,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.74,74,,,Percent of Total Billed Charges,74% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,52.91,69,,,Percent of Total Billed Charges,69% of total billed charges,64.41,84,,,Percent of Total Billed Charges,84% of total billed charges,62.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.25,89,,,Percent of total Billed Charges,89% of total Billed charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.04,77,,,Percent of total Billed charges,77% of total billed charges,65.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.17,68.25,
Naloxone 0.4mg/ml SDV,409121501,CDM,250,RC,,,Outpatient,,,170.19,85.1,,131.05,77,,,Percent of Total Billed Charges,77% of total billed charges,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.94,74,,,Percent of Total Billed Charges,74% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,142.96,84,,,Percent of Total Billed Charges,84% of total billed charges,139.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.47,89,,,Percent of total Billed Charges,89% of total Billed charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.05,77,,,Percent of total Billed charges,77% of total billed charges,144.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.55,151.47,
Naloxone 0.4mg/ml SDV,409121501,CDM,250,RC,,,Outpatient,,,170.19,85.1,,131.05,77,,,Percent of Total Billed Charges,77% of total billed charges,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.94,74,,,Percent of Total Billed Charges,74% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,142.96,84,,,Percent of Total Billed Charges,84% of total billed charges,139.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.47,89,,,Percent of total Billed Charges,89% of total Billed charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.05,77,,,Percent of total Billed charges,77% of total billed charges,144.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.55,151.47,
Naloxone 0.4mg/ml SDV,409121501,CDM,250,RC,,,Outpatient,,,170.19,85.1,,131.05,77,,,Percent of Total Billed Charges,77% of total billed charges,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.94,74,,,Percent of Total Billed Charges,74% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,142.96,84,,,Percent of Total Billed Charges,84% of total billed charges,139.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.47,89,,,Percent of total Billed Charges,89% of total Billed charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.05,77,,,Percent of total Billed charges,77% of total billed charges,144.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.55,151.47,
Naloxone 0.4mg/ml SDV,409121501,CDM,250,RC,,,Outpatient,,,170.19,85.1,,131.05,77,,,Percent of Total Billed Charges,77% of total billed charges,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.94,74,,,Percent of Total Billed Charges,74% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,142.96,84,,,Percent of Total Billed Charges,84% of total billed charges,139.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.47,89,,,Percent of total Billed Charges,89% of total Billed charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.05,77,,,Percent of total Billed charges,77% of total billed charges,144.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.55,151.47,
Naloxone 0.4mg/ml SDV,409121501,CDM,250,RC,,,Outpatient,,,170.19,85.1,,131.05,77,,,Percent of Total Billed Charges,77% of total billed charges,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.94,74,,,Percent of Total Billed Charges,74% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,142.96,84,,,Percent of Total Billed Charges,84% of total billed charges,139.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.47,89,,,Percent of total Billed Charges,89% of total Billed charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.05,77,,,Percent of total Billed charges,77% of total billed charges,144.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.55,151.47,
Naloxone 0.4mg/ml SDV,409121501,CDM,250,RC,,,Outpatient,,,170.19,85.1,,131.05,77,,,Percent of Total Billed Charges,77% of total billed charges,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.18,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.94,74,,,Percent of Total Billed Charges,74% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,117.43,69,,,Percent of Total Billed Charges,69% of total billed charges,142.96,84,,,Percent of Total Billed Charges,84% of total billed charges,139.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.47,89,,,Percent of total Billed Charges,89% of total Billed charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.05,77,,,Percent of total Billed charges,77% of total billed charges,144.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.55,151.47,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naloxone 2mg/2ml Syringe,76329336901,CDM,250,RC,,,Outpatient,,,253.99,127,,195.57,77,,,Percent of Total Billed Charges,77% of total billed charges,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,187.95,74,,,Percent of Total Billed Charges,74% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,175.25,69,,,Percent of Total Billed Charges,69% of total billed charges,213.35,84,,,Percent of Total Billed Charges,84% of total billed charges,208.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.05,89,,,Percent of total Billed Charges,89% of total Billed charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.57,77,,,Percent of total Billed charges,77% of total billed charges,215.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.5,226.05,
Naltrexone Long Acting (Vivitrol) 380mg Injection Kit SDV,65757030001,CDM,250,RC,,,Outpatient,,,7350.16,3675.08,,5659.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2296.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5439.12,74,,,Percent of Total Billed Charges,74% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,6174.13,84,,,Percent of Total Billed Charges,84% of total billed charges,6027.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,6541.64,89,,,Percent of total Billed Charges,89% of total Billed charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5659.62,77,,,Percent of total Billed charges,77% of total billed charges,6247.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2113.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3675.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1837.54,6541.64,
Naltrexone Long Acting (Vivitrol) 380mg Injection Kit SDV,65757030001,CDM,250,RC,,,Outpatient,,,7350.16,3675.08,,5659.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2296.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5439.12,74,,,Percent of Total Billed Charges,74% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,6174.13,84,,,Percent of Total Billed Charges,84% of total billed charges,6027.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,6541.64,89,,,Percent of total Billed Charges,89% of total Billed charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5659.62,77,,,Percent of total Billed charges,77% of total billed charges,6247.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2113.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3675.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1837.54,6541.64,
Naltrexone Long Acting (Vivitrol) 380mg Injection Kit SDV,65757030001,CDM,250,RC,,,Outpatient,,,7350.16,3675.08,,5659.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2296.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5439.12,74,,,Percent of Total Billed Charges,74% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,6174.13,84,,,Percent of Total Billed Charges,84% of total billed charges,6027.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,6541.64,89,,,Percent of total Billed Charges,89% of total Billed charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5659.62,77,,,Percent of total Billed charges,77% of total billed charges,6247.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2113.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3675.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1837.54,6541.64,
Naltrexone Long Acting (Vivitrol) 380mg Injection Kit SDV,65757030001,CDM,250,RC,,,Outpatient,,,7350.16,3675.08,,5659.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2296.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5439.12,74,,,Percent of Total Billed Charges,74% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,6174.13,84,,,Percent of Total Billed Charges,84% of total billed charges,6027.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,6541.64,89,,,Percent of total Billed Charges,89% of total Billed charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5659.62,77,,,Percent of total Billed charges,77% of total billed charges,6247.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2113.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3675.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1837.54,6541.64,
Naltrexone Long Acting (Vivitrol) 380mg Injection Kit SDV,65757030001,CDM,250,RC,,,Outpatient,,,7350.16,3675.08,,5659.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2296.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5439.12,74,,,Percent of Total Billed Charges,74% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,6174.13,84,,,Percent of Total Billed Charges,84% of total billed charges,6027.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,6541.64,89,,,Percent of total Billed Charges,89% of total Billed charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5659.62,77,,,Percent of total Billed charges,77% of total billed charges,6247.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2113.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3675.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1837.54,6541.64,
Naltrexone Long Acting (Vivitrol) 380mg Injection Kit SDV,65757030001,CDM,250,RC,,,Outpatient,,,7350.16,3675.08,,5659.62,77,,,Percent of Total Billed Charges,77% of total billed charges,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1874.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2296.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5439.12,74,,,Percent of Total Billed Charges,74% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5071.61,69,,,Percent of Total Billed Charges,69% of total billed charges,6174.13,84,,,Percent of Total Billed Charges,84% of total billed charges,6027.13,82,,,Percent of Total Billed Charges,82% of total billed charges ,6541.64,89,,,Percent of total Billed Charges,89% of total Billed charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5659.62,77,,,Percent of total Billed charges,77% of total billed charges,6247.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2113.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3675.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2998.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6541.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1837.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1837.54,6541.64,
Naltrexone 50mg Tablet,68084029121,CDM,250,RC,,,Outpatient,,,42.95,21.48,,33.07,77,,,Percent of Total Billed Charges,77% of total billed charges,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.78,74,,,Percent of Total Billed Charges,74% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,36.08,84,,,Percent of Total Billed Charges,84% of total billed charges,35.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.23,89,,,Percent of total Billed Charges,89% of total Billed charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.07,77,,,Percent of total Billed charges,77% of total billed charges,36.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.74,38.23,
Naltrexone 50mg Tablet,68084029121,CDM,250,RC,,,Outpatient,,,42.95,21.48,,33.07,77,,,Percent of Total Billed Charges,77% of total billed charges,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.78,74,,,Percent of Total Billed Charges,74% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,36.08,84,,,Percent of Total Billed Charges,84% of total billed charges,35.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.23,89,,,Percent of total Billed Charges,89% of total Billed charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.07,77,,,Percent of total Billed charges,77% of total billed charges,36.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.74,38.23,
Naltrexone 50mg Tablet,68084029121,CDM,250,RC,,,Outpatient,,,42.95,21.48,,33.07,77,,,Percent of Total Billed Charges,77% of total billed charges,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.78,74,,,Percent of Total Billed Charges,74% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,36.08,84,,,Percent of Total Billed Charges,84% of total billed charges,35.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.23,89,,,Percent of total Billed Charges,89% of total Billed charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.07,77,,,Percent of total Billed charges,77% of total billed charges,36.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.74,38.23,
Naltrexone 50mg Tablet,68084029121,CDM,250,RC,,,Outpatient,,,42.95,21.48,,33.07,77,,,Percent of Total Billed Charges,77% of total billed charges,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.78,74,,,Percent of Total Billed Charges,74% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,36.08,84,,,Percent of Total Billed Charges,84% of total billed charges,35.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.23,89,,,Percent of total Billed Charges,89% of total Billed charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.07,77,,,Percent of total Billed charges,77% of total billed charges,36.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.74,38.23,
Naltrexone 50mg Tablet,68084029121,CDM,250,RC,,,Outpatient,,,42.95,21.48,,33.07,77,,,Percent of Total Billed Charges,77% of total billed charges,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.78,74,,,Percent of Total Billed Charges,74% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,36.08,84,,,Percent of Total Billed Charges,84% of total billed charges,35.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.23,89,,,Percent of total Billed Charges,89% of total Billed charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.07,77,,,Percent of total Billed charges,77% of total billed charges,36.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.74,38.23,
Naltrexone 50mg Tablet,68084029121,CDM,250,RC,,,Outpatient,,,42.95,21.48,,33.07,77,,,Percent of Total Billed Charges,77% of total billed charges,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,31.78,74,,,Percent of Total Billed Charges,74% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,29.64,69,,,Percent of Total Billed Charges,69% of total billed charges,36.08,84,,,Percent of Total Billed Charges,84% of total billed charges,35.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.23,89,,,Percent of total Billed Charges,89% of total Billed charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.07,77,,,Percent of total Billed charges,77% of total billed charges,36.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.74,38.23,
Naproxen 250mg Tablet,68462018801,CDM,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Naproxen 250mg Tablet,68462018801,CDM,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Naproxen 250mg Tablet,68462018801,CDM,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Naproxen 250mg Tablet,68462018801,CDM,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Naproxen 250mg Tablet,68462018801,CDM,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Naproxen 250mg Tablet,68462018801,CDM,250,RC,,,Outpatient,,,12.32,6.16,,9.49,77,,,Percent of Total Billed Charges,77% of total billed charges,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.12,74,,,Percent of Total Billed Charges,74% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,8.5,69,,,Percent of Total Billed Charges,69% of total billed charges,10.35,84,,,Percent of Total Billed Charges,84% of total billed charges,10.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.96,89,,,Percent of total Billed Charges,89% of total Billed charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.49,77,,,Percent of total Billed charges,77% of total billed charges,10.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.08,10.96,
Nebivolol 10mg Tablet,62559027730,CDM,250,RC,,,Outpatient,,,55.01,27.51,,42.36,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.71,74,,,Percent of Total Billed Charges,74% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,46.21,84,,,Percent of Total Billed Charges,84% of total billed charges,45.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.96,89,,,Percent of total Billed Charges,89% of total Billed charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.36,77,,,Percent of total Billed charges,77% of total billed charges,46.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.96,
Nebivolol 10mg Tablet,62559027730,CDM,250,RC,,,Outpatient,,,55.01,27.51,,42.36,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.71,74,,,Percent of Total Billed Charges,74% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,46.21,84,,,Percent of Total Billed Charges,84% of total billed charges,45.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.96,89,,,Percent of total Billed Charges,89% of total Billed charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.36,77,,,Percent of total Billed charges,77% of total billed charges,46.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.96,
Nebivolol 10mg Tablet,62559027730,CDM,250,RC,,,Outpatient,,,55.01,27.51,,42.36,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.71,74,,,Percent of Total Billed Charges,74% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,46.21,84,,,Percent of Total Billed Charges,84% of total billed charges,45.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.96,89,,,Percent of total Billed Charges,89% of total Billed charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.36,77,,,Percent of total Billed charges,77% of total billed charges,46.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.96,
Nebivolol 10mg Tablet,62559027730,CDM,250,RC,,,Outpatient,,,55.01,27.51,,42.36,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.71,74,,,Percent of Total Billed Charges,74% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,46.21,84,,,Percent of Total Billed Charges,84% of total billed charges,45.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.96,89,,,Percent of total Billed Charges,89% of total Billed charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.36,77,,,Percent of total Billed charges,77% of total billed charges,46.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.96,
Nebivolol 10mg Tablet,62559027730,CDM,250,RC,,,Outpatient,,,55.01,27.51,,42.36,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.71,74,,,Percent of Total Billed Charges,74% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,46.21,84,,,Percent of Total Billed Charges,84% of total billed charges,45.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.96,89,,,Percent of total Billed Charges,89% of total Billed charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.36,77,,,Percent of total Billed charges,77% of total billed charges,46.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.96,
Nebivolol 10mg Tablet,62559027730,CDM,250,RC,,,Outpatient,,,55.01,27.51,,42.36,77,,,Percent of Total Billed Charges,77% of total billed charges,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.71,74,,,Percent of Total Billed Charges,74% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,37.96,69,,,Percent of Total Billed Charges,69% of total billed charges,46.21,84,,,Percent of Total Billed Charges,84% of total billed charges,45.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.96,89,,,Percent of total Billed Charges,89% of total Billed charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.36,77,,,Percent of total Billed charges,77% of total billed charges,46.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,48.96,
Nebivolol 2.5mg Tablet,59651013730,CDM,250,RC,,,Outpatient,,,46.73,23.37,,35.98,77,,,Percent of Total Billed Charges,77% of total billed charges,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.58,74,,,Percent of Total Billed Charges,74% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,84,,,Percent of Total Billed Charges,84% of total billed charges,38.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.59,89,,,Percent of total Billed Charges,89% of total Billed charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.98,77,,,Percent of total Billed charges,77% of total billed charges,39.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.68,41.59,
Nebivolol 2.5mg Tablet,59651013730,CDM,250,RC,,,Outpatient,,,46.73,23.37,,35.98,77,,,Percent of Total Billed Charges,77% of total billed charges,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.58,74,,,Percent of Total Billed Charges,74% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,84,,,Percent of Total Billed Charges,84% of total billed charges,38.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.59,89,,,Percent of total Billed Charges,89% of total Billed charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.98,77,,,Percent of total Billed charges,77% of total billed charges,39.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.68,41.59,
Nebivolol 2.5mg Tablet,59651013730,CDM,250,RC,,,Outpatient,,,46.73,23.37,,35.98,77,,,Percent of Total Billed Charges,77% of total billed charges,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.58,74,,,Percent of Total Billed Charges,74% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,84,,,Percent of Total Billed Charges,84% of total billed charges,38.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.59,89,,,Percent of total Billed Charges,89% of total Billed charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.98,77,,,Percent of total Billed charges,77% of total billed charges,39.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.68,41.59,
Nebivolol 2.5mg Tablet,59651013730,CDM,250,RC,,,Outpatient,,,46.73,23.37,,35.98,77,,,Percent of Total Billed Charges,77% of total billed charges,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.58,74,,,Percent of Total Billed Charges,74% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,84,,,Percent of Total Billed Charges,84% of total billed charges,38.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.59,89,,,Percent of total Billed Charges,89% of total Billed charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.98,77,,,Percent of total Billed charges,77% of total billed charges,39.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.68,41.59,
Nebivolol 2.5mg Tablet,59651013730,CDM,250,RC,,,Outpatient,,,46.73,23.37,,35.98,77,,,Percent of Total Billed Charges,77% of total billed charges,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.58,74,,,Percent of Total Billed Charges,74% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,84,,,Percent of Total Billed Charges,84% of total billed charges,38.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.59,89,,,Percent of total Billed Charges,89% of total Billed charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.98,77,,,Percent of total Billed charges,77% of total billed charges,39.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.68,41.59,
Nebivolol 2.5mg Tablet,59651013730,CDM,250,RC,,,Outpatient,,,46.73,23.37,,35.98,77,,,Percent of Total Billed Charges,77% of total billed charges,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.58,74,,,Percent of Total Billed Charges,74% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,32.24,69,,,Percent of Total Billed Charges,69% of total billed charges,39.25,84,,,Percent of Total Billed Charges,84% of total billed charges,38.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.59,89,,,Percent of total Billed Charges,89% of total Billed charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.98,77,,,Percent of total Billed charges,77% of total billed charges,39.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.68,41.59,
Neomycin/Polymyxin/HC OTIC Susp 10ml,24208063562,CDM,250,RC,,,Outpatient,,,294.05,147.03,,226.42,77,,,Percent of Total Billed Charges,77% of total billed charges,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.6,74,,,Percent of Total Billed Charges,74% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,247,84,,,Percent of Total Billed Charges,84% of total billed charges,241.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.7,89,,,Percent of total Billed Charges,89% of total Billed charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.42,77,,,Percent of total Billed charges,77% of total billed charges,249.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.51,261.7,
Neomycin/Polymyxin/HC OTIC Susp 10ml,24208063562,CDM,250,RC,,,Outpatient,,,294.05,147.03,,226.42,77,,,Percent of Total Billed Charges,77% of total billed charges,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.6,74,,,Percent of Total Billed Charges,74% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,247,84,,,Percent of Total Billed Charges,84% of total billed charges,241.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.7,89,,,Percent of total Billed Charges,89% of total Billed charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.42,77,,,Percent of total Billed charges,77% of total billed charges,249.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.51,261.7,
Neomycin/Polymyxin/HC OTIC Susp 10ml,24208063562,CDM,250,RC,,,Outpatient,,,294.05,147.03,,226.42,77,,,Percent of Total Billed Charges,77% of total billed charges,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.6,74,,,Percent of Total Billed Charges,74% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,247,84,,,Percent of Total Billed Charges,84% of total billed charges,241.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.7,89,,,Percent of total Billed Charges,89% of total Billed charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.42,77,,,Percent of total Billed charges,77% of total billed charges,249.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.51,261.7,
Neomycin/Polymyxin/HC OTIC Susp 10ml,24208063562,CDM,250,RC,,,Outpatient,,,294.05,147.03,,226.42,77,,,Percent of Total Billed Charges,77% of total billed charges,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.6,74,,,Percent of Total Billed Charges,74% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,247,84,,,Percent of Total Billed Charges,84% of total billed charges,241.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.7,89,,,Percent of total Billed Charges,89% of total Billed charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.42,77,,,Percent of total Billed charges,77% of total billed charges,249.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.51,261.7,
Neomycin/Polymyxin/HC OTIC Susp 10ml,24208063562,CDM,250,RC,,,Outpatient,,,294.05,147.03,,226.42,77,,,Percent of Total Billed Charges,77% of total billed charges,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.6,74,,,Percent of Total Billed Charges,74% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,247,84,,,Percent of Total Billed Charges,84% of total billed charges,241.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.7,89,,,Percent of total Billed Charges,89% of total Billed charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.42,77,,,Percent of total Billed charges,77% of total billed charges,249.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.51,261.7,
Neomycin/Polymyxin/HC OTIC Susp 10ml,24208063562,CDM,250,RC,,,Outpatient,,,294.05,147.03,,226.42,77,,,Percent of Total Billed Charges,77% of total billed charges,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,91.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,217.6,74,,,Percent of Total Billed Charges,74% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,202.89,69,,,Percent of Total Billed Charges,69% of total billed charges,247,84,,,Percent of Total Billed Charges,84% of total billed charges,241.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,261.7,89,,,Percent of total Billed Charges,89% of total Billed charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.42,77,,,Percent of total Billed charges,77% of total billed charges,249.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,84.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,147.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,119.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.51,261.7,
Neomycin/Polymyxin/Gramicidin (Neosporin) OPHTH Soln 10ml,24208079062,CDM,250,RC,,,Outpatient,,,218.4,109.2,,168.17,77,,,Percent of Total Billed Charges,77% of total billed charges,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.62,74,,,Percent of Total Billed Charges,74% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,183.46,84,,,Percent of Total Billed Charges,84% of total billed charges,179.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.17,77,,,Percent of total Billed charges,77% of total billed charges,185.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.6,194.38,
Neomycin/Polymyxin/Gramicidin (Neosporin) OPHTH Soln 10ml,24208079062,CDM,250,RC,,,Outpatient,,,218.4,109.2,,168.17,77,,,Percent of Total Billed Charges,77% of total billed charges,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.62,74,,,Percent of Total Billed Charges,74% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,183.46,84,,,Percent of Total Billed Charges,84% of total billed charges,179.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.17,77,,,Percent of total Billed charges,77% of total billed charges,185.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.6,194.38,
Neomycin/Polymyxin/Gramicidin (Neosporin) OPHTH Soln 10ml,24208079062,CDM,250,RC,,,Outpatient,,,218.4,109.2,,168.17,77,,,Percent of Total Billed Charges,77% of total billed charges,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.62,74,,,Percent of Total Billed Charges,74% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,183.46,84,,,Percent of Total Billed Charges,84% of total billed charges,179.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.17,77,,,Percent of total Billed charges,77% of total billed charges,185.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.6,194.38,
Neomycin/Polymyxin/Gramicidin (Neosporin) OPHTH Soln 10ml,24208079062,CDM,250,RC,,,Outpatient,,,218.4,109.2,,168.17,77,,,Percent of Total Billed Charges,77% of total billed charges,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.62,74,,,Percent of Total Billed Charges,74% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,183.46,84,,,Percent of Total Billed Charges,84% of total billed charges,179.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.17,77,,,Percent of total Billed charges,77% of total billed charges,185.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.6,194.38,
Neomycin/Polymyxin/Gramicidin (Neosporin) OPHTH Soln 10ml,24208079062,CDM,250,RC,,,Outpatient,,,218.4,109.2,,168.17,77,,,Percent of Total Billed Charges,77% of total billed charges,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.62,74,,,Percent of Total Billed Charges,74% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,183.46,84,,,Percent of Total Billed Charges,84% of total billed charges,179.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.17,77,,,Percent of total Billed charges,77% of total billed charges,185.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.6,194.38,
Neomycin/Polymyxin/Gramicidin (Neosporin) OPHTH Soln 10ml,24208079062,CDM,250,RC,,,Outpatient,,,218.4,109.2,,168.17,77,,,Percent of Total Billed Charges,77% of total billed charges,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,161.62,74,,,Percent of Total Billed Charges,74% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,150.7,69,,,Percent of Total Billed Charges,69% of total billed charges,183.46,84,,,Percent of Total Billed Charges,84% of total billed charges,179.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,194.38,89,,,Percent of total Billed Charges,89% of total Billed charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,168.17,77,,,Percent of total Billed charges,77% of total billed charges,185.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,109.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.6,194.38,
Neomycin/Polymyxin/Bacitracin TOP Oint 0.9 Gram/Packet,47682022335,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Neomycin/Polymyxin/Bacitracin TOP Oint 0.9 Gram/Packet,47682022335,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Neomycin/Polymyxin/Bacitracin TOP Oint 0.9 Gram/Packet,47682022335,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Neomycin/Polymyxin/Bacitracin TOP Oint 0.9 Gram/Packet,47682022335,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Neomycin/Polymyxin/Bacitracin TOP Oint 0.9 Gram/Packet,47682022335,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Neomycin/Polymyxin/Bacitracin TOP Oint 0.9 Gram/Packet,47682022335,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Neomycin/Polymyxin/Bacitracin TOP Oint 30gm,713026831,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Neomycin/Polymyxin/Bacitracin TOP Oint 30gm,713026831,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Neomycin/Polymyxin/Bacitracin TOP Oint 30gm,713026831,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Neomycin/Polymyxin/Bacitracin TOP Oint 30gm,713026831,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Neomycin/Polymyxin/Bacitracin TOP Oint 30gm,713026831,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Neomycin/Polymyxin/Bacitracin TOP Oint 30gm,713026831,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Neomycin/Polymyxin/Dexameth OPHTH Oint 3.5gm,61314063136,CDM,250,RC,,,Outpatient,,,156.59,78.3,,120.57,77,,,Percent of Total Billed Charges,77% of total billed charges,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.88,74,,,Percent of Total Billed Charges,74% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,131.54,84,,,Percent of Total Billed Charges,84% of total billed charges,128.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.37,89,,,Percent of total Billed Charges,89% of total Billed charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.57,77,,,Percent of total Billed charges,77% of total billed charges,133.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.15,139.37,
Neomycin/Polymyxin/Dexameth OPHTH Oint 3.5gm,61314063136,CDM,250,RC,,,Outpatient,,,156.59,78.3,,120.57,77,,,Percent of Total Billed Charges,77% of total billed charges,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.88,74,,,Percent of Total Billed Charges,74% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,131.54,84,,,Percent of Total Billed Charges,84% of total billed charges,128.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.37,89,,,Percent of total Billed Charges,89% of total Billed charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.57,77,,,Percent of total Billed charges,77% of total billed charges,133.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.15,139.37,
Neomycin/Polymyxin/Dexameth OPHTH Oint 3.5gm,61314063136,CDM,250,RC,,,Outpatient,,,156.59,78.3,,120.57,77,,,Percent of Total Billed Charges,77% of total billed charges,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.88,74,,,Percent of Total Billed Charges,74% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,131.54,84,,,Percent of Total Billed Charges,84% of total billed charges,128.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.37,89,,,Percent of total Billed Charges,89% of total Billed charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.57,77,,,Percent of total Billed charges,77% of total billed charges,133.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.15,139.37,
Neomycin/Polymyxin/Dexameth OPHTH Oint 3.5gm,61314063136,CDM,250,RC,,,Outpatient,,,156.59,78.3,,120.57,77,,,Percent of Total Billed Charges,77% of total billed charges,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.88,74,,,Percent of Total Billed Charges,74% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,131.54,84,,,Percent of Total Billed Charges,84% of total billed charges,128.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.37,89,,,Percent of total Billed Charges,89% of total Billed charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.57,77,,,Percent of total Billed charges,77% of total billed charges,133.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.15,139.37,
Neomycin/Polymyxin/Dexameth OPHTH Oint 3.5gm,61314063136,CDM,250,RC,,,Outpatient,,,156.59,78.3,,120.57,77,,,Percent of Total Billed Charges,77% of total billed charges,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.88,74,,,Percent of Total Billed Charges,74% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,131.54,84,,,Percent of Total Billed Charges,84% of total billed charges,128.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.37,89,,,Percent of total Billed Charges,89% of total Billed charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.57,77,,,Percent of total Billed charges,77% of total billed charges,133.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.15,139.37,
Neomycin/Polymyxin/Dexameth OPHTH Oint 3.5gm,61314063136,CDM,250,RC,,,Outpatient,,,156.59,78.3,,120.57,77,,,Percent of Total Billed Charges,77% of total billed charges,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.88,74,,,Percent of Total Billed Charges,74% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,108.05,69,,,Percent of Total Billed Charges,69% of total billed charges,131.54,84,,,Percent of Total Billed Charges,84% of total billed charges,128.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.37,89,,,Percent of total Billed Charges,89% of total Billed charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.57,77,,,Percent of total Billed charges,77% of total billed charges,133.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.15,139.37,
Neomycin/Polymyxin/Bacitracin (Neo-Polycin) OPHTH Oint 3.5gm,24208078055,CDM,250,RC,,,Outpatient,,,201.2,100.6,,154.92,77,,,Percent of Total Billed Charges,77% of total billed charges,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.89,74,,,Percent of Total Billed Charges,74% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,169.01,84,,,Percent of Total Billed Charges,84% of total billed charges,164.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.07,89,,,Percent of total Billed Charges,89% of total Billed charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.92,77,,,Percent of total Billed charges,77% of total billed charges,171.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,179.07,
Neomycin/Polymyxin/Bacitracin (Neo-Polycin) OPHTH Oint 3.5gm,24208078055,CDM,250,RC,,,Outpatient,,,201.2,100.6,,154.92,77,,,Percent of Total Billed Charges,77% of total billed charges,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.89,74,,,Percent of Total Billed Charges,74% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,169.01,84,,,Percent of Total Billed Charges,84% of total billed charges,164.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.07,89,,,Percent of total Billed Charges,89% of total Billed charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.92,77,,,Percent of total Billed charges,77% of total billed charges,171.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,179.07,
Neomycin/Polymyxin/Bacitracin (Neo-Polycin) OPHTH Oint 3.5gm,24208078055,CDM,250,RC,,,Outpatient,,,201.2,100.6,,154.92,77,,,Percent of Total Billed Charges,77% of total billed charges,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.89,74,,,Percent of Total Billed Charges,74% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,169.01,84,,,Percent of Total Billed Charges,84% of total billed charges,164.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.07,89,,,Percent of total Billed Charges,89% of total Billed charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.92,77,,,Percent of total Billed charges,77% of total billed charges,171.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,179.07,
Neomycin/Polymyxin/Bacitracin (Neo-Polycin) OPHTH Oint 3.5gm,24208078055,CDM,250,RC,,,Outpatient,,,201.2,100.6,,154.92,77,,,Percent of Total Billed Charges,77% of total billed charges,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.89,74,,,Percent of Total Billed Charges,74% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,169.01,84,,,Percent of Total Billed Charges,84% of total billed charges,164.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.07,89,,,Percent of total Billed Charges,89% of total Billed charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.92,77,,,Percent of total Billed charges,77% of total billed charges,171.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,179.07,
Neomycin/Polymyxin/Bacitracin (Neo-Polycin) OPHTH Oint 3.5gm,24208078055,CDM,250,RC,,,Outpatient,,,201.2,100.6,,154.92,77,,,Percent of Total Billed Charges,77% of total billed charges,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.89,74,,,Percent of Total Billed Charges,74% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,169.01,84,,,Percent of Total Billed Charges,84% of total billed charges,164.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.07,89,,,Percent of total Billed Charges,89% of total Billed charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.92,77,,,Percent of total Billed charges,77% of total billed charges,171.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,179.07,
Neomycin/Polymyxin/Bacitracin (Neo-Polycin) OPHTH Oint 3.5gm,24208078055,CDM,250,RC,,,Outpatient,,,201.2,100.6,,154.92,77,,,Percent of Total Billed Charges,77% of total billed charges,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.89,74,,,Percent of Total Billed Charges,74% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,138.83,69,,,Percent of Total Billed Charges,69% of total billed charges,169.01,84,,,Percent of Total Billed Charges,84% of total billed charges,164.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,179.07,89,,,Percent of total Billed Charges,89% of total Billed charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.92,77,,,Percent of total Billed charges,77% of total billed charges,171.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,82.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,179.07,
Neomycin 500mg Tablet,93117701,CDM,250,RC,,,Outpatient,,,18.98,9.49,,14.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.05,74,,,Percent of Total Billed Charges,74% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,84,,,Percent of Total Billed Charges,84% of total billed charges,15.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.89,89,,,Percent of total Billed Charges,89% of total Billed charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.61,77,,,Percent of total Billed charges,77% of total billed charges,16.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.89,
Neomycin 500mg Tablet,93117701,CDM,250,RC,,,Outpatient,,,18.98,9.49,,14.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.05,74,,,Percent of Total Billed Charges,74% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,84,,,Percent of Total Billed Charges,84% of total billed charges,15.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.89,89,,,Percent of total Billed Charges,89% of total Billed charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.61,77,,,Percent of total Billed charges,77% of total billed charges,16.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.89,
Neomycin 500mg Tablet,93117701,CDM,250,RC,,,Outpatient,,,18.98,9.49,,14.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.05,74,,,Percent of Total Billed Charges,74% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,84,,,Percent of Total Billed Charges,84% of total billed charges,15.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.89,89,,,Percent of total Billed Charges,89% of total Billed charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.61,77,,,Percent of total Billed charges,77% of total billed charges,16.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.89,
Neomycin 500mg Tablet,93117701,CDM,250,RC,,,Outpatient,,,18.98,9.49,,14.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.05,74,,,Percent of Total Billed Charges,74% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,84,,,Percent of Total Billed Charges,84% of total billed charges,15.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.89,89,,,Percent of total Billed Charges,89% of total Billed charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.61,77,,,Percent of total Billed charges,77% of total billed charges,16.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.89,
Neomycin 500mg Tablet,93117701,CDM,250,RC,,,Outpatient,,,18.98,9.49,,14.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.05,74,,,Percent of Total Billed Charges,74% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,84,,,Percent of Total Billed Charges,84% of total billed charges,15.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.89,89,,,Percent of total Billed Charges,89% of total Billed charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.61,77,,,Percent of total Billed charges,77% of total billed charges,16.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.89,
Neomycin 500mg Tablet,93117701,CDM,250,RC,,,Outpatient,,,18.98,9.49,,14.61,77,,,Percent of Total Billed Charges,77% of total billed charges,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.05,74,,,Percent of Total Billed Charges,74% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,13.1,69,,,Percent of Total Billed Charges,69% of total billed charges,15.94,84,,,Percent of Total Billed Charges,84% of total billed charges,15.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.89,89,,,Percent of total Billed Charges,89% of total Billed charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.61,77,,,Percent of total Billed charges,77% of total billed charges,16.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.75,16.89,
Neomycin/Polymyxin/Dexameth OPHTH Susp 5ml,24208083060,CDM,250,RC,,,Outpatient,,,168.34,84.17,,129.62,77,,,Percent of Total Billed Charges,77% of total billed charges,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.57,74,,,Percent of Total Billed Charges,74% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,141.41,84,,,Percent of Total Billed Charges,84% of total billed charges,138.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.82,89,,,Percent of total Billed Charges,89% of total Billed charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.62,77,,,Percent of total Billed charges,77% of total billed charges,143.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,149.82,
Neomycin/Polymyxin/Dexameth OPHTH Susp 5ml,24208083060,CDM,250,RC,,,Outpatient,,,168.34,84.17,,129.62,77,,,Percent of Total Billed Charges,77% of total billed charges,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.57,74,,,Percent of Total Billed Charges,74% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,141.41,84,,,Percent of Total Billed Charges,84% of total billed charges,138.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.82,89,,,Percent of total Billed Charges,89% of total Billed charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.62,77,,,Percent of total Billed charges,77% of total billed charges,143.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,149.82,
Neomycin/Polymyxin/Dexameth OPHTH Susp 5ml,24208083060,CDM,250,RC,,,Outpatient,,,168.34,84.17,,129.62,77,,,Percent of Total Billed Charges,77% of total billed charges,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.57,74,,,Percent of Total Billed Charges,74% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,141.41,84,,,Percent of Total Billed Charges,84% of total billed charges,138.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.82,89,,,Percent of total Billed Charges,89% of total Billed charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.62,77,,,Percent of total Billed charges,77% of total billed charges,143.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,149.82,
Neomycin/Polymyxin/Dexameth OPHTH Susp 5ml,24208083060,CDM,250,RC,,,Outpatient,,,168.34,84.17,,129.62,77,,,Percent of Total Billed Charges,77% of total billed charges,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.57,74,,,Percent of Total Billed Charges,74% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,141.41,84,,,Percent of Total Billed Charges,84% of total billed charges,138.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.82,89,,,Percent of total Billed Charges,89% of total Billed charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.62,77,,,Percent of total Billed charges,77% of total billed charges,143.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,149.82,
Neomycin/Polymyxin/Dexameth OPHTH Susp 5ml,24208083060,CDM,250,RC,,,Outpatient,,,168.34,84.17,,129.62,77,,,Percent of Total Billed Charges,77% of total billed charges,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.57,74,,,Percent of Total Billed Charges,74% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,141.41,84,,,Percent of Total Billed Charges,84% of total billed charges,138.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.82,89,,,Percent of total Billed Charges,89% of total Billed charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.62,77,,,Percent of total Billed charges,77% of total billed charges,143.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,149.82,
Neomycin/Polymyxin/Dexameth OPHTH Susp 5ml,24208083060,CDM,250,RC,,,Outpatient,,,168.34,84.17,,129.62,77,,,Percent of Total Billed Charges,77% of total billed charges,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.57,74,,,Percent of Total Billed Charges,74% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,116.15,69,,,Percent of Total Billed Charges,69% of total billed charges,141.41,84,,,Percent of Total Billed Charges,84% of total billed charges,138.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.82,89,,,Percent of total Billed Charges,89% of total Billed charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.62,77,,,Percent of total Billed charges,77% of total billed charges,143.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.09,149.82,
Nicotine 14mg Topical Patch,536110788,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 14mg Topical Patch,536110788,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 14mg Topical Patch,536110788,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 14mg Topical Patch,536110788,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 14mg Topical Patch,536110788,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 14mg Topical Patch,536110788,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 7mg Topical Patch,536589488,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 7mg Topical Patch,536589488,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 7mg Topical Patch,536589488,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 7mg Topical Patch,536589488,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 7mg Topical Patch,536589488,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 7mg Topical Patch,536589488,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 21mg Topical Patch,536589688,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 21mg Topical Patch,536589688,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 21mg Topical Patch,536589688,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 21mg Topical Patch,536589688,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 21mg Topical Patch,536589688,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nicotine 21mg Topical Patch,536589688,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
NIFEdipine 10mg Capsule,23155019401,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
NIFEdipine 10mg Capsule,23155019401,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
NIFEdipine 10mg Capsule,23155019401,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
NIFEdipine 10mg Capsule,23155019401,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
NIFEdipine 10mg Capsule,23155019401,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
NIFEdipine 10mg Capsule,23155019401,CDM,250,RC,,,Outpatient,,,15.04,7.52,,11.58,77,,,Percent of Total Billed Charges,77% of total billed charges,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.13,74,,,Percent of Total Billed Charges,74% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,84,,,Percent of Total Billed Charges,84% of total billed charges,12.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.39,89,,,Percent of total Billed Charges,89% of total Billed charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.58,77,,,Percent of total Billed charges,77% of total billed charges,12.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.76,13.39,
NIFEdipine 30mg Extended Release Tablet,50268059715,CDM,250,RC,,,Outpatient,,,17.29,8.65,,13.31,77,,,Percent of Total Billed Charges,77% of total billed charges,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.79,74,,,Percent of Total Billed Charges,74% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,84,,,Percent of Total Billed Charges,84% of total billed charges,14.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.39,89,,,Percent of total Billed Charges,89% of total Billed charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.31,77,,,Percent of total Billed charges,77% of total billed charges,14.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.32,15.39,
NIFEdipine 30mg Extended Release Tablet,50268059715,CDM,250,RC,,,Outpatient,,,17.29,8.65,,13.31,77,,,Percent of Total Billed Charges,77% of total billed charges,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.79,74,,,Percent of Total Billed Charges,74% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,84,,,Percent of Total Billed Charges,84% of total billed charges,14.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.39,89,,,Percent of total Billed Charges,89% of total Billed charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.31,77,,,Percent of total Billed charges,77% of total billed charges,14.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.32,15.39,
NIFEdipine 30mg Extended Release Tablet,50268059715,CDM,250,RC,,,Outpatient,,,17.29,8.65,,13.31,77,,,Percent of Total Billed Charges,77% of total billed charges,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.79,74,,,Percent of Total Billed Charges,74% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,84,,,Percent of Total Billed Charges,84% of total billed charges,14.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.39,89,,,Percent of total Billed Charges,89% of total Billed charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.31,77,,,Percent of total Billed charges,77% of total billed charges,14.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.32,15.39,
NIFEdipine 30mg Extended Release Tablet,50268059715,CDM,250,RC,,,Outpatient,,,17.29,8.65,,13.31,77,,,Percent of Total Billed Charges,77% of total billed charges,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.79,74,,,Percent of Total Billed Charges,74% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,84,,,Percent of Total Billed Charges,84% of total billed charges,14.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.39,89,,,Percent of total Billed Charges,89% of total Billed charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.31,77,,,Percent of total Billed charges,77% of total billed charges,14.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.32,15.39,
NIFEdipine 30mg Extended Release Tablet,50268059715,CDM,250,RC,,,Outpatient,,,17.29,8.65,,13.31,77,,,Percent of Total Billed Charges,77% of total billed charges,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.79,74,,,Percent of Total Billed Charges,74% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,84,,,Percent of Total Billed Charges,84% of total billed charges,14.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.39,89,,,Percent of total Billed Charges,89% of total Billed charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.31,77,,,Percent of total Billed charges,77% of total billed charges,14.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.32,15.39,
NIFEdipine 30mg Extended Release Tablet,50268059715,CDM,250,RC,,,Outpatient,,,17.29,8.65,,13.31,77,,,Percent of Total Billed Charges,77% of total billed charges,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12.79,74,,,Percent of Total Billed Charges,74% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,69,,,Percent of Total Billed Charges,69% of total billed charges,14.52,84,,,Percent of Total Billed Charges,84% of total billed charges,14.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.39,89,,,Percent of total Billed Charges,89% of total Billed charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.31,77,,,Percent of total Billed charges,77% of total billed charges,14.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.32,15.39,
NIFEdipine 90mg Extended Release Tablet,68084060321,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
NIFEdipine 90mg Extended Release Tablet,68084060321,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
NIFEdipine 90mg Extended Release Tablet,68084060321,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
NIFEdipine 90mg Extended Release Tablet,68084060321,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
NIFEdipine 90mg Extended Release Tablet,68084060321,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
NIFEdipine 90mg Extended Release Tablet,68084060321,CDM,250,RC,,,Outpatient,,,40.19,20.1,,30.95,77,,,Percent of Total Billed Charges,77% of total billed charges,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.74,74,,,Percent of Total Billed Charges,74% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,27.73,69,,,Percent of Total Billed Charges,69% of total billed charges,33.76,84,,,Percent of Total Billed Charges,84% of total billed charges,32.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.77,89,,,Percent of total Billed Charges,89% of total Billed charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.95,77,,,Percent of total Billed charges,77% of total billed charges,34.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.05,35.77,
Nitric Oxide charge per hour,,,250,RC,,,Outpatient,,,26.52,13.26,,20.42,77,,,Percent of Total Billed Charges,77% of total billed charges,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.62,74,,,Percent of Total Billed Charges,74% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,22.28,84,,,Percent of Total Billed Charges,84% of total billed charges,21.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.6,89,,,Percent of total Billed Charges,89% of total Billed charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.42,77,,,Percent of total Billed charges,77% of total billed charges,22.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.63,23.6,
Nitric Oxide charge per hour,,,250,RC,,,Outpatient,,,26.52,13.26,,20.42,77,,,Percent of Total Billed Charges,77% of total billed charges,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.62,74,,,Percent of Total Billed Charges,74% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,22.28,84,,,Percent of Total Billed Charges,84% of total billed charges,21.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.6,89,,,Percent of total Billed Charges,89% of total Billed charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.42,77,,,Percent of total Billed charges,77% of total billed charges,22.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.63,23.6,
Nitric Oxide charge per hour,,,250,RC,,,Outpatient,,,26.52,13.26,,20.42,77,,,Percent of Total Billed Charges,77% of total billed charges,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.62,74,,,Percent of Total Billed Charges,74% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,22.28,84,,,Percent of Total Billed Charges,84% of total billed charges,21.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.6,89,,,Percent of total Billed Charges,89% of total Billed charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.42,77,,,Percent of total Billed charges,77% of total billed charges,22.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.63,23.6,
Nitric Oxide charge per hour,,,250,RC,,,Outpatient,,,26.52,13.26,,20.42,77,,,Percent of Total Billed Charges,77% of total billed charges,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.62,74,,,Percent of Total Billed Charges,74% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,22.28,84,,,Percent of Total Billed Charges,84% of total billed charges,21.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.6,89,,,Percent of total Billed Charges,89% of total Billed charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.42,77,,,Percent of total Billed charges,77% of total billed charges,22.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.63,23.6,
Nitric Oxide charge per hour,,,250,RC,,,Outpatient,,,26.52,13.26,,20.42,77,,,Percent of Total Billed Charges,77% of total billed charges,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.62,74,,,Percent of Total Billed Charges,74% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,22.28,84,,,Percent of Total Billed Charges,84% of total billed charges,21.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.6,89,,,Percent of total Billed Charges,89% of total Billed charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.42,77,,,Percent of total Billed charges,77% of total billed charges,22.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.63,23.6,
Nitric Oxide charge per hour,,,250,RC,,,Outpatient,,,26.52,13.26,,20.42,77,,,Percent of Total Billed Charges,77% of total billed charges,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.62,74,,,Percent of Total Billed Charges,74% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.3,69,,,Percent of Total Billed Charges,69% of total billed charges,22.28,84,,,Percent of Total Billed Charges,84% of total billed charges,21.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.6,89,,,Percent of total Billed Charges,89% of total Billed charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.42,77,,,Percent of total Billed charges,77% of total billed charges,22.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.63,23.6,
Nitroglycerin 0.4mg Sublingual Tablet (25 Tabs/Bottle),71041813,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nitroglycerin 0.4mg Sublingual Tablet (25 Tabs/Bottle),71041813,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nitroglycerin 0.4mg Sublingual Tablet (25 Tabs/Bottle),71041813,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nitroglycerin 0.4mg Sublingual Tablet (25 Tabs/Bottle),71041813,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nitroglycerin 0.4mg Sublingual Tablet (25 Tabs/Bottle),71041813,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nitroglycerin 0.4mg Sublingual Tablet (25 Tabs/Bottle),71041813,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Nitrofurantoin ER 100mg Capsule,,,250,RC,,,Outpatient,,,45.26,22.63,,34.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.49,74,,,Percent of Total Billed Charges,74% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,84,,,Percent of Total Billed Charges,84% of total billed charges,37.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.28,89,,,Percent of total Billed Charges,89% of total Billed charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,77,,,Percent of total Billed charges,77% of total billed charges,38.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.32,40.28,
Nitrofurantoin ER 100mg Capsule,,,250,RC,,,Outpatient,,,45.26,22.63,,34.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.49,74,,,Percent of Total Billed Charges,74% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,84,,,Percent of Total Billed Charges,84% of total billed charges,37.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.28,89,,,Percent of total Billed Charges,89% of total Billed charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,77,,,Percent of total Billed charges,77% of total billed charges,38.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.32,40.28,
Nitrofurantoin ER 100mg Capsule,,,250,RC,,,Outpatient,,,45.26,22.63,,34.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.49,74,,,Percent of Total Billed Charges,74% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,84,,,Percent of Total Billed Charges,84% of total billed charges,37.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.28,89,,,Percent of total Billed Charges,89% of total Billed charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,77,,,Percent of total Billed charges,77% of total billed charges,38.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.32,40.28,
Nitrofurantoin ER 100mg Capsule,,,250,RC,,,Outpatient,,,45.26,22.63,,34.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.49,74,,,Percent of Total Billed Charges,74% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,84,,,Percent of Total Billed Charges,84% of total billed charges,37.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.28,89,,,Percent of total Billed Charges,89% of total Billed charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,77,,,Percent of total Billed charges,77% of total billed charges,38.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.32,40.28,
Nitrofurantoin ER 100mg Capsule,,,250,RC,,,Outpatient,,,45.26,22.63,,34.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.49,74,,,Percent of Total Billed Charges,74% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,84,,,Percent of Total Billed Charges,84% of total billed charges,37.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.28,89,,,Percent of total Billed Charges,89% of total Billed charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,77,,,Percent of total Billed charges,77% of total billed charges,38.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.32,40.28,
Nitrofurantoin ER 100mg Capsule,,,250,RC,,,Outpatient,,,45.26,22.63,,34.85,77,,,Percent of Total Billed Charges,77% of total billed charges,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.49,74,,,Percent of Total Billed Charges,74% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,31.23,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,84,,,Percent of Total Billed Charges,84% of total billed charges,37.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.28,89,,,Percent of total Billed Charges,89% of total Billed charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.85,77,,,Percent of total Billed charges,77% of total billed charges,38.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.32,40.28,
Nitroglycerin UD Ointment (1 Packet=1 Inch=1gm),281032608,CDM,250,RC,,,Outpatient,,,33.43,16.72,,25.74,77,,,Percent of Total Billed Charges,77% of total billed charges,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.74,74,,,Percent of Total Billed Charges,74% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,84,,,Percent of Total Billed Charges,84% of total billed charges,27.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.75,89,,,Percent of total Billed Charges,89% of total Billed charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.74,77,,,Percent of total Billed charges,77% of total billed charges,28.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.36,29.75,
Nitroglycerin UD Ointment (1 Packet=1 Inch=1gm),281032608,CDM,250,RC,,,Outpatient,,,33.43,16.72,,25.74,77,,,Percent of Total Billed Charges,77% of total billed charges,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.74,74,,,Percent of Total Billed Charges,74% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,84,,,Percent of Total Billed Charges,84% of total billed charges,27.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.75,89,,,Percent of total Billed Charges,89% of total Billed charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.74,77,,,Percent of total Billed charges,77% of total billed charges,28.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.36,29.75,
Nitroglycerin UD Ointment (1 Packet=1 Inch=1gm),281032608,CDM,250,RC,,,Outpatient,,,33.43,16.72,,25.74,77,,,Percent of Total Billed Charges,77% of total billed charges,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.74,74,,,Percent of Total Billed Charges,74% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,84,,,Percent of Total Billed Charges,84% of total billed charges,27.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.75,89,,,Percent of total Billed Charges,89% of total Billed charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.74,77,,,Percent of total Billed charges,77% of total billed charges,28.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.36,29.75,
Nitroglycerin UD Ointment (1 Packet=1 Inch=1gm),281032608,CDM,250,RC,,,Outpatient,,,33.43,16.72,,25.74,77,,,Percent of Total Billed Charges,77% of total billed charges,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.74,74,,,Percent of Total Billed Charges,74% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,84,,,Percent of Total Billed Charges,84% of total billed charges,27.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.75,89,,,Percent of total Billed Charges,89% of total Billed charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.74,77,,,Percent of total Billed charges,77% of total billed charges,28.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.36,29.75,
Nitroglycerin UD Ointment (1 Packet=1 Inch=1gm),281032608,CDM,250,RC,,,Outpatient,,,33.43,16.72,,25.74,77,,,Percent of Total Billed Charges,77% of total billed charges,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.74,74,,,Percent of Total Billed Charges,74% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,84,,,Percent of Total Billed Charges,84% of total billed charges,27.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.75,89,,,Percent of total Billed Charges,89% of total Billed charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.74,77,,,Percent of total Billed charges,77% of total billed charges,28.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.36,29.75,
Nitroglycerin UD Ointment (1 Packet=1 Inch=1gm),281032608,CDM,250,RC,,,Outpatient,,,33.43,16.72,,25.74,77,,,Percent of Total Billed Charges,77% of total billed charges,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.74,74,,,Percent of Total Billed Charges,74% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,23.07,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,84,,,Percent of Total Billed Charges,84% of total billed charges,27.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.75,89,,,Percent of total Billed Charges,89% of total Billed charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.74,77,,,Percent of total Billed charges,77% of total billed charges,28.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.36,29.75,
Nitroglycerin 0.1mg/hr Topical Patch,378910293,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Nitroglycerin 0.1mg/hr Topical Patch,378910293,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Nitroglycerin 0.1mg/hr Topical Patch,378910293,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Nitroglycerin 0.1mg/hr Topical Patch,378910293,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Nitroglycerin 0.1mg/hr Topical Patch,378910293,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Nitroglycerin 0.1mg/hr Topical Patch,378910293,CDM,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Nitroglycerin 0.2mg/hr Topical Patch,378910493,CDM,250,RC,,,Outpatient,,,22.83,11.42,,17.58,77,,,Percent of Total Billed Charges,77% of total billed charges,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.89,74,,,Percent of Total Billed Charges,74% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,19.18,84,,,Percent of Total Billed Charges,84% of total billed charges,18.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.32,89,,,Percent of total Billed Charges,89% of total Billed charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.58,77,,,Percent of total Billed charges,77% of total billed charges,19.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,20.32,
Nitroglycerin 0.2mg/hr Topical Patch,378910493,CDM,250,RC,,,Outpatient,,,22.83,11.42,,17.58,77,,,Percent of Total Billed Charges,77% of total billed charges,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.89,74,,,Percent of Total Billed Charges,74% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,19.18,84,,,Percent of Total Billed Charges,84% of total billed charges,18.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.32,89,,,Percent of total Billed Charges,89% of total Billed charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.58,77,,,Percent of total Billed charges,77% of total billed charges,19.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,20.32,
Nitroglycerin 0.2mg/hr Topical Patch,378910493,CDM,250,RC,,,Outpatient,,,22.83,11.42,,17.58,77,,,Percent of Total Billed Charges,77% of total billed charges,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.89,74,,,Percent of Total Billed Charges,74% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,19.18,84,,,Percent of Total Billed Charges,84% of total billed charges,18.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.32,89,,,Percent of total Billed Charges,89% of total Billed charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.58,77,,,Percent of total Billed charges,77% of total billed charges,19.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,20.32,
Nitroglycerin 0.2mg/hr Topical Patch,378910493,CDM,250,RC,,,Outpatient,,,22.83,11.42,,17.58,77,,,Percent of Total Billed Charges,77% of total billed charges,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.89,74,,,Percent of Total Billed Charges,74% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,19.18,84,,,Percent of Total Billed Charges,84% of total billed charges,18.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.32,89,,,Percent of total Billed Charges,89% of total Billed charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.58,77,,,Percent of total Billed charges,77% of total billed charges,19.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,20.32,
Nitroglycerin 0.2mg/hr Topical Patch,378910493,CDM,250,RC,,,Outpatient,,,22.83,11.42,,17.58,77,,,Percent of Total Billed Charges,77% of total billed charges,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.89,74,,,Percent of Total Billed Charges,74% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,19.18,84,,,Percent of Total Billed Charges,84% of total billed charges,18.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.32,89,,,Percent of total Billed Charges,89% of total Billed charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.58,77,,,Percent of total Billed charges,77% of total billed charges,19.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,20.32,
Nitroglycerin 0.2mg/hr Topical Patch,378910493,CDM,250,RC,,,Outpatient,,,22.83,11.42,,17.58,77,,,Percent of Total Billed Charges,77% of total billed charges,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.89,74,,,Percent of Total Billed Charges,74% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,15.75,69,,,Percent of Total Billed Charges,69% of total billed charges,19.18,84,,,Percent of Total Billed Charges,84% of total billed charges,18.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,20.32,89,,,Percent of total Billed Charges,89% of total Billed charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.58,77,,,Percent of total Billed charges,77% of total billed charges,19.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.71,20.32,
Nitroglycerin 0.4mg/hr Topical Patch,378911293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,19.53,77,,,Percent of Total Billed Charges,77% of total billed charges,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.77,74,,,Percent of Total Billed Charges,74% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,21.3,84,,,Percent of Total Billed Charges,84% of total billed charges,20.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.57,89,,,Percent of total Billed Charges,89% of total Billed charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.53,77,,,Percent of total Billed charges,77% of total billed charges,21.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,22.57,
Nitroglycerin 0.4mg/hr Topical Patch,378911293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,19.53,77,,,Percent of Total Billed Charges,77% of total billed charges,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.77,74,,,Percent of Total Billed Charges,74% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,21.3,84,,,Percent of Total Billed Charges,84% of total billed charges,20.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.57,89,,,Percent of total Billed Charges,89% of total Billed charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.53,77,,,Percent of total Billed charges,77% of total billed charges,21.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,22.57,
Nitroglycerin 0.4mg/hr Topical Patch,378911293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,19.53,77,,,Percent of Total Billed Charges,77% of total billed charges,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.77,74,,,Percent of Total Billed Charges,74% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,21.3,84,,,Percent of Total Billed Charges,84% of total billed charges,20.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.57,89,,,Percent of total Billed Charges,89% of total Billed charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.53,77,,,Percent of total Billed charges,77% of total billed charges,21.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,22.57,
Nitroglycerin 0.4mg/hr Topical Patch,378911293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,19.53,77,,,Percent of Total Billed Charges,77% of total billed charges,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.77,74,,,Percent of Total Billed Charges,74% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,21.3,84,,,Percent of Total Billed Charges,84% of total billed charges,20.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.57,89,,,Percent of total Billed Charges,89% of total Billed charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.53,77,,,Percent of total Billed charges,77% of total billed charges,21.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,22.57,
Nitroglycerin 0.4mg/hr Topical Patch,378911293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,19.53,77,,,Percent of Total Billed Charges,77% of total billed charges,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.77,74,,,Percent of Total Billed Charges,74% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,21.3,84,,,Percent of Total Billed Charges,84% of total billed charges,20.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.57,89,,,Percent of total Billed Charges,89% of total Billed charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.53,77,,,Percent of total Billed charges,77% of total billed charges,21.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,22.57,
Nitroglycerin 0.4mg/hr Topical Patch,378911293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,19.53,77,,,Percent of Total Billed Charges,77% of total billed charges,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.77,74,,,Percent of Total Billed Charges,74% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17.5,69,,,Percent of Total Billed Charges,69% of total billed charges,21.3,84,,,Percent of Total Billed Charges,84% of total billed charges,20.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.57,89,,,Percent of total Billed Charges,89% of total Billed charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.53,77,,,Percent of total Billed charges,77% of total billed charges,21.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.34,22.57,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
Nitroglycerin 25mg/250ml (100mcg/ml) IV Bottle,338104702,CDM,250,RC,,,Outpatient,,,250.99,125.5,,193.26,77,,,Percent of Total Billed Charges,77% of total billed charges,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.73,74,,,Percent of Total Billed Charges,74% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,173.18,69,,,Percent of Total Billed Charges,69% of total billed charges,210.83,84,,,Percent of Total Billed Charges,84% of total billed charges,205.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,223.38,89,,,Percent of total Billed Charges,89% of total Billed charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.26,77,,,Percent of total Billed charges,77% of total billed charges,213.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.75,223.38,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1481.62,740.81,,1140.85,77,,,Percent of Total Billed Charges,77% of total billed charges,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1096.4,74,,,Percent of Total Billed Charges,74% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1244.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1214.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1318.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.85,77,,,Percent of total Billed charges,77% of total billed charges,1259.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,425.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,740.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.41,1318.64,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1541.69,770.85,,1187.1,77,,,Percent of Total Billed Charges,77% of total billed charges,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1140.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1295.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1264.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1372.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.1,77,,,Percent of total Billed charges,77% of total billed charges,1310.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,770.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.42,1372.1,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1481.62,740.81,,1140.85,77,,,Percent of Total Billed Charges,77% of total billed charges,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1096.4,74,,,Percent of Total Billed Charges,74% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1244.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1214.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1318.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.85,77,,,Percent of total Billed charges,77% of total billed charges,1259.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,425.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,740.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.41,1318.64,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1541.69,770.85,,1187.1,77,,,Percent of Total Billed Charges,77% of total billed charges,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1140.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1295.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1264.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1372.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.1,77,,,Percent of total Billed charges,77% of total billed charges,1310.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,770.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.42,1372.1,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1481.62,740.81,,1140.85,77,,,Percent of Total Billed Charges,77% of total billed charges,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1096.4,74,,,Percent of Total Billed Charges,74% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1244.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1214.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1318.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.85,77,,,Percent of total Billed charges,77% of total billed charges,1259.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,425.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,740.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.41,1318.64,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1541.69,770.85,,1187.1,77,,,Percent of Total Billed Charges,77% of total billed charges,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1140.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1295.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1264.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1372.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.1,77,,,Percent of total Billed charges,77% of total billed charges,1310.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,770.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.42,1372.1,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1481.62,740.81,,1140.85,77,,,Percent of Total Billed Charges,77% of total billed charges,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1096.4,74,,,Percent of Total Billed Charges,74% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1244.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1214.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1318.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.85,77,,,Percent of total Billed charges,77% of total billed charges,1259.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,425.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,740.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.41,1318.64,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1541.69,770.85,,1187.1,77,,,Percent of Total Billed Charges,77% of total billed charges,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1140.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1295.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1264.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1372.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.1,77,,,Percent of total Billed charges,77% of total billed charges,1310.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,770.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.42,1372.1,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1481.62,740.81,,1140.85,77,,,Percent of Total Billed Charges,77% of total billed charges,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1096.4,74,,,Percent of Total Billed Charges,74% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1244.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1214.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1318.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.85,77,,,Percent of total Billed charges,77% of total billed charges,1259.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,425.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,740.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.41,1318.64,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1541.69,770.85,,1187.1,77,,,Percent of Total Billed Charges,77% of total billed charges,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1140.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1295.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1264.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1372.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.1,77,,,Percent of total Billed charges,77% of total billed charges,1310.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,770.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.42,1372.1,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1481.62,740.81,,1140.85,77,,,Percent of Total Billed Charges,77% of total billed charges,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,377.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,463.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1096.4,74,,,Percent of Total Billed Charges,74% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1022.32,69,,,Percent of Total Billed Charges,69% of total billed charges,1244.56,84,,,Percent of Total Billed Charges,84% of total billed charges,1214.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1318.64,89,,,Percent of total Billed Charges,89% of total Billed charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1140.85,77,,,Percent of total Billed charges,77% of total billed charges,1259.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,425.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,740.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,604.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1318.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,370.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,370.41,1318.64,
NitroPRUSSIDE 50mg/2ml SDV,,,250,RC,,,Outpatient,,,1541.69,770.85,,1187.1,77,,,Percent of Total Billed Charges,77% of total billed charges,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,393.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,481.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1140.85,74,,,Percent of Total Billed Charges,74% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1063.77,69,,,Percent of Total Billed Charges,69% of total billed charges,1295.02,84,,,Percent of Total Billed Charges,84% of total billed charges,1264.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,1372.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.1,77,,,Percent of total Billed charges,77% of total billed charges,1310.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,443.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,770.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,629.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1372.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,385.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,385.42,1372.1,
Nitroglycerin Oral Spray 4.9gm/60 Sprays,45802021001,CDM,250,RC,,,Outpatient,,,778.34,389.17,,599.32,77,,,Percent of Total Billed Charges,77% of total billed charges,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,575.97,74,,,Percent of Total Billed Charges,74% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,653.81,84,,,Percent of Total Billed Charges,84% of total billed charges,638.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,692.72,89,,,Percent of total Billed Charges,89% of total Billed charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.32,77,,,Percent of total Billed charges,77% of total billed charges,661.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.59,692.72,
Nitroglycerin Oral Spray 4.9gm/60 Sprays,45802021001,CDM,250,RC,,,Outpatient,,,778.34,389.17,,599.32,77,,,Percent of Total Billed Charges,77% of total billed charges,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,575.97,74,,,Percent of Total Billed Charges,74% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,653.81,84,,,Percent of Total Billed Charges,84% of total billed charges,638.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,692.72,89,,,Percent of total Billed Charges,89% of total Billed charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.32,77,,,Percent of total Billed charges,77% of total billed charges,661.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.59,692.72,
Nitroglycerin Oral Spray 4.9gm/60 Sprays,45802021001,CDM,250,RC,,,Outpatient,,,778.34,389.17,,599.32,77,,,Percent of Total Billed Charges,77% of total billed charges,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,575.97,74,,,Percent of Total Billed Charges,74% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,653.81,84,,,Percent of Total Billed Charges,84% of total billed charges,638.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,692.72,89,,,Percent of total Billed Charges,89% of total Billed charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.32,77,,,Percent of total Billed charges,77% of total billed charges,661.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.59,692.72,
Nitroglycerin Oral Spray 4.9gm/60 Sprays,45802021001,CDM,250,RC,,,Outpatient,,,778.34,389.17,,599.32,77,,,Percent of Total Billed Charges,77% of total billed charges,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,575.97,74,,,Percent of Total Billed Charges,74% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,653.81,84,,,Percent of Total Billed Charges,84% of total billed charges,638.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,692.72,89,,,Percent of total Billed Charges,89% of total Billed charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.32,77,,,Percent of total Billed charges,77% of total billed charges,661.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.59,692.72,
Nitroglycerin Oral Spray 4.9gm/60 Sprays,45802021001,CDM,250,RC,,,Outpatient,,,778.34,389.17,,599.32,77,,,Percent of Total Billed Charges,77% of total billed charges,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,575.97,74,,,Percent of Total Billed Charges,74% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,653.81,84,,,Percent of Total Billed Charges,84% of total billed charges,638.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,692.72,89,,,Percent of total Billed Charges,89% of total Billed charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.32,77,,,Percent of total Billed charges,77% of total billed charges,661.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.59,692.72,
Nitroglycerin Oral Spray 4.9gm/60 Sprays,45802021001,CDM,250,RC,,,Outpatient,,,778.34,389.17,,599.32,77,,,Percent of Total Billed Charges,77% of total billed charges,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,198.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,243.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,575.97,74,,,Percent of Total Billed Charges,74% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,537.05,69,,,Percent of Total Billed Charges,69% of total billed charges,653.81,84,,,Percent of Total Billed Charges,84% of total billed charges,638.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,692.72,89,,,Percent of total Billed Charges,89% of total Billed charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.32,77,,,Percent of total Billed charges,77% of total billed charges,661.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,223.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,389.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,317.56,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,692.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,194.59,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.59,692.72,
Nitrofurantoin Macrocrystals 50mg Capsule,47781030701,CDM,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nitrofurantoin Macrocrystals 50mg Capsule,47781030701,CDM,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nitrofurantoin Macrocrystals 50mg Capsule,47781030701,CDM,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nitrofurantoin Macrocrystals 50mg Capsule,47781030701,CDM,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nitrofurantoin Macrocrystals 50mg Capsule,47781030701,CDM,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nitrofurantoin Macrocrystals 50mg Capsule,47781030701,CDM,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nitroglycerin Oral Spray 400 mcg/1 Spray (CARDIO ONLY),,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Nitroglycerin Oral Spray 400 mcg/1 Spray (CARDIO ONLY),,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Nitroglycerin Oral Spray 400 mcg/1 Spray (CARDIO ONLY),,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Nitroglycerin Oral Spray 400 mcg/1 Spray (CARDIO ONLY),,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Nitroglycerin Oral Spray 400 mcg/1 Spray (CARDIO ONLY),,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Nitroglycerin Oral Spray 400 mcg/1 Spray (CARDIO ONLY),,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20776.96,10388.48,,15998.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6492.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15374.95,74,,,Percent of Total Billed Charges,74% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17452.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18491.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15998.26,77,,,Percent of total Billed charges,77% of total billed charges,17660.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5973.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10388.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5194.24,18491.49,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20243.49,10121.75,,15587.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6326.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14980.18,74,,,Percent of Total Billed Charges,74% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17004.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18016.71,89,,,Percent of total Billed Charges,89% of total Billed charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.49,77,,,Percent of total Billed charges,77% of total billed charges,17206.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5820,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5060.87,18016.71,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20776.96,10388.48,,15998.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6492.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15374.95,74,,,Percent of Total Billed Charges,74% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17452.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18491.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15998.26,77,,,Percent of total Billed charges,77% of total billed charges,17660.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5973.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10388.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5194.24,18491.49,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20243.49,10121.75,,15587.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6326.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14980.18,74,,,Percent of Total Billed Charges,74% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17004.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18016.71,89,,,Percent of total Billed Charges,89% of total Billed charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.49,77,,,Percent of total Billed charges,77% of total billed charges,17206.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5820,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5060.87,18016.71,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20776.96,10388.48,,15998.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6492.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15374.95,74,,,Percent of Total Billed Charges,74% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17452.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18491.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15998.26,77,,,Percent of total Billed charges,77% of total billed charges,17660.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5973.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10388.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5194.24,18491.49,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20243.49,10121.75,,15587.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6326.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14980.18,74,,,Percent of Total Billed Charges,74% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17004.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18016.71,89,,,Percent of total Billed Charges,89% of total Billed charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.49,77,,,Percent of total Billed charges,77% of total billed charges,17206.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5820,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5060.87,18016.71,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20776.96,10388.48,,15998.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6492.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15374.95,74,,,Percent of Total Billed Charges,74% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17452.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18491.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15998.26,77,,,Percent of total Billed charges,77% of total billed charges,17660.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5973.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10388.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5194.24,18491.49,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20243.49,10121.75,,15587.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6326.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14980.18,74,,,Percent of Total Billed Charges,74% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17004.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18016.71,89,,,Percent of total Billed Charges,89% of total Billed charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.49,77,,,Percent of total Billed charges,77% of total billed charges,17206.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5820,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5060.87,18016.71,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20776.96,10388.48,,15998.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6492.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15374.95,74,,,Percent of Total Billed Charges,74% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17452.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18491.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15998.26,77,,,Percent of total Billed charges,77% of total billed charges,17660.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5973.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10388.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5194.24,18491.49,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20243.49,10121.75,,15587.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6326.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14980.18,74,,,Percent of Total Billed Charges,74% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17004.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18016.71,89,,,Percent of total Billed Charges,89% of total Billed charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.49,77,,,Percent of total Billed charges,77% of total billed charges,17206.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5820,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5060.87,18016.71,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20776.96,10388.48,,15998.26,77,,,Percent of Total Billed Charges,77% of total billed charges,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5298.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6492.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15374.95,74,,,Percent of Total Billed Charges,74% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,14336.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17452.65,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18491.49,89,,,Percent of total Billed Charges,89% of total Billed charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15998.26,77,,,Percent of total Billed charges,77% of total billed charges,17660.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5973.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10388.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8477,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18491.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5194.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5194.24,18491.49,
Nivolumab (Opdivo) 100mg/10ml Liquid SDV,3377412,CDM,250,RC,,,Outpatient,,,20243.49,10121.75,,15587.49,77,,,Percent of Total Billed Charges,77% of total billed charges,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5162.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6326.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14980.18,74,,,Percent of Total Billed Charges,74% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,13968.01,69,,,Percent of Total Billed Charges,69% of total billed charges,17004.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18016.71,89,,,Percent of total Billed Charges,89% of total Billed charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15587.49,77,,,Percent of total Billed charges,77% of total billed charges,17206.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5820,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10121.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8259.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18016.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5060.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5060.87,18016.71,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24262.3,12131.15,,18681.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7581.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17954.1,74,,,Percent of Total Billed Charges,74% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,20380.33,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21593.45,89,,,Percent of total Billed Charges,89% of total Billed charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18681.97,77,,,Percent of total Billed charges,77% of total billed charges,20622.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6975.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12131.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6065.58,21593.45,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24902.46,12451.23,,19174.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6350.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6350.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7782.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18427.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20918.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22163.19,89,,,Percent of total Billed Charges,89% of total Billed charges,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19174.89,77,,,Percent of total Billed charges,77% of total billed charges,21167.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7159.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12451.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6225.62,22163.19,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24262.3,12131.15,,18681.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7581.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17954.1,74,,,Percent of Total Billed Charges,74% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,20380.33,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21593.45,89,,,Percent of total Billed Charges,89% of total Billed charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18681.97,77,,,Percent of total Billed charges,77% of total billed charges,20622.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6975.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12131.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6065.58,21593.45,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24262.3,12131.15,,18681.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7581.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17954.1,74,,,Percent of Total Billed Charges,74% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,20380.33,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21593.45,89,,,Percent of total Billed Charges,89% of total Billed charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18681.97,77,,,Percent of total Billed charges,77% of total billed charges,20622.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6975.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12131.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6065.58,21593.45,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24902.46,12451.23,,19174.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6350.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6350.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7782.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18427.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20918.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22163.19,89,,,Percent of total Billed Charges,89% of total Billed charges,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19174.89,77,,,Percent of total Billed charges,77% of total billed charges,21167.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7159.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12451.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6225.62,22163.19,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24262.3,12131.15,,18681.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7581.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17954.1,74,,,Percent of Total Billed Charges,74% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,20380.33,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21593.45,89,,,Percent of total Billed Charges,89% of total Billed charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18681.97,77,,,Percent of total Billed charges,77% of total billed charges,20622.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6975.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12131.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6065.58,21593.45,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24262.3,12131.15,,18681.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7581.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17954.1,74,,,Percent of Total Billed Charges,74% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,20380.33,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21593.45,89,,,Percent of total Billed Charges,89% of total Billed charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18681.97,77,,,Percent of total Billed charges,77% of total billed charges,20622.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6975.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12131.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6065.58,21593.45,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24902.46,12451.23,,19174.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6350.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6350.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7782.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18427.82,74,,,Percent of Total Billed Charges,74% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,17182.7,69,,,Percent of Total Billed Charges,69% of total billed charges,20918.07,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22163.19,89,,,Percent of total Billed Charges,89% of total Billed charges,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19174.89,77,,,Percent of total Billed charges,77% of total billed charges,21167.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7159.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12451.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10160.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22163.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6225.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6225.62,22163.19,
Nivolumab (Opdivo) 120mg/12ml Liquid SDV,3375614,CDM,250,RC,,,Outpatient,,,24262.3,12131.15,,18681.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6186.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7581.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17954.1,74,,,Percent of Total Billed Charges,74% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,16740.99,69,,,Percent of Total Billed Charges,69% of total billed charges,20380.33,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21593.45,89,,,Percent of total Billed Charges,89% of total Billed charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18681.97,77,,,Percent of total Billed charges,77% of total billed charges,20622.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6975.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12131.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9899.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21593.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6065.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6065.58,21593.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,36371.29,18185.65,,28005.89,77,,,Percent of Total Billed Charges,77% of total billed charges,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11366.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26914.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30551.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32370.45,89,,,Percent of total Billed Charges,89% of total Billed charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28005.89,77,,,Percent of total Billed charges,77% of total billed charges,30915.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10456.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18185.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9092.82,32370.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,35434.52,17717.26,,27284.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11073.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26221.54,74,,,Percent of Total Billed Charges,74% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,29765,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31536.72,89,,,Percent of total Billed Charges,89% of total Billed charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27284.58,77,,,Percent of total Billed charges,77% of total billed charges,30119.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10187.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17717.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8858.63,31536.72,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,36371.29,18185.65,,28005.89,77,,,Percent of Total Billed Charges,77% of total billed charges,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11366.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26914.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30551.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32370.45,89,,,Percent of total Billed Charges,89% of total Billed charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28005.89,77,,,Percent of total Billed charges,77% of total billed charges,30915.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10456.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18185.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9092.82,32370.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,35434.52,17717.26,,27284.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11073.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26221.54,74,,,Percent of Total Billed Charges,74% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,29765,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31536.72,89,,,Percent of total Billed Charges,89% of total Billed charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27284.58,77,,,Percent of total Billed charges,77% of total billed charges,30119.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10187.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17717.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8858.63,31536.72,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,36371.29,18185.65,,28005.89,77,,,Percent of Total Billed Charges,77% of total billed charges,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11366.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26914.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30551.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32370.45,89,,,Percent of total Billed Charges,89% of total Billed charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28005.89,77,,,Percent of total Billed charges,77% of total billed charges,30915.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10456.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18185.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9092.82,32370.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,35434.52,17717.26,,27284.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11073.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26221.54,74,,,Percent of Total Billed Charges,74% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,29765,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31536.72,89,,,Percent of total Billed Charges,89% of total Billed charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27284.58,77,,,Percent of total Billed charges,77% of total billed charges,30119.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10187.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17717.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8858.63,31536.72,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,36371.29,18185.65,,28005.89,77,,,Percent of Total Billed Charges,77% of total billed charges,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11366.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26914.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30551.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32370.45,89,,,Percent of total Billed Charges,89% of total Billed charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28005.89,77,,,Percent of total Billed charges,77% of total billed charges,30915.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10456.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18185.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9092.82,32370.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,35434.52,17717.26,,27284.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11073.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26221.54,74,,,Percent of Total Billed Charges,74% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,29765,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31536.72,89,,,Percent of total Billed Charges,89% of total Billed charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27284.58,77,,,Percent of total Billed charges,77% of total billed charges,30119.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10187.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17717.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8858.63,31536.72,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,36371.29,18185.65,,28005.89,77,,,Percent of Total Billed Charges,77% of total billed charges,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11366.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26914.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30551.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32370.45,89,,,Percent of total Billed Charges,89% of total Billed charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28005.89,77,,,Percent of total Billed charges,77% of total billed charges,30915.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10456.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18185.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9092.82,32370.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,35434.52,17717.26,,27284.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11073.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26221.54,74,,,Percent of Total Billed Charges,74% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,29765,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31536.72,89,,,Percent of total Billed Charges,89% of total Billed charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27284.58,77,,,Percent of total Billed charges,77% of total billed charges,30119.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10187.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17717.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8858.63,31536.72,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,36371.29,18185.65,,28005.89,77,,,Percent of Total Billed Charges,77% of total billed charges,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9274.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11366.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26914.75,74,,,Percent of Total Billed Charges,74% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,25096.19,69,,,Percent of Total Billed Charges,69% of total billed charges,30551.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,32370.45,89,,,Percent of total Billed Charges,89% of total Billed charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28005.89,77,,,Percent of total Billed charges,77% of total billed charges,30915.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10456.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,18185.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14839.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32370.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9092.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9092.82,32370.45,
Nivolumab (Opdivo) 240mg/24ml Liquid SDV,3373413,CDM,250,RC,,,Outpatient,,,35434.52,17717.26,,27284.58,77,,,Percent of Total Billed Charges,77% of total billed charges,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9035.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11073.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,26221.54,74,,,Percent of Total Billed Charges,74% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,24449.82,69,,,Percent of Total Billed Charges,69% of total billed charges,29765,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31536.72,89,,,Percent of total Billed Charges,89% of total Billed charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27284.58,77,,,Percent of total Billed charges,77% of total billed charges,30119.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10187.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17717.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14457.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31536.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8858.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8858.63,31536.72,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,9138.53,4569.27,,7036.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2855.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6762.51,74,,,Percent of Total Billed Charges,74% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7676.37,84,,,Percent of Total Billed Charges,84% of total billed charges,7493.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,8133.29,89,,,Percent of total Billed Charges,89% of total Billed charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7036.67,77,,,Percent of total Billed charges,77% of total billed charges,7767.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2627.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4569.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.63,8133.29,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,8906.05,4453.03,,6857.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2783.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6590.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7481.08,84,,,Percent of Total Billed Charges,84% of total billed charges,7302.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,7926.38,89,,,Percent of total Billed Charges,89% of total Billed charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6857.66,77,,,Percent of total Billed charges,77% of total billed charges,7570.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2560.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4453.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2226.51,7926.38,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,9138.53,4569.27,,7036.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2855.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6762.51,74,,,Percent of Total Billed Charges,74% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7676.37,84,,,Percent of Total Billed Charges,84% of total billed charges,7493.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,8133.29,89,,,Percent of total Billed Charges,89% of total Billed charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7036.67,77,,,Percent of total Billed charges,77% of total billed charges,7767.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2627.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4569.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.63,8133.29,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,8906.05,4453.03,,6857.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2783.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6590.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7481.08,84,,,Percent of Total Billed Charges,84% of total billed charges,7302.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,7926.38,89,,,Percent of total Billed Charges,89% of total Billed charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6857.66,77,,,Percent of total Billed charges,77% of total billed charges,7570.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2560.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4453.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2226.51,7926.38,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,9138.53,4569.27,,7036.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2855.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6762.51,74,,,Percent of Total Billed Charges,74% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7676.37,84,,,Percent of Total Billed Charges,84% of total billed charges,7493.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,8133.29,89,,,Percent of total Billed Charges,89% of total Billed charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7036.67,77,,,Percent of total Billed charges,77% of total billed charges,7767.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2627.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4569.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.63,8133.29,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,8906.05,4453.03,,6857.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2783.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6590.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7481.08,84,,,Percent of Total Billed Charges,84% of total billed charges,7302.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,7926.38,89,,,Percent of total Billed Charges,89% of total Billed charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6857.66,77,,,Percent of total Billed charges,77% of total billed charges,7570.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2560.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4453.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2226.51,7926.38,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,9138.53,4569.27,,7036.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2855.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6762.51,74,,,Percent of Total Billed Charges,74% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7676.37,84,,,Percent of Total Billed Charges,84% of total billed charges,7493.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,8133.29,89,,,Percent of total Billed Charges,89% of total Billed charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7036.67,77,,,Percent of total Billed charges,77% of total billed charges,7767.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2627.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4569.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.63,8133.29,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,8906.05,4453.03,,6857.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2783.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6590.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7481.08,84,,,Percent of Total Billed Charges,84% of total billed charges,7302.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,7926.38,89,,,Percent of total Billed Charges,89% of total Billed charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6857.66,77,,,Percent of total Billed charges,77% of total billed charges,7570.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2560.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4453.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2226.51,7926.38,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,9138.53,4569.27,,7036.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2855.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6762.51,74,,,Percent of Total Billed Charges,74% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7676.37,84,,,Percent of Total Billed Charges,84% of total billed charges,7493.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,8133.29,89,,,Percent of total Billed Charges,89% of total Billed charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7036.67,77,,,Percent of total Billed charges,77% of total billed charges,7767.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2627.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4569.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.63,8133.29,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,8906.05,4453.03,,6857.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2783.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6590.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7481.08,84,,,Percent of Total Billed Charges,84% of total billed charges,7302.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,7926.38,89,,,Percent of total Billed Charges,89% of total Billed charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6857.66,77,,,Percent of total Billed charges,77% of total billed charges,7570.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2560.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4453.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2226.51,7926.38,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,9138.53,4569.27,,7036.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2330.33,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2855.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6762.51,74,,,Percent of Total Billed Charges,74% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,6305.59,69,,,Percent of Total Billed Charges,69% of total billed charges,7676.37,84,,,Percent of Total Billed Charges,84% of total billed charges,7493.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,8133.29,89,,,Percent of total Billed Charges,89% of total Billed charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7036.67,77,,,Percent of total Billed charges,77% of total billed charges,7767.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2627.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4569.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3728.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8133.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2284.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.63,8133.29,
Nivolumab (Opdivo) 40mg/4ml Liquid SDV,3377211,CDM,250,RC,,,Outpatient,,,8906.05,4453.03,,6857.66,77,,,Percent of Total Billed Charges,77% of total billed charges,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2271.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2783.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6590.48,74,,,Percent of Total Billed Charges,74% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6145.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7481.08,84,,,Percent of Total Billed Charges,84% of total billed charges,7302.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,7926.38,89,,,Percent of total Billed Charges,89% of total Billed charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6857.66,77,,,Percent of total Billed charges,77% of total billed charges,7570.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2560.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4453.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3633.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7926.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2226.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2226.51,7926.38,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Norepinephrine 4mg/4ml SDV,51991098399,CDM,250,RC,,,Outpatient,,,180.19,90.1,,138.75,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.34,74,,,Percent of Total Billed Charges,74% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,124.33,69,,,Percent of Total Billed Charges,69% of total billed charges,151.36,84,,,Percent of Total Billed Charges,84% of total billed charges,147.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.37,89,,,Percent of total Billed Charges,89% of total Billed charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.75,77,,,Percent of total Billed charges,77% of total billed charges,153.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.37,
Nortriptyline 10mg Capsule,93081001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Nortriptyline 10mg Capsule,93081001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Nortriptyline 10mg Capsule,93081001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Nortriptyline 10mg Capsule,93081001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Nortriptyline 10mg Capsule,93081001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Nortriptyline 10mg Capsule,93081001,CDM,250,RC,,,Outpatient,,,11.85,5.93,,9.12,77,,,Percent of Total Billed Charges,77% of total billed charges,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.77,74,,,Percent of Total Billed Charges,74% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,8.18,69,,,Percent of Total Billed Charges,69% of total billed charges,9.95,84,,,Percent of Total Billed Charges,84% of total billed charges,9.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.55,89,,,Percent of total Billed Charges,89% of total Billed charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.12,77,,,Percent of total Billed charges,77% of total billed charges,10.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.96,10.55,
Nortriptyline 25mg Capsule,93081101,CDM,250,RC,,,Outpatient,,,18.8,9.4,,14.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.91,74,,,Percent of Total Billed Charges,74% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.73,89,,,Percent of total Billed Charges,89% of total Billed charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,77,,,Percent of total Billed charges,77% of total billed charges,15.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,16.73,
Nortriptyline 25mg Capsule,93081101,CDM,250,RC,,,Outpatient,,,18.8,9.4,,14.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.91,74,,,Percent of Total Billed Charges,74% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.73,89,,,Percent of total Billed Charges,89% of total Billed charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,77,,,Percent of total Billed charges,77% of total billed charges,15.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,16.73,
Nortriptyline 25mg Capsule,93081101,CDM,250,RC,,,Outpatient,,,18.8,9.4,,14.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.91,74,,,Percent of Total Billed Charges,74% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.73,89,,,Percent of total Billed Charges,89% of total Billed charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,77,,,Percent of total Billed charges,77% of total billed charges,15.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,16.73,
Nortriptyline 25mg Capsule,93081101,CDM,250,RC,,,Outpatient,,,18.8,9.4,,14.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.91,74,,,Percent of Total Billed Charges,74% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.73,89,,,Percent of total Billed Charges,89% of total Billed charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,77,,,Percent of total Billed charges,77% of total billed charges,15.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,16.73,
Nortriptyline 25mg Capsule,93081101,CDM,250,RC,,,Outpatient,,,18.8,9.4,,14.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.91,74,,,Percent of Total Billed Charges,74% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.73,89,,,Percent of total Billed Charges,89% of total Billed charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,77,,,Percent of total Billed charges,77% of total billed charges,15.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,16.73,
Nortriptyline 25mg Capsule,93081101,CDM,250,RC,,,Outpatient,,,18.8,9.4,,14.48,77,,,Percent of Total Billed Charges,77% of total billed charges,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.91,74,,,Percent of Total Billed Charges,74% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,12.97,69,,,Percent of Total Billed Charges,69% of total billed charges,15.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15.42,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.73,89,,,Percent of total Billed Charges,89% of total Billed charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.48,77,,,Percent of total Billed charges,77% of total billed charges,15.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.7,16.73,
"Nystatin Oral Suspension 500,000 units/5ml UDC",,,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
"Nystatin Oral Suspension 500,000 units/5ml UDC",,,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
"Nystatin Oral Suspension 500,000 units/5ml UDC",,,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
"Nystatin Oral Suspension 500,000 units/5ml UDC",,,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
"Nystatin Oral Suspension 500,000 units/5ml UDC",,,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
"Nystatin Oral Suspension 500,000 units/5ml UDC",,,250,RC,,,Outpatient,,,26.3,13.15,,20.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.46,74,,,Percent of Total Billed Charges,74% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,18.15,69,,,Percent of Total Billed Charges,69% of total billed charges,22.09,84,,,Percent of Total Billed Charges,84% of total billed charges,21.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.41,89,,,Percent of total Billed Charges,89% of total Billed charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.25,77,,,Percent of total Billed charges,77% of total billed charges,22.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.56,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.58,23.41,
Nystatin/Triamcinolone Cream 15gm,,,250,RC,,,Outpatient,,,177.3,88.65,,136.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.2,74,,,Percent of Total Billed Charges,74% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,148.93,84,,,Percent of Total Billed Charges,84% of total billed charges,145.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.8,89,,,Percent of total Billed Charges,89% of total Billed charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.52,77,,,Percent of total Billed charges,77% of total billed charges,150.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,157.8,
Nystatin/Triamcinolone Cream 15gm,,,250,RC,,,Outpatient,,,177.3,88.65,,136.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.2,74,,,Percent of Total Billed Charges,74% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,148.93,84,,,Percent of Total Billed Charges,84% of total billed charges,145.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.8,89,,,Percent of total Billed Charges,89% of total Billed charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.52,77,,,Percent of total Billed charges,77% of total billed charges,150.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,157.8,
Nystatin/Triamcinolone Cream 15gm,,,250,RC,,,Outpatient,,,177.3,88.65,,136.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.2,74,,,Percent of Total Billed Charges,74% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,148.93,84,,,Percent of Total Billed Charges,84% of total billed charges,145.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.8,89,,,Percent of total Billed Charges,89% of total Billed charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.52,77,,,Percent of total Billed charges,77% of total billed charges,150.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,157.8,
Nystatin/Triamcinolone Cream 15gm,,,250,RC,,,Outpatient,,,177.3,88.65,,136.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.2,74,,,Percent of Total Billed Charges,74% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,148.93,84,,,Percent of Total Billed Charges,84% of total billed charges,145.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.8,89,,,Percent of total Billed Charges,89% of total Billed charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.52,77,,,Percent of total Billed charges,77% of total billed charges,150.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,157.8,
Nystatin/Triamcinolone Cream 15gm,,,250,RC,,,Outpatient,,,177.3,88.65,,136.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.2,74,,,Percent of Total Billed Charges,74% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,148.93,84,,,Percent of Total Billed Charges,84% of total billed charges,145.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.8,89,,,Percent of total Billed Charges,89% of total Billed charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.52,77,,,Percent of total Billed charges,77% of total billed charges,150.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,157.8,
Nystatin/Triamcinolone Cream 15gm,,,250,RC,,,Outpatient,,,177.3,88.65,,136.52,77,,,Percent of Total Billed Charges,77% of total billed charges,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.2,74,,,Percent of Total Billed Charges,74% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,122.34,69,,,Percent of Total Billed Charges,69% of total billed charges,148.93,84,,,Percent of Total Billed Charges,84% of total billed charges,145.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.8,89,,,Percent of total Billed Charges,89% of total Billed charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.52,77,,,Percent of total Billed charges,77% of total billed charges,150.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.33,157.8,
Nystatin Topical Powder 15gm,574200815,CDM,250,RC,,,Outpatient,,,164.55,82.28,,126.7,77,,,Percent of Total Billed Charges,77% of total billed charges,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.77,74,,,Percent of Total Billed Charges,74% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,138.22,84,,,Percent of Total Billed Charges,84% of total billed charges,134.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.45,89,,,Percent of total Billed Charges,89% of total Billed charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.7,77,,,Percent of total Billed charges,77% of total billed charges,139.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.14,146.45,
Nystatin Topical Powder 15gm,574200815,CDM,250,RC,,,Outpatient,,,164.55,82.28,,126.7,77,,,Percent of Total Billed Charges,77% of total billed charges,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.77,74,,,Percent of Total Billed Charges,74% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,138.22,84,,,Percent of Total Billed Charges,84% of total billed charges,134.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.45,89,,,Percent of total Billed Charges,89% of total Billed charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.7,77,,,Percent of total Billed charges,77% of total billed charges,139.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.14,146.45,
Nystatin Topical Powder 15gm,574200815,CDM,250,RC,,,Outpatient,,,164.55,82.28,,126.7,77,,,Percent of Total Billed Charges,77% of total billed charges,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.77,74,,,Percent of Total Billed Charges,74% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,138.22,84,,,Percent of Total Billed Charges,84% of total billed charges,134.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.45,89,,,Percent of total Billed Charges,89% of total Billed charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.7,77,,,Percent of total Billed charges,77% of total billed charges,139.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.14,146.45,
Nystatin Topical Powder 15gm,574200815,CDM,250,RC,,,Outpatient,,,164.55,82.28,,126.7,77,,,Percent of Total Billed Charges,77% of total billed charges,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.77,74,,,Percent of Total Billed Charges,74% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,138.22,84,,,Percent of Total Billed Charges,84% of total billed charges,134.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.45,89,,,Percent of total Billed Charges,89% of total Billed charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.7,77,,,Percent of total Billed charges,77% of total billed charges,139.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.14,146.45,
Nystatin Topical Powder 15gm,574200815,CDM,250,RC,,,Outpatient,,,164.55,82.28,,126.7,77,,,Percent of Total Billed Charges,77% of total billed charges,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.77,74,,,Percent of Total Billed Charges,74% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,138.22,84,,,Percent of Total Billed Charges,84% of total billed charges,134.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.45,89,,,Percent of total Billed Charges,89% of total Billed charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.7,77,,,Percent of total Billed charges,77% of total billed charges,139.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.14,146.45,
Nystatin Topical Powder 15gm,574200815,CDM,250,RC,,,Outpatient,,,164.55,82.28,,126.7,77,,,Percent of Total Billed Charges,77% of total billed charges,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,121.77,74,,,Percent of Total Billed Charges,74% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,113.54,69,,,Percent of Total Billed Charges,69% of total billed charges,138.22,84,,,Percent of Total Billed Charges,84% of total billed charges,134.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.45,89,,,Percent of total Billed Charges,89% of total Billed charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,126.7,77,,,Percent of total Billed charges,77% of total billed charges,139.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.14,146.45,
"Nystatin 100,000 Units Cream 30gm",45802005911,CDM,250,RC,,,Outpatient,,,177.71,88.86,,136.84,77,,,Percent of Total Billed Charges,77% of total billed charges,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.51,74,,,Percent of Total Billed Charges,74% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,149.28,84,,,Percent of Total Billed Charges,84% of total billed charges,145.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.16,89,,,Percent of total Billed Charges,89% of total Billed charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.84,77,,,Percent of total Billed charges,77% of total billed charges,151.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.43,158.16,
"Nystatin 100,000 Units Cream 30gm",45802005911,CDM,250,RC,,,Outpatient,,,177.71,88.86,,136.84,77,,,Percent of Total Billed Charges,77% of total billed charges,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.51,74,,,Percent of Total Billed Charges,74% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,149.28,84,,,Percent of Total Billed Charges,84% of total billed charges,145.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.16,89,,,Percent of total Billed Charges,89% of total Billed charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.84,77,,,Percent of total Billed charges,77% of total billed charges,151.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.43,158.16,
"Nystatin 100,000 Units Cream 30gm",45802005911,CDM,250,RC,,,Outpatient,,,177.71,88.86,,136.84,77,,,Percent of Total Billed Charges,77% of total billed charges,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.51,74,,,Percent of Total Billed Charges,74% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,149.28,84,,,Percent of Total Billed Charges,84% of total billed charges,145.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.16,89,,,Percent of total Billed Charges,89% of total Billed charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.84,77,,,Percent of total Billed charges,77% of total billed charges,151.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.43,158.16,
"Nystatin 100,000 Units Cream 30gm",45802005911,CDM,250,RC,,,Outpatient,,,177.71,88.86,,136.84,77,,,Percent of Total Billed Charges,77% of total billed charges,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.51,74,,,Percent of Total Billed Charges,74% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,149.28,84,,,Percent of Total Billed Charges,84% of total billed charges,145.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.16,89,,,Percent of total Billed Charges,89% of total Billed charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.84,77,,,Percent of total Billed charges,77% of total billed charges,151.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.43,158.16,
"Nystatin 100,000 Units Cream 30gm",45802005911,CDM,250,RC,,,Outpatient,,,177.71,88.86,,136.84,77,,,Percent of Total Billed Charges,77% of total billed charges,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.51,74,,,Percent of Total Billed Charges,74% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,149.28,84,,,Percent of Total Billed Charges,84% of total billed charges,145.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.16,89,,,Percent of total Billed Charges,89% of total Billed charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.84,77,,,Percent of total Billed charges,77% of total billed charges,151.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.43,158.16,
"Nystatin 100,000 Units Cream 30gm",45802005911,CDM,250,RC,,,Outpatient,,,177.71,88.86,,136.84,77,,,Percent of Total Billed Charges,77% of total billed charges,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.51,74,,,Percent of Total Billed Charges,74% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,69,,,Percent of Total Billed Charges,69% of total billed charges,149.28,84,,,Percent of Total Billed Charges,84% of total billed charges,145.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,158.16,89,,,Percent of total Billed Charges,89% of total Billed charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.84,77,,,Percent of total Billed charges,77% of total billed charges,151.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,158.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.43,158.16,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,33858.63,16929.32,,26071.15,77,,,Percent of Total Billed Charges,77% of total billed charges,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10580.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25055.39,74,,,Percent of Total Billed Charges,74% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,28441.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30134.18,89,,,Percent of total Billed Charges,89% of total Billed charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.15,77,,,Percent of total Billed charges,77% of total billed charges,28779.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9734.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16929.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8464.66,30134.18,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,33858.63,16929.32,,26071.15,77,,,Percent of Total Billed Charges,77% of total billed charges,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10580.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25055.39,74,,,Percent of Total Billed Charges,74% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,28441.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30134.18,89,,,Percent of total Billed Charges,89% of total Billed charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.15,77,,,Percent of total Billed charges,77% of total billed charges,28779.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9734.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16929.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8464.66,30134.18,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,33858.63,16929.32,,26071.15,77,,,Percent of Total Billed Charges,77% of total billed charges,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10580.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25055.39,74,,,Percent of Total Billed Charges,74% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,28441.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30134.18,89,,,Percent of total Billed Charges,89% of total Billed charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.15,77,,,Percent of total Billed charges,77% of total billed charges,28779.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9734.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16929.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8464.66,30134.18,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,33858.63,16929.32,,26071.15,77,,,Percent of Total Billed Charges,77% of total billed charges,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10580.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25055.39,74,,,Percent of Total Billed Charges,74% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,28441.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30134.18,89,,,Percent of total Billed Charges,89% of total Billed charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.15,77,,,Percent of total Billed charges,77% of total billed charges,28779.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9734.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16929.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8464.66,30134.18,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,33858.63,16929.32,,26071.15,77,,,Percent of Total Billed Charges,77% of total billed charges,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10580.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25055.39,74,,,Percent of Total Billed Charges,74% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,28441.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30134.18,89,,,Percent of total Billed Charges,89% of total Billed charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.15,77,,,Percent of total Billed charges,77% of total billed charges,28779.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9734.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16929.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8464.66,30134.18,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,33858.63,16929.32,,26071.15,77,,,Percent of Total Billed Charges,77% of total billed charges,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8633.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10580.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25055.39,74,,,Percent of Total Billed Charges,74% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23362.45,69,,,Percent of Total Billed Charges,69% of total billed charges,28441.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,30134.18,89,,,Percent of total Billed Charges,89% of total Billed charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26071.15,77,,,Percent of total Billed charges,77% of total billed charges,28779.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9734.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16929.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13814.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30134.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8464.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8464.66,30134.18,
Obinutuzumab (Gazyva) 1000mg/40ml Liquid MDV,50242007001,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Ocrelizumab (Ocrevus) 300mg/10ml Liquid SDV,50242015001,CDM,250,RC,,,Outpatient,,,91263.45,45631.73,,70272.86,77,,,Percent of Total Billed Charges,77% of total billed charges,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28519.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67534.95,74,,,Percent of Total Billed Charges,74% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76661.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,81224.47,89,,,Percent of total Billed Charges,89% of total Billed charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70272.86,77,,,Percent of total Billed charges,77% of total billed charges,77573.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26238.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45631.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,81224.47,
Ocrelizumab (Ocrevus) 300mg/10ml Liquid SDV,50242015001,CDM,250,RC,,,Outpatient,,,91263.45,45631.73,,70272.86,77,,,Percent of Total Billed Charges,77% of total billed charges,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28519.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67534.95,74,,,Percent of Total Billed Charges,74% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76661.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,81224.47,89,,,Percent of total Billed Charges,89% of total Billed charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70272.86,77,,,Percent of total Billed charges,77% of total billed charges,77573.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26238.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45631.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,81224.47,
Ocrelizumab (Ocrevus) 300mg/10ml Liquid SDV,50242015001,CDM,250,RC,,,Outpatient,,,91263.45,45631.73,,70272.86,77,,,Percent of Total Billed Charges,77% of total billed charges,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28519.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67534.95,74,,,Percent of Total Billed Charges,74% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76661.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,81224.47,89,,,Percent of total Billed Charges,89% of total Billed charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70272.86,77,,,Percent of total Billed charges,77% of total billed charges,77573.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26238.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45631.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,81224.47,
Ocrelizumab (Ocrevus) 300mg/10ml Liquid SDV,50242015001,CDM,250,RC,,,Outpatient,,,91263.45,45631.73,,70272.86,77,,,Percent of Total Billed Charges,77% of total billed charges,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28519.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67534.95,74,,,Percent of Total Billed Charges,74% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76661.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,81224.47,89,,,Percent of total Billed Charges,89% of total Billed charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70272.86,77,,,Percent of total Billed charges,77% of total billed charges,77573.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26238.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45631.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,81224.47,
Ocrelizumab (Ocrevus) 300mg/10ml Liquid SDV,50242015001,CDM,250,RC,,,Outpatient,,,91263.45,45631.73,,70272.86,77,,,Percent of Total Billed Charges,77% of total billed charges,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28519.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67534.95,74,,,Percent of Total Billed Charges,74% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76661.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,81224.47,89,,,Percent of total Billed Charges,89% of total Billed charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70272.86,77,,,Percent of total Billed charges,77% of total billed charges,77573.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26238.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45631.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,81224.47,
Ocrelizumab (Ocrevus) 300mg/10ml Liquid SDV,50242015001,CDM,250,RC,,,Outpatient,,,91263.45,45631.73,,70272.86,77,,,Percent of Total Billed Charges,77% of total billed charges,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23272.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28519.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67534.95,74,,,Percent of Total Billed Charges,74% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62971.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76661.3,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,81224.47,89,,,Percent of total Billed Charges,89% of total Billed charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70272.86,77,,,Percent of total Billed charges,77% of total billed charges,77573.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26238.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45631.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37235.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81224.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22815.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,81224.47,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide 100mcg/ml Ampule,78018101,CDM,250,RC,,,Outpatient,,,217.54,108.77,,167.51,77,,,Percent of Total Billed Charges,77% of total billed charges,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,160.98,74,,,Percent of Total Billed Charges,74% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,150.1,69,,,Percent of Total Billed Charges,69% of total billed charges,182.73,84,,,Percent of Total Billed Charges,84% of total billed charges,178.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,193.61,89,,,Percent of total Billed Charges,89% of total Billed charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.51,77,,,Percent of total Billed charges,77% of total billed charges,184.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,62.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,108.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,88.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,193.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.39,193.61,
Octreotide Long Acting (Sandostatin LAR Depot) 30mg SDV,78082581,CDM,250,RC,,,Outpatient,,,32845.95,16422.98,,25291.38,77,,,Percent of Total Billed Charges,77% of total billed charges,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10264.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24306,74,,,Percent of Total Billed Charges,74% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,27590.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29232.9,89,,,Percent of total Billed Charges,89% of total Billed charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25291.38,77,,,Percent of total Billed charges,77% of total billed charges,27919.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9443.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16422.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8211.49,29232.9,
Octreotide Long Acting (Sandostatin LAR Depot) 30mg SDV,78082581,CDM,250,RC,,,Outpatient,,,32845.95,16422.98,,25291.38,77,,,Percent of Total Billed Charges,77% of total billed charges,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10264.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24306,74,,,Percent of Total Billed Charges,74% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,27590.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29232.9,89,,,Percent of total Billed Charges,89% of total Billed charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25291.38,77,,,Percent of total Billed charges,77% of total billed charges,27919.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9443.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16422.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8211.49,29232.9,
Octreotide Long Acting (Sandostatin LAR Depot) 30mg SDV,78082581,CDM,250,RC,,,Outpatient,,,32845.95,16422.98,,25291.38,77,,,Percent of Total Billed Charges,77% of total billed charges,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10264.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24306,74,,,Percent of Total Billed Charges,74% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,27590.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29232.9,89,,,Percent of total Billed Charges,89% of total Billed charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25291.38,77,,,Percent of total Billed charges,77% of total billed charges,27919.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9443.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16422.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8211.49,29232.9,
Octreotide Long Acting (Sandostatin LAR Depot) 30mg SDV,78082581,CDM,250,RC,,,Outpatient,,,32845.95,16422.98,,25291.38,77,,,Percent of Total Billed Charges,77% of total billed charges,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10264.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24306,74,,,Percent of Total Billed Charges,74% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,27590.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29232.9,89,,,Percent of total Billed Charges,89% of total Billed charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25291.38,77,,,Percent of total Billed charges,77% of total billed charges,27919.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9443.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16422.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8211.49,29232.9,
Octreotide Long Acting (Sandostatin LAR Depot) 30mg SDV,78082581,CDM,250,RC,,,Outpatient,,,32845.95,16422.98,,25291.38,77,,,Percent of Total Billed Charges,77% of total billed charges,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10264.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24306,74,,,Percent of Total Billed Charges,74% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,27590.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29232.9,89,,,Percent of total Billed Charges,89% of total Billed charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25291.38,77,,,Percent of total Billed charges,77% of total billed charges,27919.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9443.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16422.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8211.49,29232.9,
Octreotide Long Acting (Sandostatin LAR Depot) 30mg SDV,78082581,CDM,250,RC,,,Outpatient,,,32845.95,16422.98,,25291.38,77,,,Percent of Total Billed Charges,77% of total billed charges,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8375.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10264.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24306,74,,,Percent of Total Billed Charges,74% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,22663.71,69,,,Percent of Total Billed Charges,69% of total billed charges,27590.6,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29232.9,89,,,Percent of total Billed Charges,89% of total Billed charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25291.38,77,,,Percent of total Billed charges,77% of total billed charges,27919.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9443.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16422.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13401.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29232.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8211.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8211.49,29232.9,
Ofloxacin 0.3% EYE/EAR Drops 5ml,24208043405,CDM,250,RC,,,Outpatient,,,173.11,86.56,,133.29,77,,,Percent of Total Billed Charges,77% of total billed charges,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.1,74,,,Percent of Total Billed Charges,74% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,145.41,84,,,Percent of Total Billed Charges,84% of total billed charges,141.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.07,89,,,Percent of total Billed Charges,89% of total Billed charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.29,77,,,Percent of total Billed charges,77% of total billed charges,147.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.28,154.07,
Ofloxacin 0.3% EYE/EAR Drops 5ml,24208043405,CDM,250,RC,,,Outpatient,,,173.11,86.56,,133.29,77,,,Percent of Total Billed Charges,77% of total billed charges,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.1,74,,,Percent of Total Billed Charges,74% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,145.41,84,,,Percent of Total Billed Charges,84% of total billed charges,141.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.07,89,,,Percent of total Billed Charges,89% of total Billed charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.29,77,,,Percent of total Billed charges,77% of total billed charges,147.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.28,154.07,
Ofloxacin 0.3% EYE/EAR Drops 5ml,24208043405,CDM,250,RC,,,Outpatient,,,173.11,86.56,,133.29,77,,,Percent of Total Billed Charges,77% of total billed charges,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.1,74,,,Percent of Total Billed Charges,74% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,145.41,84,,,Percent of Total Billed Charges,84% of total billed charges,141.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.07,89,,,Percent of total Billed Charges,89% of total Billed charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.29,77,,,Percent of total Billed charges,77% of total billed charges,147.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.28,154.07,
Ofloxacin 0.3% EYE/EAR Drops 5ml,24208043405,CDM,250,RC,,,Outpatient,,,173.11,86.56,,133.29,77,,,Percent of Total Billed Charges,77% of total billed charges,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.1,74,,,Percent of Total Billed Charges,74% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,145.41,84,,,Percent of Total Billed Charges,84% of total billed charges,141.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.07,89,,,Percent of total Billed Charges,89% of total Billed charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.29,77,,,Percent of total Billed charges,77% of total billed charges,147.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.28,154.07,
Ofloxacin 0.3% EYE/EAR Drops 5ml,24208043405,CDM,250,RC,,,Outpatient,,,173.11,86.56,,133.29,77,,,Percent of Total Billed Charges,77% of total billed charges,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.1,74,,,Percent of Total Billed Charges,74% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,145.41,84,,,Percent of Total Billed Charges,84% of total billed charges,141.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.07,89,,,Percent of total Billed Charges,89% of total Billed charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.29,77,,,Percent of total Billed charges,77% of total billed charges,147.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.28,154.07,
Ofloxacin 0.3% EYE/EAR Drops 5ml,24208043405,CDM,250,RC,,,Outpatient,,,173.11,86.56,,133.29,77,,,Percent of Total Billed Charges,77% of total billed charges,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.1,74,,,Percent of Total Billed Charges,74% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,119.45,69,,,Percent of Total Billed Charges,69% of total billed charges,145.41,84,,,Percent of Total Billed Charges,84% of total billed charges,141.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.07,89,,,Percent of total Billed Charges,89% of total Billed charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,133.29,77,,,Percent of total Billed charges,77% of total billed charges,147.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,86.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.28,154.07,
OLANZapine 10mg SDV,2759701,CDM,250,RC,,,Outpatient,,,336.76,168.38,,259.31,77,,,Percent of Total Billed Charges,77% of total billed charges,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.2,74,,,Percent of Total Billed Charges,74% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,282.88,84,,,Percent of Total Billed Charges,84% of total billed charges,276.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.72,89,,,Percent of total Billed Charges,89% of total Billed charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.31,77,,,Percent of total Billed charges,77% of total billed charges,286.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.19,299.72,
OLANZapine 10mg SDV,2759701,CDM,250,RC,,,Outpatient,,,336.76,168.38,,259.31,77,,,Percent of Total Billed Charges,77% of total billed charges,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.2,74,,,Percent of Total Billed Charges,74% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,282.88,84,,,Percent of Total Billed Charges,84% of total billed charges,276.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.72,89,,,Percent of total Billed Charges,89% of total Billed charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.31,77,,,Percent of total Billed charges,77% of total billed charges,286.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.19,299.72,
OLANZapine 10mg SDV,2759701,CDM,250,RC,,,Outpatient,,,336.76,168.38,,259.31,77,,,Percent of Total Billed Charges,77% of total billed charges,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.2,74,,,Percent of Total Billed Charges,74% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,282.88,84,,,Percent of Total Billed Charges,84% of total billed charges,276.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.72,89,,,Percent of total Billed Charges,89% of total Billed charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.31,77,,,Percent of total Billed charges,77% of total billed charges,286.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.19,299.72,
OLANZapine 10mg SDV,2759701,CDM,250,RC,,,Outpatient,,,336.76,168.38,,259.31,77,,,Percent of Total Billed Charges,77% of total billed charges,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.2,74,,,Percent of Total Billed Charges,74% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,282.88,84,,,Percent of Total Billed Charges,84% of total billed charges,276.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.72,89,,,Percent of total Billed Charges,89% of total Billed charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.31,77,,,Percent of total Billed charges,77% of total billed charges,286.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.19,299.72,
OLANZapine 10mg SDV,2759701,CDM,250,RC,,,Outpatient,,,336.76,168.38,,259.31,77,,,Percent of Total Billed Charges,77% of total billed charges,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.2,74,,,Percent of Total Billed Charges,74% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,282.88,84,,,Percent of Total Billed Charges,84% of total billed charges,276.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.72,89,,,Percent of total Billed Charges,89% of total Billed charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.31,77,,,Percent of total Billed charges,77% of total billed charges,286.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.19,299.72,
OLANZapine 10mg SDV,2759701,CDM,250,RC,,,Outpatient,,,336.76,168.38,,259.31,77,,,Percent of Total Billed Charges,77% of total billed charges,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,85.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,105.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,249.2,74,,,Percent of Total Billed Charges,74% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,232.36,69,,,Percent of Total Billed Charges,69% of total billed charges,282.88,84,,,Percent of Total Billed Charges,84% of total billed charges,276.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,299.72,89,,,Percent of total Billed Charges,89% of total Billed charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.31,77,,,Percent of total Billed charges,77% of total billed charges,286.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,96.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,168.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,137.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,299.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,84.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.19,299.72,
OLANZapine 5mg ODT Tablet,60505327503,CDM,250,RC,,,Outpatient,,,105.81,52.91,,81.47,77,,,Percent of Total Billed Charges,77% of total billed charges,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.3,74,,,Percent of Total Billed Charges,74% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,84,,,Percent of Total Billed Charges,84% of total billed charges,86.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.17,89,,,Percent of total Billed Charges,89% of total Billed charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.47,77,,,Percent of total Billed charges,77% of total billed charges,89.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.45,94.17,
OLANZapine 5mg ODT Tablet,60505327503,CDM,250,RC,,,Outpatient,,,105.81,52.91,,81.47,77,,,Percent of Total Billed Charges,77% of total billed charges,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.3,74,,,Percent of Total Billed Charges,74% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,84,,,Percent of Total Billed Charges,84% of total billed charges,86.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.17,89,,,Percent of total Billed Charges,89% of total Billed charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.47,77,,,Percent of total Billed charges,77% of total billed charges,89.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.45,94.17,
OLANZapine 5mg ODT Tablet,60505327503,CDM,250,RC,,,Outpatient,,,105.81,52.91,,81.47,77,,,Percent of Total Billed Charges,77% of total billed charges,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.3,74,,,Percent of Total Billed Charges,74% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,84,,,Percent of Total Billed Charges,84% of total billed charges,86.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.17,89,,,Percent of total Billed Charges,89% of total Billed charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.47,77,,,Percent of total Billed charges,77% of total billed charges,89.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.45,94.17,
OLANZapine 5mg ODT Tablet,60505327503,CDM,250,RC,,,Outpatient,,,105.81,52.91,,81.47,77,,,Percent of Total Billed Charges,77% of total billed charges,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.3,74,,,Percent of Total Billed Charges,74% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,84,,,Percent of Total Billed Charges,84% of total billed charges,86.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.17,89,,,Percent of total Billed Charges,89% of total Billed charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.47,77,,,Percent of total Billed charges,77% of total billed charges,89.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.45,94.17,
OLANZapine 5mg ODT Tablet,60505327503,CDM,250,RC,,,Outpatient,,,105.81,52.91,,81.47,77,,,Percent of Total Billed Charges,77% of total billed charges,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.3,74,,,Percent of Total Billed Charges,74% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,84,,,Percent of Total Billed Charges,84% of total billed charges,86.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.17,89,,,Percent of total Billed Charges,89% of total Billed charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.47,77,,,Percent of total Billed charges,77% of total billed charges,89.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.45,94.17,
OLANZapine 5mg ODT Tablet,60505327503,CDM,250,RC,,,Outpatient,,,105.81,52.91,,81.47,77,,,Percent of Total Billed Charges,77% of total billed charges,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,78.3,74,,,Percent of Total Billed Charges,74% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,73.01,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,84,,,Percent of Total Billed Charges,84% of total billed charges,86.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,94.17,89,,,Percent of total Billed Charges,89% of total Billed charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.47,77,,,Percent of total Billed charges,77% of total billed charges,89.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,52.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.45,94.17,
OLANZapine 5mg Tablet,904637761,CDM,250,RC,,,Outpatient,,,8.38,4.19,,6.45,77,,,Percent of Total Billed Charges,77% of total billed charges,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.2,74,,,Percent of Total Billed Charges,74% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,7.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.46,89,,,Percent of total Billed Charges,89% of total Billed charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,77,,,Percent of total Billed charges,77% of total billed charges,7.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.1,7.46,
OLANZapine 5mg Tablet,904637761,CDM,250,RC,,,Outpatient,,,8.38,4.19,,6.45,77,,,Percent of Total Billed Charges,77% of total billed charges,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.2,74,,,Percent of Total Billed Charges,74% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,7.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.46,89,,,Percent of total Billed Charges,89% of total Billed charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,77,,,Percent of total Billed charges,77% of total billed charges,7.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.1,7.46,
OLANZapine 5mg Tablet,904637761,CDM,250,RC,,,Outpatient,,,8.38,4.19,,6.45,77,,,Percent of Total Billed Charges,77% of total billed charges,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.2,74,,,Percent of Total Billed Charges,74% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,7.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.46,89,,,Percent of total Billed Charges,89% of total Billed charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,77,,,Percent of total Billed charges,77% of total billed charges,7.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.1,7.46,
OLANZapine 5mg Tablet,904637761,CDM,250,RC,,,Outpatient,,,8.38,4.19,,6.45,77,,,Percent of Total Billed Charges,77% of total billed charges,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.2,74,,,Percent of Total Billed Charges,74% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,7.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.46,89,,,Percent of total Billed Charges,89% of total Billed charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,77,,,Percent of total Billed charges,77% of total billed charges,7.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.1,7.46,
OLANZapine 5mg Tablet,904637761,CDM,250,RC,,,Outpatient,,,8.38,4.19,,6.45,77,,,Percent of Total Billed Charges,77% of total billed charges,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.2,74,,,Percent of Total Billed Charges,74% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,7.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.46,89,,,Percent of total Billed Charges,89% of total Billed charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,77,,,Percent of total Billed charges,77% of total billed charges,7.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.1,7.46,
OLANZapine 5mg Tablet,904637761,CDM,250,RC,,,Outpatient,,,8.38,4.19,,6.45,77,,,Percent of Total Billed Charges,77% of total billed charges,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.2,74,,,Percent of Total Billed Charges,74% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,5.78,69,,,Percent of Total Billed Charges,69% of total billed charges,7.04,84,,,Percent of Total Billed Charges,84% of total billed charges,6.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.46,89,,,Percent of total Billed Charges,89% of total Billed charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,77,,,Percent of total Billed charges,77% of total billed charges,7.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.1,7.46,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2045.15,1022.58,,1574.77,77,,,Percent of Total Billed Charges,77% of total billed charges,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1513.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1717.93,84,,,Percent of Total Billed Charges,84% of total billed charges,1677.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1820.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1574.77,77,,,Percent of total Billed charges,77% of total billed charges,1738.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,587.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1022.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,1820.18,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2128.7,1064.35,,1639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1575.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1788.11,84,,,Percent of Total Billed Charges,84% of total billed charges,1745.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1894.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1639.1,77,,,Percent of total Billed charges,77% of total billed charges,1809.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1064.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.18,1894.54,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2045.15,1022.58,,1574.77,77,,,Percent of Total Billed Charges,77% of total billed charges,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1513.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1717.93,84,,,Percent of Total Billed Charges,84% of total billed charges,1677.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1820.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1574.77,77,,,Percent of total Billed charges,77% of total billed charges,1738.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,587.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1022.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,1820.18,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2128.7,1064.35,,1639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1575.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1788.11,84,,,Percent of Total Billed Charges,84% of total billed charges,1745.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1894.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1639.1,77,,,Percent of total Billed charges,77% of total billed charges,1809.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1064.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.18,1894.54,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2045.15,1022.58,,1574.77,77,,,Percent of Total Billed Charges,77% of total billed charges,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1513.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1717.93,84,,,Percent of Total Billed Charges,84% of total billed charges,1677.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1820.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1574.77,77,,,Percent of total Billed charges,77% of total billed charges,1738.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,587.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1022.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,1820.18,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2128.7,1064.35,,1639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1575.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1788.11,84,,,Percent of Total Billed Charges,84% of total billed charges,1745.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1894.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1639.1,77,,,Percent of total Billed charges,77% of total billed charges,1809.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1064.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.18,1894.54,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2045.15,1022.58,,1574.77,77,,,Percent of Total Billed Charges,77% of total billed charges,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1513.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1717.93,84,,,Percent of Total Billed Charges,84% of total billed charges,1677.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1820.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1574.77,77,,,Percent of total Billed charges,77% of total billed charges,1738.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,587.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1022.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,1820.18,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2128.7,1064.35,,1639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1575.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1788.11,84,,,Percent of Total Billed Charges,84% of total billed charges,1745.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1894.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1639.1,77,,,Percent of total Billed charges,77% of total billed charges,1809.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1064.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.18,1894.54,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2045.15,1022.58,,1574.77,77,,,Percent of Total Billed Charges,77% of total billed charges,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1513.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1717.93,84,,,Percent of Total Billed Charges,84% of total billed charges,1677.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1820.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1574.77,77,,,Percent of total Billed charges,77% of total billed charges,1738.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,587.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1022.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,1820.18,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2128.7,1064.35,,1639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1575.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1788.11,84,,,Percent of Total Billed Charges,84% of total billed charges,1745.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1894.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1639.1,77,,,Percent of total Billed charges,77% of total billed charges,1809.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1064.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.18,1894.54,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2045.15,1022.58,,1574.77,77,,,Percent of Total Billed Charges,77% of total billed charges,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,521.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,639.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1513.41,74,,,Percent of Total Billed Charges,74% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1411.15,69,,,Percent of Total Billed Charges,69% of total billed charges,1717.93,84,,,Percent of Total Billed Charges,84% of total billed charges,1677.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,1820.18,89,,,Percent of total Billed Charges,89% of total Billed charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1574.77,77,,,Percent of total Billed charges,77% of total billed charges,1738.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,587.98,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1022.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,834.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1820.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,511.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,511.29,1820.18,
Omadacycline 100mg SDV,71715000102,CDM,250,RC,,,Outpatient,,,2128.7,1064.35,,1639.1,77,,,Percent of Total Billed Charges,77% of total billed charges,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,542.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,665.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1575.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1468.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1788.11,84,,,Percent of Total Billed Charges,84% of total billed charges,1745.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1894.54,89,,,Percent of total Billed Charges,89% of total Billed charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1639.1,77,,,Percent of total Billed charges,77% of total billed charges,1809.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,612,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1064.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,868.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1894.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,532.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,532.18,1894.54,
Omalizumab (Xolair) 150mg/ml Syringe,50242021501,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg/ml Syringe,50242021501,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg/ml Syringe,50242021501,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg/ml Syringe,50242021501,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg/ml Syringe,50242021501,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg/ml Syringe,50242021501,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg SDV,50242004062,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg SDV,50242004062,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg SDV,50242004062,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg SDV,50242004062,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg SDV,50242004062,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 150mg SDV,50242004062,CDM,250,RC,,,Outpatient,,,7070.8,3535.4,,5444.52,77,,,Percent of Total Billed Charges,77% of total billed charges,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1803.05,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2209.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5232.39,74,,,Percent of Total Billed Charges,74% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4878.85,69,,,Percent of Total Billed Charges,69% of total billed charges,5939.47,84,,,Percent of Total Billed Charges,84% of total billed charges,5798.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,6293.01,89,,,Percent of total Billed Charges,89% of total Billed charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5444.52,77,,,Percent of total Billed charges,77% of total billed charges,6010.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2032.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3535.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2884.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6293.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1767.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1767.7,6293.01,
Omalizumab (Xolair) 300mg/2ml Syringe,50242022701,CDM,250,RC,,,Outpatient,,,13641.61,6820.81,,10504.04,77,,,Percent of Total Billed Charges,77% of total billed charges,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4263,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10094.79,74,,,Percent of Total Billed Charges,74% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11458.95,84,,,Percent of Total Billed Charges,84% of total billed charges,11186.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,12141.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10504.04,77,,,Percent of total Billed charges,77% of total billed charges,11595.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3921.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6820.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3410.4,12141.03,
Omalizumab (Xolair) 300mg/2ml Syringe,50242022701,CDM,250,RC,,,Outpatient,,,13641.61,6820.81,,10504.04,77,,,Percent of Total Billed Charges,77% of total billed charges,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4263,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10094.79,74,,,Percent of Total Billed Charges,74% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11458.95,84,,,Percent of Total Billed Charges,84% of total billed charges,11186.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,12141.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10504.04,77,,,Percent of total Billed charges,77% of total billed charges,11595.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3921.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6820.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3410.4,12141.03,
Omalizumab (Xolair) 300mg/2ml Syringe,50242022701,CDM,250,RC,,,Outpatient,,,13641.61,6820.81,,10504.04,77,,,Percent of Total Billed Charges,77% of total billed charges,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4263,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10094.79,74,,,Percent of Total Billed Charges,74% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11458.95,84,,,Percent of Total Billed Charges,84% of total billed charges,11186.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,12141.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10504.04,77,,,Percent of total Billed charges,77% of total billed charges,11595.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3921.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6820.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3410.4,12141.03,
Omalizumab (Xolair) 300mg/2ml Syringe,50242022701,CDM,250,RC,,,Outpatient,,,13641.61,6820.81,,10504.04,77,,,Percent of Total Billed Charges,77% of total billed charges,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4263,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10094.79,74,,,Percent of Total Billed Charges,74% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11458.95,84,,,Percent of Total Billed Charges,84% of total billed charges,11186.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,12141.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10504.04,77,,,Percent of total Billed charges,77% of total billed charges,11595.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3921.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6820.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3410.4,12141.03,
Omalizumab (Xolair) 300mg/2ml Syringe,50242022701,CDM,250,RC,,,Outpatient,,,13641.61,6820.81,,10504.04,77,,,Percent of Total Billed Charges,77% of total billed charges,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4263,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10094.79,74,,,Percent of Total Billed Charges,74% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11458.95,84,,,Percent of Total Billed Charges,84% of total billed charges,11186.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,12141.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10504.04,77,,,Percent of total Billed charges,77% of total billed charges,11595.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3921.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6820.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3410.4,12141.03,
Omalizumab (Xolair) 300mg/2ml Syringe,50242022701,CDM,250,RC,,,Outpatient,,,13641.61,6820.81,,10504.04,77,,,Percent of Total Billed Charges,77% of total billed charges,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3478.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4263,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10094.79,74,,,Percent of Total Billed Charges,74% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,9412.71,69,,,Percent of Total Billed Charges,69% of total billed charges,11458.95,84,,,Percent of Total Billed Charges,84% of total billed charges,11186.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,12141.03,89,,,Percent of total Billed Charges,89% of total Billed charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10504.04,77,,,Percent of total Billed charges,77% of total billed charges,11595.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3921.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6820.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5565.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12141.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3410.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3410.4,12141.03,
Omalizumab (Xolair) 75mg/0.5ml Syringe,50242021401,CDM,250,RC,,,Outpatient,,,3785.4,1892.7,,2914.76,77,,,Percent of Total Billed Charges,77% of total billed charges,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1182.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2801.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3179.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3104.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,3369.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2914.76,77,,,Percent of total Billed charges,77% of total billed charges,3217.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1088.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1892.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.35,3369.01,
Omalizumab (Xolair) 75mg/0.5ml Syringe,50242021401,CDM,250,RC,,,Outpatient,,,3785.4,1892.7,,2914.76,77,,,Percent of Total Billed Charges,77% of total billed charges,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1182.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2801.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3179.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3104.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,3369.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2914.76,77,,,Percent of total Billed charges,77% of total billed charges,3217.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1088.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1892.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.35,3369.01,
Omalizumab (Xolair) 75mg/0.5ml Syringe,50242021401,CDM,250,RC,,,Outpatient,,,3785.4,1892.7,,2914.76,77,,,Percent of Total Billed Charges,77% of total billed charges,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1182.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2801.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3179.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3104.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,3369.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2914.76,77,,,Percent of total Billed charges,77% of total billed charges,3217.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1088.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1892.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.35,3369.01,
Omalizumab (Xolair) 75mg/0.5ml Syringe,50242021401,CDM,250,RC,,,Outpatient,,,3785.4,1892.7,,2914.76,77,,,Percent of Total Billed Charges,77% of total billed charges,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1182.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2801.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3179.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3104.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,3369.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2914.76,77,,,Percent of total Billed charges,77% of total billed charges,3217.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1088.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1892.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.35,3369.01,
Omalizumab (Xolair) 75mg/0.5ml Syringe,50242021401,CDM,250,RC,,,Outpatient,,,3785.4,1892.7,,2914.76,77,,,Percent of Total Billed Charges,77% of total billed charges,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1182.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2801.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3179.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3104.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,3369.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2914.76,77,,,Percent of total Billed charges,77% of total billed charges,3217.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1088.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1892.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.35,3369.01,
Omalizumab (Xolair) 75mg/0.5ml Syringe,50242021401,CDM,250,RC,,,Outpatient,,,3785.4,1892.7,,2914.76,77,,,Percent of Total Billed Charges,77% of total billed charges,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,965.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1182.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2801.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2611.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3179.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3104.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,3369.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2914.76,77,,,Percent of total Billed charges,77% of total billed charges,3217.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1088.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1892.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1544.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3369.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,946.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,946.35,3369.01,
Fish Oil 1000mg Capsule,904723860,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fish Oil 1000mg Capsule,904723860,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fish Oil 1000mg Capsule,904723860,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fish Oil 1000mg Capsule,904723860,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fish Oil 1000mg Capsule,904723860,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Fish Oil 1000mg Capsule,904723860,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Omeprazole 20mg Capsule,68084012801,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Omeprazole 20mg Capsule,68084012801,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Omeprazole 20mg Capsule,68084012801,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Omeprazole 20mg Capsule,68084012801,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Omeprazole 20mg Capsule,68084012801,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Omeprazole 20mg Capsule,68084012801,CDM,250,RC,,,Outpatient,,,15.42,7.71,,11.87,77,,,Percent of Total Billed Charges,77% of total billed charges,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.41,74,,,Percent of Total Billed Charges,74% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.64,69,,,Percent of Total Billed Charges,69% of total billed charges,12.95,84,,,Percent of Total Billed Charges,84% of total billed charges,12.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.72,89,,,Percent of total Billed Charges,89% of total Billed charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.87,77,,,Percent of total Billed charges,77% of total billed charges,13.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.72,
Onabotulinumtoxina 100unit SDV,23114501,CDM,250,RC,,,Outpatient,,,2917.54,1458.77,,2246.51,77,,,Percent of Total Billed Charges,77% of total billed charges,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.98,74,,,Percent of Total Billed Charges,74% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2450.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2392.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,2596.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2246.51,77,,,Percent of total Billed charges,77% of total billed charges,2479.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.39,2596.61,
Onabotulinumtoxina 100unit SDV,23114501,CDM,250,RC,,,Outpatient,,,2917.54,1458.77,,2246.51,77,,,Percent of Total Billed Charges,77% of total billed charges,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.98,74,,,Percent of Total Billed Charges,74% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2450.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2392.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,2596.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2246.51,77,,,Percent of total Billed charges,77% of total billed charges,2479.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.39,2596.61,
Onabotulinumtoxina 100unit SDV,23114501,CDM,250,RC,,,Outpatient,,,2917.54,1458.77,,2246.51,77,,,Percent of Total Billed Charges,77% of total billed charges,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.98,74,,,Percent of Total Billed Charges,74% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2450.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2392.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,2596.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2246.51,77,,,Percent of total Billed charges,77% of total billed charges,2479.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.39,2596.61,
Onabotulinumtoxina 100unit SDV,23114501,CDM,250,RC,,,Outpatient,,,2917.54,1458.77,,2246.51,77,,,Percent of Total Billed Charges,77% of total billed charges,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.98,74,,,Percent of Total Billed Charges,74% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2450.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2392.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,2596.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2246.51,77,,,Percent of total Billed charges,77% of total billed charges,2479.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.39,2596.61,
Onabotulinumtoxina 100unit SDV,23114501,CDM,250,RC,,,Outpatient,,,2917.54,1458.77,,2246.51,77,,,Percent of Total Billed Charges,77% of total billed charges,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.98,74,,,Percent of Total Billed Charges,74% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2450.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2392.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,2596.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2246.51,77,,,Percent of total Billed charges,77% of total billed charges,2479.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.39,2596.61,
Onabotulinumtoxina 100unit SDV,23114501,CDM,250,RC,,,Outpatient,,,2917.54,1458.77,,2246.51,77,,,Percent of Total Billed Charges,77% of total billed charges,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.98,74,,,Percent of Total Billed Charges,74% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2013.1,69,,,Percent of Total Billed Charges,69% of total billed charges,2450.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2392.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,2596.61,89,,,Percent of total Billed Charges,89% of total Billed charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2246.51,77,,,Percent of total Billed charges,77% of total billed charges,2479.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1190.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2596.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.39,2596.61,
Ondansetron 4mg ODT,68462015713,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ondansetron 4mg ODT,68462015713,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ondansetron 4mg ODT,68462015713,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ondansetron 4mg ODT,68462015713,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ondansetron 4mg ODT,68462015713,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ondansetron 4mg ODT,68462015713,CDM,250,RC,,,Outpatient,,,168.26,84.13,,129.56,77,,,Percent of Total Billed Charges,77% of total billed charges,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.51,74,,,Percent of Total Billed Charges,74% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,116.1,69,,,Percent of Total Billed Charges,69% of total billed charges,141.34,84,,,Percent of Total Billed Charges,84% of total billed charges,137.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.75,89,,,Percent of total Billed Charges,89% of total Billed charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.56,77,,,Percent of total Billed charges,77% of total billed charges,143.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.07,149.75,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 4mg/2ml SDV,409475503,CDM,250,RC,,,Outpatient,,,50.53,25.27,,38.91,77,,,Percent of Total Billed Charges,77% of total billed charges,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.89,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,37.39,74,,,Percent of Total Billed Charges,74% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,69,,,Percent of Total Billed Charges,69% of total billed charges,42.45,84,,,Percent of Total Billed Charges,84% of total billed charges,41.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,44.97,89,,,Percent of total Billed Charges,89% of total Billed charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.91,77,,,Percent of total Billed charges,77% of total billed charges,42.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.63,44.97,
Ondansetron 8mg Tablet,904655261,CDM,250,RC,,,Outpatient,,,10.91,5.46,,8.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.07,74,,,Percent of Total Billed Charges,74% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.71,89,,,Percent of total Billed Charges,89% of total Billed charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.4,77,,,Percent of total Billed charges,77% of total billed charges,9.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.73,9.71,
Ondansetron 8mg Tablet,904655261,CDM,250,RC,,,Outpatient,,,10.91,5.46,,8.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.07,74,,,Percent of Total Billed Charges,74% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.71,89,,,Percent of total Billed Charges,89% of total Billed charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.4,77,,,Percent of total Billed charges,77% of total billed charges,9.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.73,9.71,
Ondansetron 8mg Tablet,904655261,CDM,250,RC,,,Outpatient,,,10.91,5.46,,8.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.07,74,,,Percent of Total Billed Charges,74% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.71,89,,,Percent of total Billed Charges,89% of total Billed charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.4,77,,,Percent of total Billed charges,77% of total billed charges,9.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.73,9.71,
Ondansetron 8mg Tablet,904655261,CDM,250,RC,,,Outpatient,,,10.91,5.46,,8.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.07,74,,,Percent of Total Billed Charges,74% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.71,89,,,Percent of total Billed Charges,89% of total Billed charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.4,77,,,Percent of total Billed charges,77% of total billed charges,9.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.73,9.71,
Ondansetron 8mg Tablet,904655261,CDM,250,RC,,,Outpatient,,,10.91,5.46,,8.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.07,74,,,Percent of Total Billed Charges,74% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.71,89,,,Percent of total Billed Charges,89% of total Billed charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.4,77,,,Percent of total Billed charges,77% of total billed charges,9.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.73,9.71,
Ondansetron 8mg Tablet,904655261,CDM,250,RC,,,Outpatient,,,10.91,5.46,,8.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.07,74,,,Percent of Total Billed Charges,74% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,7.53,69,,,Percent of Total Billed Charges,69% of total billed charges,9.16,84,,,Percent of Total Billed Charges,84% of total billed charges,8.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.71,89,,,Percent of total Billed Charges,89% of total Billed charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.4,77,,,Percent of total Billed charges,77% of total billed charges,9.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.73,9.71,
Orphenadrine 60mg/2ml SDV,641618210,CDM,250,RC,,,Outpatient,,,168.3,84.15,,129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.54,74,,,Percent of Total Billed Charges,74% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,141.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.79,89,,,Percent of total Billed Charges,89% of total Billed charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.59,77,,,Percent of total Billed charges,77% of total billed charges,143.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.08,149.79,
Orphenadrine 60mg/2ml SDV,641618210,CDM,250,RC,,,Outpatient,,,168.3,84.15,,129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.54,74,,,Percent of Total Billed Charges,74% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,141.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.79,89,,,Percent of total Billed Charges,89% of total Billed charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.59,77,,,Percent of total Billed charges,77% of total billed charges,143.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.08,149.79,
Orphenadrine 60mg/2ml SDV,641618210,CDM,250,RC,,,Outpatient,,,168.3,84.15,,129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.54,74,,,Percent of Total Billed Charges,74% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,141.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.79,89,,,Percent of total Billed Charges,89% of total Billed charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.59,77,,,Percent of total Billed charges,77% of total billed charges,143.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.08,149.79,
Orphenadrine 60mg/2ml SDV,641618210,CDM,250,RC,,,Outpatient,,,168.3,84.15,,129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.54,74,,,Percent of Total Billed Charges,74% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,141.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.79,89,,,Percent of total Billed Charges,89% of total Billed charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.59,77,,,Percent of total Billed charges,77% of total billed charges,143.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.08,149.79,
Orphenadrine 60mg/2ml SDV,641618210,CDM,250,RC,,,Outpatient,,,168.3,84.15,,129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.54,74,,,Percent of Total Billed Charges,74% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,141.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.79,89,,,Percent of total Billed Charges,89% of total Billed charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.59,77,,,Percent of total Billed charges,77% of total billed charges,143.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.08,149.79,
Orphenadrine 60mg/2ml SDV,641618210,CDM,250,RC,,,Outpatient,,,168.3,84.15,,129.59,77,,,Percent of Total Billed Charges,77% of total billed charges,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.54,74,,,Percent of Total Billed Charges,74% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,116.13,69,,,Percent of Total Billed Charges,69% of total billed charges,141.37,84,,,Percent of Total Billed Charges,84% of total billed charges,138.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.79,89,,,Percent of total Billed Charges,89% of total Billed charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.59,77,,,Percent of total Billed charges,77% of total billed charges,143.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.08,149.79,
Oseltamivir 30mg Capsule,4080285,CDM,250,RC,,,Outpatient,,,103.41,51.71,,79.63,77,,,Percent of Total Billed Charges,77% of total billed charges,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.52,74,,,Percent of Total Billed Charges,74% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,86.86,84,,,Percent of Total Billed Charges,84% of total billed charges,84.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.03,89,,,Percent of total Billed Charges,89% of total Billed charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.63,77,,,Percent of total Billed charges,77% of total billed charges,87.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.85,92.03,
Oseltamivir 30mg Capsule,4080285,CDM,250,RC,,,Outpatient,,,103.41,51.71,,79.63,77,,,Percent of Total Billed Charges,77% of total billed charges,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.52,74,,,Percent of Total Billed Charges,74% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,86.86,84,,,Percent of Total Billed Charges,84% of total billed charges,84.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.03,89,,,Percent of total Billed Charges,89% of total Billed charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.63,77,,,Percent of total Billed charges,77% of total billed charges,87.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.85,92.03,
Oseltamivir 30mg Capsule,4080285,CDM,250,RC,,,Outpatient,,,103.41,51.71,,79.63,77,,,Percent of Total Billed Charges,77% of total billed charges,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.52,74,,,Percent of Total Billed Charges,74% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,86.86,84,,,Percent of Total Billed Charges,84% of total billed charges,84.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.03,89,,,Percent of total Billed Charges,89% of total Billed charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.63,77,,,Percent of total Billed charges,77% of total billed charges,87.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.85,92.03,
Oseltamivir 30mg Capsule,4080285,CDM,250,RC,,,Outpatient,,,103.41,51.71,,79.63,77,,,Percent of Total Billed Charges,77% of total billed charges,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.52,74,,,Percent of Total Billed Charges,74% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,86.86,84,,,Percent of Total Billed Charges,84% of total billed charges,84.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.03,89,,,Percent of total Billed Charges,89% of total Billed charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.63,77,,,Percent of total Billed charges,77% of total billed charges,87.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.85,92.03,
Oseltamivir 30mg Capsule,4080285,CDM,250,RC,,,Outpatient,,,103.41,51.71,,79.63,77,,,Percent of Total Billed Charges,77% of total billed charges,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.52,74,,,Percent of Total Billed Charges,74% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,86.86,84,,,Percent of Total Billed Charges,84% of total billed charges,84.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.03,89,,,Percent of total Billed Charges,89% of total Billed charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.63,77,,,Percent of total Billed charges,77% of total billed charges,87.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.85,92.03,
Oseltamivir 30mg Capsule,4080285,CDM,250,RC,,,Outpatient,,,103.41,51.71,,79.63,77,,,Percent of Total Billed Charges,77% of total billed charges,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,76.52,74,,,Percent of Total Billed Charges,74% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,71.35,69,,,Percent of Total Billed Charges,69% of total billed charges,86.86,84,,,Percent of Total Billed Charges,84% of total billed charges,84.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,92.03,89,,,Percent of total Billed Charges,89% of total Billed charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.63,77,,,Percent of total Billed charges,77% of total billed charges,87.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,51.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,42.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.85,92.03,
Oseltamivir Oral Susp 6mg/ml 60ml,4082205,CDM,250,RC,,,Outpatient,,,528.26,264.13,,406.76,77,,,Percent of Total Billed Charges,77% of total billed charges,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,390.91,74,,,Percent of Total Billed Charges,74% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,443.74,84,,,Percent of Total Billed Charges,84% of total billed charges,433.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.15,89,,,Percent of total Billed Charges,89% of total Billed charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.76,77,,,Percent of total Billed charges,77% of total billed charges,449.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.07,470.15,
Oseltamivir Oral Susp 6mg/ml 60ml,4082205,CDM,250,RC,,,Outpatient,,,528.26,264.13,,406.76,77,,,Percent of Total Billed Charges,77% of total billed charges,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,390.91,74,,,Percent of Total Billed Charges,74% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,443.74,84,,,Percent of Total Billed Charges,84% of total billed charges,433.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.15,89,,,Percent of total Billed Charges,89% of total Billed charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.76,77,,,Percent of total Billed charges,77% of total billed charges,449.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.07,470.15,
Oseltamivir Oral Susp 6mg/ml 60ml,4082205,CDM,250,RC,,,Outpatient,,,528.26,264.13,,406.76,77,,,Percent of Total Billed Charges,77% of total billed charges,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,390.91,74,,,Percent of Total Billed Charges,74% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,443.74,84,,,Percent of Total Billed Charges,84% of total billed charges,433.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.15,89,,,Percent of total Billed Charges,89% of total Billed charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.76,77,,,Percent of total Billed charges,77% of total billed charges,449.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.07,470.15,
Oseltamivir Oral Susp 6mg/ml 60ml,4082205,CDM,250,RC,,,Outpatient,,,528.26,264.13,,406.76,77,,,Percent of Total Billed Charges,77% of total billed charges,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,390.91,74,,,Percent of Total Billed Charges,74% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,443.74,84,,,Percent of Total Billed Charges,84% of total billed charges,433.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.15,89,,,Percent of total Billed Charges,89% of total Billed charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.76,77,,,Percent of total Billed charges,77% of total billed charges,449.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.07,470.15,
Oseltamivir Oral Susp 6mg/ml 60ml,4082205,CDM,250,RC,,,Outpatient,,,528.26,264.13,,406.76,77,,,Percent of Total Billed Charges,77% of total billed charges,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,390.91,74,,,Percent of Total Billed Charges,74% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,443.74,84,,,Percent of Total Billed Charges,84% of total billed charges,433.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.15,89,,,Percent of total Billed Charges,89% of total Billed charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.76,77,,,Percent of total Billed charges,77% of total billed charges,449.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.07,470.15,
Oseltamivir Oral Susp 6mg/ml 60ml,4082205,CDM,250,RC,,,Outpatient,,,528.26,264.13,,406.76,77,,,Percent of Total Billed Charges,77% of total billed charges,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,165.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,390.91,74,,,Percent of Total Billed Charges,74% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,364.5,69,,,Percent of Total Billed Charges,69% of total billed charges,443.74,84,,,Percent of Total Billed Charges,84% of total billed charges,433.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,470.15,89,,,Percent of total Billed Charges,89% of total Billed charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,406.76,77,,,Percent of total Billed charges,77% of total billed charges,449.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,151.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,264.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,215.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,470.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,132.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.07,470.15,
Oseltamivir 75mg Capsule,4080085,CDM,250,RC,,,Outpatient,,,112.31,56.16,,86.48,77,,,Percent of Total Billed Charges,77% of total billed charges,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.11,74,,,Percent of Total Billed Charges,74% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,84,,,Percent of Total Billed Charges,84% of total billed charges,92.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.96,89,,,Percent of total Billed Charges,89% of total Billed charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.48,77,,,Percent of total Billed charges,77% of total billed charges,95.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.08,99.96,
Oseltamivir 75mg Capsule,4080085,CDM,250,RC,,,Outpatient,,,112.31,56.16,,86.48,77,,,Percent of Total Billed Charges,77% of total billed charges,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.11,74,,,Percent of Total Billed Charges,74% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,84,,,Percent of Total Billed Charges,84% of total billed charges,92.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.96,89,,,Percent of total Billed Charges,89% of total Billed charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.48,77,,,Percent of total Billed charges,77% of total billed charges,95.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.08,99.96,
Oseltamivir 75mg Capsule,4080085,CDM,250,RC,,,Outpatient,,,112.31,56.16,,86.48,77,,,Percent of Total Billed Charges,77% of total billed charges,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.11,74,,,Percent of Total Billed Charges,74% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,84,,,Percent of Total Billed Charges,84% of total billed charges,92.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.96,89,,,Percent of total Billed Charges,89% of total Billed charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.48,77,,,Percent of total Billed charges,77% of total billed charges,95.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.08,99.96,
Oseltamivir 75mg Capsule,4080085,CDM,250,RC,,,Outpatient,,,112.31,56.16,,86.48,77,,,Percent of Total Billed Charges,77% of total billed charges,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.11,74,,,Percent of Total Billed Charges,74% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,84,,,Percent of Total Billed Charges,84% of total billed charges,92.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.96,89,,,Percent of total Billed Charges,89% of total Billed charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.48,77,,,Percent of total Billed charges,77% of total billed charges,95.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.08,99.96,
Oseltamivir 75mg Capsule,4080085,CDM,250,RC,,,Outpatient,,,112.31,56.16,,86.48,77,,,Percent of Total Billed Charges,77% of total billed charges,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.11,74,,,Percent of Total Billed Charges,74% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,84,,,Percent of Total Billed Charges,84% of total billed charges,92.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.96,89,,,Percent of total Billed Charges,89% of total Billed charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.48,77,,,Percent of total Billed charges,77% of total billed charges,95.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.08,99.96,
Oseltamivir 75mg Capsule,4080085,CDM,250,RC,,,Outpatient,,,112.31,56.16,,86.48,77,,,Percent of Total Billed Charges,77% of total billed charges,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,83.11,74,,,Percent of Total Billed Charges,74% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,77.49,69,,,Percent of Total Billed Charges,69% of total billed charges,94.34,84,,,Percent of Total Billed Charges,84% of total billed charges,92.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.96,89,,,Percent of total Billed Charges,89% of total Billed charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.48,77,,,Percent of total Billed charges,77% of total billed charges,95.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.08,99.96,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxacillin 2gm SDV,55150012824,CDM,250,RC,,,Outpatient,,,223.38,111.69,,172,77,,,Percent of Total Billed Charges,77% of total billed charges,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.3,74,,,Percent of Total Billed Charges,74% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,154.13,69,,,Percent of Total Billed Charges,69% of total billed charges,187.64,84,,,Percent of Total Billed Charges,84% of total billed charges,183.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,198.81,89,,,Percent of total Billed Charges,89% of total Billed charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172,77,,,Percent of total Billed charges,77% of total billed charges,189.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,111.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,198.81,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.85,198.81,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3611.68,1805.84,,2780.99,77,,,Percent of Total Billed Charges,77% of total billed charges,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1128.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3033.81,84,,,Percent of Total Billed Charges,84% of total billed charges,2961.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,3214.4,89,,,Percent of total Billed Charges,89% of total Billed charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2780.99,77,,,Percent of total Billed charges,77% of total billed charges,3069.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1038.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1805.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902.92,3214.4,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3522.14,1761.07,,2712.05,77,,,Percent of Total Billed Charges,77% of total billed charges,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1100.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2606.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2958.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2888.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3134.7,89,,,Percent of total Billed Charges,89% of total Billed charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2712.05,77,,,Percent of total Billed charges,77% of total billed charges,2993.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1012.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1761.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.54,3134.7,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3611.68,1805.84,,2780.99,77,,,Percent of Total Billed Charges,77% of total billed charges,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1128.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3033.81,84,,,Percent of Total Billed Charges,84% of total billed charges,2961.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,3214.4,89,,,Percent of total Billed Charges,89% of total Billed charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2780.99,77,,,Percent of total Billed charges,77% of total billed charges,3069.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1038.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1805.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902.92,3214.4,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3522.14,1761.07,,2712.05,77,,,Percent of Total Billed Charges,77% of total billed charges,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1100.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2606.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2958.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2888.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3134.7,89,,,Percent of total Billed Charges,89% of total Billed charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2712.05,77,,,Percent of total Billed charges,77% of total billed charges,2993.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1012.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1761.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.54,3134.7,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3611.68,1805.84,,2780.99,77,,,Percent of Total Billed Charges,77% of total billed charges,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1128.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3033.81,84,,,Percent of Total Billed Charges,84% of total billed charges,2961.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,3214.4,89,,,Percent of total Billed Charges,89% of total Billed charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2780.99,77,,,Percent of total Billed charges,77% of total billed charges,3069.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1038.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1805.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902.92,3214.4,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3522.14,1761.07,,2712.05,77,,,Percent of Total Billed Charges,77% of total billed charges,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1100.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2606.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2958.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2888.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3134.7,89,,,Percent of total Billed Charges,89% of total Billed charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2712.05,77,,,Percent of total Billed charges,77% of total billed charges,2993.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1012.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1761.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.54,3134.7,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3611.68,1805.84,,2780.99,77,,,Percent of Total Billed Charges,77% of total billed charges,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1128.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3033.81,84,,,Percent of Total Billed Charges,84% of total billed charges,2961.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,3214.4,89,,,Percent of total Billed Charges,89% of total Billed charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2780.99,77,,,Percent of total Billed charges,77% of total billed charges,3069.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1038.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1805.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902.92,3214.4,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3522.14,1761.07,,2712.05,77,,,Percent of Total Billed Charges,77% of total billed charges,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1100.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2606.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2958.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2888.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3134.7,89,,,Percent of total Billed Charges,89% of total Billed charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2712.05,77,,,Percent of total Billed charges,77% of total billed charges,2993.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1012.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1761.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.54,3134.7,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3611.68,1805.84,,2780.99,77,,,Percent of Total Billed Charges,77% of total billed charges,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1128.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3033.81,84,,,Percent of Total Billed Charges,84% of total billed charges,2961.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,3214.4,89,,,Percent of total Billed Charges,89% of total Billed charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2780.99,77,,,Percent of total Billed charges,77% of total billed charges,3069.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1038.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1805.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902.92,3214.4,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3522.14,1761.07,,2712.05,77,,,Percent of Total Billed Charges,77% of total billed charges,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1100.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2606.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2958.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2888.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3134.7,89,,,Percent of total Billed Charges,89% of total Billed charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2712.05,77,,,Percent of total Billed charges,77% of total billed charges,2993.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1012.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1761.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.54,3134.7,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3611.68,1805.84,,2780.99,77,,,Percent of Total Billed Charges,77% of total billed charges,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,920.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1128.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2672.64,74,,,Percent of Total Billed Charges,74% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,2492.06,69,,,Percent of Total Billed Charges,69% of total billed charges,3033.81,84,,,Percent of Total Billed Charges,84% of total billed charges,2961.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,3214.4,89,,,Percent of total Billed Charges,89% of total Billed charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2780.99,77,,,Percent of total Billed charges,77% of total billed charges,3069.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1038.36,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1805.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1473.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3214.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,902.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,902.92,3214.4,
Oxaliplatin 100mg/20ml Liquid SDV,61703036322,CDM,250,RC,,,Outpatient,,,3522.14,1761.07,,2712.05,77,,,Percent of Total Billed Charges,77% of total billed charges,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,898.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1100.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2606.38,74,,,Percent of Total Billed Charges,74% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2430.28,69,,,Percent of Total Billed Charges,69% of total billed charges,2958.6,84,,,Percent of Total Billed Charges,84% of total billed charges,2888.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3134.7,89,,,Percent of total Billed Charges,89% of total Billed charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2712.05,77,,,Percent of total Billed charges,77% of total billed charges,2993.82,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1012.62,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1761.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1437.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3134.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,880.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,880.54,3134.7,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5221.39,2610.7,,4020.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1631.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3863.83,74,,,Percent of Total Billed Charges,74% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4385.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4281.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,4647.04,89,,,Percent of total Billed Charges,89% of total Billed charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4020.47,77,,,Percent of total Billed charges,77% of total billed charges,4438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1501.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2610.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1305.35,4647.04,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5090.22,2545.11,,3919.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3766.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,4275.78,84,,,Percent of Total Billed Charges,84% of total billed charges,4173.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4530.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3919.47,77,,,Percent of total Billed charges,77% of total billed charges,4326.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1463.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2545.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272.56,4530.3,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5221.39,2610.7,,4020.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1631.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3863.83,74,,,Percent of Total Billed Charges,74% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4385.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4281.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,4647.04,89,,,Percent of total Billed Charges,89% of total Billed charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4020.47,77,,,Percent of total Billed charges,77% of total billed charges,4438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1501.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2610.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1305.35,4647.04,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5090.22,2545.11,,3919.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3766.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,4275.78,84,,,Percent of Total Billed Charges,84% of total billed charges,4173.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4530.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3919.47,77,,,Percent of total Billed charges,77% of total billed charges,4326.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1463.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2545.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272.56,4530.3,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5221.39,2610.7,,4020.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1631.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3863.83,74,,,Percent of Total Billed Charges,74% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4385.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4281.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,4647.04,89,,,Percent of total Billed Charges,89% of total Billed charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4020.47,77,,,Percent of total Billed charges,77% of total billed charges,4438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1501.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2610.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1305.35,4647.04,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5090.22,2545.11,,3919.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3766.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,4275.78,84,,,Percent of Total Billed Charges,84% of total billed charges,4173.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4530.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3919.47,77,,,Percent of total Billed charges,77% of total billed charges,4326.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1463.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2545.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272.56,4530.3,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5221.39,2610.7,,4020.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1631.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3863.83,74,,,Percent of Total Billed Charges,74% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4385.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4281.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,4647.04,89,,,Percent of total Billed Charges,89% of total Billed charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4020.47,77,,,Percent of total Billed charges,77% of total billed charges,4438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1501.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2610.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1305.35,4647.04,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5090.22,2545.11,,3919.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3766.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,4275.78,84,,,Percent of Total Billed Charges,84% of total billed charges,4173.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4530.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3919.47,77,,,Percent of total Billed charges,77% of total billed charges,4326.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1463.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2545.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272.56,4530.3,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5221.39,2610.7,,4020.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1631.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3863.83,74,,,Percent of Total Billed Charges,74% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4385.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4281.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,4647.04,89,,,Percent of total Billed Charges,89% of total Billed charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4020.47,77,,,Percent of total Billed charges,77% of total billed charges,4438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1501.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2610.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1305.35,4647.04,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5090.22,2545.11,,3919.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3766.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,4275.78,84,,,Percent of Total Billed Charges,84% of total billed charges,4173.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4530.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3919.47,77,,,Percent of total Billed charges,77% of total billed charges,4326.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1463.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2545.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272.56,4530.3,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5221.39,2610.7,,4020.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1331.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1631.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3863.83,74,,,Percent of Total Billed Charges,74% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3602.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4385.97,84,,,Percent of Total Billed Charges,84% of total billed charges,4281.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,4647.04,89,,,Percent of total Billed Charges,89% of total Billed charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4020.47,77,,,Percent of total Billed charges,77% of total billed charges,4438.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1501.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2610.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2130.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4647.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1305.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1305.35,4647.04,
Oxaliplatin 50mg/10ml Liquid SDV,61703036318,CDM,250,RC,,,Outpatient,,,5090.22,2545.11,,3919.47,77,,,Percent of Total Billed Charges,77% of total billed charges,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1298.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1590.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3766.76,74,,,Percent of Total Billed Charges,74% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3512.25,69,,,Percent of Total Billed Charges,69% of total billed charges,4275.78,84,,,Percent of Total Billed Charges,84% of total billed charges,4173.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,4530.3,89,,,Percent of total Billed Charges,89% of total Billed charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3919.47,77,,,Percent of total Billed charges,77% of total billed charges,4326.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1463.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2545.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2076.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4530.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1272.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1272.56,4530.3,
OXcarbazepine 150mg Tablet,51991029201,CDM,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
OXcarbazepine 150mg Tablet,51991029201,CDM,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
OXcarbazepine 150mg Tablet,51991029201,CDM,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
OXcarbazepine 150mg Tablet,51991029201,CDM,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
OXcarbazepine 150mg Tablet,51991029201,CDM,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
OXcarbazepine 150mg Tablet,51991029201,CDM,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
oxyBUTYnin IR 5mg Tablet,832003801,CDM,250,RC,,,Outpatient,,,11.19,5.6,,8.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.28,74,,,Percent of Total Billed Charges,74% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,9.4,84,,,Percent of Total Billed Charges,84% of total billed charges,9.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.96,89,,,Percent of total Billed Charges,89% of total Billed charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,77,,,Percent of total Billed charges,77% of total billed charges,9.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.8,9.96,
oxyBUTYnin IR 5mg Tablet,832003801,CDM,250,RC,,,Outpatient,,,11.19,5.6,,8.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.28,74,,,Percent of Total Billed Charges,74% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,9.4,84,,,Percent of Total Billed Charges,84% of total billed charges,9.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.96,89,,,Percent of total Billed Charges,89% of total Billed charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,77,,,Percent of total Billed charges,77% of total billed charges,9.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.8,9.96,
oxyBUTYnin IR 5mg Tablet,832003801,CDM,250,RC,,,Outpatient,,,11.19,5.6,,8.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.28,74,,,Percent of Total Billed Charges,74% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,9.4,84,,,Percent of Total Billed Charges,84% of total billed charges,9.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.96,89,,,Percent of total Billed Charges,89% of total Billed charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,77,,,Percent of total Billed charges,77% of total billed charges,9.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.8,9.96,
oxyBUTYnin IR 5mg Tablet,832003801,CDM,250,RC,,,Outpatient,,,11.19,5.6,,8.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.28,74,,,Percent of Total Billed Charges,74% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,9.4,84,,,Percent of Total Billed Charges,84% of total billed charges,9.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.96,89,,,Percent of total Billed Charges,89% of total Billed charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,77,,,Percent of total Billed charges,77% of total billed charges,9.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.8,9.96,
oxyBUTYnin IR 5mg Tablet,832003801,CDM,250,RC,,,Outpatient,,,11.19,5.6,,8.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.28,74,,,Percent of Total Billed Charges,74% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,9.4,84,,,Percent of Total Billed Charges,84% of total billed charges,9.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.96,89,,,Percent of total Billed Charges,89% of total Billed charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,77,,,Percent of total Billed charges,77% of total billed charges,9.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.8,9.96,
oxyBUTYnin IR 5mg Tablet,832003801,CDM,250,RC,,,Outpatient,,,11.19,5.6,,8.62,77,,,Percent of Total Billed Charges,77% of total billed charges,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.28,74,,,Percent of Total Billed Charges,74% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,7.72,69,,,Percent of Total Billed Charges,69% of total billed charges,9.4,84,,,Percent of Total Billed Charges,84% of total billed charges,9.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.96,89,,,Percent of total Billed Charges,89% of total Billed charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,77,,,Percent of total Billed charges,77% of total billed charges,9.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.6,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.8,9.96,
OxyBUTYnin XL 5mg Tablet,,,250,RC,,,Outpatient,,,31.28,15.64,,24.09,77,,,Percent of Total Billed Charges,77% of total billed charges,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.15,74,,,Percent of Total Billed Charges,74% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,26.28,84,,,Percent of Total Billed Charges,84% of total billed charges,25.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.84,89,,,Percent of total Billed Charges,89% of total Billed charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.09,77,,,Percent of total Billed charges,77% of total billed charges,26.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,27.84,
OxyBUTYnin XL 5mg Tablet,,,250,RC,,,Outpatient,,,31.28,15.64,,24.09,77,,,Percent of Total Billed Charges,77% of total billed charges,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.15,74,,,Percent of Total Billed Charges,74% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,26.28,84,,,Percent of Total Billed Charges,84% of total billed charges,25.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.84,89,,,Percent of total Billed Charges,89% of total Billed charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.09,77,,,Percent of total Billed charges,77% of total billed charges,26.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,27.84,
OxyBUTYnin XL 5mg Tablet,,,250,RC,,,Outpatient,,,31.28,15.64,,24.09,77,,,Percent of Total Billed Charges,77% of total billed charges,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.15,74,,,Percent of Total Billed Charges,74% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,26.28,84,,,Percent of Total Billed Charges,84% of total billed charges,25.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.84,89,,,Percent of total Billed Charges,89% of total Billed charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.09,77,,,Percent of total Billed charges,77% of total billed charges,26.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,27.84,
OxyBUTYnin XL 5mg Tablet,,,250,RC,,,Outpatient,,,31.28,15.64,,24.09,77,,,Percent of Total Billed Charges,77% of total billed charges,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.15,74,,,Percent of Total Billed Charges,74% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,26.28,84,,,Percent of Total Billed Charges,84% of total billed charges,25.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.84,89,,,Percent of total Billed Charges,89% of total Billed charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.09,77,,,Percent of total Billed charges,77% of total billed charges,26.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,27.84,
OxyBUTYnin XL 5mg Tablet,,,250,RC,,,Outpatient,,,31.28,15.64,,24.09,77,,,Percent of Total Billed Charges,77% of total billed charges,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.15,74,,,Percent of Total Billed Charges,74% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,26.28,84,,,Percent of Total Billed Charges,84% of total billed charges,25.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.84,89,,,Percent of total Billed Charges,89% of total Billed charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.09,77,,,Percent of total Billed charges,77% of total billed charges,26.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,27.84,
OxyBUTYnin XL 5mg Tablet,,,250,RC,,,Outpatient,,,31.28,15.64,,24.09,77,,,Percent of Total Billed Charges,77% of total billed charges,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.15,74,,,Percent of Total Billed Charges,74% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,21.58,69,,,Percent of Total Billed Charges,69% of total billed charges,26.28,84,,,Percent of Total Billed Charges,84% of total billed charges,25.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.84,89,,,Percent of total Billed Charges,89% of total Billed charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.09,77,,,Percent of total Billed charges,77% of total billed charges,26.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.82,27.84,
oxyCODONE Controlled Release 10mg Tablet,59011041020,CDM,250,RC,,,Outpatient,,,53.16,26.58,,40.93,77,,,Percent of Total Billed Charges,77% of total billed charges,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.34,74,,,Percent of Total Billed Charges,74% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.65,84,,,Percent of Total Billed Charges,84% of total billed charges,43.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.31,89,,,Percent of total Billed Charges,89% of total Billed charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.93,77,,,Percent of total Billed charges,77% of total billed charges,45.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.29,47.31,
oxyCODONE Controlled Release 10mg Tablet,59011041020,CDM,250,RC,,,Outpatient,,,53.16,26.58,,40.93,77,,,Percent of Total Billed Charges,77% of total billed charges,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.34,74,,,Percent of Total Billed Charges,74% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.65,84,,,Percent of Total Billed Charges,84% of total billed charges,43.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.31,89,,,Percent of total Billed Charges,89% of total Billed charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.93,77,,,Percent of total Billed charges,77% of total billed charges,45.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.29,47.31,
oxyCODONE Controlled Release 10mg Tablet,59011041020,CDM,250,RC,,,Outpatient,,,53.16,26.58,,40.93,77,,,Percent of Total Billed Charges,77% of total billed charges,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.34,74,,,Percent of Total Billed Charges,74% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.65,84,,,Percent of Total Billed Charges,84% of total billed charges,43.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.31,89,,,Percent of total Billed Charges,89% of total Billed charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.93,77,,,Percent of total Billed charges,77% of total billed charges,45.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.29,47.31,
oxyCODONE Controlled Release 10mg Tablet,59011041020,CDM,250,RC,,,Outpatient,,,53.16,26.58,,40.93,77,,,Percent of Total Billed Charges,77% of total billed charges,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.34,74,,,Percent of Total Billed Charges,74% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.65,84,,,Percent of Total Billed Charges,84% of total billed charges,43.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.31,89,,,Percent of total Billed Charges,89% of total Billed charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.93,77,,,Percent of total Billed charges,77% of total billed charges,45.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.29,47.31,
oxyCODONE Controlled Release 10mg Tablet,59011041020,CDM,250,RC,,,Outpatient,,,53.16,26.58,,40.93,77,,,Percent of Total Billed Charges,77% of total billed charges,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.34,74,,,Percent of Total Billed Charges,74% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.65,84,,,Percent of Total Billed Charges,84% of total billed charges,43.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.31,89,,,Percent of total Billed Charges,89% of total Billed charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.93,77,,,Percent of total Billed charges,77% of total billed charges,45.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.29,47.31,
oxyCODONE Controlled Release 10mg Tablet,59011041020,CDM,250,RC,,,Outpatient,,,53.16,26.58,,40.93,77,,,Percent of Total Billed Charges,77% of total billed charges,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.34,74,,,Percent of Total Billed Charges,74% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,36.68,69,,,Percent of Total Billed Charges,69% of total billed charges,44.65,84,,,Percent of Total Billed Charges,84% of total billed charges,43.59,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.31,89,,,Percent of total Billed Charges,89% of total Billed charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.93,77,,,Percent of total Billed charges,77% of total billed charges,45.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.29,47.31,
oxyCODONE/APAP 5/325mg Tablet,406051201,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
oxyCODONE/APAP 5/325mg Tablet,406051201,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
oxyCODONE/APAP 5/325mg Tablet,406051201,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
oxyCODONE/APAP 5/325mg Tablet,406051201,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
oxyCODONE/APAP 5/325mg Tablet,406051201,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
oxyCODONE/APAP 5/325mg Tablet,406051201,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
oxyCODONE/APAP 10/325mg Tablet,406052301,CDM,250,RC,,,Outpatient,,,38.31,19.16,,29.5,77,,,Percent of Total Billed Charges,77% of total billed charges,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.35,74,,,Percent of Total Billed Charges,74% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.18,84,,,Percent of Total Billed Charges,84% of total billed charges,31.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.1,89,,,Percent of total Billed Charges,89% of total Billed charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,77,,,Percent of total Billed charges,77% of total billed charges,32.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.58,34.1,
oxyCODONE/APAP 10/325mg Tablet,406052301,CDM,250,RC,,,Outpatient,,,38.31,19.16,,29.5,77,,,Percent of Total Billed Charges,77% of total billed charges,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.35,74,,,Percent of Total Billed Charges,74% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.18,84,,,Percent of Total Billed Charges,84% of total billed charges,31.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.1,89,,,Percent of total Billed Charges,89% of total Billed charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,77,,,Percent of total Billed charges,77% of total billed charges,32.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.58,34.1,
oxyCODONE/APAP 10/325mg Tablet,406052301,CDM,250,RC,,,Outpatient,,,38.31,19.16,,29.5,77,,,Percent of Total Billed Charges,77% of total billed charges,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.35,74,,,Percent of Total Billed Charges,74% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.18,84,,,Percent of Total Billed Charges,84% of total billed charges,31.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.1,89,,,Percent of total Billed Charges,89% of total Billed charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,77,,,Percent of total Billed charges,77% of total billed charges,32.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.58,34.1,
oxyCODONE/APAP 10/325mg Tablet,406052301,CDM,250,RC,,,Outpatient,,,38.31,19.16,,29.5,77,,,Percent of Total Billed Charges,77% of total billed charges,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.35,74,,,Percent of Total Billed Charges,74% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.18,84,,,Percent of Total Billed Charges,84% of total billed charges,31.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.1,89,,,Percent of total Billed Charges,89% of total Billed charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,77,,,Percent of total Billed charges,77% of total billed charges,32.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.58,34.1,
oxyCODONE/APAP 10/325mg Tablet,406052301,CDM,250,RC,,,Outpatient,,,38.31,19.16,,29.5,77,,,Percent of Total Billed Charges,77% of total billed charges,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.35,74,,,Percent of Total Billed Charges,74% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.18,84,,,Percent of Total Billed Charges,84% of total billed charges,31.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.1,89,,,Percent of total Billed Charges,89% of total Billed charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,77,,,Percent of total Billed charges,77% of total billed charges,32.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.58,34.1,
oxyCODONE/APAP 10/325mg Tablet,406052301,CDM,250,RC,,,Outpatient,,,38.31,19.16,,29.5,77,,,Percent of Total Billed Charges,77% of total billed charges,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,28.35,74,,,Percent of Total Billed Charges,74% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,26.43,69,,,Percent of Total Billed Charges,69% of total billed charges,32.18,84,,,Percent of Total Billed Charges,84% of total billed charges,31.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,34.1,89,,,Percent of total Billed Charges,89% of total Billed charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,77,,,Percent of total Billed charges,77% of total billed charges,32.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,19.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,15.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.58,34.1,
oxyCODONE Controlled Release 20mg Tablet,59011042020,CDM,250,RC,,,Outpatient,,,77.06,38.53,,59.34,77,,,Percent of Total Billed Charges,77% of total billed charges,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.02,74,,,Percent of Total Billed Charges,74% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.73,84,,,Percent of Total Billed Charges,84% of total billed charges,63.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.58,89,,,Percent of total Billed Charges,89% of total Billed charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,77,,,Percent of total Billed charges,77% of total billed charges,65.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.27,68.58,
oxyCODONE Controlled Release 20mg Tablet,59011042020,CDM,250,RC,,,Outpatient,,,77.06,38.53,,59.34,77,,,Percent of Total Billed Charges,77% of total billed charges,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.02,74,,,Percent of Total Billed Charges,74% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.73,84,,,Percent of Total Billed Charges,84% of total billed charges,63.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.58,89,,,Percent of total Billed Charges,89% of total Billed charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,77,,,Percent of total Billed charges,77% of total billed charges,65.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.27,68.58,
oxyCODONE Controlled Release 20mg Tablet,59011042020,CDM,250,RC,,,Outpatient,,,77.06,38.53,,59.34,77,,,Percent of Total Billed Charges,77% of total billed charges,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.02,74,,,Percent of Total Billed Charges,74% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.73,84,,,Percent of Total Billed Charges,84% of total billed charges,63.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.58,89,,,Percent of total Billed Charges,89% of total Billed charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,77,,,Percent of total Billed charges,77% of total billed charges,65.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.27,68.58,
oxyCODONE Controlled Release 20mg Tablet,59011042020,CDM,250,RC,,,Outpatient,,,77.06,38.53,,59.34,77,,,Percent of Total Billed Charges,77% of total billed charges,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.02,74,,,Percent of Total Billed Charges,74% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.73,84,,,Percent of Total Billed Charges,84% of total billed charges,63.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.58,89,,,Percent of total Billed Charges,89% of total Billed charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,77,,,Percent of total Billed charges,77% of total billed charges,65.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.27,68.58,
oxyCODONE Controlled Release 20mg Tablet,59011042020,CDM,250,RC,,,Outpatient,,,77.06,38.53,,59.34,77,,,Percent of Total Billed Charges,77% of total billed charges,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.02,74,,,Percent of Total Billed Charges,74% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.73,84,,,Percent of Total Billed Charges,84% of total billed charges,63.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.58,89,,,Percent of total Billed Charges,89% of total Billed charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,77,,,Percent of total Billed charges,77% of total billed charges,65.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.27,68.58,
oxyCODONE Controlled Release 20mg Tablet,59011042020,CDM,250,RC,,,Outpatient,,,77.06,38.53,,59.34,77,,,Percent of Total Billed Charges,77% of total billed charges,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.02,74,,,Percent of Total Billed Charges,74% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,53.17,69,,,Percent of Total Billed Charges,69% of total billed charges,64.73,84,,,Percent of Total Billed Charges,84% of total billed charges,63.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.58,89,,,Percent of total Billed Charges,89% of total Billed charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.34,77,,,Percent of total Billed charges,77% of total billed charges,65.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.27,68.58,
Oxycodone 5mg/5ml UDC,904682894,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Oxycodone 5mg/5ml UDC,904682894,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Oxycodone 5mg/5ml UDC,904682894,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Oxycodone 5mg/5ml UDC,904682894,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Oxycodone 5mg/5ml UDC,904682894,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
Oxycodone 5mg/5ml UDC,904682894,CDM,250,RC,,,Outpatient,,,43.65,21.83,,33.61,77,,,Percent of Total Billed Charges,77% of total billed charges,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.3,74,,,Percent of Total Billed Charges,74% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,30.12,69,,,Percent of Total Billed Charges,69% of total billed charges,36.67,84,,,Percent of Total Billed Charges,84% of total billed charges,35.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.85,89,,,Percent of total Billed Charges,89% of total Billed charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.61,77,,,Percent of total Billed charges,77% of total billed charges,37.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.85,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.91,38.85,
oxyCODONE Immediate Rel 5mg Tab,406055262,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
oxyCODONE Immediate Rel 5mg Tab,406055262,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
oxyCODONE Immediate Rel 5mg Tab,406055262,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
oxyCODONE Immediate Rel 5mg Tab,406055262,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
oxyCODONE Immediate Rel 5mg Tab,406055262,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
oxyCODONE Immediate Rel 5mg Tab,406055262,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Oxymetazoline Nasal Spray 15ml,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Oxymetazoline Nasal Spray 15ml,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Oxymetazoline Nasal Spray 15ml,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Oxymetazoline Nasal Spray 15ml,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Oxymetazoline Nasal Spray 15ml,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Oxymetazoline Nasal Spray 15ml,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Oxytocin 10units/ml SDV,42023011625,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Oxytocin 10units/ml SDV,42023011625,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Oxytocin 10units/ml SDV,42023011625,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Oxytocin 10units/ml SDV,42023011625,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Oxytocin 10units/ml SDV,42023011625,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Oxytocin 10units/ml SDV,42023011625,CDM,250,RC,,,Outpatient,,,69.61,34.81,,53.6,77,,,Percent of Total Billed Charges,77% of total billed charges,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.51,74,,,Percent of Total Billed Charges,74% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,48.03,69,,,Percent of Total Billed Charges,69% of total billed charges,58.47,84,,,Percent of Total Billed Charges,84% of total billed charges,57.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,61.95,89,,,Percent of total Billed Charges,89% of total Billed charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.6,77,,,Percent of total Billed charges,77% of total billed charges,59.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.4,61.95,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
Oxytocin in NS 30unit/500ml Bag,71266510001,CDM,250,RC,,,Outpatient,,,254.42,127.21,,195.9,77,,,Percent of Total Billed Charges,77% of total billed charges,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,64.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,188.27,74,,,Percent of Total Billed Charges,74% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,175.55,69,,,Percent of Total Billed Charges,69% of total billed charges,213.71,84,,,Percent of Total Billed Charges,84% of total billed charges,208.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,226.43,89,,,Percent of total Billed Charges,89% of total Billed charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.9,77,,,Percent of total Billed charges,77% of total billed charges,216.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,73.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,127.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,103.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,226.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.61,226.43,
PACLitaxeL Protein-Bound 100mg/20ml Powder Vial,60505623004,CDM,250,RC,,,Outpatient,,,12574.8,6287.4,,9682.6,77,,,Percent of Total Billed Charges,77% of total billed charges,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3929.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9305.35,74,,,Percent of Total Billed Charges,74% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,10562.83,84,,,Percent of Total Billed Charges,84% of total billed charges,10311.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,11191.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9682.6,77,,,Percent of total Billed charges,77% of total billed charges,10688.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3615.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6287.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3143.7,11191.57,
PACLitaxeL Protein-Bound 100mg/20ml Powder Vial,60505623004,CDM,250,RC,,,Outpatient,,,12574.8,6287.4,,9682.6,77,,,Percent of Total Billed Charges,77% of total billed charges,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3929.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9305.35,74,,,Percent of Total Billed Charges,74% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,10562.83,84,,,Percent of Total Billed Charges,84% of total billed charges,10311.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,11191.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9682.6,77,,,Percent of total Billed charges,77% of total billed charges,10688.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3615.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6287.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3143.7,11191.57,
PACLitaxeL Protein-Bound 100mg/20ml Powder Vial,60505623004,CDM,250,RC,,,Outpatient,,,12574.8,6287.4,,9682.6,77,,,Percent of Total Billed Charges,77% of total billed charges,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3929.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9305.35,74,,,Percent of Total Billed Charges,74% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,10562.83,84,,,Percent of Total Billed Charges,84% of total billed charges,10311.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,11191.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9682.6,77,,,Percent of total Billed charges,77% of total billed charges,10688.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3615.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6287.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3143.7,11191.57,
PACLitaxeL Protein-Bound 100mg/20ml Powder Vial,60505623004,CDM,250,RC,,,Outpatient,,,12574.8,6287.4,,9682.6,77,,,Percent of Total Billed Charges,77% of total billed charges,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3929.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9305.35,74,,,Percent of Total Billed Charges,74% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,10562.83,84,,,Percent of Total Billed Charges,84% of total billed charges,10311.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,11191.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9682.6,77,,,Percent of total Billed charges,77% of total billed charges,10688.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3615.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6287.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3143.7,11191.57,
PACLitaxeL Protein-Bound 100mg/20ml Powder Vial,60505623004,CDM,250,RC,,,Outpatient,,,12574.8,6287.4,,9682.6,77,,,Percent of Total Billed Charges,77% of total billed charges,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3929.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9305.35,74,,,Percent of Total Billed Charges,74% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,10562.83,84,,,Percent of Total Billed Charges,84% of total billed charges,10311.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,11191.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9682.6,77,,,Percent of total Billed charges,77% of total billed charges,10688.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3615.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6287.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3143.7,11191.57,
PACLitaxeL Protein-Bound 100mg/20ml Powder Vial,60505623004,CDM,250,RC,,,Outpatient,,,12574.8,6287.4,,9682.6,77,,,Percent of Total Billed Charges,77% of total billed charges,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3206.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3929.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9305.35,74,,,Percent of Total Billed Charges,74% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,8676.61,69,,,Percent of Total Billed Charges,69% of total billed charges,10562.83,84,,,Percent of Total Billed Charges,84% of total billed charges,10311.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,11191.57,89,,,Percent of total Billed Charges,89% of total Billed charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9682.6,77,,,Percent of total Billed charges,77% of total billed charges,10688.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3615.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6287.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5130.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11191.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3143.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3143.7,11191.57,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11341.18,5670.59,,8732.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3544.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8392.47,74,,,Percent of Total Billed Charges,74% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,9526.59,84,,,Percent of Total Billed Charges,84% of total billed charges,9299.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,10093.65,89,,,Percent of total Billed Charges,89% of total Billed charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8732.71,77,,,Percent of total Billed charges,77% of total billed charges,9640,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3260.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5670.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2835.3,10093.65,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11052.5,5526.25,,8510.43,77,,,Percent of Total Billed Charges,77% of total billed charges,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3453.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8178.85,74,,,Percent of Total Billed Charges,74% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,9284.1,84,,,Percent of Total Billed Charges,84% of total billed charges,9063.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9836.73,89,,,Percent of total Billed Charges,89% of total Billed charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8510.43,77,,,Percent of total Billed charges,77% of total billed charges,9394.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3177.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5526.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2763.13,9836.73,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11341.18,5670.59,,8732.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3544.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8392.47,74,,,Percent of Total Billed Charges,74% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,9526.59,84,,,Percent of Total Billed Charges,84% of total billed charges,9299.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,10093.65,89,,,Percent of total Billed Charges,89% of total Billed charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8732.71,77,,,Percent of total Billed charges,77% of total billed charges,9640,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3260.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5670.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2835.3,10093.65,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11052.5,5526.25,,8510.43,77,,,Percent of Total Billed Charges,77% of total billed charges,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3453.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8178.85,74,,,Percent of Total Billed Charges,74% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,9284.1,84,,,Percent of Total Billed Charges,84% of total billed charges,9063.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9836.73,89,,,Percent of total Billed Charges,89% of total Billed charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8510.43,77,,,Percent of total Billed charges,77% of total billed charges,9394.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3177.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5526.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2763.13,9836.73,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11341.18,5670.59,,8732.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3544.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8392.47,74,,,Percent of Total Billed Charges,74% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,9526.59,84,,,Percent of Total Billed Charges,84% of total billed charges,9299.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,10093.65,89,,,Percent of total Billed Charges,89% of total Billed charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8732.71,77,,,Percent of total Billed charges,77% of total billed charges,9640,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3260.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5670.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2835.3,10093.65,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11052.5,5526.25,,8510.43,77,,,Percent of Total Billed Charges,77% of total billed charges,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3453.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8178.85,74,,,Percent of Total Billed Charges,74% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,9284.1,84,,,Percent of Total Billed Charges,84% of total billed charges,9063.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9836.73,89,,,Percent of total Billed Charges,89% of total Billed charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8510.43,77,,,Percent of total Billed charges,77% of total billed charges,9394.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3177.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5526.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2763.13,9836.73,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11341.18,5670.59,,8732.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3544.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8392.47,74,,,Percent of Total Billed Charges,74% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,9526.59,84,,,Percent of Total Billed Charges,84% of total billed charges,9299.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,10093.65,89,,,Percent of total Billed Charges,89% of total Billed charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8732.71,77,,,Percent of total Billed charges,77% of total billed charges,9640,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3260.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5670.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2835.3,10093.65,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11052.5,5526.25,,8510.43,77,,,Percent of Total Billed Charges,77% of total billed charges,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3453.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8178.85,74,,,Percent of Total Billed Charges,74% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,9284.1,84,,,Percent of Total Billed Charges,84% of total billed charges,9063.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9836.73,89,,,Percent of total Billed Charges,89% of total Billed charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8510.43,77,,,Percent of total Billed charges,77% of total billed charges,9394.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3177.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5526.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2763.13,9836.73,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11341.18,5670.59,,8732.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3544.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8392.47,74,,,Percent of Total Billed Charges,74% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,9526.59,84,,,Percent of Total Billed Charges,84% of total billed charges,9299.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,10093.65,89,,,Percent of total Billed Charges,89% of total Billed charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8732.71,77,,,Percent of total Billed charges,77% of total billed charges,9640,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3260.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5670.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2835.3,10093.65,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11052.5,5526.25,,8510.43,77,,,Percent of Total Billed Charges,77% of total billed charges,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3453.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8178.85,74,,,Percent of Total Billed Charges,74% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,9284.1,84,,,Percent of Total Billed Charges,84% of total billed charges,9063.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9836.73,89,,,Percent of total Billed Charges,89% of total Billed charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8510.43,77,,,Percent of total Billed charges,77% of total billed charges,9394.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3177.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5526.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2763.13,9836.73,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11341.18,5670.59,,8732.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2892,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3544.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8392.47,74,,,Percent of Total Billed Charges,74% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,7825.41,69,,,Percent of Total Billed Charges,69% of total billed charges,9526.59,84,,,Percent of Total Billed Charges,84% of total billed charges,9299.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,10093.65,89,,,Percent of total Billed Charges,89% of total Billed charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8732.71,77,,,Percent of total Billed charges,77% of total billed charges,9640,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3260.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5670.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4627.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10093.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2835.3,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2835.3,10093.65,
PACLitaxeL Protein-Bound (Abraxane) 100mg/20ml Powder SDV,68817013450,CDM,250,RC,,,Outpatient,,,11052.5,5526.25,,8510.43,77,,,Percent of Total Billed Charges,77% of total billed charges,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2818.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3453.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8178.85,74,,,Percent of Total Billed Charges,74% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,7626.23,69,,,Percent of Total Billed Charges,69% of total billed charges,9284.1,84,,,Percent of Total Billed Charges,84% of total billed charges,9063.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,9836.73,89,,,Percent of total Billed Charges,89% of total Billed charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8510.43,77,,,Percent of total Billed charges,77% of total billed charges,9394.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3177.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5526.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4509.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9836.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2763.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2763.13,9836.73,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6856.29,3428.15,,5279.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2142.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5073.65,74,,,Percent of Total Billed Charges,74% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5759.28,84,,,Percent of Total Billed Charges,84% of total billed charges,5622.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,6102.1,89,,,Percent of total Billed Charges,89% of total Billed charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5279.34,77,,,Percent of total Billed charges,77% of total billed charges,5827.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1971.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3428.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1714.07,6102.1,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6682.84,3341.42,,5145.79,77,,,Percent of Total Billed Charges,77% of total billed charges,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2088.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4945.3,74,,,Percent of Total Billed Charges,74% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5613.59,84,,,Percent of Total Billed Charges,84% of total billed charges,5479.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,5947.73,89,,,Percent of total Billed Charges,89% of total Billed charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5145.79,77,,,Percent of total Billed charges,77% of total billed charges,5680.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1921.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3341.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.71,5947.73,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6856.29,3428.15,,5279.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2142.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5073.65,74,,,Percent of Total Billed Charges,74% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5759.28,84,,,Percent of Total Billed Charges,84% of total billed charges,5622.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,6102.1,89,,,Percent of total Billed Charges,89% of total Billed charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5279.34,77,,,Percent of total Billed charges,77% of total billed charges,5827.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1971.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3428.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1714.07,6102.1,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6682.84,3341.42,,5145.79,77,,,Percent of Total Billed Charges,77% of total billed charges,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2088.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4945.3,74,,,Percent of Total Billed Charges,74% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5613.59,84,,,Percent of Total Billed Charges,84% of total billed charges,5479.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,5947.73,89,,,Percent of total Billed Charges,89% of total Billed charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5145.79,77,,,Percent of total Billed charges,77% of total billed charges,5680.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1921.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3341.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.71,5947.73,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6856.29,3428.15,,5279.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2142.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5073.65,74,,,Percent of Total Billed Charges,74% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5759.28,84,,,Percent of Total Billed Charges,84% of total billed charges,5622.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,6102.1,89,,,Percent of total Billed Charges,89% of total Billed charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5279.34,77,,,Percent of total Billed charges,77% of total billed charges,5827.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1971.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3428.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1714.07,6102.1,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6682.84,3341.42,,5145.79,77,,,Percent of Total Billed Charges,77% of total billed charges,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2088.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4945.3,74,,,Percent of Total Billed Charges,74% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5613.59,84,,,Percent of Total Billed Charges,84% of total billed charges,5479.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,5947.73,89,,,Percent of total Billed Charges,89% of total Billed charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5145.79,77,,,Percent of total Billed charges,77% of total billed charges,5680.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1921.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3341.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.71,5947.73,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6856.29,3428.15,,5279.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2142.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5073.65,74,,,Percent of Total Billed Charges,74% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5759.28,84,,,Percent of Total Billed Charges,84% of total billed charges,5622.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,6102.1,89,,,Percent of total Billed Charges,89% of total Billed charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5279.34,77,,,Percent of total Billed charges,77% of total billed charges,5827.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1971.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3428.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1714.07,6102.1,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6682.84,3341.42,,5145.79,77,,,Percent of Total Billed Charges,77% of total billed charges,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2088.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4945.3,74,,,Percent of Total Billed Charges,74% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5613.59,84,,,Percent of Total Billed Charges,84% of total billed charges,5479.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,5947.73,89,,,Percent of total Billed Charges,89% of total Billed charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5145.79,77,,,Percent of total Billed charges,77% of total billed charges,5680.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1921.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3341.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.71,5947.73,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6856.29,3428.15,,5279.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2142.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5073.65,74,,,Percent of Total Billed Charges,74% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5759.28,84,,,Percent of Total Billed Charges,84% of total billed charges,5622.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,6102.1,89,,,Percent of total Billed Charges,89% of total Billed charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5279.34,77,,,Percent of total Billed charges,77% of total billed charges,5827.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1971.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3428.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1714.07,6102.1,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6682.84,3341.42,,5145.79,77,,,Percent of Total Billed Charges,77% of total billed charges,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2088.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4945.3,74,,,Percent of Total Billed Charges,74% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5613.59,84,,,Percent of Total Billed Charges,84% of total billed charges,5479.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,5947.73,89,,,Percent of total Billed Charges,89% of total Billed charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5145.79,77,,,Percent of total Billed charges,77% of total billed charges,5680.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1921.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3341.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.71,5947.73,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6856.29,3428.15,,5279.34,77,,,Percent of Total Billed Charges,77% of total billed charges,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1748.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2142.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5073.65,74,,,Percent of Total Billed Charges,74% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4730.84,69,,,Percent of Total Billed Charges,69% of total billed charges,5759.28,84,,,Percent of Total Billed Charges,84% of total billed charges,5622.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,6102.1,89,,,Percent of total Billed Charges,89% of total Billed charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5279.34,77,,,Percent of total Billed charges,77% of total billed charges,5827.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1971.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3428.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2797.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6102.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1714.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1714.07,6102.1,
PACLitaxel 300mg/50ml Liquid MDV,61703034250,CDM,250,RC,,,Outpatient,,,6682.84,3341.42,,5145.79,77,,,Percent of Total Billed Charges,77% of total billed charges,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1704.12,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2088.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4945.3,74,,,Percent of Total Billed Charges,74% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,4611.16,69,,,Percent of Total Billed Charges,69% of total billed charges,5613.59,84,,,Percent of Total Billed Charges,84% of total billed charges,5479.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,5947.73,89,,,Percent of total Billed Charges,89% of total Billed charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5145.79,77,,,Percent of total Billed charges,77% of total billed charges,5680.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1921.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3341.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2726.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5947.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1670.71,5947.73,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4713.15,2356.58,,3629.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1472.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3487.73,74,,,Percent of Total Billed Charges,74% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3959.05,84,,,Percent of Total Billed Charges,84% of total billed charges,3864.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,4194.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3629.13,77,,,Percent of total Billed charges,77% of total billed charges,4006.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2356.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.29,4194.7,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4595.12,2297.56,,3538.24,77,,,Percent of Total Billed Charges,77% of total billed charges,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1435.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3400.39,74,,,Percent of Total Billed Charges,74% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3859.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3768,82,,,Percent of Total Billed Charges,82% of total billed charges ,4089.66,89,,,Percent of total Billed Charges,89% of total Billed charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3538.24,77,,,Percent of total Billed charges,77% of total billed charges,3905.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1321.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2297.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.78,4089.66,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4713.15,2356.58,,3629.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1472.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3487.73,74,,,Percent of Total Billed Charges,74% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3959.05,84,,,Percent of Total Billed Charges,84% of total billed charges,3864.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,4194.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3629.13,77,,,Percent of total Billed charges,77% of total billed charges,4006.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2356.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.29,4194.7,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4595.12,2297.56,,3538.24,77,,,Percent of Total Billed Charges,77% of total billed charges,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1435.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3400.39,74,,,Percent of Total Billed Charges,74% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3859.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3768,82,,,Percent of Total Billed Charges,82% of total billed charges ,4089.66,89,,,Percent of total Billed Charges,89% of total Billed charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3538.24,77,,,Percent of total Billed charges,77% of total billed charges,3905.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1321.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2297.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.78,4089.66,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4713.15,2356.58,,3629.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1472.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3487.73,74,,,Percent of Total Billed Charges,74% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3959.05,84,,,Percent of Total Billed Charges,84% of total billed charges,3864.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,4194.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3629.13,77,,,Percent of total Billed charges,77% of total billed charges,4006.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2356.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.29,4194.7,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4595.12,2297.56,,3538.24,77,,,Percent of Total Billed Charges,77% of total billed charges,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1435.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3400.39,74,,,Percent of Total Billed Charges,74% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3859.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3768,82,,,Percent of Total Billed Charges,82% of total billed charges ,4089.66,89,,,Percent of total Billed Charges,89% of total Billed charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3538.24,77,,,Percent of total Billed charges,77% of total billed charges,3905.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1321.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2297.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.78,4089.66,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4713.15,2356.58,,3629.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1472.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3487.73,74,,,Percent of Total Billed Charges,74% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3959.05,84,,,Percent of Total Billed Charges,84% of total billed charges,3864.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,4194.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3629.13,77,,,Percent of total Billed charges,77% of total billed charges,4006.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2356.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.29,4194.7,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4595.12,2297.56,,3538.24,77,,,Percent of Total Billed Charges,77% of total billed charges,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1435.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3400.39,74,,,Percent of Total Billed Charges,74% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3859.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3768,82,,,Percent of Total Billed Charges,82% of total billed charges ,4089.66,89,,,Percent of total Billed Charges,89% of total Billed charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3538.24,77,,,Percent of total Billed charges,77% of total billed charges,3905.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1321.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2297.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.78,4089.66,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4713.15,2356.58,,3629.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1472.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3487.73,74,,,Percent of Total Billed Charges,74% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3959.05,84,,,Percent of Total Billed Charges,84% of total billed charges,3864.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,4194.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3629.13,77,,,Percent of total Billed charges,77% of total billed charges,4006.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2356.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.29,4194.7,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4595.12,2297.56,,3538.24,77,,,Percent of Total Billed Charges,77% of total billed charges,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1435.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3400.39,74,,,Percent of Total Billed Charges,74% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3859.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3768,82,,,Percent of Total Billed Charges,82% of total billed charges ,4089.66,89,,,Percent of total Billed Charges,89% of total Billed charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3538.24,77,,,Percent of total Billed charges,77% of total billed charges,3905.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1321.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2297.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.78,4089.66,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4713.15,2356.58,,3629.13,77,,,Percent of Total Billed Charges,77% of total billed charges,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1201.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1472.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3487.73,74,,,Percent of Total Billed Charges,74% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3252.07,69,,,Percent of Total Billed Charges,69% of total billed charges,3959.05,84,,,Percent of Total Billed Charges,84% of total billed charges,3864.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,4194.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3629.13,77,,,Percent of total Billed charges,77% of total billed charges,4006.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1355.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2356.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1922.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4194.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1178.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1178.29,4194.7,
PACLitaxel 100mg/16.7ml Liquid MDV,63323076316,CDM,250,RC,,,Outpatient,,,4595.12,2297.56,,3538.24,77,,,Percent of Total Billed Charges,77% of total billed charges,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1171.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1435.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3400.39,74,,,Percent of Total Billed Charges,74% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3859.9,84,,,Percent of Total Billed Charges,84% of total billed charges,3768,82,,,Percent of Total Billed Charges,82% of total billed charges ,4089.66,89,,,Percent of total Billed Charges,89% of total Billed charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3538.24,77,,,Percent of total Billed charges,77% of total billed charges,3905.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1321.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2297.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1874.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4089.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1148.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1148.78,4089.66,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1575.97,787.99,,1213.5,77,,,Percent of Total Billed Charges,77% of total billed charges,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1166.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1323.81,84,,,Percent of Total Billed Charges,84% of total billed charges,1292.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,1402.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,77,,,Percent of total Billed charges,77% of total billed charges,1339.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,787.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,1402.61,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1539.08,769.54,,1185.09,77,,,Percent of Total Billed Charges,77% of total billed charges,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1292.83,84,,,Percent of Total Billed Charges,84% of total billed charges,1262.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1369.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.09,77,,,Percent of total Billed charges,77% of total billed charges,1308.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,769.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.77,1369.78,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1575.97,787.99,,1213.5,77,,,Percent of Total Billed Charges,77% of total billed charges,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1166.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1323.81,84,,,Percent of Total Billed Charges,84% of total billed charges,1292.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,1402.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,77,,,Percent of total Billed charges,77% of total billed charges,1339.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,787.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,1402.61,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1539.08,769.54,,1185.09,77,,,Percent of Total Billed Charges,77% of total billed charges,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1292.83,84,,,Percent of Total Billed Charges,84% of total billed charges,1262.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1369.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.09,77,,,Percent of total Billed charges,77% of total billed charges,1308.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,769.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.77,1369.78,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1575.97,787.99,,1213.5,77,,,Percent of Total Billed Charges,77% of total billed charges,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1166.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1323.81,84,,,Percent of Total Billed Charges,84% of total billed charges,1292.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,1402.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,77,,,Percent of total Billed charges,77% of total billed charges,1339.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,787.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,1402.61,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1539.08,769.54,,1185.09,77,,,Percent of Total Billed Charges,77% of total billed charges,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1292.83,84,,,Percent of Total Billed Charges,84% of total billed charges,1262.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1369.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.09,77,,,Percent of total Billed charges,77% of total billed charges,1308.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,769.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.77,1369.78,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1575.97,787.99,,1213.5,77,,,Percent of Total Billed Charges,77% of total billed charges,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1166.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1323.81,84,,,Percent of Total Billed Charges,84% of total billed charges,1292.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,1402.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,77,,,Percent of total Billed charges,77% of total billed charges,1339.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,787.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,1402.61,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1539.08,769.54,,1185.09,77,,,Percent of Total Billed Charges,77% of total billed charges,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1292.83,84,,,Percent of Total Billed Charges,84% of total billed charges,1262.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1369.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.09,77,,,Percent of total Billed charges,77% of total billed charges,1308.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,769.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.77,1369.78,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1575.97,787.99,,1213.5,77,,,Percent of Total Billed Charges,77% of total billed charges,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1166.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1323.81,84,,,Percent of Total Billed Charges,84% of total billed charges,1292.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,1402.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,77,,,Percent of total Billed charges,77% of total billed charges,1339.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,787.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,1402.61,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1539.08,769.54,,1185.09,77,,,Percent of Total Billed Charges,77% of total billed charges,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1292.83,84,,,Percent of Total Billed Charges,84% of total billed charges,1262.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1369.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.09,77,,,Percent of total Billed charges,77% of total billed charges,1308.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,769.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.77,1369.78,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1575.97,787.99,,1213.5,77,,,Percent of Total Billed Charges,77% of total billed charges,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,401.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,492.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1166.22,74,,,Percent of Total Billed Charges,74% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1087.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1323.81,84,,,Percent of Total Billed Charges,84% of total billed charges,1292.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,1402.61,89,,,Percent of total Billed Charges,89% of total Billed charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1213.5,77,,,Percent of total Billed charges,77% of total billed charges,1339.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,453.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,787.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,643,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1402.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.99,1402.61,
PACLitaxel 30mg/5ml Liquid MDV,70860020005,CDM,250,RC,,,Outpatient,,,1539.08,769.54,,1185.09,77,,,Percent of Total Billed Charges,77% of total billed charges,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,392.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,480.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1138.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1292.83,84,,,Percent of Total Billed Charges,84% of total billed charges,1262.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,1369.78,89,,,Percent of total Billed Charges,89% of total Billed charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1185.09,77,,,Percent of total Billed charges,77% of total billed charges,1308.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,442.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,769.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,627.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1369.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,384.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.77,1369.78,
Palonosetron 0.25mg/5ml Liquid SDV,60505619301,CDM,250,RC,,,Outpatient,,,1336.32,668.16,,1028.97,77,,,Percent of Total Billed Charges,77% of total billed charges,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,988.88,74,,,Percent of Total Billed Charges,74% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1122.51,84,,,Percent of Total Billed Charges,84% of total billed charges,1095.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1189.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1028.97,77,,,Percent of total Billed charges,77% of total billed charges,1135.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,668.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.08,1189.32,
Palonosetron 0.25mg/5ml Liquid SDV,60505619301,CDM,250,RC,,,Outpatient,,,1336.32,668.16,,1028.97,77,,,Percent of Total Billed Charges,77% of total billed charges,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,988.88,74,,,Percent of Total Billed Charges,74% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1122.51,84,,,Percent of Total Billed Charges,84% of total billed charges,1095.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1189.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1028.97,77,,,Percent of total Billed charges,77% of total billed charges,1135.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,668.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.08,1189.32,
Palonosetron 0.25mg/5ml Liquid SDV,60505619301,CDM,250,RC,,,Outpatient,,,1336.32,668.16,,1028.97,77,,,Percent of Total Billed Charges,77% of total billed charges,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,988.88,74,,,Percent of Total Billed Charges,74% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1122.51,84,,,Percent of Total Billed Charges,84% of total billed charges,1095.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1189.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1028.97,77,,,Percent of total Billed charges,77% of total billed charges,1135.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,668.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.08,1189.32,
Palonosetron 0.25mg/5ml Liquid SDV,60505619301,CDM,250,RC,,,Outpatient,,,1336.32,668.16,,1028.97,77,,,Percent of Total Billed Charges,77% of total billed charges,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,988.88,74,,,Percent of Total Billed Charges,74% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1122.51,84,,,Percent of Total Billed Charges,84% of total billed charges,1095.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1189.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1028.97,77,,,Percent of total Billed charges,77% of total billed charges,1135.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,668.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.08,1189.32,
Palonosetron 0.25mg/5ml Liquid SDV,60505619301,CDM,250,RC,,,Outpatient,,,1336.32,668.16,,1028.97,77,,,Percent of Total Billed Charges,77% of total billed charges,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,988.88,74,,,Percent of Total Billed Charges,74% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1122.51,84,,,Percent of Total Billed Charges,84% of total billed charges,1095.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1189.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1028.97,77,,,Percent of total Billed charges,77% of total billed charges,1135.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,668.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.08,1189.32,
Palonosetron 0.25mg/5ml Liquid SDV,60505619301,CDM,250,RC,,,Outpatient,,,1336.32,668.16,,1028.97,77,,,Percent of Total Billed Charges,77% of total billed charges,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,417.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,988.88,74,,,Percent of Total Billed Charges,74% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,922.06,69,,,Percent of Total Billed Charges,69% of total billed charges,1122.51,84,,,Percent of Total Billed Charges,84% of total billed charges,1095.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,1189.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1028.97,77,,,Percent of total Billed charges,77% of total billed charges,1135.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,384.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,668.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,545.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1189.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,334.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,334.08,1189.32,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1630.91,815.46,,1255.8,77,,,Percent of Total Billed Charges,77% of total billed charges,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1206.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1369.96,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.8,77,,,Percent of total Billed charges,77% of total billed charges,1386.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.73,1451.51,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1592.6,796.3,,1226.3,77,,,Percent of Total Billed Charges,77% of total billed charges,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1178.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1337.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1305.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1226.3,77,,,Percent of total Billed charges,77% of total billed charges,1353.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,796.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.15,1417.41,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1630.91,815.46,,1255.8,77,,,Percent of Total Billed Charges,77% of total billed charges,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1206.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1369.96,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.8,77,,,Percent of total Billed charges,77% of total billed charges,1386.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.73,1451.51,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1592.6,796.3,,1226.3,77,,,Percent of Total Billed Charges,77% of total billed charges,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1178.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1337.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1305.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1226.3,77,,,Percent of total Billed charges,77% of total billed charges,1353.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,796.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.15,1417.41,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1630.91,815.46,,1255.8,77,,,Percent of Total Billed Charges,77% of total billed charges,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1206.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1369.96,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.8,77,,,Percent of total Billed charges,77% of total billed charges,1386.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.73,1451.51,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1592.6,796.3,,1226.3,77,,,Percent of Total Billed Charges,77% of total billed charges,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1178.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1337.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1305.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1226.3,77,,,Percent of total Billed charges,77% of total billed charges,1353.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,796.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.15,1417.41,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1630.91,815.46,,1255.8,77,,,Percent of Total Billed Charges,77% of total billed charges,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1206.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1369.96,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.8,77,,,Percent of total Billed charges,77% of total billed charges,1386.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.73,1451.51,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1592.6,796.3,,1226.3,77,,,Percent of Total Billed Charges,77% of total billed charges,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1178.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1337.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1305.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1226.3,77,,,Percent of total Billed charges,77% of total billed charges,1353.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,796.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.15,1417.41,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1630.91,815.46,,1255.8,77,,,Percent of Total Billed Charges,77% of total billed charges,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1206.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1369.96,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.8,77,,,Percent of total Billed charges,77% of total billed charges,1386.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.73,1451.51,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1592.6,796.3,,1226.3,77,,,Percent of Total Billed Charges,77% of total billed charges,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1178.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1337.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1305.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1226.3,77,,,Percent of total Billed charges,77% of total billed charges,1353.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,796.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.15,1417.41,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1630.91,815.46,,1255.8,77,,,Percent of Total Billed Charges,77% of total billed charges,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,415.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,509.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1206.87,74,,,Percent of Total Billed Charges,74% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1125.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1369.96,84,,,Percent of Total Billed Charges,84% of total billed charges,1337.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,1451.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1255.8,77,,,Percent of total Billed charges,77% of total billed charges,1386.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,468.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,815.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,665.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1451.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,407.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,407.73,1451.51,
Pamidronate 30mg/10ml Liquid SDV,61703032418,CDM,250,RC,,,Outpatient,,,1592.6,796.3,,1226.3,77,,,Percent of Total Billed Charges,77% of total billed charges,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,406.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,497.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1178.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1098.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1337.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1305.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,1417.41,89,,,Percent of total Billed Charges,89% of total Billed charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1226.3,77,,,Percent of total Billed charges,77% of total billed charges,1353.71,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,457.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,796.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,649.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1417.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,398.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.15,1417.41,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4198.45,2099.23,,3232.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1312.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3106.85,74,,,Percent of Total Billed Charges,74% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3526.7,84,,,Percent of Total Billed Charges,84% of total billed charges,3442.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3736.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3232.81,77,,,Percent of total Billed charges,77% of total billed charges,3568.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1207.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2099.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.61,3736.62,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4093.74,2046.87,,3152.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1279.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3029.37,74,,,Percent of Total Billed Charges,74% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3438.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3356.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,3643.43,89,,,Percent of total Billed Charges,89% of total Billed charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3152.18,77,,,Percent of total Billed charges,77% of total billed charges,3479.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2046.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1023.44,3643.43,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4198.45,2099.23,,3232.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1312.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3106.85,74,,,Percent of Total Billed Charges,74% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3526.7,84,,,Percent of Total Billed Charges,84% of total billed charges,3442.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3736.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3232.81,77,,,Percent of total Billed charges,77% of total billed charges,3568.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1207.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2099.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.61,3736.62,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4093.74,2046.87,,3152.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1279.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3029.37,74,,,Percent of Total Billed Charges,74% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3438.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3356.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,3643.43,89,,,Percent of total Billed Charges,89% of total Billed charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3152.18,77,,,Percent of total Billed charges,77% of total billed charges,3479.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2046.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1023.44,3643.43,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4198.45,2099.23,,3232.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1312.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3106.85,74,,,Percent of Total Billed Charges,74% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3526.7,84,,,Percent of Total Billed Charges,84% of total billed charges,3442.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3736.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3232.81,77,,,Percent of total Billed charges,77% of total billed charges,3568.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1207.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2099.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.61,3736.62,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4093.74,2046.87,,3152.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1279.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3029.37,74,,,Percent of Total Billed Charges,74% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3438.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3356.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,3643.43,89,,,Percent of total Billed Charges,89% of total Billed charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3152.18,77,,,Percent of total Billed charges,77% of total billed charges,3479.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2046.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1023.44,3643.43,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4198.45,2099.23,,3232.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1312.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3106.85,74,,,Percent of Total Billed Charges,74% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3526.7,84,,,Percent of Total Billed Charges,84% of total billed charges,3442.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3736.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3232.81,77,,,Percent of total Billed charges,77% of total billed charges,3568.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1207.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2099.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.61,3736.62,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4093.74,2046.87,,3152.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1279.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3029.37,74,,,Percent of Total Billed Charges,74% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3438.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3356.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,3643.43,89,,,Percent of total Billed Charges,89% of total Billed charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3152.18,77,,,Percent of total Billed charges,77% of total billed charges,3479.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2046.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1023.44,3643.43,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4198.45,2099.23,,3232.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1312.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3106.85,74,,,Percent of Total Billed Charges,74% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3526.7,84,,,Percent of Total Billed Charges,84% of total billed charges,3442.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3736.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3232.81,77,,,Percent of total Billed charges,77% of total billed charges,3568.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1207.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2099.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.61,3736.62,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4093.74,2046.87,,3152.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1279.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3029.37,74,,,Percent of Total Billed Charges,74% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3438.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3356.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,3643.43,89,,,Percent of total Billed Charges,89% of total Billed charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3152.18,77,,,Percent of total Billed charges,77% of total billed charges,3479.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2046.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1023.44,3643.43,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4198.45,2099.23,,3232.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1070.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1312.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3106.85,74,,,Percent of Total Billed Charges,74% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2896.93,69,,,Percent of Total Billed Charges,69% of total billed charges,3526.7,84,,,Percent of Total Billed Charges,84% of total billed charges,3442.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,3736.62,89,,,Percent of total Billed Charges,89% of total Billed charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3232.81,77,,,Percent of total Billed charges,77% of total billed charges,3568.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1207.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2099.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1712.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3736.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1049.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1049.61,3736.62,
Pamidronate 90mg/10ml Liquid SDV,67457044610,CDM,250,RC,,,Outpatient,,,4093.74,2046.87,,3152.18,77,,,Percent of Total Billed Charges,77% of total billed charges,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1043.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1279.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3029.37,74,,,Percent of Total Billed Charges,74% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,2824.68,69,,,Percent of Total Billed Charges,69% of total billed charges,3438.74,84,,,Percent of Total Billed Charges,84% of total billed charges,3356.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,3643.43,89,,,Percent of total Billed Charges,89% of total Billed charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3152.18,77,,,Percent of total Billed charges,77% of total billed charges,3479.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1176.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2046.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1670.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3643.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1023.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1023.44,3643.43,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12338.27,6169.14,,9500.47,77,,,Percent of Total Billed Charges,77% of total billed charges,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3855.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9130.32,74,,,Percent of Total Billed Charges,74% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,10364.15,84,,,Percent of Total Billed Charges,84% of total billed charges,10117.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,10981.06,89,,,Percent of total Billed Charges,89% of total Billed charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9500.47,77,,,Percent of total Billed charges,77% of total billed charges,10487.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3547.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6169.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3084.57,10981.06,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12023.05,6011.53,,9257.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3757.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8897.06,74,,,Percent of Total Billed Charges,74% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,10099.36,84,,,Percent of Total Billed Charges,84% of total billed charges,9858.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,10700.51,89,,,Percent of total Billed Charges,89% of total Billed charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9257.75,77,,,Percent of total Billed charges,77% of total billed charges,10219.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3456.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6011.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3005.76,10700.51,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12338.27,6169.14,,9500.47,77,,,Percent of Total Billed Charges,77% of total billed charges,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3855.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9130.32,74,,,Percent of Total Billed Charges,74% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,10364.15,84,,,Percent of Total Billed Charges,84% of total billed charges,10117.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,10981.06,89,,,Percent of total Billed Charges,89% of total Billed charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9500.47,77,,,Percent of total Billed charges,77% of total billed charges,10487.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3547.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6169.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3084.57,10981.06,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12023.05,6011.53,,9257.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3757.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8897.06,74,,,Percent of Total Billed Charges,74% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,10099.36,84,,,Percent of Total Billed Charges,84% of total billed charges,9858.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,10700.51,89,,,Percent of total Billed Charges,89% of total Billed charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9257.75,77,,,Percent of total Billed charges,77% of total billed charges,10219.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3456.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6011.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3005.76,10700.51,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12338.27,6169.14,,9500.47,77,,,Percent of Total Billed Charges,77% of total billed charges,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3855.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9130.32,74,,,Percent of Total Billed Charges,74% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,10364.15,84,,,Percent of Total Billed Charges,84% of total billed charges,10117.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,10981.06,89,,,Percent of total Billed Charges,89% of total Billed charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9500.47,77,,,Percent of total Billed charges,77% of total billed charges,10487.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3547.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6169.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3084.57,10981.06,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12023.05,6011.53,,9257.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3757.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8897.06,74,,,Percent of Total Billed Charges,74% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,10099.36,84,,,Percent of Total Billed Charges,84% of total billed charges,9858.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,10700.51,89,,,Percent of total Billed Charges,89% of total Billed charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9257.75,77,,,Percent of total Billed charges,77% of total billed charges,10219.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3456.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6011.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3005.76,10700.51,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12338.27,6169.14,,9500.47,77,,,Percent of Total Billed Charges,77% of total billed charges,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3855.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9130.32,74,,,Percent of Total Billed Charges,74% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,10364.15,84,,,Percent of Total Billed Charges,84% of total billed charges,10117.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,10981.06,89,,,Percent of total Billed Charges,89% of total Billed charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9500.47,77,,,Percent of total Billed charges,77% of total billed charges,10487.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3547.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6169.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3084.57,10981.06,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12023.05,6011.53,,9257.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3757.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8897.06,74,,,Percent of Total Billed Charges,74% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,10099.36,84,,,Percent of Total Billed Charges,84% of total billed charges,9858.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,10700.51,89,,,Percent of total Billed Charges,89% of total Billed charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9257.75,77,,,Percent of total Billed charges,77% of total billed charges,10219.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3456.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6011.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3005.76,10700.51,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12338.27,6169.14,,9500.47,77,,,Percent of Total Billed Charges,77% of total billed charges,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3855.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9130.32,74,,,Percent of Total Billed Charges,74% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,10364.15,84,,,Percent of Total Billed Charges,84% of total billed charges,10117.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,10981.06,89,,,Percent of total Billed Charges,89% of total Billed charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9500.47,77,,,Percent of total Billed charges,77% of total billed charges,10487.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3547.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6169.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3084.57,10981.06,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12023.05,6011.53,,9257.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3757.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8897.06,74,,,Percent of Total Billed Charges,74% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,10099.36,84,,,Percent of Total Billed Charges,84% of total billed charges,9858.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,10700.51,89,,,Percent of total Billed Charges,89% of total Billed charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9257.75,77,,,Percent of total Billed charges,77% of total billed charges,10219.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3456.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6011.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3005.76,10700.51,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12338.27,6169.14,,9500.47,77,,,Percent of Total Billed Charges,77% of total billed charges,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3146.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3855.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9130.32,74,,,Percent of Total Billed Charges,74% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,8513.41,69,,,Percent of Total Billed Charges,69% of total billed charges,10364.15,84,,,Percent of Total Billed Charges,84% of total billed charges,10117.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,10981.06,89,,,Percent of total Billed Charges,89% of total Billed charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9500.47,77,,,Percent of total Billed charges,77% of total billed charges,10487.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3547.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6169.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5034.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10981.06,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3084.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3084.57,10981.06,
Panitumumab (Vectibix) 100mg/5ml Liquid SDV,55513095401,CDM,250,RC,,,Outpatient,,,12023.05,6011.53,,9257.75,77,,,Percent of Total Billed Charges,77% of total billed charges,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3065.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3757.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8897.06,74,,,Percent of Total Billed Charges,74% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,8295.9,69,,,Percent of Total Billed Charges,69% of total billed charges,10099.36,84,,,Percent of Total Billed Charges,84% of total billed charges,9858.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,10700.51,89,,,Percent of total Billed Charges,89% of total Billed charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9257.75,77,,,Percent of total Billed charges,77% of total billed charges,10219.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3456.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6011.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4905.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10700.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3005.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3005.76,10700.51,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32893.07,16446.54,,25327.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10279.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24340.87,74,,,Percent of Total Billed Charges,74% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,27630.18,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29274.83,89,,,Percent of total Billed Charges,89% of total Billed charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25327.66,77,,,Percent of total Billed charges,77% of total billed charges,27959.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9456.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16446.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8223.27,29274.83,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32046.25,16023.13,,24675.61,77,,,Percent of Total Billed Charges,77% of total billed charges,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10014.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23714.23,74,,,Percent of Total Billed Charges,74% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26918.85,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,28521.16,89,,,Percent of total Billed Charges,89% of total Billed charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24675.61,77,,,Percent of total Billed charges,77% of total billed charges,27239.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9213.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16023.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8011.56,28521.16,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32893.07,16446.54,,25327.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10279.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24340.87,74,,,Percent of Total Billed Charges,74% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,27630.18,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29274.83,89,,,Percent of total Billed Charges,89% of total Billed charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25327.66,77,,,Percent of total Billed charges,77% of total billed charges,27959.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9456.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16446.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8223.27,29274.83,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32046.25,16023.13,,24675.61,77,,,Percent of Total Billed Charges,77% of total billed charges,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10014.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23714.23,74,,,Percent of Total Billed Charges,74% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26918.85,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,28521.16,89,,,Percent of total Billed Charges,89% of total Billed charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24675.61,77,,,Percent of total Billed charges,77% of total billed charges,27239.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9213.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16023.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8011.56,28521.16,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32893.07,16446.54,,25327.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10279.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24340.87,74,,,Percent of Total Billed Charges,74% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,27630.18,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29274.83,89,,,Percent of total Billed Charges,89% of total Billed charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25327.66,77,,,Percent of total Billed charges,77% of total billed charges,27959.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9456.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16446.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8223.27,29274.83,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32046.25,16023.13,,24675.61,77,,,Percent of Total Billed Charges,77% of total billed charges,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10014.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23714.23,74,,,Percent of Total Billed Charges,74% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26918.85,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,28521.16,89,,,Percent of total Billed Charges,89% of total Billed charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24675.61,77,,,Percent of total Billed charges,77% of total billed charges,27239.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9213.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16023.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8011.56,28521.16,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32893.07,16446.54,,25327.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10279.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24340.87,74,,,Percent of Total Billed Charges,74% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,27630.18,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29274.83,89,,,Percent of total Billed Charges,89% of total Billed charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25327.66,77,,,Percent of total Billed charges,77% of total billed charges,27959.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9456.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16446.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8223.27,29274.83,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32046.25,16023.13,,24675.61,77,,,Percent of Total Billed Charges,77% of total billed charges,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10014.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23714.23,74,,,Percent of Total Billed Charges,74% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26918.85,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,28521.16,89,,,Percent of total Billed Charges,89% of total Billed charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24675.61,77,,,Percent of total Billed charges,77% of total billed charges,27239.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9213.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16023.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8011.56,28521.16,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32893.07,16446.54,,25327.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10279.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24340.87,74,,,Percent of Total Billed Charges,74% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,27630.18,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29274.83,89,,,Percent of total Billed Charges,89% of total Billed charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25327.66,77,,,Percent of total Billed charges,77% of total billed charges,27959.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9456.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16446.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8223.27,29274.83,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32046.25,16023.13,,24675.61,77,,,Percent of Total Billed Charges,77% of total billed charges,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10014.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23714.23,74,,,Percent of Total Billed Charges,74% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26918.85,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,28521.16,89,,,Percent of total Billed Charges,89% of total Billed charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24675.61,77,,,Percent of total Billed charges,77% of total billed charges,27239.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9213.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16023.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8011.56,28521.16,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32893.07,16446.54,,25327.66,77,,,Percent of Total Billed Charges,77% of total billed charges,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8387.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10279.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24340.87,74,,,Percent of Total Billed Charges,74% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,22696.22,69,,,Percent of Total Billed Charges,69% of total billed charges,27630.18,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,29274.83,89,,,Percent of total Billed Charges,89% of total Billed charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25327.66,77,,,Percent of total Billed charges,77% of total billed charges,27959.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9456.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16446.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13420.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29274.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8223.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8223.27,29274.83,
Panitumumab (Vectibix) 400mg/20ml Liquid SDV,55513095601,CDM,250,RC,,,Outpatient,,,32046.25,16023.13,,24675.61,77,,,Percent of Total Billed Charges,77% of total billed charges,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8171.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10014.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23714.23,74,,,Percent of Total Billed Charges,74% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,22111.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26918.85,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,28521.16,89,,,Percent of total Billed Charges,89% of total Billed charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24675.61,77,,,Percent of total Billed charges,77% of total billed charges,27239.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9213.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16023.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13074.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28521.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8011.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8011.56,28521.16,
Pantoprazole 40mg Tablet,,,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Pantoprazole 40mg Tablet,,,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Pantoprazole 40mg Tablet,,,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Pantoprazole 40mg Tablet,,,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Pantoprazole 40mg Tablet,,,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Pantoprazole 40mg Tablet,,,250,RC,,,Outpatient,,,7.82,3.91,,6.02,77,,,Percent of Total Billed Charges,77% of total billed charges,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.44,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.79,74,,,Percent of Total Billed Charges,74% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6.57,84,,,Percent of Total Billed Charges,84% of total billed charges,6.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.96,89,,,Percent of total Billed Charges,89% of total Billed charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.02,77,,,Percent of total Billed charges,77% of total billed charges,6.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.96,6.96,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
Pantoprazole 40mg SDV,62756012940,CDM,250,RC,,,Outpatient,,,122.24,61.12,,94.12,77,,,Percent of Total Billed Charges,77% of total billed charges,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.46,74,,,Percent of Total Billed Charges,74% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,84.35,69,,,Percent of Total Billed Charges,69% of total billed charges,102.68,84,,,Percent of Total Billed Charges,84% of total billed charges,100.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.79,89,,,Percent of total Billed Charges,89% of total Billed charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.12,77,,,Percent of total Billed charges,77% of total billed charges,103.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,61.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.56,108.79,
PARoxetine 20mg Tablet,904567761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
PARoxetine 20mg Tablet,904567761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
PARoxetine 20mg Tablet,904567761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
PARoxetine 20mg Tablet,904567761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
PARoxetine 20mg Tablet,904567761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
PARoxetine 20mg Tablet,904567761,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
Polyvitamin w/Iron Drops 50ml,87040501,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Polyvitamin w/Iron Drops 50ml,87040501,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Polyvitamin w/Iron Drops 50ml,87040501,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Polyvitamin w/Iron Drops 50ml,87040501,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Polyvitamin w/Iron Drops 50ml,87040501,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Polyvitamin w/Iron Drops 50ml,87040501,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Moviprep Oral Solution,65649020175,CDM,250,RC,,,Outpatient,,,438.68,219.34,,337.78,77,,,Percent of Total Billed Charges,77% of total billed charges,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.62,74,,,Percent of Total Billed Charges,74% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,368.49,84,,,Percent of Total Billed Charges,84% of total billed charges,359.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.43,89,,,Percent of total Billed Charges,89% of total Billed charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.78,77,,,Percent of total Billed charges,77% of total billed charges,372.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.67,390.43,
Moviprep Oral Solution,65649020175,CDM,250,RC,,,Outpatient,,,438.68,219.34,,337.78,77,,,Percent of Total Billed Charges,77% of total billed charges,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.62,74,,,Percent of Total Billed Charges,74% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,368.49,84,,,Percent of Total Billed Charges,84% of total billed charges,359.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.43,89,,,Percent of total Billed Charges,89% of total Billed charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.78,77,,,Percent of total Billed charges,77% of total billed charges,372.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.67,390.43,
Moviprep Oral Solution,65649020175,CDM,250,RC,,,Outpatient,,,438.68,219.34,,337.78,77,,,Percent of Total Billed Charges,77% of total billed charges,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.62,74,,,Percent of Total Billed Charges,74% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,368.49,84,,,Percent of Total Billed Charges,84% of total billed charges,359.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.43,89,,,Percent of total Billed Charges,89% of total Billed charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.78,77,,,Percent of total Billed charges,77% of total billed charges,372.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.67,390.43,
Moviprep Oral Solution,65649020175,CDM,250,RC,,,Outpatient,,,438.68,219.34,,337.78,77,,,Percent of Total Billed Charges,77% of total billed charges,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.62,74,,,Percent of Total Billed Charges,74% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,368.49,84,,,Percent of Total Billed Charges,84% of total billed charges,359.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.43,89,,,Percent of total Billed Charges,89% of total Billed charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.78,77,,,Percent of total Billed charges,77% of total billed charges,372.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.67,390.43,
Moviprep Oral Solution,65649020175,CDM,250,RC,,,Outpatient,,,438.68,219.34,,337.78,77,,,Percent of Total Billed Charges,77% of total billed charges,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.62,74,,,Percent of Total Billed Charges,74% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,368.49,84,,,Percent of Total Billed Charges,84% of total billed charges,359.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.43,89,,,Percent of total Billed Charges,89% of total Billed charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.78,77,,,Percent of total Billed charges,77% of total billed charges,372.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.67,390.43,
Moviprep Oral Solution,65649020175,CDM,250,RC,,,Outpatient,,,438.68,219.34,,337.78,77,,,Percent of Total Billed Charges,77% of total billed charges,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,111.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,137.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,324.62,74,,,Percent of Total Billed Charges,74% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,302.69,69,,,Percent of Total Billed Charges,69% of total billed charges,368.49,84,,,Percent of Total Billed Charges,84% of total billed charges,359.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,390.43,89,,,Percent of total Billed Charges,89% of total Billed charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.78,77,,,Percent of total Billed charges,77% of total billed charges,372.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,126.12,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,219.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,178.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,390.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,109.67,390.43,
"PEG (Golytely) Oral Soln 4,000ml",52268010001,CDM,250,RC,,,Outpatient,,,209.62,104.81,,161.41,77,,,Percent of Total Billed Charges,77% of total billed charges,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.12,74,,,Percent of Total Billed Charges,74% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.08,84,,,Percent of Total Billed Charges,84% of total billed charges,171.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.56,89,,,Percent of total Billed Charges,89% of total Billed charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.41,77,,,Percent of total Billed charges,77% of total billed charges,178.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.41,186.56,
"PEG (Golytely) Oral Soln 4,000ml",52268010001,CDM,250,RC,,,Outpatient,,,209.62,104.81,,161.41,77,,,Percent of Total Billed Charges,77% of total billed charges,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.12,74,,,Percent of Total Billed Charges,74% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.08,84,,,Percent of Total Billed Charges,84% of total billed charges,171.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.56,89,,,Percent of total Billed Charges,89% of total Billed charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.41,77,,,Percent of total Billed charges,77% of total billed charges,178.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.41,186.56,
"PEG (Golytely) Oral Soln 4,000ml",52268010001,CDM,250,RC,,,Outpatient,,,209.62,104.81,,161.41,77,,,Percent of Total Billed Charges,77% of total billed charges,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.12,74,,,Percent of Total Billed Charges,74% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.08,84,,,Percent of Total Billed Charges,84% of total billed charges,171.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.56,89,,,Percent of total Billed Charges,89% of total Billed charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.41,77,,,Percent of total Billed charges,77% of total billed charges,178.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.41,186.56,
"PEG (Golytely) Oral Soln 4,000ml",52268010001,CDM,250,RC,,,Outpatient,,,209.62,104.81,,161.41,77,,,Percent of Total Billed Charges,77% of total billed charges,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.12,74,,,Percent of Total Billed Charges,74% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.08,84,,,Percent of Total Billed Charges,84% of total billed charges,171.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.56,89,,,Percent of total Billed Charges,89% of total Billed charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.41,77,,,Percent of total Billed charges,77% of total billed charges,178.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.41,186.56,
"PEG (Golytely) Oral Soln 4,000ml",52268010001,CDM,250,RC,,,Outpatient,,,209.62,104.81,,161.41,77,,,Percent of Total Billed Charges,77% of total billed charges,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.12,74,,,Percent of Total Billed Charges,74% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.08,84,,,Percent of Total Billed Charges,84% of total billed charges,171.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.56,89,,,Percent of total Billed Charges,89% of total Billed charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.41,77,,,Percent of total Billed charges,77% of total billed charges,178.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.41,186.56,
"PEG (Golytely) Oral Soln 4,000ml",52268010001,CDM,250,RC,,,Outpatient,,,209.62,104.81,,161.41,77,,,Percent of Total Billed Charges,77% of total billed charges,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.12,74,,,Percent of Total Billed Charges,74% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,144.64,69,,,Percent of Total Billed Charges,69% of total billed charges,176.08,84,,,Percent of Total Billed Charges,84% of total billed charges,171.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.56,89,,,Percent of total Billed Charges,89% of total Billed charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.41,77,,,Percent of total Billed charges,77% of total billed charges,178.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.52,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.41,186.56,
Pegfilgrastim (Neulasta) 6mg Syringe,55513019001,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) 6mg Syringe,55513019001,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) 6mg Syringe,55513019001,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) 6mg Syringe,55513019001,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) 6mg Syringe,55513019001,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) 6mg Syringe,55513019001,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) Onpro 6mg Kit,55513019201,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) Onpro 6mg Kit,55513019201,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) Onpro 6mg Kit,55513019201,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) Onpro 6mg Kit,55513019201,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) Onpro 6mg Kit,55513019201,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim (Neulasta) Onpro 6mg Kit,55513019201,CDM,250,RC,,,Outpatient,,,28628.29,14314.15,,22043.78,77,,,Percent of Total Billed Charges,77% of total billed charges,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7300.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8946.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21184.93,74,,,Percent of Total Billed Charges,74% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,19753.52,69,,,Percent of Total Billed Charges,69% of total billed charges,24047.76,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25479.18,89,,,Percent of total Billed Charges,89% of total Billed charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22043.78,77,,,Percent of total Billed charges,77% of total billed charges,24334.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8230.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14314.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11680.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25479.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7157.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7157.07,25479.18,
Pegfilgrastim-JMDB 6mg Syringe (Fulphila),83257000541,CDM,250,RC,,,Outpatient,,,9953.94,4976.97,,7664.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3110.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7365.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8361.31,84,,,Percent of Total Billed Charges,84% of total billed charges,8162.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,8859.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7664.53,77,,,Percent of total Billed charges,77% of total billed charges,8460.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2861.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4976.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2488.49,8859.01,
Pegfilgrastim-JMDB 6mg Syringe (Fulphila),83257000541,CDM,250,RC,,,Outpatient,,,9953.94,4976.97,,7664.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3110.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7365.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8361.31,84,,,Percent of Total Billed Charges,84% of total billed charges,8162.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,8859.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7664.53,77,,,Percent of total Billed charges,77% of total billed charges,8460.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2861.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4976.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2488.49,8859.01,
Pegfilgrastim-JMDB 6mg Syringe (Fulphila),83257000541,CDM,250,RC,,,Outpatient,,,9953.94,4976.97,,7664.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3110.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7365.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8361.31,84,,,Percent of Total Billed Charges,84% of total billed charges,8162.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,8859.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7664.53,77,,,Percent of total Billed charges,77% of total billed charges,8460.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2861.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4976.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2488.49,8859.01,
Pegfilgrastim-JMDB 6mg Syringe (Fulphila),83257000541,CDM,250,RC,,,Outpatient,,,9953.94,4976.97,,7664.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3110.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7365.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8361.31,84,,,Percent of Total Billed Charges,84% of total billed charges,8162.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,8859.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7664.53,77,,,Percent of total Billed charges,77% of total billed charges,8460.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2861.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4976.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2488.49,8859.01,
Pegfilgrastim-JMDB 6mg Syringe (Fulphila),83257000541,CDM,250,RC,,,Outpatient,,,9953.94,4976.97,,7664.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3110.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7365.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8361.31,84,,,Percent of Total Billed Charges,84% of total billed charges,8162.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,8859.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7664.53,77,,,Percent of total Billed charges,77% of total billed charges,8460.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2861.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4976.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2488.49,8859.01,
Pegfilgrastim-JMDB 6mg Syringe (Fulphila),83257000541,CDM,250,RC,,,Outpatient,,,9953.94,4976.97,,7664.53,77,,,Percent of Total Billed Charges,77% of total billed charges,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2538.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3110.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7365.92,74,,,Percent of Total Billed Charges,74% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6868.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8361.31,84,,,Percent of Total Billed Charges,84% of total billed charges,8162.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,8859.01,89,,,Percent of total Billed Charges,89% of total Billed charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7664.53,77,,,Percent of total Billed charges,77% of total billed charges,8460.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2861.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4976.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4061.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8859.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2488.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2488.49,8859.01,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,27582,13791,,21238.14,77,,,Percent of Total Billed Charges,77% of total billed charges,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8619.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20410.68,74,,,Percent of Total Billed Charges,74% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,23168.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24547.98,89,,,Percent of total Billed Charges,89% of total Billed charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21238.14,77,,,Percent of total Billed charges,77% of total billed charges,23444.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7929.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13791,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6895.5,24547.98,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,26872.54,13436.27,,20691.86,77,,,Percent of Total Billed Charges,77% of total billed charges,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8397.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19885.68,74,,,Percent of Total Billed Charges,74% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,22572.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23916.56,89,,,Percent of total Billed Charges,89% of total Billed charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20691.86,77,,,Percent of total Billed charges,77% of total billed charges,22841.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7725.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13436.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6718.14,23916.56,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,27582,13791,,21238.14,77,,,Percent of Total Billed Charges,77% of total billed charges,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8619.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20410.68,74,,,Percent of Total Billed Charges,74% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,23168.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24547.98,89,,,Percent of total Billed Charges,89% of total Billed charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21238.14,77,,,Percent of total Billed charges,77% of total billed charges,23444.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7929.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13791,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6895.5,24547.98,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,26872.54,13436.27,,20691.86,77,,,Percent of Total Billed Charges,77% of total billed charges,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8397.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19885.68,74,,,Percent of Total Billed Charges,74% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,22572.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23916.56,89,,,Percent of total Billed Charges,89% of total Billed charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20691.86,77,,,Percent of total Billed charges,77% of total billed charges,22841.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7725.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13436.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6718.14,23916.56,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,27582,13791,,21238.14,77,,,Percent of Total Billed Charges,77% of total billed charges,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8619.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20410.68,74,,,Percent of Total Billed Charges,74% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,23168.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24547.98,89,,,Percent of total Billed Charges,89% of total Billed charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21238.14,77,,,Percent of total Billed charges,77% of total billed charges,23444.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7929.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13791,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6895.5,24547.98,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,26872.54,13436.27,,20691.86,77,,,Percent of Total Billed Charges,77% of total billed charges,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8397.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19885.68,74,,,Percent of Total Billed Charges,74% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,22572.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23916.56,89,,,Percent of total Billed Charges,89% of total Billed charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20691.86,77,,,Percent of total Billed charges,77% of total billed charges,22841.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7725.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13436.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6718.14,23916.56,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,27582,13791,,21238.14,77,,,Percent of Total Billed Charges,77% of total billed charges,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8619.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20410.68,74,,,Percent of Total Billed Charges,74% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,23168.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24547.98,89,,,Percent of total Billed Charges,89% of total Billed charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21238.14,77,,,Percent of total Billed charges,77% of total billed charges,23444.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7929.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13791,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6895.5,24547.98,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,26872.54,13436.27,,20691.86,77,,,Percent of Total Billed Charges,77% of total billed charges,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8397.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19885.68,74,,,Percent of Total Billed Charges,74% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,22572.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23916.56,89,,,Percent of total Billed Charges,89% of total Billed charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20691.86,77,,,Percent of total Billed charges,77% of total billed charges,22841.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7725.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13436.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6718.14,23916.56,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,27582,13791,,21238.14,77,,,Percent of Total Billed Charges,77% of total billed charges,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8619.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20410.68,74,,,Percent of Total Billed Charges,74% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,23168.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24547.98,89,,,Percent of total Billed Charges,89% of total Billed charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21238.14,77,,,Percent of total Billed charges,77% of total billed charges,23444.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7929.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13791,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6895.5,24547.98,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,26872.54,13436.27,,20691.86,77,,,Percent of Total Billed Charges,77% of total billed charges,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8397.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19885.68,74,,,Percent of Total Billed Charges,74% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,22572.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23916.56,89,,,Percent of total Billed Charges,89% of total Billed charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20691.86,77,,,Percent of total Billed charges,77% of total billed charges,22841.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7725.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13436.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6718.14,23916.56,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,27582,13791,,21238.14,77,,,Percent of Total Billed Charges,77% of total billed charges,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7033.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8619.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20410.68,74,,,Percent of Total Billed Charges,74% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,19031.58,69,,,Percent of Total Billed Charges,69% of total billed charges,23168.88,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24547.98,89,,,Percent of total Billed Charges,89% of total Billed charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21238.14,77,,,Percent of total Billed charges,77% of total billed charges,23444.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7929.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13791,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11253.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24547.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6895.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6895.5,24547.98,
Pembrolizumab (Keytruda) 100mg/4ml Liquid SDV,6302602,CDM,250,RC,,,Outpatient,,,26872.54,13436.27,,20691.86,77,,,Percent of Total Billed Charges,77% of total billed charges,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6852.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8397.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19885.68,74,,,Percent of Total Billed Charges,74% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,18542.05,69,,,Percent of Total Billed Charges,69% of total billed charges,22572.93,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23916.56,89,,,Percent of total Billed Charges,89% of total Billed charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20691.86,77,,,Percent of total Billed charges,77% of total billed charges,22841.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7725.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13436.27,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10964,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23916.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6718.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6718.14,23916.56,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1062.05,531.03,,817.78,77,,,Percent of Total Billed Charges,77% of total billed charges,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.92,74,,,Percent of Total Billed Charges,74% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,892.12,84,,,Percent of Total Billed Charges,84% of total billed charges,870.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,945.22,89,,,Percent of total Billed Charges,89% of total Billed charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.78,77,,,Percent of total Billed charges,77% of total billed charges,902.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,531.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.51,945.22,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1039.21,519.61,,800.19,77,,,Percent of Total Billed Charges,77% of total billed charges,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.02,74,,,Percent of Total Billed Charges,74% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,872.94,84,,,Percent of Total Billed Charges,84% of total billed charges,852.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,924.9,89,,,Percent of total Billed Charges,89% of total Billed charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.19,77,,,Percent of total Billed charges,77% of total billed charges,883.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,298.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,519.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.8,924.9,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1062.05,531.03,,817.78,77,,,Percent of Total Billed Charges,77% of total billed charges,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.92,74,,,Percent of Total Billed Charges,74% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,892.12,84,,,Percent of Total Billed Charges,84% of total billed charges,870.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,945.22,89,,,Percent of total Billed Charges,89% of total Billed charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.78,77,,,Percent of total Billed charges,77% of total billed charges,902.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,531.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.51,945.22,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1039.21,519.61,,800.19,77,,,Percent of Total Billed Charges,77% of total billed charges,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.02,74,,,Percent of Total Billed Charges,74% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,872.94,84,,,Percent of Total Billed Charges,84% of total billed charges,852.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,924.9,89,,,Percent of total Billed Charges,89% of total Billed charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.19,77,,,Percent of total Billed charges,77% of total billed charges,883.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,298.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,519.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.8,924.9,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1062.05,531.03,,817.78,77,,,Percent of Total Billed Charges,77% of total billed charges,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.92,74,,,Percent of Total Billed Charges,74% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,892.12,84,,,Percent of Total Billed Charges,84% of total billed charges,870.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,945.22,89,,,Percent of total Billed Charges,89% of total Billed charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.78,77,,,Percent of total Billed charges,77% of total billed charges,902.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,531.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.51,945.22,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1039.21,519.61,,800.19,77,,,Percent of Total Billed Charges,77% of total billed charges,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.02,74,,,Percent of Total Billed Charges,74% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,872.94,84,,,Percent of Total Billed Charges,84% of total billed charges,852.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,924.9,89,,,Percent of total Billed Charges,89% of total Billed charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.19,77,,,Percent of total Billed charges,77% of total billed charges,883.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,298.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,519.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.8,924.9,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1062.05,531.03,,817.78,77,,,Percent of Total Billed Charges,77% of total billed charges,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.92,74,,,Percent of Total Billed Charges,74% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,892.12,84,,,Percent of Total Billed Charges,84% of total billed charges,870.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,945.22,89,,,Percent of total Billed Charges,89% of total Billed charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.78,77,,,Percent of total Billed charges,77% of total billed charges,902.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,531.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.51,945.22,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1039.21,519.61,,800.19,77,,,Percent of Total Billed Charges,77% of total billed charges,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.02,74,,,Percent of Total Billed Charges,74% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,872.94,84,,,Percent of Total Billed Charges,84% of total billed charges,852.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,924.9,89,,,Percent of total Billed Charges,89% of total Billed charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.19,77,,,Percent of total Billed charges,77% of total billed charges,883.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,298.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,519.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.8,924.9,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1062.05,531.03,,817.78,77,,,Percent of Total Billed Charges,77% of total billed charges,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.92,74,,,Percent of Total Billed Charges,74% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,892.12,84,,,Percent of Total Billed Charges,84% of total billed charges,870.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,945.22,89,,,Percent of total Billed Charges,89% of total Billed charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.78,77,,,Percent of total Billed charges,77% of total billed charges,902.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,531.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.51,945.22,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1039.21,519.61,,800.19,77,,,Percent of Total Billed Charges,77% of total billed charges,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.02,74,,,Percent of Total Billed Charges,74% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,872.94,84,,,Percent of Total Billed Charges,84% of total billed charges,852.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,924.9,89,,,Percent of total Billed Charges,89% of total Billed charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.19,77,,,Percent of total Billed charges,77% of total billed charges,883.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,298.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,519.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.8,924.9,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1062.05,531.03,,817.78,77,,,Percent of Total Billed Charges,77% of total billed charges,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,270.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,331.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,785.92,74,,,Percent of Total Billed Charges,74% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,732.81,69,,,Percent of Total Billed Charges,69% of total billed charges,892.12,84,,,Percent of Total Billed Charges,84% of total billed charges,870.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,945.22,89,,,Percent of total Billed Charges,89% of total Billed charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,817.78,77,,,Percent of total Billed charges,77% of total billed charges,902.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,305.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,531.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,433.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,945.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,265.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.51,945.22,
PEMEtrexed 100mg/4ml Powder SDV,,,250,RC,,,Outpatient,,,1039.21,519.61,,800.19,77,,,Percent of Total Billed Charges,77% of total billed charges,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,265,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,324.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,769.02,74,,,Percent of Total Billed Charges,74% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,717.05,69,,,Percent of Total Billed Charges,69% of total billed charges,872.94,84,,,Percent of Total Billed Charges,84% of total billed charges,852.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,924.9,89,,,Percent of total Billed Charges,89% of total Billed charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,800.19,77,,,Percent of total Billed charges,77% of total billed charges,883.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,298.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,519.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,424,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,924.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,259.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,259.8,924.9,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3297.49,1648.75,,2539.07,77,,,Percent of Total Billed Charges,77% of total billed charges,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1030.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2440.14,74,,,Percent of Total Billed Charges,74% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2769.89,84,,,Percent of Total Billed Charges,84% of total billed charges,2703.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,2934.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2539.07,77,,,Percent of total Billed charges,77% of total billed charges,2802.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,948.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1648.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.37,2934.77,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3216.84,1608.42,,2476.97,77,,,Percent of Total Billed Charges,77% of total billed charges,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2380.46,74,,,Percent of Total Billed Charges,74% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2702.15,84,,,Percent of Total Billed Charges,84% of total billed charges,2637.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,2862.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.97,77,,,Percent of total Billed charges,77% of total billed charges,2734.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1608.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.21,2862.99,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3297.49,1648.75,,2539.07,77,,,Percent of Total Billed Charges,77% of total billed charges,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1030.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2440.14,74,,,Percent of Total Billed Charges,74% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2769.89,84,,,Percent of Total Billed Charges,84% of total billed charges,2703.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,2934.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2539.07,77,,,Percent of total Billed charges,77% of total billed charges,2802.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,948.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1648.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.37,2934.77,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3216.84,1608.42,,2476.97,77,,,Percent of Total Billed Charges,77% of total billed charges,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2380.46,74,,,Percent of Total Billed Charges,74% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2702.15,84,,,Percent of Total Billed Charges,84% of total billed charges,2637.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,2862.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.97,77,,,Percent of total Billed charges,77% of total billed charges,2734.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1608.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.21,2862.99,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3297.49,1648.75,,2539.07,77,,,Percent of Total Billed Charges,77% of total billed charges,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1030.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2440.14,74,,,Percent of Total Billed Charges,74% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2769.89,84,,,Percent of Total Billed Charges,84% of total billed charges,2703.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,2934.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2539.07,77,,,Percent of total Billed charges,77% of total billed charges,2802.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,948.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1648.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.37,2934.77,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3216.84,1608.42,,2476.97,77,,,Percent of Total Billed Charges,77% of total billed charges,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2380.46,74,,,Percent of Total Billed Charges,74% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2702.15,84,,,Percent of Total Billed Charges,84% of total billed charges,2637.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,2862.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.97,77,,,Percent of total Billed charges,77% of total billed charges,2734.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1608.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.21,2862.99,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3297.49,1648.75,,2539.07,77,,,Percent of Total Billed Charges,77% of total billed charges,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1030.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2440.14,74,,,Percent of Total Billed Charges,74% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2769.89,84,,,Percent of Total Billed Charges,84% of total billed charges,2703.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,2934.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2539.07,77,,,Percent of total Billed charges,77% of total billed charges,2802.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,948.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1648.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.37,2934.77,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3216.84,1608.42,,2476.97,77,,,Percent of Total Billed Charges,77% of total billed charges,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2380.46,74,,,Percent of Total Billed Charges,74% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2702.15,84,,,Percent of Total Billed Charges,84% of total billed charges,2637.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,2862.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.97,77,,,Percent of total Billed charges,77% of total billed charges,2734.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1608.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.21,2862.99,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3297.49,1648.75,,2539.07,77,,,Percent of Total Billed Charges,77% of total billed charges,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1030.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2440.14,74,,,Percent of Total Billed Charges,74% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2769.89,84,,,Percent of Total Billed Charges,84% of total billed charges,2703.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,2934.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2539.07,77,,,Percent of total Billed charges,77% of total billed charges,2802.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,948.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1648.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.37,2934.77,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3216.84,1608.42,,2476.97,77,,,Percent of Total Billed Charges,77% of total billed charges,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2380.46,74,,,Percent of Total Billed Charges,74% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2702.15,84,,,Percent of Total Billed Charges,84% of total billed charges,2637.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,2862.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.97,77,,,Percent of total Billed charges,77% of total billed charges,2734.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1608.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.21,2862.99,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3297.49,1648.75,,2539.07,77,,,Percent of Total Billed Charges,77% of total billed charges,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,840.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1030.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2440.14,74,,,Percent of Total Billed Charges,74% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2275.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2769.89,84,,,Percent of Total Billed Charges,84% of total billed charges,2703.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,2934.77,89,,,Percent of total Billed Charges,89% of total Billed charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2539.07,77,,,Percent of total Billed charges,77% of total billed charges,2802.87,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,948.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1648.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1345.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2934.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,824.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,824.37,2934.77,
PEMEtrexed 500mg/20ml Powder SDV,,,250,RC,,,Outpatient,,,3216.84,1608.42,,2476.97,77,,,Percent of Total Billed Charges,77% of total billed charges,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,820.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1005.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2380.46,74,,,Percent of Total Billed Charges,74% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2219.62,69,,,Percent of Total Billed Charges,69% of total billed charges,2702.15,84,,,Percent of Total Billed Charges,84% of total billed charges,2637.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,2862.99,89,,,Percent of total Billed Charges,89% of total Billed charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2476.97,77,,,Percent of total Billed charges,77% of total billed charges,2734.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,924.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1608.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1312.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2862.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,804.21,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,804.21,2862.99,
"Penicillin G Benzathine 1,200,000unit/2ml Syringe",60793070110,CDM,250,RC,,,Outpatient,,,1398.55,699.28,,1076.88,77,,,Percent of Total Billed Charges,77% of total billed charges,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1034.93,74,,,Percent of Total Billed Charges,74% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,1174.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1146.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1244.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.88,77,,,Percent of total Billed charges,77% of total billed charges,1188.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,699.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.64,1244.71,
"Penicillin G Benzathine 1,200,000unit/2ml Syringe",60793070110,CDM,250,RC,,,Outpatient,,,1398.55,699.28,,1076.88,77,,,Percent of Total Billed Charges,77% of total billed charges,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1034.93,74,,,Percent of Total Billed Charges,74% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,1174.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1146.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1244.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.88,77,,,Percent of total Billed charges,77% of total billed charges,1188.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,699.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.64,1244.71,
"Penicillin G Benzathine 1,200,000unit/2ml Syringe",60793070110,CDM,250,RC,,,Outpatient,,,1398.55,699.28,,1076.88,77,,,Percent of Total Billed Charges,77% of total billed charges,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1034.93,74,,,Percent of Total Billed Charges,74% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,1174.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1146.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1244.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.88,77,,,Percent of total Billed charges,77% of total billed charges,1188.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,699.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.64,1244.71,
"Penicillin G Benzathine 1,200,000unit/2ml Syringe",60793070110,CDM,250,RC,,,Outpatient,,,1398.55,699.28,,1076.88,77,,,Percent of Total Billed Charges,77% of total billed charges,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1034.93,74,,,Percent of Total Billed Charges,74% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,1174.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1146.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1244.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.88,77,,,Percent of total Billed charges,77% of total billed charges,1188.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,699.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.64,1244.71,
"Penicillin G Benzathine 1,200,000unit/2ml Syringe",60793070110,CDM,250,RC,,,Outpatient,,,1398.55,699.28,,1076.88,77,,,Percent of Total Billed Charges,77% of total billed charges,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1034.93,74,,,Percent of Total Billed Charges,74% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,1174.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1146.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1244.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.88,77,,,Percent of total Billed charges,77% of total billed charges,1188.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,699.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.64,1244.71,
"Penicillin G Benzathine 1,200,000unit/2ml Syringe",60793070110,CDM,250,RC,,,Outpatient,,,1398.55,699.28,,1076.88,77,,,Percent of Total Billed Charges,77% of total billed charges,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,356.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,437.05,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1034.93,74,,,Percent of Total Billed Charges,74% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,965,69,,,Percent of Total Billed Charges,69% of total billed charges,965,69,,,Percent of Total Billed Charges,69% of total billed charges,1174.78,84,,,Percent of Total Billed Charges,84% of total billed charges,1146.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1244.71,89,,,Percent of total Billed Charges,89% of total Billed charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1076.88,77,,,Percent of total Billed charges,77% of total billed charges,1188.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,402.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,699.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,570.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1244.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,349.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,349.64,1244.71,
Penicillin VK Susp 250mg/5ml 200ml,93412774,CDM,250,RC,,,Outpatient,,,137.66,68.83,,106,77,,,Percent of Total Billed Charges,77% of total billed charges,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.87,74,,,Percent of Total Billed Charges,74% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,115.63,84,,,Percent of Total Billed Charges,84% of total billed charges,112.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.52,89,,,Percent of total Billed Charges,89% of total Billed charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106,77,,,Percent of total Billed charges,77% of total billed charges,117.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.42,122.52,
Penicillin VK Susp 250mg/5ml 200ml,93412774,CDM,250,RC,,,Outpatient,,,137.66,68.83,,106,77,,,Percent of Total Billed Charges,77% of total billed charges,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.87,74,,,Percent of Total Billed Charges,74% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,115.63,84,,,Percent of Total Billed Charges,84% of total billed charges,112.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.52,89,,,Percent of total Billed Charges,89% of total Billed charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106,77,,,Percent of total Billed charges,77% of total billed charges,117.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.42,122.52,
Penicillin VK Susp 250mg/5ml 200ml,93412774,CDM,250,RC,,,Outpatient,,,137.66,68.83,,106,77,,,Percent of Total Billed Charges,77% of total billed charges,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.87,74,,,Percent of Total Billed Charges,74% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,115.63,84,,,Percent of Total Billed Charges,84% of total billed charges,112.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.52,89,,,Percent of total Billed Charges,89% of total Billed charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106,77,,,Percent of total Billed charges,77% of total billed charges,117.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.42,122.52,
Penicillin VK Susp 250mg/5ml 200ml,93412774,CDM,250,RC,,,Outpatient,,,137.66,68.83,,106,77,,,Percent of Total Billed Charges,77% of total billed charges,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.87,74,,,Percent of Total Billed Charges,74% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,115.63,84,,,Percent of Total Billed Charges,84% of total billed charges,112.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.52,89,,,Percent of total Billed Charges,89% of total Billed charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106,77,,,Percent of total Billed charges,77% of total billed charges,117.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.42,122.52,
Penicillin VK Susp 250mg/5ml 200ml,93412774,CDM,250,RC,,,Outpatient,,,137.66,68.83,,106,77,,,Percent of Total Billed Charges,77% of total billed charges,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.87,74,,,Percent of Total Billed Charges,74% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,115.63,84,,,Percent of Total Billed Charges,84% of total billed charges,112.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.52,89,,,Percent of total Billed Charges,89% of total Billed charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106,77,,,Percent of total Billed charges,77% of total billed charges,117.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.42,122.52,
Penicillin VK Susp 250mg/5ml 200ml,93412774,CDM,250,RC,,,Outpatient,,,137.66,68.83,,106,77,,,Percent of Total Billed Charges,77% of total billed charges,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,101.87,74,,,Percent of Total Billed Charges,74% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,94.99,69,,,Percent of Total Billed Charges,69% of total billed charges,115.63,84,,,Percent of Total Billed Charges,84% of total billed charges,112.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,122.52,89,,,Percent of total Billed Charges,89% of total Billed charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106,77,,,Percent of total Billed charges,77% of total billed charges,117.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,39.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,68.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.42,122.52,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin G Potassium 5MU SDV,49052083,CDM,250,RC,,,Outpatient,,,144.61,72.31,,111.35,77,,,Percent of Total Billed Charges,77% of total billed charges,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.01,74,,,Percent of Total Billed Charges,74% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,99.78,69,,,Percent of Total Billed Charges,69% of total billed charges,121.47,84,,,Percent of Total Billed Charges,84% of total billed charges,118.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.7,89,,,Percent of total Billed Charges,89% of total Billed charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.35,77,,,Percent of total Billed charges,77% of total billed charges,122.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.15,128.7,
Penicillin VK 500mg Tablet,93117401,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Penicillin VK 500mg Tablet,93117401,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Penicillin VK 500mg Tablet,93117401,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Penicillin VK 500mg Tablet,93117401,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Penicillin VK 500mg Tablet,93117401,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Penicillin VK 500mg Tablet,93117401,CDM,250,RC,,,Outpatient,,,23.96,11.98,,18.45,77,,,Percent of Total Billed Charges,77% of total billed charges,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17.73,74,,,Percent of Total Billed Charges,74% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,16.53,69,,,Percent of Total Billed Charges,69% of total billed charges,20.13,84,,,Percent of Total Billed Charges,84% of total billed charges,19.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.32,89,,,Percent of total Billed Charges,89% of total Billed charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.45,77,,,Percent of total Billed charges,77% of total billed charges,20.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.89,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.99,21.32,
Pentoxifylline 400mg ER Tablet,904544861,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Pentoxifylline 400mg ER Tablet,904544861,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Pentoxifylline 400mg ER Tablet,904544861,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Pentoxifylline 400mg ER Tablet,904544861,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Pentoxifylline 400mg ER Tablet,904544861,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Pentoxifylline 400mg ER Tablet,904544861,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1450.57,725.29,,1116.94,77,,,Percent of Total Billed Charges,77% of total billed charges,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1073.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1218.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1189.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1291.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.94,77,,,Percent of total Billed charges,77% of total billed charges,1232.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,725.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.64,1291.01,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1509.35,754.68,,1162.2,77,,,Percent of Total Billed Charges,77% of total billed charges,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1237.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1343.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.2,77,,,Percent of total Billed charges,77% of total billed charges,1282.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,754.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.34,1343.32,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1450.57,725.29,,1116.94,77,,,Percent of Total Billed Charges,77% of total billed charges,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1073.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1218.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1189.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1291.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.94,77,,,Percent of total Billed charges,77% of total billed charges,1232.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,725.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.64,1291.01,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1509.35,754.68,,1162.2,77,,,Percent of Total Billed Charges,77% of total billed charges,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1237.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1343.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.2,77,,,Percent of total Billed charges,77% of total billed charges,1282.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,754.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.34,1343.32,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1450.57,725.29,,1116.94,77,,,Percent of Total Billed Charges,77% of total billed charges,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1073.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1218.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1189.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1291.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.94,77,,,Percent of total Billed charges,77% of total billed charges,1232.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,725.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.64,1291.01,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1509.35,754.68,,1162.2,77,,,Percent of Total Billed Charges,77% of total billed charges,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1237.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1343.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.2,77,,,Percent of total Billed charges,77% of total billed charges,1282.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,754.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.34,1343.32,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1450.57,725.29,,1116.94,77,,,Percent of Total Billed Charges,77% of total billed charges,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1073.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1218.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1189.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1291.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.94,77,,,Percent of total Billed charges,77% of total billed charges,1232.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,725.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.64,1291.01,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1509.35,754.68,,1162.2,77,,,Percent of Total Billed Charges,77% of total billed charges,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1237.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1343.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.2,77,,,Percent of total Billed charges,77% of total billed charges,1282.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,754.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.34,1343.32,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1450.57,725.29,,1116.94,77,,,Percent of Total Billed Charges,77% of total billed charges,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1073.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1218.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1189.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1291.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.94,77,,,Percent of total Billed charges,77% of total billed charges,1232.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,725.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.64,1291.01,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1509.35,754.68,,1162.2,77,,,Percent of Total Billed Charges,77% of total billed charges,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1237.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1343.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.2,77,,,Percent of total Billed charges,77% of total billed charges,1282.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,754.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.34,1343.32,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1450.57,725.29,,1116.94,77,,,Percent of Total Billed Charges,77% of total billed charges,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,369.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1073.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1000.89,69,,,Percent of Total Billed Charges,69% of total billed charges,1218.48,84,,,Percent of Total Billed Charges,84% of total billed charges,1189.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,1291.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1116.94,77,,,Percent of total Billed charges,77% of total billed charges,1232.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,417.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,725.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,591.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1291.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,362.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,362.64,1291.01,
Peramivir 200mg/20ml SDV,61364018103,CDM,250,RC,,,Outpatient,,,1509.35,754.68,,1162.2,77,,,Percent of Total Billed Charges,77% of total billed charges,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,384.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,471.67,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1116.92,74,,,Percent of Total Billed Charges,74% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1041.45,69,,,Percent of Total Billed Charges,69% of total billed charges,1267.85,84,,,Percent of Total Billed Charges,84% of total billed charges,1237.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,1343.32,89,,,Percent of total Billed Charges,89% of total Billed charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1162.2,77,,,Percent of total Billed charges,77% of total billed charges,1282.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,433.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,754.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,615.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1343.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,377.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.34,1343.32,
Permethrin 1% Lotion 59ml,63736012002,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Permethrin 1% Lotion 59ml,63736012002,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Permethrin 1% Lotion 59ml,63736012002,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Permethrin 1% Lotion 59ml,63736012002,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Permethrin 1% Lotion 59ml,63736012002,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Permethrin 1% Lotion 59ml,63736012002,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Permethrin 5% Cream 60gm,472024260,CDM,250,RC,,,Outpatient,,,431.34,215.67,,332.13,77,,,Percent of Total Billed Charges,77% of total billed charges,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.19,74,,,Percent of Total Billed Charges,74% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,362.33,84,,,Percent of Total Billed Charges,84% of total billed charges,353.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,383.89,89,,,Percent of total Billed Charges,89% of total Billed charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.13,77,,,Percent of total Billed charges,77% of total billed charges,366.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,215.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.84,383.89,
Permethrin 5% Cream 60gm,472024260,CDM,250,RC,,,Outpatient,,,431.34,215.67,,332.13,77,,,Percent of Total Billed Charges,77% of total billed charges,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.19,74,,,Percent of Total Billed Charges,74% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,362.33,84,,,Percent of Total Billed Charges,84% of total billed charges,353.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,383.89,89,,,Percent of total Billed Charges,89% of total Billed charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.13,77,,,Percent of total Billed charges,77% of total billed charges,366.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,215.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.84,383.89,
Permethrin 5% Cream 60gm,472024260,CDM,250,RC,,,Outpatient,,,431.34,215.67,,332.13,77,,,Percent of Total Billed Charges,77% of total billed charges,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.19,74,,,Percent of Total Billed Charges,74% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,362.33,84,,,Percent of Total Billed Charges,84% of total billed charges,353.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,383.89,89,,,Percent of total Billed Charges,89% of total Billed charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.13,77,,,Percent of total Billed charges,77% of total billed charges,366.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,215.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.84,383.89,
Permethrin 5% Cream 60gm,472024260,CDM,250,RC,,,Outpatient,,,431.34,215.67,,332.13,77,,,Percent of Total Billed Charges,77% of total billed charges,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.19,74,,,Percent of Total Billed Charges,74% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,362.33,84,,,Percent of Total Billed Charges,84% of total billed charges,353.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,383.89,89,,,Percent of total Billed Charges,89% of total Billed charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.13,77,,,Percent of total Billed charges,77% of total billed charges,366.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,215.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.84,383.89,
Permethrin 5% Cream 60gm,472024260,CDM,250,RC,,,Outpatient,,,431.34,215.67,,332.13,77,,,Percent of Total Billed Charges,77% of total billed charges,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.19,74,,,Percent of Total Billed Charges,74% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,362.33,84,,,Percent of Total Billed Charges,84% of total billed charges,353.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,383.89,89,,,Percent of total Billed Charges,89% of total Billed charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.13,77,,,Percent of total Billed charges,77% of total billed charges,366.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,215.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.84,383.89,
Permethrin 5% Cream 60gm,472024260,CDM,250,RC,,,Outpatient,,,431.34,215.67,,332.13,77,,,Percent of Total Billed Charges,77% of total billed charges,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,109.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,134.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,319.19,74,,,Percent of Total Billed Charges,74% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,297.62,69,,,Percent of Total Billed Charges,69% of total billed charges,362.33,84,,,Percent of Total Billed Charges,84% of total billed charges,353.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,383.89,89,,,Percent of total Billed Charges,89% of total Billed charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,332.13,77,,,Percent of total Billed charges,77% of total billed charges,366.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,124.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,215.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,175.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,383.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.84,383.89,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,31115.16,15557.58,,23958.67,77,,,Percent of Total Billed Charges,77% of total billed charges,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9723.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23025.22,74,,,Percent of Total Billed Charges,74% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26136.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,27692.49,89,,,Percent of total Billed Charges,89% of total Billed charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23958.67,77,,,Percent of total Billed charges,77% of total billed charges,26447.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8945.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15557.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7778.79,27692.49,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,30314.32,15157.16,,23342.03,77,,,Percent of Total Billed Charges,77% of total billed charges,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9473.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22432.6,74,,,Percent of Total Billed Charges,74% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25464.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26979.74,89,,,Percent of total Billed Charges,89% of total Billed charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23342.03,77,,,Percent of total Billed charges,77% of total billed charges,25767.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8715.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15157.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7578.58,26979.74,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,31115.16,15557.58,,23958.67,77,,,Percent of Total Billed Charges,77% of total billed charges,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9723.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23025.22,74,,,Percent of Total Billed Charges,74% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26136.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,27692.49,89,,,Percent of total Billed Charges,89% of total Billed charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23958.67,77,,,Percent of total Billed charges,77% of total billed charges,26447.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8945.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15557.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7778.79,27692.49,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,30314.32,15157.16,,23342.03,77,,,Percent of Total Billed Charges,77% of total billed charges,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9473.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22432.6,74,,,Percent of Total Billed Charges,74% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25464.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26979.74,89,,,Percent of total Billed Charges,89% of total Billed charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23342.03,77,,,Percent of total Billed charges,77% of total billed charges,25767.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8715.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15157.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7578.58,26979.74,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,31115.16,15557.58,,23958.67,77,,,Percent of Total Billed Charges,77% of total billed charges,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9723.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23025.22,74,,,Percent of Total Billed Charges,74% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26136.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,27692.49,89,,,Percent of total Billed Charges,89% of total Billed charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23958.67,77,,,Percent of total Billed charges,77% of total billed charges,26447.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8945.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15557.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7778.79,27692.49,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,30314.32,15157.16,,23342.03,77,,,Percent of Total Billed Charges,77% of total billed charges,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9473.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22432.6,74,,,Percent of Total Billed Charges,74% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25464.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26979.74,89,,,Percent of total Billed Charges,89% of total Billed charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23342.03,77,,,Percent of total Billed charges,77% of total billed charges,25767.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8715.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15157.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7578.58,26979.74,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,31115.16,15557.58,,23958.67,77,,,Percent of Total Billed Charges,77% of total billed charges,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9723.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23025.22,74,,,Percent of Total Billed Charges,74% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26136.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,27692.49,89,,,Percent of total Billed Charges,89% of total Billed charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23958.67,77,,,Percent of total Billed charges,77% of total billed charges,26447.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8945.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15557.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7778.79,27692.49,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,30314.32,15157.16,,23342.03,77,,,Percent of Total Billed Charges,77% of total billed charges,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9473.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22432.6,74,,,Percent of Total Billed Charges,74% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25464.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26979.74,89,,,Percent of total Billed Charges,89% of total Billed charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23342.03,77,,,Percent of total Billed charges,77% of total billed charges,25767.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8715.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15157.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7578.58,26979.74,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,31115.16,15557.58,,23958.67,77,,,Percent of Total Billed Charges,77% of total billed charges,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9723.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23025.22,74,,,Percent of Total Billed Charges,74% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26136.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,27692.49,89,,,Percent of total Billed Charges,89% of total Billed charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23958.67,77,,,Percent of total Billed charges,77% of total billed charges,26447.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8945.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15557.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7778.79,27692.49,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,30314.32,15157.16,,23342.03,77,,,Percent of Total Billed Charges,77% of total billed charges,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9473.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22432.6,74,,,Percent of Total Billed Charges,74% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25464.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26979.74,89,,,Percent of total Billed Charges,89% of total Billed charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23342.03,77,,,Percent of total Billed charges,77% of total billed charges,25767.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8715.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15157.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7578.58,26979.74,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,31115.16,15557.58,,23958.67,77,,,Percent of Total Billed Charges,77% of total billed charges,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7934.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9723.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23025.22,74,,,Percent of Total Billed Charges,74% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,21469.46,69,,,Percent of Total Billed Charges,69% of total billed charges,26136.73,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,27692.49,89,,,Percent of total Billed Charges,89% of total Billed charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23958.67,77,,,Percent of total Billed charges,77% of total billed charges,26447.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8945.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15557.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12694.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27692.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7778.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7778.79,27692.49,
Pertuzumab (Perjeta) 420mg/14ml Liquid SDV,50242014501,CDM,250,RC,,,Outpatient,,,30314.32,15157.16,,23342.03,77,,,Percent of Total Billed Charges,77% of total billed charges,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7730.15,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9473.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22432.6,74,,,Percent of Total Billed Charges,74% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,20916.88,69,,,Percent of Total Billed Charges,69% of total billed charges,25464.03,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,26979.74,89,,,Percent of total Billed Charges,89% of total Billed charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23342.03,77,,,Percent of total Billed charges,77% of total billed charges,25767.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8715.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15157.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12368.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26979.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7578.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7578.58,26979.74,
"Petrolatum, White Jelly 28.4 GM",53329006801,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
"Petrolatum, White Jelly 28.4 GM",53329006801,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
"Petrolatum, White Jelly 28.4 GM",53329006801,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
"Petrolatum, White Jelly 28.4 GM",53329006801,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
"Petrolatum, White Jelly 28.4 GM",53329006801,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
"Petrolatum, White Jelly 28.4 GM",53329006801,CDM,250,RC,,,Outpatient,,,10.3,5.15,,7.93,77,,,Percent of Total Billed Charges,77% of total billed charges,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.62,74,,,Percent of Total Billed Charges,74% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,7.11,69,,,Percent of Total Billed Charges,69% of total billed charges,8.65,84,,,Percent of Total Billed Charges,84% of total billed charges,8.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.17,89,,,Percent of total Billed Charges,89% of total Billed charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.93,77,,,Percent of total Billed charges,77% of total billed charges,8.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.17,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.58,9.17,
Phenytoin 100mg Extended Release Capsule,,,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Phenytoin 100mg Extended Release Capsule,,,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Phenytoin 100mg Extended Release Capsule,,,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Phenytoin 100mg Extended Release Capsule,,,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Phenytoin 100mg Extended Release Capsule,,,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Phenytoin 100mg Extended Release Capsule,,,250,RC,,,Outpatient,,,22.45,11.23,,17.29,77,,,Percent of Total Billed Charges,77% of total billed charges,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16.61,74,,,Percent of Total Billed Charges,74% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,15.49,69,,,Percent of Total Billed Charges,69% of total billed charges,18.86,84,,,Percent of Total Billed Charges,84% of total billed charges,18.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,19.98,89,,,Percent of total Billed Charges,89% of total Billed charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.29,77,,,Percent of total Billed charges,77% of total billed charges,19.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.61,19.98,
Phenytoin Oral Liquid 100mg/4ml UDC,,,250,RC,,,Outpatient,,,61.8,30.9,,47.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.73,74,,,Percent of Total Billed Charges,74% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,51.91,84,,,Percent of Total Billed Charges,84% of total billed charges,50.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,55,89,,,Percent of total Billed Charges,89% of total Billed charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.59,77,,,Percent of total Billed charges,77% of total billed charges,52.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.45,55,
Phenytoin Oral Liquid 100mg/4ml UDC,,,250,RC,,,Outpatient,,,61.8,30.9,,47.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.73,74,,,Percent of Total Billed Charges,74% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,51.91,84,,,Percent of Total Billed Charges,84% of total billed charges,50.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,55,89,,,Percent of total Billed Charges,89% of total Billed charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.59,77,,,Percent of total Billed charges,77% of total billed charges,52.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.45,55,
Phenytoin Oral Liquid 100mg/4ml UDC,,,250,RC,,,Outpatient,,,61.8,30.9,,47.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.73,74,,,Percent of Total Billed Charges,74% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,51.91,84,,,Percent of Total Billed Charges,84% of total billed charges,50.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,55,89,,,Percent of total Billed Charges,89% of total Billed charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.59,77,,,Percent of total Billed charges,77% of total billed charges,52.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.45,55,
Phenytoin Oral Liquid 100mg/4ml UDC,,,250,RC,,,Outpatient,,,61.8,30.9,,47.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.73,74,,,Percent of Total Billed Charges,74% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,51.91,84,,,Percent of Total Billed Charges,84% of total billed charges,50.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,55,89,,,Percent of total Billed Charges,89% of total Billed charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.59,77,,,Percent of total Billed charges,77% of total billed charges,52.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.45,55,
Phenytoin Oral Liquid 100mg/4ml UDC,,,250,RC,,,Outpatient,,,61.8,30.9,,47.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.73,74,,,Percent of Total Billed Charges,74% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,51.91,84,,,Percent of Total Billed Charges,84% of total billed charges,50.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,55,89,,,Percent of total Billed Charges,89% of total Billed charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.59,77,,,Percent of total Billed charges,77% of total billed charges,52.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.45,55,
Phenytoin Oral Liquid 100mg/4ml UDC,,,250,RC,,,Outpatient,,,61.8,30.9,,47.59,77,,,Percent of Total Billed Charges,77% of total billed charges,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,45.73,74,,,Percent of Total Billed Charges,74% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,42.64,69,,,Percent of Total Billed Charges,69% of total billed charges,51.91,84,,,Percent of Total Billed Charges,84% of total billed charges,50.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,55,89,,,Percent of total Billed Charges,89% of total Billed charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.59,77,,,Percent of total Billed charges,77% of total billed charges,52.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.45,55,
Phenazopyridine 100mg Tablet,75826011410,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Phenazopyridine 100mg Tablet,75826011410,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Phenazopyridine 100mg Tablet,75826011410,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Phenazopyridine 100mg Tablet,75826011410,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Phenazopyridine 100mg Tablet,75826011410,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Phenazopyridine 100mg Tablet,75826011410,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
Phenylephrine 10mg/ml SDV,641614225,CDM,250,RC,,,Outpatient,,,72.9,36.45,,56.13,77,,,Percent of Total Billed Charges,77% of total billed charges,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.95,74,,,Percent of Total Billed Charges,74% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,50.3,69,,,Percent of Total Billed Charges,69% of total billed charges,61.24,84,,,Percent of Total Billed Charges,84% of total billed charges,59.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.88,89,,,Percent of total Billed Charges,89% of total Billed charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.13,77,,,Percent of total Billed charges,77% of total billed charges,61.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.23,64.88,
PHENobarbital 130mg/ml SDV,641047725,CDM,250,RC,,,Outpatient,,,443.86,221.93,,341.77,77,,,Percent of Total Billed Charges,77% of total billed charges,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.46,74,,,Percent of Total Billed Charges,74% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.84,84,,,Percent of Total Billed Charges,84% of total billed charges,363.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.04,89,,,Percent of total Billed Charges,89% of total Billed charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.77,77,,,Percent of total Billed charges,77% of total billed charges,377.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.97,395.04,
PHENobarbital 130mg/ml SDV,641047725,CDM,250,RC,,,Outpatient,,,443.86,221.93,,341.77,77,,,Percent of Total Billed Charges,77% of total billed charges,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.46,74,,,Percent of Total Billed Charges,74% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.84,84,,,Percent of Total Billed Charges,84% of total billed charges,363.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.04,89,,,Percent of total Billed Charges,89% of total Billed charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.77,77,,,Percent of total Billed charges,77% of total billed charges,377.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.97,395.04,
PHENobarbital 130mg/ml SDV,641047725,CDM,250,RC,,,Outpatient,,,443.86,221.93,,341.77,77,,,Percent of Total Billed Charges,77% of total billed charges,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.46,74,,,Percent of Total Billed Charges,74% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.84,84,,,Percent of Total Billed Charges,84% of total billed charges,363.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.04,89,,,Percent of total Billed Charges,89% of total Billed charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.77,77,,,Percent of total Billed charges,77% of total billed charges,377.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.97,395.04,
PHENobarbital 130mg/ml SDV,641047725,CDM,250,RC,,,Outpatient,,,443.86,221.93,,341.77,77,,,Percent of Total Billed Charges,77% of total billed charges,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.46,74,,,Percent of Total Billed Charges,74% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.84,84,,,Percent of Total Billed Charges,84% of total billed charges,363.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.04,89,,,Percent of total Billed Charges,89% of total Billed charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.77,77,,,Percent of total Billed charges,77% of total billed charges,377.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.97,395.04,
PHENobarbital 130mg/ml SDV,641047725,CDM,250,RC,,,Outpatient,,,443.86,221.93,,341.77,77,,,Percent of Total Billed Charges,77% of total billed charges,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.46,74,,,Percent of Total Billed Charges,74% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.84,84,,,Percent of Total Billed Charges,84% of total billed charges,363.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.04,89,,,Percent of total Billed Charges,89% of total Billed charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.77,77,,,Percent of total Billed charges,77% of total billed charges,377.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.97,395.04,
PHENobarbital 130mg/ml SDV,641047725,CDM,250,RC,,,Outpatient,,,443.86,221.93,,341.77,77,,,Percent of Total Billed Charges,77% of total billed charges,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,113.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,328.46,74,,,Percent of Total Billed Charges,74% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,306.26,69,,,Percent of Total Billed Charges,69% of total billed charges,372.84,84,,,Percent of Total Billed Charges,84% of total billed charges,363.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,395.04,89,,,Percent of total Billed Charges,89% of total Billed charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,341.77,77,,,Percent of total Billed charges,77% of total billed charges,377.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,181.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,395.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.97,395.04,
Phenylephrine 0.25% Nasal Spray 15ml,225080047,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Phenylephrine 0.25% Nasal Spray 15ml,225080047,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Phenylephrine 0.25% Nasal Spray 15ml,225080047,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Phenylephrine 0.25% Nasal Spray 15ml,225080047,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Phenylephrine 0.25% Nasal Spray 15ml,225080047,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Phenylephrine 0.25% Nasal Spray 15ml,225080047,CDM,250,RC,,,Outpatient,,,5.15,2.58,,3.97,77,,,Percent of Total Billed Charges,77% of total billed charges,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.81,74,,,Percent of Total Billed Charges,74% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,3.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.33,84,,,Percent of Total Billed Charges,84% of total billed charges,4.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.58,89,,,Percent of total Billed Charges,89% of total Billed charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,77,,,Percent of total Billed charges,77% of total billed charges,4.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.29,4.58,
Belladonna & Phenobarb 5ml UDC,59212042204,CDM,250,RC,,,Outpatient,,,151.3,75.65,,116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.96,74,,,Percent of Total Billed Charges,74% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,127.09,84,,,Percent of Total Billed Charges,84% of total billed charges,124.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.66,89,,,Percent of total Billed Charges,89% of total Billed charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,77,,,Percent of total Billed charges,77% of total billed charges,128.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.83,134.66,
Belladonna & Phenobarb 5ml UDC,59212042204,CDM,250,RC,,,Outpatient,,,151.3,75.65,,116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.96,74,,,Percent of Total Billed Charges,74% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,127.09,84,,,Percent of Total Billed Charges,84% of total billed charges,124.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.66,89,,,Percent of total Billed Charges,89% of total Billed charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,77,,,Percent of total Billed charges,77% of total billed charges,128.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.83,134.66,
Belladonna & Phenobarb 5ml UDC,59212042204,CDM,250,RC,,,Outpatient,,,151.3,75.65,,116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.96,74,,,Percent of Total Billed Charges,74% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,127.09,84,,,Percent of Total Billed Charges,84% of total billed charges,124.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.66,89,,,Percent of total Billed Charges,89% of total Billed charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,77,,,Percent of total Billed charges,77% of total billed charges,128.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.83,134.66,
Belladonna & Phenobarb 5ml UDC,59212042204,CDM,250,RC,,,Outpatient,,,151.3,75.65,,116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.96,74,,,Percent of Total Billed Charges,74% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,127.09,84,,,Percent of Total Billed Charges,84% of total billed charges,124.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.66,89,,,Percent of total Billed Charges,89% of total Billed charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,77,,,Percent of total Billed charges,77% of total billed charges,128.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.83,134.66,
Belladonna & Phenobarb 5ml UDC,59212042204,CDM,250,RC,,,Outpatient,,,151.3,75.65,,116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.96,74,,,Percent of Total Billed Charges,74% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,127.09,84,,,Percent of Total Billed Charges,84% of total billed charges,124.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.66,89,,,Percent of total Billed Charges,89% of total Billed charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,77,,,Percent of total Billed charges,77% of total billed charges,128.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.83,134.66,
Belladonna & Phenobarb 5ml UDC,59212042204,CDM,250,RC,,,Outpatient,,,151.3,75.65,,116.5,77,,,Percent of Total Billed Charges,77% of total billed charges,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,111.96,74,,,Percent of Total Billed Charges,74% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,104.4,69,,,Percent of Total Billed Charges,69% of total billed charges,127.09,84,,,Percent of Total Billed Charges,84% of total billed charges,124.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,134.66,89,,,Percent of total Billed Charges,89% of total Billed charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.5,77,,,Percent of total Billed charges,77% of total billed charges,128.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.5,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,75.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,61.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.83,134.66,
Sore Throat Spray 177ml,904630521,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sore Throat Spray 177ml,904630521,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sore Throat Spray 177ml,904630521,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sore Throat Spray 177ml,904630521,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sore Throat Spray 177ml,904630521,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sore Throat Spray 177ml,904630521,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Phenol Liquid 1 Swab,884629730,CDM,250,RC,,,Outpatient,,,47.7,23.85,,36.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.3,74,,,Percent of Total Billed Charges,74% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,40.07,84,,,Percent of Total Billed Charges,84% of total billed charges,39.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.45,89,,,Percent of total Billed Charges,89% of total Billed charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.73,77,,,Percent of total Billed charges,77% of total billed charges,40.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,42.45,
Phenol Liquid 1 Swab,884629730,CDM,250,RC,,,Outpatient,,,47.7,23.85,,36.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.3,74,,,Percent of Total Billed Charges,74% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,40.07,84,,,Percent of Total Billed Charges,84% of total billed charges,39.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.45,89,,,Percent of total Billed Charges,89% of total Billed charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.73,77,,,Percent of total Billed charges,77% of total billed charges,40.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,42.45,
Phenol Liquid 1 Swab,884629730,CDM,250,RC,,,Outpatient,,,47.7,23.85,,36.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.3,74,,,Percent of Total Billed Charges,74% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,40.07,84,,,Percent of Total Billed Charges,84% of total billed charges,39.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.45,89,,,Percent of total Billed Charges,89% of total Billed charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.73,77,,,Percent of total Billed charges,77% of total billed charges,40.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,42.45,
Phenol Liquid 1 Swab,884629730,CDM,250,RC,,,Outpatient,,,47.7,23.85,,36.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.3,74,,,Percent of Total Billed Charges,74% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,40.07,84,,,Percent of Total Billed Charges,84% of total billed charges,39.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.45,89,,,Percent of total Billed Charges,89% of total Billed charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.73,77,,,Percent of total Billed charges,77% of total billed charges,40.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,42.45,
Phenol Liquid 1 Swab,884629730,CDM,250,RC,,,Outpatient,,,47.7,23.85,,36.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.3,74,,,Percent of Total Billed Charges,74% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,40.07,84,,,Percent of Total Billed Charges,84% of total billed charges,39.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.45,89,,,Percent of total Billed Charges,89% of total Billed charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.73,77,,,Percent of total Billed charges,77% of total billed charges,40.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,42.45,
Phenol Liquid 1 Swab,884629730,CDM,250,RC,,,Outpatient,,,47.7,23.85,,36.73,77,,,Percent of Total Billed Charges,77% of total billed charges,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.3,74,,,Percent of Total Billed Charges,74% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,32.91,69,,,Percent of Total Billed Charges,69% of total billed charges,40.07,84,,,Percent of Total Billed Charges,84% of total billed charges,39.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.45,89,,,Percent of total Billed Charges,89% of total Billed charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.73,77,,,Percent of total Billed charges,77% of total billed charges,40.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.93,42.45,
Phenylephrine-NS PF 1mg/10ml Syringe,71266901001,CDM,250,RC,,,Outpatient,,,268.59,134.3,,206.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.76,74,,,Percent of Total Billed Charges,74% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,225.62,84,,,Percent of Total Billed Charges,84% of total billed charges,220.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.05,89,,,Percent of total Billed Charges,89% of total Billed charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.81,77,,,Percent of total Billed charges,77% of total billed charges,228.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,239.05,
Phenylephrine-NS PF 1mg/10ml Syringe,71266901001,CDM,250,RC,,,Outpatient,,,268.59,134.3,,206.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.76,74,,,Percent of Total Billed Charges,74% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,225.62,84,,,Percent of Total Billed Charges,84% of total billed charges,220.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.05,89,,,Percent of total Billed Charges,89% of total Billed charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.81,77,,,Percent of total Billed charges,77% of total billed charges,228.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,239.05,
Phenylephrine-NS PF 1mg/10ml Syringe,71266901001,CDM,250,RC,,,Outpatient,,,268.59,134.3,,206.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.76,74,,,Percent of Total Billed Charges,74% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,225.62,84,,,Percent of Total Billed Charges,84% of total billed charges,220.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.05,89,,,Percent of total Billed Charges,89% of total Billed charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.81,77,,,Percent of total Billed charges,77% of total billed charges,228.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,239.05,
Phenylephrine-NS PF 1mg/10ml Syringe,71266901001,CDM,250,RC,,,Outpatient,,,268.59,134.3,,206.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.76,74,,,Percent of Total Billed Charges,74% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,225.62,84,,,Percent of Total Billed Charges,84% of total billed charges,220.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.05,89,,,Percent of total Billed Charges,89% of total Billed charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.81,77,,,Percent of total Billed charges,77% of total billed charges,228.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,239.05,
Phenylephrine-NS PF 1mg/10ml Syringe,71266901001,CDM,250,RC,,,Outpatient,,,268.59,134.3,,206.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.76,74,,,Percent of Total Billed Charges,74% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,225.62,84,,,Percent of Total Billed Charges,84% of total billed charges,220.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.05,89,,,Percent of total Billed Charges,89% of total Billed charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.81,77,,,Percent of total Billed charges,77% of total billed charges,228.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,239.05,
Phenylephrine-NS PF 1mg/10ml Syringe,71266901001,CDM,250,RC,,,Outpatient,,,268.59,134.3,,206.81,77,,,Percent of Total Billed Charges,77% of total billed charges,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,198.76,74,,,Percent of Total Billed Charges,74% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,185.33,69,,,Percent of Total Billed Charges,69% of total billed charges,225.62,84,,,Percent of Total Billed Charges,84% of total billed charges,220.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,239.05,89,,,Percent of total Billed Charges,89% of total Billed charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.81,77,,,Percent of total Billed charges,77% of total billed charges,228.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,134.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,109.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,239.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.15,239.05,
Preparation-H Rectal Oint 28Gm,573287193,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Preparation-H Rectal Oint 28Gm,573287193,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Preparation-H Rectal Oint 28Gm,573287193,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Preparation-H Rectal Oint 28Gm,573287193,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Preparation-H Rectal Oint 28Gm,573287193,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Preparation-H Rectal Oint 28Gm,573287193,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Phenylephrine 2.5% OPHTH Soln 2ml,70756062925,CDM,250,RC,,,Outpatient,,,197.76,98.88,,152.28,77,,,Percent of Total Billed Charges,77% of total billed charges,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.34,74,,,Percent of Total Billed Charges,74% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,166.12,84,,,Percent of Total Billed Charges,84% of total billed charges,162.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.01,89,,,Percent of total Billed Charges,89% of total Billed charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.28,77,,,Percent of total Billed charges,77% of total billed charges,168.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.44,176.01,
Phenylephrine 2.5% OPHTH Soln 2ml,70756062925,CDM,250,RC,,,Outpatient,,,197.76,98.88,,152.28,77,,,Percent of Total Billed Charges,77% of total billed charges,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.34,74,,,Percent of Total Billed Charges,74% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,166.12,84,,,Percent of Total Billed Charges,84% of total billed charges,162.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.01,89,,,Percent of total Billed Charges,89% of total Billed charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.28,77,,,Percent of total Billed charges,77% of total billed charges,168.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.44,176.01,
Phenylephrine 2.5% OPHTH Soln 2ml,70756062925,CDM,250,RC,,,Outpatient,,,197.76,98.88,,152.28,77,,,Percent of Total Billed Charges,77% of total billed charges,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.34,74,,,Percent of Total Billed Charges,74% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,166.12,84,,,Percent of Total Billed Charges,84% of total billed charges,162.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.01,89,,,Percent of total Billed Charges,89% of total Billed charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.28,77,,,Percent of total Billed charges,77% of total billed charges,168.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.44,176.01,
Phenylephrine 2.5% OPHTH Soln 2ml,70756062925,CDM,250,RC,,,Outpatient,,,197.76,98.88,,152.28,77,,,Percent of Total Billed Charges,77% of total billed charges,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.34,74,,,Percent of Total Billed Charges,74% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,166.12,84,,,Percent of Total Billed Charges,84% of total billed charges,162.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.01,89,,,Percent of total Billed Charges,89% of total Billed charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.28,77,,,Percent of total Billed charges,77% of total billed charges,168.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.44,176.01,
Phenylephrine 2.5% OPHTH Soln 2ml,70756062925,CDM,250,RC,,,Outpatient,,,197.76,98.88,,152.28,77,,,Percent of Total Billed Charges,77% of total billed charges,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.34,74,,,Percent of Total Billed Charges,74% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,166.12,84,,,Percent of Total Billed Charges,84% of total billed charges,162.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.01,89,,,Percent of total Billed Charges,89% of total Billed charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.28,77,,,Percent of total Billed charges,77% of total billed charges,168.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.44,176.01,
Phenylephrine 2.5% OPHTH Soln 2ml,70756062925,CDM,250,RC,,,Outpatient,,,197.76,98.88,,152.28,77,,,Percent of Total Billed Charges,77% of total billed charges,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.34,74,,,Percent of Total Billed Charges,74% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,136.45,69,,,Percent of Total Billed Charges,69% of total billed charges,166.12,84,,,Percent of Total Billed Charges,84% of total billed charges,162.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.01,89,,,Percent of total Billed Charges,89% of total Billed charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.28,77,,,Percent of total Billed charges,77% of total billed charges,168.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,98.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.44,176.01,
PHENobarbital 30mg Tablet,143150001,CDM,250,RC,,,Outpatient,,,8.94,4.47,,6.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7.51,84,,,Percent of Total Billed Charges,84% of total billed charges,7.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.96,89,,,Percent of total Billed Charges,89% of total Billed charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,77,,,Percent of total Billed charges,77% of total billed charges,7.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.24,7.96,
PHENobarbital 30mg Tablet,143150001,CDM,250,RC,,,Outpatient,,,8.94,4.47,,6.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7.51,84,,,Percent of Total Billed Charges,84% of total billed charges,7.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.96,89,,,Percent of total Billed Charges,89% of total Billed charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,77,,,Percent of total Billed charges,77% of total billed charges,7.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.24,7.96,
PHENobarbital 30mg Tablet,143150001,CDM,250,RC,,,Outpatient,,,8.94,4.47,,6.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7.51,84,,,Percent of Total Billed Charges,84% of total billed charges,7.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.96,89,,,Percent of total Billed Charges,89% of total Billed charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,77,,,Percent of total Billed charges,77% of total billed charges,7.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.24,7.96,
PHENobarbital 30mg Tablet,143150001,CDM,250,RC,,,Outpatient,,,8.94,4.47,,6.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7.51,84,,,Percent of Total Billed Charges,84% of total billed charges,7.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.96,89,,,Percent of total Billed Charges,89% of total Billed charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,77,,,Percent of total Billed charges,77% of total billed charges,7.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.24,7.96,
PHENobarbital 30mg Tablet,143150001,CDM,250,RC,,,Outpatient,,,8.94,4.47,,6.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7.51,84,,,Percent of Total Billed Charges,84% of total billed charges,7.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.96,89,,,Percent of total Billed Charges,89% of total Billed charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,77,,,Percent of total Billed charges,77% of total billed charges,7.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.24,7.96,
PHENobarbital 30mg Tablet,143150001,CDM,250,RC,,,Outpatient,,,8.94,4.47,,6.88,77,,,Percent of Total Billed Charges,77% of total billed charges,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.62,74,,,Percent of Total Billed Charges,74% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,69,,,Percent of Total Billed Charges,69% of total billed charges,7.51,84,,,Percent of Total Billed Charges,84% of total billed charges,7.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.96,89,,,Percent of total Billed Charges,89% of total Billed charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,77,,,Percent of total Billed charges,77% of total billed charges,7.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.24,7.96,
Phenytoin Chewable 50mg Tablet,71000740,CDM,250,RC,,,Outpatient,,,26.02,13.01,,20.04,77,,,Percent of Total Billed Charges,77% of total billed charges,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.25,74,,,Percent of Total Billed Charges,74% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.86,84,,,Percent of Total Billed Charges,84% of total billed charges,21.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.16,89,,,Percent of total Billed Charges,89% of total Billed charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.04,77,,,Percent of total Billed charges,77% of total billed charges,22.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.51,23.16,
Phenytoin Chewable 50mg Tablet,71000740,CDM,250,RC,,,Outpatient,,,26.02,13.01,,20.04,77,,,Percent of Total Billed Charges,77% of total billed charges,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.25,74,,,Percent of Total Billed Charges,74% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.86,84,,,Percent of Total Billed Charges,84% of total billed charges,21.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.16,89,,,Percent of total Billed Charges,89% of total Billed charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.04,77,,,Percent of total Billed charges,77% of total billed charges,22.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.51,23.16,
Phenytoin Chewable 50mg Tablet,71000740,CDM,250,RC,,,Outpatient,,,26.02,13.01,,20.04,77,,,Percent of Total Billed Charges,77% of total billed charges,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.25,74,,,Percent of Total Billed Charges,74% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.86,84,,,Percent of Total Billed Charges,84% of total billed charges,21.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.16,89,,,Percent of total Billed Charges,89% of total Billed charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.04,77,,,Percent of total Billed charges,77% of total billed charges,22.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.51,23.16,
Phenytoin Chewable 50mg Tablet,71000740,CDM,250,RC,,,Outpatient,,,26.02,13.01,,20.04,77,,,Percent of Total Billed Charges,77% of total billed charges,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.25,74,,,Percent of Total Billed Charges,74% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.86,84,,,Percent of Total Billed Charges,84% of total billed charges,21.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.16,89,,,Percent of total Billed Charges,89% of total Billed charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.04,77,,,Percent of total Billed charges,77% of total billed charges,22.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.51,23.16,
Phenytoin Chewable 50mg Tablet,71000740,CDM,250,RC,,,Outpatient,,,26.02,13.01,,20.04,77,,,Percent of Total Billed Charges,77% of total billed charges,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.25,74,,,Percent of Total Billed Charges,74% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.86,84,,,Percent of Total Billed Charges,84% of total billed charges,21.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.16,89,,,Percent of total Billed Charges,89% of total Billed charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.04,77,,,Percent of total Billed charges,77% of total billed charges,22.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.51,23.16,
Phenytoin Chewable 50mg Tablet,71000740,CDM,250,RC,,,Outpatient,,,26.02,13.01,,20.04,77,,,Percent of Total Billed Charges,77% of total billed charges,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.25,74,,,Percent of Total Billed Charges,74% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,17.95,69,,,Percent of Total Billed Charges,69% of total billed charges,21.86,84,,,Percent of Total Billed Charges,84% of total billed charges,21.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.16,89,,,Percent of total Billed Charges,89% of total Billed charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.04,77,,,Percent of total Billed charges,77% of total billed charges,22.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.51,23.16,
Phenytoin 100mg/2ml SDV,641049325,CDM,250,RC,,,Outpatient,,,51.43,25.72,,39.6,77,,,Percent of Total Billed Charges,77% of total billed charges,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.06,74,,,Percent of Total Billed Charges,74% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,43.2,84,,,Percent of Total Billed Charges,84% of total billed charges,42.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.77,89,,,Percent of total Billed Charges,89% of total Billed charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.6,77,,,Percent of total Billed charges,77% of total billed charges,43.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.86,45.77,
Phenytoin 100mg/2ml SDV,641049325,CDM,250,RC,,,Outpatient,,,51.43,25.72,,39.6,77,,,Percent of Total Billed Charges,77% of total billed charges,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.06,74,,,Percent of Total Billed Charges,74% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,43.2,84,,,Percent of Total Billed Charges,84% of total billed charges,42.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.77,89,,,Percent of total Billed Charges,89% of total Billed charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.6,77,,,Percent of total Billed charges,77% of total billed charges,43.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.86,45.77,
Phenytoin 100mg/2ml SDV,641049325,CDM,250,RC,,,Outpatient,,,51.43,25.72,,39.6,77,,,Percent of Total Billed Charges,77% of total billed charges,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.06,74,,,Percent of Total Billed Charges,74% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,43.2,84,,,Percent of Total Billed Charges,84% of total billed charges,42.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.77,89,,,Percent of total Billed Charges,89% of total Billed charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.6,77,,,Percent of total Billed charges,77% of total billed charges,43.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.86,45.77,
Phenytoin 100mg/2ml SDV,641049325,CDM,250,RC,,,Outpatient,,,51.43,25.72,,39.6,77,,,Percent of Total Billed Charges,77% of total billed charges,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.06,74,,,Percent of Total Billed Charges,74% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,43.2,84,,,Percent of Total Billed Charges,84% of total billed charges,42.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.77,89,,,Percent of total Billed Charges,89% of total Billed charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.6,77,,,Percent of total Billed charges,77% of total billed charges,43.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.86,45.77,
Phenytoin 100mg/2ml SDV,641049325,CDM,250,RC,,,Outpatient,,,51.43,25.72,,39.6,77,,,Percent of Total Billed Charges,77% of total billed charges,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.06,74,,,Percent of Total Billed Charges,74% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,43.2,84,,,Percent of Total Billed Charges,84% of total billed charges,42.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.77,89,,,Percent of total Billed Charges,89% of total Billed charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.6,77,,,Percent of total Billed charges,77% of total billed charges,43.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.86,45.77,
Phenytoin 100mg/2ml SDV,641049325,CDM,250,RC,,,Outpatient,,,51.43,25.72,,39.6,77,,,Percent of Total Billed Charges,77% of total billed charges,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.11,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.06,74,,,Percent of Total Billed Charges,74% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,35.49,69,,,Percent of Total Billed Charges,69% of total billed charges,43.2,84,,,Percent of Total Billed Charges,84% of total billed charges,42.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,45.77,89,,,Percent of total Billed Charges,89% of total Billed charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.6,77,,,Percent of total Billed charges,77% of total billed charges,43.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,20.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.86,45.77,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenytoin 250mg/5ml SDV,,,250,RC,,,Outpatient,,,53.49,26.75,,41.19,77,,,Percent of Total Billed Charges,77% of total billed charges,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,39.58,74,,,Percent of Total Billed Charges,74% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,36.91,69,,,Percent of Total Billed Charges,69% of total billed charges,44.93,84,,,Percent of Total Billed Charges,84% of total billed charges,43.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,47.61,89,,,Percent of total Billed Charges,89% of total Billed charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.19,77,,,Percent of total Billed charges,77% of total billed charges,45.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,26.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.37,47.61,
Phenylephrine 10% OPHTH Soln 5ml,,,250,RC,,,Outpatient,,,177.26,88.63,,136.49,77,,,Percent of Total Billed Charges,77% of total billed charges,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.17,74,,,Percent of Total Billed Charges,74% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,148.9,84,,,Percent of Total Billed Charges,84% of total billed charges,145.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.76,89,,,Percent of total Billed Charges,89% of total Billed charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.49,77,,,Percent of total Billed charges,77% of total billed charges,150.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.32,157.76,
Phenylephrine 10% OPHTH Soln 5ml,,,250,RC,,,Outpatient,,,177.26,88.63,,136.49,77,,,Percent of Total Billed Charges,77% of total billed charges,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.17,74,,,Percent of Total Billed Charges,74% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,148.9,84,,,Percent of Total Billed Charges,84% of total billed charges,145.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.76,89,,,Percent of total Billed Charges,89% of total Billed charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.49,77,,,Percent of total Billed charges,77% of total billed charges,150.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.32,157.76,
Phenylephrine 10% OPHTH Soln 5ml,,,250,RC,,,Outpatient,,,177.26,88.63,,136.49,77,,,Percent of Total Billed Charges,77% of total billed charges,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.17,74,,,Percent of Total Billed Charges,74% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,148.9,84,,,Percent of Total Billed Charges,84% of total billed charges,145.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.76,89,,,Percent of total Billed Charges,89% of total Billed charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.49,77,,,Percent of total Billed charges,77% of total billed charges,150.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.32,157.76,
Phenylephrine 10% OPHTH Soln 5ml,,,250,RC,,,Outpatient,,,177.26,88.63,,136.49,77,,,Percent of Total Billed Charges,77% of total billed charges,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.17,74,,,Percent of Total Billed Charges,74% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,148.9,84,,,Percent of Total Billed Charges,84% of total billed charges,145.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.76,89,,,Percent of total Billed Charges,89% of total Billed charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.49,77,,,Percent of total Billed charges,77% of total billed charges,150.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.32,157.76,
Phenylephrine 10% OPHTH Soln 5ml,,,250,RC,,,Outpatient,,,177.26,88.63,,136.49,77,,,Percent of Total Billed Charges,77% of total billed charges,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.17,74,,,Percent of Total Billed Charges,74% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,148.9,84,,,Percent of Total Billed Charges,84% of total billed charges,145.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.76,89,,,Percent of total Billed Charges,89% of total Billed charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.49,77,,,Percent of total Billed charges,77% of total billed charges,150.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.32,157.76,
Phenylephrine 10% OPHTH Soln 5ml,,,250,RC,,,Outpatient,,,177.26,88.63,,136.49,77,,,Percent of Total Billed Charges,77% of total billed charges,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,55.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,131.17,74,,,Percent of Total Billed Charges,74% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,122.31,69,,,Percent of Total Billed Charges,69% of total billed charges,148.9,84,,,Percent of Total Billed Charges,84% of total billed charges,145.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,157.76,89,,,Percent of total Billed Charges,89% of total Billed charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.49,77,,,Percent of total Billed charges,77% of total billed charges,150.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,88.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,72.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,157.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,44.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.32,157.76,
Phentolamine 5mg SDV,143956410,CDM,250,RC,,,Outpatient,,,2222.48,1111.24,,1711.31,77,,,Percent of Total Billed Charges,77% of total billed charges,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1644.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1822.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,1978.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1711.31,77,,,Percent of total Billed charges,77% of total billed charges,1889.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1111.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.62,1978.01,
Phentolamine 5mg SDV,143956410,CDM,250,RC,,,Outpatient,,,2222.48,1111.24,,1711.31,77,,,Percent of Total Billed Charges,77% of total billed charges,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1644.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1822.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,1978.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1711.31,77,,,Percent of total Billed charges,77% of total billed charges,1889.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1111.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.62,1978.01,
Phentolamine 5mg SDV,143956410,CDM,250,RC,,,Outpatient,,,2222.48,1111.24,,1711.31,77,,,Percent of Total Billed Charges,77% of total billed charges,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1644.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1822.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,1978.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1711.31,77,,,Percent of total Billed charges,77% of total billed charges,1889.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1111.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.62,1978.01,
Phentolamine 5mg SDV,143956410,CDM,250,RC,,,Outpatient,,,2222.48,1111.24,,1711.31,77,,,Percent of Total Billed Charges,77% of total billed charges,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1644.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1822.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,1978.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1711.31,77,,,Percent of total Billed charges,77% of total billed charges,1889.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1111.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.62,1978.01,
Phentolamine 5mg SDV,143956410,CDM,250,RC,,,Outpatient,,,2222.48,1111.24,,1711.31,77,,,Percent of Total Billed Charges,77% of total billed charges,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1644.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1822.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,1978.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1711.31,77,,,Percent of total Billed charges,77% of total billed charges,1889.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1111.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.62,1978.01,
Phentolamine 5mg SDV,143956410,CDM,250,RC,,,Outpatient,,,2222.48,1111.24,,1711.31,77,,,Percent of Total Billed Charges,77% of total billed charges,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,566.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1644.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1533.51,69,,,Percent of Total Billed Charges,69% of total billed charges,1866.88,84,,,Percent of Total Billed Charges,84% of total billed charges,1822.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,1978.01,89,,,Percent of total Billed Charges,89% of total Billed charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1711.31,77,,,Percent of total Billed charges,77% of total billed charges,1889.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,638.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1111.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,906.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1978.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,555.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,555.62,1978.01,
PHENobarbital Pediatric 65mg/ml SDV,14789012705,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
PHENobarbital Pediatric 65mg/ml SDV,14789012705,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
PHENobarbital Pediatric 65mg/ml SDV,14789012705,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
PHENobarbital Pediatric 65mg/ml SDV,14789012705,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
PHENobarbital Pediatric 65mg/ml SDV,14789012705,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
PHENobarbital Pediatric 65mg/ml SDV,14789012705,CDM,250,RC,,,Outpatient,,,153.48,76.74,,118.18,77,,,Percent of Total Billed Charges,77% of total billed charges,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.58,74,,,Percent of Total Billed Charges,74% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,105.9,69,,,Percent of Total Billed Charges,69% of total billed charges,128.92,84,,,Percent of Total Billed Charges,84% of total billed charges,125.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,136.6,89,,,Percent of total Billed Charges,89% of total Billed charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.18,77,,,Percent of total Billed charges,77% of total billed charges,130.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.37,136.6,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 10mg/ml Ampule,409915801,CDM,250,RC,,,Outpatient,,,329.14,164.57,,253.44,77,,,Percent of Total Billed Charges,77% of total billed charges,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,83.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,102.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,243.56,74,,,Percent of Total Billed Charges,74% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,227.11,69,,,Percent of Total Billed Charges,69% of total billed charges,276.48,84,,,Percent of Total Billed Charges,84% of total billed charges,269.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,292.93,89,,,Percent of total Billed Charges,89% of total Billed charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,253.44,77,,,Percent of total Billed charges,77% of total billed charges,279.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,94.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,164.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,134.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,292.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.29,292.93,
Phytonadione (Vitamin K) 1mg/0.5mL Syringe (OB only),76329124001,CDM,250,RC,,,Outpatient,,,200.36,100.18,,154.28,77,,,Percent of Total Billed Charges,77% of total billed charges,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.27,74,,,Percent of Total Billed Charges,74% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,84,,,Percent of Total Billed Charges,84% of total billed charges,164.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.32,89,,,Percent of total Billed Charges,89% of total Billed charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.28,77,,,Percent of total Billed charges,77% of total billed charges,170.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.09,178.32,
Phytonadione (Vitamin K) 1mg/0.5mL Syringe (OB only),76329124001,CDM,250,RC,,,Outpatient,,,200.36,100.18,,154.28,77,,,Percent of Total Billed Charges,77% of total billed charges,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.27,74,,,Percent of Total Billed Charges,74% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,84,,,Percent of Total Billed Charges,84% of total billed charges,164.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.32,89,,,Percent of total Billed Charges,89% of total Billed charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.28,77,,,Percent of total Billed charges,77% of total billed charges,170.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.09,178.32,
Phytonadione (Vitamin K) 1mg/0.5mL Syringe (OB only),76329124001,CDM,250,RC,,,Outpatient,,,200.36,100.18,,154.28,77,,,Percent of Total Billed Charges,77% of total billed charges,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.27,74,,,Percent of Total Billed Charges,74% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,84,,,Percent of Total Billed Charges,84% of total billed charges,164.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.32,89,,,Percent of total Billed Charges,89% of total Billed charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.28,77,,,Percent of total Billed charges,77% of total billed charges,170.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.09,178.32,
Phytonadione (Vitamin K) 1mg/0.5mL Syringe (OB only),76329124001,CDM,250,RC,,,Outpatient,,,200.36,100.18,,154.28,77,,,Percent of Total Billed Charges,77% of total billed charges,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.27,74,,,Percent of Total Billed Charges,74% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,84,,,Percent of Total Billed Charges,84% of total billed charges,164.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.32,89,,,Percent of total Billed Charges,89% of total Billed charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.28,77,,,Percent of total Billed charges,77% of total billed charges,170.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.09,178.32,
Phytonadione (Vitamin K) 1mg/0.5mL Syringe (OB only),76329124001,CDM,250,RC,,,Outpatient,,,200.36,100.18,,154.28,77,,,Percent of Total Billed Charges,77% of total billed charges,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.27,74,,,Percent of Total Billed Charges,74% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,84,,,Percent of Total Billed Charges,84% of total billed charges,164.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.32,89,,,Percent of total Billed Charges,89% of total Billed charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.28,77,,,Percent of total Billed charges,77% of total billed charges,170.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.09,178.32,
Phytonadione (Vitamin K) 1mg/0.5mL Syringe (OB only),76329124001,CDM,250,RC,,,Outpatient,,,200.36,100.18,,154.28,77,,,Percent of Total Billed Charges,77% of total billed charges,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,148.27,74,,,Percent of Total Billed Charges,74% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,138.25,69,,,Percent of Total Billed Charges,69% of total billed charges,168.3,84,,,Percent of Total Billed Charges,84% of total billed charges,164.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,178.32,89,,,Percent of total Billed Charges,89% of total Billed charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.28,77,,,Percent of total Billed charges,77% of total billed charges,170.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,57.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,100.18,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,81.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,178.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,50.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.09,178.32,
Phytonadione (Vitamin K) 5mg Tablet,,,250,RC,,,Outpatient,,,311.79,155.9,,240.08,77,,,Percent of Total Billed Charges,77% of total billed charges,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.72,74,,,Percent of Total Billed Charges,74% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,261.9,84,,,Percent of Total Billed Charges,84% of total billed charges,255.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.49,89,,,Percent of total Billed Charges,89% of total Billed charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.08,77,,,Percent of total Billed charges,77% of total billed charges,265.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.95,277.49,
Phytonadione (Vitamin K) 5mg Tablet,,,250,RC,,,Outpatient,,,311.79,155.9,,240.08,77,,,Percent of Total Billed Charges,77% of total billed charges,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.72,74,,,Percent of Total Billed Charges,74% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,261.9,84,,,Percent of Total Billed Charges,84% of total billed charges,255.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.49,89,,,Percent of total Billed Charges,89% of total Billed charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.08,77,,,Percent of total Billed charges,77% of total billed charges,265.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.95,277.49,
Phytonadione (Vitamin K) 5mg Tablet,,,250,RC,,,Outpatient,,,311.79,155.9,,240.08,77,,,Percent of Total Billed Charges,77% of total billed charges,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.72,74,,,Percent of Total Billed Charges,74% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,261.9,84,,,Percent of Total Billed Charges,84% of total billed charges,255.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.49,89,,,Percent of total Billed Charges,89% of total Billed charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.08,77,,,Percent of total Billed charges,77% of total billed charges,265.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.95,277.49,
Phytonadione (Vitamin K) 5mg Tablet,,,250,RC,,,Outpatient,,,311.79,155.9,,240.08,77,,,Percent of Total Billed Charges,77% of total billed charges,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.72,74,,,Percent of Total Billed Charges,74% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,261.9,84,,,Percent of Total Billed Charges,84% of total billed charges,255.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.49,89,,,Percent of total Billed Charges,89% of total Billed charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.08,77,,,Percent of total Billed charges,77% of total billed charges,265.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.95,277.49,
Phytonadione (Vitamin K) 5mg Tablet,,,250,RC,,,Outpatient,,,311.79,155.9,,240.08,77,,,Percent of Total Billed Charges,77% of total billed charges,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.72,74,,,Percent of Total Billed Charges,74% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,261.9,84,,,Percent of Total Billed Charges,84% of total billed charges,255.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.49,89,,,Percent of total Billed Charges,89% of total Billed charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.08,77,,,Percent of total Billed charges,77% of total billed charges,265.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.95,277.49,
Phytonadione (Vitamin K) 5mg Tablet,,,250,RC,,,Outpatient,,,311.79,155.9,,240.08,77,,,Percent of Total Billed Charges,77% of total billed charges,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,230.72,74,,,Percent of Total Billed Charges,74% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,215.14,69,,,Percent of Total Billed Charges,69% of total billed charges,261.9,84,,,Percent of Total Billed Charges,84% of total billed charges,255.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.49,89,,,Percent of total Billed Charges,89% of total Billed charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.08,77,,,Percent of total Billed charges,77% of total billed charges,265.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,155.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.95,277.49,
Pilocarpine 1% OPHTH Soln 15ml,61314020315,CDM,250,RC,,,Outpatient,,,344.56,172.28,,265.31,77,,,Percent of Total Billed Charges,77% of total billed charges,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.97,74,,,Percent of Total Billed Charges,74% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,289.43,84,,,Percent of Total Billed Charges,84% of total billed charges,282.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.66,89,,,Percent of total Billed Charges,89% of total Billed charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.31,77,,,Percent of total Billed charges,77% of total billed charges,292.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.14,306.66,
Pilocarpine 1% OPHTH Soln 15ml,61314020315,CDM,250,RC,,,Outpatient,,,344.56,172.28,,265.31,77,,,Percent of Total Billed Charges,77% of total billed charges,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.97,74,,,Percent of Total Billed Charges,74% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,289.43,84,,,Percent of Total Billed Charges,84% of total billed charges,282.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.66,89,,,Percent of total Billed Charges,89% of total Billed charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.31,77,,,Percent of total Billed charges,77% of total billed charges,292.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.14,306.66,
Pilocarpine 1% OPHTH Soln 15ml,61314020315,CDM,250,RC,,,Outpatient,,,344.56,172.28,,265.31,77,,,Percent of Total Billed Charges,77% of total billed charges,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.97,74,,,Percent of Total Billed Charges,74% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,289.43,84,,,Percent of Total Billed Charges,84% of total billed charges,282.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.66,89,,,Percent of total Billed Charges,89% of total Billed charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.31,77,,,Percent of total Billed charges,77% of total billed charges,292.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.14,306.66,
Pilocarpine 1% OPHTH Soln 15ml,61314020315,CDM,250,RC,,,Outpatient,,,344.56,172.28,,265.31,77,,,Percent of Total Billed Charges,77% of total billed charges,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.97,74,,,Percent of Total Billed Charges,74% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,289.43,84,,,Percent of Total Billed Charges,84% of total billed charges,282.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.66,89,,,Percent of total Billed Charges,89% of total Billed charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.31,77,,,Percent of total Billed charges,77% of total billed charges,292.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.14,306.66,
Pilocarpine 1% OPHTH Soln 15ml,61314020315,CDM,250,RC,,,Outpatient,,,344.56,172.28,,265.31,77,,,Percent of Total Billed Charges,77% of total billed charges,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.97,74,,,Percent of Total Billed Charges,74% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,289.43,84,,,Percent of Total Billed Charges,84% of total billed charges,282.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.66,89,,,Percent of total Billed Charges,89% of total Billed charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.31,77,,,Percent of total Billed charges,77% of total billed charges,292.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.14,306.66,
Pilocarpine 1% OPHTH Soln 15ml,61314020315,CDM,250,RC,,,Outpatient,,,344.56,172.28,,265.31,77,,,Percent of Total Billed Charges,77% of total billed charges,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,87.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,107.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,254.97,74,,,Percent of Total Billed Charges,74% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,237.75,69,,,Percent of Total Billed Charges,69% of total billed charges,289.43,84,,,Percent of Total Billed Charges,84% of total billed charges,282.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,306.66,89,,,Percent of total Billed Charges,89% of total Billed charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,265.31,77,,,Percent of total Billed charges,77% of total billed charges,292.88,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,99.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,172.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,140.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,306.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,86.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,86.14,306.66,
Pilocarpine 2% OPHTH Soln 15ml,61314020415,CDM,250,RC,,,Outpatient,,,352.31,176.16,,271.28,77,,,Percent of Total Billed Charges,77% of total billed charges,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.71,74,,,Percent of Total Billed Charges,74% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,295.94,84,,,Percent of Total Billed Charges,84% of total billed charges,288.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,89,,,Percent of total Billed Charges,89% of total Billed charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.28,77,,,Percent of total Billed charges,77% of total billed charges,299.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.08,313.56,
Pilocarpine 2% OPHTH Soln 15ml,61314020415,CDM,250,RC,,,Outpatient,,,352.31,176.16,,271.28,77,,,Percent of Total Billed Charges,77% of total billed charges,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.71,74,,,Percent of Total Billed Charges,74% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,295.94,84,,,Percent of Total Billed Charges,84% of total billed charges,288.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,89,,,Percent of total Billed Charges,89% of total Billed charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.28,77,,,Percent of total Billed charges,77% of total billed charges,299.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.08,313.56,
Pilocarpine 2% OPHTH Soln 15ml,61314020415,CDM,250,RC,,,Outpatient,,,352.31,176.16,,271.28,77,,,Percent of Total Billed Charges,77% of total billed charges,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.71,74,,,Percent of Total Billed Charges,74% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,295.94,84,,,Percent of Total Billed Charges,84% of total billed charges,288.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,89,,,Percent of total Billed Charges,89% of total Billed charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.28,77,,,Percent of total Billed charges,77% of total billed charges,299.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.08,313.56,
Pilocarpine 2% OPHTH Soln 15ml,61314020415,CDM,250,RC,,,Outpatient,,,352.31,176.16,,271.28,77,,,Percent of Total Billed Charges,77% of total billed charges,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.71,74,,,Percent of Total Billed Charges,74% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,295.94,84,,,Percent of Total Billed Charges,84% of total billed charges,288.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,89,,,Percent of total Billed Charges,89% of total Billed charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.28,77,,,Percent of total Billed charges,77% of total billed charges,299.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.08,313.56,
Pilocarpine 2% OPHTH Soln 15ml,61314020415,CDM,250,RC,,,Outpatient,,,352.31,176.16,,271.28,77,,,Percent of Total Billed Charges,77% of total billed charges,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.71,74,,,Percent of Total Billed Charges,74% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,295.94,84,,,Percent of Total Billed Charges,84% of total billed charges,288.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,89,,,Percent of total Billed Charges,89% of total Billed charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.28,77,,,Percent of total Billed charges,77% of total billed charges,299.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.08,313.56,
Pilocarpine 2% OPHTH Soln 15ml,61314020415,CDM,250,RC,,,Outpatient,,,352.31,176.16,,271.28,77,,,Percent of Total Billed Charges,77% of total billed charges,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.71,74,,,Percent of Total Billed Charges,74% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,243.09,69,,,Percent of Total Billed Charges,69% of total billed charges,295.94,84,,,Percent of Total Billed Charges,84% of total billed charges,288.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.56,89,,,Percent of total Billed Charges,89% of total Billed charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.28,77,,,Percent of total Billed charges,77% of total billed charges,299.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.08,313.56,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 2.25gm SDV,781311095,CDM,250,RC,,,Outpatient,,,141.24,70.62,,108.75,77,,,Percent of Total Billed Charges,77% of total billed charges,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,104.52,74,,,Percent of Total Billed Charges,74% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,97.46,69,,,Percent of Total Billed Charges,69% of total billed charges,118.64,84,,,Percent of Total Billed Charges,84% of total billed charges,115.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,125.7,89,,,Percent of total Billed Charges,89% of total Billed charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.75,77,,,Percent of total Billed charges,77% of total billed charges,120.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,70.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,57.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,125.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.31,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.31,125.7,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 3.375gm SDV,25021016530,CDM,250,RC,,,Outpatient,,,130.47,65.24,,100.46,77,,,Percent of Total Billed Charges,77% of total billed charges,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.55,74,,,Percent of Total Billed Charges,74% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,90.02,69,,,Percent of Total Billed Charges,69% of total billed charges,109.59,84,,,Percent of Total Billed Charges,84% of total billed charges,106.99,82,,,Percent of Total Billed Charges,82% of total billed charges ,116.12,89,,,Percent of total Billed Charges,89% of total Billed charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.46,77,,,Percent of total Billed charges,77% of total billed charges,110.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.62,116.12,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Piperacillin-Tazobactam 4.5gm SDV,44567080310,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,85907.13,42953.57,,66148.49,77,,,Percent of Total Billed Charges,77% of total billed charges,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26845.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63571.28,74,,,Percent of Total Billed Charges,74% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,72161.99,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,76457.35,89,,,Percent of total Billed Charges,89% of total Billed charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66148.49,77,,,Percent of total Billed charges,77% of total billed charges,73021.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24698.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42953.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,76457.35,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,83690.02,41845.01,,64441.32,77,,,Percent of Total Billed Charges,77% of total billed charges,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61930.61,74,,,Percent of Total Billed Charges,74% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,70299.62,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,74484.12,89,,,Percent of total Billed Charges,89% of total Billed charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64441.32,77,,,Percent of total Billed charges,77% of total billed charges,71136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24060.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41845.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,74484.12,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,85907.13,42953.57,,66148.49,77,,,Percent of Total Billed Charges,77% of total billed charges,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26845.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63571.28,74,,,Percent of Total Billed Charges,74% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,72161.99,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,76457.35,89,,,Percent of total Billed Charges,89% of total Billed charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66148.49,77,,,Percent of total Billed charges,77% of total billed charges,73021.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24698.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42953.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,76457.35,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,83690.02,41845.01,,64441.32,77,,,Percent of Total Billed Charges,77% of total billed charges,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61930.61,74,,,Percent of Total Billed Charges,74% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,70299.62,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,74484.12,89,,,Percent of total Billed Charges,89% of total Billed charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64441.32,77,,,Percent of total Billed charges,77% of total billed charges,71136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24060.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41845.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,74484.12,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,85907.13,42953.57,,66148.49,77,,,Percent of Total Billed Charges,77% of total billed charges,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26845.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63571.28,74,,,Percent of Total Billed Charges,74% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,72161.99,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,76457.35,89,,,Percent of total Billed Charges,89% of total Billed charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66148.49,77,,,Percent of total Billed charges,77% of total billed charges,73021.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24698.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42953.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,76457.35,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,83690.02,41845.01,,64441.32,77,,,Percent of Total Billed Charges,77% of total billed charges,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61930.61,74,,,Percent of Total Billed Charges,74% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,70299.62,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,74484.12,89,,,Percent of total Billed Charges,89% of total Billed charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64441.32,77,,,Percent of total Billed charges,77% of total billed charges,71136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24060.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41845.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,74484.12,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,85907.13,42953.57,,66148.49,77,,,Percent of Total Billed Charges,77% of total billed charges,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26845.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63571.28,74,,,Percent of Total Billed Charges,74% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,72161.99,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,76457.35,89,,,Percent of total Billed Charges,89% of total Billed charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66148.49,77,,,Percent of total Billed charges,77% of total billed charges,73021.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24698.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42953.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,76457.35,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,83690.02,41845.01,,64441.32,77,,,Percent of Total Billed Charges,77% of total billed charges,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61930.61,74,,,Percent of Total Billed Charges,74% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,70299.62,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,74484.12,89,,,Percent of total Billed Charges,89% of total Billed charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64441.32,77,,,Percent of total Billed charges,77% of total billed charges,71136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24060.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41845.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,74484.12,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,85907.13,42953.57,,66148.49,77,,,Percent of Total Billed Charges,77% of total billed charges,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26845.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63571.28,74,,,Percent of Total Billed Charges,74% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,72161.99,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,76457.35,89,,,Percent of total Billed Charges,89% of total Billed charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66148.49,77,,,Percent of total Billed charges,77% of total billed charges,73021.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24698.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42953.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,76457.35,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,83690.02,41845.01,,64441.32,77,,,Percent of Total Billed Charges,77% of total billed charges,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61930.61,74,,,Percent of Total Billed Charges,74% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,70299.62,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,74484.12,89,,,Percent of total Billed Charges,89% of total Billed charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64441.32,77,,,Percent of total Billed charges,77% of total billed charges,71136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24060.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41845.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,74484.12,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,85907.13,42953.57,,66148.49,77,,,Percent of Total Billed Charges,77% of total billed charges,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21906.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26845.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63571.28,74,,,Percent of Total Billed Charges,74% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,59275.92,69,,,Percent of Total Billed Charges,69% of total billed charges,72161.99,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,76457.35,89,,,Percent of total Billed Charges,89% of total Billed charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66148.49,77,,,Percent of total Billed charges,77% of total billed charges,73021.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24698.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42953.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35050.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76457.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21476.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,76457.35,
Polatuzumab Vedotin-PIIQ (Polivy) 140mg/7ml Powder SDV,50242010501,CDM,250,RC,,,Outpatient,,,83690.02,41845.01,,64441.32,77,,,Percent of Total Billed Charges,77% of total billed charges,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21340.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26153.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,61930.61,74,,,Percent of Total Billed Charges,74% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,57746.11,69,,,Percent of Total Billed Charges,69% of total billed charges,70299.62,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,74484.12,89,,,Percent of total Billed Charges,89% of total Billed charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64441.32,77,,,Percent of total Billed charges,77% of total billed charges,71136.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24060.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41845.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,34145.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74484.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20922.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15000,74484.12,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,25286.66,12643.33,,19470.73,77,,,Percent of Total Billed Charges,77% of total billed charges,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7902.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18712.13,74,,,Percent of Total Billed Charges,74% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,21240.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22505.13,89,,,Percent of total Billed Charges,89% of total Billed charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19470.73,77,,,Percent of total Billed charges,77% of total billed charges,21493.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7269.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12643.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6321.67,22505.13,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,24637.33,12318.67,,18970.74,77,,,Percent of Total Billed Charges,77% of total billed charges,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7699.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18231.62,74,,,Percent of Total Billed Charges,74% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,20695.36,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21927.22,89,,,Percent of total Billed Charges,89% of total Billed charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18970.74,77,,,Percent of total Billed charges,77% of total billed charges,20941.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7083.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12318.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6159.33,21927.22,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,25286.66,12643.33,,19470.73,77,,,Percent of Total Billed Charges,77% of total billed charges,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7902.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18712.13,74,,,Percent of Total Billed Charges,74% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,21240.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22505.13,89,,,Percent of total Billed Charges,89% of total Billed charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19470.73,77,,,Percent of total Billed charges,77% of total billed charges,21493.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7269.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12643.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6321.67,22505.13,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,24637.33,12318.67,,18970.74,77,,,Percent of Total Billed Charges,77% of total billed charges,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7699.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18231.62,74,,,Percent of Total Billed Charges,74% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,20695.36,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21927.22,89,,,Percent of total Billed Charges,89% of total Billed charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18970.74,77,,,Percent of total Billed charges,77% of total billed charges,20941.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7083.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12318.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6159.33,21927.22,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,25286.66,12643.33,,19470.73,77,,,Percent of Total Billed Charges,77% of total billed charges,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7902.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18712.13,74,,,Percent of Total Billed Charges,74% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,21240.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22505.13,89,,,Percent of total Billed Charges,89% of total Billed charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19470.73,77,,,Percent of total Billed charges,77% of total billed charges,21493.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7269.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12643.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6321.67,22505.13,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,24637.33,12318.67,,18970.74,77,,,Percent of Total Billed Charges,77% of total billed charges,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7699.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18231.62,74,,,Percent of Total Billed Charges,74% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,20695.36,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21927.22,89,,,Percent of total Billed Charges,89% of total Billed charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18970.74,77,,,Percent of total Billed charges,77% of total billed charges,20941.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7083.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12318.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6159.33,21927.22,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,25286.66,12643.33,,19470.73,77,,,Percent of Total Billed Charges,77% of total billed charges,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7902.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18712.13,74,,,Percent of Total Billed Charges,74% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,21240.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22505.13,89,,,Percent of total Billed Charges,89% of total Billed charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19470.73,77,,,Percent of total Billed charges,77% of total billed charges,21493.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7269.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12643.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6321.67,22505.13,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,24637.33,12318.67,,18970.74,77,,,Percent of Total Billed Charges,77% of total billed charges,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7699.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18231.62,74,,,Percent of Total Billed Charges,74% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,20695.36,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21927.22,89,,,Percent of total Billed Charges,89% of total Billed charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18970.74,77,,,Percent of total Billed charges,77% of total billed charges,20941.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7083.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12318.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6159.33,21927.22,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,25286.66,12643.33,,19470.73,77,,,Percent of Total Billed Charges,77% of total billed charges,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7902.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18712.13,74,,,Percent of Total Billed Charges,74% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,21240.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22505.13,89,,,Percent of total Billed Charges,89% of total Billed charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19470.73,77,,,Percent of total Billed charges,77% of total billed charges,21493.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7269.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12643.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6321.67,22505.13,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,24637.33,12318.67,,18970.74,77,,,Percent of Total Billed Charges,77% of total billed charges,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7699.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18231.62,74,,,Percent of Total Billed Charges,74% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,20695.36,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21927.22,89,,,Percent of total Billed Charges,89% of total Billed charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18970.74,77,,,Percent of total Billed charges,77% of total billed charges,20941.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7083.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12318.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6159.33,21927.22,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,25286.66,12643.33,,19470.73,77,,,Percent of Total Billed Charges,77% of total billed charges,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6448.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7902.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18712.13,74,,,Percent of Total Billed Charges,74% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,17447.8,69,,,Percent of Total Billed Charges,69% of total billed charges,21240.79,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22505.13,89,,,Percent of total Billed Charges,89% of total Billed charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19470.73,77,,,Percent of total Billed charges,77% of total billed charges,21493.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7269.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12643.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10316.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22505.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6321.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6321.67,22505.13,
Polatuzumab Vedotin-PIIQ (Polivy) 30mg/1.5ml Powder SDV,50242010301,CDM,250,RC,,,Outpatient,,,24637.33,12318.67,,18970.74,77,,,Percent of Total Billed Charges,77% of total billed charges,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6282.52,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7699.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18231.62,74,,,Percent of Total Billed Charges,74% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,16999.76,69,,,Percent of Total Billed Charges,69% of total billed charges,20695.36,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21927.22,89,,,Percent of total Billed Charges,89% of total Billed charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18970.74,77,,,Percent of total Billed charges,77% of total billed charges,20941.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7083.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12318.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10052.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21927.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6159.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6159.33,21927.22,
"Poliomyelitis Vaccine, Inactivated 5ml MDV",49281086010,CDM,250,RC,,,Outpatient,,,1905.86,952.93,,1467.51,77,,,Percent of Total Billed Charges,77% of total billed charges,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1410.34,74,,,Percent of Total Billed Charges,74% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1600.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1562.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1696.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1467.51,77,,,Percent of total Billed charges,77% of total billed charges,1619.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.47,1696.22,
"Poliomyelitis Vaccine, Inactivated 5ml MDV",49281086010,CDM,250,RC,,,Outpatient,,,1905.86,952.93,,1467.51,77,,,Percent of Total Billed Charges,77% of total billed charges,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1410.34,74,,,Percent of Total Billed Charges,74% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1600.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1562.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1696.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1467.51,77,,,Percent of total Billed charges,77% of total billed charges,1619.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.47,1696.22,
"Poliomyelitis Vaccine, Inactivated 5ml MDV",49281086010,CDM,250,RC,,,Outpatient,,,1905.86,952.93,,1467.51,77,,,Percent of Total Billed Charges,77% of total billed charges,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1410.34,74,,,Percent of Total Billed Charges,74% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1600.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1562.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1696.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1467.51,77,,,Percent of total Billed charges,77% of total billed charges,1619.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.47,1696.22,
"Poliomyelitis Vaccine, Inactivated 5ml MDV",49281086010,CDM,250,RC,,,Outpatient,,,1905.86,952.93,,1467.51,77,,,Percent of Total Billed Charges,77% of total billed charges,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1410.34,74,,,Percent of Total Billed Charges,74% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1600.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1562.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1696.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1467.51,77,,,Percent of total Billed charges,77% of total billed charges,1619.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.47,1696.22,
"Poliomyelitis Vaccine, Inactivated 5ml MDV",49281086010,CDM,250,RC,,,Outpatient,,,1905.86,952.93,,1467.51,77,,,Percent of Total Billed Charges,77% of total billed charges,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1410.34,74,,,Percent of Total Billed Charges,74% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1600.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1562.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1696.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1467.51,77,,,Percent of total Billed charges,77% of total billed charges,1619.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.47,1696.22,
"Poliomyelitis Vaccine, Inactivated 5ml MDV",49281086010,CDM,250,RC,,,Outpatient,,,1905.86,952.93,,1467.51,77,,,Percent of Total Billed Charges,77% of total billed charges,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,485.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,595.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1410.34,74,,,Percent of Total Billed Charges,74% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1315.04,69,,,Percent of Total Billed Charges,69% of total billed charges,1600.92,84,,,Percent of Total Billed Charges,84% of total billed charges,1562.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,1696.22,89,,,Percent of total Billed Charges,89% of total Billed charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1467.51,77,,,Percent of total Billed charges,77% of total billed charges,1619.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,547.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,952.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,777.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1696.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,476.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,476.47,1696.22,
Polymyx B/Trimeth OPHTH Soln 10ml,61314062810,CDM,250,RC,,,Outpatient,,,148.27,74.14,,114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.72,74,,,Percent of Total Billed Charges,74% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.55,84,,,Percent of Total Billed Charges,84% of total billed charges,121.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.96,89,,,Percent of total Billed Charges,89% of total Billed charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.17,77,,,Percent of total Billed charges,77% of total billed charges,126.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,131.96,
Polymyx B/Trimeth OPHTH Soln 10ml,61314062810,CDM,250,RC,,,Outpatient,,,148.27,74.14,,114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.72,74,,,Percent of Total Billed Charges,74% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.55,84,,,Percent of Total Billed Charges,84% of total billed charges,121.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.96,89,,,Percent of total Billed Charges,89% of total Billed charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.17,77,,,Percent of total Billed charges,77% of total billed charges,126.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,131.96,
Polymyx B/Trimeth OPHTH Soln 10ml,61314062810,CDM,250,RC,,,Outpatient,,,148.27,74.14,,114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.72,74,,,Percent of Total Billed Charges,74% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.55,84,,,Percent of Total Billed Charges,84% of total billed charges,121.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.96,89,,,Percent of total Billed Charges,89% of total Billed charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.17,77,,,Percent of total Billed charges,77% of total billed charges,126.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,131.96,
Polymyx B/Trimeth OPHTH Soln 10ml,61314062810,CDM,250,RC,,,Outpatient,,,148.27,74.14,,114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.72,74,,,Percent of Total Billed Charges,74% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.55,84,,,Percent of Total Billed Charges,84% of total billed charges,121.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.96,89,,,Percent of total Billed Charges,89% of total Billed charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.17,77,,,Percent of total Billed charges,77% of total billed charges,126.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,131.96,
Polymyx B/Trimeth OPHTH Soln 10ml,61314062810,CDM,250,RC,,,Outpatient,,,148.27,74.14,,114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.72,74,,,Percent of Total Billed Charges,74% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.55,84,,,Percent of Total Billed Charges,84% of total billed charges,121.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.96,89,,,Percent of total Billed Charges,89% of total Billed charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.17,77,,,Percent of total Billed charges,77% of total billed charges,126.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,131.96,
Polymyx B/Trimeth OPHTH Soln 10ml,61314062810,CDM,250,RC,,,Outpatient,,,148.27,74.14,,114.17,77,,,Percent of Total Billed Charges,77% of total billed charges,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,109.72,74,,,Percent of Total Billed Charges,74% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,102.31,69,,,Percent of Total Billed Charges,69% of total billed charges,124.55,84,,,Percent of Total Billed Charges,84% of total billed charges,121.58,82,,,Percent of Total Billed Charges,82% of total billed charges ,131.96,89,,,Percent of total Billed Charges,89% of total Billed charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.17,77,,,Percent of total Billed charges,77% of total billed charges,126.03,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,42.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,74.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,60.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,131.96,
Polyethylene Glycol (Miralax) 17gm Packets,51079030630,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Polyethylene Glycol (Miralax) 17gm Packets,51079030630,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Polyethylene Glycol (Miralax) 17gm Packets,51079030630,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Polyethylene Glycol (Miralax) 17gm Packets,51079030630,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Polyethylene Glycol (Miralax) 17gm Packets,51079030630,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Polyethylene Glycol (Miralax) 17gm Packets,51079030630,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Polyethylene Glycol (Miralax Bowel Prep) 238gm Powder,43386031208,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Polyethylene Glycol (Miralax Bowel Prep) 238gm Powder,43386031208,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Polyethylene Glycol (Miralax Bowel Prep) 238gm Powder,43386031208,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Polyethylene Glycol (Miralax Bowel Prep) 238gm Powder,43386031208,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Polyethylene Glycol (Miralax Bowel Prep) 238gm Powder,43386031208,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Polyethylene Glycol (Miralax Bowel Prep) 238gm Powder,43386031208,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Dextrose 5%-1/2NS+10meq KCL 1000ml Premixed IV Bag,338066904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+10meq KCL 1000ml Premixed IV Bag,338066904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+10meq KCL 1000ml Premixed IV Bag,338066904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+10meq KCL 1000ml Premixed IV Bag,338066904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+10meq KCL 1000ml Premixed IV Bag,338066904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+10meq KCL 1000ml Premixed IV Bag,338066904,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,72.49,36.25,,55.82,77,,,Percent of Total Billed Charges,77% of total billed charges,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,53.64,74,,,Percent of Total Billed Charges,74% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,50.02,69,,,Percent of Total Billed Charges,69% of total billed charges,60.89,84,,,Percent of Total Billed Charges,84% of total billed charges,59.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,64.52,89,,,Percent of total Billed Charges,89% of total Billed charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.82,77,,,Percent of total Billed charges,77% of total billed charges,61.62,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.12,64.52,
Potassium Chloride 10meq/100ml IV Bag,338070948,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 10meq ER Tablet,904721661,CDM,250,RC,,,Outpatient,,,7.53,3.77,,5.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.57,74,,,Percent of Total Billed Charges,74% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6.33,84,,,Percent of Total Billed Charges,84% of total billed charges,6.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,77,,,Percent of total Billed charges,77% of total billed charges,6.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.7,
Potassium Chloride 10meq ER Tablet,904721661,CDM,250,RC,,,Outpatient,,,7.53,3.77,,5.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.57,74,,,Percent of Total Billed Charges,74% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6.33,84,,,Percent of Total Billed Charges,84% of total billed charges,6.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,77,,,Percent of total Billed charges,77% of total billed charges,6.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.7,
Potassium Chloride 10meq ER Tablet,904721661,CDM,250,RC,,,Outpatient,,,7.53,3.77,,5.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.57,74,,,Percent of Total Billed Charges,74% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6.33,84,,,Percent of Total Billed Charges,84% of total billed charges,6.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,77,,,Percent of total Billed charges,77% of total billed charges,6.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.7,
Potassium Chloride 10meq ER Tablet,904721661,CDM,250,RC,,,Outpatient,,,7.53,3.77,,5.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.57,74,,,Percent of Total Billed Charges,74% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6.33,84,,,Percent of Total Billed Charges,84% of total billed charges,6.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,77,,,Percent of total Billed charges,77% of total billed charges,6.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.7,
Potassium Chloride 10meq ER Tablet,904721661,CDM,250,RC,,,Outpatient,,,7.53,3.77,,5.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.57,74,,,Percent of Total Billed Charges,74% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6.33,84,,,Percent of Total Billed Charges,84% of total billed charges,6.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,77,,,Percent of total Billed charges,77% of total billed charges,6.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.7,
Potassium Chloride 10meq ER Tablet,904721661,CDM,250,RC,,,Outpatient,,,7.53,3.77,,5.8,77,,,Percent of Total Billed Charges,77% of total billed charges,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.57,74,,,Percent of Total Billed Charges,74% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6.33,84,,,Percent of Total Billed Charges,84% of total billed charges,6.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.7,89,,,Percent of total Billed Charges,89% of total Billed charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.8,77,,,Percent of total Billed charges,77% of total billed charges,6.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.88,6.7,
Potassium Citrate 10meq Tablet,178061001,CDM,250,RC,,,Outpatient,,,29.12,14.56,,22.42,77,,,Percent of Total Billed Charges,77% of total billed charges,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.55,74,,,Percent of Total Billed Charges,74% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,24.46,84,,,Percent of Total Billed Charges,84% of total billed charges,23.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.92,89,,,Percent of total Billed Charges,89% of total Billed charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.42,77,,,Percent of total Billed charges,77% of total billed charges,24.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.28,25.92,
Potassium Citrate 10meq Tablet,178061001,CDM,250,RC,,,Outpatient,,,29.12,14.56,,22.42,77,,,Percent of Total Billed Charges,77% of total billed charges,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.55,74,,,Percent of Total Billed Charges,74% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,24.46,84,,,Percent of Total Billed Charges,84% of total billed charges,23.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.92,89,,,Percent of total Billed Charges,89% of total Billed charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.42,77,,,Percent of total Billed charges,77% of total billed charges,24.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.28,25.92,
Potassium Citrate 10meq Tablet,178061001,CDM,250,RC,,,Outpatient,,,29.12,14.56,,22.42,77,,,Percent of Total Billed Charges,77% of total billed charges,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.55,74,,,Percent of Total Billed Charges,74% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,24.46,84,,,Percent of Total Billed Charges,84% of total billed charges,23.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.92,89,,,Percent of total Billed Charges,89% of total Billed charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.42,77,,,Percent of total Billed charges,77% of total billed charges,24.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.28,25.92,
Potassium Citrate 10meq Tablet,178061001,CDM,250,RC,,,Outpatient,,,29.12,14.56,,22.42,77,,,Percent of Total Billed Charges,77% of total billed charges,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.55,74,,,Percent of Total Billed Charges,74% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,24.46,84,,,Percent of Total Billed Charges,84% of total billed charges,23.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.92,89,,,Percent of total Billed Charges,89% of total Billed charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.42,77,,,Percent of total Billed charges,77% of total billed charges,24.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.28,25.92,
Potassium Citrate 10meq Tablet,178061001,CDM,250,RC,,,Outpatient,,,29.12,14.56,,22.42,77,,,Percent of Total Billed Charges,77% of total billed charges,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.55,74,,,Percent of Total Billed Charges,74% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,24.46,84,,,Percent of Total Billed Charges,84% of total billed charges,23.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.92,89,,,Percent of total Billed Charges,89% of total Billed charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.42,77,,,Percent of total Billed charges,77% of total billed charges,24.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.28,25.92,
Potassium Citrate 10meq Tablet,178061001,CDM,250,RC,,,Outpatient,,,29.12,14.56,,22.42,77,,,Percent of Total Billed Charges,77% of total billed charges,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.55,74,,,Percent of Total Billed Charges,74% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,20.09,69,,,Percent of Total Billed Charges,69% of total billed charges,24.46,84,,,Percent of Total Billed Charges,84% of total billed charges,23.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.92,89,,,Percent of total Billed Charges,89% of total Billed charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.42,77,,,Percent of total Billed charges,77% of total billed charges,24.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.28,25.92,
Potassium 10meq Effervescent Tablet,51801001430,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Potassium 10meq Effervescent Tablet,51801001430,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Potassium 10meq Effervescent Tablet,51801001430,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Potassium 10meq Effervescent Tablet,51801001430,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Potassium 10meq Effervescent Tablet,51801001430,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Potassium 10meq Effervescent Tablet,51801001430,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Sodium Chloride 0.9%+20meq KCL 1000ml Premixed IV Bag,338069104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9%+20meq KCL 1000ml Premixed IV Bag,338069104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9%+20meq KCL 1000ml Premixed IV Bag,338069104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9%+20meq KCL 1000ml Premixed IV Bag,338069104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9%+20meq KCL 1000ml Premixed IV Bag,338069104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.9%+20meq KCL 1000ml Premixed IV Bag,338069104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45%+20meq KCL 1000ml Premixed IV Bag,338070434,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45%+20meq KCL 1000ml Premixed IV Bag,338070434,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45%+20meq KCL 1000ml Premixed IV Bag,338070434,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45%+20meq KCL 1000ml Premixed IV Bag,338070434,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45%+20meq KCL 1000ml Premixed IV Bag,338070434,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45%+20meq KCL 1000ml Premixed IV Bag,338070434,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+20meq KCL 1000ml Premixed IV Bag,338067104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+20meq KCL 1000ml Premixed IV Bag,338067104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+20meq KCL 1000ml Premixed IV Bag,338067104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+20meq KCL 1000ml Premixed IV Bag,338067104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+20meq KCL 1000ml Premixed IV Bag,338067104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+20meq KCL 1000ml Premixed IV Bag,338067104,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 20meq/15ml UDC,603154258,CDM,250,RC,,,Outpatient,,,91.04,45.52,,70.1,77,,,Percent of Total Billed Charges,77% of total billed charges,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.37,74,,,Percent of Total Billed Charges,74% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,76.47,84,,,Percent of Total Billed Charges,84% of total billed charges,74.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.03,89,,,Percent of total Billed Charges,89% of total Billed charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.1,77,,,Percent of total Billed charges,77% of total billed charges,77.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.76,81.03,
Potassium Chloride 20meq/15ml UDC,603154258,CDM,250,RC,,,Outpatient,,,91.04,45.52,,70.1,77,,,Percent of Total Billed Charges,77% of total billed charges,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.37,74,,,Percent of Total Billed Charges,74% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,76.47,84,,,Percent of Total Billed Charges,84% of total billed charges,74.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.03,89,,,Percent of total Billed Charges,89% of total Billed charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.1,77,,,Percent of total Billed charges,77% of total billed charges,77.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.76,81.03,
Potassium Chloride 20meq/15ml UDC,603154258,CDM,250,RC,,,Outpatient,,,91.04,45.52,,70.1,77,,,Percent of Total Billed Charges,77% of total billed charges,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.37,74,,,Percent of Total Billed Charges,74% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,76.47,84,,,Percent of Total Billed Charges,84% of total billed charges,74.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.03,89,,,Percent of total Billed Charges,89% of total Billed charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.1,77,,,Percent of total Billed charges,77% of total billed charges,77.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.76,81.03,
Potassium Chloride 20meq/15ml UDC,603154258,CDM,250,RC,,,Outpatient,,,91.04,45.52,,70.1,77,,,Percent of Total Billed Charges,77% of total billed charges,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.37,74,,,Percent of Total Billed Charges,74% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,76.47,84,,,Percent of Total Billed Charges,84% of total billed charges,74.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.03,89,,,Percent of total Billed Charges,89% of total Billed charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.1,77,,,Percent of total Billed charges,77% of total billed charges,77.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.76,81.03,
Potassium Chloride 20meq/15ml UDC,603154258,CDM,250,RC,,,Outpatient,,,91.04,45.52,,70.1,77,,,Percent of Total Billed Charges,77% of total billed charges,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.37,74,,,Percent of Total Billed Charges,74% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,76.47,84,,,Percent of Total Billed Charges,84% of total billed charges,74.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.03,89,,,Percent of total Billed Charges,89% of total Billed charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.1,77,,,Percent of total Billed charges,77% of total billed charges,77.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.76,81.03,
Potassium Chloride 20meq/15ml UDC,603154258,CDM,250,RC,,,Outpatient,,,91.04,45.52,,70.1,77,,,Percent of Total Billed Charges,77% of total billed charges,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.37,74,,,Percent of Total Billed Charges,74% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,62.82,69,,,Percent of Total Billed Charges,69% of total billed charges,76.47,84,,,Percent of Total Billed Charges,84% of total billed charges,74.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,81.03,89,,,Percent of total Billed Charges,89% of total Billed charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.1,77,,,Percent of total Billed charges,77% of total billed charges,77.38,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,81.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.76,81.03,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq/100ml IV Bag,338070548,CDM,250,RC,,,Outpatient,,,73.56,36.78,,56.64,77,,,Percent of Total Billed Charges,77% of total billed charges,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.43,74,,,Percent of Total Billed Charges,74% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,50.76,69,,,Percent of Total Billed Charges,69% of total billed charges,61.79,84,,,Percent of Total Billed Charges,84% of total billed charges,60.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.47,89,,,Percent of total Billed Charges,89% of total Billed charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.64,77,,,Percent of total Billed charges,77% of total billed charges,62.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,30.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.39,65.47,
Potassium Chloride 20meq ER Tablet,245531901,CDM,250,RC,,,Outpatient,,,11.38,5.69,,8.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.42,74,,,Percent of Total Billed Charges,74% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,9.56,84,,,Percent of Total Billed Charges,84% of total billed charges,9.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.13,89,,,Percent of total Billed Charges,89% of total Billed charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,77,,,Percent of total Billed charges,77% of total billed charges,9.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.85,10.13,
Potassium Chloride 20meq ER Tablet,245531901,CDM,250,RC,,,Outpatient,,,11.38,5.69,,8.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.42,74,,,Percent of Total Billed Charges,74% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,9.56,84,,,Percent of Total Billed Charges,84% of total billed charges,9.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.13,89,,,Percent of total Billed Charges,89% of total Billed charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,77,,,Percent of total Billed charges,77% of total billed charges,9.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.85,10.13,
Potassium Chloride 20meq ER Tablet,245531901,CDM,250,RC,,,Outpatient,,,11.38,5.69,,8.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.42,74,,,Percent of Total Billed Charges,74% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,9.56,84,,,Percent of Total Billed Charges,84% of total billed charges,9.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.13,89,,,Percent of total Billed Charges,89% of total Billed charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,77,,,Percent of total Billed charges,77% of total billed charges,9.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.85,10.13,
Potassium Chloride 20meq ER Tablet,245531901,CDM,250,RC,,,Outpatient,,,11.38,5.69,,8.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.42,74,,,Percent of Total Billed Charges,74% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,9.56,84,,,Percent of Total Billed Charges,84% of total billed charges,9.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.13,89,,,Percent of total Billed Charges,89% of total Billed charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,77,,,Percent of total Billed charges,77% of total billed charges,9.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.85,10.13,
Potassium Chloride 20meq ER Tablet,245531901,CDM,250,RC,,,Outpatient,,,11.38,5.69,,8.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.42,74,,,Percent of Total Billed Charges,74% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,9.56,84,,,Percent of Total Billed Charges,84% of total billed charges,9.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.13,89,,,Percent of total Billed Charges,89% of total Billed charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,77,,,Percent of total Billed charges,77% of total billed charges,9.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.85,10.13,
Potassium Chloride 20meq ER Tablet,245531901,CDM,250,RC,,,Outpatient,,,11.38,5.69,,8.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.42,74,,,Percent of Total Billed Charges,74% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,7.85,69,,,Percent of Total Billed Charges,69% of total billed charges,9.56,84,,,Percent of Total Billed Charges,84% of total billed charges,9.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.13,89,,,Percent of total Billed Charges,89% of total Billed charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,77,,,Percent of total Billed charges,77% of total billed charges,9.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.85,10.13,
Potassium 25meq Effervescent Tablet,51801000601,CDM,250,RC,,,Outpatient,,,19.73,9.87,,15.19,77,,,Percent of Total Billed Charges,77% of total billed charges,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.6,74,,,Percent of Total Billed Charges,74% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,16.57,84,,,Percent of Total Billed Charges,84% of total billed charges,16.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.56,89,,,Percent of total Billed Charges,89% of total Billed charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.19,77,,,Percent of total Billed charges,77% of total billed charges,16.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.93,17.56,
Potassium 25meq Effervescent Tablet,51801000601,CDM,250,RC,,,Outpatient,,,19.73,9.87,,15.19,77,,,Percent of Total Billed Charges,77% of total billed charges,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.6,74,,,Percent of Total Billed Charges,74% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,16.57,84,,,Percent of Total Billed Charges,84% of total billed charges,16.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.56,89,,,Percent of total Billed Charges,89% of total Billed charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.19,77,,,Percent of total Billed charges,77% of total billed charges,16.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.93,17.56,
Potassium 25meq Effervescent Tablet,51801000601,CDM,250,RC,,,Outpatient,,,19.73,9.87,,15.19,77,,,Percent of Total Billed Charges,77% of total billed charges,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.6,74,,,Percent of Total Billed Charges,74% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,16.57,84,,,Percent of Total Billed Charges,84% of total billed charges,16.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.56,89,,,Percent of total Billed Charges,89% of total Billed charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.19,77,,,Percent of total Billed charges,77% of total billed charges,16.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.93,17.56,
Potassium 25meq Effervescent Tablet,51801000601,CDM,250,RC,,,Outpatient,,,19.73,9.87,,15.19,77,,,Percent of Total Billed Charges,77% of total billed charges,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.6,74,,,Percent of Total Billed Charges,74% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,16.57,84,,,Percent of Total Billed Charges,84% of total billed charges,16.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.56,89,,,Percent of total Billed Charges,89% of total Billed charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.19,77,,,Percent of total Billed charges,77% of total billed charges,16.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.93,17.56,
Potassium 25meq Effervescent Tablet,51801000601,CDM,250,RC,,,Outpatient,,,19.73,9.87,,15.19,77,,,Percent of Total Billed Charges,77% of total billed charges,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.6,74,,,Percent of Total Billed Charges,74% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,16.57,84,,,Percent of Total Billed Charges,84% of total billed charges,16.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.56,89,,,Percent of total Billed Charges,89% of total Billed charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.19,77,,,Percent of total Billed charges,77% of total billed charges,16.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.93,17.56,
Potassium 25meq Effervescent Tablet,51801000601,CDM,250,RC,,,Outpatient,,,19.73,9.87,,15.19,77,,,Percent of Total Billed Charges,77% of total billed charges,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.6,74,,,Percent of Total Billed Charges,74% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,13.61,69,,,Percent of Total Billed Charges,69% of total billed charges,16.57,84,,,Percent of Total Billed Charges,84% of total billed charges,16.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.56,89,,,Percent of total Billed Charges,89% of total Billed charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.19,77,,,Percent of total Billed charges,77% of total billed charges,16.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.67,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.93,17.56,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
Potassium ACETATE 40meq/20ml (2meq/1ml) SDV,409818301,CDM,250,RC,,,Outpatient,,,71.25,35.63,,54.86,77,,,Percent of Total Billed Charges,77% of total billed charges,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.17,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.73,74,,,Percent of Total Billed Charges,74% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,49.16,69,,,Percent of Total Billed Charges,69% of total billed charges,59.85,84,,,Percent of Total Billed Charges,84% of total billed charges,58.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.41,89,,,Percent of total Billed Charges,89% of total Billed charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.86,77,,,Percent of total Billed charges,77% of total billed charges,60.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.81,63.41,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
"Potassium Phosphate (K=4.4 MEQ, P04=3MMOL/ml) 15ml SDV",409729501,CDM,250,RC,,,Outpatient,,,161.64,80.82,,124.46,77,,,Percent of Total Billed Charges,77% of total billed charges,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.51,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,119.61,74,,,Percent of Total Billed Charges,74% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,111.53,69,,,Percent of Total Billed Charges,69% of total billed charges,135.78,84,,,Percent of Total Billed Charges,84% of total billed charges,132.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,143.86,89,,,Percent of total Billed Charges,89% of total Billed charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.46,77,,,Percent of total Billed charges,77% of total billed charges,137.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,46.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,80.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,65.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,143.86,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,143.86,
Dextrose 5%-1/2NS+40meq KCL 1000ml Premixed IV Bag,338067504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+40meq KCL 1000ml Premixed IV Bag,338067504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+40meq KCL 1000ml Premixed IV Bag,338067504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+40meq KCL 1000ml Premixed IV Bag,338067504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+40meq KCL 1000ml Premixed IV Bag,338067504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Dextrose 5%-1/2NS+40meq KCL 1000ml Premixed IV Bag,338067504,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
Potassium Chloride 40meq/100ml IV Bag,338070348,CDM,250,RC,,,Outpatient,,,73.31,36.66,,56.45,77,,,Percent of Total Billed Charges,77% of total billed charges,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,54.25,74,,,Percent of Total Billed Charges,74% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,50.58,69,,,Percent of Total Billed Charges,69% of total billed charges,61.58,84,,,Percent of Total Billed Charges,84% of total billed charges,60.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,65.25,89,,,Percent of total Billed Charges,89% of total Billed charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.45,77,,,Percent of total Billed charges,77% of total billed charges,62.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,36.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.33,65.25,
K-Phos (Sodium Free) 500mg Tablet For Soln,486111101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
K-Phos (Sodium Free) 500mg Tablet For Soln,486111101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
K-Phos (Sodium Free) 500mg Tablet For Soln,486111101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
K-Phos (Sodium Free) 500mg Tablet For Soln,486111101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
K-Phos (Sodium Free) 500mg Tablet For Soln,486111101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
K-Phos (Sodium Free) 500mg Tablet For Soln,486111101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Potassium Iodide Drops 65 mg/ml 30ml,178031430,CDM,250,RC,,,Outpatient,,,190.05,95.03,,146.34,77,,,Percent of Total Billed Charges,77% of total billed charges,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.64,74,,,Percent of Total Billed Charges,74% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,159.64,84,,,Percent of Total Billed Charges,84% of total billed charges,155.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.14,89,,,Percent of total Billed Charges,89% of total Billed charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.34,77,,,Percent of total Billed charges,77% of total billed charges,161.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.51,169.14,
Potassium Iodide Drops 65 mg/ml 30ml,178031430,CDM,250,RC,,,Outpatient,,,190.05,95.03,,146.34,77,,,Percent of Total Billed Charges,77% of total billed charges,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.64,74,,,Percent of Total Billed Charges,74% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,159.64,84,,,Percent of Total Billed Charges,84% of total billed charges,155.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.14,89,,,Percent of total Billed Charges,89% of total Billed charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.34,77,,,Percent of total Billed charges,77% of total billed charges,161.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.51,169.14,
Potassium Iodide Drops 65 mg/ml 30ml,178031430,CDM,250,RC,,,Outpatient,,,190.05,95.03,,146.34,77,,,Percent of Total Billed Charges,77% of total billed charges,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.64,74,,,Percent of Total Billed Charges,74% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,159.64,84,,,Percent of Total Billed Charges,84% of total billed charges,155.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.14,89,,,Percent of total Billed Charges,89% of total Billed charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.34,77,,,Percent of total Billed charges,77% of total billed charges,161.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.51,169.14,
Potassium Iodide Drops 65 mg/ml 30ml,178031430,CDM,250,RC,,,Outpatient,,,190.05,95.03,,146.34,77,,,Percent of Total Billed Charges,77% of total billed charges,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.64,74,,,Percent of Total Billed Charges,74% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,159.64,84,,,Percent of Total Billed Charges,84% of total billed charges,155.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.14,89,,,Percent of total Billed Charges,89% of total Billed charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.34,77,,,Percent of total Billed charges,77% of total billed charges,161.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.51,169.14,
Potassium Iodide Drops 65 mg/ml 30ml,178031430,CDM,250,RC,,,Outpatient,,,190.05,95.03,,146.34,77,,,Percent of Total Billed Charges,77% of total billed charges,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.64,74,,,Percent of Total Billed Charges,74% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,159.64,84,,,Percent of Total Billed Charges,84% of total billed charges,155.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.14,89,,,Percent of total Billed Charges,89% of total Billed charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.34,77,,,Percent of total Billed charges,77% of total billed charges,161.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.51,169.14,
Potassium Iodide Drops 65 mg/ml 30ml,178031430,CDM,250,RC,,,Outpatient,,,190.05,95.03,,146.34,77,,,Percent of Total Billed Charges,77% of total billed charges,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,59.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,140.64,74,,,Percent of Total Billed Charges,74% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,131.13,69,,,Percent of Total Billed Charges,69% of total billed charges,159.64,84,,,Percent of Total Billed Charges,84% of total billed charges,155.84,82,,,Percent of Total Billed Charges,82% of total billed charges ,169.14,89,,,Percent of total Billed Charges,89% of total Billed charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.34,77,,,Percent of total Billed charges,77% of total billed charges,161.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,54.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,95.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,77.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,47.51,169.14,
Povidone Iodine 5% OPHTH Soln CATS CHARGE,65041130,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Povidone Iodine 5% OPHTH Soln CATS CHARGE,65041130,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Povidone Iodine 5% OPHTH Soln CATS CHARGE,65041130,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Povidone Iodine 5% OPHTH Soln CATS CHARGE,65041130,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Povidone Iodine 5% OPHTH Soln CATS CHARGE,65041130,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Povidone Iodine 5% OPHTH Soln CATS CHARGE,65041130,CDM,250,RC,,,Outpatient,,,24.64,12.32,,18.97,77,,,Percent of Total Billed Charges,77% of total billed charges,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.23,74,,,Percent of Total Billed Charges,74% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17,69,,,Percent of Total Billed Charges,69% of total billed charges,17,69,,,Percent of Total Billed Charges,69% of total billed charges,20.7,84,,,Percent of Total Billed Charges,84% of total billed charges,20.2,82,,,Percent of Total Billed Charges,82% of total billed charges ,21.93,89,,,Percent of total Billed Charges,89% of total Billed charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.97,77,,,Percent of total Billed charges,77% of total billed charges,20.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.32,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.16,21.93,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,426.2,213.1,,328.17,77,,,Percent of Total Billed Charges,77% of total billed charges,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.39,74,,,Percent of Total Billed Charges,74% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,358.01,84,,,Percent of Total Billed Charges,84% of total billed charges,349.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,379.32,89,,,Percent of total Billed Charges,89% of total Billed charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.17,77,,,Percent of total Billed charges,77% of total billed charges,362.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,213.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.55,379.32,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,442.29,221.15,,340.56,77,,,Percent of Total Billed Charges,77% of total billed charges,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.29,74,,,Percent of Total Billed Charges,74% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,371.52,84,,,Percent of Total Billed Charges,84% of total billed charges,362.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.64,89,,,Percent of total Billed Charges,89% of total Billed charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.56,77,,,Percent of total Billed charges,77% of total billed charges,375.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.57,393.64,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,426.2,213.1,,328.17,77,,,Percent of Total Billed Charges,77% of total billed charges,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.39,74,,,Percent of Total Billed Charges,74% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,358.01,84,,,Percent of Total Billed Charges,84% of total billed charges,349.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,379.32,89,,,Percent of total Billed Charges,89% of total Billed charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.17,77,,,Percent of total Billed charges,77% of total billed charges,362.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,213.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.55,379.32,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,442.29,221.15,,340.56,77,,,Percent of Total Billed Charges,77% of total billed charges,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.29,74,,,Percent of Total Billed Charges,74% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,371.52,84,,,Percent of Total Billed Charges,84% of total billed charges,362.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.64,89,,,Percent of total Billed Charges,89% of total Billed charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.56,77,,,Percent of total Billed charges,77% of total billed charges,375.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.57,393.64,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,426.2,213.1,,328.17,77,,,Percent of Total Billed Charges,77% of total billed charges,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.39,74,,,Percent of Total Billed Charges,74% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,358.01,84,,,Percent of Total Billed Charges,84% of total billed charges,349.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,379.32,89,,,Percent of total Billed Charges,89% of total Billed charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.17,77,,,Percent of total Billed charges,77% of total billed charges,362.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,213.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.55,379.32,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,442.29,221.15,,340.56,77,,,Percent of Total Billed Charges,77% of total billed charges,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.29,74,,,Percent of Total Billed Charges,74% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,371.52,84,,,Percent of Total Billed Charges,84% of total billed charges,362.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.64,89,,,Percent of total Billed Charges,89% of total Billed charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.56,77,,,Percent of total Billed charges,77% of total billed charges,375.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.57,393.64,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,426.2,213.1,,328.17,77,,,Percent of Total Billed Charges,77% of total billed charges,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.39,74,,,Percent of Total Billed Charges,74% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,358.01,84,,,Percent of Total Billed Charges,84% of total billed charges,349.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,379.32,89,,,Percent of total Billed Charges,89% of total Billed charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.17,77,,,Percent of total Billed charges,77% of total billed charges,362.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,213.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.55,379.32,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,442.29,221.15,,340.56,77,,,Percent of Total Billed Charges,77% of total billed charges,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.29,74,,,Percent of Total Billed Charges,74% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,371.52,84,,,Percent of Total Billed Charges,84% of total billed charges,362.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.64,89,,,Percent of total Billed Charges,89% of total Billed charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.56,77,,,Percent of total Billed charges,77% of total billed charges,375.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.57,393.64,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,426.2,213.1,,328.17,77,,,Percent of Total Billed Charges,77% of total billed charges,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.39,74,,,Percent of Total Billed Charges,74% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,358.01,84,,,Percent of Total Billed Charges,84% of total billed charges,349.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,379.32,89,,,Percent of total Billed Charges,89% of total Billed charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.17,77,,,Percent of total Billed charges,77% of total billed charges,362.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,213.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.55,379.32,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,442.29,221.15,,340.56,77,,,Percent of Total Billed Charges,77% of total billed charges,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.29,74,,,Percent of Total Billed Charges,74% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,371.52,84,,,Percent of Total Billed Charges,84% of total billed charges,362.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.64,89,,,Percent of total Billed Charges,89% of total Billed charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.56,77,,,Percent of total Billed charges,77% of total billed charges,375.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.57,393.64,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,426.2,213.1,,328.17,77,,,Percent of Total Billed Charges,77% of total billed charges,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,108.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,133.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,315.39,74,,,Percent of Total Billed Charges,74% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,294.08,69,,,Percent of Total Billed Charges,69% of total billed charges,358.01,84,,,Percent of Total Billed Charges,84% of total billed charges,349.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,379.32,89,,,Percent of total Billed Charges,89% of total Billed charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,328.17,77,,,Percent of total Billed charges,77% of total billed charges,362.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,122.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,213.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,173.89,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,379.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.55,379.32,
Pralidoxime (Protopam) 1000mg SDV,60977014101,CDM,250,RC,,,Outpatient,,,442.29,221.15,,340.56,77,,,Percent of Total Billed Charges,77% of total billed charges,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,112.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,138.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,327.29,74,,,Percent of Total Billed Charges,74% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,305.18,69,,,Percent of Total Billed Charges,69% of total billed charges,371.52,84,,,Percent of Total Billed Charges,84% of total billed charges,362.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,393.64,89,,,Percent of total Billed Charges,89% of total Billed charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,340.56,77,,,Percent of total Billed charges,77% of total billed charges,375.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,127.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,221.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,180.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,393.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,110.57,393.64,
Pramipexole 0.5mg Tablet,,,250,RC,,,Outpatient,,,14.38,7.19,,11.07,77,,,Percent of Total Billed Charges,77% of total billed charges,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.64,74,,,Percent of Total Billed Charges,74% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,84,,,Percent of Total Billed Charges,84% of total billed charges,11.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.07,77,,,Percent of total Billed charges,77% of total billed charges,12.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.6,12.8,
Pramipexole 0.5mg Tablet,,,250,RC,,,Outpatient,,,14.38,7.19,,11.07,77,,,Percent of Total Billed Charges,77% of total billed charges,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.64,74,,,Percent of Total Billed Charges,74% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,84,,,Percent of Total Billed Charges,84% of total billed charges,11.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.07,77,,,Percent of total Billed charges,77% of total billed charges,12.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.6,12.8,
Pramipexole 0.5mg Tablet,,,250,RC,,,Outpatient,,,14.38,7.19,,11.07,77,,,Percent of Total Billed Charges,77% of total billed charges,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.64,74,,,Percent of Total Billed Charges,74% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,84,,,Percent of Total Billed Charges,84% of total billed charges,11.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.07,77,,,Percent of total Billed charges,77% of total billed charges,12.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.6,12.8,
Pramipexole 0.5mg Tablet,,,250,RC,,,Outpatient,,,14.38,7.19,,11.07,77,,,Percent of Total Billed Charges,77% of total billed charges,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.64,74,,,Percent of Total Billed Charges,74% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,84,,,Percent of Total Billed Charges,84% of total billed charges,11.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.07,77,,,Percent of total Billed charges,77% of total billed charges,12.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.6,12.8,
Pramipexole 0.5mg Tablet,,,250,RC,,,Outpatient,,,14.38,7.19,,11.07,77,,,Percent of Total Billed Charges,77% of total billed charges,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.64,74,,,Percent of Total Billed Charges,74% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,84,,,Percent of Total Billed Charges,84% of total billed charges,11.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.07,77,,,Percent of total Billed charges,77% of total billed charges,12.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.6,12.8,
Pramipexole 0.5mg Tablet,,,250,RC,,,Outpatient,,,14.38,7.19,,11.07,77,,,Percent of Total Billed Charges,77% of total billed charges,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.67,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.49,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.64,74,,,Percent of Total Billed Charges,74% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.92,69,,,Percent of Total Billed Charges,69% of total billed charges,12.08,84,,,Percent of Total Billed Charges,84% of total billed charges,11.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.8,89,,,Percent of total Billed Charges,89% of total Billed charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.07,77,,,Percent of total Billed charges,77% of total billed charges,12.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.6,12.8,
Prasugrel 5mg Tablet,60505464203,CDM,250,RC,,,Outpatient,,,121.63,60.82,,93.66,77,,,Percent of Total Billed Charges,77% of total billed charges,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.01,74,,,Percent of Total Billed Charges,74% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,102.17,84,,,Percent of Total Billed Charges,84% of total billed charges,99.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.25,89,,,Percent of total Billed Charges,89% of total Billed charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.66,77,,,Percent of total Billed charges,77% of total billed charges,103.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.41,108.25,
Prasugrel 5mg Tablet,60505464203,CDM,250,RC,,,Outpatient,,,121.63,60.82,,93.66,77,,,Percent of Total Billed Charges,77% of total billed charges,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.01,74,,,Percent of Total Billed Charges,74% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,102.17,84,,,Percent of Total Billed Charges,84% of total billed charges,99.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.25,89,,,Percent of total Billed Charges,89% of total Billed charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.66,77,,,Percent of total Billed charges,77% of total billed charges,103.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.41,108.25,
Prasugrel 5mg Tablet,60505464203,CDM,250,RC,,,Outpatient,,,121.63,60.82,,93.66,77,,,Percent of Total Billed Charges,77% of total billed charges,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.01,74,,,Percent of Total Billed Charges,74% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,102.17,84,,,Percent of Total Billed Charges,84% of total billed charges,99.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.25,89,,,Percent of total Billed Charges,89% of total Billed charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.66,77,,,Percent of total Billed charges,77% of total billed charges,103.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.41,108.25,
Prasugrel 5mg Tablet,60505464203,CDM,250,RC,,,Outpatient,,,121.63,60.82,,93.66,77,,,Percent of Total Billed Charges,77% of total billed charges,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.01,74,,,Percent of Total Billed Charges,74% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,102.17,84,,,Percent of Total Billed Charges,84% of total billed charges,99.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.25,89,,,Percent of total Billed Charges,89% of total Billed charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.66,77,,,Percent of total Billed charges,77% of total billed charges,103.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.41,108.25,
Prasugrel 5mg Tablet,60505464203,CDM,250,RC,,,Outpatient,,,121.63,60.82,,93.66,77,,,Percent of Total Billed Charges,77% of total billed charges,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.01,74,,,Percent of Total Billed Charges,74% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,102.17,84,,,Percent of Total Billed Charges,84% of total billed charges,99.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.25,89,,,Percent of total Billed Charges,89% of total Billed charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.66,77,,,Percent of total Billed charges,77% of total billed charges,103.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.41,108.25,
Prasugrel 5mg Tablet,60505464203,CDM,250,RC,,,Outpatient,,,121.63,60.82,,93.66,77,,,Percent of Total Billed Charges,77% of total billed charges,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.01,74,,,Percent of Total Billed Charges,74% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,83.92,69,,,Percent of Total Billed Charges,69% of total billed charges,102.17,84,,,Percent of Total Billed Charges,84% of total billed charges,99.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.25,89,,,Percent of total Billed Charges,89% of total Billed charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.66,77,,,Percent of total Billed charges,77% of total billed charges,103.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.97,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.41,108.25,
predniSONE 10mg Tablet,54001729,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
predniSONE 10mg Tablet,54001729,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
predniSONE 10mg Tablet,54001729,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
predniSONE 10mg Tablet,54001729,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
predniSONE 10mg Tablet,54001729,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
predniSONE 10mg Tablet,54001729,CDM,250,RC,,,Outpatient,,,7.25,3.63,,5.58,77,,,Percent of Total Billed Charges,77% of total billed charges,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.37,74,,,Percent of Total Billed Charges,74% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5,69,,,Percent of Total Billed Charges,69% of total billed charges,5,69,,,Percent of Total Billed Charges,69% of total billed charges,6.09,84,,,Percent of Total Billed Charges,84% of total billed charges,5.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.45,89,,,Percent of total Billed Charges,89% of total Billed charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.58,77,,,Percent of total Billed charges,77% of total billed charges,6.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.45,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.81,6.45,
prednisoLONE Oral Soln 15mg/5ml UDC,,,250,RC,,,Outpatient,,,19.64,9.82,,15.12,77,,,Percent of Total Billed Charges,77% of total billed charges,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.53,74,,,Percent of Total Billed Charges,74% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16.5,84,,,Percent of Total Billed Charges,84% of total billed charges,16.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.48,89,,,Percent of total Billed Charges,89% of total Billed charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,77,,,Percent of total Billed charges,77% of total billed charges,16.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,17.48,
prednisoLONE Oral Soln 15mg/5ml UDC,,,250,RC,,,Outpatient,,,19.64,9.82,,15.12,77,,,Percent of Total Billed Charges,77% of total billed charges,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.53,74,,,Percent of Total Billed Charges,74% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16.5,84,,,Percent of Total Billed Charges,84% of total billed charges,16.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.48,89,,,Percent of total Billed Charges,89% of total Billed charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,77,,,Percent of total Billed charges,77% of total billed charges,16.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,17.48,
prednisoLONE Oral Soln 15mg/5ml UDC,,,250,RC,,,Outpatient,,,19.64,9.82,,15.12,77,,,Percent of Total Billed Charges,77% of total billed charges,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.53,74,,,Percent of Total Billed Charges,74% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16.5,84,,,Percent of Total Billed Charges,84% of total billed charges,16.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.48,89,,,Percent of total Billed Charges,89% of total Billed charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,77,,,Percent of total Billed charges,77% of total billed charges,16.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,17.48,
prednisoLONE Oral Soln 15mg/5ml UDC,,,250,RC,,,Outpatient,,,19.64,9.82,,15.12,77,,,Percent of Total Billed Charges,77% of total billed charges,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.53,74,,,Percent of Total Billed Charges,74% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16.5,84,,,Percent of Total Billed Charges,84% of total billed charges,16.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.48,89,,,Percent of total Billed Charges,89% of total Billed charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,77,,,Percent of total Billed charges,77% of total billed charges,16.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,17.48,
prednisoLONE Oral Soln 15mg/5ml UDC,,,250,RC,,,Outpatient,,,19.64,9.82,,15.12,77,,,Percent of Total Billed Charges,77% of total billed charges,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.53,74,,,Percent of Total Billed Charges,74% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16.5,84,,,Percent of Total Billed Charges,84% of total billed charges,16.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.48,89,,,Percent of total Billed Charges,89% of total Billed charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,77,,,Percent of total Billed charges,77% of total billed charges,16.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,17.48,
prednisoLONE Oral Soln 15mg/5ml UDC,,,250,RC,,,Outpatient,,,19.64,9.82,,15.12,77,,,Percent of Total Billed Charges,77% of total billed charges,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.53,74,,,Percent of Total Billed Charges,74% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,13.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16.5,84,,,Percent of Total Billed Charges,84% of total billed charges,16.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.48,89,,,Percent of total Billed Charges,89% of total Billed charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.12,77,,,Percent of total Billed charges,77% of total billed charges,16.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.91,17.48,
predniSONE 1mg Tablet,54474125,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
predniSONE 1mg Tablet,54474125,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
predniSONE 1mg Tablet,54474125,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
predniSONE 1mg Tablet,54474125,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
predniSONE 1mg Tablet,54474125,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
predniSONE 1mg Tablet,54474125,CDM,250,RC,,,Outpatient,,,7.35,3.68,,5.66,77,,,Percent of Total Billed Charges,77% of total billed charges,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.44,74,,,Percent of Total Billed Charges,74% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.07,69,,,Percent of Total Billed Charges,69% of total billed charges,6.17,84,,,Percent of Total Billed Charges,84% of total billed charges,6.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.54,89,,,Percent of total Billed Charges,89% of total Billed charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.66,77,,,Percent of total Billed charges,77% of total billed charges,6.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.84,6.54,
predniSONE 20mg Tablet,603533921,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
predniSONE 20mg Tablet,603533921,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
predniSONE 20mg Tablet,603533921,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
predniSONE 20mg Tablet,603533921,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
predniSONE 20mg Tablet,603533921,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
predniSONE 20mg Tablet,603533921,CDM,250,RC,,,Outpatient,,,7.44,3.72,,5.73,77,,,Percent of Total Billed Charges,77% of total billed charges,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.51,74,,,Percent of Total Billed Charges,74% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,5.13,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,84,,,Percent of Total Billed Charges,84% of total billed charges,6.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.62,89,,,Percent of total Billed Charges,89% of total Billed charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.73,77,,,Percent of total Billed charges,77% of total billed charges,6.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.86,6.62,
prednisoLONE 1% OPHTH Susp 5ml,61314063705,CDM,250,RC,,,Outpatient,,,195.59,97.8,,150.6,77,,,Percent of Total Billed Charges,77% of total billed charges,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.74,74,,,Percent of Total Billed Charges,74% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,164.3,84,,,Percent of Total Billed Charges,84% of total billed charges,160.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.08,89,,,Percent of total Billed Charges,89% of total Billed charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.6,77,,,Percent of total Billed charges,77% of total billed charges,166.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.9,174.08,
prednisoLONE 1% OPHTH Susp 5ml,61314063705,CDM,250,RC,,,Outpatient,,,195.59,97.8,,150.6,77,,,Percent of Total Billed Charges,77% of total billed charges,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.74,74,,,Percent of Total Billed Charges,74% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,164.3,84,,,Percent of Total Billed Charges,84% of total billed charges,160.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.08,89,,,Percent of total Billed Charges,89% of total Billed charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.6,77,,,Percent of total Billed charges,77% of total billed charges,166.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.9,174.08,
prednisoLONE 1% OPHTH Susp 5ml,61314063705,CDM,250,RC,,,Outpatient,,,195.59,97.8,,150.6,77,,,Percent of Total Billed Charges,77% of total billed charges,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.74,74,,,Percent of Total Billed Charges,74% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,164.3,84,,,Percent of Total Billed Charges,84% of total billed charges,160.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.08,89,,,Percent of total Billed Charges,89% of total Billed charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.6,77,,,Percent of total Billed charges,77% of total billed charges,166.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.9,174.08,
prednisoLONE 1% OPHTH Susp 5ml,61314063705,CDM,250,RC,,,Outpatient,,,195.59,97.8,,150.6,77,,,Percent of Total Billed Charges,77% of total billed charges,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.74,74,,,Percent of Total Billed Charges,74% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,164.3,84,,,Percent of Total Billed Charges,84% of total billed charges,160.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.08,89,,,Percent of total Billed Charges,89% of total Billed charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.6,77,,,Percent of total Billed charges,77% of total billed charges,166.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.9,174.08,
prednisoLONE 1% OPHTH Susp 5ml,61314063705,CDM,250,RC,,,Outpatient,,,195.59,97.8,,150.6,77,,,Percent of Total Billed Charges,77% of total billed charges,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.74,74,,,Percent of Total Billed Charges,74% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,164.3,84,,,Percent of Total Billed Charges,84% of total billed charges,160.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.08,89,,,Percent of total Billed Charges,89% of total Billed charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.6,77,,,Percent of total Billed charges,77% of total billed charges,166.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.9,174.08,
prednisoLONE 1% OPHTH Susp 5ml,61314063705,CDM,250,RC,,,Outpatient,,,195.59,97.8,,150.6,77,,,Percent of Total Billed Charges,77% of total billed charges,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,144.74,74,,,Percent of Total Billed Charges,74% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,134.96,69,,,Percent of Total Billed Charges,69% of total billed charges,164.3,84,,,Percent of Total Billed Charges,84% of total billed charges,160.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,174.08,89,,,Percent of total Billed Charges,89% of total Billed charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,150.6,77,,,Percent of total Billed charges,77% of total billed charges,166.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,97.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,79.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.9,174.08,
Pregabalin 50mg Capsule,71101368,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 50mg Capsule,71101368,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 50mg Capsule,71101368,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 50mg Capsule,71101368,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 50mg Capsule,71101368,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 50mg Capsule,71101368,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 75mg Capsule,71101468,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 75mg Capsule,71101468,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 75mg Capsule,71101468,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 75mg Capsule,71101468,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 75mg Capsule,71101468,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Pregabalin 75mg Capsule,71101468,CDM,250,RC,,,Outpatient,,,76.49,38.25,,58.9,77,,,Percent of Total Billed Charges,77% of total billed charges,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,56.6,74,,,Percent of Total Billed Charges,74% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,52.78,69,,,Percent of Total Billed Charges,69% of total billed charges,64.25,84,,,Percent of Total Billed Charges,84% of total billed charges,62.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,68.08,89,,,Percent of total Billed Charges,89% of total Billed charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,58.9,77,,,Percent of total Billed charges,77% of total billed charges,65.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,21.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.08,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.12,68.08,
Prenatal Vitamin Tablet,60258019309,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Prenatal Vitamin Tablet,60258019309,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Prenatal Vitamin Tablet,60258019309,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Prenatal Vitamin Tablet,60258019309,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Prenatal Vitamin Tablet,60258019309,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Prenatal Vitamin Tablet,60258019309,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Primidone 250mg Tablet,66490069110,CDM,250,RC,,,Outpatient,,,238.7,119.35,,183.8,77,,,Percent of Total Billed Charges,77% of total billed charges,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.64,74,,,Percent of Total Billed Charges,74% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,200.51,84,,,Percent of Total Billed Charges,84% of total billed charges,195.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.44,89,,,Percent of total Billed Charges,89% of total Billed charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.8,77,,,Percent of total Billed charges,77% of total billed charges,202.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,212.44,
Primidone 250mg Tablet,66490069110,CDM,250,RC,,,Outpatient,,,238.7,119.35,,183.8,77,,,Percent of Total Billed Charges,77% of total billed charges,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.64,74,,,Percent of Total Billed Charges,74% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,200.51,84,,,Percent of Total Billed Charges,84% of total billed charges,195.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.44,89,,,Percent of total Billed Charges,89% of total Billed charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.8,77,,,Percent of total Billed charges,77% of total billed charges,202.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,212.44,
Primidone 250mg Tablet,66490069110,CDM,250,RC,,,Outpatient,,,238.7,119.35,,183.8,77,,,Percent of Total Billed Charges,77% of total billed charges,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.64,74,,,Percent of Total Billed Charges,74% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,200.51,84,,,Percent of Total Billed Charges,84% of total billed charges,195.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.44,89,,,Percent of total Billed Charges,89% of total Billed charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.8,77,,,Percent of total Billed charges,77% of total billed charges,202.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,212.44,
Primidone 250mg Tablet,66490069110,CDM,250,RC,,,Outpatient,,,238.7,119.35,,183.8,77,,,Percent of Total Billed Charges,77% of total billed charges,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.64,74,,,Percent of Total Billed Charges,74% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,200.51,84,,,Percent of Total Billed Charges,84% of total billed charges,195.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.44,89,,,Percent of total Billed Charges,89% of total Billed charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.8,77,,,Percent of total Billed charges,77% of total billed charges,202.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,212.44,
Primidone 250mg Tablet,66490069110,CDM,250,RC,,,Outpatient,,,238.7,119.35,,183.8,77,,,Percent of Total Billed Charges,77% of total billed charges,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.64,74,,,Percent of Total Billed Charges,74% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,200.51,84,,,Percent of Total Billed Charges,84% of total billed charges,195.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.44,89,,,Percent of total Billed Charges,89% of total Billed charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.8,77,,,Percent of total Billed charges,77% of total billed charges,202.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,212.44,
Primidone 250mg Tablet,66490069110,CDM,250,RC,,,Outpatient,,,238.7,119.35,,183.8,77,,,Percent of Total Billed Charges,77% of total billed charges,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,60.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,74.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,176.64,74,,,Percent of Total Billed Charges,74% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,164.7,69,,,Percent of Total Billed Charges,69% of total billed charges,200.51,84,,,Percent of Total Billed Charges,84% of total billed charges,195.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,212.44,89,,,Percent of total Billed Charges,89% of total Billed charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.8,77,,,Percent of total Billed charges,77% of total billed charges,202.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,68.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,119.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,97.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.44,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.68,212.44,
Primidone 50mg Tablet,527130101,CDM,250,RC,,,Outpatient,,,9.69,4.85,,7.46,77,,,Percent of Total Billed Charges,77% of total billed charges,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.17,74,,,Percent of Total Billed Charges,74% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,8.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.62,89,,,Percent of total Billed Charges,89% of total Billed charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,77,,,Percent of total Billed charges,77% of total billed charges,8.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,8.62,
Primidone 50mg Tablet,527130101,CDM,250,RC,,,Outpatient,,,9.69,4.85,,7.46,77,,,Percent of Total Billed Charges,77% of total billed charges,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.17,74,,,Percent of Total Billed Charges,74% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,8.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.62,89,,,Percent of total Billed Charges,89% of total Billed charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,77,,,Percent of total Billed charges,77% of total billed charges,8.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,8.62,
Primidone 50mg Tablet,527130101,CDM,250,RC,,,Outpatient,,,9.69,4.85,,7.46,77,,,Percent of Total Billed Charges,77% of total billed charges,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.17,74,,,Percent of Total Billed Charges,74% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,8.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.62,89,,,Percent of total Billed Charges,89% of total Billed charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,77,,,Percent of total Billed charges,77% of total billed charges,8.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,8.62,
Primidone 50mg Tablet,527130101,CDM,250,RC,,,Outpatient,,,9.69,4.85,,7.46,77,,,Percent of Total Billed Charges,77% of total billed charges,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.17,74,,,Percent of Total Billed Charges,74% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,8.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.62,89,,,Percent of total Billed Charges,89% of total Billed charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,77,,,Percent of total Billed charges,77% of total billed charges,8.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,8.62,
Primidone 50mg Tablet,527130101,CDM,250,RC,,,Outpatient,,,9.69,4.85,,7.46,77,,,Percent of Total Billed Charges,77% of total billed charges,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.17,74,,,Percent of Total Billed Charges,74% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,8.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.62,89,,,Percent of total Billed Charges,89% of total Billed charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,77,,,Percent of total Billed charges,77% of total billed charges,8.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,8.62,
Primidone 50mg Tablet,527130101,CDM,250,RC,,,Outpatient,,,9.69,4.85,,7.46,77,,,Percent of Total Billed Charges,77% of total billed charges,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.17,74,,,Percent of Total Billed Charges,74% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,6.69,69,,,Percent of Total Billed Charges,69% of total billed charges,8.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.62,89,,,Percent of total Billed Charges,89% of total Billed charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.46,77,,,Percent of total Billed charges,77% of total billed charges,8.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.42,8.62,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,450.07,225.04,,346.55,77,,,Percent of Total Billed Charges,77% of total billed charges,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.05,74,,,Percent of Total Billed Charges,74% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,378.06,84,,,Percent of Total Billed Charges,84% of total billed charges,369.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.56,89,,,Percent of total Billed Charges,89% of total Billed charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.55,77,,,Percent of total Billed charges,77% of total billed charges,382.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,225.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.52,400.56,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,467.16,233.58,,359.71,77,,,Percent of Total Billed Charges,77% of total billed charges,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.7,74,,,Percent of Total Billed Charges,74% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,392.41,84,,,Percent of Total Billed Charges,84% of total billed charges,383.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.77,89,,,Percent of total Billed Charges,89% of total Billed charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.71,77,,,Percent of total Billed charges,77% of total billed charges,397.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,233.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.79,415.77,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,450.07,225.04,,346.55,77,,,Percent of Total Billed Charges,77% of total billed charges,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.05,74,,,Percent of Total Billed Charges,74% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,378.06,84,,,Percent of Total Billed Charges,84% of total billed charges,369.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.56,89,,,Percent of total Billed Charges,89% of total Billed charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.55,77,,,Percent of total Billed charges,77% of total billed charges,382.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,225.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.52,400.56,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,467.16,233.58,,359.71,77,,,Percent of Total Billed Charges,77% of total billed charges,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.7,74,,,Percent of Total Billed Charges,74% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,392.41,84,,,Percent of Total Billed Charges,84% of total billed charges,383.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.77,89,,,Percent of total Billed Charges,89% of total Billed charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.71,77,,,Percent of total Billed charges,77% of total billed charges,397.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,233.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.79,415.77,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,450.07,225.04,,346.55,77,,,Percent of Total Billed Charges,77% of total billed charges,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.05,74,,,Percent of Total Billed Charges,74% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,378.06,84,,,Percent of Total Billed Charges,84% of total billed charges,369.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.56,89,,,Percent of total Billed Charges,89% of total Billed charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.55,77,,,Percent of total Billed charges,77% of total billed charges,382.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,225.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.52,400.56,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,467.16,233.58,,359.71,77,,,Percent of Total Billed Charges,77% of total billed charges,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.7,74,,,Percent of Total Billed Charges,74% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,392.41,84,,,Percent of Total Billed Charges,84% of total billed charges,383.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.77,89,,,Percent of total Billed Charges,89% of total Billed charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.71,77,,,Percent of total Billed charges,77% of total billed charges,397.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,233.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.79,415.77,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,450.07,225.04,,346.55,77,,,Percent of Total Billed Charges,77% of total billed charges,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.05,74,,,Percent of Total Billed Charges,74% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,378.06,84,,,Percent of Total Billed Charges,84% of total billed charges,369.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.56,89,,,Percent of total Billed Charges,89% of total Billed charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.55,77,,,Percent of total Billed charges,77% of total billed charges,382.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,225.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.52,400.56,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,467.16,233.58,,359.71,77,,,Percent of Total Billed Charges,77% of total billed charges,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.7,74,,,Percent of Total Billed Charges,74% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,392.41,84,,,Percent of Total Billed Charges,84% of total billed charges,383.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.77,89,,,Percent of total Billed Charges,89% of total Billed charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.71,77,,,Percent of total Billed charges,77% of total billed charges,397.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,233.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.79,415.77,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,450.07,225.04,,346.55,77,,,Percent of Total Billed Charges,77% of total billed charges,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.05,74,,,Percent of Total Billed Charges,74% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,378.06,84,,,Percent of Total Billed Charges,84% of total billed charges,369.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.56,89,,,Percent of total Billed Charges,89% of total Billed charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.55,77,,,Percent of total Billed charges,77% of total billed charges,382.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,225.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.52,400.56,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,467.16,233.58,,359.71,77,,,Percent of Total Billed Charges,77% of total billed charges,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.7,74,,,Percent of Total Billed Charges,74% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,392.41,84,,,Percent of Total Billed Charges,84% of total billed charges,383.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.77,89,,,Percent of total Billed Charges,89% of total Billed charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.71,77,,,Percent of total Billed charges,77% of total billed charges,397.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,233.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.79,415.77,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,450.07,225.04,,346.55,77,,,Percent of Total Billed Charges,77% of total billed charges,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,114.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,140.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,333.05,74,,,Percent of Total Billed Charges,74% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,310.55,69,,,Percent of Total Billed Charges,69% of total billed charges,378.06,84,,,Percent of Total Billed Charges,84% of total billed charges,369.06,82,,,Percent of Total Billed Charges,82% of total billed charges ,400.56,89,,,Percent of total Billed Charges,89% of total Billed charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,346.55,77,,,Percent of total Billed charges,77% of total billed charges,382.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,129.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,225.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,183.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,400.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,112.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,112.52,400.56,
Procainamide 1000mg/10ml MDV,409190201,CDM,250,RC,,,Outpatient,,,467.16,233.58,,359.71,77,,,Percent of Total Billed Charges,77% of total billed charges,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,119.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,345.7,74,,,Percent of Total Billed Charges,74% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,322.34,69,,,Percent of Total Billed Charges,69% of total billed charges,392.41,84,,,Percent of Total Billed Charges,84% of total billed charges,383.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,415.77,89,,,Percent of total Billed Charges,89% of total Billed charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,359.71,77,,,Percent of total Billed charges,77% of total billed charges,397.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,134.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,233.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,190.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,415.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.79,415.77,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 10mg/2ml SDV,55390007710,CDM,250,RC,,,Outpatient,,,77.83,38.92,,59.93,77,,,Percent of Total Billed Charges,77% of total billed charges,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,57.59,74,,,Percent of Total Billed Charges,74% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,53.7,69,,,Percent of Total Billed Charges,69% of total billed charges,65.38,84,,,Percent of Total Billed Charges,84% of total billed charges,63.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,69.27,89,,,Percent of total Billed Charges,89% of total Billed charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.93,77,,,Percent of total Billed charges,77% of total billed charges,66.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,38.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,31.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.27,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,69.27,
Prochlorperazine 25mg Suppository,574722612,CDM,250,RC,,,Outpatient,,,93.87,46.94,,72.28,77,,,Percent of Total Billed Charges,77% of total billed charges,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.46,74,,,Percent of Total Billed Charges,74% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,78.85,84,,,Percent of Total Billed Charges,84% of total billed charges,76.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.54,89,,,Percent of total Billed Charges,89% of total Billed charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.28,77,,,Percent of total Billed charges,77% of total billed charges,79.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.47,83.54,
Prochlorperazine 25mg Suppository,574722612,CDM,250,RC,,,Outpatient,,,93.87,46.94,,72.28,77,,,Percent of Total Billed Charges,77% of total billed charges,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.46,74,,,Percent of Total Billed Charges,74% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,78.85,84,,,Percent of Total Billed Charges,84% of total billed charges,76.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.54,89,,,Percent of total Billed Charges,89% of total Billed charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.28,77,,,Percent of total Billed charges,77% of total billed charges,79.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.47,83.54,
Prochlorperazine 25mg Suppository,574722612,CDM,250,RC,,,Outpatient,,,93.87,46.94,,72.28,77,,,Percent of Total Billed Charges,77% of total billed charges,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.46,74,,,Percent of Total Billed Charges,74% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,78.85,84,,,Percent of Total Billed Charges,84% of total billed charges,76.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.54,89,,,Percent of total Billed Charges,89% of total Billed charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.28,77,,,Percent of total Billed charges,77% of total billed charges,79.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.47,83.54,
Prochlorperazine 25mg Suppository,574722612,CDM,250,RC,,,Outpatient,,,93.87,46.94,,72.28,77,,,Percent of Total Billed Charges,77% of total billed charges,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.46,74,,,Percent of Total Billed Charges,74% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,78.85,84,,,Percent of Total Billed Charges,84% of total billed charges,76.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.54,89,,,Percent of total Billed Charges,89% of total Billed charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.28,77,,,Percent of total Billed charges,77% of total billed charges,79.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.47,83.54,
Prochlorperazine 25mg Suppository,574722612,CDM,250,RC,,,Outpatient,,,93.87,46.94,,72.28,77,,,Percent of Total Billed Charges,77% of total billed charges,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.46,74,,,Percent of Total Billed Charges,74% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,78.85,84,,,Percent of Total Billed Charges,84% of total billed charges,76.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.54,89,,,Percent of total Billed Charges,89% of total Billed charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.28,77,,,Percent of total Billed charges,77% of total billed charges,79.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.47,83.54,
Prochlorperazine 25mg Suppository,574722612,CDM,250,RC,,,Outpatient,,,93.87,46.94,,72.28,77,,,Percent of Total Billed Charges,77% of total billed charges,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.46,74,,,Percent of Total Billed Charges,74% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,64.77,69,,,Percent of Total Billed Charges,69% of total billed charges,78.85,84,,,Percent of Total Billed Charges,84% of total billed charges,76.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.54,89,,,Percent of total Billed Charges,89% of total Billed charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.28,77,,,Percent of total Billed charges,77% of total billed charges,79.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.47,83.54,
Prochlorperazine 5mg Tablet,50268068415,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Prochlorperazine 5mg Tablet,50268068415,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Prochlorperazine 5mg Tablet,50268068415,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Prochlorperazine 5mg Tablet,50268068415,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Prochlorperazine 5mg Tablet,50268068415,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Prochlorperazine 5mg Tablet,50268068415,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Promethazine 12.5mg Suppository,713053612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 12.5mg Suppository,713053612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 12.5mg Suppository,713053612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 12.5mg Suppository,713053612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 12.5mg Suppository,713053612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 12.5mg Suppository,713053612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Suppository,713052612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Suppository,713052612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Suppository,713052612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Suppository,713052612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Suppository,713052612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Suppository,713052612,CDM,250,RC,,,Outpatient,,,130.11,65.06,,100.18,77,,,Percent of Total Billed Charges,77% of total billed charges,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,96.28,74,,,Percent of Total Billed Charges,74% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,89.78,69,,,Percent of Total Billed Charges,69% of total billed charges,109.29,84,,,Percent of Total Billed Charges,84% of total billed charges,106.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,115.8,89,,,Percent of total Billed Charges,89% of total Billed charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,100.18,77,,,Percent of total Billed charges,77% of total billed charges,110.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.41,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.53,115.8,
Promethazine 25mg Tablet,53746052101,CDM,250,RC,,,Outpatient,,,9.79,4.9,,7.54,77,,,Percent of Total Billed Charges,77% of total billed charges,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.71,89,,,Percent of total Billed Charges,89% of total Billed charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,77,,,Percent of total Billed charges,77% of total billed charges,8.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.45,8.71,
Promethazine 25mg Tablet,53746052101,CDM,250,RC,,,Outpatient,,,9.79,4.9,,7.54,77,,,Percent of Total Billed Charges,77% of total billed charges,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.71,89,,,Percent of total Billed Charges,89% of total Billed charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,77,,,Percent of total Billed charges,77% of total billed charges,8.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.45,8.71,
Promethazine 25mg Tablet,53746052101,CDM,250,RC,,,Outpatient,,,9.79,4.9,,7.54,77,,,Percent of Total Billed Charges,77% of total billed charges,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.71,89,,,Percent of total Billed Charges,89% of total Billed charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,77,,,Percent of total Billed charges,77% of total billed charges,8.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.45,8.71,
Promethazine 25mg Tablet,53746052101,CDM,250,RC,,,Outpatient,,,9.79,4.9,,7.54,77,,,Percent of Total Billed Charges,77% of total billed charges,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.71,89,,,Percent of total Billed Charges,89% of total Billed charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,77,,,Percent of total Billed charges,77% of total billed charges,8.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.45,8.71,
Promethazine 25mg Tablet,53746052101,CDM,250,RC,,,Outpatient,,,9.79,4.9,,7.54,77,,,Percent of Total Billed Charges,77% of total billed charges,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.71,89,,,Percent of total Billed Charges,89% of total Billed charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,77,,,Percent of total Billed charges,77% of total billed charges,8.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.45,8.71,
Promethazine 25mg Tablet,53746052101,CDM,250,RC,,,Outpatient,,,9.79,4.9,,7.54,77,,,Percent of Total Billed Charges,77% of total billed charges,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.24,74,,,Percent of Total Billed Charges,74% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.22,84,,,Percent of Total Billed Charges,84% of total billed charges,8.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.71,89,,,Percent of total Billed Charges,89% of total Billed charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.54,77,,,Percent of total Billed charges,77% of total billed charges,8.32,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.99,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.45,8.71,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine 25mg/ml SDV,641095525,CDM,250,RC,,,Outpatient,,,54.39,27.2,,41.88,77,,,Percent of Total Billed Charges,77% of total billed charges,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,40.25,74,,,Percent of Total Billed Charges,74% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,37.53,69,,,Percent of Total Billed Charges,69% of total billed charges,45.69,84,,,Percent of Total Billed Charges,84% of total billed charges,44.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,48.41,89,,,Percent of total Billed Charges,89% of total Billed charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.88,77,,,Percent of total Billed charges,77% of total billed charges,46.23,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.19,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.6,48.41,
Promethazine Liquid 6.25mg/5ml UDC,,,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Promethazine Liquid 6.25mg/5ml UDC,,,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Promethazine Liquid 6.25mg/5ml UDC,,,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Promethazine Liquid 6.25mg/5ml UDC,,,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Promethazine Liquid 6.25mg/5ml UDC,,,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Promethazine Liquid 6.25mg/5ml UDC,,,250,RC,,,Outpatient,,,9.97,4.99,,7.68,77,,,Percent of Total Billed Charges,77% of total billed charges,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,84,,,Percent of Total Billed Charges,84% of total billed charges,8.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.68,77,,,Percent of total Billed charges,77% of total billed charges,8.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.07,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.49,8.87,
Propofol 200mg/20ml SDV,63323026929,CDM,250,RC,,,Outpatient,,,209.39,104.7,,161.23,77,,,Percent of Total Billed Charges,77% of total billed charges,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.95,74,,,Percent of Total Billed Charges,74% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,175.89,84,,,Percent of Total Billed Charges,84% of total billed charges,171.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.36,89,,,Percent of total Billed Charges,89% of total Billed charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,77,,,Percent of total Billed charges,77% of total billed charges,177.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.35,186.36,
Propofol 200mg/20ml SDV,63323026929,CDM,250,RC,,,Outpatient,,,209.39,104.7,,161.23,77,,,Percent of Total Billed Charges,77% of total billed charges,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.95,74,,,Percent of Total Billed Charges,74% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,175.89,84,,,Percent of Total Billed Charges,84% of total billed charges,171.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.36,89,,,Percent of total Billed Charges,89% of total Billed charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,77,,,Percent of total Billed charges,77% of total billed charges,177.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.35,186.36,
Propofol 200mg/20ml SDV,63323026929,CDM,250,RC,,,Outpatient,,,209.39,104.7,,161.23,77,,,Percent of Total Billed Charges,77% of total billed charges,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.95,74,,,Percent of Total Billed Charges,74% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,175.89,84,,,Percent of Total Billed Charges,84% of total billed charges,171.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.36,89,,,Percent of total Billed Charges,89% of total Billed charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,77,,,Percent of total Billed charges,77% of total billed charges,177.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.35,186.36,
Propofol 200mg/20ml SDV,63323026929,CDM,250,RC,,,Outpatient,,,209.39,104.7,,161.23,77,,,Percent of Total Billed Charges,77% of total billed charges,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.95,74,,,Percent of Total Billed Charges,74% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,175.89,84,,,Percent of Total Billed Charges,84% of total billed charges,171.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.36,89,,,Percent of total Billed Charges,89% of total Billed charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,77,,,Percent of total Billed charges,77% of total billed charges,177.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.35,186.36,
Propofol 200mg/20ml SDV,63323026929,CDM,250,RC,,,Outpatient,,,209.39,104.7,,161.23,77,,,Percent of Total Billed Charges,77% of total billed charges,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.95,74,,,Percent of Total Billed Charges,74% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,175.89,84,,,Percent of Total Billed Charges,84% of total billed charges,171.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.36,89,,,Percent of total Billed Charges,89% of total Billed charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,77,,,Percent of total Billed charges,77% of total billed charges,177.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.35,186.36,
Propofol 200mg/20ml SDV,63323026929,CDM,250,RC,,,Outpatient,,,209.39,104.7,,161.23,77,,,Percent of Total Billed Charges,77% of total billed charges,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,154.95,74,,,Percent of Total Billed Charges,74% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,144.48,69,,,Percent of Total Billed Charges,69% of total billed charges,175.89,84,,,Percent of Total Billed Charges,84% of total billed charges,171.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.36,89,,,Percent of total Billed Charges,89% of total Billed charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.23,77,,,Percent of total Billed charges,77% of total billed charges,177.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.7,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.35,186.36,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,299.46,149.73,,230.58,77,,,Percent of Total Billed Charges,77% of total billed charges,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.6,74,,,Percent of Total Billed Charges,74% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,251.55,84,,,Percent of Total Billed Charges,84% of total billed charges,245.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.52,89,,,Percent of total Billed Charges,89% of total Billed charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.58,77,,,Percent of total Billed charges,77% of total billed charges,254.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,266.52,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,19.31,9.66,,14.87,77,,,Percent of Total Billed Charges,77% of total billed charges,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.29,74,,,Percent of Total Billed Charges,74% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,16.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.19,89,,,Percent of total Billed Charges,89% of total Billed charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,77,,,Percent of total Billed charges,77% of total billed charges,16.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,17.19,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,299.46,149.73,,230.58,77,,,Percent of Total Billed Charges,77% of total billed charges,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.6,74,,,Percent of Total Billed Charges,74% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,251.55,84,,,Percent of Total Billed Charges,84% of total billed charges,245.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.52,89,,,Percent of total Billed Charges,89% of total Billed charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.58,77,,,Percent of total Billed charges,77% of total billed charges,254.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,266.52,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,19.31,9.66,,14.87,77,,,Percent of Total Billed Charges,77% of total billed charges,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.29,74,,,Percent of Total Billed Charges,74% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,16.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.19,89,,,Percent of total Billed Charges,89% of total Billed charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,77,,,Percent of total Billed charges,77% of total billed charges,16.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,17.19,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,299.46,149.73,,230.58,77,,,Percent of Total Billed Charges,77% of total billed charges,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.6,74,,,Percent of Total Billed Charges,74% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,251.55,84,,,Percent of Total Billed Charges,84% of total billed charges,245.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.52,89,,,Percent of total Billed Charges,89% of total Billed charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.58,77,,,Percent of total Billed charges,77% of total billed charges,254.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,266.52,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,19.31,9.66,,14.87,77,,,Percent of Total Billed Charges,77% of total billed charges,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.29,74,,,Percent of Total Billed Charges,74% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,16.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.19,89,,,Percent of total Billed Charges,89% of total Billed charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,77,,,Percent of total Billed charges,77% of total billed charges,16.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,17.19,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,299.46,149.73,,230.58,77,,,Percent of Total Billed Charges,77% of total billed charges,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.6,74,,,Percent of Total Billed Charges,74% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,251.55,84,,,Percent of Total Billed Charges,84% of total billed charges,245.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.52,89,,,Percent of total Billed Charges,89% of total Billed charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.58,77,,,Percent of total Billed charges,77% of total billed charges,254.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,266.52,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,19.31,9.66,,14.87,77,,,Percent of Total Billed Charges,77% of total billed charges,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.29,74,,,Percent of Total Billed Charges,74% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,16.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.19,89,,,Percent of total Billed Charges,89% of total Billed charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,77,,,Percent of total Billed charges,77% of total billed charges,16.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,17.19,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,299.46,149.73,,230.58,77,,,Percent of Total Billed Charges,77% of total billed charges,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.6,74,,,Percent of Total Billed Charges,74% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,251.55,84,,,Percent of Total Billed Charges,84% of total billed charges,245.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.52,89,,,Percent of total Billed Charges,89% of total Billed charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.58,77,,,Percent of total Billed charges,77% of total billed charges,254.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,266.52,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,19.31,9.66,,14.87,77,,,Percent of Total Billed Charges,77% of total billed charges,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.29,74,,,Percent of Total Billed Charges,74% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,16.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.19,89,,,Percent of total Billed Charges,89% of total Billed charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,77,,,Percent of total Billed charges,77% of total billed charges,16.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,17.19,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,299.46,149.73,,230.58,77,,,Percent of Total Billed Charges,77% of total billed charges,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.6,74,,,Percent of Total Billed Charges,74% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,206.63,69,,,Percent of Total Billed Charges,69% of total billed charges,251.55,84,,,Percent of Total Billed Charges,84% of total billed charges,245.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.52,89,,,Percent of total Billed Charges,89% of total Billed charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.58,77,,,Percent of total Billed charges,77% of total billed charges,254.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.87,266.52,
Propofol 500mg/50ml SDV,63323026957,CDM,250,RC,,,Outpatient,,,19.31,9.66,,14.87,77,,,Percent of Total Billed Charges,77% of total billed charges,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.29,74,,,Percent of Total Billed Charges,74% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,13.32,69,,,Percent of Total Billed Charges,69% of total billed charges,16.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.19,89,,,Percent of total Billed Charges,89% of total Billed charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.87,77,,,Percent of total Billed charges,77% of total billed charges,16.41,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.83,17.19,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,378.93,189.47,,291.78,77,,,Percent of Total Billed Charges,77% of total billed charges,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.41,74,,,Percent of Total Billed Charges,74% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,318.3,84,,,Percent of Total Billed Charges,84% of total billed charges,310.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.25,89,,,Percent of total Billed Charges,89% of total Billed charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.78,77,,,Percent of total Billed charges,77% of total billed charges,322.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,189.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.73,337.25,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,30.9,15.45,,23.79,77,,,Percent of Total Billed Charges,77% of total billed charges,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.87,74,,,Percent of Total Billed Charges,74% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,25.96,84,,,Percent of Total Billed Charges,84% of total billed charges,25.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.5,89,,,Percent of total Billed Charges,89% of total Billed charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.79,77,,,Percent of total Billed charges,77% of total billed charges,26.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,27.5,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,378.93,189.47,,291.78,77,,,Percent of Total Billed Charges,77% of total billed charges,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.41,74,,,Percent of Total Billed Charges,74% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,318.3,84,,,Percent of Total Billed Charges,84% of total billed charges,310.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.25,89,,,Percent of total Billed Charges,89% of total Billed charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.78,77,,,Percent of total Billed charges,77% of total billed charges,322.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,189.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.73,337.25,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,30.9,15.45,,23.79,77,,,Percent of Total Billed Charges,77% of total billed charges,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.87,74,,,Percent of Total Billed Charges,74% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,25.96,84,,,Percent of Total Billed Charges,84% of total billed charges,25.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.5,89,,,Percent of total Billed Charges,89% of total Billed charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.79,77,,,Percent of total Billed charges,77% of total billed charges,26.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,27.5,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,378.93,189.47,,291.78,77,,,Percent of Total Billed Charges,77% of total billed charges,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.41,74,,,Percent of Total Billed Charges,74% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,318.3,84,,,Percent of Total Billed Charges,84% of total billed charges,310.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.25,89,,,Percent of total Billed Charges,89% of total Billed charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.78,77,,,Percent of total Billed charges,77% of total billed charges,322.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,189.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.73,337.25,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,30.9,15.45,,23.79,77,,,Percent of Total Billed Charges,77% of total billed charges,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.87,74,,,Percent of Total Billed Charges,74% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,25.96,84,,,Percent of Total Billed Charges,84% of total billed charges,25.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.5,89,,,Percent of total Billed Charges,89% of total Billed charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.79,77,,,Percent of total Billed charges,77% of total billed charges,26.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,27.5,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,378.93,189.47,,291.78,77,,,Percent of Total Billed Charges,77% of total billed charges,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.41,74,,,Percent of Total Billed Charges,74% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,318.3,84,,,Percent of Total Billed Charges,84% of total billed charges,310.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.25,89,,,Percent of total Billed Charges,89% of total Billed charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.78,77,,,Percent of total Billed charges,77% of total billed charges,322.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,189.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.73,337.25,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,30.9,15.45,,23.79,77,,,Percent of Total Billed Charges,77% of total billed charges,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.87,74,,,Percent of Total Billed Charges,74% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,25.96,84,,,Percent of Total Billed Charges,84% of total billed charges,25.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.5,89,,,Percent of total Billed Charges,89% of total Billed charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.79,77,,,Percent of total Billed charges,77% of total billed charges,26.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,27.5,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,378.93,189.47,,291.78,77,,,Percent of Total Billed Charges,77% of total billed charges,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.41,74,,,Percent of Total Billed Charges,74% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,318.3,84,,,Percent of Total Billed Charges,84% of total billed charges,310.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.25,89,,,Percent of total Billed Charges,89% of total Billed charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.78,77,,,Percent of total Billed charges,77% of total billed charges,322.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,189.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.73,337.25,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,30.9,15.45,,23.79,77,,,Percent of Total Billed Charges,77% of total billed charges,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.87,74,,,Percent of Total Billed Charges,74% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,25.96,84,,,Percent of Total Billed Charges,84% of total billed charges,25.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.5,89,,,Percent of total Billed Charges,89% of total Billed charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.79,77,,,Percent of total Billed charges,77% of total billed charges,26.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,27.5,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,378.93,189.47,,291.78,77,,,Percent of Total Billed Charges,77% of total billed charges,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,96.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,280.41,74,,,Percent of Total Billed Charges,74% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,261.46,69,,,Percent of Total Billed Charges,69% of total billed charges,318.3,84,,,Percent of Total Billed Charges,84% of total billed charges,310.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,337.25,89,,,Percent of total Billed Charges,89% of total Billed charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,291.78,77,,,Percent of total Billed charges,77% of total billed charges,322.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,108.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,189.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,154.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,337.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,94.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,94.73,337.25,
Propofol 1000mg/100ml SDV,63323026965,CDM,250,RC,,,Outpatient,,,30.9,15.45,,23.79,77,,,Percent of Total Billed Charges,77% of total billed charges,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.88,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.66,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,22.87,74,,,Percent of Total Billed Charges,74% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,21.32,69,,,Percent of Total Billed Charges,69% of total billed charges,25.96,84,,,Percent of Total Billed Charges,84% of total billed charges,25.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.5,89,,,Percent of total Billed Charges,89% of total Billed charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.79,77,,,Percent of total Billed charges,77% of total billed charges,26.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.73,27.5,
Propafenone 150mg Tablet,59651025601,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Propafenone 150mg Tablet,59651025601,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Propafenone 150mg Tablet,59651025601,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Propafenone 150mg Tablet,59651025601,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Propafenone 150mg Tablet,59651025601,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Propafenone 150mg Tablet,59651025601,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Proparacaine 0.5% OPHTH Soln 15ml,24208073006,CDM,250,RC,,,Outpatient,,,171.48,85.74,,132.04,77,,,Percent of Total Billed Charges,77% of total billed charges,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.9,74,,,Percent of Total Billed Charges,74% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,144.04,84,,,Percent of Total Billed Charges,84% of total billed charges,140.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.62,89,,,Percent of total Billed Charges,89% of total Billed charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.04,77,,,Percent of total Billed charges,77% of total billed charges,145.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.87,152.62,
Proparacaine 0.5% OPHTH Soln 15ml,24208073006,CDM,250,RC,,,Outpatient,,,171.48,85.74,,132.04,77,,,Percent of Total Billed Charges,77% of total billed charges,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.9,74,,,Percent of Total Billed Charges,74% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,144.04,84,,,Percent of Total Billed Charges,84% of total billed charges,140.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.62,89,,,Percent of total Billed Charges,89% of total Billed charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.04,77,,,Percent of total Billed charges,77% of total billed charges,145.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.87,152.62,
Proparacaine 0.5% OPHTH Soln 15ml,24208073006,CDM,250,RC,,,Outpatient,,,171.48,85.74,,132.04,77,,,Percent of Total Billed Charges,77% of total billed charges,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.9,74,,,Percent of Total Billed Charges,74% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,144.04,84,,,Percent of Total Billed Charges,84% of total billed charges,140.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.62,89,,,Percent of total Billed Charges,89% of total Billed charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.04,77,,,Percent of total Billed charges,77% of total billed charges,145.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.87,152.62,
Proparacaine 0.5% OPHTH Soln 15ml,24208073006,CDM,250,RC,,,Outpatient,,,171.48,85.74,,132.04,77,,,Percent of Total Billed Charges,77% of total billed charges,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.9,74,,,Percent of Total Billed Charges,74% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,144.04,84,,,Percent of Total Billed Charges,84% of total billed charges,140.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.62,89,,,Percent of total Billed Charges,89% of total Billed charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.04,77,,,Percent of total Billed charges,77% of total billed charges,145.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.87,152.62,
Proparacaine 0.5% OPHTH Soln 15ml,24208073006,CDM,250,RC,,,Outpatient,,,171.48,85.74,,132.04,77,,,Percent of Total Billed Charges,77% of total billed charges,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.9,74,,,Percent of Total Billed Charges,74% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,144.04,84,,,Percent of Total Billed Charges,84% of total billed charges,140.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.62,89,,,Percent of total Billed Charges,89% of total Billed charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.04,77,,,Percent of total Billed charges,77% of total billed charges,145.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.87,152.62,
Proparacaine 0.5% OPHTH Soln 15ml,24208073006,CDM,250,RC,,,Outpatient,,,171.48,85.74,,132.04,77,,,Percent of Total Billed Charges,77% of total billed charges,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,126.9,74,,,Percent of Total Billed Charges,74% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,118.32,69,,,Percent of Total Billed Charges,69% of total billed charges,144.04,84,,,Percent of Total Billed Charges,84% of total billed charges,140.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.62,89,,,Percent of total Billed Charges,89% of total Billed charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.04,77,,,Percent of total Billed charges,77% of total billed charges,145.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.87,152.62,
Propranolol 1mg/ml Vial,55390000310,CDM,250,RC,,,Outpatient,,,90.99,45.5,,70.06,77,,,Percent of Total Billed Charges,77% of total billed charges,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.33,74,,,Percent of Total Billed Charges,74% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,84,,,Percent of Total Billed Charges,84% of total billed charges,74.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.98,89,,,Percent of total Billed Charges,89% of total Billed charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.06,77,,,Percent of total Billed charges,77% of total billed charges,77.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.98,
Propranolol 1mg/ml Vial,55390000310,CDM,250,RC,,,Outpatient,,,90.99,45.5,,70.06,77,,,Percent of Total Billed Charges,77% of total billed charges,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.33,74,,,Percent of Total Billed Charges,74% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,84,,,Percent of Total Billed Charges,84% of total billed charges,74.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.98,89,,,Percent of total Billed Charges,89% of total Billed charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.06,77,,,Percent of total Billed charges,77% of total billed charges,77.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.98,
Propranolol 1mg/ml Vial,55390000310,CDM,250,RC,,,Outpatient,,,90.99,45.5,,70.06,77,,,Percent of Total Billed Charges,77% of total billed charges,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.33,74,,,Percent of Total Billed Charges,74% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,84,,,Percent of Total Billed Charges,84% of total billed charges,74.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.98,89,,,Percent of total Billed Charges,89% of total Billed charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.06,77,,,Percent of total Billed charges,77% of total billed charges,77.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.98,
Propranolol 1mg/ml Vial,55390000310,CDM,250,RC,,,Outpatient,,,90.99,45.5,,70.06,77,,,Percent of Total Billed Charges,77% of total billed charges,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.33,74,,,Percent of Total Billed Charges,74% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,84,,,Percent of Total Billed Charges,84% of total billed charges,74.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.98,89,,,Percent of total Billed Charges,89% of total Billed charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.06,77,,,Percent of total Billed charges,77% of total billed charges,77.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.98,
Propranolol 1mg/ml Vial,55390000310,CDM,250,RC,,,Outpatient,,,90.99,45.5,,70.06,77,,,Percent of Total Billed Charges,77% of total billed charges,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.33,74,,,Percent of Total Billed Charges,74% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,84,,,Percent of Total Billed Charges,84% of total billed charges,74.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.98,89,,,Percent of total Billed Charges,89% of total Billed charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.06,77,,,Percent of total Billed charges,77% of total billed charges,77.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.98,
Propranolol 1mg/ml Vial,55390000310,CDM,250,RC,,,Outpatient,,,90.99,45.5,,70.06,77,,,Percent of Total Billed Charges,77% of total billed charges,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,67.33,74,,,Percent of Total Billed Charges,74% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,62.78,69,,,Percent of Total Billed Charges,69% of total billed charges,76.43,84,,,Percent of Total Billed Charges,84% of total billed charges,74.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,80.98,89,,,Percent of total Billed Charges,89% of total Billed charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.06,77,,,Percent of total Billed charges,77% of total billed charges,77.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.16,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,45.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.75,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.75,80.98,
Propranolol 20mg Tablet,,,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Propranolol 20mg Tablet,,,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Propranolol 20mg Tablet,,,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Propranolol 20mg Tablet,,,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Propranolol 20mg Tablet,,,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Propranolol 20mg Tablet,,,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Propylthiouracil 50mg Tablet,480924201,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Propylthiouracil 50mg Tablet,480924201,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Propylthiouracil 50mg Tablet,480924201,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Propylthiouracil 50mg Tablet,480924201,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Propylthiouracil 50mg Tablet,480924201,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Propylthiouracil 50mg Tablet,480924201,CDM,250,RC,,,Outpatient,,,13.45,6.73,,10.36,77,,,Percent of Total Billed Charges,77% of total billed charges,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.2,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.95,74,,,Percent of Total Billed Charges,74% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,9.28,69,,,Percent of Total Billed Charges,69% of total billed charges,11.3,84,,,Percent of Total Billed Charges,84% of total billed charges,11.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.97,89,,,Percent of total Billed Charges,89% of total Billed charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.36,77,,,Percent of total Billed charges,77% of total billed charges,11.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.97,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.36,11.97,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Protamine 250mg/25ml SDV,63323022930,CDM,250,RC,,,Outpatient,,,352.4,176.2,,271.35,77,,,Percent of Total Billed Charges,77% of total billed charges,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,89.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,110.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,260.78,74,,,Percent of Total Billed Charges,74% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,243.16,69,,,Percent of Total Billed Charges,69% of total billed charges,296.02,84,,,Percent of Total Billed Charges,84% of total billed charges,288.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,313.64,89,,,Percent of total Billed Charges,89% of total Billed charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,271.35,77,,,Percent of total Billed charges,77% of total billed charges,299.54,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,101.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,176.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,143.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,313.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,88.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.1,313.64,
Psyllium Packet (1 Dose/Packet),37000002404,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Psyllium Packet (1 Dose/Packet),37000002404,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Psyllium Packet (1 Dose/Packet),37000002404,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Psyllium Packet (1 Dose/Packet),37000002404,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Psyllium Packet (1 Dose/Packet),37000002404,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Psyllium Packet (1 Dose/Packet),37000002404,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Pyrazinamide 500mg Tablet,70954048420,CDM,250,RC,,,Outpatient,,,60.29,30.15,,46.42,77,,,Percent of Total Billed Charges,77% of total billed charges,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.61,74,,,Percent of Total Billed Charges,74% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,50.64,84,,,Percent of Total Billed Charges,84% of total billed charges,49.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.66,89,,,Percent of total Billed Charges,89% of total Billed charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.42,77,,,Percent of total Billed charges,77% of total billed charges,51.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.07,53.66,
Pyrazinamide 500mg Tablet,70954048420,CDM,250,RC,,,Outpatient,,,60.29,30.15,,46.42,77,,,Percent of Total Billed Charges,77% of total billed charges,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.61,74,,,Percent of Total Billed Charges,74% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,50.64,84,,,Percent of Total Billed Charges,84% of total billed charges,49.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.66,89,,,Percent of total Billed Charges,89% of total Billed charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.42,77,,,Percent of total Billed charges,77% of total billed charges,51.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.07,53.66,
Pyrazinamide 500mg Tablet,70954048420,CDM,250,RC,,,Outpatient,,,60.29,30.15,,46.42,77,,,Percent of Total Billed Charges,77% of total billed charges,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.61,74,,,Percent of Total Billed Charges,74% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,50.64,84,,,Percent of Total Billed Charges,84% of total billed charges,49.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.66,89,,,Percent of total Billed Charges,89% of total Billed charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.42,77,,,Percent of total Billed charges,77% of total billed charges,51.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.07,53.66,
Pyrazinamide 500mg Tablet,70954048420,CDM,250,RC,,,Outpatient,,,60.29,30.15,,46.42,77,,,Percent of Total Billed Charges,77% of total billed charges,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.61,74,,,Percent of Total Billed Charges,74% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,50.64,84,,,Percent of Total Billed Charges,84% of total billed charges,49.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.66,89,,,Percent of total Billed Charges,89% of total Billed charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.42,77,,,Percent of total Billed charges,77% of total billed charges,51.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.07,53.66,
Pyrazinamide 500mg Tablet,70954048420,CDM,250,RC,,,Outpatient,,,60.29,30.15,,46.42,77,,,Percent of Total Billed Charges,77% of total billed charges,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.61,74,,,Percent of Total Billed Charges,74% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,50.64,84,,,Percent of Total Billed Charges,84% of total billed charges,49.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.66,89,,,Percent of total Billed Charges,89% of total Billed charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.42,77,,,Percent of total Billed charges,77% of total billed charges,51.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.07,53.66,
Pyrazinamide 500mg Tablet,70954048420,CDM,250,RC,,,Outpatient,,,60.29,30.15,,46.42,77,,,Percent of Total Billed Charges,77% of total billed charges,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.61,74,,,Percent of Total Billed Charges,74% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,41.6,69,,,Percent of Total Billed Charges,69% of total billed charges,50.64,84,,,Percent of Total Billed Charges,84% of total billed charges,49.44,82,,,Percent of Total Billed Charges,82% of total billed charges ,53.66,89,,,Percent of total Billed Charges,89% of total Billed charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.42,77,,,Percent of total Billed charges,77% of total billed charges,51.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.07,53.66,
Pyridoxine (Vitamin B6) 100 mg/ml MDV,63323018001,CDM,250,RC,,,Outpatient,,,180.91,90.46,,139.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.87,74,,,Percent of Total Billed Charges,74% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,151.96,84,,,Percent of Total Billed Charges,84% of total billed charges,148.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.01,89,,,Percent of total Billed Charges,89% of total Billed charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.3,77,,,Percent of total Billed charges,77% of total billed charges,153.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.23,161.01,
Pyridoxine (Vitamin B6) 100 mg/ml MDV,63323018001,CDM,250,RC,,,Outpatient,,,180.91,90.46,,139.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.87,74,,,Percent of Total Billed Charges,74% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,151.96,84,,,Percent of Total Billed Charges,84% of total billed charges,148.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.01,89,,,Percent of total Billed Charges,89% of total Billed charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.3,77,,,Percent of total Billed charges,77% of total billed charges,153.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.23,161.01,
Pyridoxine (Vitamin B6) 100 mg/ml MDV,63323018001,CDM,250,RC,,,Outpatient,,,180.91,90.46,,139.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.87,74,,,Percent of Total Billed Charges,74% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,151.96,84,,,Percent of Total Billed Charges,84% of total billed charges,148.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.01,89,,,Percent of total Billed Charges,89% of total Billed charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.3,77,,,Percent of total Billed charges,77% of total billed charges,153.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.23,161.01,
Pyridoxine (Vitamin B6) 100 mg/ml MDV,63323018001,CDM,250,RC,,,Outpatient,,,180.91,90.46,,139.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.87,74,,,Percent of Total Billed Charges,74% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,151.96,84,,,Percent of Total Billed Charges,84% of total billed charges,148.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.01,89,,,Percent of total Billed Charges,89% of total Billed charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.3,77,,,Percent of total Billed charges,77% of total billed charges,153.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.23,161.01,
Pyridoxine (Vitamin B6) 100 mg/ml MDV,63323018001,CDM,250,RC,,,Outpatient,,,180.91,90.46,,139.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.87,74,,,Percent of Total Billed Charges,74% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,151.96,84,,,Percent of Total Billed Charges,84% of total billed charges,148.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.01,89,,,Percent of total Billed Charges,89% of total Billed charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.3,77,,,Percent of total Billed charges,77% of total billed charges,153.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.23,161.01,
Pyridoxine (Vitamin B6) 100 mg/ml MDV,63323018001,CDM,250,RC,,,Outpatient,,,180.91,90.46,,139.3,77,,,Percent of Total Billed Charges,77% of total billed charges,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,46.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.87,74,,,Percent of Total Billed Charges,74% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,124.83,69,,,Percent of Total Billed Charges,69% of total billed charges,151.96,84,,,Percent of Total Billed Charges,84% of total billed charges,148.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,161.01,89,,,Percent of total Billed Charges,89% of total Billed charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.3,77,,,Percent of total Billed charges,77% of total billed charges,153.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,52.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.23,161.01,
Pyridoxine (Vitamin B6) 50mg Tablet,77333094010,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Pyridoxine (Vitamin B6) 50mg Tablet,77333094010,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Pyridoxine (Vitamin B6) 50mg Tablet,77333094010,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Pyridoxine (Vitamin B6) 50mg Tablet,77333094010,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Pyridoxine (Vitamin B6) 50mg Tablet,77333094010,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Pyridoxine (Vitamin B6) 50mg Tablet,77333094010,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
QUEtiapine 100mg Tablet,904664061,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
QUEtiapine 100mg Tablet,904664061,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
QUEtiapine 100mg Tablet,904664061,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
QUEtiapine 100mg Tablet,904664061,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
QUEtiapine 100mg Tablet,904664061,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
QUEtiapine 100mg Tablet,904664061,CDM,250,RC,,,Outpatient,,,9.41,4.71,,7.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,6.49,69,,,Percent of Total Billed Charges,69% of total billed charges,7.9,84,,,Percent of Total Billed Charges,84% of total billed charges,7.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.37,89,,,Percent of total Billed Charges,89% of total Billed charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.25,77,,,Percent of total Billed charges,77% of total billed charges,8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.71,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.35,8.37,
QUEtiapine 25mg Tablet,904663861,CDM,250,RC,,,Outpatient,,,7.72,3.86,,5.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.71,74,,,Percent of Total Billed Charges,74% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,6.48,84,,,Percent of Total Billed Charges,84% of total billed charges,6.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.87,89,,,Percent of total Billed Charges,89% of total Billed charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.94,77,,,Percent of total Billed charges,77% of total billed charges,6.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,6.87,
QUEtiapine 25mg Tablet,904663861,CDM,250,RC,,,Outpatient,,,7.72,3.86,,5.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.71,74,,,Percent of Total Billed Charges,74% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,6.48,84,,,Percent of Total Billed Charges,84% of total billed charges,6.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.87,89,,,Percent of total Billed Charges,89% of total Billed charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.94,77,,,Percent of total Billed charges,77% of total billed charges,6.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,6.87,
QUEtiapine 25mg Tablet,904663861,CDM,250,RC,,,Outpatient,,,7.72,3.86,,5.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.71,74,,,Percent of Total Billed Charges,74% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,6.48,84,,,Percent of Total Billed Charges,84% of total billed charges,6.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.87,89,,,Percent of total Billed Charges,89% of total Billed charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.94,77,,,Percent of total Billed charges,77% of total billed charges,6.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,6.87,
QUEtiapine 25mg Tablet,904663861,CDM,250,RC,,,Outpatient,,,7.72,3.86,,5.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.71,74,,,Percent of Total Billed Charges,74% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,6.48,84,,,Percent of Total Billed Charges,84% of total billed charges,6.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.87,89,,,Percent of total Billed Charges,89% of total Billed charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.94,77,,,Percent of total Billed charges,77% of total billed charges,6.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,6.87,
QUEtiapine 25mg Tablet,904663861,CDM,250,RC,,,Outpatient,,,7.72,3.86,,5.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.71,74,,,Percent of Total Billed Charges,74% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,6.48,84,,,Percent of Total Billed Charges,84% of total billed charges,6.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.87,89,,,Percent of total Billed Charges,89% of total Billed charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.94,77,,,Percent of total Billed charges,77% of total billed charges,6.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,6.87,
QUEtiapine 25mg Tablet,904663861,CDM,250,RC,,,Outpatient,,,7.72,3.86,,5.94,77,,,Percent of Total Billed Charges,77% of total billed charges,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.71,74,,,Percent of Total Billed Charges,74% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,5.33,69,,,Percent of Total Billed Charges,69% of total billed charges,6.48,84,,,Percent of Total Billed Charges,84% of total billed charges,6.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.87,89,,,Percent of total Billed Charges,89% of total Billed charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.94,77,,,Percent of total Billed charges,77% of total billed charges,6.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.93,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.93,6.87,
QUEtiapine ER 50 mg,68180061207,CDM,250,RC,,,Outpatient,,,67.66,33.83,,52.1,77,,,Percent of Total Billed Charges,77% of total billed charges,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.07,74,,,Percent of Total Billed Charges,74% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,56.83,84,,,Percent of Total Billed Charges,84% of total billed charges,55.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.22,89,,,Percent of total Billed Charges,89% of total Billed charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,77,,,Percent of total Billed charges,77% of total billed charges,57.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,60.22,
QUEtiapine ER 50 mg,68180061207,CDM,250,RC,,,Outpatient,,,67.66,33.83,,52.1,77,,,Percent of Total Billed Charges,77% of total billed charges,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.07,74,,,Percent of Total Billed Charges,74% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,56.83,84,,,Percent of Total Billed Charges,84% of total billed charges,55.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.22,89,,,Percent of total Billed Charges,89% of total Billed charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,77,,,Percent of total Billed charges,77% of total billed charges,57.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,60.22,
QUEtiapine ER 50 mg,68180061207,CDM,250,RC,,,Outpatient,,,67.66,33.83,,52.1,77,,,Percent of Total Billed Charges,77% of total billed charges,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.07,74,,,Percent of Total Billed Charges,74% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,56.83,84,,,Percent of Total Billed Charges,84% of total billed charges,55.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.22,89,,,Percent of total Billed Charges,89% of total Billed charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,77,,,Percent of total Billed charges,77% of total billed charges,57.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,60.22,
QUEtiapine ER 50 mg,68180061207,CDM,250,RC,,,Outpatient,,,67.66,33.83,,52.1,77,,,Percent of Total Billed Charges,77% of total billed charges,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.07,74,,,Percent of Total Billed Charges,74% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,56.83,84,,,Percent of Total Billed Charges,84% of total billed charges,55.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.22,89,,,Percent of total Billed Charges,89% of total Billed charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,77,,,Percent of total Billed charges,77% of total billed charges,57.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,60.22,
QUEtiapine ER 50 mg,68180061207,CDM,250,RC,,,Outpatient,,,67.66,33.83,,52.1,77,,,Percent of Total Billed Charges,77% of total billed charges,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.07,74,,,Percent of Total Billed Charges,74% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,56.83,84,,,Percent of Total Billed Charges,84% of total billed charges,55.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.22,89,,,Percent of total Billed Charges,89% of total Billed charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,77,,,Percent of total Billed charges,77% of total billed charges,57.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,60.22,
QUEtiapine ER 50 mg,68180061207,CDM,250,RC,,,Outpatient,,,67.66,33.83,,52.1,77,,,Percent of Total Billed Charges,77% of total billed charges,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.07,74,,,Percent of Total Billed Charges,74% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,46.69,69,,,Percent of Total Billed Charges,69% of total billed charges,56.83,84,,,Percent of Total Billed Charges,84% of total billed charges,55.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.22,89,,,Percent of total Billed Charges,89% of total Billed charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.1,77,,,Percent of total Billed charges,77% of total billed charges,57.51,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.45,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.92,60.22,
quiNINE Sulfate 324mg Capsule,13310015307,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
quiNINE Sulfate 324mg Capsule,13310015307,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
quiNINE Sulfate 324mg Capsule,13310015307,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
quiNINE Sulfate 324mg Capsule,13310015307,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
quiNINE Sulfate 324mg Capsule,13310015307,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
quiNINE Sulfate 324mg Capsule,13310015307,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Rabies Immune Globulin 300 IU/2ml *Vial/Infiltrate* SDV,,,250,RC,,,Outpatient,,,3361.29,1680.65,,2588.19,77,,,Percent of Total Billed Charges,77% of total billed charges,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2487.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2823.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2756.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2991.55,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2588.19,77,,,Percent of total Billed charges,77% of total billed charges,2857.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.32,2991.55,
Rabies Immune Globulin 300 IU/2ml *Vial/Infiltrate* SDV,,,250,RC,,,Outpatient,,,3361.29,1680.65,,2588.19,77,,,Percent of Total Billed Charges,77% of total billed charges,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2487.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2823.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2756.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2991.55,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2588.19,77,,,Percent of total Billed charges,77% of total billed charges,2857.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.32,2991.55,
Rabies Immune Globulin 300 IU/2ml *Vial/Infiltrate* SDV,,,250,RC,,,Outpatient,,,3361.29,1680.65,,2588.19,77,,,Percent of Total Billed Charges,77% of total billed charges,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2487.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2823.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2756.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2991.55,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2588.19,77,,,Percent of total Billed charges,77% of total billed charges,2857.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.32,2991.55,
Rabies Immune Globulin 300 IU/2ml *Vial/Infiltrate* SDV,,,250,RC,,,Outpatient,,,3361.29,1680.65,,2588.19,77,,,Percent of Total Billed Charges,77% of total billed charges,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2487.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2823.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2756.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2991.55,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2588.19,77,,,Percent of total Billed charges,77% of total billed charges,2857.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.32,2991.55,
Rabies Immune Globulin 300 IU/2ml *Vial/Infiltrate* SDV,,,250,RC,,,Outpatient,,,3361.29,1680.65,,2588.19,77,,,Percent of Total Billed Charges,77% of total billed charges,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2487.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2823.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2756.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2991.55,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2588.19,77,,,Percent of total Billed charges,77% of total billed charges,2857.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.32,2991.55,
Rabies Immune Globulin 300 IU/2ml *Vial/Infiltrate* SDV,,,250,RC,,,Outpatient,,,3361.29,1680.65,,2588.19,77,,,Percent of Total Billed Charges,77% of total billed charges,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,857.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1050.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2487.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2319.29,69,,,Percent of Total Billed Charges,69% of total billed charges,2823.48,84,,,Percent of Total Billed Charges,84% of total billed charges,2756.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,2991.55,89,,,Percent of total Billed Charges,89% of total Billed charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2588.19,77,,,Percent of total Billed charges,77% of total billed charges,2857.1,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,966.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1680.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1371.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2991.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,840.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,840.32,2991.55,
Rabies Antigen IM Vaccine 2.5 IU/1ml Dose (1 Kit),50632001001,CDM,250,RC,,,Outpatient,,,2252.46,1126.23,,1734.39,77,,,Percent of Total Billed Charges,77% of total billed charges,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,703.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1666.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1847.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2004.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1734.39,77,,,Percent of total Billed charges,77% of total billed charges,1914.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,647.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1126.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.12,2004.69,
Rabies Antigen IM Vaccine 2.5 IU/1ml Dose (1 Kit),50632001001,CDM,250,RC,,,Outpatient,,,2252.46,1126.23,,1734.39,77,,,Percent of Total Billed Charges,77% of total billed charges,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,703.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1666.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1847.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2004.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1734.39,77,,,Percent of total Billed charges,77% of total billed charges,1914.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,647.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1126.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.12,2004.69,
Rabies Antigen IM Vaccine 2.5 IU/1ml Dose (1 Kit),50632001001,CDM,250,RC,,,Outpatient,,,2252.46,1126.23,,1734.39,77,,,Percent of Total Billed Charges,77% of total billed charges,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,703.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1666.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1847.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2004.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1734.39,77,,,Percent of total Billed charges,77% of total billed charges,1914.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,647.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1126.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.12,2004.69,
Rabies Antigen IM Vaccine 2.5 IU/1ml Dose (1 Kit),50632001001,CDM,250,RC,,,Outpatient,,,2252.46,1126.23,,1734.39,77,,,Percent of Total Billed Charges,77% of total billed charges,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,703.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1666.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1847.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2004.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1734.39,77,,,Percent of total Billed charges,77% of total billed charges,1914.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,647.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1126.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.12,2004.69,
Rabies Antigen IM Vaccine 2.5 IU/1ml Dose (1 Kit),50632001001,CDM,250,RC,,,Outpatient,,,2252.46,1126.23,,1734.39,77,,,Percent of Total Billed Charges,77% of total billed charges,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,703.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1666.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1847.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2004.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1734.39,77,,,Percent of total Billed charges,77% of total billed charges,1914.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,647.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1126.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.12,2004.69,
Rabies Antigen IM Vaccine 2.5 IU/1ml Dose (1 Kit),50632001001,CDM,250,RC,,,Outpatient,,,2252.46,1126.23,,1734.39,77,,,Percent of Total Billed Charges,77% of total billed charges,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,574.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,703.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1666.82,74,,,Percent of Total Billed Charges,74% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1554.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1892.07,84,,,Percent of Total Billed Charges,84% of total billed charges,1847.02,82,,,Percent of Total Billed Charges,82% of total billed charges ,2004.69,89,,,Percent of total Billed Charges,89% of total Billed charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1734.39,77,,,Percent of total Billed charges,77% of total billed charges,1914.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,647.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1126.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,919,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2004.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,563.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,563.12,2004.69,
Regadenoson 0.4mg/5ml Prefilled IV Syringe,,,250,RC,,,Outpatient,,,169.69,84.85,,130.66,77,,,Percent of Total Billed Charges,77% of total billed charges,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.57,74,,,Percent of Total Billed Charges,74% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,142.54,84,,,Percent of Total Billed Charges,84% of total billed charges,139.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.02,89,,,Percent of total Billed Charges,89% of total Billed charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.66,77,,,Percent of total Billed charges,77% of total billed charges,144.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.42,151.02,
Regadenoson 0.4mg/5ml Prefilled IV Syringe,,,250,RC,,,Outpatient,,,169.69,84.85,,130.66,77,,,Percent of Total Billed Charges,77% of total billed charges,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.57,74,,,Percent of Total Billed Charges,74% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,142.54,84,,,Percent of Total Billed Charges,84% of total billed charges,139.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.02,89,,,Percent of total Billed Charges,89% of total Billed charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.66,77,,,Percent of total Billed charges,77% of total billed charges,144.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.42,151.02,
Regadenoson 0.4mg/5ml Prefilled IV Syringe,,,250,RC,,,Outpatient,,,169.69,84.85,,130.66,77,,,Percent of Total Billed Charges,77% of total billed charges,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.57,74,,,Percent of Total Billed Charges,74% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,142.54,84,,,Percent of Total Billed Charges,84% of total billed charges,139.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.02,89,,,Percent of total Billed Charges,89% of total Billed charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.66,77,,,Percent of total Billed charges,77% of total billed charges,144.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.42,151.02,
Regadenoson 0.4mg/5ml Prefilled IV Syringe,,,250,RC,,,Outpatient,,,169.69,84.85,,130.66,77,,,Percent of Total Billed Charges,77% of total billed charges,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.57,74,,,Percent of Total Billed Charges,74% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,142.54,84,,,Percent of Total Billed Charges,84% of total billed charges,139.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.02,89,,,Percent of total Billed Charges,89% of total Billed charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.66,77,,,Percent of total Billed charges,77% of total billed charges,144.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.42,151.02,
Regadenoson 0.4mg/5ml Prefilled IV Syringe,,,250,RC,,,Outpatient,,,169.69,84.85,,130.66,77,,,Percent of Total Billed Charges,77% of total billed charges,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.57,74,,,Percent of Total Billed Charges,74% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,142.54,84,,,Percent of Total Billed Charges,84% of total billed charges,139.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.02,89,,,Percent of total Billed Charges,89% of total Billed charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.66,77,,,Percent of total Billed charges,77% of total billed charges,144.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.42,151.02,
Regadenoson 0.4mg/5ml Prefilled IV Syringe,,,250,RC,,,Outpatient,,,169.69,84.85,,130.66,77,,,Percent of Total Billed Charges,77% of total billed charges,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,125.57,74,,,Percent of Total Billed Charges,74% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,117.09,69,,,Percent of Total Billed Charges,69% of total billed charges,142.54,84,,,Percent of Total Billed Charges,84% of total billed charges,139.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,151.02,89,,,Percent of total Billed Charges,89% of total Billed charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,130.66,77,,,Percent of total Billed charges,77% of total billed charges,144.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,84.85,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,69.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,151.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.42,151.02,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2710.32,1355.16,,2086.95,77,,,Percent of Total Billed Charges,77% of total billed charges,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,2412.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.95,77,,,Percent of total Billed charges,77% of total billed charges,2303.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1355.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.58,2412.18,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2821.59,1410.8,,2172.62,77,,,Percent of Total Billed Charges,77% of total billed charges,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,881.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2087.98,74,,,Percent of Total Billed Charges,74% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2370.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2313.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,2511.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2172.62,77,,,Percent of total Billed charges,77% of total billed charges,2398.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1410.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.4,2511.22,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2710.32,1355.16,,2086.95,77,,,Percent of Total Billed Charges,77% of total billed charges,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,2412.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.95,77,,,Percent of total Billed charges,77% of total billed charges,2303.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1355.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.58,2412.18,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2821.59,1410.8,,2172.62,77,,,Percent of Total Billed Charges,77% of total billed charges,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,881.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2087.98,74,,,Percent of Total Billed Charges,74% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2370.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2313.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,2511.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2172.62,77,,,Percent of total Billed charges,77% of total billed charges,2398.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1410.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.4,2511.22,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2710.32,1355.16,,2086.95,77,,,Percent of Total Billed Charges,77% of total billed charges,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,2412.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.95,77,,,Percent of total Billed charges,77% of total billed charges,2303.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1355.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.58,2412.18,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2821.59,1410.8,,2172.62,77,,,Percent of Total Billed Charges,77% of total billed charges,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,881.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2087.98,74,,,Percent of Total Billed Charges,74% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2370.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2313.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,2511.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2172.62,77,,,Percent of total Billed charges,77% of total billed charges,2398.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1410.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.4,2511.22,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2710.32,1355.16,,2086.95,77,,,Percent of Total Billed Charges,77% of total billed charges,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,2412.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.95,77,,,Percent of total Billed charges,77% of total billed charges,2303.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1355.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.58,2412.18,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2821.59,1410.8,,2172.62,77,,,Percent of Total Billed Charges,77% of total billed charges,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,881.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2087.98,74,,,Percent of Total Billed Charges,74% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2370.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2313.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,2511.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2172.62,77,,,Percent of total Billed charges,77% of total billed charges,2398.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1410.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.4,2511.22,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2710.32,1355.16,,2086.95,77,,,Percent of Total Billed Charges,77% of total billed charges,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,2412.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.95,77,,,Percent of total Billed charges,77% of total billed charges,2303.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1355.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.58,2412.18,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2821.59,1410.8,,2172.62,77,,,Percent of Total Billed Charges,77% of total billed charges,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,881.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2087.98,74,,,Percent of Total Billed Charges,74% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2370.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2313.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,2511.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2172.62,77,,,Percent of total Billed charges,77% of total billed charges,2398.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1410.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.4,2511.22,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2710.32,1355.16,,2086.95,77,,,Percent of Total Billed Charges,77% of total billed charges,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.64,74,,,Percent of Total Billed Charges,74% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,1870.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.67,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,2412.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.95,77,,,Percent of total Billed charges,77% of total billed charges,2303.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1355.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2412.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.58,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.58,2412.18,
Remdesivir 100mg SDV,61958290102,CDM,250,RC,,,Outpatient,,,2821.59,1410.8,,2172.62,77,,,Percent of Total Billed Charges,77% of total billed charges,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,719.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,881.75,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2087.98,74,,,Percent of Total Billed Charges,74% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1946.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2370.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2313.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,2511.22,89,,,Percent of total Billed Charges,89% of total Billed charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2172.62,77,,,Percent of total Billed charges,77% of total billed charges,2398.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,811.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1410.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1151.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2511.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,705.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,705.4,2511.22,
"Rho (D) Immune Globulin 1,500 Unit (300mcg)/2ml Syringe",44206030010,CDM,250,RC,,,Outpatient,,,708.92,354.46,,545.87,77,,,Percent of Total Billed Charges,77% of total billed charges,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.6,74,,,Percent of Total Billed Charges,74% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,595.49,84,,,Percent of Total Billed Charges,84% of total billed charges,581.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,630.94,89,,,Percent of total Billed Charges,89% of total Billed charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.87,77,,,Percent of total Billed charges,77% of total billed charges,602.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,354.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.23,630.94,
"Rho (D) Immune Globulin 1,500 Unit (300mcg)/2ml Syringe",44206030010,CDM,250,RC,,,Outpatient,,,708.92,354.46,,545.87,77,,,Percent of Total Billed Charges,77% of total billed charges,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.6,74,,,Percent of Total Billed Charges,74% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,595.49,84,,,Percent of Total Billed Charges,84% of total billed charges,581.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,630.94,89,,,Percent of total Billed Charges,89% of total Billed charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.87,77,,,Percent of total Billed charges,77% of total billed charges,602.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,354.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.23,630.94,
"Rho (D) Immune Globulin 1,500 Unit (300mcg)/2ml Syringe",44206030010,CDM,250,RC,,,Outpatient,,,708.92,354.46,,545.87,77,,,Percent of Total Billed Charges,77% of total billed charges,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.6,74,,,Percent of Total Billed Charges,74% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,595.49,84,,,Percent of Total Billed Charges,84% of total billed charges,581.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,630.94,89,,,Percent of total Billed Charges,89% of total Billed charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.87,77,,,Percent of total Billed charges,77% of total billed charges,602.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,354.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.23,630.94,
"Rho (D) Immune Globulin 1,500 Unit (300mcg)/2ml Syringe",44206030010,CDM,250,RC,,,Outpatient,,,708.92,354.46,,545.87,77,,,Percent of Total Billed Charges,77% of total billed charges,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.6,74,,,Percent of Total Billed Charges,74% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,595.49,84,,,Percent of Total Billed Charges,84% of total billed charges,581.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,630.94,89,,,Percent of total Billed Charges,89% of total Billed charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.87,77,,,Percent of total Billed charges,77% of total billed charges,602.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,354.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.23,630.94,
"Rho (D) Immune Globulin 1,500 Unit (300mcg)/2ml Syringe",44206030010,CDM,250,RC,,,Outpatient,,,708.92,354.46,,545.87,77,,,Percent of Total Billed Charges,77% of total billed charges,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.6,74,,,Percent of Total Billed Charges,74% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,595.49,84,,,Percent of Total Billed Charges,84% of total billed charges,581.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,630.94,89,,,Percent of total Billed Charges,89% of total Billed charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.87,77,,,Percent of total Billed charges,77% of total billed charges,602.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,354.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.23,630.94,
"Rho (D) Immune Globulin 1,500 Unit (300mcg)/2ml Syringe",44206030010,CDM,250,RC,,,Outpatient,,,708.92,354.46,,545.87,77,,,Percent of Total Billed Charges,77% of total billed charges,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,524.6,74,,,Percent of Total Billed Charges,74% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,489.15,69,,,Percent of Total Billed Charges,69% of total billed charges,595.49,84,,,Percent of Total Billed Charges,84% of total billed charges,581.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,630.94,89,,,Percent of total Billed Charges,89% of total Billed charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,545.87,77,,,Percent of total Billed charges,77% of total billed charges,602.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,203.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,354.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,289.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,630.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.23,630.94,
rifAMPin 300mg Capsule,68180065906,CDM,250,RC,,,Outpatient,,,45.41,22.71,,34.97,77,,,Percent of Total Billed Charges,77% of total billed charges,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.6,74,,,Percent of Total Billed Charges,74% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,38.14,84,,,Percent of Total Billed Charges,84% of total billed charges,37.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.41,89,,,Percent of total Billed Charges,89% of total Billed charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.97,77,,,Percent of total Billed charges,77% of total billed charges,38.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,40.41,
rifAMPin 300mg Capsule,68180065906,CDM,250,RC,,,Outpatient,,,45.41,22.71,,34.97,77,,,Percent of Total Billed Charges,77% of total billed charges,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.6,74,,,Percent of Total Billed Charges,74% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,38.14,84,,,Percent of Total Billed Charges,84% of total billed charges,37.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.41,89,,,Percent of total Billed Charges,89% of total Billed charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.97,77,,,Percent of total Billed charges,77% of total billed charges,38.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,40.41,
rifAMPin 300mg Capsule,68180065906,CDM,250,RC,,,Outpatient,,,45.41,22.71,,34.97,77,,,Percent of Total Billed Charges,77% of total billed charges,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.6,74,,,Percent of Total Billed Charges,74% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,38.14,84,,,Percent of Total Billed Charges,84% of total billed charges,37.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.41,89,,,Percent of total Billed Charges,89% of total Billed charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.97,77,,,Percent of total Billed charges,77% of total billed charges,38.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,40.41,
rifAMPin 300mg Capsule,68180065906,CDM,250,RC,,,Outpatient,,,45.41,22.71,,34.97,77,,,Percent of Total Billed Charges,77% of total billed charges,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.6,74,,,Percent of Total Billed Charges,74% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,38.14,84,,,Percent of Total Billed Charges,84% of total billed charges,37.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.41,89,,,Percent of total Billed Charges,89% of total Billed charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.97,77,,,Percent of total Billed charges,77% of total billed charges,38.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,40.41,
rifAMPin 300mg Capsule,68180065906,CDM,250,RC,,,Outpatient,,,45.41,22.71,,34.97,77,,,Percent of Total Billed Charges,77% of total billed charges,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.6,74,,,Percent of Total Billed Charges,74% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,38.14,84,,,Percent of Total Billed Charges,84% of total billed charges,37.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.41,89,,,Percent of total Billed Charges,89% of total Billed charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.97,77,,,Percent of total Billed charges,77% of total billed charges,38.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,40.41,
rifAMPin 300mg Capsule,68180065906,CDM,250,RC,,,Outpatient,,,45.41,22.71,,34.97,77,,,Percent of Total Billed Charges,77% of total billed charges,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33.6,74,,,Percent of Total Billed Charges,74% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,31.33,69,,,Percent of Total Billed Charges,69% of total billed charges,38.14,84,,,Percent of Total Billed Charges,84% of total billed charges,37.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,40.41,89,,,Percent of total Billed Charges,89% of total Billed charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.97,77,,,Percent of total Billed charges,77% of total billed charges,38.6,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,40.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.35,40.41,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,835.38,417.69,,643.24,77,,,Percent of Total Billed Charges,77% of total billed charges,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.18,74,,,Percent of Total Billed Charges,74% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,701.72,84,,,Percent of Total Billed Charges,84% of total billed charges,685.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,743.49,89,,,Percent of total Billed Charges,89% of total Billed charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.24,77,,,Percent of total Billed charges,77% of total billed charges,710.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,417.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.85,743.49,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,868.52,434.26,,668.76,77,,,Percent of Total Billed Charges,77% of total billed charges,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.7,74,,,Percent of Total Billed Charges,74% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,729.56,84,,,Percent of Total Billed Charges,84% of total billed charges,712.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.98,89,,,Percent of total Billed Charges,89% of total Billed charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.76,77,,,Percent of total Billed charges,77% of total billed charges,738.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,434.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.13,772.98,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,835.38,417.69,,643.24,77,,,Percent of Total Billed Charges,77% of total billed charges,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.18,74,,,Percent of Total Billed Charges,74% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,701.72,84,,,Percent of Total Billed Charges,84% of total billed charges,685.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,743.49,89,,,Percent of total Billed Charges,89% of total Billed charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.24,77,,,Percent of total Billed charges,77% of total billed charges,710.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,417.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.85,743.49,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,868.52,434.26,,668.76,77,,,Percent of Total Billed Charges,77% of total billed charges,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.7,74,,,Percent of Total Billed Charges,74% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,729.56,84,,,Percent of Total Billed Charges,84% of total billed charges,712.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.98,89,,,Percent of total Billed Charges,89% of total Billed charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.76,77,,,Percent of total Billed charges,77% of total billed charges,738.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,434.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.13,772.98,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,835.38,417.69,,643.24,77,,,Percent of Total Billed Charges,77% of total billed charges,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.18,74,,,Percent of Total Billed Charges,74% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,701.72,84,,,Percent of Total Billed Charges,84% of total billed charges,685.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,743.49,89,,,Percent of total Billed Charges,89% of total Billed charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.24,77,,,Percent of total Billed charges,77% of total billed charges,710.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,417.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.85,743.49,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,868.52,434.26,,668.76,77,,,Percent of Total Billed Charges,77% of total billed charges,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.7,74,,,Percent of Total Billed Charges,74% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,729.56,84,,,Percent of Total Billed Charges,84% of total billed charges,712.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.98,89,,,Percent of total Billed Charges,89% of total Billed charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.76,77,,,Percent of total Billed charges,77% of total billed charges,738.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,434.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.13,772.98,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,835.38,417.69,,643.24,77,,,Percent of Total Billed Charges,77% of total billed charges,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.18,74,,,Percent of Total Billed Charges,74% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,701.72,84,,,Percent of Total Billed Charges,84% of total billed charges,685.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,743.49,89,,,Percent of total Billed Charges,89% of total Billed charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.24,77,,,Percent of total Billed charges,77% of total billed charges,710.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,417.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.85,743.49,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,868.52,434.26,,668.76,77,,,Percent of Total Billed Charges,77% of total billed charges,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.7,74,,,Percent of Total Billed Charges,74% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,729.56,84,,,Percent of Total Billed Charges,84% of total billed charges,712.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.98,89,,,Percent of total Billed Charges,89% of total Billed charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.76,77,,,Percent of total Billed charges,77% of total billed charges,738.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,434.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.13,772.98,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,835.38,417.69,,643.24,77,,,Percent of Total Billed Charges,77% of total billed charges,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.18,74,,,Percent of Total Billed Charges,74% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,701.72,84,,,Percent of Total Billed Charges,84% of total billed charges,685.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,743.49,89,,,Percent of total Billed Charges,89% of total Billed charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.24,77,,,Percent of total Billed charges,77% of total billed charges,710.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,417.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.85,743.49,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,868.52,434.26,,668.76,77,,,Percent of Total Billed Charges,77% of total billed charges,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.7,74,,,Percent of Total Billed Charges,74% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,729.56,84,,,Percent of Total Billed Charges,84% of total billed charges,712.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.98,89,,,Percent of total Billed Charges,89% of total Billed charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.76,77,,,Percent of total Billed charges,77% of total billed charges,738.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,434.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.13,772.98,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,835.38,417.69,,643.24,77,,,Percent of Total Billed Charges,77% of total billed charges,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,213.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,261.06,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,618.18,74,,,Percent of Total Billed Charges,74% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,576.41,69,,,Percent of Total Billed Charges,69% of total billed charges,701.72,84,,,Percent of Total Billed Charges,84% of total billed charges,685.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,743.49,89,,,Percent of total Billed Charges,89% of total Billed charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,643.24,77,,,Percent of total Billed charges,77% of total billed charges,710.07,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,240.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,417.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,340.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,743.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,208.85,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.85,743.49,
rifAMPin 600mg SDV,68059701,CDM,250,RC,,,Outpatient,,,868.52,434.26,,668.76,77,,,Percent of Total Billed Charges,77% of total billed charges,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,221.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,271.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,642.7,74,,,Percent of Total Billed Charges,74% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,599.28,69,,,Percent of Total Billed Charges,69% of total billed charges,729.56,84,,,Percent of Total Billed Charges,84% of total billed charges,712.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,772.98,89,,,Percent of total Billed Charges,89% of total Billed charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,668.76,77,,,Percent of total Billed charges,77% of total billed charges,738.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,249.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,434.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,354.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,772.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,217.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.13,772.98,
Lactated Ringers 1000ml IV Bag,338011704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 1000ml IV Bag,338011704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 1000ml IV Bag,338011704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 1000ml IV Bag,338011704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 1000ml IV Bag,338011704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 1000ml IV Bag,338011704,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 500ml IV Bag,338011703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 500ml IV Bag,338011703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 500ml IV Bag,338011703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 500ml IV Bag,338011703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 500ml IV Bag,338011703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Lactated Ringers 500ml IV Bag,338011703,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
risperiDONE 0.25mg Tablet,68382011214,CDM,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
risperiDONE 0.25mg Tablet,68382011214,CDM,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
risperiDONE 0.25mg Tablet,68382011214,CDM,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
risperiDONE 0.25mg Tablet,68382011214,CDM,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
risperiDONE 0.25mg Tablet,68382011214,CDM,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
risperiDONE 0.25mg Tablet,68382011214,CDM,250,RC,,,Outpatient,,,41.6,20.8,,32.03,77,,,Percent of Total Billed Charges,77% of total billed charges,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.61,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.78,74,,,Percent of Total Billed Charges,74% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,28.7,69,,,Percent of Total Billed Charges,69% of total billed charges,34.94,84,,,Percent of Total Billed Charges,84% of total billed charges,34.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,37.02,89,,,Percent of total Billed Charges,89% of total Billed charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.03,77,,,Percent of total Billed charges,77% of total billed charges,35.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.4,37.02,
risperiDONE 1mg Tablet,50458030001,CDM,250,RC,,,Outpatient,,,48.14,24.07,,37.07,77,,,Percent of Total Billed Charges,77% of total billed charges,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.62,74,,,Percent of Total Billed Charges,74% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,40.44,84,,,Percent of Total Billed Charges,84% of total billed charges,39.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.84,89,,,Percent of total Billed Charges,89% of total Billed charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,77,,,Percent of total Billed charges,77% of total billed charges,40.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.04,42.84,
risperiDONE 1mg Tablet,50458030001,CDM,250,RC,,,Outpatient,,,48.14,24.07,,37.07,77,,,Percent of Total Billed Charges,77% of total billed charges,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.62,74,,,Percent of Total Billed Charges,74% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,40.44,84,,,Percent of Total Billed Charges,84% of total billed charges,39.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.84,89,,,Percent of total Billed Charges,89% of total Billed charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,77,,,Percent of total Billed charges,77% of total billed charges,40.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.04,42.84,
risperiDONE 1mg Tablet,50458030001,CDM,250,RC,,,Outpatient,,,48.14,24.07,,37.07,77,,,Percent of Total Billed Charges,77% of total billed charges,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.62,74,,,Percent of Total Billed Charges,74% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,40.44,84,,,Percent of Total Billed Charges,84% of total billed charges,39.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.84,89,,,Percent of total Billed Charges,89% of total Billed charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,77,,,Percent of total Billed charges,77% of total billed charges,40.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.04,42.84,
risperiDONE 1mg Tablet,50458030001,CDM,250,RC,,,Outpatient,,,48.14,24.07,,37.07,77,,,Percent of Total Billed Charges,77% of total billed charges,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.62,74,,,Percent of Total Billed Charges,74% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,40.44,84,,,Percent of Total Billed Charges,84% of total billed charges,39.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.84,89,,,Percent of total Billed Charges,89% of total Billed charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,77,,,Percent of total Billed charges,77% of total billed charges,40.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.04,42.84,
risperiDONE 1mg Tablet,50458030001,CDM,250,RC,,,Outpatient,,,48.14,24.07,,37.07,77,,,Percent of Total Billed Charges,77% of total billed charges,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.62,74,,,Percent of Total Billed Charges,74% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,40.44,84,,,Percent of Total Billed Charges,84% of total billed charges,39.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.84,89,,,Percent of total Billed Charges,89% of total Billed charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,77,,,Percent of total Billed charges,77% of total billed charges,40.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.04,42.84,
risperiDONE 1mg Tablet,50458030001,CDM,250,RC,,,Outpatient,,,48.14,24.07,,37.07,77,,,Percent of Total Billed Charges,77% of total billed charges,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.62,74,,,Percent of Total Billed Charges,74% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,33.22,69,,,Percent of Total Billed Charges,69% of total billed charges,40.44,84,,,Percent of Total Billed Charges,84% of total billed charges,39.47,82,,,Percent of Total Billed Charges,82% of total billed charges ,42.84,89,,,Percent of total Billed Charges,89% of total Billed charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.07,77,,,Percent of total Billed charges,77% of total billed charges,40.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.04,42.84,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4381.77,2190.89,,3373.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1369.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3242.51,74,,,Percent of Total Billed Charges,74% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3680.69,84,,,Percent of Total Billed Charges,84% of total billed charges,3593.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,3899.78,89,,,Percent of total Billed Charges,89% of total Billed charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3373.96,77,,,Percent of total Billed charges,77% of total billed charges,3724.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1259.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2190.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1095.44,3899.78,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4272.32,2136.16,,3289.69,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3161.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.75,84,,,Percent of Total Billed Charges,84% of total billed charges,3503.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,3802.36,89,,,Percent of total Billed Charges,89% of total Billed charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3289.69,77,,,Percent of total Billed charges,77% of total billed charges,3631.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2136.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.08,3802.36,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4381.77,2190.89,,3373.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1369.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3242.51,74,,,Percent of Total Billed Charges,74% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3680.69,84,,,Percent of Total Billed Charges,84% of total billed charges,3593.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,3899.78,89,,,Percent of total Billed Charges,89% of total Billed charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3373.96,77,,,Percent of total Billed charges,77% of total billed charges,3724.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1259.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2190.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1095.44,3899.78,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4272.32,2136.16,,3289.69,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3161.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.75,84,,,Percent of Total Billed Charges,84% of total billed charges,3503.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,3802.36,89,,,Percent of total Billed Charges,89% of total Billed charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3289.69,77,,,Percent of total Billed charges,77% of total billed charges,3631.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2136.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.08,3802.36,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4381.77,2190.89,,3373.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1369.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3242.51,74,,,Percent of Total Billed Charges,74% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3680.69,84,,,Percent of Total Billed Charges,84% of total billed charges,3593.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,3899.78,89,,,Percent of total Billed Charges,89% of total Billed charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3373.96,77,,,Percent of total Billed charges,77% of total billed charges,3724.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1259.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2190.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1095.44,3899.78,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4272.32,2136.16,,3289.69,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3161.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.75,84,,,Percent of Total Billed Charges,84% of total billed charges,3503.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,3802.36,89,,,Percent of total Billed Charges,89% of total Billed charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3289.69,77,,,Percent of total Billed charges,77% of total billed charges,3631.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2136.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.08,3802.36,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4381.77,2190.89,,3373.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1369.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3242.51,74,,,Percent of Total Billed Charges,74% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3680.69,84,,,Percent of Total Billed Charges,84% of total billed charges,3593.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,3899.78,89,,,Percent of total Billed Charges,89% of total Billed charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3373.96,77,,,Percent of total Billed charges,77% of total billed charges,3724.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1259.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2190.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1095.44,3899.78,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4272.32,2136.16,,3289.69,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3161.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.75,84,,,Percent of Total Billed Charges,84% of total billed charges,3503.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,3802.36,89,,,Percent of total Billed Charges,89% of total Billed charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3289.69,77,,,Percent of total Billed charges,77% of total billed charges,3631.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2136.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.08,3802.36,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4381.77,2190.89,,3373.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1369.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3242.51,74,,,Percent of Total Billed Charges,74% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3680.69,84,,,Percent of Total Billed Charges,84% of total billed charges,3593.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,3899.78,89,,,Percent of total Billed Charges,89% of total Billed charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3373.96,77,,,Percent of total Billed charges,77% of total billed charges,3724.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1259.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2190.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1095.44,3899.78,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4272.32,2136.16,,3289.69,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3161.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.75,84,,,Percent of Total Billed Charges,84% of total billed charges,3503.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,3802.36,89,,,Percent of total Billed Charges,89% of total Billed charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3289.69,77,,,Percent of total Billed charges,77% of total billed charges,3631.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2136.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.08,3802.36,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4381.77,2190.89,,3373.96,77,,,Percent of Total Billed Charges,77% of total billed charges,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1117.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1369.3,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3242.51,74,,,Percent of Total Billed Charges,74% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3023.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3680.69,84,,,Percent of Total Billed Charges,84% of total billed charges,3593.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,3899.78,89,,,Percent of total Billed Charges,89% of total Billed charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3373.96,77,,,Percent of total Billed charges,77% of total billed charges,3724.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1259.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2190.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1787.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3899.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1095.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1095.44,3899.78,
rITUXimab-PVVR (Ruxience) 100mg/10ml Liquid SDV,69023801,CDM,250,RC,,,Outpatient,,,4272.32,2136.16,,3289.69,77,,,Percent of Total Billed Charges,77% of total billed charges,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1089.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1335.1,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3161.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,2947.9,69,,,Percent of Total Billed Charges,69% of total billed charges,3588.75,84,,,Percent of Total Billed Charges,84% of total billed charges,3503.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,3802.36,89,,,Percent of total Billed Charges,89% of total Billed charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3289.69,77,,,Percent of total Billed charges,77% of total billed charges,3631.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1228.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2136.16,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1743.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3802.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1068.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1068.08,3802.36,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,21310.87,10655.44,,16409.37,77,,,Percent of Total Billed Charges,77% of total billed charges,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6659.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15770.04,74,,,Percent of Total Billed Charges,74% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17901.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18966.67,89,,,Percent of total Billed Charges,89% of total Billed charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16409.37,77,,,Percent of total Billed charges,77% of total billed charges,18114.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6126.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10655.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5327.72,18966.67,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,20763.59,10381.8,,15987.96,77,,,Percent of Total Billed Charges,77% of total billed charges,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6488.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15365.06,74,,,Percent of Total Billed Charges,74% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,17441.42,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18479.6,89,,,Percent of total Billed Charges,89% of total Billed charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15987.96,77,,,Percent of total Billed charges,77% of total billed charges,17649.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5969.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10381.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5190.9,18479.6,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,21310.87,10655.44,,16409.37,77,,,Percent of Total Billed Charges,77% of total billed charges,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6659.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15770.04,74,,,Percent of Total Billed Charges,74% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17901.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18966.67,89,,,Percent of total Billed Charges,89% of total Billed charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16409.37,77,,,Percent of total Billed charges,77% of total billed charges,18114.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6126.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10655.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5327.72,18966.67,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,20763.59,10381.8,,15987.96,77,,,Percent of Total Billed Charges,77% of total billed charges,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6488.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15365.06,74,,,Percent of Total Billed Charges,74% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,17441.42,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18479.6,89,,,Percent of total Billed Charges,89% of total Billed charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15987.96,77,,,Percent of total Billed charges,77% of total billed charges,17649.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5969.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10381.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5190.9,18479.6,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,21310.87,10655.44,,16409.37,77,,,Percent of Total Billed Charges,77% of total billed charges,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6659.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15770.04,74,,,Percent of Total Billed Charges,74% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17901.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18966.67,89,,,Percent of total Billed Charges,89% of total Billed charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16409.37,77,,,Percent of total Billed charges,77% of total billed charges,18114.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6126.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10655.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5327.72,18966.67,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,20763.59,10381.8,,15987.96,77,,,Percent of Total Billed Charges,77% of total billed charges,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6488.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15365.06,74,,,Percent of Total Billed Charges,74% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,17441.42,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18479.6,89,,,Percent of total Billed Charges,89% of total Billed charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15987.96,77,,,Percent of total Billed charges,77% of total billed charges,17649.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5969.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10381.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5190.9,18479.6,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,21310.87,10655.44,,16409.37,77,,,Percent of Total Billed Charges,77% of total billed charges,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6659.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15770.04,74,,,Percent of Total Billed Charges,74% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17901.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18966.67,89,,,Percent of total Billed Charges,89% of total Billed charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16409.37,77,,,Percent of total Billed charges,77% of total billed charges,18114.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6126.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10655.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5327.72,18966.67,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,20763.59,10381.8,,15987.96,77,,,Percent of Total Billed Charges,77% of total billed charges,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6488.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15365.06,74,,,Percent of Total Billed Charges,74% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,17441.42,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18479.6,89,,,Percent of total Billed Charges,89% of total Billed charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15987.96,77,,,Percent of total Billed charges,77% of total billed charges,17649.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5969.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10381.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5190.9,18479.6,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,21310.87,10655.44,,16409.37,77,,,Percent of Total Billed Charges,77% of total billed charges,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6659.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15770.04,74,,,Percent of Total Billed Charges,74% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17901.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18966.67,89,,,Percent of total Billed Charges,89% of total Billed charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16409.37,77,,,Percent of total Billed charges,77% of total billed charges,18114.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6126.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10655.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5327.72,18966.67,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,20763.59,10381.8,,15987.96,77,,,Percent of Total Billed Charges,77% of total billed charges,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6488.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15365.06,74,,,Percent of Total Billed Charges,74% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,17441.42,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18479.6,89,,,Percent of total Billed Charges,89% of total Billed charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15987.96,77,,,Percent of total Billed charges,77% of total billed charges,17649.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5969.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10381.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5190.9,18479.6,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,21310.87,10655.44,,16409.37,77,,,Percent of Total Billed Charges,77% of total billed charges,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5434.27,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6659.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15770.04,74,,,Percent of Total Billed Charges,74% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,14704.5,69,,,Percent of Total Billed Charges,69% of total billed charges,17901.13,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18966.67,89,,,Percent of total Billed Charges,89% of total Billed charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16409.37,77,,,Percent of total Billed charges,77% of total billed charges,18114.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6126.88,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10655.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8694.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18966.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5327.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5327.72,18966.67,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,20763.59,10381.8,,15987.96,77,,,Percent of Total Billed Charges,77% of total billed charges,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5294.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6488.62,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15365.06,74,,,Percent of Total Billed Charges,74% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,14326.88,69,,,Percent of Total Billed Charges,69% of total billed charges,17441.42,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,18479.6,89,,,Percent of total Billed Charges,89% of total Billed charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15987.96,77,,,Percent of total Billed charges,77% of total billed charges,17649.05,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5969.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10381.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8471.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18479.6,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5190.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5190.9,18479.6,
rITUXimab-PVVR (Ruxience) 500mg/50ml Liquid SDV,69024901,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5696.8,2848.4,,4386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1780.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4215.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4785.31,84,,,Percent of Total Billed Charges,84% of total billed charges,4671.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,5070.15,89,,,Percent of total Billed Charges,89% of total Billed charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4386.54,77,,,Percent of total Billed charges,77% of total billed charges,4842.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1637.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2848.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1424.2,5070.15,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5553.34,2776.67,,4276.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1735.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4109.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4664.81,84,,,Percent of Total Billed Charges,84% of total billed charges,4553.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,4942.47,89,,,Percent of total Billed Charges,89% of total Billed charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4276.07,77,,,Percent of total Billed charges,77% of total billed charges,4720.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1596.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2776.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.34,4942.47,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5696.8,2848.4,,4386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1780.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4215.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4785.31,84,,,Percent of Total Billed Charges,84% of total billed charges,4671.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,5070.15,89,,,Percent of total Billed Charges,89% of total Billed charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4386.54,77,,,Percent of total Billed charges,77% of total billed charges,4842.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1637.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2848.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1424.2,5070.15,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5553.34,2776.67,,4276.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1735.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4109.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4664.81,84,,,Percent of Total Billed Charges,84% of total billed charges,4553.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,4942.47,89,,,Percent of total Billed Charges,89% of total Billed charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4276.07,77,,,Percent of total Billed charges,77% of total billed charges,4720.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1596.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2776.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.34,4942.47,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5696.8,2848.4,,4386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1780.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4215.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4785.31,84,,,Percent of Total Billed Charges,84% of total billed charges,4671.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,5070.15,89,,,Percent of total Billed Charges,89% of total Billed charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4386.54,77,,,Percent of total Billed charges,77% of total billed charges,4842.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1637.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2848.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1424.2,5070.15,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5553.34,2776.67,,4276.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1735.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4109.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4664.81,84,,,Percent of Total Billed Charges,84% of total billed charges,4553.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,4942.47,89,,,Percent of total Billed Charges,89% of total Billed charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4276.07,77,,,Percent of total Billed charges,77% of total billed charges,4720.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1596.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2776.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.34,4942.47,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5696.8,2848.4,,4386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1780.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4215.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4785.31,84,,,Percent of Total Billed Charges,84% of total billed charges,4671.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,5070.15,89,,,Percent of total Billed Charges,89% of total Billed charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4386.54,77,,,Percent of total Billed charges,77% of total billed charges,4842.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1637.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2848.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1424.2,5070.15,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5553.34,2776.67,,4276.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1735.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4109.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4664.81,84,,,Percent of Total Billed Charges,84% of total billed charges,4553.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,4942.47,89,,,Percent of total Billed Charges,89% of total Billed charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4276.07,77,,,Percent of total Billed charges,77% of total billed charges,4720.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1596.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2776.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.34,4942.47,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5696.8,2848.4,,4386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1780.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4215.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4785.31,84,,,Percent of Total Billed Charges,84% of total billed charges,4671.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,5070.15,89,,,Percent of total Billed Charges,89% of total Billed charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4386.54,77,,,Percent of total Billed charges,77% of total billed charges,4842.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1637.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2848.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1424.2,5070.15,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5553.34,2776.67,,4276.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1735.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4109.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4664.81,84,,,Percent of Total Billed Charges,84% of total billed charges,4553.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,4942.47,89,,,Percent of total Billed Charges,89% of total Billed charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4276.07,77,,,Percent of total Billed charges,77% of total billed charges,4720.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1596.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2776.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.34,4942.47,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5696.8,2848.4,,4386.54,77,,,Percent of Total Billed Charges,77% of total billed charges,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1452.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1780.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4215.63,74,,,Percent of Total Billed Charges,74% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,3930.79,69,,,Percent of Total Billed Charges,69% of total billed charges,4785.31,84,,,Percent of Total Billed Charges,84% of total billed charges,4671.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,5070.15,89,,,Percent of total Billed Charges,89% of total Billed charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4386.54,77,,,Percent of total Billed charges,77% of total billed charges,4842.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1637.83,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2848.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2324.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5070.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1424.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1424.2,5070.15,
riTUXimab (Rituxan) 100mg/10ml Liquid SDV,50242005121,CDM,250,RC,,,Outpatient,,,5553.34,2776.67,,4276.07,77,,,Percent of Total Billed Charges,77% of total billed charges,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1416.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1735.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4109.47,74,,,Percent of Total Billed Charges,74% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,3831.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4664.81,84,,,Percent of Total Billed Charges,84% of total billed charges,4553.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,4942.47,89,,,Percent of total Billed Charges,89% of total Billed charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4276.07,77,,,Percent of total Billed charges,77% of total billed charges,4720.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1596.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2776.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2265.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4942.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1388.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1388.34,4942.47,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27886.01,13943.01,,21472.23,77,,,Percent of Total Billed Charges,77% of total billed charges,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8714.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20635.65,74,,,Percent of Total Billed Charges,74% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,23424.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24818.55,89,,,Percent of total Billed Charges,89% of total Billed charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21472.23,77,,,Percent of total Billed charges,77% of total billed charges,23703.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8017.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13943.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6971.5,24818.55,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27168.69,13584.35,,20919.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8490.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20104.83,74,,,Percent of Total Billed Charges,74% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,22821.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24180.13,89,,,Percent of total Billed Charges,89% of total Billed charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20919.89,77,,,Percent of total Billed charges,77% of total billed charges,23093.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7811,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13584.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.17,24180.13,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27886.01,13943.01,,21472.23,77,,,Percent of Total Billed Charges,77% of total billed charges,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8714.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20635.65,74,,,Percent of Total Billed Charges,74% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,23424.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24818.55,89,,,Percent of total Billed Charges,89% of total Billed charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21472.23,77,,,Percent of total Billed charges,77% of total billed charges,23703.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8017.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13943.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6971.5,24818.55,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27168.69,13584.35,,20919.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8490.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20104.83,74,,,Percent of Total Billed Charges,74% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,22821.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24180.13,89,,,Percent of total Billed Charges,89% of total Billed charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20919.89,77,,,Percent of total Billed charges,77% of total billed charges,23093.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7811,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13584.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.17,24180.13,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27886.01,13943.01,,21472.23,77,,,Percent of Total Billed Charges,77% of total billed charges,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8714.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20635.65,74,,,Percent of Total Billed Charges,74% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,23424.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24818.55,89,,,Percent of total Billed Charges,89% of total Billed charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21472.23,77,,,Percent of total Billed charges,77% of total billed charges,23703.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8017.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13943.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6971.5,24818.55,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27168.69,13584.35,,20919.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8490.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20104.83,74,,,Percent of Total Billed Charges,74% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,22821.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24180.13,89,,,Percent of total Billed Charges,89% of total Billed charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20919.89,77,,,Percent of total Billed charges,77% of total billed charges,23093.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7811,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13584.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.17,24180.13,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27886.01,13943.01,,21472.23,77,,,Percent of Total Billed Charges,77% of total billed charges,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8714.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20635.65,74,,,Percent of Total Billed Charges,74% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,23424.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24818.55,89,,,Percent of total Billed Charges,89% of total Billed charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21472.23,77,,,Percent of total Billed charges,77% of total billed charges,23703.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8017.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13943.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6971.5,24818.55,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27168.69,13584.35,,20919.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8490.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20104.83,74,,,Percent of Total Billed Charges,74% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,22821.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24180.13,89,,,Percent of total Billed Charges,89% of total Billed charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20919.89,77,,,Percent of total Billed charges,77% of total billed charges,23093.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7811,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13584.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.17,24180.13,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27886.01,13943.01,,21472.23,77,,,Percent of Total Billed Charges,77% of total billed charges,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8714.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20635.65,74,,,Percent of Total Billed Charges,74% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,23424.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24818.55,89,,,Percent of total Billed Charges,89% of total Billed charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21472.23,77,,,Percent of total Billed charges,77% of total billed charges,23703.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8017.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13943.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6971.5,24818.55,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27168.69,13584.35,,20919.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8490.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20104.83,74,,,Percent of Total Billed Charges,74% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,22821.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24180.13,89,,,Percent of total Billed Charges,89% of total Billed charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20919.89,77,,,Percent of total Billed charges,77% of total billed charges,23093.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7811,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13584.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.17,24180.13,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27886.01,13943.01,,21472.23,77,,,Percent of Total Billed Charges,77% of total billed charges,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7110.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8714.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20635.65,74,,,Percent of Total Billed Charges,74% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,19241.35,69,,,Percent of Total Billed Charges,69% of total billed charges,23424.25,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24818.55,89,,,Percent of total Billed Charges,89% of total Billed charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21472.23,77,,,Percent of total Billed charges,77% of total billed charges,23703.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8017.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13943.01,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11377.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24818.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6971.5,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6971.5,24818.55,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,27168.69,13584.35,,20919.89,77,,,Percent of Total Billed Charges,77% of total billed charges,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6928.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8490.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20104.83,74,,,Percent of Total Billed Charges,74% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,18746.4,69,,,Percent of Total Billed Charges,69% of total billed charges,22821.7,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24180.13,89,,,Percent of total Billed Charges,89% of total Billed charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20919.89,77,,,Percent of total Billed charges,77% of total billed charges,23093.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7811,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13584.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11084.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24180.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6792.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6792.17,24180.13,
riTUXimab (Rituxan) 500mg/50ml Liquid SDV,50242005306,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Rivaroxaban 10mg Tablet,50458058010,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 10mg Tablet,50458058010,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 10mg Tablet,50458058010,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 10mg Tablet,50458058010,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 10mg Tablet,50458058010,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 10mg Tablet,50458058010,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 15mg Tablet,50458057830,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 15mg Tablet,50458057830,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 15mg Tablet,50458057830,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 15mg Tablet,50458057830,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 15mg Tablet,50458057830,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rivaroxaban 15mg Tablet,50458057830,CDM,250,RC,,,Outpatient,,,139.15,69.58,,107.15,77,,,Percent of Total Billed Charges,77% of total billed charges,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,102.97,74,,,Percent of Total Billed Charges,74% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,96.01,69,,,Percent of Total Billed Charges,69% of total billed charges,116.89,84,,,Percent of Total Billed Charges,84% of total billed charges,114.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,123.84,89,,,Percent of total Billed Charges,89% of total Billed charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.15,77,,,Percent of total Billed charges,77% of total billed charges,118.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,40.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,69.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,56.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,123.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,34.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.79,123.84,
Rocuronium 50mg/5ml MDV,67457022805,CDM,250,RC,,,Outpatient,,,209.81,104.91,,161.55,77,,,Percent of Total Billed Charges,77% of total billed charges,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.26,74,,,Percent of Total Billed Charges,74% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,176.24,84,,,Percent of Total Billed Charges,84% of total billed charges,172.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.73,89,,,Percent of total Billed Charges,89% of total Billed charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.55,77,,,Percent of total Billed charges,77% of total billed charges,178.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.45,186.73,
Rocuronium 50mg/5ml MDV,67457022805,CDM,250,RC,,,Outpatient,,,209.81,104.91,,161.55,77,,,Percent of Total Billed Charges,77% of total billed charges,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.26,74,,,Percent of Total Billed Charges,74% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,176.24,84,,,Percent of Total Billed Charges,84% of total billed charges,172.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.73,89,,,Percent of total Billed Charges,89% of total Billed charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.55,77,,,Percent of total Billed charges,77% of total billed charges,178.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.45,186.73,
Rocuronium 50mg/5ml MDV,67457022805,CDM,250,RC,,,Outpatient,,,209.81,104.91,,161.55,77,,,Percent of Total Billed Charges,77% of total billed charges,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.26,74,,,Percent of Total Billed Charges,74% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,176.24,84,,,Percent of Total Billed Charges,84% of total billed charges,172.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.73,89,,,Percent of total Billed Charges,89% of total Billed charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.55,77,,,Percent of total Billed charges,77% of total billed charges,178.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.45,186.73,
Rocuronium 50mg/5ml MDV,67457022805,CDM,250,RC,,,Outpatient,,,209.81,104.91,,161.55,77,,,Percent of Total Billed Charges,77% of total billed charges,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.26,74,,,Percent of Total Billed Charges,74% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,176.24,84,,,Percent of Total Billed Charges,84% of total billed charges,172.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.73,89,,,Percent of total Billed Charges,89% of total Billed charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.55,77,,,Percent of total Billed charges,77% of total billed charges,178.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.45,186.73,
Rocuronium 50mg/5ml MDV,67457022805,CDM,250,RC,,,Outpatient,,,209.81,104.91,,161.55,77,,,Percent of Total Billed Charges,77% of total billed charges,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.26,74,,,Percent of Total Billed Charges,74% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,176.24,84,,,Percent of Total Billed Charges,84% of total billed charges,172.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.73,89,,,Percent of total Billed Charges,89% of total Billed charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.55,77,,,Percent of total Billed charges,77% of total billed charges,178.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.45,186.73,
Rocuronium 50mg/5ml MDV,67457022805,CDM,250,RC,,,Outpatient,,,209.81,104.91,,161.55,77,,,Percent of Total Billed Charges,77% of total billed charges,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,65.57,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,155.26,74,,,Percent of Total Billed Charges,74% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,144.77,69,,,Percent of Total Billed Charges,69% of total billed charges,176.24,84,,,Percent of Total Billed Charges,84% of total billed charges,172.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,186.73,89,,,Percent of total Billed Charges,89% of total Billed charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,161.55,77,,,Percent of total Billed charges,77% of total billed charges,178.34,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,60.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,104.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,85.6,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.73,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.45,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.45,186.73,
Romosozumab-AQQG (Evenity) 105 mg/1.17ml Syringe,55513088001,CDM,250,RC,,,Outpatient,,,5989.37,2994.69,,4611.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1871.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4432.13,74,,,Percent of Total Billed Charges,74% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,5031.07,84,,,Percent of Total Billed Charges,84% of total billed charges,4911.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,5330.54,89,,,Percent of total Billed Charges,89% of total Billed charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.81,77,,,Percent of total Billed charges,77% of total billed charges,5090.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1721.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2994.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.34,5330.54,
Romosozumab-AQQG (Evenity) 105 mg/1.17ml Syringe,55513088001,CDM,250,RC,,,Outpatient,,,5989.37,2994.69,,4611.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1871.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4432.13,74,,,Percent of Total Billed Charges,74% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,5031.07,84,,,Percent of Total Billed Charges,84% of total billed charges,4911.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,5330.54,89,,,Percent of total Billed Charges,89% of total Billed charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.81,77,,,Percent of total Billed charges,77% of total billed charges,5090.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1721.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2994.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.34,5330.54,
Romosozumab-AQQG (Evenity) 105 mg/1.17ml Syringe,55513088001,CDM,250,RC,,,Outpatient,,,5989.37,2994.69,,4611.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1871.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4432.13,74,,,Percent of Total Billed Charges,74% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,5031.07,84,,,Percent of Total Billed Charges,84% of total billed charges,4911.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,5330.54,89,,,Percent of total Billed Charges,89% of total Billed charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.81,77,,,Percent of total Billed charges,77% of total billed charges,5090.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1721.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2994.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.34,5330.54,
Romosozumab-AQQG (Evenity) 105 mg/1.17ml Syringe,55513088001,CDM,250,RC,,,Outpatient,,,5989.37,2994.69,,4611.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1871.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4432.13,74,,,Percent of Total Billed Charges,74% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,5031.07,84,,,Percent of Total Billed Charges,84% of total billed charges,4911.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,5330.54,89,,,Percent of total Billed Charges,89% of total Billed charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.81,77,,,Percent of total Billed charges,77% of total billed charges,5090.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1721.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2994.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.34,5330.54,
Romosozumab-AQQG (Evenity) 105 mg/1.17ml Syringe,55513088001,CDM,250,RC,,,Outpatient,,,5989.37,2994.69,,4611.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1871.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4432.13,74,,,Percent of Total Billed Charges,74% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,5031.07,84,,,Percent of Total Billed Charges,84% of total billed charges,4911.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,5330.54,89,,,Percent of total Billed Charges,89% of total Billed charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.81,77,,,Percent of total Billed charges,77% of total billed charges,5090.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1721.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2994.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.34,5330.54,
Romosozumab-AQQG (Evenity) 105 mg/1.17ml Syringe,55513088001,CDM,250,RC,,,Outpatient,,,5989.37,2994.69,,4611.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1527.29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1871.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4432.13,74,,,Percent of Total Billed Charges,74% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,4132.67,69,,,Percent of Total Billed Charges,69% of total billed charges,5031.07,84,,,Percent of Total Billed Charges,84% of total billed charges,4911.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,5330.54,89,,,Percent of total Billed Charges,89% of total Billed charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4611.81,77,,,Percent of total Billed charges,77% of total billed charges,5090.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1721.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2994.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2443.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5330.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1497.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1497.34,5330.54,
rOPINIRole 0.5mg Tablet,43547026910,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 0.5mg Tablet,43547026910,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 0.5mg Tablet,43547026910,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 0.5mg Tablet,43547026910,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 0.5mg Tablet,43547026910,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 0.5mg Tablet,43547026910,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 1mg Tablet,43547027010,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 1mg Tablet,43547027010,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 1mg Tablet,43547027010,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 1mg Tablet,43547027010,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 1mg Tablet,43547027010,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
rOPINIRole 1mg Tablet,43547027010,CDM,250,RC,,,Outpatient,,,28.46,14.23,,21.91,77,,,Percent of Total Billed Charges,77% of total billed charges,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.26,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.06,74,,,Percent of Total Billed Charges,74% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,19.64,69,,,Percent of Total Billed Charges,69% of total billed charges,23.91,84,,,Percent of Total Billed Charges,84% of total billed charges,23.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.33,89,,,Percent of total Billed Charges,89% of total Billed charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.91,77,,,Percent of total Billed charges,77% of total billed charges,24.19,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.23,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.12,25.33,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,465.61,232.81,,358.52,77,,,Percent of Total Billed Charges,77% of total billed charges,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.55,74,,,Percent of Total Billed Charges,74% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,391.11,84,,,Percent of Total Billed Charges,84% of total billed charges,381.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.39,89,,,Percent of total Billed Charges,89% of total Billed charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.52,77,,,Percent of total Billed charges,77% of total billed charges,395.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.4,414.39,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,43.54,21.77,,33.53,77,,,Percent of Total Billed Charges,77% of total billed charges,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.22,74,,,Percent of Total Billed Charges,74% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,84,,,Percent of Total Billed Charges,84% of total billed charges,35.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.75,89,,,Percent of total Billed Charges,89% of total Billed charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.53,77,,,Percent of total Billed charges,77% of total billed charges,37.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.89,38.75,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,465.61,232.81,,358.52,77,,,Percent of Total Billed Charges,77% of total billed charges,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.55,74,,,Percent of Total Billed Charges,74% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,391.11,84,,,Percent of Total Billed Charges,84% of total billed charges,381.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.39,89,,,Percent of total Billed Charges,89% of total Billed charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.52,77,,,Percent of total Billed charges,77% of total billed charges,395.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.4,414.39,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,43.54,21.77,,33.53,77,,,Percent of Total Billed Charges,77% of total billed charges,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.22,74,,,Percent of Total Billed Charges,74% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,84,,,Percent of Total Billed Charges,84% of total billed charges,35.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.75,89,,,Percent of total Billed Charges,89% of total Billed charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.53,77,,,Percent of total Billed charges,77% of total billed charges,37.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.89,38.75,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,465.61,232.81,,358.52,77,,,Percent of Total Billed Charges,77% of total billed charges,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.55,74,,,Percent of Total Billed Charges,74% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,391.11,84,,,Percent of Total Billed Charges,84% of total billed charges,381.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.39,89,,,Percent of total Billed Charges,89% of total Billed charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.52,77,,,Percent of total Billed charges,77% of total billed charges,395.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.4,414.39,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,43.54,21.77,,33.53,77,,,Percent of Total Billed Charges,77% of total billed charges,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.22,74,,,Percent of Total Billed Charges,74% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,84,,,Percent of Total Billed Charges,84% of total billed charges,35.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.75,89,,,Percent of total Billed Charges,89% of total Billed charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.53,77,,,Percent of total Billed charges,77% of total billed charges,37.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.89,38.75,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,465.61,232.81,,358.52,77,,,Percent of Total Billed Charges,77% of total billed charges,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.55,74,,,Percent of Total Billed Charges,74% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,391.11,84,,,Percent of Total Billed Charges,84% of total billed charges,381.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.39,89,,,Percent of total Billed Charges,89% of total Billed charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.52,77,,,Percent of total Billed charges,77% of total billed charges,395.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.4,414.39,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,43.54,21.77,,33.53,77,,,Percent of Total Billed Charges,77% of total billed charges,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.22,74,,,Percent of Total Billed Charges,74% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,84,,,Percent of Total Billed Charges,84% of total billed charges,35.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.75,89,,,Percent of total Billed Charges,89% of total Billed charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.53,77,,,Percent of total Billed charges,77% of total billed charges,37.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.89,38.75,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,465.61,232.81,,358.52,77,,,Percent of Total Billed Charges,77% of total billed charges,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.55,74,,,Percent of Total Billed Charges,74% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,391.11,84,,,Percent of Total Billed Charges,84% of total billed charges,381.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.39,89,,,Percent of total Billed Charges,89% of total Billed charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.52,77,,,Percent of total Billed charges,77% of total billed charges,395.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.4,414.39,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,43.54,21.77,,33.53,77,,,Percent of Total Billed Charges,77% of total billed charges,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.22,74,,,Percent of Total Billed Charges,74% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,84,,,Percent of Total Billed Charges,84% of total billed charges,35.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.75,89,,,Percent of total Billed Charges,89% of total Billed charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.53,77,,,Percent of total Billed charges,77% of total billed charges,37.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.89,38.75,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,465.61,232.81,,358.52,77,,,Percent of Total Billed Charges,77% of total billed charges,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,118.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,145.5,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,344.55,74,,,Percent of Total Billed Charges,74% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,321.27,69,,,Percent of Total Billed Charges,69% of total billed charges,391.11,84,,,Percent of Total Billed Charges,84% of total billed charges,381.8,82,,,Percent of Total Billed Charges,82% of total billed charges ,414.39,89,,,Percent of total Billed Charges,89% of total Billed charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,358.52,77,,,Percent of total Billed charges,77% of total billed charges,395.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,133.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,232.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,189.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,414.39,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,116.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,116.4,414.39,
Ropivacaine 400mg/200ml (0.2%) IV Bag,25021067167,CDM,250,RC,,,Outpatient,,,43.54,21.77,,33.53,77,,,Percent of Total Billed Charges,77% of total billed charges,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,32.22,74,,,Percent of Total Billed Charges,74% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,69,,,Percent of Total Billed Charges,69% of total billed charges,36.57,84,,,Percent of Total Billed Charges,84% of total billed charges,35.7,82,,,Percent of Total Billed Charges,82% of total billed charges ,38.75,89,,,Percent of total Billed Charges,89% of total Billed charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.53,77,,,Percent of total Billed charges,77% of total billed charges,37.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,21.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,17.76,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.89,38.75,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,244.99,122.5,,188.64,77,,,Percent of Total Billed Charges,77% of total billed charges,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.29,74,,,Percent of Total Billed Charges,74% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,205.79,84,,,Percent of Total Billed Charges,84% of total billed charges,200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.04,89,,,Percent of total Billed Charges,89% of total Billed charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.64,77,,,Percent of total Billed charges,77% of total billed charges,208.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.04,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,242.97,121.49,,187.09,77,,,Percent of Total Billed Charges,77% of total billed charges,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.8,74,,,Percent of Total Billed Charges,74% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,204.09,84,,,Percent of Total Billed Charges,84% of total billed charges,199.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.24,89,,,Percent of total Billed Charges,89% of total Billed charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.09,77,,,Percent of total Billed charges,77% of total billed charges,206.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.74,216.24,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,244.99,122.5,,188.64,77,,,Percent of Total Billed Charges,77% of total billed charges,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.29,74,,,Percent of Total Billed Charges,74% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,205.79,84,,,Percent of Total Billed Charges,84% of total billed charges,200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.04,89,,,Percent of total Billed Charges,89% of total Billed charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.64,77,,,Percent of total Billed charges,77% of total billed charges,208.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.04,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,242.97,121.49,,187.09,77,,,Percent of Total Billed Charges,77% of total billed charges,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.8,74,,,Percent of Total Billed Charges,74% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,204.09,84,,,Percent of Total Billed Charges,84% of total billed charges,199.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.24,89,,,Percent of total Billed Charges,89% of total Billed charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.09,77,,,Percent of total Billed charges,77% of total billed charges,206.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.74,216.24,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,244.99,122.5,,188.64,77,,,Percent of Total Billed Charges,77% of total billed charges,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.29,74,,,Percent of Total Billed Charges,74% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,205.79,84,,,Percent of Total Billed Charges,84% of total billed charges,200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.04,89,,,Percent of total Billed Charges,89% of total Billed charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.64,77,,,Percent of total Billed charges,77% of total billed charges,208.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.04,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,242.97,121.49,,187.09,77,,,Percent of Total Billed Charges,77% of total billed charges,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.8,74,,,Percent of Total Billed Charges,74% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,204.09,84,,,Percent of Total Billed Charges,84% of total billed charges,199.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.24,89,,,Percent of total Billed Charges,89% of total Billed charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.09,77,,,Percent of total Billed charges,77% of total billed charges,206.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.74,216.24,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,244.99,122.5,,188.64,77,,,Percent of Total Billed Charges,77% of total billed charges,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.29,74,,,Percent of Total Billed Charges,74% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,205.79,84,,,Percent of Total Billed Charges,84% of total billed charges,200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.04,89,,,Percent of total Billed Charges,89% of total Billed charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.64,77,,,Percent of total Billed charges,77% of total billed charges,208.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.04,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,242.97,121.49,,187.09,77,,,Percent of Total Billed Charges,77% of total billed charges,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.8,74,,,Percent of Total Billed Charges,74% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,204.09,84,,,Percent of Total Billed Charges,84% of total billed charges,199.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.24,89,,,Percent of total Billed Charges,89% of total Billed charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.09,77,,,Percent of total Billed charges,77% of total billed charges,206.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.74,216.24,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,244.99,122.5,,188.64,77,,,Percent of Total Billed Charges,77% of total billed charges,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.29,74,,,Percent of Total Billed Charges,74% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,205.79,84,,,Percent of Total Billed Charges,84% of total billed charges,200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.04,89,,,Percent of total Billed Charges,89% of total Billed charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.64,77,,,Percent of total Billed charges,77% of total billed charges,208.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.04,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,242.97,121.49,,187.09,77,,,Percent of Total Billed Charges,77% of total billed charges,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.8,74,,,Percent of Total Billed Charges,74% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,204.09,84,,,Percent of Total Billed Charges,84% of total billed charges,199.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.24,89,,,Percent of total Billed Charges,89% of total Billed charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.09,77,,,Percent of total Billed charges,77% of total billed charges,206.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.74,216.24,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,244.99,122.5,,188.64,77,,,Percent of Total Billed Charges,77% of total billed charges,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,62.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,181.29,74,,,Percent of Total Billed Charges,74% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,169.04,69,,,Percent of Total Billed Charges,69% of total billed charges,205.79,84,,,Percent of Total Billed Charges,84% of total billed charges,200.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,218.04,89,,,Percent of total Billed Charges,89% of total Billed charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,188.64,77,,,Percent of total Billed charges,77% of total billed charges,208.24,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,70.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,122.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,218.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,61.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.25,218.04,
Ropivacaine 40mg/20ml (0.2%) 20ml SDV,63323028523,CDM,250,RC,,,Outpatient,,,242.97,121.49,,187.09,77,,,Percent of Total Billed Charges,77% of total billed charges,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,75.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,179.8,74,,,Percent of Total Billed Charges,74% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,167.65,69,,,Percent of Total Billed Charges,69% of total billed charges,204.09,84,,,Percent of Total Billed Charges,84% of total billed charges,199.24,82,,,Percent of Total Billed Charges,82% of total billed charges ,216.24,89,,,Percent of total Billed Charges,89% of total Billed charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,187.09,77,,,Percent of total Billed charges,77% of total billed charges,206.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,69.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,121.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,99.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,216.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.74,216.24,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,319.24,159.62,,245.81,77,,,Percent of Total Billed Charges,77% of total billed charges,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.24,74,,,Percent of Total Billed Charges,74% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,268.16,84,,,Percent of Total Billed Charges,84% of total billed charges,261.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.12,89,,,Percent of total Billed Charges,89% of total Billed charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.81,77,,,Percent of total Billed charges,77% of total billed charges,271.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,159.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.81,284.12,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,315.3,157.65,,242.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.32,74,,,Percent of Total Billed Charges,74% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,264.85,84,,,Percent of Total Billed Charges,84% of total billed charges,258.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.62,89,,,Percent of total Billed Charges,89% of total Billed charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.78,77,,,Percent of total Billed charges,77% of total billed charges,268.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.83,280.62,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,319.24,159.62,,245.81,77,,,Percent of Total Billed Charges,77% of total billed charges,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.24,74,,,Percent of Total Billed Charges,74% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,268.16,84,,,Percent of Total Billed Charges,84% of total billed charges,261.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.12,89,,,Percent of total Billed Charges,89% of total Billed charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.81,77,,,Percent of total Billed charges,77% of total billed charges,271.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,159.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.81,284.12,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,315.3,157.65,,242.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.32,74,,,Percent of Total Billed Charges,74% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,264.85,84,,,Percent of Total Billed Charges,84% of total billed charges,258.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.62,89,,,Percent of total Billed Charges,89% of total Billed charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.78,77,,,Percent of total Billed charges,77% of total billed charges,268.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.83,280.62,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,319.24,159.62,,245.81,77,,,Percent of Total Billed Charges,77% of total billed charges,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.24,74,,,Percent of Total Billed Charges,74% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,268.16,84,,,Percent of Total Billed Charges,84% of total billed charges,261.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.12,89,,,Percent of total Billed Charges,89% of total Billed charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.81,77,,,Percent of total Billed charges,77% of total billed charges,271.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,159.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.81,284.12,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,315.3,157.65,,242.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.32,74,,,Percent of Total Billed Charges,74% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,264.85,84,,,Percent of Total Billed Charges,84% of total billed charges,258.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.62,89,,,Percent of total Billed Charges,89% of total Billed charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.78,77,,,Percent of total Billed charges,77% of total billed charges,268.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.83,280.62,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,319.24,159.62,,245.81,77,,,Percent of Total Billed Charges,77% of total billed charges,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.24,74,,,Percent of Total Billed Charges,74% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,268.16,84,,,Percent of Total Billed Charges,84% of total billed charges,261.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.12,89,,,Percent of total Billed Charges,89% of total Billed charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.81,77,,,Percent of total Billed charges,77% of total billed charges,271.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,159.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.81,284.12,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,315.3,157.65,,242.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.32,74,,,Percent of Total Billed Charges,74% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,264.85,84,,,Percent of Total Billed Charges,84% of total billed charges,258.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.62,89,,,Percent of total Billed Charges,89% of total Billed charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.78,77,,,Percent of total Billed charges,77% of total billed charges,268.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.83,280.62,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,319.24,159.62,,245.81,77,,,Percent of Total Billed Charges,77% of total billed charges,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.24,74,,,Percent of Total Billed Charges,74% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,268.16,84,,,Percent of Total Billed Charges,84% of total billed charges,261.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.12,89,,,Percent of total Billed Charges,89% of total Billed charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.81,77,,,Percent of total Billed charges,77% of total billed charges,271.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,159.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.81,284.12,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,315.3,157.65,,242.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.32,74,,,Percent of Total Billed Charges,74% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,264.85,84,,,Percent of Total Billed Charges,84% of total billed charges,258.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.62,89,,,Percent of total Billed Charges,89% of total Billed charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.78,77,,,Percent of total Billed charges,77% of total billed charges,268.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.83,280.62,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,319.24,159.62,,245.81,77,,,Percent of Total Billed Charges,77% of total billed charges,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.76,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,236.24,74,,,Percent of Total Billed Charges,74% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,220.28,69,,,Percent of Total Billed Charges,69% of total billed charges,268.16,84,,,Percent of Total Billed Charges,84% of total billed charges,261.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,284.12,89,,,Percent of total Billed Charges,89% of total Billed charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,245.81,77,,,Percent of total Billed charges,77% of total billed charges,271.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,159.62,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,130.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.81,284.12,
Ropivacaine 150mg/20ml (0.75%) SDV,63323028721,CDM,250,RC,,,Outpatient,,,315.3,157.65,,242.78,77,,,Percent of Total Billed Charges,77% of total billed charges,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.32,74,,,Percent of Total Billed Charges,74% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,217.56,69,,,Percent of Total Billed Charges,69% of total billed charges,264.85,84,,,Percent of Total Billed Charges,84% of total billed charges,258.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.62,89,,,Percent of total Billed Charges,89% of total Billed charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.78,77,,,Percent of total Billed charges,77% of total billed charges,268.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.62,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.83,280.62,
Rosuvastatin 10mg Tablet,50268070915,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
Rosuvastatin 10mg Tablet,50268070915,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
Rosuvastatin 10mg Tablet,50268070915,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
Rosuvastatin 10mg Tablet,50268070915,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
Rosuvastatin 10mg Tablet,50268070915,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
Rosuvastatin 10mg Tablet,50268070915,CDM,250,RC,,,Outpatient,,,17.86,8.93,,13.75,77,,,Percent of Total Billed Charges,77% of total billed charges,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.22,74,,,Percent of Total Billed Charges,74% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,12.32,69,,,Percent of Total Billed Charges,69% of total billed charges,15,84,,,Percent of Total Billed Charges,84% of total billed charges,14.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,15.9,89,,,Percent of total Billed Charges,89% of total Billed charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,77,,,Percent of total Billed charges,77% of total billed charges,15.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8.93,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.47,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.47,15.9,
"RSV Vacc, Pref A & Pref B/PF (Abrysvo) 0.5ml SDV",69034401,CDM,250,RC,,,Outpatient,,,1354.05,677.03,,1042.62,77,,,Percent of Total Billed Charges,77% of total billed charges,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1002,74,,,Percent of Total Billed Charges,74% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1110.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1205.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.62,77,,,Percent of total Billed charges,77% of total billed charges,1150.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,677.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.51,1205.1,
"RSV Vacc, Pref A & Pref B/PF (Abrysvo) 0.5ml SDV",69034401,CDM,250,RC,,,Outpatient,,,1354.05,677.03,,1042.62,77,,,Percent of Total Billed Charges,77% of total billed charges,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1002,74,,,Percent of Total Billed Charges,74% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1110.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1205.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.62,77,,,Percent of total Billed charges,77% of total billed charges,1150.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,677.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.51,1205.1,
"RSV Vacc, Pref A & Pref B/PF (Abrysvo) 0.5ml SDV",69034401,CDM,250,RC,,,Outpatient,,,1354.05,677.03,,1042.62,77,,,Percent of Total Billed Charges,77% of total billed charges,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1002,74,,,Percent of Total Billed Charges,74% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1110.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1205.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.62,77,,,Percent of total Billed charges,77% of total billed charges,1150.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,677.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.51,1205.1,
"RSV Vacc, Pref A & Pref B/PF (Abrysvo) 0.5ml SDV",69034401,CDM,250,RC,,,Outpatient,,,1354.05,677.03,,1042.62,77,,,Percent of Total Billed Charges,77% of total billed charges,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1002,74,,,Percent of Total Billed Charges,74% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1110.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1205.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.62,77,,,Percent of total Billed charges,77% of total billed charges,1150.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,677.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.51,1205.1,
"RSV Vacc, Pref A & Pref B/PF (Abrysvo) 0.5ml SDV",69034401,CDM,250,RC,,,Outpatient,,,1354.05,677.03,,1042.62,77,,,Percent of Total Billed Charges,77% of total billed charges,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1002,74,,,Percent of Total Billed Charges,74% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1110.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1205.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.62,77,,,Percent of total Billed charges,77% of total billed charges,1150.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,677.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.51,1205.1,
"RSV Vacc, Pref A & Pref B/PF (Abrysvo) 0.5ml SDV",69034401,CDM,250,RC,,,Outpatient,,,1354.05,677.03,,1042.62,77,,,Percent of Total Billed Charges,77% of total billed charges,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,345.28,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,423.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1002,74,,,Percent of Total Billed Charges,74% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,934.29,69,,,Percent of Total Billed Charges,69% of total billed charges,1137.4,84,,,Percent of Total Billed Charges,84% of total billed charges,1110.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,1205.1,89,,,Percent of total Billed Charges,89% of total Billed charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1042.62,77,,,Percent of total Billed charges,77% of total billed charges,1150.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,389.29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,677.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,552.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1205.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,338.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.51,1205.1,
Florastor 250mg Capsule,4142000007,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Florastor 250mg Capsule,4142000007,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Florastor 250mg Capsule,4142000007,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Florastor 250mg Capsule,4142000007,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Florastor 250mg Capsule,4142000007,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Florastor 250mg Capsule,4142000007,CDM,250,RC,,,Outpatient,,,14.29,7.15,,11,77,,,Percent of Total Billed Charges,77% of total billed charges,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.57,74,,,Percent of Total Billed Charges,74% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,9.86,69,,,Percent of Total Billed Charges,69% of total billed charges,12,84,,,Percent of Total Billed Charges,84% of total billed charges,11.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,12.72,89,,,Percent of total Billed Charges,89% of total Billed charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11,77,,,Percent of total Billed charges,77% of total billed charges,12.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.57,12.72,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,16156.3,8078.15,,12440.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5048.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11955.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,13571.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13248.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,14379.11,89,,,Percent of total Billed Charges,89% of total Billed charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12440.35,77,,,Percent of total Billed charges,77% of total billed charges,13732.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4644.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8078.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4039.08,14379.11,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,15743.1,7871.55,,12122.19,77,,,Percent of Total Billed Charges,77% of total billed charges,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4919.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11649.89,74,,,Percent of Total Billed Charges,74% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,13224.2,84,,,Percent of Total Billed Charges,84% of total billed charges,12909.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,14011.36,89,,,Percent of total Billed Charges,89% of total Billed charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12122.19,77,,,Percent of total Billed charges,77% of total billed charges,13381.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4526.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7871.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3935.78,14011.36,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,16156.3,8078.15,,12440.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5048.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11955.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,13571.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13248.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,14379.11,89,,,Percent of total Billed Charges,89% of total Billed charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12440.35,77,,,Percent of total Billed charges,77% of total billed charges,13732.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4644.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8078.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4039.08,14379.11,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,15743.1,7871.55,,12122.19,77,,,Percent of Total Billed Charges,77% of total billed charges,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4919.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11649.89,74,,,Percent of Total Billed Charges,74% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,13224.2,84,,,Percent of Total Billed Charges,84% of total billed charges,12909.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,14011.36,89,,,Percent of total Billed Charges,89% of total Billed charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12122.19,77,,,Percent of total Billed charges,77% of total billed charges,13381.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4526.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7871.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3935.78,14011.36,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,16156.3,8078.15,,12440.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5048.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11955.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,13571.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13248.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,14379.11,89,,,Percent of total Billed Charges,89% of total Billed charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12440.35,77,,,Percent of total Billed charges,77% of total billed charges,13732.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4644.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8078.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4039.08,14379.11,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,15743.1,7871.55,,12122.19,77,,,Percent of Total Billed Charges,77% of total billed charges,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4919.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11649.89,74,,,Percent of Total Billed Charges,74% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,13224.2,84,,,Percent of Total Billed Charges,84% of total billed charges,12909.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,14011.36,89,,,Percent of total Billed Charges,89% of total Billed charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12122.19,77,,,Percent of total Billed charges,77% of total billed charges,13381.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4526.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7871.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3935.78,14011.36,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,16156.3,8078.15,,12440.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5048.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11955.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,13571.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13248.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,14379.11,89,,,Percent of total Billed Charges,89% of total Billed charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12440.35,77,,,Percent of total Billed charges,77% of total billed charges,13732.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4644.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8078.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4039.08,14379.11,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,15743.1,7871.55,,12122.19,77,,,Percent of Total Billed Charges,77% of total billed charges,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4919.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11649.89,74,,,Percent of Total Billed Charges,74% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,13224.2,84,,,Percent of Total Billed Charges,84% of total billed charges,12909.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,14011.36,89,,,Percent of total Billed Charges,89% of total Billed charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12122.19,77,,,Percent of total Billed charges,77% of total billed charges,13381.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4526.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7871.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3935.78,14011.36,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,16156.3,8078.15,,12440.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5048.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11955.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,13571.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13248.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,14379.11,89,,,Percent of total Billed Charges,89% of total Billed charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12440.35,77,,,Percent of total Billed charges,77% of total billed charges,13732.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4644.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8078.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4039.08,14379.11,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,15743.1,7871.55,,12122.19,77,,,Percent of Total Billed Charges,77% of total billed charges,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4919.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11649.89,74,,,Percent of Total Billed Charges,74% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,13224.2,84,,,Percent of Total Billed Charges,84% of total billed charges,12909.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,14011.36,89,,,Percent of total Billed Charges,89% of total Billed charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12122.19,77,,,Percent of total Billed charges,77% of total billed charges,13381.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4526.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7871.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3935.78,14011.36,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,16156.3,8078.15,,12440.35,77,,,Percent of Total Billed Charges,77% of total billed charges,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4119.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5048.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11955.66,74,,,Percent of Total Billed Charges,74% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11147.85,69,,,Percent of Total Billed Charges,69% of total billed charges,13571.29,84,,,Percent of Total Billed Charges,84% of total billed charges,13248.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,14379.11,89,,,Percent of total Billed Charges,89% of total Billed charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12440.35,77,,,Percent of total Billed charges,77% of total billed charges,13732.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4644.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8078.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6591.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14379.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4039.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4039.08,14379.11,
Sacituzumab Govitecan-HZIY (Trodelvy) 180mg/18ml Powder SDV,55135013201,CDM,250,RC,,,Outpatient,,,15743.1,7871.55,,12122.19,77,,,Percent of Total Billed Charges,77% of total billed charges,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4014.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4919.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11649.89,74,,,Percent of Total Billed Charges,74% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,10862.74,69,,,Percent of Total Billed Charges,69% of total billed charges,13224.2,84,,,Percent of Total Billed Charges,84% of total billed charges,12909.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,14011.36,89,,,Percent of total Billed Charges,89% of total Billed charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12122.19,77,,,Percent of total Billed charges,77% of total billed charges,13381.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4526.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7871.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6423.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14011.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3935.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3935.78,14011.36,
Sacubitril/Valsartan 24mg/26mg Tablet,78065920,CDM,250,RC,,,Outpatient,,,86.03,43.02,,66.24,77,,,Percent of Total Billed Charges,77% of total billed charges,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.66,74,,,Percent of Total Billed Charges,74% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,72.27,84,,,Percent of Total Billed Charges,84% of total billed charges,70.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.57,89,,,Percent of total Billed Charges,89% of total Billed charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,77,,,Percent of total Billed charges,77% of total billed charges,73.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,76.57,
Sacubitril/Valsartan 24mg/26mg Tablet,78065920,CDM,250,RC,,,Outpatient,,,86.03,43.02,,66.24,77,,,Percent of Total Billed Charges,77% of total billed charges,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.66,74,,,Percent of Total Billed Charges,74% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,72.27,84,,,Percent of Total Billed Charges,84% of total billed charges,70.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.57,89,,,Percent of total Billed Charges,89% of total Billed charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,77,,,Percent of total Billed charges,77% of total billed charges,73.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,76.57,
Sacubitril/Valsartan 24mg/26mg Tablet,78065920,CDM,250,RC,,,Outpatient,,,86.03,43.02,,66.24,77,,,Percent of Total Billed Charges,77% of total billed charges,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.66,74,,,Percent of Total Billed Charges,74% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,72.27,84,,,Percent of Total Billed Charges,84% of total billed charges,70.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.57,89,,,Percent of total Billed Charges,89% of total Billed charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,77,,,Percent of total Billed charges,77% of total billed charges,73.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,76.57,
Sacubitril/Valsartan 24mg/26mg Tablet,78065920,CDM,250,RC,,,Outpatient,,,86.03,43.02,,66.24,77,,,Percent of Total Billed Charges,77% of total billed charges,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.66,74,,,Percent of Total Billed Charges,74% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,72.27,84,,,Percent of Total Billed Charges,84% of total billed charges,70.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.57,89,,,Percent of total Billed Charges,89% of total Billed charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,77,,,Percent of total Billed charges,77% of total billed charges,73.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,76.57,
Sacubitril/Valsartan 24mg/26mg Tablet,78065920,CDM,250,RC,,,Outpatient,,,86.03,43.02,,66.24,77,,,Percent of Total Billed Charges,77% of total billed charges,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.66,74,,,Percent of Total Billed Charges,74% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,72.27,84,,,Percent of Total Billed Charges,84% of total billed charges,70.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.57,89,,,Percent of total Billed Charges,89% of total Billed charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,77,,,Percent of total Billed charges,77% of total billed charges,73.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,76.57,
Sacubitril/Valsartan 24mg/26mg Tablet,78065920,CDM,250,RC,,,Outpatient,,,86.03,43.02,,66.24,77,,,Percent of Total Billed Charges,77% of total billed charges,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.66,74,,,Percent of Total Billed Charges,74% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,59.36,69,,,Percent of Total Billed Charges,69% of total billed charges,72.27,84,,,Percent of Total Billed Charges,84% of total billed charges,70.54,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.57,89,,,Percent of total Billed Charges,89% of total Billed charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.24,77,,,Percent of total Billed charges,77% of total billed charges,73.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,76.57,
Biotene Moisturizing Mouth Gel 42gm,48582051201,CDM,250,RC,,,Outpatient,,,85.93,42.97,,66.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.59,74,,,Percent of Total Billed Charges,74% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,72.18,84,,,Percent of Total Billed Charges,84% of total billed charges,70.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.48,89,,,Percent of total Billed Charges,89% of total Billed charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.17,77,,,Percent of total Billed charges,77% of total billed charges,73.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.48,76.48,
Biotene Moisturizing Mouth Gel 42gm,48582051201,CDM,250,RC,,,Outpatient,,,85.93,42.97,,66.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.59,74,,,Percent of Total Billed Charges,74% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,72.18,84,,,Percent of Total Billed Charges,84% of total billed charges,70.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.48,89,,,Percent of total Billed Charges,89% of total Billed charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.17,77,,,Percent of total Billed charges,77% of total billed charges,73.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.48,76.48,
Biotene Moisturizing Mouth Gel 42gm,48582051201,CDM,250,RC,,,Outpatient,,,85.93,42.97,,66.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.59,74,,,Percent of Total Billed Charges,74% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,72.18,84,,,Percent of Total Billed Charges,84% of total billed charges,70.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.48,89,,,Percent of total Billed Charges,89% of total Billed charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.17,77,,,Percent of total Billed charges,77% of total billed charges,73.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.48,76.48,
Biotene Moisturizing Mouth Gel 42gm,48582051201,CDM,250,RC,,,Outpatient,,,85.93,42.97,,66.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.59,74,,,Percent of Total Billed Charges,74% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,72.18,84,,,Percent of Total Billed Charges,84% of total billed charges,70.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.48,89,,,Percent of total Billed Charges,89% of total Billed charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.17,77,,,Percent of total Billed charges,77% of total billed charges,73.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.48,76.48,
Biotene Moisturizing Mouth Gel 42gm,48582051201,CDM,250,RC,,,Outpatient,,,85.93,42.97,,66.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.59,74,,,Percent of Total Billed Charges,74% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,72.18,84,,,Percent of Total Billed Charges,84% of total billed charges,70.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.48,89,,,Percent of total Billed Charges,89% of total Billed charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.17,77,,,Percent of total Billed charges,77% of total billed charges,73.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.48,76.48,
Biotene Moisturizing Mouth Gel 42gm,48582051201,CDM,250,RC,,,Outpatient,,,85.93,42.97,,66.17,77,,,Percent of Total Billed Charges,77% of total billed charges,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.91,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,26.85,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,63.59,74,,,Percent of Total Billed Charges,74% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,59.29,69,,,Percent of Total Billed Charges,69% of total billed charges,72.18,84,,,Percent of Total Billed Charges,84% of total billed charges,70.46,82,,,Percent of Total Billed Charges,82% of total billed charges ,76.48,89,,,Percent of total Billed Charges,89% of total Billed charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.17,77,,,Percent of total Billed charges,77% of total billed charges,73.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,42.97,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.06,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.48,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.48,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.48,76.48,
Scopolamine 1 MG/3 DAY Patch,10019055304,CDM,250,RC,,,Outpatient,,,180.18,90.09,,138.74,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.33,74,,,Percent of Total Billed Charges,74% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,151.35,84,,,Percent of Total Billed Charges,84% of total billed charges,147.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.36,89,,,Percent of total Billed Charges,89% of total Billed charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,77,,,Percent of total Billed charges,77% of total billed charges,153.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.36,
Scopolamine 1 MG/3 DAY Patch,10019055304,CDM,250,RC,,,Outpatient,,,180.18,90.09,,138.74,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.33,74,,,Percent of Total Billed Charges,74% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,151.35,84,,,Percent of Total Billed Charges,84% of total billed charges,147.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.36,89,,,Percent of total Billed Charges,89% of total Billed charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,77,,,Percent of total Billed charges,77% of total billed charges,153.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.36,
Scopolamine 1 MG/3 DAY Patch,10019055304,CDM,250,RC,,,Outpatient,,,180.18,90.09,,138.74,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.33,74,,,Percent of Total Billed Charges,74% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,151.35,84,,,Percent of Total Billed Charges,84% of total billed charges,147.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.36,89,,,Percent of total Billed Charges,89% of total Billed charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,77,,,Percent of total Billed charges,77% of total billed charges,153.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.36,
Scopolamine 1 MG/3 DAY Patch,10019055304,CDM,250,RC,,,Outpatient,,,180.18,90.09,,138.74,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.33,74,,,Percent of Total Billed Charges,74% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,151.35,84,,,Percent of Total Billed Charges,84% of total billed charges,147.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.36,89,,,Percent of total Billed Charges,89% of total Billed charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,77,,,Percent of total Billed charges,77% of total billed charges,153.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.36,
Scopolamine 1 MG/3 DAY Patch,10019055304,CDM,250,RC,,,Outpatient,,,180.18,90.09,,138.74,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.33,74,,,Percent of Total Billed Charges,74% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,151.35,84,,,Percent of Total Billed Charges,84% of total billed charges,147.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.36,89,,,Percent of total Billed Charges,89% of total Billed charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,77,,,Percent of total Billed charges,77% of total billed charges,153.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.36,
Scopolamine 1 MG/3 DAY Patch,10019055304,CDM,250,RC,,,Outpatient,,,180.18,90.09,,138.74,77,,,Percent of Total Billed Charges,77% of total billed charges,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.31,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,133.33,74,,,Percent of Total Billed Charges,74% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,124.32,69,,,Percent of Total Billed Charges,69% of total billed charges,151.35,84,,,Percent of Total Billed Charges,84% of total billed charges,147.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,160.36,89,,,Percent of total Billed Charges,89% of total Billed charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,138.74,77,,,Percent of total Billed charges,77% of total billed charges,153.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,51.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,90.09,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,73.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,160.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,45.05,160.36,
Senna Plus Docusate 8.6/50mg Tablet,67618031060,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Senna Plus Docusate 8.6/50mg Tablet,67618031060,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Senna Plus Docusate 8.6/50mg Tablet,67618031060,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Senna Plus Docusate 8.6/50mg Tablet,67618031060,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Senna Plus Docusate 8.6/50mg Tablet,67618031060,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Senna Plus Docusate 8.6/50mg Tablet,67618031060,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Senna 8.6mg Tablet,49483008001,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Senna 8.6mg Tablet,49483008001,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Senna 8.6mg Tablet,49483008001,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Senna 8.6mg Tablet,49483008001,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Senna 8.6mg Tablet,49483008001,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Senna 8.6mg Tablet,49483008001,CDM,250,RC,,,Outpatient,,,5.38,2.69,,4.14,77,,,Percent of Total Billed Charges,77% of total billed charges,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3.98,74,,,Percent of Total Billed Charges,74% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,3.71,69,,,Percent of Total Billed Charges,69% of total billed charges,4.52,84,,,Percent of Total Billed Charges,84% of total billed charges,4.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.79,89,,,Percent of total Billed Charges,89% of total Billed charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.14,77,,,Percent of total Billed charges,77% of total billed charges,4.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.69,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.35,4.79,
Sennosides Oral Soln 8.8mg/5ml UDC,536126659,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sennosides Oral Soln 8.8mg/5ml UDC,536126659,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sennosides Oral Soln 8.8mg/5ml UDC,536126659,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sennosides Oral Soln 8.8mg/5ml UDC,536126659,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sennosides Oral Soln 8.8mg/5ml UDC,536126659,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sennosides Oral Soln 8.8mg/5ml UDC,536126659,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sertraline 50mg Tablet,49490041,CDM,250,RC,,,Outpatient,,,107.15,53.58,,82.51,77,,,Percent of Total Billed Charges,77% of total billed charges,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.29,74,,,Percent of Total Billed Charges,74% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,90.01,84,,,Percent of Total Billed Charges,84% of total billed charges,87.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.36,89,,,Percent of total Billed Charges,89% of total Billed charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.51,77,,,Percent of total Billed charges,77% of total billed charges,91.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.79,95.36,
Sertraline 50mg Tablet,49490041,CDM,250,RC,,,Outpatient,,,107.15,53.58,,82.51,77,,,Percent of Total Billed Charges,77% of total billed charges,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.29,74,,,Percent of Total Billed Charges,74% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,90.01,84,,,Percent of Total Billed Charges,84% of total billed charges,87.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.36,89,,,Percent of total Billed Charges,89% of total Billed charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.51,77,,,Percent of total Billed charges,77% of total billed charges,91.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.79,95.36,
Sertraline 50mg Tablet,49490041,CDM,250,RC,,,Outpatient,,,107.15,53.58,,82.51,77,,,Percent of Total Billed Charges,77% of total billed charges,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.29,74,,,Percent of Total Billed Charges,74% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,90.01,84,,,Percent of Total Billed Charges,84% of total billed charges,87.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.36,89,,,Percent of total Billed Charges,89% of total Billed charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.51,77,,,Percent of total Billed charges,77% of total billed charges,91.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.79,95.36,
Sertraline 50mg Tablet,49490041,CDM,250,RC,,,Outpatient,,,107.15,53.58,,82.51,77,,,Percent of Total Billed Charges,77% of total billed charges,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.29,74,,,Percent of Total Billed Charges,74% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,90.01,84,,,Percent of Total Billed Charges,84% of total billed charges,87.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.36,89,,,Percent of total Billed Charges,89% of total Billed charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.51,77,,,Percent of total Billed charges,77% of total billed charges,91.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.79,95.36,
Sertraline 50mg Tablet,49490041,CDM,250,RC,,,Outpatient,,,107.15,53.58,,82.51,77,,,Percent of Total Billed Charges,77% of total billed charges,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.29,74,,,Percent of Total Billed Charges,74% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,90.01,84,,,Percent of Total Billed Charges,84% of total billed charges,87.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.36,89,,,Percent of total Billed Charges,89% of total Billed charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.51,77,,,Percent of total Billed charges,77% of total billed charges,91.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.79,95.36,
Sertraline 50mg Tablet,49490041,CDM,250,RC,,,Outpatient,,,107.15,53.58,,82.51,77,,,Percent of Total Billed Charges,77% of total billed charges,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.48,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.29,74,,,Percent of Total Billed Charges,74% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,73.93,69,,,Percent of Total Billed Charges,69% of total billed charges,90.01,84,,,Percent of Total Billed Charges,84% of total billed charges,87.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.36,89,,,Percent of total Billed Charges,89% of total Billed charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.51,77,,,Percent of total Billed charges,77% of total billed charges,91.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.36,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.79,95.36,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,303.13,151.57,,233.41,77,,,Percent of Total Billed Charges,77% of total billed charges,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.32,74,,,Percent of Total Billed Charges,74% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,254.63,84,,,Percent of Total Billed Charges,84% of total billed charges,248.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,269.79,89,,,Percent of total Billed Charges,89% of total Billed charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.41,77,,,Percent of total Billed charges,77% of total billed charges,257.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.78,269.79,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,299.61,149.81,,230.7,77,,,Percent of Total Billed Charges,77% of total billed charges,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.71,74,,,Percent of Total Billed Charges,74% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,251.67,84,,,Percent of Total Billed Charges,84% of total billed charges,245.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.65,89,,,Percent of total Billed Charges,89% of total Billed charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.7,77,,,Percent of total Billed charges,77% of total billed charges,254.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.9,266.65,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,303.13,151.57,,233.41,77,,,Percent of Total Billed Charges,77% of total billed charges,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.32,74,,,Percent of Total Billed Charges,74% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,254.63,84,,,Percent of Total Billed Charges,84% of total billed charges,248.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,269.79,89,,,Percent of total Billed Charges,89% of total Billed charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.41,77,,,Percent of total Billed charges,77% of total billed charges,257.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.78,269.79,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,299.61,149.81,,230.7,77,,,Percent of Total Billed Charges,77% of total billed charges,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.71,74,,,Percent of Total Billed Charges,74% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,251.67,84,,,Percent of Total Billed Charges,84% of total billed charges,245.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.65,89,,,Percent of total Billed Charges,89% of total Billed charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.7,77,,,Percent of total Billed charges,77% of total billed charges,254.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.9,266.65,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,303.13,151.57,,233.41,77,,,Percent of Total Billed Charges,77% of total billed charges,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.32,74,,,Percent of Total Billed Charges,74% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,254.63,84,,,Percent of Total Billed Charges,84% of total billed charges,248.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,269.79,89,,,Percent of total Billed Charges,89% of total Billed charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.41,77,,,Percent of total Billed charges,77% of total billed charges,257.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.78,269.79,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,299.61,149.81,,230.7,77,,,Percent of Total Billed Charges,77% of total billed charges,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.71,74,,,Percent of Total Billed Charges,74% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,251.67,84,,,Percent of Total Billed Charges,84% of total billed charges,245.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.65,89,,,Percent of total Billed Charges,89% of total Billed charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.7,77,,,Percent of total Billed charges,77% of total billed charges,254.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.9,266.65,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,303.13,151.57,,233.41,77,,,Percent of Total Billed Charges,77% of total billed charges,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.32,74,,,Percent of Total Billed Charges,74% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,254.63,84,,,Percent of Total Billed Charges,84% of total billed charges,248.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,269.79,89,,,Percent of total Billed Charges,89% of total Billed charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.41,77,,,Percent of total Billed charges,77% of total billed charges,257.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.78,269.79,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,299.61,149.81,,230.7,77,,,Percent of Total Billed Charges,77% of total billed charges,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.71,74,,,Percent of Total Billed Charges,74% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,251.67,84,,,Percent of Total Billed Charges,84% of total billed charges,245.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.65,89,,,Percent of total Billed Charges,89% of total Billed charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.7,77,,,Percent of total Billed charges,77% of total billed charges,254.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.9,266.65,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,303.13,151.57,,233.41,77,,,Percent of Total Billed Charges,77% of total billed charges,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.32,74,,,Percent of Total Billed Charges,74% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,254.63,84,,,Percent of Total Billed Charges,84% of total billed charges,248.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,269.79,89,,,Percent of total Billed Charges,89% of total Billed charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.41,77,,,Percent of total Billed charges,77% of total billed charges,257.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.78,269.79,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,299.61,149.81,,230.7,77,,,Percent of Total Billed Charges,77% of total billed charges,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.71,74,,,Percent of Total Billed Charges,74% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,251.67,84,,,Percent of Total Billed Charges,84% of total billed charges,245.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.65,89,,,Percent of total Billed Charges,89% of total Billed charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.7,77,,,Percent of total Billed charges,77% of total billed charges,254.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.9,266.65,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,303.13,151.57,,233.41,77,,,Percent of Total Billed Charges,77% of total billed charges,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.32,74,,,Percent of Total Billed Charges,74% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,209.16,69,,,Percent of Total Billed Charges,69% of total billed charges,254.63,84,,,Percent of Total Billed Charges,84% of total billed charges,248.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,269.79,89,,,Percent of total Billed Charges,89% of total Billed charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.41,77,,,Percent of total Billed charges,77% of total billed charges,257.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,269.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.78,269.79,
Sevoflurane Charge Per Hour,74445651,CDM,250,RC,,,Outpatient,,,299.61,149.81,,230.7,77,,,Percent of Total Billed Charges,77% of total billed charges,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,76.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,93.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,221.71,74,,,Percent of Total Billed Charges,74% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,206.73,69,,,Percent of Total Billed Charges,69% of total billed charges,251.67,84,,,Percent of Total Billed Charges,84% of total billed charges,245.68,82,,,Percent of Total Billed Charges,82% of total billed charges ,266.65,89,,,Percent of total Billed Charges,89% of total Billed charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.7,77,,,Percent of total Billed charges,77% of total billed charges,254.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,86.14,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,149.81,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,122.24,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,74.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,74.9,266.65,
Sildenafil 20mg Tablet,69419068,CDM,250,RC,,,Outpatient,,,226.7,113.35,,174.56,77,,,Percent of Total Billed Charges,77% of total billed charges,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.76,74,,,Percent of Total Billed Charges,74% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,190.43,84,,,Percent of Total Billed Charges,84% of total billed charges,185.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.76,89,,,Percent of total Billed Charges,89% of total Billed charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.56,77,,,Percent of total Billed charges,77% of total billed charges,192.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.68,201.76,
Sildenafil 20mg Tablet,69419068,CDM,250,RC,,,Outpatient,,,226.7,113.35,,174.56,77,,,Percent of Total Billed Charges,77% of total billed charges,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.76,74,,,Percent of Total Billed Charges,74% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,190.43,84,,,Percent of Total Billed Charges,84% of total billed charges,185.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.76,89,,,Percent of total Billed Charges,89% of total Billed charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.56,77,,,Percent of total Billed charges,77% of total billed charges,192.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.68,201.76,
Sildenafil 20mg Tablet,69419068,CDM,250,RC,,,Outpatient,,,226.7,113.35,,174.56,77,,,Percent of Total Billed Charges,77% of total billed charges,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.76,74,,,Percent of Total Billed Charges,74% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,190.43,84,,,Percent of Total Billed Charges,84% of total billed charges,185.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.76,89,,,Percent of total Billed Charges,89% of total Billed charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.56,77,,,Percent of total Billed charges,77% of total billed charges,192.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.68,201.76,
Sildenafil 20mg Tablet,69419068,CDM,250,RC,,,Outpatient,,,226.7,113.35,,174.56,77,,,Percent of Total Billed Charges,77% of total billed charges,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.76,74,,,Percent of Total Billed Charges,74% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,190.43,84,,,Percent of Total Billed Charges,84% of total billed charges,185.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.76,89,,,Percent of total Billed Charges,89% of total Billed charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.56,77,,,Percent of total Billed charges,77% of total billed charges,192.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.68,201.76,
Sildenafil 20mg Tablet,69419068,CDM,250,RC,,,Outpatient,,,226.7,113.35,,174.56,77,,,Percent of Total Billed Charges,77% of total billed charges,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.76,74,,,Percent of Total Billed Charges,74% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,190.43,84,,,Percent of Total Billed Charges,84% of total billed charges,185.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.76,89,,,Percent of total Billed Charges,89% of total Billed charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.56,77,,,Percent of total Billed charges,77% of total billed charges,192.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.68,201.76,
Sildenafil 20mg Tablet,69419068,CDM,250,RC,,,Outpatient,,,226.7,113.35,,174.56,77,,,Percent of Total Billed Charges,77% of total billed charges,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.76,74,,,Percent of Total Billed Charges,74% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,156.42,69,,,Percent of Total Billed Charges,69% of total billed charges,190.43,84,,,Percent of Total Billed Charges,84% of total billed charges,185.89,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.76,89,,,Percent of total Billed Charges,89% of total Billed charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.56,77,,,Percent of total Billed charges,77% of total billed charges,192.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.68,201.76,
"Silver Nitrate Swab, 1 Each",12870000101,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
"Silver Nitrate Swab, 1 Each",12870000101,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
"Silver Nitrate Swab, 1 Each",12870000101,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
"Silver Nitrate Swab, 1 Each",12870000101,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
"Silver Nitrate Swab, 1 Each",12870000101,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
"Silver Nitrate Swab, 1 Each",12870000101,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Silver Sulfadiazine 1% Cream 20gm,61570013120,CDM,250,RC,,,Outpatient,,,79.76,39.88,,61.42,77,,,Percent of Total Billed Charges,77% of total billed charges,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.02,74,,,Percent of Total Billed Charges,74% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,67,84,,,Percent of Total Billed Charges,84% of total billed charges,65.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.99,89,,,Percent of total Billed Charges,89% of total Billed charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.42,77,,,Percent of total Billed charges,77% of total billed charges,67.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.94,70.99,
Silver Sulfadiazine 1% Cream 20gm,61570013120,CDM,250,RC,,,Outpatient,,,79.76,39.88,,61.42,77,,,Percent of Total Billed Charges,77% of total billed charges,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.02,74,,,Percent of Total Billed Charges,74% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,67,84,,,Percent of Total Billed Charges,84% of total billed charges,65.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.99,89,,,Percent of total Billed Charges,89% of total Billed charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.42,77,,,Percent of total Billed charges,77% of total billed charges,67.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.94,70.99,
Silver Sulfadiazine 1% Cream 20gm,61570013120,CDM,250,RC,,,Outpatient,,,79.76,39.88,,61.42,77,,,Percent of Total Billed Charges,77% of total billed charges,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.02,74,,,Percent of Total Billed Charges,74% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,67,84,,,Percent of Total Billed Charges,84% of total billed charges,65.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.99,89,,,Percent of total Billed Charges,89% of total Billed charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.42,77,,,Percent of total Billed charges,77% of total billed charges,67.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.94,70.99,
Silver Sulfadiazine 1% Cream 20gm,61570013120,CDM,250,RC,,,Outpatient,,,79.76,39.88,,61.42,77,,,Percent of Total Billed Charges,77% of total billed charges,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.02,74,,,Percent of Total Billed Charges,74% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,67,84,,,Percent of Total Billed Charges,84% of total billed charges,65.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.99,89,,,Percent of total Billed Charges,89% of total Billed charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.42,77,,,Percent of total Billed charges,77% of total billed charges,67.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.94,70.99,
Silver Sulfadiazine 1% Cream 20gm,61570013120,CDM,250,RC,,,Outpatient,,,79.76,39.88,,61.42,77,,,Percent of Total Billed Charges,77% of total billed charges,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.02,74,,,Percent of Total Billed Charges,74% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,67,84,,,Percent of Total Billed Charges,84% of total billed charges,65.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.99,89,,,Percent of total Billed Charges,89% of total Billed charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.42,77,,,Percent of total Billed charges,77% of total billed charges,67.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.94,70.99,
Silver Sulfadiazine 1% Cream 20gm,61570013120,CDM,250,RC,,,Outpatient,,,79.76,39.88,,61.42,77,,,Percent of Total Billed Charges,77% of total billed charges,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.02,74,,,Percent of Total Billed Charges,74% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,55.03,69,,,Percent of Total Billed Charges,69% of total billed charges,67,84,,,Percent of Total Billed Charges,84% of total billed charges,65.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,70.99,89,,,Percent of total Billed Charges,89% of total Billed charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.42,77,,,Percent of total Billed charges,77% of total billed charges,67.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,22.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,39.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.94,70.99,
Silver Sulfadiazine 1% Cream 400gm,43598021040,CDM,250,RC,,,Outpatient,,,224.08,112.04,,172.54,77,,,Percent of Total Billed Charges,77% of total billed charges,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.82,74,,,Percent of Total Billed Charges,74% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,188.23,84,,,Percent of Total Billed Charges,84% of total billed charges,183.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.43,89,,,Percent of total Billed Charges,89% of total Billed charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.54,77,,,Percent of total Billed charges,77% of total billed charges,190.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.02,199.43,
Silver Sulfadiazine 1% Cream 400gm,43598021040,CDM,250,RC,,,Outpatient,,,224.08,112.04,,172.54,77,,,Percent of Total Billed Charges,77% of total billed charges,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.82,74,,,Percent of Total Billed Charges,74% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,188.23,84,,,Percent of Total Billed Charges,84% of total billed charges,183.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.43,89,,,Percent of total Billed Charges,89% of total Billed charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.54,77,,,Percent of total Billed charges,77% of total billed charges,190.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.02,199.43,
Silver Sulfadiazine 1% Cream 400gm,43598021040,CDM,250,RC,,,Outpatient,,,224.08,112.04,,172.54,77,,,Percent of Total Billed Charges,77% of total billed charges,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.82,74,,,Percent of Total Billed Charges,74% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,188.23,84,,,Percent of Total Billed Charges,84% of total billed charges,183.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.43,89,,,Percent of total Billed Charges,89% of total Billed charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.54,77,,,Percent of total Billed charges,77% of total billed charges,190.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.02,199.43,
Silver Sulfadiazine 1% Cream 400gm,43598021040,CDM,250,RC,,,Outpatient,,,224.08,112.04,,172.54,77,,,Percent of Total Billed Charges,77% of total billed charges,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.82,74,,,Percent of Total Billed Charges,74% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,188.23,84,,,Percent of Total Billed Charges,84% of total billed charges,183.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.43,89,,,Percent of total Billed Charges,89% of total Billed charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.54,77,,,Percent of total Billed charges,77% of total billed charges,190.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.02,199.43,
Silver Sulfadiazine 1% Cream 400gm,43598021040,CDM,250,RC,,,Outpatient,,,224.08,112.04,,172.54,77,,,Percent of Total Billed Charges,77% of total billed charges,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.82,74,,,Percent of Total Billed Charges,74% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,188.23,84,,,Percent of Total Billed Charges,84% of total billed charges,183.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.43,89,,,Percent of total Billed Charges,89% of total Billed charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.54,77,,,Percent of total Billed charges,77% of total billed charges,190.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.02,199.43,
Silver Sulfadiazine 1% Cream 400gm,43598021040,CDM,250,RC,,,Outpatient,,,224.08,112.04,,172.54,77,,,Percent of Total Billed Charges,77% of total billed charges,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,165.82,74,,,Percent of Total Billed Charges,74% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,154.62,69,,,Percent of Total Billed Charges,69% of total billed charges,188.23,84,,,Percent of Total Billed Charges,84% of total billed charges,183.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,199.43,89,,,Percent of total Billed Charges,89% of total Billed charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.54,77,,,Percent of total Billed charges,77% of total billed charges,190.47,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,64.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,112.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,91.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,199.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.02,199.43,
Silver Sulfadiazine 1% Cream 85gm,67877012485,CDM,250,RC,,,Outpatient,,,134.28,67.14,,103.4,77,,,Percent of Total Billed Charges,77% of total billed charges,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.37,74,,,Percent of Total Billed Charges,74% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,112.8,84,,,Percent of Total Billed Charges,84% of total billed charges,110.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.51,89,,,Percent of total Billed Charges,89% of total Billed charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.4,77,,,Percent of total Billed charges,77% of total billed charges,114.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.57,119.51,
Silver Sulfadiazine 1% Cream 85gm,67877012485,CDM,250,RC,,,Outpatient,,,134.28,67.14,,103.4,77,,,Percent of Total Billed Charges,77% of total billed charges,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.37,74,,,Percent of Total Billed Charges,74% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,112.8,84,,,Percent of Total Billed Charges,84% of total billed charges,110.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.51,89,,,Percent of total Billed Charges,89% of total Billed charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.4,77,,,Percent of total Billed charges,77% of total billed charges,114.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.57,119.51,
Silver Sulfadiazine 1% Cream 85gm,67877012485,CDM,250,RC,,,Outpatient,,,134.28,67.14,,103.4,77,,,Percent of Total Billed Charges,77% of total billed charges,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.37,74,,,Percent of Total Billed Charges,74% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,112.8,84,,,Percent of Total Billed Charges,84% of total billed charges,110.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.51,89,,,Percent of total Billed Charges,89% of total Billed charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.4,77,,,Percent of total Billed charges,77% of total billed charges,114.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.57,119.51,
Silver Sulfadiazine 1% Cream 85gm,67877012485,CDM,250,RC,,,Outpatient,,,134.28,67.14,,103.4,77,,,Percent of Total Billed Charges,77% of total billed charges,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.37,74,,,Percent of Total Billed Charges,74% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,112.8,84,,,Percent of Total Billed Charges,84% of total billed charges,110.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.51,89,,,Percent of total Billed Charges,89% of total Billed charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.4,77,,,Percent of total Billed charges,77% of total billed charges,114.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.57,119.51,
Silver Sulfadiazine 1% Cream 85gm,67877012485,CDM,250,RC,,,Outpatient,,,134.28,67.14,,103.4,77,,,Percent of Total Billed Charges,77% of total billed charges,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.37,74,,,Percent of Total Billed Charges,74% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,112.8,84,,,Percent of Total Billed Charges,84% of total billed charges,110.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.51,89,,,Percent of total Billed Charges,89% of total Billed charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.4,77,,,Percent of total Billed charges,77% of total billed charges,114.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.57,119.51,
Silver Sulfadiazine 1% Cream 85gm,67877012485,CDM,250,RC,,,Outpatient,,,134.28,67.14,,103.4,77,,,Percent of Total Billed Charges,77% of total billed charges,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,99.37,74,,,Percent of Total Billed Charges,74% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,92.65,69,,,Percent of Total Billed Charges,69% of total billed charges,112.8,84,,,Percent of Total Billed Charges,84% of total billed charges,110.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,119.51,89,,,Percent of total Billed Charges,89% of total Billed charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,103.4,77,,,Percent of total Billed charges,77% of total billed charges,114.14,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,38.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,67.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,54.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,119.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.57,119.51,
Simethicone 80mg Chewable Tablet,70000043401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Simethicone 80mg Chewable Tablet,70000043401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Simethicone 80mg Chewable Tablet,70000043401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Simethicone 80mg Chewable Tablet,70000043401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Simethicone 80mg Chewable Tablet,70000043401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Simethicone 80mg Chewable Tablet,70000043401,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Simvastatin 10mg Tablet,51079045420,CDM,250,RC,,,Outpatient,,,31.18,15.59,,24.01,77,,,Percent of Total Billed Charges,77% of total billed charges,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.07,74,,,Percent of Total Billed Charges,74% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,26.19,84,,,Percent of Total Billed Charges,84% of total billed charges,25.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.75,89,,,Percent of total Billed Charges,89% of total Billed charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.01,77,,,Percent of total Billed charges,77% of total billed charges,26.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.8,27.75,
Simvastatin 10mg Tablet,51079045420,CDM,250,RC,,,Outpatient,,,31.18,15.59,,24.01,77,,,Percent of Total Billed Charges,77% of total billed charges,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.07,74,,,Percent of Total Billed Charges,74% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,26.19,84,,,Percent of Total Billed Charges,84% of total billed charges,25.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.75,89,,,Percent of total Billed Charges,89% of total Billed charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.01,77,,,Percent of total Billed charges,77% of total billed charges,26.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.8,27.75,
Simvastatin 10mg Tablet,51079045420,CDM,250,RC,,,Outpatient,,,31.18,15.59,,24.01,77,,,Percent of Total Billed Charges,77% of total billed charges,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.07,74,,,Percent of Total Billed Charges,74% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,26.19,84,,,Percent of Total Billed Charges,84% of total billed charges,25.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.75,89,,,Percent of total Billed Charges,89% of total Billed charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.01,77,,,Percent of total Billed charges,77% of total billed charges,26.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.8,27.75,
Simvastatin 10mg Tablet,51079045420,CDM,250,RC,,,Outpatient,,,31.18,15.59,,24.01,77,,,Percent of Total Billed Charges,77% of total billed charges,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.07,74,,,Percent of Total Billed Charges,74% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,26.19,84,,,Percent of Total Billed Charges,84% of total billed charges,25.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.75,89,,,Percent of total Billed Charges,89% of total Billed charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.01,77,,,Percent of total Billed charges,77% of total billed charges,26.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.8,27.75,
Simvastatin 10mg Tablet,51079045420,CDM,250,RC,,,Outpatient,,,31.18,15.59,,24.01,77,,,Percent of Total Billed Charges,77% of total billed charges,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.07,74,,,Percent of Total Billed Charges,74% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,26.19,84,,,Percent of Total Billed Charges,84% of total billed charges,25.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.75,89,,,Percent of total Billed Charges,89% of total Billed charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.01,77,,,Percent of total Billed charges,77% of total billed charges,26.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.8,27.75,
Simvastatin 10mg Tablet,51079045420,CDM,250,RC,,,Outpatient,,,31.18,15.59,,24.01,77,,,Percent of Total Billed Charges,77% of total billed charges,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.07,74,,,Percent of Total Billed Charges,74% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,21.51,69,,,Percent of Total Billed Charges,69% of total billed charges,26.19,84,,,Percent of Total Billed Charges,84% of total billed charges,25.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.75,89,,,Percent of total Billed Charges,89% of total Billed charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.01,77,,,Percent of total Billed charges,77% of total billed charges,26.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.59,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.72,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.8,27.75,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,25,12.5,,19.25,77,,,Percent of Total Billed Charges,77% of total billed charges,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.5,74,,,Percent of Total Billed Charges,74% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,17.25,69,,,Percent of Total Billed Charges,69% of total billed charges,21,84,,,Percent of Total Billed Charges,84% of total billed charges,20.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.25,89,,,Percent of total Billed Charges,89% of total Billed charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.25,77,,,Percent of total Billed charges,77% of total billed charges,21.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.19,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.5,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.25,22.25,
Sodium Bicarb 8.4% 50meq/50ml SDV (for Buffered Lidocaine),,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Bicarb 4.2% 5meq/10ml (0.5meq/ml) SDV,51754501204,CDM,250,RC,,,Outpatient,,,100.86,50.43,,77.66,77,,,Percent of Total Billed Charges,77% of total billed charges,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.64,74,,,Percent of Total Billed Charges,74% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,69.59,69,,,Percent of Total Billed Charges,69% of total billed charges,84.72,84,,,Percent of Total Billed Charges,84% of total billed charges,82.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.77,89,,,Percent of total Billed Charges,89% of total Billed charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.66,77,,,Percent of total Billed charges,77% of total billed charges,85.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.43,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.15,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.22,89.77,
Sodium Chloride 1000mg Tablet,223176001,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Sodium Chloride 1000mg Tablet,223176001,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Sodium Chloride 1000mg Tablet,223176001,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Sodium Chloride 1000mg Tablet,223176001,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Sodium Chloride 1000mg Tablet,223176001,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Sodium Chloride 1000mg Tablet,223176001,CDM,250,RC,,,Outpatient,,,5.75,2.88,,4.43,77,,,Percent of Total Billed Charges,77% of total billed charges,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.26,74,,,Percent of Total Billed Charges,74% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,3.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4.83,84,,,Percent of Total Billed Charges,84% of total billed charges,4.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.12,89,,,Percent of total Billed Charges,89% of total Billed charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.43,77,,,Percent of total Billed charges,77% of total billed charges,4.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.88,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.44,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.44,5.12,
Sodium Chloride 0.45% 1000ml IV Bag,338004304,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45% 1000ml IV Bag,338004304,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45% 1000ml IV Bag,338004304,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45% 1000ml IV Bag,338004304,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45% 1000ml IV Bag,338004304,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Chloride 0.45% 1000ml IV Bag,338004304,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Sodium Zirconium Cyclosilicate  (1 Dose/Packet),310111039,CDM,250,RC,,,Outpatient,,,198.21,99.11,,152.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.68,74,,,Percent of Total Billed Charges,74% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,166.5,84,,,Percent of Total Billed Charges,84% of total billed charges,162.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.41,89,,,Percent of total Billed Charges,89% of total Billed charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,77,,,Percent of total Billed charges,77% of total billed charges,168.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.55,176.41,
Sodium Zirconium Cyclosilicate  (1 Dose/Packet),310111039,CDM,250,RC,,,Outpatient,,,198.21,99.11,,152.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.68,74,,,Percent of Total Billed Charges,74% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,166.5,84,,,Percent of Total Billed Charges,84% of total billed charges,162.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.41,89,,,Percent of total Billed Charges,89% of total Billed charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,77,,,Percent of total Billed charges,77% of total billed charges,168.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.55,176.41,
Sodium Zirconium Cyclosilicate  (1 Dose/Packet),310111039,CDM,250,RC,,,Outpatient,,,198.21,99.11,,152.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.68,74,,,Percent of Total Billed Charges,74% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,166.5,84,,,Percent of Total Billed Charges,84% of total billed charges,162.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.41,89,,,Percent of total Billed Charges,89% of total Billed charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,77,,,Percent of total Billed charges,77% of total billed charges,168.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.55,176.41,
Sodium Zirconium Cyclosilicate  (1 Dose/Packet),310111039,CDM,250,RC,,,Outpatient,,,198.21,99.11,,152.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.68,74,,,Percent of Total Billed Charges,74% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,166.5,84,,,Percent of Total Billed Charges,84% of total billed charges,162.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.41,89,,,Percent of total Billed Charges,89% of total Billed charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,77,,,Percent of total Billed charges,77% of total billed charges,168.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.55,176.41,
Sodium Zirconium Cyclosilicate  (1 Dose/Packet),310111039,CDM,250,RC,,,Outpatient,,,198.21,99.11,,152.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.68,74,,,Percent of Total Billed Charges,74% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,166.5,84,,,Percent of Total Billed Charges,84% of total billed charges,162.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.41,89,,,Percent of total Billed Charges,89% of total Billed charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,77,,,Percent of total Billed charges,77% of total billed charges,168.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.55,176.41,
Sodium Zirconium Cyclosilicate  (1 Dose/Packet),310111039,CDM,250,RC,,,Outpatient,,,198.21,99.11,,152.62,77,,,Percent of Total Billed Charges,77% of total billed charges,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,50.54,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,61.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,146.68,74,,,Percent of Total Billed Charges,74% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,136.76,69,,,Percent of Total Billed Charges,69% of total billed charges,166.5,84,,,Percent of Total Billed Charges,84% of total billed charges,162.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,176.41,89,,,Percent of total Billed Charges,89% of total Billed charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.62,77,,,Percent of total Billed charges,77% of total billed charges,168.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,56.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,99.11,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,80.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,176.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.55,176.41,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,556.71,278.36,,428.67,77,,,Percent of Total Billed Charges,77% of total billed charges,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.97,74,,,Percent of Total Billed Charges,74% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,467.64,84,,,Percent of Total Billed Charges,84% of total billed charges,456.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.47,89,,,Percent of total Billed Charges,89% of total Billed charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.67,77,,,Percent of total Billed charges,77% of total billed charges,473.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.18,495.47,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,578.24,289.12,,445.24,77,,,Percent of Total Billed Charges,77% of total billed charges,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,427.9,74,,,Percent of Total Billed Charges,74% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,485.72,84,,,Percent of Total Billed Charges,84% of total billed charges,474.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.63,89,,,Percent of total Billed Charges,89% of total Billed charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.24,77,,,Percent of total Billed charges,77% of total billed charges,491.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,514.63,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,556.71,278.36,,428.67,77,,,Percent of Total Billed Charges,77% of total billed charges,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.97,74,,,Percent of Total Billed Charges,74% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,467.64,84,,,Percent of Total Billed Charges,84% of total billed charges,456.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.47,89,,,Percent of total Billed Charges,89% of total Billed charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.67,77,,,Percent of total Billed charges,77% of total billed charges,473.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.18,495.47,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,578.24,289.12,,445.24,77,,,Percent of Total Billed Charges,77% of total billed charges,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,427.9,74,,,Percent of Total Billed Charges,74% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,485.72,84,,,Percent of Total Billed Charges,84% of total billed charges,474.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.63,89,,,Percent of total Billed Charges,89% of total Billed charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.24,77,,,Percent of total Billed charges,77% of total billed charges,491.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,514.63,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,556.71,278.36,,428.67,77,,,Percent of Total Billed Charges,77% of total billed charges,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.97,74,,,Percent of Total Billed Charges,74% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,467.64,84,,,Percent of Total Billed Charges,84% of total billed charges,456.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.47,89,,,Percent of total Billed Charges,89% of total Billed charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.67,77,,,Percent of total Billed charges,77% of total billed charges,473.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.18,495.47,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,578.24,289.12,,445.24,77,,,Percent of Total Billed Charges,77% of total billed charges,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,427.9,74,,,Percent of Total Billed Charges,74% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,485.72,84,,,Percent of Total Billed Charges,84% of total billed charges,474.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.63,89,,,Percent of total Billed Charges,89% of total Billed charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.24,77,,,Percent of total Billed charges,77% of total billed charges,491.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,514.63,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,556.71,278.36,,428.67,77,,,Percent of Total Billed Charges,77% of total billed charges,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.97,74,,,Percent of Total Billed Charges,74% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,467.64,84,,,Percent of Total Billed Charges,84% of total billed charges,456.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.47,89,,,Percent of total Billed Charges,89% of total Billed charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.67,77,,,Percent of total Billed charges,77% of total billed charges,473.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.18,495.47,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,578.24,289.12,,445.24,77,,,Percent of Total Billed Charges,77% of total billed charges,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,427.9,74,,,Percent of Total Billed Charges,74% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,485.72,84,,,Percent of Total Billed Charges,84% of total billed charges,474.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.63,89,,,Percent of total Billed Charges,89% of total Billed charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.24,77,,,Percent of total Billed charges,77% of total billed charges,491.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,514.63,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,556.71,278.36,,428.67,77,,,Percent of Total Billed Charges,77% of total billed charges,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.97,74,,,Percent of Total Billed Charges,74% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,467.64,84,,,Percent of Total Billed Charges,84% of total billed charges,456.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.47,89,,,Percent of total Billed Charges,89% of total Billed charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.67,77,,,Percent of total Billed charges,77% of total billed charges,473.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.18,495.47,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,578.24,289.12,,445.24,77,,,Percent of Total Billed Charges,77% of total billed charges,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,427.9,74,,,Percent of Total Billed Charges,74% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,485.72,84,,,Percent of Total Billed Charges,84% of total billed charges,474.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.63,89,,,Percent of total Billed Charges,89% of total Billed charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.24,77,,,Percent of total Billed charges,77% of total billed charges,491.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,514.63,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,556.71,278.36,,428.67,77,,,Percent of Total Billed Charges,77% of total billed charges,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,141.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,173.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,411.97,74,,,Percent of Total Billed Charges,74% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,384.13,69,,,Percent of Total Billed Charges,69% of total billed charges,467.64,84,,,Percent of Total Billed Charges,84% of total billed charges,456.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,495.47,89,,,Percent of total Billed Charges,89% of total Billed charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,428.67,77,,,Percent of total Billed charges,77% of total billed charges,473.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,160.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,278.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,227.14,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,495.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.18,495.47,
Sodium Thiosulfate Injection 12.5gm/50ml,60267070550,CDM,250,RC,,,Outpatient,,,578.24,289.12,,445.24,77,,,Percent of Total Billed Charges,77% of total billed charges,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,147.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,180.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,427.9,74,,,Percent of Total Billed Charges,74% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,398.99,69,,,Percent of Total Billed Charges,69% of total billed charges,485.72,84,,,Percent of Total Billed Charges,84% of total billed charges,474.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,514.63,89,,,Percent of total Billed Charges,89% of total Billed charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,445.24,77,,,Percent of total Billed charges,77% of total billed charges,491.5,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,166.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,289.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,235.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,514.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,144.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,144.56,514.63,
Sodium Chloride/Aloe Vera Gel 14.1gm,225052547,CDM,250,RC,,,Outpatient,,,31.09,15.55,,23.94,77,,,Percent of Total Billed Charges,77% of total billed charges,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.01,74,,,Percent of Total Billed Charges,74% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.12,84,,,Percent of Total Billed Charges,84% of total billed charges,25.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.67,89,,,Percent of total Billed Charges,89% of total Billed charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.94,77,,,Percent of total Billed charges,77% of total billed charges,26.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.77,27.67,
Sodium Chloride/Aloe Vera Gel 14.1gm,225052547,CDM,250,RC,,,Outpatient,,,31.09,15.55,,23.94,77,,,Percent of Total Billed Charges,77% of total billed charges,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.01,74,,,Percent of Total Billed Charges,74% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.12,84,,,Percent of Total Billed Charges,84% of total billed charges,25.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.67,89,,,Percent of total Billed Charges,89% of total Billed charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.94,77,,,Percent of total Billed charges,77% of total billed charges,26.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.77,27.67,
Sodium Chloride/Aloe Vera Gel 14.1gm,225052547,CDM,250,RC,,,Outpatient,,,31.09,15.55,,23.94,77,,,Percent of Total Billed Charges,77% of total billed charges,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.01,74,,,Percent of Total Billed Charges,74% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.12,84,,,Percent of Total Billed Charges,84% of total billed charges,25.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.67,89,,,Percent of total Billed Charges,89% of total Billed charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.94,77,,,Percent of total Billed charges,77% of total billed charges,26.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.77,27.67,
Sodium Chloride/Aloe Vera Gel 14.1gm,225052547,CDM,250,RC,,,Outpatient,,,31.09,15.55,,23.94,77,,,Percent of Total Billed Charges,77% of total billed charges,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.01,74,,,Percent of Total Billed Charges,74% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.12,84,,,Percent of Total Billed Charges,84% of total billed charges,25.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.67,89,,,Percent of total Billed Charges,89% of total Billed charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.94,77,,,Percent of total Billed charges,77% of total billed charges,26.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.77,27.67,
Sodium Chloride/Aloe Vera Gel 14.1gm,225052547,CDM,250,RC,,,Outpatient,,,31.09,15.55,,23.94,77,,,Percent of Total Billed Charges,77% of total billed charges,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.01,74,,,Percent of Total Billed Charges,74% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.12,84,,,Percent of Total Billed Charges,84% of total billed charges,25.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.67,89,,,Percent of total Billed Charges,89% of total Billed charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.94,77,,,Percent of total Billed charges,77% of total billed charges,26.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.77,27.67,
Sodium Chloride/Aloe Vera Gel 14.1gm,225052547,CDM,250,RC,,,Outpatient,,,31.09,15.55,,23.94,77,,,Percent of Total Billed Charges,77% of total billed charges,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.72,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,23.01,74,,,Percent of Total Billed Charges,74% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,21.45,69,,,Percent of Total Billed Charges,69% of total billed charges,26.12,84,,,Percent of Total Billed Charges,84% of total billed charges,25.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,27.67,89,,,Percent of total Billed Charges,89% of total Billed charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.94,77,,,Percent of total Billed charges,77% of total billed charges,26.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,15.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,12.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.77,27.67,
Sodium Polystyrene Sulfonate 15gm/60ml UD,46287000660,CDM,250,RC,,,Outpatient,,,152.08,76.04,,117.1,77,,,Percent of Total Billed Charges,77% of total billed charges,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.54,74,,,Percent of Total Billed Charges,74% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,84,,,Percent of Total Billed Charges,84% of total billed charges,124.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.35,89,,,Percent of total Billed Charges,89% of total Billed charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.1,77,,,Percent of total Billed charges,77% of total billed charges,129.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.02,135.35,
Sodium Polystyrene Sulfonate 15gm/60ml UD,46287000660,CDM,250,RC,,,Outpatient,,,152.08,76.04,,117.1,77,,,Percent of Total Billed Charges,77% of total billed charges,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.54,74,,,Percent of Total Billed Charges,74% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,84,,,Percent of Total Billed Charges,84% of total billed charges,124.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.35,89,,,Percent of total Billed Charges,89% of total Billed charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.1,77,,,Percent of total Billed charges,77% of total billed charges,129.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.02,135.35,
Sodium Polystyrene Sulfonate 15gm/60ml UD,46287000660,CDM,250,RC,,,Outpatient,,,152.08,76.04,,117.1,77,,,Percent of Total Billed Charges,77% of total billed charges,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.54,74,,,Percent of Total Billed Charges,74% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,84,,,Percent of Total Billed Charges,84% of total billed charges,124.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.35,89,,,Percent of total Billed Charges,89% of total Billed charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.1,77,,,Percent of total Billed charges,77% of total billed charges,129.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.02,135.35,
Sodium Polystyrene Sulfonate 15gm/60ml UD,46287000660,CDM,250,RC,,,Outpatient,,,152.08,76.04,,117.1,77,,,Percent of Total Billed Charges,77% of total billed charges,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.54,74,,,Percent of Total Billed Charges,74% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,84,,,Percent of Total Billed Charges,84% of total billed charges,124.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.35,89,,,Percent of total Billed Charges,89% of total Billed charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.1,77,,,Percent of total Billed charges,77% of total billed charges,129.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.02,135.35,
Sodium Polystyrene Sulfonate 15gm/60ml UD,46287000660,CDM,250,RC,,,Outpatient,,,152.08,76.04,,117.1,77,,,Percent of Total Billed Charges,77% of total billed charges,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.54,74,,,Percent of Total Billed Charges,74% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,84,,,Percent of Total Billed Charges,84% of total billed charges,124.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.35,89,,,Percent of total Billed Charges,89% of total Billed charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.1,77,,,Percent of total Billed charges,77% of total billed charges,129.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.02,135.35,
Sodium Polystyrene Sulfonate 15gm/60ml UD,46287000660,CDM,250,RC,,,Outpatient,,,152.08,76.04,,117.1,77,,,Percent of Total Billed Charges,77% of total billed charges,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,112.54,74,,,Percent of Total Billed Charges,74% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,104.94,69,,,Percent of Total Billed Charges,69% of total billed charges,127.75,84,,,Percent of Total Billed Charges,84% of total billed charges,124.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.35,89,,,Percent of total Billed Charges,89% of total Billed charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.1,77,,,Percent of total Billed charges,77% of total billed charges,129.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.02,135.35,
Phos-NaK Packet (250mg Phos/160mg NA/280mg K),60258000601,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Phos-NaK Packet (250mg Phos/160mg NA/280mg K),60258000601,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Phos-NaK Packet (250mg Phos/160mg NA/280mg K),60258000601,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Phos-NaK Packet (250mg Phos/160mg NA/280mg K),60258000601,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Phos-NaK Packet (250mg Phos/160mg NA/280mg K),60258000601,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Phos-NaK Packet (250mg Phos/160mg NA/280mg K),60258000601,CDM,250,RC,,,Outpatient,,,10.07,5.04,,7.75,77,,,Percent of Total Billed Charges,77% of total billed charges,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.45,74,,,Percent of Total Billed Charges,74% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,6.95,69,,,Percent of Total Billed Charges,69% of total billed charges,8.46,84,,,Percent of Total Billed Charges,84% of total billed charges,8.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.96,89,,,Percent of total Billed Charges,89% of total Billed charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.75,77,,,Percent of total Billed charges,77% of total billed charges,8.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.96,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.52,8.96,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,128.81,64.41,,99.18,77,,,Percent of Total Billed Charges,77% of total billed charges,32.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.32,74,,,Percent of Total Billed Charges,74% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,108.2,84,,,Percent of Total Billed Charges,84% of total billed charges,105.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.64,89,,,Percent of total Billed Charges,89% of total Billed charges,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.18,77,,,Percent of total Billed charges,77% of total billed charges,109.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,114.64,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,128.81,64.41,,99.18,77,,,Percent of Total Billed Charges,77% of total billed charges,32.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.32,74,,,Percent of Total Billed Charges,74% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,108.2,84,,,Percent of Total Billed Charges,84% of total billed charges,105.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.64,89,,,Percent of total Billed Charges,89% of total Billed charges,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.18,77,,,Percent of total Billed charges,77% of total billed charges,109.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,114.64,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,128.81,64.41,,99.18,77,,,Percent of Total Billed Charges,77% of total billed charges,32.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,95.32,74,,,Percent of Total Billed Charges,74% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,88.88,69,,,Percent of Total Billed Charges,69% of total billed charges,108.2,84,,,Percent of Total Billed Charges,84% of total billed charges,105.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.64,89,,,Percent of total Billed Charges,89% of total Billed charges,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.18,77,,,Percent of total Billed charges,77% of total billed charges,109.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.64,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.2,114.64,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) Prefilled Syringe,76329335201,CDM,250,RC,,,Outpatient,,,156.2,78.1,,120.27,77,,,Percent of Total Billed Charges,77% of total billed charges,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,39.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,48.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,115.59,74,,,Percent of Total Billed Charges,74% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,107.78,69,,,Percent of Total Billed Charges,69% of total billed charges,131.21,84,,,Percent of Total Billed Charges,84% of total billed charges,128.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,139.02,89,,,Percent of total Billed Charges,89% of total Billed charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.27,77,,,Percent of total Billed charges,77% of total billed charges,132.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,44.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,63.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,139.02,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.05,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.05,139.02,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Bicarb 8.4% 50meq/50ml (1meq/ml) SDV,,,250,RC,,,Outpatient,,,41.56,20.78,,32,77,,,Percent of Total Billed Charges,77% of total billed charges,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.75,74,,,Percent of Total Billed Charges,74% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,28.68,69,,,Percent of Total Billed Charges,69% of total billed charges,34.91,84,,,Percent of Total Billed Charges,84% of total billed charges,34.08,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.99,89,,,Percent of total Billed Charges,89% of total Billed charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32,77,,,Percent of total Billed charges,77% of total billed charges,35.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.39,36.99,
Sodium Chloride Nasal Spray 45ml,904386575,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sodium Chloride Nasal Spray 45ml,904386575,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sodium Chloride Nasal Spray 45ml,904386575,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sodium Chloride Nasal Spray 45ml,904386575,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sodium Chloride Nasal Spray 45ml,904386575,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Sodium Chloride Nasal Spray 45ml,904386575,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Dakins 0.125% Topical Solution 473ml,436067216,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.125% Topical Solution 473ml,436067216,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.125% Topical Solution 473ml,436067216,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.125% Topical Solution 473ml,436067216,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.125% Topical Solution 473ml,436067216,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.125% Topical Solution 473ml,436067216,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.25% Topical Solution 473ml,436093616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.25% Topical Solution 473ml,436093616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.25% Topical Solution 473ml,436093616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.25% Topical Solution 473ml,436093616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.25% Topical Solution 473ml,436093616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.25% Topical Solution 473ml,436093616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.5% Topical Solution 473ml,436094616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.5% Topical Solution 473ml,436094616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.5% Topical Solution 473ml,436094616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.5% Topical Solution 473ml,436094616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.5% Topical Solution 473ml,436094616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Dakins 0.5% Topical Solution 473ml,436094616,CDM,250,RC,,,Outpatient,,,93.41,46.71,,71.93,77,,,Percent of Total Billed Charges,77% of total billed charges,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.82,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.12,74,,,Percent of Total Billed Charges,74% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,64.45,69,,,Percent of Total Billed Charges,69% of total billed charges,78.46,84,,,Percent of Total Billed Charges,84% of total billed charges,76.6,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.13,89,,,Percent of total Billed Charges,89% of total Billed charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.93,77,,,Percent of total Billed charges,77% of total billed charges,79.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.71,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.35,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.35,83.13,
Sodium Chloride Irrigation Sol 500ml,338004803,CDM,250,RC,,,Outpatient,,,64.29,32.15,,49.5,77,,,Percent of Total Billed Charges,77% of total billed charges,16.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.57,74,,,Percent of Total Billed Charges,74% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,54,84,,,Percent of Total Billed Charges,84% of total billed charges,52.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.22,89,,,Percent of total Billed Charges,89% of total Billed charges,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.5,77,,,Percent of total Billed charges,77% of total billed charges,54.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.07,57.22,
Sodium Chloride Irrigation Sol 500ml,338004803,CDM,250,RC,,,Outpatient,,,64.29,32.15,,49.5,77,,,Percent of Total Billed Charges,77% of total billed charges,16.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.57,74,,,Percent of Total Billed Charges,74% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,54,84,,,Percent of Total Billed Charges,84% of total billed charges,52.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.22,89,,,Percent of total Billed Charges,89% of total Billed charges,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.5,77,,,Percent of total Billed charges,77% of total billed charges,54.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.07,57.22,
Sodium Chloride Irrigation Sol 500ml,338004803,CDM,250,RC,,,Outpatient,,,64.29,32.15,,49.5,77,,,Percent of Total Billed Charges,77% of total billed charges,16.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.09,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.57,74,,,Percent of Total Billed Charges,74% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,44.36,69,,,Percent of Total Billed Charges,69% of total billed charges,54,84,,,Percent of Total Billed Charges,84% of total billed charges,52.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,57.22,89,,,Percent of total Billed Charges,89% of total Billed charges,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.5,77,,,Percent of total Billed charges,77% of total billed charges,54.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.48,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,32.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,26.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,57.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.07,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.07,57.22,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Chloride Hypertonic 3% 500ml IV Bag,338005403,CDM,250,RC,,,Outpatient,,,157.66,78.83,,121.4,77,,,Percent of Total Billed Charges,77% of total billed charges,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,49.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,116.67,74,,,Percent of Total Billed Charges,74% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,108.79,69,,,Percent of Total Billed Charges,69% of total billed charges,132.43,84,,,Percent of Total Billed Charges,84% of total billed charges,129.28,82,,,Percent of Total Billed Charges,82% of total billed charges ,140.32,89,,,Percent of total Billed Charges,89% of total Billed charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,121.4,77,,,Percent of total Billed charges,77% of total billed charges,134.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,45.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,78.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,64.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,140.32,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.42,140.32,
Sodium Bicarbonate 650mg Tablet,223172101,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Sodium Bicarbonate 650mg Tablet,223172101,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Sodium Bicarbonate 650mg Tablet,223172101,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Sodium Bicarbonate 650mg Tablet,223172101,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Sodium Bicarbonate 650mg Tablet,223172101,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Sodium Bicarbonate 650mg Tablet,223172101,CDM,250,RC,,,Outpatient,,,5.56,2.78,,4.28,77,,,Percent of Total Billed Charges,77% of total billed charges,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.11,74,,,Percent of Total Billed Charges,74% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,3.84,69,,,Percent of Total Billed Charges,69% of total billed charges,4.67,84,,,Percent of Total Billed Charges,84% of total billed charges,4.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,4.95,89,,,Percent of total Billed Charges,89% of total Billed charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.28,77,,,Percent of total Billed charges,77% of total billed charges,4.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.27,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.39,4.95,
Fleet Pedia-Lax Enema 66ml,132020220,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Fleet Pedia-Lax Enema 66ml,132020220,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Fleet Pedia-Lax Enema 66ml,132020220,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Fleet Pedia-Lax Enema 66ml,132020220,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Fleet Pedia-Lax Enema 66ml,132020220,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Fleet Pedia-Lax Enema 66ml,132020220,CDM,250,RC,,,Outpatient,,,27.52,13.76,,21.19,77,,,Percent of Total Billed Charges,77% of total billed charges,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.36,74,,,Percent of Total Billed Charges,74% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,18.99,69,,,Percent of Total Billed Charges,69% of total billed charges,23.12,84,,,Percent of Total Billed Charges,84% of total billed charges,22.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.49,89,,,Percent of total Billed Charges,89% of total Billed charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.19,77,,,Percent of total Billed charges,77% of total billed charges,23.39,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.88,24.49,
Sorbitol 70% Solution 30ml UDC,46287050030,CDM,250,RC,,,Outpatient,,,41.51,20.76,,31.96,77,,,Percent of Total Billed Charges,77% of total billed charges,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.72,74,,,Percent of Total Billed Charges,74% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,84,,,Percent of Total Billed Charges,84% of total billed charges,34.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.94,89,,,Percent of total Billed Charges,89% of total Billed charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.96,77,,,Percent of total Billed charges,77% of total billed charges,35.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,36.94,
Sorbitol 70% Solution 30ml UDC,46287050030,CDM,250,RC,,,Outpatient,,,41.51,20.76,,31.96,77,,,Percent of Total Billed Charges,77% of total billed charges,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.72,74,,,Percent of Total Billed Charges,74% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,84,,,Percent of Total Billed Charges,84% of total billed charges,34.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.94,89,,,Percent of total Billed Charges,89% of total Billed charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.96,77,,,Percent of total Billed charges,77% of total billed charges,35.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,36.94,
Sorbitol 70% Solution 30ml UDC,46287050030,CDM,250,RC,,,Outpatient,,,41.51,20.76,,31.96,77,,,Percent of Total Billed Charges,77% of total billed charges,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.72,74,,,Percent of Total Billed Charges,74% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,84,,,Percent of Total Billed Charges,84% of total billed charges,34.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.94,89,,,Percent of total Billed Charges,89% of total Billed charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.96,77,,,Percent of total Billed charges,77% of total billed charges,35.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,36.94,
Sorbitol 70% Solution 30ml UDC,46287050030,CDM,250,RC,,,Outpatient,,,41.51,20.76,,31.96,77,,,Percent of Total Billed Charges,77% of total billed charges,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.72,74,,,Percent of Total Billed Charges,74% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,84,,,Percent of Total Billed Charges,84% of total billed charges,34.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.94,89,,,Percent of total Billed Charges,89% of total Billed charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.96,77,,,Percent of total Billed charges,77% of total billed charges,35.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,36.94,
Sorbitol 70% Solution 30ml UDC,46287050030,CDM,250,RC,,,Outpatient,,,41.51,20.76,,31.96,77,,,Percent of Total Billed Charges,77% of total billed charges,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.72,74,,,Percent of Total Billed Charges,74% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,84,,,Percent of Total Billed Charges,84% of total billed charges,34.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.94,89,,,Percent of total Billed Charges,89% of total Billed charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.96,77,,,Percent of total Billed charges,77% of total billed charges,35.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,36.94,
Sorbitol 70% Solution 30ml UDC,46287050030,CDM,250,RC,,,Outpatient,,,41.51,20.76,,31.96,77,,,Percent of Total Billed Charges,77% of total billed charges,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,30.72,74,,,Percent of Total Billed Charges,74% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,28.64,69,,,Percent of Total Billed Charges,69% of total billed charges,34.87,84,,,Percent of Total Billed Charges,84% of total billed charges,34.04,82,,,Percent of Total Billed Charges,82% of total billed charges ,36.94,89,,,Percent of total Billed Charges,89% of total Billed charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.96,77,,,Percent of total Billed charges,77% of total billed charges,35.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.93,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.38,36.94,
Sotalol 80mg Tablet,93106101,CDM,250,RC,,,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,24.07,
Sotalol 80mg Tablet,93106101,CDM,250,RC,,,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,24.07,
Sotalol 80mg Tablet,93106101,CDM,250,RC,,,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,24.07,
Sotalol 80mg Tablet,93106101,CDM,250,RC,,,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,24.07,
Sotalol 80mg Tablet,93106101,CDM,250,RC,,,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,24.07,
Sotalol 80mg Tablet,93106101,CDM,250,RC,,,Outpatient,,,27.05,13.53,,20.83,77,,,Percent of Total Billed Charges,77% of total billed charges,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20.02,74,,,Percent of Total Billed Charges,74% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,18.66,69,,,Percent of Total Billed Charges,69% of total billed charges,22.72,84,,,Percent of Total Billed Charges,84% of total billed charges,22.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,24.07,89,,,Percent of total Billed Charges,89% of total Billed charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.83,77,,,Percent of total Billed charges,77% of total billed charges,22.99,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.04,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24.07,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.76,24.07,
Spironolactone 25mg Tablet,51079010320,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Spironolactone 25mg Tablet,51079010320,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Spironolactone 25mg Tablet,51079010320,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Spironolactone 25mg Tablet,51079010320,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Spironolactone 25mg Tablet,51079010320,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Spironolactone 25mg Tablet,51079010320,CDM,250,RC,,,Outpatient,,,9.04,4.52,,6.96,77,,,Percent of Total Billed Charges,77% of total billed charges,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.69,74,,,Percent of Total Billed Charges,74% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,6.24,69,,,Percent of Total Billed Charges,69% of total billed charges,7.59,84,,,Percent of Total Billed Charges,84% of total billed charges,7.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.96,77,,,Percent of total Billed charges,77% of total billed charges,7.68,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.69,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.26,8.05,
Succinylcholine 200mg/10ml MDV,409662902,CDM,250,RC,,,Outpatient,,,303.84,151.92,,233.96,77,,,Percent of Total Billed Charges,77% of total billed charges,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.84,74,,,Percent of Total Billed Charges,74% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.23,84,,,Percent of Total Billed Charges,84% of total billed charges,249.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.42,89,,,Percent of total Billed Charges,89% of total Billed charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.96,77,,,Percent of total Billed charges,77% of total billed charges,258.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.96,270.42,
Succinylcholine 200mg/10ml MDV,409662902,CDM,250,RC,,,Outpatient,,,303.84,151.92,,233.96,77,,,Percent of Total Billed Charges,77% of total billed charges,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.84,74,,,Percent of Total Billed Charges,74% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.23,84,,,Percent of Total Billed Charges,84% of total billed charges,249.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.42,89,,,Percent of total Billed Charges,89% of total Billed charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.96,77,,,Percent of total Billed charges,77% of total billed charges,258.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.96,270.42,
Succinylcholine 200mg/10ml MDV,409662902,CDM,250,RC,,,Outpatient,,,303.84,151.92,,233.96,77,,,Percent of Total Billed Charges,77% of total billed charges,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.84,74,,,Percent of Total Billed Charges,74% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.23,84,,,Percent of Total Billed Charges,84% of total billed charges,249.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.42,89,,,Percent of total Billed Charges,89% of total Billed charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.96,77,,,Percent of total Billed charges,77% of total billed charges,258.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.96,270.42,
Succinylcholine 200mg/10ml MDV,409662902,CDM,250,RC,,,Outpatient,,,303.84,151.92,,233.96,77,,,Percent of Total Billed Charges,77% of total billed charges,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.84,74,,,Percent of Total Billed Charges,74% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.23,84,,,Percent of Total Billed Charges,84% of total billed charges,249.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.42,89,,,Percent of total Billed Charges,89% of total Billed charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.96,77,,,Percent of total Billed charges,77% of total billed charges,258.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.96,270.42,
Succinylcholine 200mg/10ml MDV,409662902,CDM,250,RC,,,Outpatient,,,303.84,151.92,,233.96,77,,,Percent of Total Billed Charges,77% of total billed charges,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.84,74,,,Percent of Total Billed Charges,74% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.23,84,,,Percent of Total Billed Charges,84% of total billed charges,249.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.42,89,,,Percent of total Billed Charges,89% of total Billed charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.96,77,,,Percent of total Billed charges,77% of total billed charges,258.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.96,270.42,
Succinylcholine 200mg/10ml MDV,409662902,CDM,250,RC,,,Outpatient,,,303.84,151.92,,233.96,77,,,Percent of Total Billed Charges,77% of total billed charges,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,77.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,94.95,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,224.84,74,,,Percent of Total Billed Charges,74% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,209.65,69,,,Percent of Total Billed Charges,69% of total billed charges,255.23,84,,,Percent of Total Billed Charges,84% of total billed charges,249.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,270.42,89,,,Percent of total Billed Charges,89% of total Billed charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,233.96,77,,,Percent of total Billed charges,77% of total billed charges,258.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,87.35,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,151.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,123.97,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,270.42,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,75.96,270.42,
Sucralfate Oral Liquid 1gm/10ml UDC,68094004362,CDM,250,RC,,,Outpatient,,,82.07,41.04,,63.19,77,,,Percent of Total Billed Charges,77% of total billed charges,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.73,74,,,Percent of Total Billed Charges,74% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,68.94,84,,,Percent of Total Billed Charges,84% of total billed charges,67.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.04,89,,,Percent of total Billed Charges,89% of total Billed charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.19,77,,,Percent of total Billed charges,77% of total billed charges,69.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.52,73.04,
Sucralfate Oral Liquid 1gm/10ml UDC,68094004362,CDM,250,RC,,,Outpatient,,,82.07,41.04,,63.19,77,,,Percent of Total Billed Charges,77% of total billed charges,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.73,74,,,Percent of Total Billed Charges,74% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,68.94,84,,,Percent of Total Billed Charges,84% of total billed charges,67.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.04,89,,,Percent of total Billed Charges,89% of total Billed charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.19,77,,,Percent of total Billed charges,77% of total billed charges,69.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.52,73.04,
Sucralfate Oral Liquid 1gm/10ml UDC,68094004362,CDM,250,RC,,,Outpatient,,,82.07,41.04,,63.19,77,,,Percent of Total Billed Charges,77% of total billed charges,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.73,74,,,Percent of Total Billed Charges,74% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,68.94,84,,,Percent of Total Billed Charges,84% of total billed charges,67.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.04,89,,,Percent of total Billed Charges,89% of total Billed charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.19,77,,,Percent of total Billed charges,77% of total billed charges,69.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.52,73.04,
Sucralfate Oral Liquid 1gm/10ml UDC,68094004362,CDM,250,RC,,,Outpatient,,,82.07,41.04,,63.19,77,,,Percent of Total Billed Charges,77% of total billed charges,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.73,74,,,Percent of Total Billed Charges,74% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,68.94,84,,,Percent of Total Billed Charges,84% of total billed charges,67.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.04,89,,,Percent of total Billed Charges,89% of total Billed charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.19,77,,,Percent of total Billed charges,77% of total billed charges,69.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.52,73.04,
Sucralfate Oral Liquid 1gm/10ml UDC,68094004362,CDM,250,RC,,,Outpatient,,,82.07,41.04,,63.19,77,,,Percent of Total Billed Charges,77% of total billed charges,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.73,74,,,Percent of Total Billed Charges,74% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,68.94,84,,,Percent of Total Billed Charges,84% of total billed charges,67.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.04,89,,,Percent of total Billed Charges,89% of total Billed charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.19,77,,,Percent of total Billed charges,77% of total billed charges,69.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.52,73.04,
Sucralfate Oral Liquid 1gm/10ml UDC,68094004362,CDM,250,RC,,,Outpatient,,,82.07,41.04,,63.19,77,,,Percent of Total Billed Charges,77% of total billed charges,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,60.73,74,,,Percent of Total Billed Charges,74% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,56.63,69,,,Percent of Total Billed Charges,69% of total billed charges,68.94,84,,,Percent of Total Billed Charges,84% of total billed charges,67.3,82,,,Percent of Total Billed Charges,82% of total billed charges ,73.04,89,,,Percent of total Billed Charges,89% of total Billed charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.19,77,,,Percent of total Billed charges,77% of total billed charges,69.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,41.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,33.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.52,73.04,
Sucralfate 1gm Tablet,51079075320,CDM,250,RC,,,Outpatient,,,8.57,4.29,,6.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.34,74,,,Percent of Total Billed Charges,74% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7.2,84,,,Percent of Total Billed Charges,84% of total billed charges,7.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.63,89,,,Percent of total Billed Charges,89% of total Billed charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.6,77,,,Percent of total Billed charges,77% of total billed charges,7.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.14,7.63,
Sucralfate 1gm Tablet,51079075320,CDM,250,RC,,,Outpatient,,,8.57,4.29,,6.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.34,74,,,Percent of Total Billed Charges,74% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7.2,84,,,Percent of Total Billed Charges,84% of total billed charges,7.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.63,89,,,Percent of total Billed Charges,89% of total Billed charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.6,77,,,Percent of total Billed charges,77% of total billed charges,7.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.14,7.63,
Sucralfate 1gm Tablet,51079075320,CDM,250,RC,,,Outpatient,,,8.57,4.29,,6.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.34,74,,,Percent of Total Billed Charges,74% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7.2,84,,,Percent of Total Billed Charges,84% of total billed charges,7.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.63,89,,,Percent of total Billed Charges,89% of total Billed charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.6,77,,,Percent of total Billed charges,77% of total billed charges,7.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.14,7.63,
Sucralfate 1gm Tablet,51079075320,CDM,250,RC,,,Outpatient,,,8.57,4.29,,6.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.34,74,,,Percent of Total Billed Charges,74% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7.2,84,,,Percent of Total Billed Charges,84% of total billed charges,7.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.63,89,,,Percent of total Billed Charges,89% of total Billed charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.6,77,,,Percent of total Billed charges,77% of total billed charges,7.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.14,7.63,
Sucralfate 1gm Tablet,51079075320,CDM,250,RC,,,Outpatient,,,8.57,4.29,,6.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.34,74,,,Percent of Total Billed Charges,74% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7.2,84,,,Percent of Total Billed Charges,84% of total billed charges,7.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.63,89,,,Percent of total Billed Charges,89% of total Billed charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.6,77,,,Percent of total Billed charges,77% of total billed charges,7.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.14,7.63,
Sucralfate 1gm Tablet,51079075320,CDM,250,RC,,,Outpatient,,,8.57,4.29,,6.6,77,,,Percent of Total Billed Charges,77% of total billed charges,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.34,74,,,Percent of Total Billed Charges,74% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,5.91,69,,,Percent of Total Billed Charges,69% of total billed charges,7.2,84,,,Percent of Total Billed Charges,84% of total billed charges,7.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.63,89,,,Percent of total Billed Charges,89% of total Billed charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.6,77,,,Percent of total Billed charges,77% of total billed charges,7.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.14,7.63,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
SUFentanil Vial 50mcg/ml SDV,409338221,CDM,250,RC,,,Outpatient,,,110.57,55.29,,85.14,77,,,Percent of Total Billed Charges,77% of total billed charges,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,81.82,74,,,Percent of Total Billed Charges,74% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,76.29,69,,,Percent of Total Billed Charges,69% of total billed charges,92.88,84,,,Percent of Total Billed Charges,84% of total billed charges,90.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,98.41,89,,,Percent of total Billed Charges,89% of total Billed charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.14,77,,,Percent of total Billed charges,77% of total billed charges,93.98,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,31.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.29,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.64,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.64,98.41,
Sugammadex 200mg/2ml SDV,6542312,CDM,250,RC,,,Outpatient,,,617.56,308.78,,475.52,77,,,Percent of Total Billed Charges,77% of total billed charges,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,456.99,74,,,Percent of Total Billed Charges,74% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,518.75,84,,,Percent of Total Billed Charges,84% of total billed charges,506.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,549.63,89,,,Percent of total Billed Charges,89% of total Billed charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.52,77,,,Percent of total Billed charges,77% of total billed charges,524.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,308.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.39,549.63,
Sugammadex 200mg/2ml SDV,6542312,CDM,250,RC,,,Outpatient,,,617.56,308.78,,475.52,77,,,Percent of Total Billed Charges,77% of total billed charges,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,456.99,74,,,Percent of Total Billed Charges,74% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,518.75,84,,,Percent of Total Billed Charges,84% of total billed charges,506.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,549.63,89,,,Percent of total Billed Charges,89% of total Billed charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.52,77,,,Percent of total Billed charges,77% of total billed charges,524.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,308.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.39,549.63,
Sugammadex 200mg/2ml SDV,6542312,CDM,250,RC,,,Outpatient,,,617.56,308.78,,475.52,77,,,Percent of Total Billed Charges,77% of total billed charges,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,456.99,74,,,Percent of Total Billed Charges,74% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,518.75,84,,,Percent of Total Billed Charges,84% of total billed charges,506.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,549.63,89,,,Percent of total Billed Charges,89% of total Billed charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.52,77,,,Percent of total Billed charges,77% of total billed charges,524.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,308.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.39,549.63,
Sugammadex 200mg/2ml SDV,6542312,CDM,250,RC,,,Outpatient,,,617.56,308.78,,475.52,77,,,Percent of Total Billed Charges,77% of total billed charges,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,456.99,74,,,Percent of Total Billed Charges,74% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,518.75,84,,,Percent of Total Billed Charges,84% of total billed charges,506.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,549.63,89,,,Percent of total Billed Charges,89% of total Billed charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.52,77,,,Percent of total Billed charges,77% of total billed charges,524.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,308.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.39,549.63,
Sugammadex 200mg/2ml SDV,6542312,CDM,250,RC,,,Outpatient,,,617.56,308.78,,475.52,77,,,Percent of Total Billed Charges,77% of total billed charges,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,456.99,74,,,Percent of Total Billed Charges,74% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,518.75,84,,,Percent of Total Billed Charges,84% of total billed charges,506.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,549.63,89,,,Percent of total Billed Charges,89% of total Billed charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.52,77,,,Percent of total Billed charges,77% of total billed charges,524.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,308.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.39,549.63,
Sugammadex 200mg/2ml SDV,6542312,CDM,250,RC,,,Outpatient,,,617.56,308.78,,475.52,77,,,Percent of Total Billed Charges,77% of total billed charges,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,157.48,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,192.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,456.99,74,,,Percent of Total Billed Charges,74% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,426.12,69,,,Percent of Total Billed Charges,69% of total billed charges,518.75,84,,,Percent of Total Billed Charges,84% of total billed charges,506.4,82,,,Percent of Total Billed Charges,82% of total billed charges ,549.63,89,,,Percent of total Billed Charges,89% of total Billed charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,475.52,77,,,Percent of total Billed charges,77% of total billed charges,524.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,177.55,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,308.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,251.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,549.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.39,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.39,549.63,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfamethoxazole/Trimethoprim 800-160mg/10ml SDV,70069036210,CDM,250,RC,,,Outpatient,,,165.09,82.55,,127.12,77,,,Percent of Total Billed Charges,77% of total billed charges,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.1,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,51.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,122.17,74,,,Percent of Total Billed Charges,74% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,113.91,69,,,Percent of Total Billed Charges,69% of total billed charges,138.68,84,,,Percent of Total Billed Charges,84% of total billed charges,135.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,146.93,89,,,Percent of total Billed Charges,89% of total Billed charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.12,77,,,Percent of total Billed charges,77% of total billed charges,140.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,47.46,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,82.55,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,67.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,146.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.27,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.27,146.93,
Sulfacetamide 10% OPHTH Soln 15ml,24208067004,CDM,250,RC,,,Outpatient,,,215.16,107.58,,165.67,77,,,Percent of Total Billed Charges,77% of total billed charges,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.22,74,,,Percent of Total Billed Charges,74% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,180.73,84,,,Percent of Total Billed Charges,84% of total billed charges,176.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,191.49,89,,,Percent of total Billed Charges,89% of total Billed charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.67,77,,,Percent of total Billed charges,77% of total billed charges,182.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.79,191.49,
Sulfacetamide 10% OPHTH Soln 15ml,24208067004,CDM,250,RC,,,Outpatient,,,215.16,107.58,,165.67,77,,,Percent of Total Billed Charges,77% of total billed charges,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.22,74,,,Percent of Total Billed Charges,74% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,180.73,84,,,Percent of Total Billed Charges,84% of total billed charges,176.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,191.49,89,,,Percent of total Billed Charges,89% of total Billed charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.67,77,,,Percent of total Billed charges,77% of total billed charges,182.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.79,191.49,
Sulfacetamide 10% OPHTH Soln 15ml,24208067004,CDM,250,RC,,,Outpatient,,,215.16,107.58,,165.67,77,,,Percent of Total Billed Charges,77% of total billed charges,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.22,74,,,Percent of Total Billed Charges,74% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,180.73,84,,,Percent of Total Billed Charges,84% of total billed charges,176.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,191.49,89,,,Percent of total Billed Charges,89% of total Billed charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.67,77,,,Percent of total Billed charges,77% of total billed charges,182.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.79,191.49,
Sulfacetamide 10% OPHTH Soln 15ml,24208067004,CDM,250,RC,,,Outpatient,,,215.16,107.58,,165.67,77,,,Percent of Total Billed Charges,77% of total billed charges,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.22,74,,,Percent of Total Billed Charges,74% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,180.73,84,,,Percent of Total Billed Charges,84% of total billed charges,176.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,191.49,89,,,Percent of total Billed Charges,89% of total Billed charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.67,77,,,Percent of total Billed charges,77% of total billed charges,182.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.79,191.49,
Sulfacetamide 10% OPHTH Soln 15ml,24208067004,CDM,250,RC,,,Outpatient,,,215.16,107.58,,165.67,77,,,Percent of Total Billed Charges,77% of total billed charges,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.22,74,,,Percent of Total Billed Charges,74% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,180.73,84,,,Percent of Total Billed Charges,84% of total billed charges,176.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,191.49,89,,,Percent of total Billed Charges,89% of total Billed charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.67,77,,,Percent of total Billed charges,77% of total billed charges,182.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.79,191.49,
Sulfacetamide 10% OPHTH Soln 15ml,24208067004,CDM,250,RC,,,Outpatient,,,215.16,107.58,,165.67,77,,,Percent of Total Billed Charges,77% of total billed charges,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,67.24,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,159.22,74,,,Percent of Total Billed Charges,74% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,148.46,69,,,Percent of Total Billed Charges,69% of total billed charges,180.73,84,,,Percent of Total Billed Charges,84% of total billed charges,176.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,191.49,89,,,Percent of total Billed Charges,89% of total Billed charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,165.67,77,,,Percent of total Billed charges,77% of total billed charges,182.89,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,61.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,107.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,87.79,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,191.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.79,191.49,
Sulfamethoxazole/Trimethoprim DS 800/160mg Tablet,904272561,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Sulfamethoxazole/Trimethoprim DS 800/160mg Tablet,904272561,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Sulfamethoxazole/Trimethoprim DS 800/160mg Tablet,904272561,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Sulfamethoxazole/Trimethoprim DS 800/160mg Tablet,904272561,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Sulfamethoxazole/Trimethoprim DS 800/160mg Tablet,904272561,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Sulfamethoxazole/Trimethoprim DS 800/160mg Tablet,904272561,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Sulfamethoxazole/Trimethoprim 200-40/5ml 20ml UDC,121085320,CDM,250,RC,,,Outpatient,,,48.49,24.25,,37.34,77,,,Percent of Total Billed Charges,77% of total billed charges,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.88,74,,,Percent of Total Billed Charges,74% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.73,84,,,Percent of Total Billed Charges,84% of total billed charges,39.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.16,89,,,Percent of total Billed Charges,89% of total Billed charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.34,77,,,Percent of total Billed charges,77% of total billed charges,41.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.12,43.16,
Sulfamethoxazole/Trimethoprim 200-40/5ml 20ml UDC,121085320,CDM,250,RC,,,Outpatient,,,48.49,24.25,,37.34,77,,,Percent of Total Billed Charges,77% of total billed charges,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.88,74,,,Percent of Total Billed Charges,74% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.73,84,,,Percent of Total Billed Charges,84% of total billed charges,39.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.16,89,,,Percent of total Billed Charges,89% of total Billed charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.34,77,,,Percent of total Billed charges,77% of total billed charges,41.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.12,43.16,
Sulfamethoxazole/Trimethoprim 200-40/5ml 20ml UDC,121085320,CDM,250,RC,,,Outpatient,,,48.49,24.25,,37.34,77,,,Percent of Total Billed Charges,77% of total billed charges,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.88,74,,,Percent of Total Billed Charges,74% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.73,84,,,Percent of Total Billed Charges,84% of total billed charges,39.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.16,89,,,Percent of total Billed Charges,89% of total Billed charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.34,77,,,Percent of total Billed charges,77% of total billed charges,41.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.12,43.16,
Sulfamethoxazole/Trimethoprim 200-40/5ml 20ml UDC,121085320,CDM,250,RC,,,Outpatient,,,48.49,24.25,,37.34,77,,,Percent of Total Billed Charges,77% of total billed charges,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.88,74,,,Percent of Total Billed Charges,74% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.73,84,,,Percent of Total Billed Charges,84% of total billed charges,39.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.16,89,,,Percent of total Billed Charges,89% of total Billed charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.34,77,,,Percent of total Billed charges,77% of total billed charges,41.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.12,43.16,
Sulfamethoxazole/Trimethoprim 200-40/5ml 20ml UDC,121085320,CDM,250,RC,,,Outpatient,,,48.49,24.25,,37.34,77,,,Percent of Total Billed Charges,77% of total billed charges,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.88,74,,,Percent of Total Billed Charges,74% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.73,84,,,Percent of Total Billed Charges,84% of total billed charges,39.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.16,89,,,Percent of total Billed Charges,89% of total Billed charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.34,77,,,Percent of total Billed charges,77% of total billed charges,41.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.12,43.16,
Sulfamethoxazole/Trimethoprim 200-40/5ml 20ml UDC,121085320,CDM,250,RC,,,Outpatient,,,48.49,24.25,,37.34,77,,,Percent of Total Billed Charges,77% of total billed charges,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.88,74,,,Percent of Total Billed Charges,74% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,33.46,69,,,Percent of Total Billed Charges,69% of total billed charges,40.73,84,,,Percent of Total Billed Charges,84% of total billed charges,39.76,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.16,89,,,Percent of total Billed Charges,89% of total Billed charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.34,77,,,Percent of total Billed charges,77% of total billed charges,41.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.78,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.12,43.16,
sulfaSALAzine 500mg Tablet,13010110,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
sulfaSALAzine 500mg Tablet,13010110,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
sulfaSALAzine 500mg Tablet,13010110,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
sulfaSALAzine 500mg Tablet,13010110,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
sulfaSALAzine 500mg Tablet,13010110,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
sulfaSALAzine 500mg Tablet,13010110,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
SUMAtriptan 25mg Tablet,173073500,CDM,250,RC,,,Outpatient,,,250.42,125.21,,192.82,77,,,Percent of Total Billed Charges,77% of total billed charges,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.31,74,,,Percent of Total Billed Charges,74% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,210.35,84,,,Percent of Total Billed Charges,84% of total billed charges,205.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.87,89,,,Percent of total Billed Charges,89% of total Billed charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.82,77,,,Percent of total Billed charges,77% of total billed charges,212.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,222.87,
SUMAtriptan 25mg Tablet,173073500,CDM,250,RC,,,Outpatient,,,250.42,125.21,,192.82,77,,,Percent of Total Billed Charges,77% of total billed charges,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.31,74,,,Percent of Total Billed Charges,74% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,210.35,84,,,Percent of Total Billed Charges,84% of total billed charges,205.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.87,89,,,Percent of total Billed Charges,89% of total Billed charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.82,77,,,Percent of total Billed charges,77% of total billed charges,212.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,222.87,
SUMAtriptan 25mg Tablet,173073500,CDM,250,RC,,,Outpatient,,,250.42,125.21,,192.82,77,,,Percent of Total Billed Charges,77% of total billed charges,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.31,74,,,Percent of Total Billed Charges,74% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,210.35,84,,,Percent of Total Billed Charges,84% of total billed charges,205.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.87,89,,,Percent of total Billed Charges,89% of total Billed charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.82,77,,,Percent of total Billed charges,77% of total billed charges,212.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,222.87,
SUMAtriptan 25mg Tablet,173073500,CDM,250,RC,,,Outpatient,,,250.42,125.21,,192.82,77,,,Percent of Total Billed Charges,77% of total billed charges,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.31,74,,,Percent of Total Billed Charges,74% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,210.35,84,,,Percent of Total Billed Charges,84% of total billed charges,205.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.87,89,,,Percent of total Billed Charges,89% of total Billed charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.82,77,,,Percent of total Billed charges,77% of total billed charges,212.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,222.87,
SUMAtriptan 25mg Tablet,173073500,CDM,250,RC,,,Outpatient,,,250.42,125.21,,192.82,77,,,Percent of Total Billed Charges,77% of total billed charges,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.31,74,,,Percent of Total Billed Charges,74% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,210.35,84,,,Percent of Total Billed Charges,84% of total billed charges,205.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.87,89,,,Percent of total Billed Charges,89% of total Billed charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.82,77,,,Percent of total Billed charges,77% of total billed charges,212.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,222.87,
SUMAtriptan 25mg Tablet,173073500,CDM,250,RC,,,Outpatient,,,250.42,125.21,,192.82,77,,,Percent of Total Billed Charges,77% of total billed charges,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,63.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,78.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,185.31,74,,,Percent of Total Billed Charges,74% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,172.79,69,,,Percent of Total Billed Charges,69% of total billed charges,210.35,84,,,Percent of Total Billed Charges,84% of total billed charges,205.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,222.87,89,,,Percent of total Billed Charges,89% of total Billed charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,192.82,77,,,Percent of total Billed charges,77% of total billed charges,212.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,72,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,125.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,102.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,222.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.61,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.61,222.87,
SUMAtriptin 6mg/0.5ml SDV,173044902,CDM,250,RC,,,Outpatient,,,939.97,469.99,,723.78,77,,,Percent of Total Billed Charges,77% of total billed charges,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.58,74,,,Percent of Total Billed Charges,74% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,789.57,84,,,Percent of Total Billed Charges,84% of total billed charges,770.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.57,89,,,Percent of total Billed Charges,89% of total Billed charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.78,77,,,Percent of total Billed charges,77% of total billed charges,798.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.99,836.57,
SUMAtriptin 6mg/0.5ml SDV,173044902,CDM,250,RC,,,Outpatient,,,939.97,469.99,,723.78,77,,,Percent of Total Billed Charges,77% of total billed charges,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.58,74,,,Percent of Total Billed Charges,74% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,789.57,84,,,Percent of Total Billed Charges,84% of total billed charges,770.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.57,89,,,Percent of total Billed Charges,89% of total Billed charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.78,77,,,Percent of total Billed charges,77% of total billed charges,798.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.99,836.57,
SUMAtriptin 6mg/0.5ml SDV,173044902,CDM,250,RC,,,Outpatient,,,939.97,469.99,,723.78,77,,,Percent of Total Billed Charges,77% of total billed charges,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.58,74,,,Percent of Total Billed Charges,74% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,789.57,84,,,Percent of Total Billed Charges,84% of total billed charges,770.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.57,89,,,Percent of total Billed Charges,89% of total Billed charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.78,77,,,Percent of total Billed charges,77% of total billed charges,798.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.99,836.57,
SUMAtriptin 6mg/0.5ml SDV,173044902,CDM,250,RC,,,Outpatient,,,939.97,469.99,,723.78,77,,,Percent of Total Billed Charges,77% of total billed charges,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.58,74,,,Percent of Total Billed Charges,74% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,789.57,84,,,Percent of Total Billed Charges,84% of total billed charges,770.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.57,89,,,Percent of total Billed Charges,89% of total Billed charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.78,77,,,Percent of total Billed charges,77% of total billed charges,798.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.99,836.57,
SUMAtriptin 6mg/0.5ml SDV,173044902,CDM,250,RC,,,Outpatient,,,939.97,469.99,,723.78,77,,,Percent of Total Billed Charges,77% of total billed charges,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.58,74,,,Percent of Total Billed Charges,74% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,789.57,84,,,Percent of Total Billed Charges,84% of total billed charges,770.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.57,89,,,Percent of total Billed Charges,89% of total Billed charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.78,77,,,Percent of total Billed charges,77% of total billed charges,798.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.99,836.57,
SUMAtriptin 6mg/0.5ml SDV,173044902,CDM,250,RC,,,Outpatient,,,939.97,469.99,,723.78,77,,,Percent of Total Billed Charges,77% of total billed charges,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.69,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.58,74,,,Percent of Total Billed Charges,74% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,648.58,69,,,Percent of Total Billed Charges,69% of total billed charges,789.57,84,,,Percent of Total Billed Charges,84% of total billed charges,770.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.57,89,,,Percent of total Billed Charges,89% of total Billed charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.78,77,,,Percent of total Billed charges,77% of total billed charges,798.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.51,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.99,836.57,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9703.22,4851.61,,7471.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3032.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7180.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8150.7,84,,,Percent of Total Billed Charges,84% of total billed charges,7956.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8635.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7471.48,77,,,Percent of total Billed charges,77% of total billed charges,8247.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2789.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4851.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2425.81,8635.87,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9456.91,4728.46,,7281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2955.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6998.11,74,,,Percent of Total Billed Charges,74% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7943.8,84,,,Percent of Total Billed Charges,84% of total billed charges,7754.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,8416.65,89,,,Percent of total Billed Charges,89% of total Billed charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7281.82,77,,,Percent of total Billed charges,77% of total billed charges,8038.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2718.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4728.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2364.23,8416.65,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9703.22,4851.61,,7471.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3032.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7180.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8150.7,84,,,Percent of Total Billed Charges,84% of total billed charges,7956.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8635.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7471.48,77,,,Percent of total Billed charges,77% of total billed charges,8247.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2789.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4851.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2425.81,8635.87,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9456.91,4728.46,,7281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2955.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6998.11,74,,,Percent of Total Billed Charges,74% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7943.8,84,,,Percent of Total Billed Charges,84% of total billed charges,7754.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,8416.65,89,,,Percent of total Billed Charges,89% of total Billed charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7281.82,77,,,Percent of total Billed charges,77% of total billed charges,8038.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2718.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4728.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2364.23,8416.65,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9703.22,4851.61,,7471.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3032.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7180.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8150.7,84,,,Percent of Total Billed Charges,84% of total billed charges,7956.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8635.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7471.48,77,,,Percent of total Billed charges,77% of total billed charges,8247.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2789.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4851.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2425.81,8635.87,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9456.91,4728.46,,7281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2955.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6998.11,74,,,Percent of Total Billed Charges,74% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7943.8,84,,,Percent of Total Billed Charges,84% of total billed charges,7754.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,8416.65,89,,,Percent of total Billed Charges,89% of total Billed charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7281.82,77,,,Percent of total Billed charges,77% of total billed charges,8038.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2718.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4728.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2364.23,8416.65,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9703.22,4851.61,,7471.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3032.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7180.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8150.7,84,,,Percent of Total Billed Charges,84% of total billed charges,7956.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8635.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7471.48,77,,,Percent of total Billed charges,77% of total billed charges,8247.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2789.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4851.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2425.81,8635.87,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9456.91,4728.46,,7281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2955.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6998.11,74,,,Percent of Total Billed Charges,74% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7943.8,84,,,Percent of Total Billed Charges,84% of total billed charges,7754.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,8416.65,89,,,Percent of total Billed Charges,89% of total Billed charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7281.82,77,,,Percent of total Billed charges,77% of total billed charges,8038.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2718.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4728.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2364.23,8416.65,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9703.22,4851.61,,7471.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3032.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7180.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8150.7,84,,,Percent of Total Billed Charges,84% of total billed charges,7956.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8635.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7471.48,77,,,Percent of total Billed charges,77% of total billed charges,8247.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2789.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4851.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2425.81,8635.87,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9456.91,4728.46,,7281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2955.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6998.11,74,,,Percent of Total Billed Charges,74% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7943.8,84,,,Percent of Total Billed Charges,84% of total billed charges,7754.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,8416.65,89,,,Percent of total Billed Charges,89% of total Billed charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7281.82,77,,,Percent of total Billed charges,77% of total billed charges,8038.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2718.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4728.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2364.23,8416.65,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9703.22,4851.61,,7471.48,77,,,Percent of Total Billed Charges,77% of total billed charges,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2474.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3032.26,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7180.38,74,,,Percent of Total Billed Charges,74% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,6695.22,69,,,Percent of Total Billed Charges,69% of total billed charges,8150.7,84,,,Percent of Total Billed Charges,84% of total billed charges,7956.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8635.87,89,,,Percent of total Billed Charges,89% of total Billed charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7471.48,77,,,Percent of total Billed charges,77% of total billed charges,8247.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2789.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4851.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3958.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8635.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2425.81,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2425.81,8635.87,
Tafasitamab-CXIX (Monjuvi) 200mg/5ml Powder SDV,73535020801,CDM,250,RC,,,Outpatient,,,9456.91,4728.46,,7281.82,77,,,Percent of Total Billed Charges,77% of total billed charges,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2411.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2955.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6998.11,74,,,Percent of Total Billed Charges,74% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,6525.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7943.8,84,,,Percent of Total Billed Charges,84% of total billed charges,7754.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,8416.65,89,,,Percent of total Billed Charges,89% of total Billed charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7281.82,77,,,Percent of total Billed charges,77% of total billed charges,8038.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2718.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4728.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3858.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8416.65,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2364.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2364.23,8416.65,
Tamoxifen 10mg Tablet,63739014310,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Tamoxifen 10mg Tablet,63739014310,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Tamoxifen 10mg Tablet,63739014310,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Tamoxifen 10mg Tablet,63739014310,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Tamoxifen 10mg Tablet,63739014310,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Tamoxifen 10mg Tablet,63739014310,CDM,250,RC,,,Outpatient,,,9.5,4.75,,7.32,77,,,Percent of Total Billed Charges,77% of total billed charges,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.42,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.03,74,,,Percent of Total Billed Charges,74% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,6.56,69,,,Percent of Total Billed Charges,69% of total billed charges,7.98,84,,,Percent of Total Billed Charges,84% of total billed charges,7.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,8.46,89,,,Percent of total Billed Charges,89% of total Billed charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.32,77,,,Percent of total Billed charges,77% of total billed charges,8.08,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.88,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.38,8.46,
Tamsulosin 0.4mg Capsule,,,250,RC,,,Outpatient,,,44.6,22.3,,34.34,77,,,Percent of Total Billed Charges,77% of total billed charges,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33,74,,,Percent of Total Billed Charges,74% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.46,84,,,Percent of Total Billed Charges,84% of total billed charges,36.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.69,89,,,Percent of total Billed Charges,89% of total Billed charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.34,77,,,Percent of total Billed charges,77% of total billed charges,37.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,39.69,
Tamsulosin 0.4mg Capsule,,,250,RC,,,Outpatient,,,44.6,22.3,,34.34,77,,,Percent of Total Billed Charges,77% of total billed charges,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33,74,,,Percent of Total Billed Charges,74% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.46,84,,,Percent of Total Billed Charges,84% of total billed charges,36.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.69,89,,,Percent of total Billed Charges,89% of total Billed charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.34,77,,,Percent of total Billed charges,77% of total billed charges,37.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,39.69,
Tamsulosin 0.4mg Capsule,,,250,RC,,,Outpatient,,,44.6,22.3,,34.34,77,,,Percent of Total Billed Charges,77% of total billed charges,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33,74,,,Percent of Total Billed Charges,74% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.46,84,,,Percent of Total Billed Charges,84% of total billed charges,36.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.69,89,,,Percent of total Billed Charges,89% of total Billed charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.34,77,,,Percent of total Billed charges,77% of total billed charges,37.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,39.69,
Tamsulosin 0.4mg Capsule,,,250,RC,,,Outpatient,,,44.6,22.3,,34.34,77,,,Percent of Total Billed Charges,77% of total billed charges,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33,74,,,Percent of Total Billed Charges,74% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.46,84,,,Percent of Total Billed Charges,84% of total billed charges,36.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.69,89,,,Percent of total Billed Charges,89% of total Billed charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.34,77,,,Percent of total Billed charges,77% of total billed charges,37.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,39.69,
Tamsulosin 0.4mg Capsule,,,250,RC,,,Outpatient,,,44.6,22.3,,34.34,77,,,Percent of Total Billed Charges,77% of total billed charges,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33,74,,,Percent of Total Billed Charges,74% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.46,84,,,Percent of Total Billed Charges,84% of total billed charges,36.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.69,89,,,Percent of total Billed Charges,89% of total Billed charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.34,77,,,Percent of total Billed charges,77% of total billed charges,37.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,39.69,
Tamsulosin 0.4mg Capsule,,,250,RC,,,Outpatient,,,44.6,22.3,,34.34,77,,,Percent of Total Billed Charges,77% of total billed charges,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.37,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.94,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,33,74,,,Percent of Total Billed Charges,74% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,30.77,69,,,Percent of Total Billed Charges,69% of total billed charges,37.46,84,,,Percent of Total Billed Charges,84% of total billed charges,36.57,82,,,Percent of Total Billed Charges,82% of total billed charges ,39.69,89,,,Percent of total Billed Charges,89% of total Billed charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,34.34,77,,,Percent of total Billed charges,77% of total billed charges,37.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,12.82,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,22.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.15,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.15,39.69,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,28649.95,14324.98,,22060.46,77,,,Percent of Total Billed Charges,77% of total billed charges,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8953.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21200.96,74,,,Percent of Total Billed Charges,74% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24065.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25498.46,89,,,Percent of total Billed Charges,89% of total Billed charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22060.46,77,,,Percent of total Billed charges,77% of total billed charges,24352.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8236.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14324.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7162.49,25498.46,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,27913.64,13956.82,,21493.5,77,,,Percent of Total Billed Charges,77% of total billed charges,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8723.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20656.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,23447.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24843.14,89,,,Percent of total Billed Charges,89% of total Billed charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21493.5,77,,,Percent of total Billed charges,77% of total billed charges,23726.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8025.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13956.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6978.41,24843.14,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,28649.95,14324.98,,22060.46,77,,,Percent of Total Billed Charges,77% of total billed charges,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8953.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21200.96,74,,,Percent of Total Billed Charges,74% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24065.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25498.46,89,,,Percent of total Billed Charges,89% of total Billed charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22060.46,77,,,Percent of total Billed charges,77% of total billed charges,24352.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8236.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14324.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7162.49,25498.46,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,27913.64,13956.82,,21493.5,77,,,Percent of Total Billed Charges,77% of total billed charges,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8723.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20656.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,23447.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24843.14,89,,,Percent of total Billed Charges,89% of total Billed charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21493.5,77,,,Percent of total Billed charges,77% of total billed charges,23726.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8025.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13956.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6978.41,24843.14,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,28649.95,14324.98,,22060.46,77,,,Percent of Total Billed Charges,77% of total billed charges,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8953.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21200.96,74,,,Percent of Total Billed Charges,74% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24065.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25498.46,89,,,Percent of total Billed Charges,89% of total Billed charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22060.46,77,,,Percent of total Billed charges,77% of total billed charges,24352.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8236.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14324.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7162.49,25498.46,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,27913.64,13956.82,,21493.5,77,,,Percent of Total Billed Charges,77% of total billed charges,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8723.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20656.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,23447.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24843.14,89,,,Percent of total Billed Charges,89% of total Billed charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21493.5,77,,,Percent of total Billed charges,77% of total billed charges,23726.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8025.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13956.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6978.41,24843.14,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,28649.95,14324.98,,22060.46,77,,,Percent of Total Billed Charges,77% of total billed charges,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8953.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21200.96,74,,,Percent of Total Billed Charges,74% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24065.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25498.46,89,,,Percent of total Billed Charges,89% of total Billed charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22060.46,77,,,Percent of total Billed charges,77% of total billed charges,24352.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8236.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14324.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7162.49,25498.46,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,27913.64,13956.82,,21493.5,77,,,Percent of Total Billed Charges,77% of total billed charges,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8723.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20656.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,23447.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24843.14,89,,,Percent of total Billed Charges,89% of total Billed charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21493.5,77,,,Percent of total Billed charges,77% of total billed charges,23726.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8025.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13956.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6978.41,24843.14,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,28649.95,14324.98,,22060.46,77,,,Percent of Total Billed Charges,77% of total billed charges,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8953.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21200.96,74,,,Percent of Total Billed Charges,74% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24065.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25498.46,89,,,Percent of total Billed Charges,89% of total Billed charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22060.46,77,,,Percent of total Billed charges,77% of total billed charges,24352.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8236.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14324.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7162.49,25498.46,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,27913.64,13956.82,,21493.5,77,,,Percent of Total Billed Charges,77% of total billed charges,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8723.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20656.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,23447.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24843.14,89,,,Percent of total Billed Charges,89% of total Billed charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21493.5,77,,,Percent of total Billed charges,77% of total billed charges,23726.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8025.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13956.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6978.41,24843.14,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,28649.95,14324.98,,22060.46,77,,,Percent of Total Billed Charges,77% of total billed charges,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7305.74,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8953.11,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21200.96,74,,,Percent of Total Billed Charges,74% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,19768.47,69,,,Percent of Total Billed Charges,69% of total billed charges,24065.96,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,25498.46,89,,,Percent of total Billed Charges,89% of total Billed charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22060.46,77,,,Percent of total Billed charges,77% of total billed charges,24352.46,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8236.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14324.98,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11689.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25498.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7162.49,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7162.49,25498.46,
Temsirolimus (Torisel) 25mg Liquid SDV for Dilution to 30mg/3ml,8117901,CDM,250,RC,,,Outpatient,,,27913.64,13956.82,,21493.5,77,,,Percent of Total Billed Charges,77% of total billed charges,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7117.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8723.01,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,20656.09,74,,,Percent of Total Billed Charges,74% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,19260.41,69,,,Percent of Total Billed Charges,69% of total billed charges,23447.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,24843.14,89,,,Percent of total Billed Charges,89% of total Billed charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21493.5,77,,,Percent of total Billed charges,77% of total billed charges,23726.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8025.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13956.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11388.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24843.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6978.41,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6978.41,24843.14,
Tenecteplase 50mg Kit,50242012047,CDM,250,RC,,,Outpatient,,,34907.26,17453.63,,26878.59,77,,,Percent of Total Billed Charges,77% of total billed charges,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10908.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25831.37,74,,,Percent of Total Billed Charges,74% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,29322.1,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31067.46,89,,,Percent of total Billed Charges,89% of total Billed charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26878.59,77,,,Percent of total Billed charges,77% of total billed charges,29671.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10035.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17453.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8726.82,31067.46,
Tenecteplase 50mg Kit,50242012047,CDM,250,RC,,,Outpatient,,,34907.26,17453.63,,26878.59,77,,,Percent of Total Billed Charges,77% of total billed charges,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10908.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25831.37,74,,,Percent of Total Billed Charges,74% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,29322.1,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31067.46,89,,,Percent of total Billed Charges,89% of total Billed charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26878.59,77,,,Percent of total Billed charges,77% of total billed charges,29671.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10035.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17453.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8726.82,31067.46,
Tenecteplase 50mg Kit,50242012047,CDM,250,RC,,,Outpatient,,,34907.26,17453.63,,26878.59,77,,,Percent of Total Billed Charges,77% of total billed charges,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10908.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25831.37,74,,,Percent of Total Billed Charges,74% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,29322.1,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31067.46,89,,,Percent of total Billed Charges,89% of total Billed charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26878.59,77,,,Percent of total Billed charges,77% of total billed charges,29671.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10035.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17453.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8726.82,31067.46,
Tenecteplase 50mg Kit,50242012047,CDM,250,RC,,,Outpatient,,,34907.26,17453.63,,26878.59,77,,,Percent of Total Billed Charges,77% of total billed charges,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10908.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25831.37,74,,,Percent of Total Billed Charges,74% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,29322.1,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31067.46,89,,,Percent of total Billed Charges,89% of total Billed charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26878.59,77,,,Percent of total Billed charges,77% of total billed charges,29671.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10035.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17453.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8726.82,31067.46,
Tenecteplase 50mg Kit,50242012047,CDM,250,RC,,,Outpatient,,,34907.26,17453.63,,26878.59,77,,,Percent of Total Billed Charges,77% of total billed charges,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10908.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25831.37,74,,,Percent of Total Billed Charges,74% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,29322.1,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31067.46,89,,,Percent of total Billed Charges,89% of total Billed charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26878.59,77,,,Percent of total Billed charges,77% of total billed charges,29671.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10035.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17453.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8726.82,31067.46,
Tenecteplase 50mg Kit,50242012047,CDM,250,RC,,,Outpatient,,,34907.26,17453.63,,26878.59,77,,,Percent of Total Billed Charges,77% of total billed charges,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8901.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10908.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,25831.37,74,,,Percent of Total Billed Charges,74% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,24086.01,69,,,Percent of Total Billed Charges,69% of total billed charges,29322.1,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,31067.46,89,,,Percent of total Billed Charges,89% of total Billed charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26878.59,77,,,Percent of total Billed charges,77% of total billed charges,29671.17,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,10035.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,17453.63,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,14242.16,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31067.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8726.82,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8726.82,31067.46,
Terazosin 5mg Capsule,50268076615,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Terazosin 5mg Capsule,50268076615,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Terazosin 5mg Capsule,50268076615,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Terazosin 5mg Capsule,50268076615,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Terazosin 5mg Capsule,50268076615,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Terazosin 5mg Capsule,50268076615,CDM,250,RC,,,Outpatient,,,20.11,10.06,,15.48,77,,,Percent of Total Billed Charges,77% of total billed charges,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.13,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.28,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14.88,74,,,Percent of Total Billed Charges,74% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,13.88,69,,,Percent of Total Billed Charges,69% of total billed charges,16.89,84,,,Percent of Total Billed Charges,84% of total billed charges,16.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,17.9,89,,,Percent of total Billed Charges,89% of total Billed charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.48,77,,,Percent of total Billed charges,77% of total billed charges,17.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.03,17.9,
Terbutaline 1mg/ml SDV,63323066501,CDM,250,RC,,,Outpatient,,,167.74,83.87,,129.16,77,,,Percent of Total Billed Charges,77% of total billed charges,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.13,74,,,Percent of Total Billed Charges,74% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,140.9,84,,,Percent of Total Billed Charges,84% of total billed charges,137.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.29,89,,,Percent of total Billed Charges,89% of total Billed charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.16,77,,,Percent of total Billed charges,77% of total billed charges,142.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.94,149.29,
Terbutaline 1mg/ml SDV,63323066501,CDM,250,RC,,,Outpatient,,,167.74,83.87,,129.16,77,,,Percent of Total Billed Charges,77% of total billed charges,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.13,74,,,Percent of Total Billed Charges,74% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,140.9,84,,,Percent of Total Billed Charges,84% of total billed charges,137.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.29,89,,,Percent of total Billed Charges,89% of total Billed charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.16,77,,,Percent of total Billed charges,77% of total billed charges,142.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.94,149.29,
Terbutaline 1mg/ml SDV,63323066501,CDM,250,RC,,,Outpatient,,,167.74,83.87,,129.16,77,,,Percent of Total Billed Charges,77% of total billed charges,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.13,74,,,Percent of Total Billed Charges,74% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,140.9,84,,,Percent of Total Billed Charges,84% of total billed charges,137.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.29,89,,,Percent of total Billed Charges,89% of total Billed charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.16,77,,,Percent of total Billed charges,77% of total billed charges,142.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.94,149.29,
Terbutaline 1mg/ml SDV,63323066501,CDM,250,RC,,,Outpatient,,,167.74,83.87,,129.16,77,,,Percent of Total Billed Charges,77% of total billed charges,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.13,74,,,Percent of Total Billed Charges,74% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,140.9,84,,,Percent of Total Billed Charges,84% of total billed charges,137.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.29,89,,,Percent of total Billed Charges,89% of total Billed charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.16,77,,,Percent of total Billed charges,77% of total billed charges,142.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.94,149.29,
Terbutaline 1mg/ml SDV,63323066501,CDM,250,RC,,,Outpatient,,,167.74,83.87,,129.16,77,,,Percent of Total Billed Charges,77% of total billed charges,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.13,74,,,Percent of Total Billed Charges,74% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,140.9,84,,,Percent of Total Billed Charges,84% of total billed charges,137.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.29,89,,,Percent of total Billed Charges,89% of total Billed charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.16,77,,,Percent of total Billed charges,77% of total billed charges,142.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.94,149.29,
Terbutaline 1mg/ml SDV,63323066501,CDM,250,RC,,,Outpatient,,,167.74,83.87,,129.16,77,,,Percent of Total Billed Charges,77% of total billed charges,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,42.77,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,52.42,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,124.13,74,,,Percent of Total Billed Charges,74% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,115.74,69,,,Percent of Total Billed Charges,69% of total billed charges,140.9,84,,,Percent of Total Billed Charges,84% of total billed charges,137.55,82,,,Percent of Total Billed Charges,82% of total billed charges ,149.29,89,,,Percent of total Billed Charges,89% of total Billed charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.16,77,,,Percent of total Billed charges,77% of total billed charges,142.58,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,48.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,83.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,68.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,149.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.94,149.29,
Terbinafine (LamISIL) 1% Cream 30gm,67810030,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Terbinafine (LamISIL) 1% Cream 30gm,67810030,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Terbinafine (LamISIL) 1% Cream 30gm,67810030,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Terbinafine (LamISIL) 1% Cream 30gm,67810030,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Terbinafine (LamISIL) 1% Cream 30gm,67810030,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Terbinafine (LamISIL) 1% Cream 30gm,67810030,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Terbutaline 5mg Tablet,527131101,CDM,250,RC,,,Outpatient,,,63.55,31.78,,48.93,77,,,Percent of Total Billed Charges,77% of total billed charges,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.03,74,,,Percent of Total Billed Charges,74% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,53.38,84,,,Percent of Total Billed Charges,84% of total billed charges,52.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.56,89,,,Percent of total Billed Charges,89% of total Billed charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.93,77,,,Percent of total Billed charges,77% of total billed charges,54.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,56.56,
Terbutaline 5mg Tablet,527131101,CDM,250,RC,,,Outpatient,,,63.55,31.78,,48.93,77,,,Percent of Total Billed Charges,77% of total billed charges,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.03,74,,,Percent of Total Billed Charges,74% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,53.38,84,,,Percent of Total Billed Charges,84% of total billed charges,52.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.56,89,,,Percent of total Billed Charges,89% of total Billed charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.93,77,,,Percent of total Billed charges,77% of total billed charges,54.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,56.56,
Terbutaline 5mg Tablet,527131101,CDM,250,RC,,,Outpatient,,,63.55,31.78,,48.93,77,,,Percent of Total Billed Charges,77% of total billed charges,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.03,74,,,Percent of Total Billed Charges,74% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,53.38,84,,,Percent of Total Billed Charges,84% of total billed charges,52.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.56,89,,,Percent of total Billed Charges,89% of total Billed charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.93,77,,,Percent of total Billed charges,77% of total billed charges,54.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,56.56,
Terbutaline 5mg Tablet,527131101,CDM,250,RC,,,Outpatient,,,63.55,31.78,,48.93,77,,,Percent of Total Billed Charges,77% of total billed charges,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.03,74,,,Percent of Total Billed Charges,74% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,53.38,84,,,Percent of Total Billed Charges,84% of total billed charges,52.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.56,89,,,Percent of total Billed Charges,89% of total Billed charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.93,77,,,Percent of total Billed charges,77% of total billed charges,54.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,56.56,
Terbutaline 5mg Tablet,527131101,CDM,250,RC,,,Outpatient,,,63.55,31.78,,48.93,77,,,Percent of Total Billed Charges,77% of total billed charges,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.03,74,,,Percent of Total Billed Charges,74% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,53.38,84,,,Percent of Total Billed Charges,84% of total billed charges,52.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.56,89,,,Percent of total Billed Charges,89% of total Billed charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.93,77,,,Percent of total Billed charges,77% of total billed charges,54.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,56.56,
Terbutaline 5mg Tablet,527131101,CDM,250,RC,,,Outpatient,,,63.55,31.78,,48.93,77,,,Percent of Total Billed Charges,77% of total billed charges,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.86,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,47.03,74,,,Percent of Total Billed Charges,74% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,43.85,69,,,Percent of Total Billed Charges,69% of total billed charges,53.38,84,,,Percent of Total Billed Charges,84% of total billed charges,52.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,56.56,89,,,Percent of total Billed Charges,89% of total Billed charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.93,77,,,Percent of total Billed charges,77% of total billed charges,54.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.78,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.89,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.89,56.56,
Tetanus/Diptheria IM 0.5ml Syringe,49281021515,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Syringe,49281021515,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Syringe,49281021515,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Syringe,49281021515,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Syringe,49281021515,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Syringe,49281021515,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Vial (OE-N),49281021510,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Vial (OE-N),49281021510,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Vial (OE-N),49281021510,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Vial (OE-N),49281021510,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Vial (OE-N),49281021510,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus/Diptheria IM 0.5ml Vial (OE-N),49281021510,CDM,250,RC,,,Outpatient,,,270.84,135.42,,208.55,77,,,Percent of Total Billed Charges,77% of total billed charges,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,69.06,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,84.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,200.42,74,,,Percent of Total Billed Charges,74% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,186.88,69,,,Percent of Total Billed Charges,69% of total billed charges,227.51,84,,,Percent of Total Billed Charges,84% of total billed charges,222.09,82,,,Percent of Total Billed Charges,82% of total billed charges ,241.05,89,,,Percent of total Billed Charges,89% of total Billed charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,208.55,77,,,Percent of total Billed charges,77% of total billed charges,230.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,77.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,135.42,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,110.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,241.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,67.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.71,241.05,
Tetanus Immune Globulin 250units/ml Syringe,13533063402,CDM,250,RC,,,Outpatient,,,2931.66,1465.83,,2257.38,77,,,Percent of Total Billed Charges,77% of total billed charges,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2169.43,74,,,Percent of Total Billed Charges,74% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2462.59,84,,,Percent of Total Billed Charges,84% of total billed charges,2403.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,2609.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2257.38,77,,,Percent of total Billed charges,77% of total billed charges,2491.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,842.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1465.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.92,2609.18,
Tetanus Immune Globulin 250units/ml Syringe,13533063402,CDM,250,RC,,,Outpatient,,,2931.66,1465.83,,2257.38,77,,,Percent of Total Billed Charges,77% of total billed charges,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2169.43,74,,,Percent of Total Billed Charges,74% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2462.59,84,,,Percent of Total Billed Charges,84% of total billed charges,2403.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,2609.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2257.38,77,,,Percent of total Billed charges,77% of total billed charges,2491.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,842.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1465.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.92,2609.18,
Tetanus Immune Globulin 250units/ml Syringe,13533063402,CDM,250,RC,,,Outpatient,,,2931.66,1465.83,,2257.38,77,,,Percent of Total Billed Charges,77% of total billed charges,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2169.43,74,,,Percent of Total Billed Charges,74% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2462.59,84,,,Percent of Total Billed Charges,84% of total billed charges,2403.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,2609.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2257.38,77,,,Percent of total Billed charges,77% of total billed charges,2491.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,842.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1465.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.92,2609.18,
Tetanus Immune Globulin 250units/ml Syringe,13533063402,CDM,250,RC,,,Outpatient,,,2931.66,1465.83,,2257.38,77,,,Percent of Total Billed Charges,77% of total billed charges,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2169.43,74,,,Percent of Total Billed Charges,74% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2462.59,84,,,Percent of Total Billed Charges,84% of total billed charges,2403.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,2609.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2257.38,77,,,Percent of total Billed charges,77% of total billed charges,2491.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,842.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1465.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.92,2609.18,
Tetanus Immune Globulin 250units/ml Syringe,13533063402,CDM,250,RC,,,Outpatient,,,2931.66,1465.83,,2257.38,77,,,Percent of Total Billed Charges,77% of total billed charges,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2169.43,74,,,Percent of Total Billed Charges,74% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2462.59,84,,,Percent of Total Billed Charges,84% of total billed charges,2403.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,2609.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2257.38,77,,,Percent of total Billed charges,77% of total billed charges,2491.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,842.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1465.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.92,2609.18,
Tetanus Immune Globulin 250units/ml Syringe,13533063402,CDM,250,RC,,,Outpatient,,,2931.66,1465.83,,2257.38,77,,,Percent of Total Billed Charges,77% of total billed charges,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,747.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,916.14,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2169.43,74,,,Percent of Total Billed Charges,74% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2022.85,69,,,Percent of Total Billed Charges,69% of total billed charges,2462.59,84,,,Percent of Total Billed Charges,84% of total billed charges,2403.96,82,,,Percent of Total Billed Charges,82% of total billed charges ,2609.18,89,,,Percent of total Billed Charges,89% of total Billed charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2257.38,77,,,Percent of total Billed charges,77% of total billed charges,2491.91,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,842.85,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1465.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1196.12,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2609.18,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,732.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,732.92,2609.18,
Tetracycline 250mg Capsule,,,250,RC,,,Outpatient,,,60.67,30.34,,46.72,77,,,Percent of Total Billed Charges,77% of total billed charges,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.9,74,,,Percent of Total Billed Charges,74% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,50.96,84,,,Percent of Total Billed Charges,84% of total billed charges,49.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,54,89,,,Percent of total Billed Charges,89% of total Billed charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.72,77,,,Percent of total Billed charges,77% of total billed charges,51.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.17,54,
Tetracycline 250mg Capsule,,,250,RC,,,Outpatient,,,60.67,30.34,,46.72,77,,,Percent of Total Billed Charges,77% of total billed charges,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.9,74,,,Percent of Total Billed Charges,74% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,50.96,84,,,Percent of Total Billed Charges,84% of total billed charges,49.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,54,89,,,Percent of total Billed Charges,89% of total Billed charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.72,77,,,Percent of total Billed charges,77% of total billed charges,51.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.17,54,
Tetracycline 250mg Capsule,,,250,RC,,,Outpatient,,,60.67,30.34,,46.72,77,,,Percent of Total Billed Charges,77% of total billed charges,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.9,74,,,Percent of Total Billed Charges,74% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,50.96,84,,,Percent of Total Billed Charges,84% of total billed charges,49.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,54,89,,,Percent of total Billed Charges,89% of total Billed charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.72,77,,,Percent of total Billed charges,77% of total billed charges,51.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.17,54,
Tetracycline 250mg Capsule,,,250,RC,,,Outpatient,,,60.67,30.34,,46.72,77,,,Percent of Total Billed Charges,77% of total billed charges,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.9,74,,,Percent of Total Billed Charges,74% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,50.96,84,,,Percent of Total Billed Charges,84% of total billed charges,49.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,54,89,,,Percent of total Billed Charges,89% of total Billed charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.72,77,,,Percent of total Billed charges,77% of total billed charges,51.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.17,54,
Tetracycline 250mg Capsule,,,250,RC,,,Outpatient,,,60.67,30.34,,46.72,77,,,Percent of Total Billed Charges,77% of total billed charges,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.9,74,,,Percent of Total Billed Charges,74% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,50.96,84,,,Percent of Total Billed Charges,84% of total billed charges,49.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,54,89,,,Percent of total Billed Charges,89% of total Billed charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.72,77,,,Percent of total Billed charges,77% of total billed charges,51.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.17,54,
Tetracycline 250mg Capsule,,,250,RC,,,Outpatient,,,60.67,30.34,,46.72,77,,,Percent of Total Billed Charges,77% of total billed charges,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.47,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,44.9,74,,,Percent of Total Billed Charges,74% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,41.86,69,,,Percent of Total Billed Charges,69% of total billed charges,50.96,84,,,Percent of Total Billed Charges,84% of total billed charges,49.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,54,89,,,Percent of total Billed Charges,89% of total Billed charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.72,77,,,Percent of total Billed charges,77% of total billed charges,51.57,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,17.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,30.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,24.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.17,54,
Tetracaine 0.5% OPHTH Soln 4ml,65074114,CDM,250,RC,,,Outpatient,,,113.73,56.87,,87.57,77,,,Percent of Total Billed Charges,77% of total billed charges,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.16,74,,,Percent of Total Billed Charges,74% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,95.53,84,,,Percent of Total Billed Charges,84% of total billed charges,93.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.22,89,,,Percent of total Billed Charges,89% of total Billed charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.57,77,,,Percent of total Billed charges,77% of total billed charges,96.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.43,101.22,
Tetracaine 0.5% OPHTH Soln 4ml,65074114,CDM,250,RC,,,Outpatient,,,113.73,56.87,,87.57,77,,,Percent of Total Billed Charges,77% of total billed charges,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.16,74,,,Percent of Total Billed Charges,74% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,95.53,84,,,Percent of Total Billed Charges,84% of total billed charges,93.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.22,89,,,Percent of total Billed Charges,89% of total Billed charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.57,77,,,Percent of total Billed charges,77% of total billed charges,96.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.43,101.22,
Tetracaine 0.5% OPHTH Soln 4ml,65074114,CDM,250,RC,,,Outpatient,,,113.73,56.87,,87.57,77,,,Percent of Total Billed Charges,77% of total billed charges,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.16,74,,,Percent of Total Billed Charges,74% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,95.53,84,,,Percent of Total Billed Charges,84% of total billed charges,93.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.22,89,,,Percent of total Billed Charges,89% of total Billed charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.57,77,,,Percent of total Billed charges,77% of total billed charges,96.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.43,101.22,
Tetracaine 0.5% OPHTH Soln 4ml,65074114,CDM,250,RC,,,Outpatient,,,113.73,56.87,,87.57,77,,,Percent of Total Billed Charges,77% of total billed charges,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.16,74,,,Percent of Total Billed Charges,74% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,95.53,84,,,Percent of Total Billed Charges,84% of total billed charges,93.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.22,89,,,Percent of total Billed Charges,89% of total Billed charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.57,77,,,Percent of total Billed charges,77% of total billed charges,96.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.43,101.22,
Tetracaine 0.5% OPHTH Soln 4ml,65074114,CDM,250,RC,,,Outpatient,,,113.73,56.87,,87.57,77,,,Percent of Total Billed Charges,77% of total billed charges,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.16,74,,,Percent of Total Billed Charges,74% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,95.53,84,,,Percent of Total Billed Charges,84% of total billed charges,93.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.22,89,,,Percent of total Billed Charges,89% of total Billed charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.57,77,,,Percent of total Billed charges,77% of total billed charges,96.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.43,101.22,
Tetracaine 0.5% OPHTH Soln 4ml,65074114,CDM,250,RC,,,Outpatient,,,113.73,56.87,,87.57,77,,,Percent of Total Billed Charges,77% of total billed charges,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,35.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,84.16,74,,,Percent of Total Billed Charges,74% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,78.47,69,,,Percent of Total Billed Charges,69% of total billed charges,95.53,84,,,Percent of Total Billed Charges,84% of total billed charges,93.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,101.22,89,,,Percent of total Billed Charges,89% of total Billed charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,87.57,77,,,Percent of total Billed charges,77% of total billed charges,96.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.7,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,56.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,46.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,28.43,101.22,
Cetacaine Topical Spray 5gm,10223020104,CDM,250,RC,,,Outpatient,,,317.72,158.86,,244.64,77,,,Percent of Total Billed Charges,77% of total billed charges,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.11,74,,,Percent of Total Billed Charges,74% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,266.88,84,,,Percent of Total Billed Charges,84% of total billed charges,260.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.77,89,,,Percent of total Billed Charges,89% of total Billed charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.64,77,,,Percent of total Billed charges,77% of total billed charges,270.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.43,282.77,
Cetacaine Topical Spray 5gm,10223020104,CDM,250,RC,,,Outpatient,,,317.72,158.86,,244.64,77,,,Percent of Total Billed Charges,77% of total billed charges,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.11,74,,,Percent of Total Billed Charges,74% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,266.88,84,,,Percent of Total Billed Charges,84% of total billed charges,260.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.77,89,,,Percent of total Billed Charges,89% of total Billed charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.64,77,,,Percent of total Billed charges,77% of total billed charges,270.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.43,282.77,
Cetacaine Topical Spray 5gm,10223020104,CDM,250,RC,,,Outpatient,,,317.72,158.86,,244.64,77,,,Percent of Total Billed Charges,77% of total billed charges,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.11,74,,,Percent of Total Billed Charges,74% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,266.88,84,,,Percent of Total Billed Charges,84% of total billed charges,260.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.77,89,,,Percent of total Billed Charges,89% of total Billed charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.64,77,,,Percent of total Billed charges,77% of total billed charges,270.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.43,282.77,
Cetacaine Topical Spray 5gm,10223020104,CDM,250,RC,,,Outpatient,,,317.72,158.86,,244.64,77,,,Percent of Total Billed Charges,77% of total billed charges,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.11,74,,,Percent of Total Billed Charges,74% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,266.88,84,,,Percent of Total Billed Charges,84% of total billed charges,260.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.77,89,,,Percent of total Billed Charges,89% of total Billed charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.64,77,,,Percent of total Billed charges,77% of total billed charges,270.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.43,282.77,
Cetacaine Topical Spray 5gm,10223020104,CDM,250,RC,,,Outpatient,,,317.72,158.86,,244.64,77,,,Percent of Total Billed Charges,77% of total billed charges,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.11,74,,,Percent of Total Billed Charges,74% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,266.88,84,,,Percent of Total Billed Charges,84% of total billed charges,260.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.77,89,,,Percent of total Billed Charges,89% of total Billed charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.64,77,,,Percent of total Billed charges,77% of total billed charges,270.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.43,282.77,
Cetacaine Topical Spray 5gm,10223020104,CDM,250,RC,,,Outpatient,,,317.72,158.86,,244.64,77,,,Percent of Total Billed Charges,77% of total billed charges,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,81.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,99.29,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,235.11,74,,,Percent of Total Billed Charges,74% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,219.23,69,,,Percent of Total Billed Charges,69% of total billed charges,266.88,84,,,Percent of Total Billed Charges,84% of total billed charges,260.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,282.77,89,,,Percent of total Billed Charges,89% of total Billed charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,244.64,77,,,Percent of total Billed charges,77% of total billed charges,270.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,91.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,158.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,129.63,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,282.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.43,282.77,
Tezepelumab-EKKO (Tezspire) 210mg Syringe,55513011201,CDM,250,RC,,,Outpatient,,,19791.02,9895.51,,15239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14645.35,74,,,Percent of Total Billed Charges,74% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16624.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17614.01,89,,,Percent of total Billed Charges,89% of total Billed charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15239.09,77,,,Percent of total Billed charges,77% of total billed charges,16822.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5689.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9895.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4947.76,17614.01,
Tezepelumab-EKKO (Tezspire) 210mg Syringe,55513011201,CDM,250,RC,,,Outpatient,,,19791.02,9895.51,,15239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14645.35,74,,,Percent of Total Billed Charges,74% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16624.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17614.01,89,,,Percent of total Billed Charges,89% of total Billed charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15239.09,77,,,Percent of total Billed charges,77% of total billed charges,16822.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5689.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9895.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4947.76,17614.01,
Tezepelumab-EKKO (Tezspire) 210mg Syringe,55513011201,CDM,250,RC,,,Outpatient,,,19791.02,9895.51,,15239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14645.35,74,,,Percent of Total Billed Charges,74% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16624.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17614.01,89,,,Percent of total Billed Charges,89% of total Billed charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15239.09,77,,,Percent of total Billed charges,77% of total billed charges,16822.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5689.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9895.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4947.76,17614.01,
Tezepelumab-EKKO (Tezspire) 210mg Syringe,55513011201,CDM,250,RC,,,Outpatient,,,19791.02,9895.51,,15239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14645.35,74,,,Percent of Total Billed Charges,74% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16624.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17614.01,89,,,Percent of total Billed Charges,89% of total Billed charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15239.09,77,,,Percent of total Billed charges,77% of total billed charges,16822.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5689.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9895.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4947.76,17614.01,
Tezepelumab-EKKO (Tezspire) 210mg Syringe,55513011201,CDM,250,RC,,,Outpatient,,,19791.02,9895.51,,15239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14645.35,74,,,Percent of Total Billed Charges,74% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16624.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17614.01,89,,,Percent of total Billed Charges,89% of total Billed charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15239.09,77,,,Percent of total Billed charges,77% of total billed charges,16822.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5689.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9895.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4947.76,17614.01,
Tezepelumab-EKKO (Tezspire) 210mg Syringe,55513011201,CDM,250,RC,,,Outpatient,,,19791.02,9895.51,,15239.09,77,,,Percent of Total Billed Charges,77% of total billed charges,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5046.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6184.69,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,14645.35,74,,,Percent of Total Billed Charges,74% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,13655.8,69,,,Percent of Total Billed Charges,69% of total billed charges,16624.46,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,17614.01,89,,,Percent of total Billed Charges,89% of total Billed charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15239.09,77,,,Percent of total Billed charges,77% of total billed charges,16822.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5689.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9895.51,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8074.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17614.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4947.76,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4947.76,17614.01,
Theophylline 400mg 24hr Tablet (Scored),42858070101,CDM,250,RC,,,Outpatient,,,14.76,7.38,,11.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.92,74,,,Percent of Total Billed Charges,74% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,12.4,84,,,Percent of Total Billed Charges,84% of total billed charges,12.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.37,77,,,Percent of total Billed charges,77% of total billed charges,12.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.69,13.14,
Theophylline 400mg 24hr Tablet (Scored),42858070101,CDM,250,RC,,,Outpatient,,,14.76,7.38,,11.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.92,74,,,Percent of Total Billed Charges,74% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,12.4,84,,,Percent of Total Billed Charges,84% of total billed charges,12.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.37,77,,,Percent of total Billed charges,77% of total billed charges,12.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.69,13.14,
Theophylline 400mg 24hr Tablet (Scored),42858070101,CDM,250,RC,,,Outpatient,,,14.76,7.38,,11.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.92,74,,,Percent of Total Billed Charges,74% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,12.4,84,,,Percent of Total Billed Charges,84% of total billed charges,12.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.37,77,,,Percent of total Billed charges,77% of total billed charges,12.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.69,13.14,
Theophylline 400mg 24hr Tablet (Scored),42858070101,CDM,250,RC,,,Outpatient,,,14.76,7.38,,11.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.92,74,,,Percent of Total Billed Charges,74% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,12.4,84,,,Percent of Total Billed Charges,84% of total billed charges,12.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.37,77,,,Percent of total Billed charges,77% of total billed charges,12.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.69,13.14,
Theophylline 400mg 24hr Tablet (Scored),42858070101,CDM,250,RC,,,Outpatient,,,14.76,7.38,,11.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.92,74,,,Percent of Total Billed Charges,74% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,12.4,84,,,Percent of Total Billed Charges,84% of total billed charges,12.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.37,77,,,Percent of total Billed charges,77% of total billed charges,12.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.69,13.14,
Theophylline 400mg 24hr Tablet (Scored),42858070101,CDM,250,RC,,,Outpatient,,,14.76,7.38,,11.37,77,,,Percent of Total Billed Charges,77% of total billed charges,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10.92,74,,,Percent of Total Billed Charges,74% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,10.18,69,,,Percent of Total Billed Charges,69% of total billed charges,12.4,84,,,Percent of Total Billed Charges,84% of total billed charges,12.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.14,89,,,Percent of total Billed Charges,89% of total Billed charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.37,77,,,Percent of total Billed charges,77% of total billed charges,12.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.69,13.14,
Thiamin (Vitamin B1) 100mg Tablet,77333093410,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Thiamin (Vitamin B1) 100mg Tablet,77333093410,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Thiamin (Vitamin B1) 100mg Tablet,77333093410,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Thiamin (Vitamin B1) 100mg Tablet,77333093410,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Thiamin (Vitamin B1) 100mg Tablet,77333093410,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Thiamin (Vitamin B1) 100mg Tablet,77333093410,CDM,250,RC,,,Outpatient,,,6.78,3.39,,5.22,77,,,Percent of Total Billed Charges,77% of total billed charges,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.02,74,,,Percent of Total Billed Charges,74% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,4.68,69,,,Percent of Total Billed Charges,69% of total billed charges,5.7,84,,,Percent of Total Billed Charges,84% of total billed charges,5.56,82,,,Percent of Total Billed Charges,82% of total billed charges ,6.03,89,,,Percent of total Billed Charges,89% of total Billed charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.22,77,,,Percent of total Billed charges,77% of total billed charges,5.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.95,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.03,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.7,6.03,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thiamin (Vitamin B1) 200mg/2ml MDV,63323001302,CDM,250,RC,,,Outpatient,,,121.83,60.92,,93.81,77,,,Percent of Total Billed Charges,77% of total billed charges,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.07,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,90.15,74,,,Percent of Total Billed Charges,74% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,84.06,69,,,Percent of Total Billed Charges,69% of total billed charges,102.34,84,,,Percent of Total Billed Charges,84% of total billed charges,99.9,82,,,Percent of Total Billed Charges,82% of total billed charges ,108.43,89,,,Percent of total Billed Charges,89% of total Billed charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.81,77,,,Percent of total Billed charges,77% of total billed charges,103.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,35.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.71,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,108.43,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.46,108.43,
Thioridazine 25mg Tablet,51079056620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Thioridazine 25mg Tablet,51079056620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Thioridazine 25mg Tablet,51079056620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Thioridazine 25mg Tablet,51079056620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Thioridazine 25mg Tablet,51079056620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
Thioridazine 25mg Tablet,51079056620,CDM,250,RC,,,Outpatient,,,12.13,6.07,,9.34,77,,,Percent of Total Billed Charges,77% of total billed charges,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.09,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.98,74,,,Percent of Total Billed Charges,74% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,8.37,69,,,Percent of Total Billed Charges,69% of total billed charges,10.19,84,,,Percent of Total Billed Charges,84% of total billed charges,9.95,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.8,89,,,Percent of total Billed Charges,89% of total Billed charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.34,77,,,Percent of total Billed charges,77% of total billed charges,10.31,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.8,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.03,10.8,
"Thrombin 20,000 Unit Spray Kit",60793021721,CDM,250,RC,,,Outpatient,,,1126.65,563.33,,867.52,77,,,Percent of Total Billed Charges,77% of total billed charges,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,833.72,74,,,Percent of Total Billed Charges,74% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,946.39,84,,,Percent of Total Billed Charges,84% of total billed charges,923.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1002.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,867.52,77,,,Percent of total Billed charges,77% of total billed charges,957.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.66,1002.72,
"Thrombin 20,000 Unit Spray Kit",60793021721,CDM,250,RC,,,Outpatient,,,1126.65,563.33,,867.52,77,,,Percent of Total Billed Charges,77% of total billed charges,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,833.72,74,,,Percent of Total Billed Charges,74% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,946.39,84,,,Percent of Total Billed Charges,84% of total billed charges,923.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1002.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,867.52,77,,,Percent of total Billed charges,77% of total billed charges,957.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.66,1002.72,
"Thrombin 20,000 Unit Spray Kit",60793021721,CDM,250,RC,,,Outpatient,,,1126.65,563.33,,867.52,77,,,Percent of Total Billed Charges,77% of total billed charges,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,833.72,74,,,Percent of Total Billed Charges,74% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,946.39,84,,,Percent of Total Billed Charges,84% of total billed charges,923.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1002.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,867.52,77,,,Percent of total Billed charges,77% of total billed charges,957.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.66,1002.72,
"Thrombin 20,000 Unit Spray Kit",60793021721,CDM,250,RC,,,Outpatient,,,1126.65,563.33,,867.52,77,,,Percent of Total Billed Charges,77% of total billed charges,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,833.72,74,,,Percent of Total Billed Charges,74% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,946.39,84,,,Percent of Total Billed Charges,84% of total billed charges,923.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1002.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,867.52,77,,,Percent of total Billed charges,77% of total billed charges,957.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.66,1002.72,
"Thrombin 20,000 Unit Spray Kit",60793021721,CDM,250,RC,,,Outpatient,,,1126.65,563.33,,867.52,77,,,Percent of Total Billed Charges,77% of total billed charges,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,833.72,74,,,Percent of Total Billed Charges,74% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,946.39,84,,,Percent of Total Billed Charges,84% of total billed charges,923.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1002.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,867.52,77,,,Percent of total Billed charges,77% of total billed charges,957.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.66,1002.72,
"Thrombin 20,000 Unit Spray Kit",60793021721,CDM,250,RC,,,Outpatient,,,1126.65,563.33,,867.52,77,,,Percent of Total Billed Charges,77% of total billed charges,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.3,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,352.08,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,833.72,74,,,Percent of Total Billed Charges,74% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,777.39,69,,,Percent of Total Billed Charges,69% of total billed charges,946.39,84,,,Percent of Total Billed Charges,84% of total billed charges,923.85,82,,,Percent of Total Billed Charges,82% of total billed charges ,1002.72,89,,,Percent of total Billed Charges,89% of total Billed charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,867.52,77,,,Percent of total Billed charges,77% of total billed charges,957.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,323.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,563.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,459.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1002.72,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,281.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,281.66,1002.72,
Ticagrelor 60mg Tablet,186077660,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 60mg Tablet,186077660,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 60mg Tablet,186077660,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 60mg Tablet,186077660,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 60mg Tablet,186077660,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 60mg Tablet,186077660,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 90mg Tablet,186077760,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 90mg Tablet,186077760,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 90mg Tablet,186077760,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 90mg Tablet,186077760,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 90mg Tablet,186077760,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Ticagrelor 90mg Tablet,186077760,CDM,250,RC,,,Outpatient,,,71.21,35.61,,54.83,77,,,Percent of Total Billed Charges,77% of total billed charges,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,18.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.7,74,,,Percent of Total Billed Charges,74% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,49.13,69,,,Percent of Total Billed Charges,69% of total billed charges,59.82,84,,,Percent of Total Billed Charges,84% of total billed charges,58.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,63.38,89,,,Percent of total Billed Charges,89% of total Billed charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.83,77,,,Percent of total Billed charges,77% of total billed charges,60.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.47,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.61,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,29.05,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.8,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.8,63.38,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,734.89,367.45,,565.87,77,,,Percent of Total Billed Charges,77% of total billed charges,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,543.82,74,,,Percent of Total Billed Charges,74% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.31,84,,,Percent of Total Billed Charges,84% of total billed charges,602.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,654.05,89,,,Percent of total Billed Charges,89% of total Billed charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.87,77,,,Percent of total Billed charges,77% of total billed charges,624.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,367.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.72,654.05,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,763.84,381.92,,588.16,77,,,Percent of Total Billed Charges,77% of total billed charges,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,565.24,74,,,Percent of Total Billed Charges,74% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,641.63,84,,,Percent of Total Billed Charges,84% of total billed charges,626.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,679.82,89,,,Percent of total Billed Charges,89% of total Billed charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.16,77,,,Percent of total Billed charges,77% of total billed charges,649.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,381.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,679.82,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,734.89,367.45,,565.87,77,,,Percent of Total Billed Charges,77% of total billed charges,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,543.82,74,,,Percent of Total Billed Charges,74% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.31,84,,,Percent of Total Billed Charges,84% of total billed charges,602.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,654.05,89,,,Percent of total Billed Charges,89% of total Billed charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.87,77,,,Percent of total Billed charges,77% of total billed charges,624.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,367.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.72,654.05,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,763.84,381.92,,588.16,77,,,Percent of Total Billed Charges,77% of total billed charges,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,565.24,74,,,Percent of Total Billed Charges,74% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,641.63,84,,,Percent of Total Billed Charges,84% of total billed charges,626.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,679.82,89,,,Percent of total Billed Charges,89% of total Billed charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.16,77,,,Percent of total Billed charges,77% of total billed charges,649.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,381.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,679.82,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,734.89,367.45,,565.87,77,,,Percent of Total Billed Charges,77% of total billed charges,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,543.82,74,,,Percent of Total Billed Charges,74% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.31,84,,,Percent of Total Billed Charges,84% of total billed charges,602.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,654.05,89,,,Percent of total Billed Charges,89% of total Billed charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.87,77,,,Percent of total Billed charges,77% of total billed charges,624.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,367.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.72,654.05,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,763.84,381.92,,588.16,77,,,Percent of Total Billed Charges,77% of total billed charges,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,565.24,74,,,Percent of Total Billed Charges,74% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,641.63,84,,,Percent of Total Billed Charges,84% of total billed charges,626.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,679.82,89,,,Percent of total Billed Charges,89% of total Billed charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.16,77,,,Percent of total Billed charges,77% of total billed charges,649.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,381.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,679.82,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,734.89,367.45,,565.87,77,,,Percent of Total Billed Charges,77% of total billed charges,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,543.82,74,,,Percent of Total Billed Charges,74% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.31,84,,,Percent of Total Billed Charges,84% of total billed charges,602.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,654.05,89,,,Percent of total Billed Charges,89% of total Billed charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.87,77,,,Percent of total Billed charges,77% of total billed charges,624.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,367.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.72,654.05,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,763.84,381.92,,588.16,77,,,Percent of Total Billed Charges,77% of total billed charges,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,565.24,74,,,Percent of Total Billed Charges,74% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,641.63,84,,,Percent of Total Billed Charges,84% of total billed charges,626.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,679.82,89,,,Percent of total Billed Charges,89% of total Billed charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.16,77,,,Percent of total Billed charges,77% of total billed charges,649.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,381.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,679.82,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,734.89,367.45,,565.87,77,,,Percent of Total Billed Charges,77% of total billed charges,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,543.82,74,,,Percent of Total Billed Charges,74% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.31,84,,,Percent of Total Billed Charges,84% of total billed charges,602.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,654.05,89,,,Percent of total Billed Charges,89% of total Billed charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.87,77,,,Percent of total Billed charges,77% of total billed charges,624.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,367.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.72,654.05,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,763.84,381.92,,588.16,77,,,Percent of Total Billed Charges,77% of total billed charges,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,565.24,74,,,Percent of Total Billed Charges,74% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,641.63,84,,,Percent of Total Billed Charges,84% of total billed charges,626.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,679.82,89,,,Percent of total Billed Charges,89% of total Billed charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.16,77,,,Percent of total Billed charges,77% of total billed charges,649.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,381.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,679.82,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,734.89,367.45,,565.87,77,,,Percent of Total Billed Charges,77% of total billed charges,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,187.4,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,229.65,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,543.82,74,,,Percent of Total Billed Charges,74% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,507.07,69,,,Percent of Total Billed Charges,69% of total billed charges,617.31,84,,,Percent of Total Billed Charges,84% of total billed charges,602.61,82,,,Percent of Total Billed Charges,82% of total billed charges ,654.05,89,,,Percent of total Billed Charges,89% of total Billed charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,565.87,77,,,Percent of total Billed charges,77% of total billed charges,624.66,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,211.28,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,367.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,299.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,654.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,183.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,183.72,654.05,
Tigecycline 50 mg SDV,55150022810,CDM,250,RC,,,Outpatient,,,763.84,381.92,,588.16,77,,,Percent of Total Billed Charges,77% of total billed charges,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,194.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,238.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,565.24,74,,,Percent of Total Billed Charges,74% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,527.05,69,,,Percent of Total Billed Charges,69% of total billed charges,641.63,84,,,Percent of Total Billed Charges,84% of total billed charges,626.35,82,,,Percent of Total Billed Charges,82% of total billed charges ,679.82,89,,,Percent of total Billed Charges,89% of total Billed charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,588.16,77,,,Percent of total Billed charges,77% of total billed charges,649.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,219.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,381.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,311.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,679.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,190.96,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,190.96,679.82,
Timolol 0.5% OCUDOSE Drop 1 each,24208049968,CDM,250,RC,,,Outpatient,,,92.51,46.26,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.46,74,,,Percent of Total Billed Charges,74% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,77.71,84,,,Percent of Total Billed Charges,84% of total billed charges,75.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.33,89,,,Percent of total Billed Charges,89% of total Billed charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,82.33,
Timolol 0.5% OCUDOSE Drop 1 each,24208049968,CDM,250,RC,,,Outpatient,,,92.51,46.26,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.46,74,,,Percent of Total Billed Charges,74% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,77.71,84,,,Percent of Total Billed Charges,84% of total billed charges,75.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.33,89,,,Percent of total Billed Charges,89% of total Billed charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,82.33,
Timolol 0.5% OCUDOSE Drop 1 each,24208049968,CDM,250,RC,,,Outpatient,,,92.51,46.26,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.46,74,,,Percent of Total Billed Charges,74% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,77.71,84,,,Percent of Total Billed Charges,84% of total billed charges,75.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.33,89,,,Percent of total Billed Charges,89% of total Billed charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,82.33,
Timolol 0.5% OCUDOSE Drop 1 each,24208049968,CDM,250,RC,,,Outpatient,,,92.51,46.26,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.46,74,,,Percent of Total Billed Charges,74% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,77.71,84,,,Percent of Total Billed Charges,84% of total billed charges,75.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.33,89,,,Percent of total Billed Charges,89% of total Billed charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,82.33,
Timolol 0.5% OCUDOSE Drop 1 each,24208049968,CDM,250,RC,,,Outpatient,,,92.51,46.26,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.46,74,,,Percent of Total Billed Charges,74% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,77.71,84,,,Percent of Total Billed Charges,84% of total billed charges,75.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.33,89,,,Percent of total Billed Charges,89% of total Billed charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,82.33,
Timolol 0.5% OCUDOSE Drop 1 each,24208049968,CDM,250,RC,,,Outpatient,,,92.51,46.26,,71.23,77,,,Percent of Total Billed Charges,77% of total billed charges,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,23.59,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,68.46,74,,,Percent of Total Billed Charges,74% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,63.83,69,,,Percent of Total Billed Charges,69% of total billed charges,77.71,84,,,Percent of Total Billed Charges,84% of total billed charges,75.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,82.33,89,,,Percent of total Billed Charges,89% of total Billed charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.23,77,,,Percent of total Billed charges,77% of total billed charges,78.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,26.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,46.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,37.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.13,82.33,
Timolol 0.25% OPHTH Soln 5ml,61314022605,CDM,250,RC,,,Outpatient,,,128.37,64.19,,98.84,77,,,Percent of Total Billed Charges,77% of total billed charges,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.99,74,,,Percent of Total Billed Charges,74% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,107.83,84,,,Percent of Total Billed Charges,84% of total billed charges,105.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.25,89,,,Percent of total Billed Charges,89% of total Billed charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,77,,,Percent of total Billed charges,77% of total billed charges,109.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,114.25,
Timolol 0.25% OPHTH Soln 5ml,61314022605,CDM,250,RC,,,Outpatient,,,128.37,64.19,,98.84,77,,,Percent of Total Billed Charges,77% of total billed charges,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.99,74,,,Percent of Total Billed Charges,74% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,107.83,84,,,Percent of Total Billed Charges,84% of total billed charges,105.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.25,89,,,Percent of total Billed Charges,89% of total Billed charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,77,,,Percent of total Billed charges,77% of total billed charges,109.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,114.25,
Timolol 0.25% OPHTH Soln 5ml,61314022605,CDM,250,RC,,,Outpatient,,,128.37,64.19,,98.84,77,,,Percent of Total Billed Charges,77% of total billed charges,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.99,74,,,Percent of Total Billed Charges,74% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,107.83,84,,,Percent of Total Billed Charges,84% of total billed charges,105.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.25,89,,,Percent of total Billed Charges,89% of total Billed charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,77,,,Percent of total Billed charges,77% of total billed charges,109.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,114.25,
Timolol 0.25% OPHTH Soln 5ml,61314022605,CDM,250,RC,,,Outpatient,,,128.37,64.19,,98.84,77,,,Percent of Total Billed Charges,77% of total billed charges,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.99,74,,,Percent of Total Billed Charges,74% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,107.83,84,,,Percent of Total Billed Charges,84% of total billed charges,105.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.25,89,,,Percent of total Billed Charges,89% of total Billed charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,77,,,Percent of total Billed charges,77% of total billed charges,109.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,114.25,
Timolol 0.25% OPHTH Soln 5ml,61314022605,CDM,250,RC,,,Outpatient,,,128.37,64.19,,98.84,77,,,Percent of Total Billed Charges,77% of total billed charges,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.99,74,,,Percent of Total Billed Charges,74% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,107.83,84,,,Percent of Total Billed Charges,84% of total billed charges,105.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.25,89,,,Percent of total Billed Charges,89% of total Billed charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,77,,,Percent of total Billed charges,77% of total billed charges,109.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,114.25,
Timolol 0.25% OPHTH Soln 5ml,61314022605,CDM,250,RC,,,Outpatient,,,128.37,64.19,,98.84,77,,,Percent of Total Billed Charges,77% of total billed charges,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,32.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,40.12,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,94.99,74,,,Percent of Total Billed Charges,74% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,88.58,69,,,Percent of Total Billed Charges,69% of total billed charges,107.83,84,,,Percent of Total Billed Charges,84% of total billed charges,105.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,114.25,89,,,Percent of total Billed Charges,89% of total Billed charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,98.84,77,,,Percent of total Billed charges,77% of total billed charges,109.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,36.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,64.19,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,52.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,114.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.09,114.25,
Timolol 0.5% OPHTH Soln 5ml,61314022705,CDM,250,RC,,,Outpatient,,,144.81,72.41,,111.5,77,,,Percent of Total Billed Charges,77% of total billed charges,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.16,74,,,Percent of Total Billed Charges,74% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,121.64,84,,,Percent of Total Billed Charges,84% of total billed charges,118.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.88,89,,,Percent of total Billed Charges,89% of total Billed charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,77,,,Percent of total Billed charges,77% of total billed charges,123.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.2,128.88,
Timolol 0.5% OPHTH Soln 5ml,61314022705,CDM,250,RC,,,Outpatient,,,144.81,72.41,,111.5,77,,,Percent of Total Billed Charges,77% of total billed charges,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.16,74,,,Percent of Total Billed Charges,74% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,121.64,84,,,Percent of Total Billed Charges,84% of total billed charges,118.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.88,89,,,Percent of total Billed Charges,89% of total Billed charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,77,,,Percent of total Billed charges,77% of total billed charges,123.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.2,128.88,
Timolol 0.5% OPHTH Soln 5ml,61314022705,CDM,250,RC,,,Outpatient,,,144.81,72.41,,111.5,77,,,Percent of Total Billed Charges,77% of total billed charges,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.16,74,,,Percent of Total Billed Charges,74% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,121.64,84,,,Percent of Total Billed Charges,84% of total billed charges,118.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.88,89,,,Percent of total Billed Charges,89% of total Billed charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,77,,,Percent of total Billed charges,77% of total billed charges,123.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.2,128.88,
Timolol 0.5% OPHTH Soln 5ml,61314022705,CDM,250,RC,,,Outpatient,,,144.81,72.41,,111.5,77,,,Percent of Total Billed Charges,77% of total billed charges,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.16,74,,,Percent of Total Billed Charges,74% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,121.64,84,,,Percent of Total Billed Charges,84% of total billed charges,118.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.88,89,,,Percent of total Billed Charges,89% of total Billed charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,77,,,Percent of total Billed charges,77% of total billed charges,123.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.2,128.88,
Timolol 0.5% OPHTH Soln 5ml,61314022705,CDM,250,RC,,,Outpatient,,,144.81,72.41,,111.5,77,,,Percent of Total Billed Charges,77% of total billed charges,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.16,74,,,Percent of Total Billed Charges,74% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,121.64,84,,,Percent of Total Billed Charges,84% of total billed charges,118.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.88,89,,,Percent of total Billed Charges,89% of total Billed charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,77,,,Percent of total Billed charges,77% of total billed charges,123.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.2,128.88,
Timolol 0.5% OPHTH Soln 5ml,61314022705,CDM,250,RC,,,Outpatient,,,144.81,72.41,,111.5,77,,,Percent of Total Billed Charges,77% of total billed charges,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,45.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,107.16,74,,,Percent of Total Billed Charges,74% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,99.92,69,,,Percent of Total Billed Charges,69% of total billed charges,121.64,84,,,Percent of Total Billed Charges,84% of total billed charges,118.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,128.88,89,,,Percent of total Billed Charges,89% of total Billed charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,111.5,77,,,Percent of total Billed charges,77% of total billed charges,123.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,41.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,72.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,59.08,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,128.88,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,36.2,128.88,
Tiotropium Bromide 18 mcg Capsule w/ Handihaler,597007575,CDM,250,RC,,,Outpatient,,,171.79,85.9,,132.28,77,,,Percent of Total Billed Charges,77% of total billed charges,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.12,74,,,Percent of Total Billed Charges,74% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,144.3,84,,,Percent of Total Billed Charges,84% of total billed charges,140.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.89,89,,,Percent of total Billed Charges,89% of total Billed charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.28,77,,,Percent of total Billed charges,77% of total billed charges,146.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.95,152.89,
Tiotropium Bromide 18 mcg Capsule w/ Handihaler,597007575,CDM,250,RC,,,Outpatient,,,171.79,85.9,,132.28,77,,,Percent of Total Billed Charges,77% of total billed charges,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.12,74,,,Percent of Total Billed Charges,74% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,144.3,84,,,Percent of Total Billed Charges,84% of total billed charges,140.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.89,89,,,Percent of total Billed Charges,89% of total Billed charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.28,77,,,Percent of total Billed charges,77% of total billed charges,146.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.95,152.89,
Tiotropium Bromide 18 mcg Capsule w/ Handihaler,597007575,CDM,250,RC,,,Outpatient,,,171.79,85.9,,132.28,77,,,Percent of Total Billed Charges,77% of total billed charges,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.12,74,,,Percent of Total Billed Charges,74% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,144.3,84,,,Percent of Total Billed Charges,84% of total billed charges,140.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.89,89,,,Percent of total Billed Charges,89% of total Billed charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.28,77,,,Percent of total Billed charges,77% of total billed charges,146.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.95,152.89,
Tiotropium Bromide 18 mcg Capsule w/ Handihaler,597007575,CDM,250,RC,,,Outpatient,,,171.79,85.9,,132.28,77,,,Percent of Total Billed Charges,77% of total billed charges,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.12,74,,,Percent of Total Billed Charges,74% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,144.3,84,,,Percent of Total Billed Charges,84% of total billed charges,140.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.89,89,,,Percent of total Billed Charges,89% of total Billed charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.28,77,,,Percent of total Billed charges,77% of total billed charges,146.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.95,152.89,
Tiotropium Bromide 18 mcg Capsule w/ Handihaler,597007575,CDM,250,RC,,,Outpatient,,,171.79,85.9,,132.28,77,,,Percent of Total Billed Charges,77% of total billed charges,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.12,74,,,Percent of Total Billed Charges,74% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,144.3,84,,,Percent of Total Billed Charges,84% of total billed charges,140.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.89,89,,,Percent of total Billed Charges,89% of total Billed charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.28,77,,,Percent of total Billed charges,77% of total billed charges,146.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.95,152.89,
Tiotropium Bromide 18 mcg Capsule w/ Handihaler,597007575,CDM,250,RC,,,Outpatient,,,171.79,85.9,,132.28,77,,,Percent of Total Billed Charges,77% of total billed charges,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,43.81,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,53.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,127.12,74,,,Percent of Total Billed Charges,74% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,118.54,69,,,Percent of Total Billed Charges,69% of total billed charges,144.3,84,,,Percent of Total Billed Charges,84% of total billed charges,140.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,152.89,89,,,Percent of total Billed Charges,89% of total Billed charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,132.28,77,,,Percent of total Billed charges,77% of total billed charges,146.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,49.39,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,85.9,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,70.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.89,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,42.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.95,152.89,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 12.5mg/250ml IV Bag,25208000202,CDM,250,RC,,,Outpatient,,,1138.77,569.39,,876.85,77,,,Percent of Total Billed Charges,77% of total billed charges,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,290.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,355.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,842.69,74,,,Percent of Total Billed Charges,74% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,785.75,69,,,Percent of Total Billed Charges,69% of total billed charges,956.57,84,,,Percent of Total Billed Charges,84% of total billed charges,933.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,1013.51,89,,,Percent of total Billed Charges,89% of total Billed charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,876.85,77,,,Percent of total Billed charges,77% of total billed charges,967.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,327.4,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,569.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,464.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1013.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,284.69,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,284.69,1013.51,
Tirofiban 3.75mg/15ml SDV,25208000104,CDM,250,RC,,,Outpatient,,,386.23,193.12,,297.4,77,,,Percent of Total Billed Charges,77% of total billed charges,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,285.81,74,,,Percent of Total Billed Charges,74% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,324.43,84,,,Percent of Total Billed Charges,84% of total billed charges,316.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,343.74,89,,,Percent of total Billed Charges,89% of total Billed charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.4,77,,,Percent of total Billed charges,77% of total billed charges,328.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.56,343.74,
Tirofiban 3.75mg/15ml SDV,25208000104,CDM,250,RC,,,Outpatient,,,386.23,193.12,,297.4,77,,,Percent of Total Billed Charges,77% of total billed charges,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,285.81,74,,,Percent of Total Billed Charges,74% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,324.43,84,,,Percent of Total Billed Charges,84% of total billed charges,316.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,343.74,89,,,Percent of total Billed Charges,89% of total Billed charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.4,77,,,Percent of total Billed charges,77% of total billed charges,328.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.56,343.74,
Tirofiban 3.75mg/15ml SDV,25208000104,CDM,250,RC,,,Outpatient,,,386.23,193.12,,297.4,77,,,Percent of Total Billed Charges,77% of total billed charges,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,285.81,74,,,Percent of Total Billed Charges,74% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,324.43,84,,,Percent of Total Billed Charges,84% of total billed charges,316.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,343.74,89,,,Percent of total Billed Charges,89% of total Billed charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.4,77,,,Percent of total Billed charges,77% of total billed charges,328.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.56,343.74,
Tirofiban 3.75mg/15ml SDV,25208000104,CDM,250,RC,,,Outpatient,,,386.23,193.12,,297.4,77,,,Percent of Total Billed Charges,77% of total billed charges,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,285.81,74,,,Percent of Total Billed Charges,74% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,324.43,84,,,Percent of Total Billed Charges,84% of total billed charges,316.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,343.74,89,,,Percent of total Billed Charges,89% of total Billed charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.4,77,,,Percent of total Billed charges,77% of total billed charges,328.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.56,343.74,
Tirofiban 3.75mg/15ml SDV,25208000104,CDM,250,RC,,,Outpatient,,,386.23,193.12,,297.4,77,,,Percent of Total Billed Charges,77% of total billed charges,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,285.81,74,,,Percent of Total Billed Charges,74% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,324.43,84,,,Percent of Total Billed Charges,84% of total billed charges,316.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,343.74,89,,,Percent of total Billed Charges,89% of total Billed charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.4,77,,,Percent of total Billed charges,77% of total billed charges,328.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.56,343.74,
Tirofiban 3.75mg/15ml SDV,25208000104,CDM,250,RC,,,Outpatient,,,386.23,193.12,,297.4,77,,,Percent of Total Billed Charges,77% of total billed charges,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,120.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,285.81,74,,,Percent of Total Billed Charges,74% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,266.5,69,,,Percent of Total Billed Charges,69% of total billed charges,324.43,84,,,Percent of Total Billed Charges,84% of total billed charges,316.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,343.74,89,,,Percent of total Billed Charges,89% of total Billed charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,297.4,77,,,Percent of total Billed charges,77% of total billed charges,328.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,111.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,193.12,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,157.58,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,343.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,96.56,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,96.56,343.74,
tiZANidine 4mg Tablet,51079099820,CDM,250,RC,,,Outpatient,,,28.93,14.47,,22.28,77,,,Percent of Total Billed Charges,77% of total billed charges,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.41,74,,,Percent of Total Billed Charges,74% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,84,,,Percent of Total Billed Charges,84% of total billed charges,23.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.75,89,,,Percent of total Billed Charges,89% of total Billed charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.28,77,,,Percent of total Billed charges,77% of total billed charges,24.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.23,25.75,
tiZANidine 4mg Tablet,51079099820,CDM,250,RC,,,Outpatient,,,28.93,14.47,,22.28,77,,,Percent of Total Billed Charges,77% of total billed charges,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.41,74,,,Percent of Total Billed Charges,74% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,84,,,Percent of Total Billed Charges,84% of total billed charges,23.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.75,89,,,Percent of total Billed Charges,89% of total Billed charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.28,77,,,Percent of total Billed charges,77% of total billed charges,24.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.23,25.75,
tiZANidine 4mg Tablet,51079099820,CDM,250,RC,,,Outpatient,,,28.93,14.47,,22.28,77,,,Percent of Total Billed Charges,77% of total billed charges,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.41,74,,,Percent of Total Billed Charges,74% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,84,,,Percent of Total Billed Charges,84% of total billed charges,23.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.75,89,,,Percent of total Billed Charges,89% of total Billed charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.28,77,,,Percent of total Billed charges,77% of total billed charges,24.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.23,25.75,
tiZANidine 4mg Tablet,51079099820,CDM,250,RC,,,Outpatient,,,28.93,14.47,,22.28,77,,,Percent of Total Billed Charges,77% of total billed charges,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.41,74,,,Percent of Total Billed Charges,74% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,84,,,Percent of Total Billed Charges,84% of total billed charges,23.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.75,89,,,Percent of total Billed Charges,89% of total Billed charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.28,77,,,Percent of total Billed charges,77% of total billed charges,24.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.23,25.75,
tiZANidine 4mg Tablet,51079099820,CDM,250,RC,,,Outpatient,,,28.93,14.47,,22.28,77,,,Percent of Total Billed Charges,77% of total billed charges,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.41,74,,,Percent of Total Billed Charges,74% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,84,,,Percent of Total Billed Charges,84% of total billed charges,23.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.75,89,,,Percent of total Billed Charges,89% of total Billed charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.28,77,,,Percent of total Billed charges,77% of total billed charges,24.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.23,25.75,
tiZANidine 4mg Tablet,51079099820,CDM,250,RC,,,Outpatient,,,28.93,14.47,,22.28,77,,,Percent of Total Billed Charges,77% of total billed charges,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,9.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,21.41,74,,,Percent of Total Billed Charges,74% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,19.96,69,,,Percent of Total Billed Charges,69% of total billed charges,24.3,84,,,Percent of Total Billed Charges,84% of total billed charges,23.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,25.75,89,,,Percent of total Billed Charges,89% of total Billed charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.28,77,,,Percent of total Billed charges,77% of total billed charges,24.59,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,8.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,14.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,11.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.23,25.75,
Tobramycin/Dexamethasone OPHTH Susp 2.5ml,574403125,CDM,250,RC,,,Outpatient,,,184.96,92.48,,142.42,77,,,Percent of Total Billed Charges,77% of total billed charges,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.87,74,,,Percent of Total Billed Charges,74% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,155.37,84,,,Percent of Total Billed Charges,84% of total billed charges,151.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.61,89,,,Percent of total Billed Charges,89% of total Billed charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.42,77,,,Percent of total Billed charges,77% of total billed charges,157.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.24,164.61,
Tobramycin/Dexamethasone OPHTH Susp 2.5ml,574403125,CDM,250,RC,,,Outpatient,,,184.96,92.48,,142.42,77,,,Percent of Total Billed Charges,77% of total billed charges,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.87,74,,,Percent of Total Billed Charges,74% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,155.37,84,,,Percent of Total Billed Charges,84% of total billed charges,151.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.61,89,,,Percent of total Billed Charges,89% of total Billed charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.42,77,,,Percent of total Billed charges,77% of total billed charges,157.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.24,164.61,
Tobramycin/Dexamethasone OPHTH Susp 2.5ml,574403125,CDM,250,RC,,,Outpatient,,,184.96,92.48,,142.42,77,,,Percent of Total Billed Charges,77% of total billed charges,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.87,74,,,Percent of Total Billed Charges,74% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,155.37,84,,,Percent of Total Billed Charges,84% of total billed charges,151.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.61,89,,,Percent of total Billed Charges,89% of total Billed charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.42,77,,,Percent of total Billed charges,77% of total billed charges,157.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.24,164.61,
Tobramycin/Dexamethasone OPHTH Susp 2.5ml,574403125,CDM,250,RC,,,Outpatient,,,184.96,92.48,,142.42,77,,,Percent of Total Billed Charges,77% of total billed charges,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.87,74,,,Percent of Total Billed Charges,74% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,155.37,84,,,Percent of Total Billed Charges,84% of total billed charges,151.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.61,89,,,Percent of total Billed Charges,89% of total Billed charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.42,77,,,Percent of total Billed charges,77% of total billed charges,157.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.24,164.61,
Tobramycin/Dexamethasone OPHTH Susp 2.5ml,574403125,CDM,250,RC,,,Outpatient,,,184.96,92.48,,142.42,77,,,Percent of Total Billed Charges,77% of total billed charges,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.87,74,,,Percent of Total Billed Charges,74% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,155.37,84,,,Percent of Total Billed Charges,84% of total billed charges,151.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.61,89,,,Percent of total Billed Charges,89% of total Billed charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.42,77,,,Percent of total Billed charges,77% of total billed charges,157.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.24,164.61,
Tobramycin/Dexamethasone OPHTH Susp 2.5ml,574403125,CDM,250,RC,,,Outpatient,,,184.96,92.48,,142.42,77,,,Percent of Total Billed Charges,77% of total billed charges,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,136.87,74,,,Percent of Total Billed Charges,74% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,127.62,69,,,Percent of Total Billed Charges,69% of total billed charges,155.37,84,,,Percent of Total Billed Charges,84% of total billed charges,151.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,164.61,89,,,Percent of total Billed Charges,89% of total Billed charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,142.42,77,,,Percent of total Billed charges,77% of total billed charges,157.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,53.18,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,92.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,75.46,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,164.61,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.24,164.61,
Tobramycin/Dexamethasone OPHTH Ointment 3.5gm,78087601,CDM,250,RC,,,Outpatient,,,939.48,469.74,,723.4,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.22,74,,,Percent of Total Billed Charges,74% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,789.16,84,,,Percent of Total Billed Charges,84% of total billed charges,770.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.14,89,,,Percent of total Billed Charges,89% of total Billed charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.4,77,,,Percent of total Billed charges,77% of total billed charges,798.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.87,836.14,
Tobramycin/Dexamethasone OPHTH Ointment 3.5gm,78087601,CDM,250,RC,,,Outpatient,,,939.48,469.74,,723.4,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.22,74,,,Percent of Total Billed Charges,74% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,789.16,84,,,Percent of Total Billed Charges,84% of total billed charges,770.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.14,89,,,Percent of total Billed Charges,89% of total Billed charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.4,77,,,Percent of total Billed charges,77% of total billed charges,798.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.87,836.14,
Tobramycin/Dexamethasone OPHTH Ointment 3.5gm,78087601,CDM,250,RC,,,Outpatient,,,939.48,469.74,,723.4,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.22,74,,,Percent of Total Billed Charges,74% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,789.16,84,,,Percent of Total Billed Charges,84% of total billed charges,770.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.14,89,,,Percent of total Billed Charges,89% of total Billed charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.4,77,,,Percent of total Billed charges,77% of total billed charges,798.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.87,836.14,
Tobramycin/Dexamethasone OPHTH Ointment 3.5gm,78087601,CDM,250,RC,,,Outpatient,,,939.48,469.74,,723.4,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.22,74,,,Percent of Total Billed Charges,74% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,789.16,84,,,Percent of Total Billed Charges,84% of total billed charges,770.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.14,89,,,Percent of total Billed Charges,89% of total Billed charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.4,77,,,Percent of total Billed charges,77% of total billed charges,798.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.87,836.14,
Tobramycin/Dexamethasone OPHTH Ointment 3.5gm,78087601,CDM,250,RC,,,Outpatient,,,939.48,469.74,,723.4,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.22,74,,,Percent of Total Billed Charges,74% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,789.16,84,,,Percent of Total Billed Charges,84% of total billed charges,770.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.14,89,,,Percent of total Billed Charges,89% of total Billed charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.4,77,,,Percent of total Billed charges,77% of total billed charges,798.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.87,836.14,
Tobramycin/Dexamethasone OPHTH Ointment 3.5gm,78087601,CDM,250,RC,,,Outpatient,,,939.48,469.74,,723.4,77,,,Percent of Total Billed Charges,77% of total billed charges,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,239.57,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,293.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,695.22,74,,,Percent of Total Billed Charges,74% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,648.24,69,,,Percent of Total Billed Charges,69% of total billed charges,789.16,84,,,Percent of Total Billed Charges,84% of total billed charges,770.37,82,,,Percent of Total Billed Charges,82% of total billed charges ,836.14,89,,,Percent of total Billed Charges,89% of total Billed charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,723.4,77,,,Percent of total Billed charges,77% of total billed charges,798.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,270.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,469.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,383.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,836.14,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,234.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,234.87,836.14,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tobramycin 80mg/2ml MDV,63323030602,CDM,250,RC,,,Outpatient,,,67.88,33.94,,52.27,77,,,Percent of Total Billed Charges,77% of total billed charges,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,50.23,74,,,Percent of Total Billed Charges,74% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,46.84,69,,,Percent of Total Billed Charges,69% of total billed charges,57.02,84,,,Percent of Total Billed Charges,84% of total billed charges,55.66,82,,,Percent of Total Billed Charges,82% of total billed charges ,60.41,89,,,Percent of total Billed Charges,89% of total Billed charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,52.27,77,,,Percent of total Billed charges,77% of total billed charges,57.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,19.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,33.94,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,27.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.97,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.97,60.41,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9530.39,4765.2,,7338.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7052.49,74,,,Percent of Total Billed Charges,74% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8005.53,84,,,Percent of Total Billed Charges,84% of total billed charges,7814.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,8482.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7338.4,77,,,Percent of total Billed charges,77% of total billed charges,8100.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2739.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4765.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2382.6,8482.05,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9287.78,4643.89,,7151.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2902.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6872.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7801.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7615.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,8266.12,89,,,Percent of total Billed Charges,89% of total Billed charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7151.59,77,,,Percent of total Billed charges,77% of total billed charges,7894.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2670.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4643.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2321.95,8266.12,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9530.39,4765.2,,7338.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7052.49,74,,,Percent of Total Billed Charges,74% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8005.53,84,,,Percent of Total Billed Charges,84% of total billed charges,7814.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,8482.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7338.4,77,,,Percent of total Billed charges,77% of total billed charges,8100.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2739.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4765.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2382.6,8482.05,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9287.78,4643.89,,7151.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2902.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6872.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7801.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7615.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,8266.12,89,,,Percent of total Billed Charges,89% of total Billed charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7151.59,77,,,Percent of total Billed charges,77% of total billed charges,7894.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2670.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4643.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2321.95,8266.12,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9530.39,4765.2,,7338.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7052.49,74,,,Percent of Total Billed Charges,74% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8005.53,84,,,Percent of Total Billed Charges,84% of total billed charges,7814.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,8482.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7338.4,77,,,Percent of total Billed charges,77% of total billed charges,8100.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2739.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4765.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2382.6,8482.05,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9287.78,4643.89,,7151.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2902.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6872.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7801.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7615.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,8266.12,89,,,Percent of total Billed Charges,89% of total Billed charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7151.59,77,,,Percent of total Billed charges,77% of total billed charges,7894.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2670.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4643.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2321.95,8266.12,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9530.39,4765.2,,7338.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7052.49,74,,,Percent of Total Billed Charges,74% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8005.53,84,,,Percent of Total Billed Charges,84% of total billed charges,7814.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,8482.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7338.4,77,,,Percent of total Billed charges,77% of total billed charges,8100.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2739.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4765.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2382.6,8482.05,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9287.78,4643.89,,7151.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2902.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6872.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7801.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7615.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,8266.12,89,,,Percent of total Billed Charges,89% of total Billed charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7151.59,77,,,Percent of total Billed charges,77% of total billed charges,7894.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2670.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4643.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2321.95,8266.12,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9530.39,4765.2,,7338.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7052.49,74,,,Percent of Total Billed Charges,74% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8005.53,84,,,Percent of Total Billed Charges,84% of total billed charges,7814.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,8482.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7338.4,77,,,Percent of total Billed charges,77% of total billed charges,8100.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2739.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4765.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2382.6,8482.05,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9287.78,4643.89,,7151.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2902.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6872.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7801.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7615.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,8266.12,89,,,Percent of total Billed Charges,89% of total Billed charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7151.59,77,,,Percent of total Billed charges,77% of total billed charges,7894.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2670.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4643.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2321.95,8266.12,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9530.39,4765.2,,7338.4,77,,,Percent of Total Billed Charges,77% of total billed charges,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2430.25,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2978.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7052.49,74,,,Percent of Total Billed Charges,74% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,6575.97,69,,,Percent of Total Billed Charges,69% of total billed charges,8005.53,84,,,Percent of Total Billed Charges,84% of total billed charges,7814.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,8482.05,89,,,Percent of total Billed Charges,89% of total Billed charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7338.4,77,,,Percent of total Billed charges,77% of total billed charges,8100.83,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2739.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4765.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3888.4,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8482.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2382.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2382.6,8482.05,
Tocilizumab (Actemra) 200mg/10ml Liquid SDV,50242013601,CDM,250,RC,,,Outpatient,,,9287.78,4643.89,,7151.59,77,,,Percent of Total Billed Charges,77% of total billed charges,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2368.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2902.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6872.96,74,,,Percent of Total Billed Charges,74% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6408.57,69,,,Percent of Total Billed Charges,69% of total billed charges,7801.74,84,,,Percent of Total Billed Charges,84% of total billed charges,7615.98,82,,,Percent of Total Billed Charges,82% of total billed charges ,8266.12,89,,,Percent of total Billed Charges,89% of total Billed charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7151.59,77,,,Percent of total Billed charges,77% of total billed charges,7894.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2670.24,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4643.89,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3789.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8266.12,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2321.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2321.95,8266.12,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,7066.96,3533.48,,5441.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2208.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5229.55,74,,,Percent of Total Billed Charges,74% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5936.25,84,,,Percent of Total Billed Charges,84% of total billed charges,5794.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,6289.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5441.56,77,,,Percent of total Billed charges,77% of total billed charges,6006.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2031.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3533.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.74,6289.59,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,6888.06,3444.03,,5303.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5097.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5785.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,6130.37,89,,,Percent of total Billed Charges,89% of total Billed charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5303.81,77,,,Percent of total Billed charges,77% of total billed charges,5854.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1980.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3444.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1722.02,6130.37,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,7066.96,3533.48,,5441.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2208.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5229.55,74,,,Percent of Total Billed Charges,74% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5936.25,84,,,Percent of Total Billed Charges,84% of total billed charges,5794.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,6289.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5441.56,77,,,Percent of total Billed charges,77% of total billed charges,6006.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2031.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3533.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.74,6289.59,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,6888.06,3444.03,,5303.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5097.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5785.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,6130.37,89,,,Percent of total Billed Charges,89% of total Billed charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5303.81,77,,,Percent of total Billed charges,77% of total billed charges,5854.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1980.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3444.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1722.02,6130.37,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,7066.96,3533.48,,5441.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2208.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5229.55,74,,,Percent of Total Billed Charges,74% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5936.25,84,,,Percent of Total Billed Charges,84% of total billed charges,5794.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,6289.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5441.56,77,,,Percent of total Billed charges,77% of total billed charges,6006.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2031.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3533.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.74,6289.59,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,6888.06,3444.03,,5303.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5097.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5785.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,6130.37,89,,,Percent of total Billed Charges,89% of total Billed charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5303.81,77,,,Percent of total Billed charges,77% of total billed charges,5854.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1980.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3444.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1722.02,6130.37,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,7066.96,3533.48,,5441.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2208.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5229.55,74,,,Percent of Total Billed Charges,74% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5936.25,84,,,Percent of Total Billed Charges,84% of total billed charges,5794.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,6289.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5441.56,77,,,Percent of total Billed charges,77% of total billed charges,6006.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2031.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3533.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.74,6289.59,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,6888.06,3444.03,,5303.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5097.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5785.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,6130.37,89,,,Percent of total Billed Charges,89% of total Billed charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5303.81,77,,,Percent of total Billed charges,77% of total billed charges,5854.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1980.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3444.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1722.02,6130.37,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,7066.96,3533.48,,5441.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2208.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5229.55,74,,,Percent of Total Billed Charges,74% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5936.25,84,,,Percent of Total Billed Charges,84% of total billed charges,5794.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,6289.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5441.56,77,,,Percent of total Billed charges,77% of total billed charges,6006.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2031.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3533.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.74,6289.59,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,6888.06,3444.03,,5303.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5097.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5785.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,6130.37,89,,,Percent of total Billed Charges,89% of total Billed charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5303.81,77,,,Percent of total Billed charges,77% of total billed charges,5854.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1980.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3444.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1722.02,6130.37,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,7066.96,3533.48,,5441.56,77,,,Percent of Total Billed Charges,77% of total billed charges,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1802.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2208.43,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5229.55,74,,,Percent of Total Billed Charges,74% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,4876.2,69,,,Percent of Total Billed Charges,69% of total billed charges,5936.25,84,,,Percent of Total Billed Charges,84% of total billed charges,5794.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,6289.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5441.56,77,,,Percent of total Billed charges,77% of total billed charges,6006.92,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2031.75,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3533.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2883.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6289.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1766.74,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1766.74,6289.59,
Tocilizumab-AAZG (Tyenne) 200mg/10ml Liquid SDV,65219059210,CDM,250,RC,,,Outpatient,,,6888.06,3444.03,,5303.81,77,,,Percent of Total Billed Charges,77% of total billed charges,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1756.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2152.52,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5097.16,74,,,Percent of Total Billed Charges,74% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,4752.76,69,,,Percent of Total Billed Charges,69% of total billed charges,5785.97,84,,,Percent of Total Billed Charges,84% of total billed charges,5648.21,82,,,Percent of Total Billed Charges,82% of total billed charges ,6130.37,89,,,Percent of total Billed Charges,89% of total Billed charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5303.81,77,,,Percent of total Billed charges,77% of total billed charges,5854.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1980.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3444.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2810.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6130.37,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1722.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1722.02,6130.37,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,17370.9,8685.45,,13375.59,77,,,Percent of Total Billed Charges,77% of total billed charges,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5428.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12854.47,74,,,Percent of Total Billed Charges,74% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,14591.56,84,,,Percent of Total Billed Charges,84% of total billed charges,14244.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,15460.1,89,,,Percent of total Billed Charges,89% of total Billed charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13375.59,77,,,Percent of total Billed charges,77% of total billed charges,14765.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4994.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8685.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4342.73,15460.1,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,16925.52,8462.76,,13032.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5289.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12524.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14217.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13878.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,15063.71,89,,,Percent of total Billed Charges,89% of total Billed charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13032.65,77,,,Percent of total Billed charges,77% of total billed charges,14386.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8462.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4231.38,15063.71,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,17370.9,8685.45,,13375.59,77,,,Percent of Total Billed Charges,77% of total billed charges,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5428.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12854.47,74,,,Percent of Total Billed Charges,74% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,14591.56,84,,,Percent of Total Billed Charges,84% of total billed charges,14244.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,15460.1,89,,,Percent of total Billed Charges,89% of total Billed charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13375.59,77,,,Percent of total Billed charges,77% of total billed charges,14765.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4994.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8685.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4342.73,15460.1,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,16925.52,8462.76,,13032.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5289.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12524.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14217.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13878.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,15063.71,89,,,Percent of total Billed Charges,89% of total Billed charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13032.65,77,,,Percent of total Billed charges,77% of total billed charges,14386.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8462.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4231.38,15063.71,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,17370.9,8685.45,,13375.59,77,,,Percent of Total Billed Charges,77% of total billed charges,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5428.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12854.47,74,,,Percent of Total Billed Charges,74% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,14591.56,84,,,Percent of Total Billed Charges,84% of total billed charges,14244.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,15460.1,89,,,Percent of total Billed Charges,89% of total Billed charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13375.59,77,,,Percent of total Billed charges,77% of total billed charges,14765.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4994.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8685.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4342.73,15460.1,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,16925.52,8462.76,,13032.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5289.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12524.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14217.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13878.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,15063.71,89,,,Percent of total Billed Charges,89% of total Billed charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13032.65,77,,,Percent of total Billed charges,77% of total billed charges,14386.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8462.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4231.38,15063.71,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,17370.9,8685.45,,13375.59,77,,,Percent of Total Billed Charges,77% of total billed charges,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5428.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12854.47,74,,,Percent of Total Billed Charges,74% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,14591.56,84,,,Percent of Total Billed Charges,84% of total billed charges,14244.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,15460.1,89,,,Percent of total Billed Charges,89% of total Billed charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13375.59,77,,,Percent of total Billed charges,77% of total billed charges,14765.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4994.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8685.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4342.73,15460.1,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,16925.52,8462.76,,13032.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5289.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12524.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14217.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13878.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,15063.71,89,,,Percent of total Billed Charges,89% of total Billed charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13032.65,77,,,Percent of total Billed charges,77% of total billed charges,14386.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8462.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4231.38,15063.71,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,17370.9,8685.45,,13375.59,77,,,Percent of Total Billed Charges,77% of total billed charges,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5428.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12854.47,74,,,Percent of Total Billed Charges,74% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,14591.56,84,,,Percent of Total Billed Charges,84% of total billed charges,14244.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,15460.1,89,,,Percent of total Billed Charges,89% of total Billed charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13375.59,77,,,Percent of total Billed charges,77% of total billed charges,14765.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4994.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8685.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4342.73,15460.1,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,16925.52,8462.76,,13032.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5289.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12524.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14217.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13878.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,15063.71,89,,,Percent of total Billed Charges,89% of total Billed charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13032.65,77,,,Percent of total Billed charges,77% of total billed charges,14386.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8462.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4231.38,15063.71,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,17370.9,8685.45,,13375.59,77,,,Percent of Total Billed Charges,77% of total billed charges,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4429.58,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5428.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12854.47,74,,,Percent of Total Billed Charges,74% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,11985.92,69,,,Percent of Total Billed Charges,69% of total billed charges,14591.56,84,,,Percent of Total Billed Charges,84% of total billed charges,14244.14,82,,,Percent of Total Billed Charges,82% of total billed charges ,15460.1,89,,,Percent of total Billed Charges,89% of total Billed charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13375.59,77,,,Percent of total Billed charges,77% of total billed charges,14765.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4994.13,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8685.45,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7087.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15460.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4342.73,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4342.73,15460.1,
Tocilizumab (Actemra) 400mg/20ml Liquid SDV,50242013701,CDM,250,RC,,,Outpatient,,,16925.52,8462.76,,13032.65,77,,,Percent of Total Billed Charges,77% of total billed charges,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4316.01,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5289.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12524.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,11678.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14217.44,84,,,Percent of Total Billed Charges,84% of total billed charges,13878.93,82,,,Percent of Total Billed Charges,82% of total billed charges ,15063.71,89,,,Percent of total Billed Charges,89% of total Billed charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13032.65,77,,,Percent of total Billed charges,77% of total billed charges,14386.69,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4866.09,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8462.76,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6905.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15063.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4231.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4231.38,15063.71,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13984.42,6992.21,,10768,77,,,Percent of Total Billed Charges,77% of total billed charges,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4370.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10348.47,74,,,Percent of Total Billed Charges,74% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,11746.91,84,,,Percent of Total Billed Charges,84% of total billed charges,11467.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,12446.13,89,,,Percent of total Billed Charges,89% of total Billed charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10768,77,,,Percent of total Billed charges,77% of total billed charges,11886.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4020.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6992.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3496.11,12446.13,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13626.62,6813.31,,10492.5,77,,,Percent of Total Billed Charges,77% of total billed charges,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4258.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10083.7,74,,,Percent of Total Billed Charges,74% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11446.36,84,,,Percent of Total Billed Charges,84% of total billed charges,11173.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,12127.69,89,,,Percent of total Billed Charges,89% of total Billed charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10492.5,77,,,Percent of total Billed charges,77% of total billed charges,11582.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3917.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6813.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3406.66,12127.69,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13984.42,6992.21,,10768,77,,,Percent of Total Billed Charges,77% of total billed charges,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4370.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10348.47,74,,,Percent of Total Billed Charges,74% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,11746.91,84,,,Percent of Total Billed Charges,84% of total billed charges,11467.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,12446.13,89,,,Percent of total Billed Charges,89% of total Billed charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10768,77,,,Percent of total Billed charges,77% of total billed charges,11886.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4020.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6992.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3496.11,12446.13,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13626.62,6813.31,,10492.5,77,,,Percent of Total Billed Charges,77% of total billed charges,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4258.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10083.7,74,,,Percent of Total Billed Charges,74% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11446.36,84,,,Percent of Total Billed Charges,84% of total billed charges,11173.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,12127.69,89,,,Percent of total Billed Charges,89% of total Billed charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10492.5,77,,,Percent of total Billed charges,77% of total billed charges,11582.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3917.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6813.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3406.66,12127.69,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13984.42,6992.21,,10768,77,,,Percent of Total Billed Charges,77% of total billed charges,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4370.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10348.47,74,,,Percent of Total Billed Charges,74% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,11746.91,84,,,Percent of Total Billed Charges,84% of total billed charges,11467.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,12446.13,89,,,Percent of total Billed Charges,89% of total Billed charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10768,77,,,Percent of total Billed charges,77% of total billed charges,11886.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4020.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6992.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3496.11,12446.13,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13626.62,6813.31,,10492.5,77,,,Percent of Total Billed Charges,77% of total billed charges,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4258.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10083.7,74,,,Percent of Total Billed Charges,74% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11446.36,84,,,Percent of Total Billed Charges,84% of total billed charges,11173.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,12127.69,89,,,Percent of total Billed Charges,89% of total Billed charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10492.5,77,,,Percent of total Billed charges,77% of total billed charges,11582.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3917.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6813.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3406.66,12127.69,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13984.42,6992.21,,10768,77,,,Percent of Total Billed Charges,77% of total billed charges,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4370.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10348.47,74,,,Percent of Total Billed Charges,74% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,11746.91,84,,,Percent of Total Billed Charges,84% of total billed charges,11467.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,12446.13,89,,,Percent of total Billed Charges,89% of total Billed charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10768,77,,,Percent of total Billed charges,77% of total billed charges,11886.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4020.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6992.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3496.11,12446.13,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13626.62,6813.31,,10492.5,77,,,Percent of Total Billed Charges,77% of total billed charges,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4258.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10083.7,74,,,Percent of Total Billed Charges,74% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11446.36,84,,,Percent of Total Billed Charges,84% of total billed charges,11173.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,12127.69,89,,,Percent of total Billed Charges,89% of total Billed charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10492.5,77,,,Percent of total Billed charges,77% of total billed charges,11582.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3917.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6813.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3406.66,12127.69,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13984.42,6992.21,,10768,77,,,Percent of Total Billed Charges,77% of total billed charges,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4370.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10348.47,74,,,Percent of Total Billed Charges,74% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,11746.91,84,,,Percent of Total Billed Charges,84% of total billed charges,11467.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,12446.13,89,,,Percent of total Billed Charges,89% of total Billed charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10768,77,,,Percent of total Billed charges,77% of total billed charges,11886.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4020.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6992.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3496.11,12446.13,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13626.62,6813.31,,10492.5,77,,,Percent of Total Billed Charges,77% of total billed charges,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4258.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10083.7,74,,,Percent of Total Billed Charges,74% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11446.36,84,,,Percent of Total Billed Charges,84% of total billed charges,11173.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,12127.69,89,,,Percent of total Billed Charges,89% of total Billed charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10492.5,77,,,Percent of total Billed charges,77% of total billed charges,11582.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3917.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6813.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3406.66,12127.69,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13984.42,6992.21,,10768,77,,,Percent of Total Billed Charges,77% of total billed charges,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3566.03,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4370.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10348.47,74,,,Percent of Total Billed Charges,74% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,9649.25,69,,,Percent of Total Billed Charges,69% of total billed charges,11746.91,84,,,Percent of Total Billed Charges,84% of total billed charges,11467.22,82,,,Percent of Total Billed Charges,82% of total billed charges ,12446.13,89,,,Percent of total Billed Charges,89% of total Billed charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10768,77,,,Percent of total Billed charges,77% of total billed charges,11886.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4020.52,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6992.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5705.64,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12446.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3496.11,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3496.11,12446.13,
Tocilizumab-AAZG (Tyenne) 400mg/20ml Liquid Vial,65219059420,CDM,250,RC,,,Outpatient,,,13626.62,6813.31,,10492.5,77,,,Percent of Total Billed Charges,77% of total billed charges,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3474.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4258.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,10083.7,74,,,Percent of Total Billed Charges,74% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,9402.37,69,,,Percent of Total Billed Charges,69% of total billed charges,11446.36,84,,,Percent of Total Billed Charges,84% of total billed charges,11173.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,12127.69,89,,,Percent of total Billed Charges,89% of total Billed charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10492.5,77,,,Percent of total Billed charges,77% of total billed charges,11582.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3917.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6813.31,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5559.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12127.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3406.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3406.66,12127.69,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3901.83,1950.92,,3004.41,77,,,Percent of Total Billed Charges,77% of total billed charges,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1219.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2887.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3277.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3199.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,3472.63,89,,,Percent of total Billed Charges,89% of total Billed charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3004.41,77,,,Percent of total Billed charges,77% of total billed charges,3316.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1121.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1950.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.46,3472.63,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3804.78,1902.39,,2929.68,77,,,Percent of Total Billed Charges,77% of total billed charges,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1188.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2815.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,3196.02,84,,,Percent of Total Billed Charges,84% of total billed charges,3119.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,3386.25,89,,,Percent of total Billed Charges,89% of total Billed charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.68,77,,,Percent of total Billed charges,77% of total billed charges,3234.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1093.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1902.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.2,3386.25,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3901.83,1950.92,,3004.41,77,,,Percent of Total Billed Charges,77% of total billed charges,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1219.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2887.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3277.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3199.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,3472.63,89,,,Percent of total Billed Charges,89% of total Billed charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3004.41,77,,,Percent of total Billed charges,77% of total billed charges,3316.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1121.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1950.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.46,3472.63,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3804.78,1902.39,,2929.68,77,,,Percent of Total Billed Charges,77% of total billed charges,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1188.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2815.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,3196.02,84,,,Percent of Total Billed Charges,84% of total billed charges,3119.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,3386.25,89,,,Percent of total Billed Charges,89% of total Billed charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.68,77,,,Percent of total Billed charges,77% of total billed charges,3234.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1093.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1902.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.2,3386.25,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3901.83,1950.92,,3004.41,77,,,Percent of Total Billed Charges,77% of total billed charges,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1219.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2887.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3277.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3199.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,3472.63,89,,,Percent of total Billed Charges,89% of total Billed charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3004.41,77,,,Percent of total Billed charges,77% of total billed charges,3316.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1121.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1950.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.46,3472.63,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3804.78,1902.39,,2929.68,77,,,Percent of Total Billed Charges,77% of total billed charges,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1188.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2815.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,3196.02,84,,,Percent of Total Billed Charges,84% of total billed charges,3119.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,3386.25,89,,,Percent of total Billed Charges,89% of total Billed charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.68,77,,,Percent of total Billed charges,77% of total billed charges,3234.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1093.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1902.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.2,3386.25,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3901.83,1950.92,,3004.41,77,,,Percent of Total Billed Charges,77% of total billed charges,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1219.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2887.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3277.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3199.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,3472.63,89,,,Percent of total Billed Charges,89% of total Billed charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3004.41,77,,,Percent of total Billed charges,77% of total billed charges,3316.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1121.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1950.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.46,3472.63,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3804.78,1902.39,,2929.68,77,,,Percent of Total Billed Charges,77% of total billed charges,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1188.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2815.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,3196.02,84,,,Percent of Total Billed Charges,84% of total billed charges,3119.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,3386.25,89,,,Percent of total Billed Charges,89% of total Billed charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.68,77,,,Percent of total Billed charges,77% of total billed charges,3234.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1093.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1902.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.2,3386.25,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3901.83,1950.92,,3004.41,77,,,Percent of Total Billed Charges,77% of total billed charges,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1219.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2887.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3277.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3199.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,3472.63,89,,,Percent of total Billed Charges,89% of total Billed charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3004.41,77,,,Percent of total Billed charges,77% of total billed charges,3316.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1121.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1950.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.46,3472.63,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3804.78,1902.39,,2929.68,77,,,Percent of Total Billed Charges,77% of total billed charges,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1188.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2815.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,3196.02,84,,,Percent of Total Billed Charges,84% of total billed charges,3119.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,3386.25,89,,,Percent of total Billed Charges,89% of total Billed charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.68,77,,,Percent of total Billed charges,77% of total billed charges,3234.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1093.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1902.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.2,3386.25,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3901.83,1950.92,,3004.41,77,,,Percent of Total Billed Charges,77% of total billed charges,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,994.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1219.32,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2887.35,74,,,Percent of Total Billed Charges,74% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2692.26,69,,,Percent of Total Billed Charges,69% of total billed charges,3277.54,84,,,Percent of Total Billed Charges,84% of total billed charges,3199.5,82,,,Percent of Total Billed Charges,82% of total billed charges ,3472.63,89,,,Percent of total Billed Charges,89% of total Billed charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3004.41,77,,,Percent of total Billed charges,77% of total billed charges,3316.56,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1121.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1950.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1591.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3472.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,975.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,975.46,3472.63,
Tocilizumab (Actemra) 80mg/4ml Liquid SDV,50242013501,CDM,250,RC,,,Outpatient,,,3804.78,1902.39,,2929.68,77,,,Percent of Total Billed Charges,77% of total billed charges,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,970.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1188.99,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2815.54,74,,,Percent of Total Billed Charges,74% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,2625.3,69,,,Percent of Total Billed Charges,69% of total billed charges,3196.02,84,,,Percent of Total Billed Charges,84% of total billed charges,3119.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,3386.25,89,,,Percent of total Billed Charges,89% of total Billed charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.68,77,,,Percent of total Billed charges,77% of total billed charges,3234.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1093.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1902.39,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1552.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3386.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,951.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,951.2,3386.25,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2916.48,1458.24,,2245.69,77,,,Percent of Total Billed Charges,77% of total billed charges,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2449.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2391.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,2595.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2245.69,77,,,Percent of total Billed charges,77% of total billed charges,2479.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.12,2595.67,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2844.92,1422.46,,2190.59,77,,,Percent of Total Billed Charges,77% of total billed charges,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,889.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2105.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2389.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2332.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2531.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2190.59,77,,,Percent of total Billed charges,77% of total billed charges,2418.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1422.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.23,2531.98,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2916.48,1458.24,,2245.69,77,,,Percent of Total Billed Charges,77% of total billed charges,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2449.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2391.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,2595.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2245.69,77,,,Percent of total Billed charges,77% of total billed charges,2479.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.12,2595.67,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2844.92,1422.46,,2190.59,77,,,Percent of Total Billed Charges,77% of total billed charges,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,889.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2105.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2389.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2332.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2531.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2190.59,77,,,Percent of total Billed charges,77% of total billed charges,2418.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1422.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.23,2531.98,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2916.48,1458.24,,2245.69,77,,,Percent of Total Billed Charges,77% of total billed charges,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2449.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2391.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,2595.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2245.69,77,,,Percent of total Billed charges,77% of total billed charges,2479.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.12,2595.67,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2844.92,1422.46,,2190.59,77,,,Percent of Total Billed Charges,77% of total billed charges,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,889.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2105.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2389.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2332.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2531.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2190.59,77,,,Percent of total Billed charges,77% of total billed charges,2418.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1422.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.23,2531.98,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2916.48,1458.24,,2245.69,77,,,Percent of Total Billed Charges,77% of total billed charges,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2449.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2391.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,2595.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2245.69,77,,,Percent of total Billed charges,77% of total billed charges,2479.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.12,2595.67,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2844.92,1422.46,,2190.59,77,,,Percent of Total Billed Charges,77% of total billed charges,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,889.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2105.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2389.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2332.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2531.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2190.59,77,,,Percent of total Billed charges,77% of total billed charges,2418.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1422.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.23,2531.98,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2916.48,1458.24,,2245.69,77,,,Percent of Total Billed Charges,77% of total billed charges,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2449.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2391.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,2595.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2245.69,77,,,Percent of total Billed charges,77% of total billed charges,2479.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.12,2595.67,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2844.92,1422.46,,2190.59,77,,,Percent of Total Billed Charges,77% of total billed charges,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,889.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2105.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2389.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2332.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2531.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2190.59,77,,,Percent of total Billed charges,77% of total billed charges,2418.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1422.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.23,2531.98,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2916.48,1458.24,,2245.69,77,,,Percent of Total Billed Charges,77% of total billed charges,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,743.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,911.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2158.2,74,,,Percent of Total Billed Charges,74% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2012.37,69,,,Percent of Total Billed Charges,69% of total billed charges,2449.84,84,,,Percent of Total Billed Charges,84% of total billed charges,2391.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,2595.67,89,,,Percent of total Billed Charges,89% of total Billed charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2245.69,77,,,Percent of total Billed charges,77% of total billed charges,2479.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,838.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1458.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1189.92,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2595.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,729.12,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,729.12,2595.67,
Tocilizumab-AAZG (Tyenne) 80mg/4ml Liquid Vial,65219059004,CDM,250,RC,,,Outpatient,,,2844.92,1422.46,,2190.59,77,,,Percent of Total Billed Charges,77% of total billed charges,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,725.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,889.04,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2105.24,74,,,Percent of Total Billed Charges,74% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,1962.99,69,,,Percent of Total Billed Charges,69% of total billed charges,2389.73,84,,,Percent of Total Billed Charges,84% of total billed charges,2332.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,2531.98,89,,,Percent of total Billed Charges,89% of total Billed charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2190.59,77,,,Percent of total Billed charges,77% of total billed charges,2418.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,817.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1422.46,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1160.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2531.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,711.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,711.23,2531.98,
Tolvaptan 15mg Tablet,59148002050,CDM,250,RC,,,Outpatient,,,1869.6,934.8,,1439.59,77,,,Percent of Total Billed Charges,77% of total billed charges,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1383.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1570.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1533.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1663.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.59,77,,,Percent of total Billed charges,77% of total billed charges,1589.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,934.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.4,1663.94,
Tolvaptan 15mg Tablet,59148002050,CDM,250,RC,,,Outpatient,,,1869.6,934.8,,1439.59,77,,,Percent of Total Billed Charges,77% of total billed charges,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1383.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1570.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1533.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1663.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.59,77,,,Percent of total Billed charges,77% of total billed charges,1589.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,934.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.4,1663.94,
Tolvaptan 15mg Tablet,59148002050,CDM,250,RC,,,Outpatient,,,1869.6,934.8,,1439.59,77,,,Percent of Total Billed Charges,77% of total billed charges,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1383.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1570.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1533.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1663.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.59,77,,,Percent of total Billed charges,77% of total billed charges,1589.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,934.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.4,1663.94,
Tolvaptan 15mg Tablet,59148002050,CDM,250,RC,,,Outpatient,,,1869.6,934.8,,1439.59,77,,,Percent of Total Billed Charges,77% of total billed charges,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1383.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1570.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1533.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1663.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.59,77,,,Percent of total Billed charges,77% of total billed charges,1589.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,934.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.4,1663.94,
Tolvaptan 15mg Tablet,59148002050,CDM,250,RC,,,Outpatient,,,1869.6,934.8,,1439.59,77,,,Percent of Total Billed Charges,77% of total billed charges,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1383.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1570.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1533.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1663.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.59,77,,,Percent of total Billed charges,77% of total billed charges,1589.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,934.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.4,1663.94,
Tolvaptan 15mg Tablet,59148002050,CDM,250,RC,,,Outpatient,,,1869.6,934.8,,1439.59,77,,,Percent of Total Billed Charges,77% of total billed charges,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,476.75,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,584.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1383.5,74,,,Percent of Total Billed Charges,74% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1290.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1570.46,84,,,Percent of Total Billed Charges,84% of total billed charges,1533.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1663.94,89,,,Percent of total Billed Charges,89% of total Billed charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1439.59,77,,,Percent of total Billed charges,77% of total billed charges,1589.16,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,537.51,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,934.8,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,762.8,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1663.94,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,467.4,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,467.4,1663.94,
Topiramate 200mg Tablet,50458064265,CDM,250,RC,,,Outpatient,,,152.72,76.36,,117.59,77,,,Percent of Total Billed Charges,77% of total billed charges,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.01,74,,,Percent of Total Billed Charges,74% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,128.28,84,,,Percent of Total Billed Charges,84% of total billed charges,125.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.92,89,,,Percent of total Billed Charges,89% of total Billed charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.59,77,,,Percent of total Billed charges,77% of total billed charges,129.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.18,135.92,
Topiramate 200mg Tablet,50458064265,CDM,250,RC,,,Outpatient,,,152.72,76.36,,117.59,77,,,Percent of Total Billed Charges,77% of total billed charges,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.01,74,,,Percent of Total Billed Charges,74% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,128.28,84,,,Percent of Total Billed Charges,84% of total billed charges,125.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.92,89,,,Percent of total Billed Charges,89% of total Billed charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.59,77,,,Percent of total Billed charges,77% of total billed charges,129.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.18,135.92,
Topiramate 200mg Tablet,50458064265,CDM,250,RC,,,Outpatient,,,152.72,76.36,,117.59,77,,,Percent of Total Billed Charges,77% of total billed charges,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.01,74,,,Percent of Total Billed Charges,74% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,128.28,84,,,Percent of Total Billed Charges,84% of total billed charges,125.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.92,89,,,Percent of total Billed Charges,89% of total Billed charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.59,77,,,Percent of total Billed charges,77% of total billed charges,129.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.18,135.92,
Topiramate 200mg Tablet,50458064265,CDM,250,RC,,,Outpatient,,,152.72,76.36,,117.59,77,,,Percent of Total Billed Charges,77% of total billed charges,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.01,74,,,Percent of Total Billed Charges,74% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,128.28,84,,,Percent of Total Billed Charges,84% of total billed charges,125.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.92,89,,,Percent of total Billed Charges,89% of total Billed charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.59,77,,,Percent of total Billed charges,77% of total billed charges,129.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.18,135.92,
Topiramate 200mg Tablet,50458064265,CDM,250,RC,,,Outpatient,,,152.72,76.36,,117.59,77,,,Percent of Total Billed Charges,77% of total billed charges,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.01,74,,,Percent of Total Billed Charges,74% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,128.28,84,,,Percent of Total Billed Charges,84% of total billed charges,125.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.92,89,,,Percent of total Billed Charges,89% of total Billed charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.59,77,,,Percent of total Billed charges,77% of total billed charges,129.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.18,135.92,
Topiramate 200mg Tablet,50458064265,CDM,250,RC,,,Outpatient,,,152.72,76.36,,117.59,77,,,Percent of Total Billed Charges,77% of total billed charges,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,38.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,47.73,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,113.01,74,,,Percent of Total Billed Charges,74% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,105.38,69,,,Percent of Total Billed Charges,69% of total billed charges,128.28,84,,,Percent of Total Billed Charges,84% of total billed charges,125.23,82,,,Percent of Total Billed Charges,82% of total billed charges ,135.92,89,,,Percent of total Billed Charges,89% of total Billed charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.59,77,,,Percent of total Billed charges,77% of total billed charges,129.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,43.91,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,76.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,62.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,135.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.18,135.92,
Topiramate 25mg Tablet,50458063965,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Topiramate 25mg Tablet,50458063965,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Topiramate 25mg Tablet,50458063965,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Topiramate 25mg Tablet,50458063965,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Topiramate 25mg Tablet,50458063965,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Topiramate 25mg Tablet,50458063965,CDM,250,RC,,,Outpatient,,,62.67,31.34,,48.26,77,,,Percent of Total Billed Charges,77% of total billed charges,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.98,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,19.58,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,46.38,74,,,Percent of Total Billed Charges,74% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,43.24,69,,,Percent of Total Billed Charges,69% of total billed charges,52.64,84,,,Percent of Total Billed Charges,84% of total billed charges,51.39,82,,,Percent of Total Billed Charges,82% of total billed charges ,55.78,89,,,Percent of total Billed Charges,89% of total Billed charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.26,77,,,Percent of total Billed charges,77% of total billed charges,53.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,18.02,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,31.34,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,25.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.78,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.67,55.78,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2709.82,1354.91,,2086.56,77,,,Percent of Total Billed Charges,77% of total billed charges,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.27,74,,,Percent of Total Billed Charges,74% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.25,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2411.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.56,77,,,Percent of total Billed charges,77% of total billed charges,2303.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1354.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.46,2411.74,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2614.87,1307.44,,2013.45,77,,,Percent of Total Billed Charges,77% of total billed charges,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1935,74,,,Percent of Total Billed Charges,74% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2144.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,2327.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.45,77,,,Percent of total Billed charges,77% of total billed charges,2222.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1307.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.72,2327.23,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2709.82,1354.91,,2086.56,77,,,Percent of Total Billed Charges,77% of total billed charges,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.27,74,,,Percent of Total Billed Charges,74% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.25,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2411.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.56,77,,,Percent of total Billed charges,77% of total billed charges,2303.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1354.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.46,2411.74,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2614.87,1307.44,,2013.45,77,,,Percent of Total Billed Charges,77% of total billed charges,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1935,74,,,Percent of Total Billed Charges,74% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2144.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,2327.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.45,77,,,Percent of total Billed charges,77% of total billed charges,2222.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1307.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.72,2327.23,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2709.82,1354.91,,2086.56,77,,,Percent of Total Billed Charges,77% of total billed charges,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.27,74,,,Percent of Total Billed Charges,74% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.25,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2411.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.56,77,,,Percent of total Billed charges,77% of total billed charges,2303.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1354.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.46,2411.74,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2614.87,1307.44,,2013.45,77,,,Percent of Total Billed Charges,77% of total billed charges,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1935,74,,,Percent of Total Billed Charges,74% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2144.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,2327.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.45,77,,,Percent of total Billed charges,77% of total billed charges,2222.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1307.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.72,2327.23,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2709.82,1354.91,,2086.56,77,,,Percent of Total Billed Charges,77% of total billed charges,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.27,74,,,Percent of Total Billed Charges,74% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.25,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2411.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.56,77,,,Percent of total Billed charges,77% of total billed charges,2303.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1354.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.46,2411.74,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2614.87,1307.44,,2013.45,77,,,Percent of Total Billed Charges,77% of total billed charges,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1935,74,,,Percent of Total Billed Charges,74% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2144.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,2327.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.45,77,,,Percent of total Billed charges,77% of total billed charges,2222.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1307.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.72,2327.23,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2709.82,1354.91,,2086.56,77,,,Percent of Total Billed Charges,77% of total billed charges,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.27,74,,,Percent of Total Billed Charges,74% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.25,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2411.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.56,77,,,Percent of total Billed charges,77% of total billed charges,2303.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1354.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.46,2411.74,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2614.87,1307.44,,2013.45,77,,,Percent of Total Billed Charges,77% of total billed charges,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1935,74,,,Percent of Total Billed Charges,74% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2144.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,2327.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.45,77,,,Percent of total Billed charges,77% of total billed charges,2222.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1307.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.72,2327.23,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2709.82,1354.91,,2086.56,77,,,Percent of Total Billed Charges,77% of total billed charges,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,691,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,846.82,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2005.27,74,,,Percent of Total Billed Charges,74% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,1869.78,69,,,Percent of Total Billed Charges,69% of total billed charges,2276.25,84,,,Percent of Total Billed Charges,84% of total billed charges,2222.05,82,,,Percent of Total Billed Charges,82% of total billed charges ,2411.74,89,,,Percent of total Billed Charges,89% of total Billed charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2086.56,77,,,Percent of total Billed charges,77% of total billed charges,2303.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,779.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1354.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1105.61,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2411.74,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,677.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,677.46,2411.74,
Topotecan 4mg/4ml Powder SDV,16729015131,CDM,250,RC,,,Outpatient,,,2614.87,1307.44,,2013.45,77,,,Percent of Total Billed Charges,77% of total billed charges,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,666.79,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,817.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1935,74,,,Percent of Total Billed Charges,74% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,1804.26,69,,,Percent of Total Billed Charges,69% of total billed charges,2196.49,84,,,Percent of Total Billed Charges,84% of total billed charges,2144.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,2327.23,89,,,Percent of total Billed Charges,89% of total Billed charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2013.45,77,,,Percent of total Billed charges,77% of total billed charges,2222.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,751.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1307.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1066.87,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2327.23,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,653.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,653.72,2327.23,
Torsemide 20mg Tablet,31722053101,CDM,250,RC,,,Outpatient,,,12.7,6.35,,9.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.4,74,,,Percent of Total Billed Charges,74% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.67,84,,,Percent of Total Billed Charges,84% of total billed charges,10.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.3,89,,,Percent of total Billed Charges,89% of total Billed charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.78,77,,,Percent of total Billed charges,77% of total billed charges,10.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.18,11.3,
Torsemide 20mg Tablet,31722053101,CDM,250,RC,,,Outpatient,,,12.7,6.35,,9.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.4,74,,,Percent of Total Billed Charges,74% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.67,84,,,Percent of Total Billed Charges,84% of total billed charges,10.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.3,89,,,Percent of total Billed Charges,89% of total Billed charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.78,77,,,Percent of total Billed charges,77% of total billed charges,10.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.18,11.3,
Torsemide 20mg Tablet,31722053101,CDM,250,RC,,,Outpatient,,,12.7,6.35,,9.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.4,74,,,Percent of Total Billed Charges,74% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.67,84,,,Percent of Total Billed Charges,84% of total billed charges,10.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.3,89,,,Percent of total Billed Charges,89% of total Billed charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.78,77,,,Percent of total Billed charges,77% of total billed charges,10.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.18,11.3,
Torsemide 20mg Tablet,31722053101,CDM,250,RC,,,Outpatient,,,12.7,6.35,,9.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.4,74,,,Percent of Total Billed Charges,74% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.67,84,,,Percent of Total Billed Charges,84% of total billed charges,10.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.3,89,,,Percent of total Billed Charges,89% of total Billed charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.78,77,,,Percent of total Billed charges,77% of total billed charges,10.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.18,11.3,
Torsemide 20mg Tablet,31722053101,CDM,250,RC,,,Outpatient,,,12.7,6.35,,9.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.4,74,,,Percent of Total Billed Charges,74% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.67,84,,,Percent of Total Billed Charges,84% of total billed charges,10.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.3,89,,,Percent of total Billed Charges,89% of total Billed charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.78,77,,,Percent of total Billed charges,77% of total billed charges,10.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.18,11.3,
Torsemide 20mg Tablet,31722053101,CDM,250,RC,,,Outpatient,,,12.7,6.35,,9.78,77,,,Percent of Total Billed Charges,77% of total billed charges,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.24,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.4,74,,,Percent of Total Billed Charges,74% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,8.76,69,,,Percent of Total Billed Charges,69% of total billed charges,10.67,84,,,Percent of Total Billed Charges,84% of total billed charges,10.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.3,89,,,Percent of total Billed Charges,89% of total Billed charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.78,77,,,Percent of total Billed charges,77% of total billed charges,10.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.18,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.3,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.18,11.3,
traMADol 50mg Tablet,51079099120,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
traMADol 50mg Tablet,51079099120,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
traMADol 50mg Tablet,51079099120,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
traMADol 50mg Tablet,51079099120,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
traMADol 50mg Tablet,51079099120,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
traMADol 50mg Tablet,51079099120,CDM,250,RC,,,Outpatient,,,12.51,6.26,,9.63,77,,,Percent of Total Billed Charges,77% of total billed charges,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.91,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,9.26,74,,,Percent of Total Billed Charges,74% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8.63,69,,,Percent of Total Billed Charges,69% of total billed charges,10.51,84,,,Percent of Total Billed Charges,84% of total billed charges,10.26,82,,,Percent of Total Billed Charges,82% of total billed charges ,11.13,89,,,Percent of total Billed Charges,89% of total Billed charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,77,,,Percent of total Billed charges,77% of total billed charges,10.63,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.6,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,6.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,5.1,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.13,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.13,11.13,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid 1,000mg/10ml SDV",13111401,CDM,250,RC,,,Outpatient,,,312.34,156.17,,240.5,77,,,Percent of Total Billed Charges,77% of total billed charges,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,79.65,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,97.61,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,231.13,74,,,Percent of Total Billed Charges,74% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,215.51,69,,,Percent of Total Billed Charges,69% of total billed charges,262.37,84,,,Percent of Total Billed Charges,84% of total billed charges,256.12,82,,,Percent of Total Billed Charges,82% of total billed charges ,277.98,89,,,Percent of total Billed Charges,89% of total Billed charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,240.5,77,,,Percent of total Billed charges,77% of total billed charges,265.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,89.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,156.17,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,127.43,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,277.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.09,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.09,277.98,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
"Tranexamic Acid in NS 1,000mg/100ml IV Bag",51754010801,CDM,250,RC,,,Outpatient,,,282.08,141.04,,217.2,77,,,Percent of Total Billed Charges,77% of total billed charges,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,71.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,208.74,74,,,Percent of Total Billed Charges,74% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,194.64,69,,,Percent of Total Billed Charges,69% of total billed charges,236.95,84,,,Percent of Total Billed Charges,84% of total billed charges,231.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.05,89,,,Percent of total Billed Charges,89% of total Billed charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.2,77,,,Percent of total Billed charges,77% of total billed charges,239.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.1,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.52,251.05,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8734.69,4367.35,,6725.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2729.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6463.67,74,,,Percent of Total Billed Charges,74% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7337.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7162.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,7773.87,89,,,Percent of total Billed Charges,89% of total Billed charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6725.71,77,,,Percent of total Billed charges,77% of total billed charges,7424.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2511.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4367.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2183.67,7773.87,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8513.43,4256.72,,6555.34,77,,,Percent of Total Billed Charges,77% of total billed charges,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2660.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6299.94,74,,,Percent of Total Billed Charges,74% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7151.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6981.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,7576.95,89,,,Percent of total Billed Charges,89% of total Billed charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6555.34,77,,,Percent of total Billed charges,77% of total billed charges,7236.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2447.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4256.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2128.36,7576.95,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8734.69,4367.35,,6725.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2729.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6463.67,74,,,Percent of Total Billed Charges,74% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7337.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7162.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,7773.87,89,,,Percent of total Billed Charges,89% of total Billed charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6725.71,77,,,Percent of total Billed charges,77% of total billed charges,7424.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2511.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4367.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2183.67,7773.87,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8513.43,4256.72,,6555.34,77,,,Percent of Total Billed Charges,77% of total billed charges,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2660.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6299.94,74,,,Percent of Total Billed Charges,74% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7151.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6981.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,7576.95,89,,,Percent of total Billed Charges,89% of total Billed charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6555.34,77,,,Percent of total Billed charges,77% of total billed charges,7236.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2447.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4256.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2128.36,7576.95,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8734.69,4367.35,,6725.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2729.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6463.67,74,,,Percent of Total Billed Charges,74% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7337.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7162.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,7773.87,89,,,Percent of total Billed Charges,89% of total Billed charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6725.71,77,,,Percent of total Billed charges,77% of total billed charges,7424.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2511.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4367.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2183.67,7773.87,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8513.43,4256.72,,6555.34,77,,,Percent of Total Billed Charges,77% of total billed charges,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2660.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6299.94,74,,,Percent of Total Billed Charges,74% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7151.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6981.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,7576.95,89,,,Percent of total Billed Charges,89% of total Billed charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6555.34,77,,,Percent of total Billed charges,77% of total billed charges,7236.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2447.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4256.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2128.36,7576.95,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8734.69,4367.35,,6725.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2729.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6463.67,74,,,Percent of Total Billed Charges,74% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7337.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7162.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,7773.87,89,,,Percent of total Billed Charges,89% of total Billed charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6725.71,77,,,Percent of total Billed charges,77% of total billed charges,7424.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2511.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4367.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2183.67,7773.87,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8513.43,4256.72,,6555.34,77,,,Percent of Total Billed Charges,77% of total billed charges,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2660.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6299.94,74,,,Percent of Total Billed Charges,74% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7151.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6981.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,7576.95,89,,,Percent of total Billed Charges,89% of total Billed charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6555.34,77,,,Percent of total Billed charges,77% of total billed charges,7236.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2447.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4256.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2128.36,7576.95,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8734.69,4367.35,,6725.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2729.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6463.67,74,,,Percent of Total Billed Charges,74% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7337.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7162.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,7773.87,89,,,Percent of total Billed Charges,89% of total Billed charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6725.71,77,,,Percent of total Billed charges,77% of total billed charges,7424.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2511.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4367.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2183.67,7773.87,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8513.43,4256.72,,6555.34,77,,,Percent of Total Billed Charges,77% of total billed charges,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2660.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6299.94,74,,,Percent of Total Billed Charges,74% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7151.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6981.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,7576.95,89,,,Percent of total Billed Charges,89% of total Billed charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6555.34,77,,,Percent of total Billed charges,77% of total billed charges,7236.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2447.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4256.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2128.36,7576.95,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8734.69,4367.35,,6725.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2227.35,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2729.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6463.67,74,,,Percent of Total Billed Charges,74% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,6026.94,69,,,Percent of Total Billed Charges,69% of total billed charges,7337.14,84,,,Percent of Total Billed Charges,84% of total billed charges,7162.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,7773.87,89,,,Percent of total Billed Charges,89% of total Billed charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6725.71,77,,,Percent of total Billed charges,77% of total billed charges,7424.49,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2511.22,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4367.35,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3563.75,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7773.87,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2183.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2183.67,7773.87,
Trastuzumab-QYYP (Trazimera) 150mg/7.14ml Powder SDV,69030801,CDM,250,RC,,,Outpatient,,,8513.43,4256.72,,6555.34,77,,,Percent of Total Billed Charges,77% of total billed charges,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2170.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2660.45,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6299.94,74,,,Percent of Total Billed Charges,74% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,5874.27,69,,,Percent of Total Billed Charges,69% of total billed charges,7151.28,84,,,Percent of Total Billed Charges,84% of total billed charges,6981.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,7576.95,89,,,Percent of total Billed Charges,89% of total Billed charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6555.34,77,,,Percent of total Billed charges,77% of total billed charges,7236.42,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2447.61,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4256.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3473.48,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7576.95,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2128.36,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2128.36,7576.95,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,11188.3,5594.15,,8614.99,77,,,Percent of Total Billed Charges,77% of total billed charges,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3496.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8279.34,74,,,Percent of Total Billed Charges,74% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,9398.17,84,,,Percent of Total Billed Charges,84% of total billed charges,9174.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9957.59,89,,,Percent of total Billed Charges,89% of total Billed charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8614.99,77,,,Percent of total Billed charges,77% of total billed charges,9510.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3216.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5594.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2797.08,9957.59,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,10903.58,5451.79,,8395.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3407.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8068.65,74,,,Percent of Total Billed Charges,74% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9159.01,84,,,Percent of Total Billed Charges,84% of total billed charges,8940.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,9704.19,89,,,Percent of total Billed Charges,89% of total Billed charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8395.76,77,,,Percent of total Billed charges,77% of total billed charges,9268.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3134.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5451.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2725.9,9704.19,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,11188.3,5594.15,,8614.99,77,,,Percent of Total Billed Charges,77% of total billed charges,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3496.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8279.34,74,,,Percent of Total Billed Charges,74% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,9398.17,84,,,Percent of Total Billed Charges,84% of total billed charges,9174.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9957.59,89,,,Percent of total Billed Charges,89% of total Billed charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8614.99,77,,,Percent of total Billed charges,77% of total billed charges,9510.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3216.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5594.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2797.08,9957.59,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,10903.58,5451.79,,8395.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3407.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8068.65,74,,,Percent of Total Billed Charges,74% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9159.01,84,,,Percent of Total Billed Charges,84% of total billed charges,8940.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,9704.19,89,,,Percent of total Billed Charges,89% of total Billed charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8395.76,77,,,Percent of total Billed charges,77% of total billed charges,9268.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3134.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5451.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2725.9,9704.19,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,11188.3,5594.15,,8614.99,77,,,Percent of Total Billed Charges,77% of total billed charges,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3496.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8279.34,74,,,Percent of Total Billed Charges,74% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,9398.17,84,,,Percent of Total Billed Charges,84% of total billed charges,9174.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9957.59,89,,,Percent of total Billed Charges,89% of total Billed charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8614.99,77,,,Percent of total Billed charges,77% of total billed charges,9510.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3216.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5594.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2797.08,9957.59,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,10903.58,5451.79,,8395.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3407.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8068.65,74,,,Percent of Total Billed Charges,74% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9159.01,84,,,Percent of Total Billed Charges,84% of total billed charges,8940.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,9704.19,89,,,Percent of total Billed Charges,89% of total Billed charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8395.76,77,,,Percent of total Billed charges,77% of total billed charges,9268.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3134.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5451.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2725.9,9704.19,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,11188.3,5594.15,,8614.99,77,,,Percent of Total Billed Charges,77% of total billed charges,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3496.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8279.34,74,,,Percent of Total Billed Charges,74% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,9398.17,84,,,Percent of Total Billed Charges,84% of total billed charges,9174.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9957.59,89,,,Percent of total Billed Charges,89% of total Billed charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8614.99,77,,,Percent of total Billed charges,77% of total billed charges,9510.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3216.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5594.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2797.08,9957.59,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,10903.58,5451.79,,8395.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3407.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8068.65,74,,,Percent of Total Billed Charges,74% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9159.01,84,,,Percent of Total Billed Charges,84% of total billed charges,8940.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,9704.19,89,,,Percent of total Billed Charges,89% of total Billed charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8395.76,77,,,Percent of total Billed charges,77% of total billed charges,9268.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3134.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5451.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2725.9,9704.19,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,11188.3,5594.15,,8614.99,77,,,Percent of Total Billed Charges,77% of total billed charges,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3496.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8279.34,74,,,Percent of Total Billed Charges,74% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,9398.17,84,,,Percent of Total Billed Charges,84% of total billed charges,9174.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9957.59,89,,,Percent of total Billed Charges,89% of total Billed charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8614.99,77,,,Percent of total Billed charges,77% of total billed charges,9510.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3216.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5594.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2797.08,9957.59,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,10903.58,5451.79,,8395.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3407.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8068.65,74,,,Percent of Total Billed Charges,74% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9159.01,84,,,Percent of Total Billed Charges,84% of total billed charges,8940.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,9704.19,89,,,Percent of total Billed Charges,89% of total Billed charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8395.76,77,,,Percent of total Billed charges,77% of total billed charges,9268.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3134.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5451.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2725.9,9704.19,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,11188.3,5594.15,,8614.99,77,,,Percent of Total Billed Charges,77% of total billed charges,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2853.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3496.34,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8279.34,74,,,Percent of Total Billed Charges,74% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,7719.93,69,,,Percent of Total Billed Charges,69% of total billed charges,9398.17,84,,,Percent of Total Billed Charges,84% of total billed charges,9174.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,9957.59,89,,,Percent of total Billed Charges,89% of total Billed charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8614.99,77,,,Percent of total Billed charges,77% of total billed charges,9510.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3216.64,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5594.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4564.83,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9957.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2797.08,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2797.08,9957.59,
Trastuzumab (Herceptin) 150mg/7.14ml Powder SDV,50242013201,CDM,250,RC,,,Outpatient,,,10903.58,5451.79,,8395.76,77,,,Percent of Total Billed Charges,77% of total billed charges,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2780.41,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3407.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8068.65,74,,,Percent of Total Billed Charges,74% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7523.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9159.01,84,,,Percent of Total Billed Charges,84% of total billed charges,8940.94,82,,,Percent of Total Billed Charges,82% of total billed charges ,9704.19,89,,,Percent of total Billed Charges,89% of total Billed charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8395.76,77,,,Percent of total Billed charges,77% of total billed charges,9268.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3134.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5451.79,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4448.66,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9704.19,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2725.9,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2725.9,9704.19,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9787.08,4893.54,,7536.05,77,,,Percent of Total Billed Charges,77% of total billed charges,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3058.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7242.44,74,,,Percent of Total Billed Charges,74% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8221.15,84,,,Percent of Total Billed Charges,84% of total billed charges,8025.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8710.5,89,,,Percent of total Billed Charges,89% of total Billed charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7536.05,77,,,Percent of total Billed charges,77% of total billed charges,8319.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2813.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4893.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.77,8710.5,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9538.59,4769.3,,7344.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.56,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.42,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.71,77,,,Percent of total Billed charges,77% of total billed charges,8107.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.65,8489.35,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9787.08,4893.54,,7536.05,77,,,Percent of Total Billed Charges,77% of total billed charges,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3058.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7242.44,74,,,Percent of Total Billed Charges,74% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8221.15,84,,,Percent of Total Billed Charges,84% of total billed charges,8025.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8710.5,89,,,Percent of total Billed Charges,89% of total Billed charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7536.05,77,,,Percent of total Billed charges,77% of total billed charges,8319.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2813.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4893.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.77,8710.5,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9538.59,4769.3,,7344.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.56,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.42,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.71,77,,,Percent of total Billed charges,77% of total billed charges,8107.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.65,8489.35,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9787.08,4893.54,,7536.05,77,,,Percent of Total Billed Charges,77% of total billed charges,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3058.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7242.44,74,,,Percent of Total Billed Charges,74% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8221.15,84,,,Percent of Total Billed Charges,84% of total billed charges,8025.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8710.5,89,,,Percent of total Billed Charges,89% of total Billed charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7536.05,77,,,Percent of total Billed charges,77% of total billed charges,8319.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2813.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4893.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.77,8710.5,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9538.59,4769.3,,7344.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.56,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.42,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.71,77,,,Percent of total Billed charges,77% of total billed charges,8107.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.65,8489.35,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9787.08,4893.54,,7536.05,77,,,Percent of Total Billed Charges,77% of total billed charges,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3058.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7242.44,74,,,Percent of Total Billed Charges,74% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8221.15,84,,,Percent of Total Billed Charges,84% of total billed charges,8025.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8710.5,89,,,Percent of total Billed Charges,89% of total Billed charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7536.05,77,,,Percent of total Billed charges,77% of total billed charges,8319.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2813.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4893.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.77,8710.5,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9538.59,4769.3,,7344.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.56,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.42,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.71,77,,,Percent of total Billed charges,77% of total billed charges,8107.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.65,8489.35,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9787.08,4893.54,,7536.05,77,,,Percent of Total Billed Charges,77% of total billed charges,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3058.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7242.44,74,,,Percent of Total Billed Charges,74% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8221.15,84,,,Percent of Total Billed Charges,84% of total billed charges,8025.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8710.5,89,,,Percent of total Billed Charges,89% of total Billed charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7536.05,77,,,Percent of total Billed charges,77% of total billed charges,8319.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2813.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4893.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.77,8710.5,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9538.59,4769.3,,7344.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.56,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.42,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.71,77,,,Percent of total Billed charges,77% of total billed charges,8107.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.65,8489.35,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9787.08,4893.54,,7536.05,77,,,Percent of Total Billed Charges,77% of total billed charges,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2495.71,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3058.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7242.44,74,,,Percent of Total Billed Charges,74% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,6753.09,69,,,Percent of Total Billed Charges,69% of total billed charges,8221.15,84,,,Percent of Total Billed Charges,84% of total billed charges,8025.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,8710.5,89,,,Percent of total Billed Charges,89% of total Billed charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7536.05,77,,,Percent of total Billed charges,77% of total billed charges,8319.02,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2813.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4893.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3993.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8710.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2446.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2446.77,8710.5,
Trastuzumab-ANNS (Kanjinti) 150mg/7.14ml Powder SDV,55513014101,CDM,250,RC,,,Outpatient,,,9538.59,4769.3,,7344.71,77,,,Percent of Total Billed Charges,77% of total billed charges,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2432.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2980.81,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7058.56,74,,,Percent of Total Billed Charges,74% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,6581.63,69,,,Percent of Total Billed Charges,69% of total billed charges,8012.42,84,,,Percent of Total Billed Charges,84% of total billed charges,7821.64,82,,,Percent of Total Billed Charges,82% of total billed charges ,8489.35,89,,,Percent of total Billed Charges,89% of total Billed charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7344.71,77,,,Percent of total Billed charges,77% of total billed charges,8107.8,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2742.34,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4769.3,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3891.74,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8489.35,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2384.65,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2384.65,8489.35,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6823.14,3411.57,,5253.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2132.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5049.12,74,,,Percent of Total Billed Charges,74% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,5731.44,84,,,Percent of Total Billed Charges,84% of total billed charges,5594.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,6072.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5253.82,77,,,Percent of total Billed charges,77% of total billed charges,5799.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1961.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3411.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1705.79,6072.59,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6651.31,3325.66,,5121.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2078.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4921.97,74,,,Percent of Total Billed Charges,74% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5587.1,84,,,Percent of Total Billed Charges,84% of total billed charges,5454.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,5919.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5121.51,77,,,Percent of total Billed charges,77% of total billed charges,5653.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1912.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3325.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1662.83,5919.67,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6823.14,3411.57,,5253.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2132.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5049.12,74,,,Percent of Total Billed Charges,74% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,5731.44,84,,,Percent of Total Billed Charges,84% of total billed charges,5594.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,6072.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5253.82,77,,,Percent of total Billed charges,77% of total billed charges,5799.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1961.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3411.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1705.79,6072.59,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6651.31,3325.66,,5121.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2078.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4921.97,74,,,Percent of Total Billed Charges,74% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5587.1,84,,,Percent of Total Billed Charges,84% of total billed charges,5454.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,5919.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5121.51,77,,,Percent of total Billed charges,77% of total billed charges,5653.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1912.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3325.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1662.83,5919.67,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6823.14,3411.57,,5253.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2132.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5049.12,74,,,Percent of Total Billed Charges,74% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,5731.44,84,,,Percent of Total Billed Charges,84% of total billed charges,5594.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,6072.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5253.82,77,,,Percent of total Billed charges,77% of total billed charges,5799.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1961.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3411.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1705.79,6072.59,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6651.31,3325.66,,5121.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2078.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4921.97,74,,,Percent of Total Billed Charges,74% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5587.1,84,,,Percent of Total Billed Charges,84% of total billed charges,5454.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,5919.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5121.51,77,,,Percent of total Billed charges,77% of total billed charges,5653.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1912.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3325.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1662.83,5919.67,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6823.14,3411.57,,5253.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2132.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5049.12,74,,,Percent of Total Billed Charges,74% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,5731.44,84,,,Percent of Total Billed Charges,84% of total billed charges,5594.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,6072.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5253.82,77,,,Percent of total Billed charges,77% of total billed charges,5799.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1961.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3411.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1705.79,6072.59,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6651.31,3325.66,,5121.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2078.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4921.97,74,,,Percent of Total Billed Charges,74% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5587.1,84,,,Percent of Total Billed Charges,84% of total billed charges,5454.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,5919.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5121.51,77,,,Percent of total Billed charges,77% of total billed charges,5653.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1912.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3325.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1662.83,5919.67,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6823.14,3411.57,,5253.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2132.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5049.12,74,,,Percent of Total Billed Charges,74% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,5731.44,84,,,Percent of Total Billed Charges,84% of total billed charges,5594.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,6072.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5253.82,77,,,Percent of total Billed charges,77% of total billed charges,5799.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1961.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3411.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1705.79,6072.59,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6651.31,3325.66,,5121.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2078.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4921.97,74,,,Percent of Total Billed Charges,74% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5587.1,84,,,Percent of Total Billed Charges,84% of total billed charges,5454.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,5919.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5121.51,77,,,Percent of total Billed charges,77% of total billed charges,5653.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1912.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3325.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1662.83,5919.67,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6823.14,3411.57,,5253.82,77,,,Percent of Total Billed Charges,77% of total billed charges,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1739.9,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2132.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5049.12,74,,,Percent of Total Billed Charges,74% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,4707.97,69,,,Percent of Total Billed Charges,69% of total billed charges,5731.44,84,,,Percent of Total Billed Charges,84% of total billed charges,5594.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,6072.59,89,,,Percent of total Billed Charges,89% of total Billed charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5253.82,77,,,Percent of total Billed charges,77% of total billed charges,5799.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1961.65,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3411.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2783.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6072.59,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1705.79,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1705.79,6072.59,
Trastuzumab-DKST (Ogivri) 150mg/7.14ml Powder SDV,,,250,RC,,,Outpatient,,,6651.31,3325.66,,5121.51,77,,,Percent of Total Billed Charges,77% of total billed charges,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1696.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2078.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4921.97,74,,,Percent of Total Billed Charges,74% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,4589.4,69,,,Percent of Total Billed Charges,69% of total billed charges,5587.1,84,,,Percent of Total Billed Charges,84% of total billed charges,5454.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,5919.67,89,,,Percent of total Billed Charges,89% of total Billed charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5121.51,77,,,Percent of total Billed charges,77% of total billed charges,5653.61,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1912.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3325.66,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2713.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5919.67,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1662.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1662.83,5919.67,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,17200.87,8600.44,,13244.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5375.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12728.64,74,,,Percent of Total Billed Charges,74% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,14448.73,84,,,Percent of Total Billed Charges,84% of total billed charges,14104.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,15308.77,89,,,Percent of total Billed Charges,89% of total Billed charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13244.67,77,,,Percent of total Billed charges,77% of total billed charges,14620.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4945.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8600.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.22,15308.77,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,16760.65,8380.33,,12905.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5237.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12402.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14078.95,84,,,Percent of Total Billed Charges,84% of total billed charges,13743.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,14916.98,89,,,Percent of total Billed Charges,89% of total Billed charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12905.7,77,,,Percent of total Billed charges,77% of total billed charges,14246.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4818.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8380.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4190.16,14916.98,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,17200.87,8600.44,,13244.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5375.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12728.64,74,,,Percent of Total Billed Charges,74% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,14448.73,84,,,Percent of Total Billed Charges,84% of total billed charges,14104.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,15308.77,89,,,Percent of total Billed Charges,89% of total Billed charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13244.67,77,,,Percent of total Billed charges,77% of total billed charges,14620.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4945.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8600.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.22,15308.77,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,16760.65,8380.33,,12905.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5237.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12402.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14078.95,84,,,Percent of Total Billed Charges,84% of total billed charges,13743.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,14916.98,89,,,Percent of total Billed Charges,89% of total Billed charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12905.7,77,,,Percent of total Billed charges,77% of total billed charges,14246.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4818.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8380.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4190.16,14916.98,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,17200.87,8600.44,,13244.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5375.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12728.64,74,,,Percent of Total Billed Charges,74% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,14448.73,84,,,Percent of Total Billed Charges,84% of total billed charges,14104.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,15308.77,89,,,Percent of total Billed Charges,89% of total Billed charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13244.67,77,,,Percent of total Billed charges,77% of total billed charges,14620.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4945.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8600.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.22,15308.77,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,16760.65,8380.33,,12905.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5237.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12402.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14078.95,84,,,Percent of Total Billed Charges,84% of total billed charges,13743.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,14916.98,89,,,Percent of total Billed Charges,89% of total Billed charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12905.7,77,,,Percent of total Billed charges,77% of total billed charges,14246.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4818.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8380.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4190.16,14916.98,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,17200.87,8600.44,,13244.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5375.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12728.64,74,,,Percent of Total Billed Charges,74% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,14448.73,84,,,Percent of Total Billed Charges,84% of total billed charges,14104.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,15308.77,89,,,Percent of total Billed Charges,89% of total Billed charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13244.67,77,,,Percent of total Billed charges,77% of total billed charges,14620.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4945.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8600.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.22,15308.77,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,16760.65,8380.33,,12905.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5237.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12402.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14078.95,84,,,Percent of Total Billed Charges,84% of total billed charges,13743.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,14916.98,89,,,Percent of total Billed Charges,89% of total Billed charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12905.7,77,,,Percent of total Billed charges,77% of total billed charges,14246.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4818.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8380.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4190.16,14916.98,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,17200.87,8600.44,,13244.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5375.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12728.64,74,,,Percent of Total Billed Charges,74% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,14448.73,84,,,Percent of Total Billed Charges,84% of total billed charges,14104.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,15308.77,89,,,Percent of total Billed Charges,89% of total Billed charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13244.67,77,,,Percent of total Billed charges,77% of total billed charges,14620.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4945.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8600.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.22,15308.77,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,16760.65,8380.33,,12905.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5237.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12402.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14078.95,84,,,Percent of Total Billed Charges,84% of total billed charges,13743.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,14916.98,89,,,Percent of total Billed Charges,89% of total Billed charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12905.7,77,,,Percent of total Billed charges,77% of total billed charges,14246.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4818.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8380.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4190.16,14916.98,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,17200.87,8600.44,,13244.67,77,,,Percent of Total Billed Charges,77% of total billed charges,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4386.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5375.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12728.64,74,,,Percent of Total Billed Charges,74% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,11868.6,69,,,Percent of Total Billed Charges,69% of total billed charges,14448.73,84,,,Percent of Total Billed Charges,84% of total billed charges,14104.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,15308.77,89,,,Percent of total Billed Charges,89% of total Billed charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13244.67,77,,,Percent of total Billed charges,77% of total billed charges,14620.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4945.25,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8600.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7017.95,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15308.77,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4300.22,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4300.22,15308.77,
Trastuzumab-DKST (Ogivri) 420mg/20ml Powder MDV,83257000412,CDM,250,RC,,,Outpatient,,,16760.65,8380.33,,12905.7,77,,,Percent of Total Billed Charges,77% of total billed charges,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4273.97,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5237.7,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,12402.88,74,,,Percent of Total Billed Charges,74% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,11564.85,69,,,Percent of Total Billed Charges,69% of total billed charges,14078.95,84,,,Percent of Total Billed Charges,84% of total billed charges,13743.73,82,,,Percent of Total Billed Charges,82% of total billed charges ,14916.98,89,,,Percent of total Billed Charges,89% of total Billed charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12905.7,77,,,Percent of total Billed charges,77% of total billed charges,14246.55,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4818.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,8380.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6838.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14916.98,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4190.16,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4190.16,14916.98,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,22168.12,11084.06,,17069.45,77,,,Percent of Total Billed Charges,77% of total billed charges,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6927.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16404.41,74,,,Percent of Total Billed Charges,74% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,18621.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19729.63,89,,,Percent of total Billed Charges,89% of total Billed charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17069.45,77,,,Percent of total Billed charges,77% of total billed charges,18842.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6373.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11084.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5542.03,19729.63,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,21599.44,10799.72,,16631.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6749.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15983.59,74,,,Percent of Total Billed Charges,74% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,18143.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19223.5,89,,,Percent of total Billed Charges,89% of total Billed charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16631.57,77,,,Percent of total Billed charges,77% of total billed charges,18359.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6209.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10799.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5399.86,19223.5,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,22168.12,11084.06,,17069.45,77,,,Percent of Total Billed Charges,77% of total billed charges,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6927.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16404.41,74,,,Percent of Total Billed Charges,74% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,18621.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19729.63,89,,,Percent of total Billed Charges,89% of total Billed charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17069.45,77,,,Percent of total Billed charges,77% of total billed charges,18842.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6373.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11084.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5542.03,19729.63,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,21599.44,10799.72,,16631.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6749.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15983.59,74,,,Percent of Total Billed Charges,74% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,18143.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19223.5,89,,,Percent of total Billed Charges,89% of total Billed charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16631.57,77,,,Percent of total Billed charges,77% of total billed charges,18359.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6209.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10799.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5399.86,19223.5,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,22168.12,11084.06,,17069.45,77,,,Percent of Total Billed Charges,77% of total billed charges,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6927.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16404.41,74,,,Percent of Total Billed Charges,74% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,18621.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19729.63,89,,,Percent of total Billed Charges,89% of total Billed charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17069.45,77,,,Percent of total Billed charges,77% of total billed charges,18842.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6373.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11084.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5542.03,19729.63,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,21599.44,10799.72,,16631.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6749.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15983.59,74,,,Percent of Total Billed Charges,74% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,18143.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19223.5,89,,,Percent of total Billed Charges,89% of total Billed charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16631.57,77,,,Percent of total Billed charges,77% of total billed charges,18359.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6209.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10799.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5399.86,19223.5,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,22168.12,11084.06,,17069.45,77,,,Percent of Total Billed Charges,77% of total billed charges,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6927.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16404.41,74,,,Percent of Total Billed Charges,74% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,18621.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19729.63,89,,,Percent of total Billed Charges,89% of total Billed charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17069.45,77,,,Percent of total Billed charges,77% of total billed charges,18842.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6373.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11084.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5542.03,19729.63,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,21599.44,10799.72,,16631.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6749.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15983.59,74,,,Percent of Total Billed Charges,74% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,18143.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19223.5,89,,,Percent of total Billed Charges,89% of total Billed charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16631.57,77,,,Percent of total Billed charges,77% of total billed charges,18359.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6209.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10799.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5399.86,19223.5,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,22168.12,11084.06,,17069.45,77,,,Percent of Total Billed Charges,77% of total billed charges,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6927.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16404.41,74,,,Percent of Total Billed Charges,74% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,18621.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19729.63,89,,,Percent of total Billed Charges,89% of total Billed charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17069.45,77,,,Percent of total Billed charges,77% of total billed charges,18842.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6373.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11084.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5542.03,19729.63,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,21599.44,10799.72,,16631.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6749.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15983.59,74,,,Percent of Total Billed Charges,74% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,18143.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19223.5,89,,,Percent of total Billed Charges,89% of total Billed charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16631.57,77,,,Percent of total Billed charges,77% of total billed charges,18359.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6209.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10799.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5399.86,19223.5,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,22168.12,11084.06,,17069.45,77,,,Percent of Total Billed Charges,77% of total billed charges,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5652.87,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6927.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,16404.41,74,,,Percent of Total Billed Charges,74% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,15296,69,,,Percent of Total Billed Charges,69% of total billed charges,18621.22,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19729.63,89,,,Percent of total Billed Charges,89% of total Billed charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17069.45,77,,,Percent of total Billed charges,77% of total billed charges,18842.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6373.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,11084.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9044.59,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19729.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5542.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5542.03,19729.63,
Trastuzumab-QYYP (Trazimera) 420mg/20ml Powder MDV,69030501,CDM,250,RC,,,Outpatient,,,21599.44,10799.72,,16631.57,77,,,Percent of Total Billed Charges,77% of total billed charges,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5507.86,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6749.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15983.59,74,,,Percent of Total Billed Charges,74% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,14903.61,69,,,Percent of Total Billed Charges,69% of total billed charges,18143.53,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,19223.5,89,,,Percent of total Billed Charges,89% of total Billed charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16631.57,77,,,Percent of total Billed charges,77% of total billed charges,18359.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6209.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10799.72,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8812.57,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19223.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5399.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5399.86,19223.5,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24872.76,12436.38,,19152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7772.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18405.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20893.12,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22136.76,89,,,Percent of total Billed Charges,89% of total Billed charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19152.03,77,,,Percent of total Billed charges,77% of total billed charges,21141.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7150.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12436.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6218.19,22136.76,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24234.13,12117.07,,18660.28,77,,,Percent of Total Billed Charges,77% of total billed charges,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7573.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17933.26,74,,,Percent of Total Billed Charges,74% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20356.67,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21568.38,89,,,Percent of total Billed Charges,89% of total Billed charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18660.28,77,,,Percent of total Billed charges,77% of total billed charges,20599.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6967.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12117.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6058.53,21568.38,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24872.76,12436.38,,19152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7772.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18405.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20893.12,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22136.76,89,,,Percent of total Billed Charges,89% of total Billed charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19152.03,77,,,Percent of total Billed charges,77% of total billed charges,21141.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7150.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12436.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6218.19,22136.76,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24234.13,12117.07,,18660.28,77,,,Percent of Total Billed Charges,77% of total billed charges,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7573.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17933.26,74,,,Percent of Total Billed Charges,74% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20356.67,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21568.38,89,,,Percent of total Billed Charges,89% of total Billed charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18660.28,77,,,Percent of total Billed charges,77% of total billed charges,20599.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6967.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12117.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6058.53,21568.38,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24872.76,12436.38,,19152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7772.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18405.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20893.12,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22136.76,89,,,Percent of total Billed Charges,89% of total Billed charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19152.03,77,,,Percent of total Billed charges,77% of total billed charges,21141.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7150.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12436.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6218.19,22136.76,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24234.13,12117.07,,18660.28,77,,,Percent of Total Billed Charges,77% of total billed charges,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7573.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17933.26,74,,,Percent of Total Billed Charges,74% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20356.67,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21568.38,89,,,Percent of total Billed Charges,89% of total Billed charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18660.28,77,,,Percent of total Billed charges,77% of total billed charges,20599.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6967.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12117.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6058.53,21568.38,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24872.76,12436.38,,19152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7772.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18405.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20893.12,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22136.76,89,,,Percent of total Billed Charges,89% of total Billed charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19152.03,77,,,Percent of total Billed charges,77% of total billed charges,21141.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7150.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12436.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6218.19,22136.76,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24234.13,12117.07,,18660.28,77,,,Percent of Total Billed Charges,77% of total billed charges,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7573.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17933.26,74,,,Percent of Total Billed Charges,74% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20356.67,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21568.38,89,,,Percent of total Billed Charges,89% of total Billed charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18660.28,77,,,Percent of total Billed charges,77% of total billed charges,20599.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6967.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12117.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6058.53,21568.38,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24872.76,12436.38,,19152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7772.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18405.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20893.12,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22136.76,89,,,Percent of total Billed Charges,89% of total Billed charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19152.03,77,,,Percent of total Billed charges,77% of total billed charges,21141.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7150.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12436.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6218.19,22136.76,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24234.13,12117.07,,18660.28,77,,,Percent of Total Billed Charges,77% of total billed charges,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7573.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17933.26,74,,,Percent of Total Billed Charges,74% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20356.67,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21568.38,89,,,Percent of total Billed Charges,89% of total Billed charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18660.28,77,,,Percent of total Billed charges,77% of total billed charges,20599.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6967.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12117.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6058.53,21568.38,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24872.76,12436.38,,19152.03,77,,,Percent of Total Billed Charges,77% of total billed charges,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6342.55,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7772.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18405.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,17162.2,69,,,Percent of Total Billed Charges,69% of total billed charges,20893.12,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,22136.76,89,,,Percent of total Billed Charges,89% of total Billed charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19152.03,77,,,Percent of total Billed charges,77% of total billed charges,21141.85,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7150.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12436.38,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10148.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22136.76,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6218.19,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6218.19,22136.76,
Trastuzumab-ANNS (Kanjinti) 420mg/20ml Powder MDV,55513013201,CDM,250,RC,,,Outpatient,,,24234.13,12117.07,,18660.28,77,,,Percent of Total Billed Charges,77% of total billed charges,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6179.7,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7573.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,17933.26,74,,,Percent of Total Billed Charges,74% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,16721.55,69,,,Percent of Total Billed Charges,69% of total billed charges,20356.67,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,21568.38,89,,,Percent of total Billed Charges,89% of total Billed charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18660.28,77,,,Percent of total Billed charges,77% of total billed charges,20599.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,6967.31,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12117.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,9887.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21568.38,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6058.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6058.53,21568.38,
Travoprost 0.004% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,711.06,355.53,,547.52,77,,,Percent of Total Billed Charges,77% of total billed charges,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.18,74,,,Percent of Total Billed Charges,74% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,597.29,84,,,Percent of Total Billed Charges,84% of total billed charges,583.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,632.84,89,,,Percent of total Billed Charges,89% of total Billed charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.52,77,,,Percent of total Billed charges,77% of total billed charges,604.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,355.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.77,632.84,
Travoprost 0.004% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,711.06,355.53,,547.52,77,,,Percent of Total Billed Charges,77% of total billed charges,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.18,74,,,Percent of Total Billed Charges,74% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,597.29,84,,,Percent of Total Billed Charges,84% of total billed charges,583.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,632.84,89,,,Percent of total Billed Charges,89% of total Billed charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.52,77,,,Percent of total Billed charges,77% of total billed charges,604.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,355.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.77,632.84,
Travoprost 0.004% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,711.06,355.53,,547.52,77,,,Percent of Total Billed Charges,77% of total billed charges,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.18,74,,,Percent of Total Billed Charges,74% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,597.29,84,,,Percent of Total Billed Charges,84% of total billed charges,583.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,632.84,89,,,Percent of total Billed Charges,89% of total Billed charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.52,77,,,Percent of total Billed charges,77% of total billed charges,604.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,355.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.77,632.84,
Travoprost 0.004% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,711.06,355.53,,547.52,77,,,Percent of Total Billed Charges,77% of total billed charges,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.18,74,,,Percent of Total Billed Charges,74% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,597.29,84,,,Percent of Total Billed Charges,84% of total billed charges,583.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,632.84,89,,,Percent of total Billed Charges,89% of total Billed charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.52,77,,,Percent of total Billed charges,77% of total billed charges,604.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,355.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.77,632.84,
Travoprost 0.004% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,711.06,355.53,,547.52,77,,,Percent of Total Billed Charges,77% of total billed charges,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.18,74,,,Percent of Total Billed Charges,74% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,597.29,84,,,Percent of Total Billed Charges,84% of total billed charges,583.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,632.84,89,,,Percent of total Billed Charges,89% of total Billed charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.52,77,,,Percent of total Billed charges,77% of total billed charges,604.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,355.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.77,632.84,
Travoprost 0.004% OPHTH Soln 2.5ml,,,250,RC,,,Outpatient,,,711.06,355.53,,547.52,77,,,Percent of Total Billed Charges,77% of total billed charges,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,181.32,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,222.21,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,526.18,74,,,Percent of Total Billed Charges,74% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,490.63,69,,,Percent of Total Billed Charges,69% of total billed charges,597.29,84,,,Percent of Total Billed Charges,84% of total billed charges,583.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,632.84,89,,,Percent of total Billed Charges,89% of total Billed charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,547.52,77,,,Percent of total Billed charges,77% of total billed charges,604.4,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,204.43,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,355.53,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,290.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,632.84,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,177.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,177.77,632.84,
traZODone 50mg Tablet,60687044301,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
traZODone 50mg Tablet,60687044301,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
traZODone 50mg Tablet,60687044301,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
traZODone 50mg Tablet,60687044301,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
traZODone 50mg Tablet,60687044301,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
traZODone 50mg Tablet,60687044301,CDM,250,RC,,,Outpatient,,,6.5,3.25,,5.01,77,,,Percent of Total Billed Charges,77% of total billed charges,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.66,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.81,74,,,Percent of Total Billed Charges,74% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,4.49,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,84,,,Percent of Total Billed Charges,84% of total billed charges,5.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.79,89,,,Percent of total Billed Charges,89% of total Billed charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.01,77,,,Percent of total Billed charges,77% of total billed charges,5.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.87,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.25,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.65,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.79,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.63,5.79,
Triamcinolone 0.1% Cream 15gm,168000415,CDM,250,RC,,,Outpatient,,,33.15,16.58,,25.53,77,,,Percent of Total Billed Charges,77% of total billed charges,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.53,74,,,Percent of Total Billed Charges,74% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.85,84,,,Percent of Total Billed Charges,84% of total billed charges,27.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.5,89,,,Percent of total Billed Charges,89% of total Billed charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,77,,,Percent of total Billed charges,77% of total billed charges,28.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.29,29.5,
Triamcinolone 0.1% Cream 15gm,168000415,CDM,250,RC,,,Outpatient,,,33.15,16.58,,25.53,77,,,Percent of Total Billed Charges,77% of total billed charges,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.53,74,,,Percent of Total Billed Charges,74% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.85,84,,,Percent of Total Billed Charges,84% of total billed charges,27.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.5,89,,,Percent of total Billed Charges,89% of total Billed charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,77,,,Percent of total Billed charges,77% of total billed charges,28.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.29,29.5,
Triamcinolone 0.1% Cream 15gm,168000415,CDM,250,RC,,,Outpatient,,,33.15,16.58,,25.53,77,,,Percent of Total Billed Charges,77% of total billed charges,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.53,74,,,Percent of Total Billed Charges,74% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.85,84,,,Percent of Total Billed Charges,84% of total billed charges,27.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.5,89,,,Percent of total Billed Charges,89% of total Billed charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,77,,,Percent of total Billed charges,77% of total billed charges,28.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.29,29.5,
Triamcinolone 0.1% Cream 15gm,168000415,CDM,250,RC,,,Outpatient,,,33.15,16.58,,25.53,77,,,Percent of Total Billed Charges,77% of total billed charges,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.53,74,,,Percent of Total Billed Charges,74% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.85,84,,,Percent of Total Billed Charges,84% of total billed charges,27.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.5,89,,,Percent of total Billed Charges,89% of total Billed charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,77,,,Percent of total Billed charges,77% of total billed charges,28.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.29,29.5,
Triamcinolone 0.1% Cream 15gm,168000415,CDM,250,RC,,,Outpatient,,,33.15,16.58,,25.53,77,,,Percent of Total Billed Charges,77% of total billed charges,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.53,74,,,Percent of Total Billed Charges,74% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.85,84,,,Percent of Total Billed Charges,84% of total billed charges,27.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.5,89,,,Percent of total Billed Charges,89% of total Billed charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,77,,,Percent of total Billed charges,77% of total billed charges,28.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.29,29.5,
Triamcinolone 0.1% Cream 15gm,168000415,CDM,250,RC,,,Outpatient,,,33.15,16.58,,25.53,77,,,Percent of Total Billed Charges,77% of total billed charges,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.45,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.36,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,24.53,74,,,Percent of Total Billed Charges,74% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,22.87,69,,,Percent of Total Billed Charges,69% of total billed charges,27.85,84,,,Percent of Total Billed Charges,84% of total billed charges,27.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,29.5,89,,,Percent of total Billed Charges,89% of total Billed charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.53,77,,,Percent of total Billed charges,77% of total billed charges,28.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,9.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,16.58,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,13.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.5,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.29,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.29,29.5,
Triamterene-HCTZ 37.5/25mg Tablet,60505265601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Triamterene-HCTZ 37.5/25mg Tablet,60505265601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Triamterene-HCTZ 37.5/25mg Tablet,60505265601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Triamterene-HCTZ 37.5/25mg Tablet,60505265601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Triamterene-HCTZ 37.5/25mg Tablet,60505265601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Triamterene-HCTZ 37.5/25mg Tablet,60505265601,CDM,250,RC,,,Outpatient,,,8.66,4.33,,6.67,77,,,Percent of Total Billed Charges,77% of total billed charges,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,6.41,74,,,Percent of Total Billed Charges,74% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,5.98,69,,,Percent of Total Billed Charges,69% of total billed charges,7.27,84,,,Percent of Total Billed Charges,84% of total billed charges,7.1,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.71,89,,,Percent of total Billed Charges,89% of total Billed charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.67,77,,,Percent of total Billed charges,77% of total billed charges,7.36,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.49,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,4.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.53,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.71,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.17,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.17,7.71,
Triamcinolone 40mg/ml SDV,3029305,CDM,250,RC,,,Outpatient,,,116.98,58.49,,90.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.57,74,,,Percent of Total Billed Charges,74% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,98.26,84,,,Percent of Total Billed Charges,84% of total billed charges,95.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.11,89,,,Percent of total Billed Charges,89% of total Billed charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.07,77,,,Percent of total Billed charges,77% of total billed charges,99.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.11,
Triamcinolone 40mg/ml SDV,3029305,CDM,250,RC,,,Outpatient,,,116.98,58.49,,90.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.57,74,,,Percent of Total Billed Charges,74% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,98.26,84,,,Percent of Total Billed Charges,84% of total billed charges,95.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.11,89,,,Percent of total Billed Charges,89% of total Billed charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.07,77,,,Percent of total Billed charges,77% of total billed charges,99.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.11,
Triamcinolone 40mg/ml SDV,3029305,CDM,250,RC,,,Outpatient,,,116.98,58.49,,90.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.57,74,,,Percent of Total Billed Charges,74% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,98.26,84,,,Percent of Total Billed Charges,84% of total billed charges,95.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.11,89,,,Percent of total Billed Charges,89% of total Billed charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.07,77,,,Percent of total Billed charges,77% of total billed charges,99.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.11,
Triamcinolone 40mg/ml SDV,3029305,CDM,250,RC,,,Outpatient,,,116.98,58.49,,90.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.57,74,,,Percent of Total Billed Charges,74% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,98.26,84,,,Percent of Total Billed Charges,84% of total billed charges,95.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.11,89,,,Percent of total Billed Charges,89% of total Billed charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.07,77,,,Percent of total Billed charges,77% of total billed charges,99.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.11,
Triamcinolone 40mg/ml SDV,3029305,CDM,250,RC,,,Outpatient,,,116.98,58.49,,90.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.57,74,,,Percent of Total Billed Charges,74% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,98.26,84,,,Percent of Total Billed Charges,84% of total billed charges,95.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.11,89,,,Percent of total Billed Charges,89% of total Billed charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.07,77,,,Percent of total Billed charges,77% of total billed charges,99.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.11,
Triamcinolone 40mg/ml SDV,3029305,CDM,250,RC,,,Outpatient,,,116.98,58.49,,90.07,77,,,Percent of Total Billed Charges,77% of total billed charges,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.83,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,36.56,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,86.57,74,,,Percent of Total Billed Charges,74% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,80.72,69,,,Percent of Total Billed Charges,69% of total billed charges,98.26,84,,,Percent of Total Billed Charges,84% of total billed charges,95.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,104.11,89,,,Percent of total Billed Charges,89% of total Billed charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,90.07,77,,,Percent of total Billed charges,77% of total billed charges,99.43,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,33.63,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,58.49,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,47.73,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,104.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,29.25,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,29.25,104.11,
Triamcinolone PF 40mg/ml SDV,65054301,CDM,250,RC,,,Outpatient,,,4244.95,2122.48,,3268.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3141.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3565.76,84,,,Percent of Total Billed Charges,84% of total billed charges,3480.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,3778.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.61,77,,,Percent of total Billed charges,77% of total billed charges,3608.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1220.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2122.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.24,3778.01,
Triamcinolone PF 40mg/ml SDV,65054301,CDM,250,RC,,,Outpatient,,,4244.95,2122.48,,3268.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3141.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3565.76,84,,,Percent of Total Billed Charges,84% of total billed charges,3480.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,3778.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.61,77,,,Percent of total Billed charges,77% of total billed charges,3608.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1220.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2122.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.24,3778.01,
Triamcinolone PF 40mg/ml SDV,65054301,CDM,250,RC,,,Outpatient,,,4244.95,2122.48,,3268.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3141.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3565.76,84,,,Percent of Total Billed Charges,84% of total billed charges,3480.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,3778.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.61,77,,,Percent of total Billed charges,77% of total billed charges,3608.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1220.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2122.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.24,3778.01,
Triamcinolone PF 40mg/ml SDV,65054301,CDM,250,RC,,,Outpatient,,,4244.95,2122.48,,3268.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3141.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3565.76,84,,,Percent of Total Billed Charges,84% of total billed charges,3480.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,3778.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.61,77,,,Percent of total Billed charges,77% of total billed charges,3608.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1220.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2122.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.24,3778.01,
Triamcinolone PF 40mg/ml SDV,65054301,CDM,250,RC,,,Outpatient,,,4244.95,2122.48,,3268.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3141.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3565.76,84,,,Percent of Total Billed Charges,84% of total billed charges,3480.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,3778.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.61,77,,,Percent of total Billed charges,77% of total billed charges,3608.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1220.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2122.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.24,3778.01,
Triamcinolone PF 40mg/ml SDV,65054301,CDM,250,RC,,,Outpatient,,,4244.95,2122.48,,3268.61,77,,,Percent of Total Billed Charges,77% of total billed charges,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1082.46,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1326.55,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3141.26,74,,,Percent of Total Billed Charges,74% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,2929.02,69,,,Percent of Total Billed Charges,69% of total billed charges,3565.76,84,,,Percent of Total Billed Charges,84% of total billed charges,3480.86,82,,,Percent of Total Billed Charges,82% of total billed charges ,3778.01,89,,,Percent of total Billed Charges,89% of total Billed charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3268.61,77,,,Percent of total Billed charges,77% of total billed charges,3608.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1220.42,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2122.48,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1731.94,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3778.01,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1061.24,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1061.24,3778.01,
Triamcinolone 0.1% Dental Paste 5gm,51672126705,CDM,250,RC,,,Outpatient,,,282.65,141.33,,217.64,77,,,Percent of Total Billed Charges,77% of total billed charges,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,237.43,84,,,Percent of Total Billed Charges,84% of total billed charges,231.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.56,89,,,Percent of total Billed Charges,89% of total Billed charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.64,77,,,Percent of total Billed charges,77% of total billed charges,240.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.66,251.56,
Triamcinolone 0.1% Dental Paste 5gm,51672126705,CDM,250,RC,,,Outpatient,,,282.65,141.33,,217.64,77,,,Percent of Total Billed Charges,77% of total billed charges,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,237.43,84,,,Percent of Total Billed Charges,84% of total billed charges,231.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.56,89,,,Percent of total Billed Charges,89% of total Billed charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.64,77,,,Percent of total Billed charges,77% of total billed charges,240.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.66,251.56,
Triamcinolone 0.1% Dental Paste 5gm,51672126705,CDM,250,RC,,,Outpatient,,,282.65,141.33,,217.64,77,,,Percent of Total Billed Charges,77% of total billed charges,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,237.43,84,,,Percent of Total Billed Charges,84% of total billed charges,231.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.56,89,,,Percent of total Billed Charges,89% of total Billed charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.64,77,,,Percent of total Billed charges,77% of total billed charges,240.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.66,251.56,
Triamcinolone 0.1% Dental Paste 5gm,51672126705,CDM,250,RC,,,Outpatient,,,282.65,141.33,,217.64,77,,,Percent of Total Billed Charges,77% of total billed charges,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,237.43,84,,,Percent of Total Billed Charges,84% of total billed charges,231.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.56,89,,,Percent of total Billed Charges,89% of total Billed charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.64,77,,,Percent of total Billed charges,77% of total billed charges,240.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.66,251.56,
Triamcinolone 0.1% Dental Paste 5gm,51672126705,CDM,250,RC,,,Outpatient,,,282.65,141.33,,217.64,77,,,Percent of Total Billed Charges,77% of total billed charges,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,237.43,84,,,Percent of Total Billed Charges,84% of total billed charges,231.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.56,89,,,Percent of total Billed Charges,89% of total Billed charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.64,77,,,Percent of total Billed charges,77% of total billed charges,240.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.66,251.56,
Triamcinolone 0.1% Dental Paste 5gm,51672126705,CDM,250,RC,,,Outpatient,,,282.65,141.33,,217.64,77,,,Percent of Total Billed Charges,77% of total billed charges,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,72.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,88.33,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,209.16,74,,,Percent of Total Billed Charges,74% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,195.03,69,,,Percent of Total Billed Charges,69% of total billed charges,237.43,84,,,Percent of Total Billed Charges,84% of total billed charges,231.77,82,,,Percent of Total Billed Charges,82% of total billed charges ,251.56,89,,,Percent of total Billed Charges,89% of total Billed charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.64,77,,,Percent of total Billed charges,77% of total billed charges,240.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,81.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,141.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,115.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,251.56,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,70.66,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,70.66,251.56,
Triamcinolone 0.1% Lotion 60ml,,,250,RC,,,Outpatient,,,315.07,157.54,,242.6,77,,,Percent of Total Billed Charges,77% of total billed charges,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.15,74,,,Percent of Total Billed Charges,74% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,264.66,84,,,Percent of Total Billed Charges,84% of total billed charges,258.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.41,89,,,Percent of total Billed Charges,89% of total Billed charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.6,77,,,Percent of total Billed charges,77% of total billed charges,267.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,280.41,
Triamcinolone 0.1% Lotion 60ml,,,250,RC,,,Outpatient,,,315.07,157.54,,242.6,77,,,Percent of Total Billed Charges,77% of total billed charges,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.15,74,,,Percent of Total Billed Charges,74% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,264.66,84,,,Percent of Total Billed Charges,84% of total billed charges,258.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.41,89,,,Percent of total Billed Charges,89% of total Billed charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.6,77,,,Percent of total Billed charges,77% of total billed charges,267.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,280.41,
Triamcinolone 0.1% Lotion 60ml,,,250,RC,,,Outpatient,,,315.07,157.54,,242.6,77,,,Percent of Total Billed Charges,77% of total billed charges,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.15,74,,,Percent of Total Billed Charges,74% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,264.66,84,,,Percent of Total Billed Charges,84% of total billed charges,258.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.41,89,,,Percent of total Billed Charges,89% of total Billed charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.6,77,,,Percent of total Billed charges,77% of total billed charges,267.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,280.41,
Triamcinolone 0.1% Lotion 60ml,,,250,RC,,,Outpatient,,,315.07,157.54,,242.6,77,,,Percent of Total Billed Charges,77% of total billed charges,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.15,74,,,Percent of Total Billed Charges,74% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,264.66,84,,,Percent of Total Billed Charges,84% of total billed charges,258.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.41,89,,,Percent of total Billed Charges,89% of total Billed charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.6,77,,,Percent of total Billed charges,77% of total billed charges,267.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,280.41,
Triamcinolone 0.1% Lotion 60ml,,,250,RC,,,Outpatient,,,315.07,157.54,,242.6,77,,,Percent of Total Billed Charges,77% of total billed charges,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.15,74,,,Percent of Total Billed Charges,74% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,264.66,84,,,Percent of Total Billed Charges,84% of total billed charges,258.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.41,89,,,Percent of total Billed Charges,89% of total Billed charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.6,77,,,Percent of total Billed charges,77% of total billed charges,267.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,280.41,
Triamcinolone 0.1% Lotion 60ml,,,250,RC,,,Outpatient,,,315.07,157.54,,242.6,77,,,Percent of Total Billed Charges,77% of total billed charges,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,80.34,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,98.46,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,233.15,74,,,Percent of Total Billed Charges,74% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,217.4,69,,,Percent of Total Billed Charges,69% of total billed charges,264.66,84,,,Percent of Total Billed Charges,84% of total billed charges,258.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,280.41,89,,,Percent of total Billed Charges,89% of total Billed charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,242.6,77,,,Percent of total Billed charges,77% of total billed charges,267.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,90.58,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,157.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,128.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,280.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,78.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,78.77,280.41,
Trimethoprim 100mg Tablet,,,250,RC,,,Outpatient,,,26.87,13.44,,20.69,77,,,Percent of Total Billed Charges,77% of total billed charges,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,22.57,84,,,Percent of Total Billed Charges,84% of total billed charges,22.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.91,89,,,Percent of total Billed Charges,89% of total Billed charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.69,77,,,Percent of total Billed charges,77% of total billed charges,22.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,23.91,
Trimethoprim 100mg Tablet,,,250,RC,,,Outpatient,,,26.87,13.44,,20.69,77,,,Percent of Total Billed Charges,77% of total billed charges,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,22.57,84,,,Percent of Total Billed Charges,84% of total billed charges,22.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.91,89,,,Percent of total Billed Charges,89% of total Billed charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.69,77,,,Percent of total Billed charges,77% of total billed charges,22.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,23.91,
Trimethoprim 100mg Tablet,,,250,RC,,,Outpatient,,,26.87,13.44,,20.69,77,,,Percent of Total Billed Charges,77% of total billed charges,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,22.57,84,,,Percent of Total Billed Charges,84% of total billed charges,22.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.91,89,,,Percent of total Billed Charges,89% of total Billed charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.69,77,,,Percent of total Billed charges,77% of total billed charges,22.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,23.91,
Trimethoprim 100mg Tablet,,,250,RC,,,Outpatient,,,26.87,13.44,,20.69,77,,,Percent of Total Billed Charges,77% of total billed charges,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,22.57,84,,,Percent of Total Billed Charges,84% of total billed charges,22.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.91,89,,,Percent of total Billed Charges,89% of total Billed charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.69,77,,,Percent of total Billed charges,77% of total billed charges,22.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,23.91,
Trimethoprim 100mg Tablet,,,250,RC,,,Outpatient,,,26.87,13.44,,20.69,77,,,Percent of Total Billed Charges,77% of total billed charges,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,22.57,84,,,Percent of Total Billed Charges,84% of total billed charges,22.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.91,89,,,Percent of total Billed Charges,89% of total Billed charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.69,77,,,Percent of total Billed charges,77% of total billed charges,22.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,23.91,
Trimethoprim 100mg Tablet,,,250,RC,,,Outpatient,,,26.87,13.44,,20.69,77,,,Percent of Total Billed Charges,77% of total billed charges,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.85,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19.88,74,,,Percent of Total Billed Charges,74% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,18.54,69,,,Percent of Total Billed Charges,69% of total billed charges,22.57,84,,,Percent of Total Billed Charges,84% of total billed charges,22.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,23.91,89,,,Percent of total Billed Charges,89% of total Billed charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.69,77,,,Percent of total Billed charges,77% of total billed charges,22.84,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.73,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13.44,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.91,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.72,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.72,23.91,
Tropicamide 0.5% OPHTH Soln 15ml,61314035401,CDM,250,RC,,,Outpatient,,,131.91,65.96,,101.57,77,,,Percent of Total Billed Charges,77% of total billed charges,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.61,74,,,Percent of Total Billed Charges,74% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.8,84,,,Percent of Total Billed Charges,84% of total billed charges,108.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.4,89,,,Percent of total Billed Charges,89% of total Billed charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.57,77,,,Percent of total Billed charges,77% of total billed charges,112.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.98,117.4,
Tropicamide 0.5% OPHTH Soln 15ml,61314035401,CDM,250,RC,,,Outpatient,,,131.91,65.96,,101.57,77,,,Percent of Total Billed Charges,77% of total billed charges,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.61,74,,,Percent of Total Billed Charges,74% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.8,84,,,Percent of Total Billed Charges,84% of total billed charges,108.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.4,89,,,Percent of total Billed Charges,89% of total Billed charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.57,77,,,Percent of total Billed charges,77% of total billed charges,112.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.98,117.4,
Tropicamide 0.5% OPHTH Soln 15ml,61314035401,CDM,250,RC,,,Outpatient,,,131.91,65.96,,101.57,77,,,Percent of Total Billed Charges,77% of total billed charges,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.61,74,,,Percent of Total Billed Charges,74% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.8,84,,,Percent of Total Billed Charges,84% of total billed charges,108.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.4,89,,,Percent of total Billed Charges,89% of total Billed charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.57,77,,,Percent of total Billed charges,77% of total billed charges,112.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.98,117.4,
Tropicamide 0.5% OPHTH Soln 15ml,61314035401,CDM,250,RC,,,Outpatient,,,131.91,65.96,,101.57,77,,,Percent of Total Billed Charges,77% of total billed charges,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.61,74,,,Percent of Total Billed Charges,74% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.8,84,,,Percent of Total Billed Charges,84% of total billed charges,108.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.4,89,,,Percent of total Billed Charges,89% of total Billed charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.57,77,,,Percent of total Billed charges,77% of total billed charges,112.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.98,117.4,
Tropicamide 0.5% OPHTH Soln 15ml,61314035401,CDM,250,RC,,,Outpatient,,,131.91,65.96,,101.57,77,,,Percent of Total Billed Charges,77% of total billed charges,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.61,74,,,Percent of Total Billed Charges,74% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.8,84,,,Percent of Total Billed Charges,84% of total billed charges,108.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.4,89,,,Percent of total Billed Charges,89% of total Billed charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.57,77,,,Percent of total Billed charges,77% of total billed charges,112.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.98,117.4,
Tropicamide 0.5% OPHTH Soln 15ml,61314035401,CDM,250,RC,,,Outpatient,,,131.91,65.96,,101.57,77,,,Percent of Total Billed Charges,77% of total billed charges,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,41.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,97.61,74,,,Percent of Total Billed Charges,74% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,91.02,69,,,Percent of Total Billed Charges,69% of total billed charges,110.8,84,,,Percent of Total Billed Charges,84% of total billed charges,108.17,82,,,Percent of Total Billed Charges,82% of total billed charges ,117.4,89,,,Percent of total Billed Charges,89% of total Billed charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,101.57,77,,,Percent of total Billed charges,77% of total billed charges,112.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,37.92,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,65.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,53.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,117.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,32.98,117.4,
Tropicamide 1% OPHTH Soln 15ml,70069012101,CDM,250,RC,,,Outpatient,,,174.04,87.02,,134.01,77,,,Percent of Total Billed Charges,77% of total billed charges,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.79,74,,,Percent of Total Billed Charges,74% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,146.19,84,,,Percent of Total Billed Charges,84% of total billed charges,142.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.9,89,,,Percent of total Billed Charges,89% of total Billed charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.01,77,,,Percent of total Billed charges,77% of total billed charges,147.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,154.9,
Tropicamide 1% OPHTH Soln 15ml,70069012101,CDM,250,RC,,,Outpatient,,,174.04,87.02,,134.01,77,,,Percent of Total Billed Charges,77% of total billed charges,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.79,74,,,Percent of Total Billed Charges,74% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,146.19,84,,,Percent of Total Billed Charges,84% of total billed charges,142.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.9,89,,,Percent of total Billed Charges,89% of total Billed charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.01,77,,,Percent of total Billed charges,77% of total billed charges,147.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,154.9,
Tropicamide 1% OPHTH Soln 15ml,70069012101,CDM,250,RC,,,Outpatient,,,174.04,87.02,,134.01,77,,,Percent of Total Billed Charges,77% of total billed charges,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.79,74,,,Percent of Total Billed Charges,74% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,146.19,84,,,Percent of Total Billed Charges,84% of total billed charges,142.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.9,89,,,Percent of total Billed Charges,89% of total Billed charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.01,77,,,Percent of total Billed charges,77% of total billed charges,147.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,154.9,
Tropicamide 1% OPHTH Soln 15ml,70069012101,CDM,250,RC,,,Outpatient,,,174.04,87.02,,134.01,77,,,Percent of Total Billed Charges,77% of total billed charges,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.79,74,,,Percent of Total Billed Charges,74% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,146.19,84,,,Percent of Total Billed Charges,84% of total billed charges,142.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.9,89,,,Percent of total Billed Charges,89% of total Billed charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.01,77,,,Percent of total Billed charges,77% of total billed charges,147.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,154.9,
Tropicamide 1% OPHTH Soln 15ml,70069012101,CDM,250,RC,,,Outpatient,,,174.04,87.02,,134.01,77,,,Percent of Total Billed Charges,77% of total billed charges,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.79,74,,,Percent of Total Billed Charges,74% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,146.19,84,,,Percent of Total Billed Charges,84% of total billed charges,142.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.9,89,,,Percent of total Billed Charges,89% of total Billed charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.01,77,,,Percent of total Billed charges,77% of total billed charges,147.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,154.9,
Tropicamide 1% OPHTH Soln 15ml,70069012101,CDM,250,RC,,,Outpatient,,,174.04,87.02,,134.01,77,,,Percent of Total Billed Charges,77% of total billed charges,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,44.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,54.39,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,128.79,74,,,Percent of Total Billed Charges,74% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,120.09,69,,,Percent of Total Billed Charges,69% of total billed charges,146.19,84,,,Percent of Total Billed Charges,84% of total billed charges,142.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,154.9,89,,,Percent of total Billed Charges,89% of total Billed charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,134.01,77,,,Percent of total Billed charges,77% of total billed charges,147.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,50.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,87.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,71.01,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,154.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.51,154.9,
Tropicamide 1% OPHTH Soln 3ml,61314035501,CDM,250,RC,,,Outpatient,,,120.14,60.07,,92.51,77,,,Percent of Total Billed Charges,77% of total billed charges,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.9,74,,,Percent of Total Billed Charges,74% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,100.92,84,,,Percent of Total Billed Charges,84% of total billed charges,98.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.92,89,,,Percent of total Billed Charges,89% of total Billed charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.51,77,,,Percent of total Billed charges,77% of total billed charges,102.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,106.92,
Tropicamide 1% OPHTH Soln 3ml,61314035501,CDM,250,RC,,,Outpatient,,,120.14,60.07,,92.51,77,,,Percent of Total Billed Charges,77% of total billed charges,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.9,74,,,Percent of Total Billed Charges,74% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,100.92,84,,,Percent of Total Billed Charges,84% of total billed charges,98.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.92,89,,,Percent of total Billed Charges,89% of total Billed charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.51,77,,,Percent of total Billed charges,77% of total billed charges,102.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,106.92,
Tropicamide 1% OPHTH Soln 3ml,61314035501,CDM,250,RC,,,Outpatient,,,120.14,60.07,,92.51,77,,,Percent of Total Billed Charges,77% of total billed charges,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.9,74,,,Percent of Total Billed Charges,74% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,100.92,84,,,Percent of Total Billed Charges,84% of total billed charges,98.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.92,89,,,Percent of total Billed Charges,89% of total Billed charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.51,77,,,Percent of total Billed charges,77% of total billed charges,102.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,106.92,
Tropicamide 1% OPHTH Soln 3ml,61314035501,CDM,250,RC,,,Outpatient,,,120.14,60.07,,92.51,77,,,Percent of Total Billed Charges,77% of total billed charges,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.9,74,,,Percent of Total Billed Charges,74% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,100.92,84,,,Percent of Total Billed Charges,84% of total billed charges,98.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.92,89,,,Percent of total Billed Charges,89% of total Billed charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.51,77,,,Percent of total Billed charges,77% of total billed charges,102.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,106.92,
Tropicamide 1% OPHTH Soln 3ml,61314035501,CDM,250,RC,,,Outpatient,,,120.14,60.07,,92.51,77,,,Percent of Total Billed Charges,77% of total billed charges,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.9,74,,,Percent of Total Billed Charges,74% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,100.92,84,,,Percent of Total Billed Charges,84% of total billed charges,98.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.92,89,,,Percent of total Billed Charges,89% of total Billed charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.51,77,,,Percent of total Billed charges,77% of total billed charges,102.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,106.92,
Tropicamide 1% OPHTH Soln 3ml,61314035501,CDM,250,RC,,,Outpatient,,,120.14,60.07,,92.51,77,,,Percent of Total Billed Charges,77% of total billed charges,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.64,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.54,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,88.9,74,,,Percent of Total Billed Charges,74% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,82.9,69,,,Percent of Total Billed Charges,69% of total billed charges,100.92,84,,,Percent of Total Billed Charges,84% of total billed charges,98.51,82,,,Percent of Total Billed Charges,82% of total billed charges ,106.92,89,,,Percent of total Billed Charges,89% of total Billed charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,92.51,77,,,Percent of total Billed charges,77% of total billed charges,102.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.54,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.02,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,106.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.04,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.04,106.92,
Tuberculin PPD 5 units/0.1ml Vial (10tests/vial),49281075278,CDM,250,RC,,,Outpatient,,,490.47,245.24,,377.66,77,,,Percent of Total Billed Charges,77% of total billed charges,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,362.95,74,,,Percent of Total Billed Charges,74% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,411.99,84,,,Percent of Total Billed Charges,84% of total billed charges,402.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.52,89,,,Percent of total Billed Charges,89% of total Billed charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.66,77,,,Percent of total Billed charges,77% of total billed charges,416.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,245.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,436.52,
Tuberculin PPD 5 units/0.1ml Vial (10tests/vial),49281075278,CDM,250,RC,,,Outpatient,,,490.47,245.24,,377.66,77,,,Percent of Total Billed Charges,77% of total billed charges,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,362.95,74,,,Percent of Total Billed Charges,74% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,411.99,84,,,Percent of Total Billed Charges,84% of total billed charges,402.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.52,89,,,Percent of total Billed Charges,89% of total Billed charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.66,77,,,Percent of total Billed charges,77% of total billed charges,416.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,245.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,436.52,
Tuberculin PPD 5 units/0.1ml Vial (10tests/vial),49281075278,CDM,250,RC,,,Outpatient,,,490.47,245.24,,377.66,77,,,Percent of Total Billed Charges,77% of total billed charges,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,362.95,74,,,Percent of Total Billed Charges,74% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,411.99,84,,,Percent of Total Billed Charges,84% of total billed charges,402.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.52,89,,,Percent of total Billed Charges,89% of total Billed charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.66,77,,,Percent of total Billed charges,77% of total billed charges,416.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,245.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,436.52,
Tuberculin PPD 5 units/0.1ml Vial (10tests/vial),49281075278,CDM,250,RC,,,Outpatient,,,490.47,245.24,,377.66,77,,,Percent of Total Billed Charges,77% of total billed charges,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,362.95,74,,,Percent of Total Billed Charges,74% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,411.99,84,,,Percent of Total Billed Charges,84% of total billed charges,402.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.52,89,,,Percent of total Billed Charges,89% of total Billed charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.66,77,,,Percent of total Billed charges,77% of total billed charges,416.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,245.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,436.52,
Tuberculin PPD 5 units/0.1ml Vial (10tests/vial),49281075278,CDM,250,RC,,,Outpatient,,,490.47,245.24,,377.66,77,,,Percent of Total Billed Charges,77% of total billed charges,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,362.95,74,,,Percent of Total Billed Charges,74% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,411.99,84,,,Percent of Total Billed Charges,84% of total billed charges,402.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.52,89,,,Percent of total Billed Charges,89% of total Billed charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.66,77,,,Percent of total Billed charges,77% of total billed charges,416.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,245.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,436.52,
Tuberculin PPD 5 units/0.1ml Vial (10tests/vial),49281075278,CDM,250,RC,,,Outpatient,,,490.47,245.24,,377.66,77,,,Percent of Total Billed Charges,77% of total billed charges,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,125.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,153.27,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,362.95,74,,,Percent of Total Billed Charges,74% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,338.42,69,,,Percent of Total Billed Charges,69% of total billed charges,411.99,84,,,Percent of Total Billed Charges,84% of total billed charges,402.19,82,,,Percent of Total Billed Charges,82% of total billed charges ,436.52,89,,,Percent of total Billed Charges,89% of total Billed charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,377.66,77,,,Percent of total Billed charges,77% of total billed charges,416.9,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,141.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,245.24,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,200.11,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,436.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,122.62,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,122.62,436.52,
Acetaminophen 500mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 500mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 500mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 500mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 500mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Acetaminophen 500mg Tablet,,,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Ursodiol 300mg Capsule,527132601,CDM,250,RC,,,Outpatient,,,69.71,34.86,,53.68,77,,,Percent of Total Billed Charges,77% of total billed charges,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.59,74,,,Percent of Total Billed Charges,74% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,58.56,84,,,Percent of Total Billed Charges,84% of total billed charges,57.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.04,89,,,Percent of total Billed Charges,89% of total Billed charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.68,77,,,Percent of total Billed charges,77% of total billed charges,59.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.43,62.04,
Ursodiol 300mg Capsule,527132601,CDM,250,RC,,,Outpatient,,,69.71,34.86,,53.68,77,,,Percent of Total Billed Charges,77% of total billed charges,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.59,74,,,Percent of Total Billed Charges,74% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,58.56,84,,,Percent of Total Billed Charges,84% of total billed charges,57.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.04,89,,,Percent of total Billed Charges,89% of total Billed charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.68,77,,,Percent of total Billed charges,77% of total billed charges,59.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.43,62.04,
Ursodiol 300mg Capsule,527132601,CDM,250,RC,,,Outpatient,,,69.71,34.86,,53.68,77,,,Percent of Total Billed Charges,77% of total billed charges,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.59,74,,,Percent of Total Billed Charges,74% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,58.56,84,,,Percent of Total Billed Charges,84% of total billed charges,57.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.04,89,,,Percent of total Billed Charges,89% of total Billed charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.68,77,,,Percent of total Billed charges,77% of total billed charges,59.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.43,62.04,
Ursodiol 300mg Capsule,527132601,CDM,250,RC,,,Outpatient,,,69.71,34.86,,53.68,77,,,Percent of Total Billed Charges,77% of total billed charges,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.59,74,,,Percent of Total Billed Charges,74% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,58.56,84,,,Percent of Total Billed Charges,84% of total billed charges,57.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.04,89,,,Percent of total Billed Charges,89% of total Billed charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.68,77,,,Percent of total Billed charges,77% of total billed charges,59.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.43,62.04,
Ursodiol 300mg Capsule,527132601,CDM,250,RC,,,Outpatient,,,69.71,34.86,,53.68,77,,,Percent of Total Billed Charges,77% of total billed charges,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.59,74,,,Percent of Total Billed Charges,74% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,58.56,84,,,Percent of Total Billed Charges,84% of total billed charges,57.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.04,89,,,Percent of total Billed Charges,89% of total Billed charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.68,77,,,Percent of total Billed charges,77% of total billed charges,59.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.43,62.04,
Ursodiol 300mg Capsule,527132601,CDM,250,RC,,,Outpatient,,,69.71,34.86,,53.68,77,,,Percent of Total Billed Charges,77% of total billed charges,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,51.59,74,,,Percent of Total Billed Charges,74% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,48.1,69,,,Percent of Total Billed Charges,69% of total billed charges,58.56,84,,,Percent of Total Billed Charges,84% of total billed charges,57.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.04,89,,,Percent of total Billed Charges,89% of total Billed charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,53.68,77,,,Percent of total Billed charges,77% of total billed charges,59.25,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,34.86,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.44,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.43,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.43,62.04,
"valACYclovir 1,000mg Tablet",378427693,CDM,250,RC,,,Outpatient,,,94.29,47.15,,72.6,77,,,Percent of Total Billed Charges,77% of total billed charges,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.77,74,,,Percent of Total Billed Charges,74% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,79.2,84,,,Percent of Total Billed Charges,84% of total billed charges,77.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.92,89,,,Percent of total Billed Charges,89% of total Billed charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,77,,,Percent of total Billed charges,77% of total billed charges,80.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.57,83.92,
"valACYclovir 1,000mg Tablet",378427693,CDM,250,RC,,,Outpatient,,,94.29,47.15,,72.6,77,,,Percent of Total Billed Charges,77% of total billed charges,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.77,74,,,Percent of Total Billed Charges,74% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,79.2,84,,,Percent of Total Billed Charges,84% of total billed charges,77.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.92,89,,,Percent of total Billed Charges,89% of total Billed charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,77,,,Percent of total Billed charges,77% of total billed charges,80.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.57,83.92,
"valACYclovir 1,000mg Tablet",378427693,CDM,250,RC,,,Outpatient,,,94.29,47.15,,72.6,77,,,Percent of Total Billed Charges,77% of total billed charges,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.77,74,,,Percent of Total Billed Charges,74% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,79.2,84,,,Percent of Total Billed Charges,84% of total billed charges,77.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.92,89,,,Percent of total Billed Charges,89% of total Billed charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,77,,,Percent of total Billed charges,77% of total billed charges,80.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.57,83.92,
"valACYclovir 1,000mg Tablet",378427693,CDM,250,RC,,,Outpatient,,,94.29,47.15,,72.6,77,,,Percent of Total Billed Charges,77% of total billed charges,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.77,74,,,Percent of Total Billed Charges,74% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,79.2,84,,,Percent of Total Billed Charges,84% of total billed charges,77.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.92,89,,,Percent of total Billed Charges,89% of total Billed charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,77,,,Percent of total Billed charges,77% of total billed charges,80.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.57,83.92,
"valACYclovir 1,000mg Tablet",378427693,CDM,250,RC,,,Outpatient,,,94.29,47.15,,72.6,77,,,Percent of Total Billed Charges,77% of total billed charges,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.77,74,,,Percent of Total Billed Charges,74% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,79.2,84,,,Percent of Total Billed Charges,84% of total billed charges,77.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.92,89,,,Percent of total Billed Charges,89% of total Billed charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,77,,,Percent of total Billed charges,77% of total billed charges,80.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.57,83.92,
"valACYclovir 1,000mg Tablet",378427693,CDM,250,RC,,,Outpatient,,,94.29,47.15,,72.6,77,,,Percent of Total Billed Charges,77% of total billed charges,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,24.04,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,29.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,69.77,74,,,Percent of Total Billed Charges,74% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,65.06,69,,,Percent of Total Billed Charges,69% of total billed charges,79.2,84,,,Percent of Total Billed Charges,84% of total billed charges,77.32,82,,,Percent of Total Billed Charges,82% of total billed charges ,83.92,89,,,Percent of total Billed Charges,89% of total Billed charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.6,77,,,Percent of total Billed charges,77% of total billed charges,80.15,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,27.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,47.15,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,38.47,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.92,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23.57,83.92,
Valproic Acid 250mg/5ml Oral UDC,121467505,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Valproic Acid 250mg/5ml Oral UDC,121467505,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Valproic Acid 250mg/5ml Oral UDC,121467505,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Valproic Acid 250mg/5ml Oral UDC,121467505,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Valproic Acid 250mg/5ml Oral UDC,121467505,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Valproic Acid 250mg/5ml Oral UDC,121467505,CDM,250,RC,,,Outpatient,,,25.27,12.64,,19.46,77,,,Percent of Total Billed Charges,77% of total billed charges,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.44,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.9,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.7,74,,,Percent of Total Billed Charges,74% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,17.44,69,,,Percent of Total Billed Charges,69% of total billed charges,21.23,84,,,Percent of Total Billed Charges,84% of total billed charges,20.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.49,89,,,Percent of total Billed Charges,89% of total Billed charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.46,77,,,Percent of total Billed charges,77% of total billed charges,21.48,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.64,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.32,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.32,22.49,
Valrubicin (Valstar) 800mg/20ml Intravesical Kit,24201010104,CDM,250,RC,,,Outpatient,,,26831.91,13415.96,,20660.57,77,,,Percent of Total Billed Charges,77% of total billed charges,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8384.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19855.61,74,,,Percent of Total Billed Charges,74% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,22538.8,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23880.4,89,,,Percent of total Billed Charges,89% of total Billed charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20660.57,77,,,Percent of total Billed charges,77% of total billed charges,22807.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7714.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13415.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6707.98,23880.4,
Valrubicin (Valstar) 800mg/20ml Intravesical Kit,24201010104,CDM,250,RC,,,Outpatient,,,26831.91,13415.96,,20660.57,77,,,Percent of Total Billed Charges,77% of total billed charges,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8384.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19855.61,74,,,Percent of Total Billed Charges,74% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,22538.8,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23880.4,89,,,Percent of total Billed Charges,89% of total Billed charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20660.57,77,,,Percent of total Billed charges,77% of total billed charges,22807.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7714.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13415.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6707.98,23880.4,
Valrubicin (Valstar) 800mg/20ml Intravesical Kit,24201010104,CDM,250,RC,,,Outpatient,,,26831.91,13415.96,,20660.57,77,,,Percent of Total Billed Charges,77% of total billed charges,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8384.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19855.61,74,,,Percent of Total Billed Charges,74% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,22538.8,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23880.4,89,,,Percent of total Billed Charges,89% of total Billed charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20660.57,77,,,Percent of total Billed charges,77% of total billed charges,22807.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7714.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13415.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6707.98,23880.4,
Valrubicin (Valstar) 800mg/20ml Intravesical Kit,24201010104,CDM,250,RC,,,Outpatient,,,26831.91,13415.96,,20660.57,77,,,Percent of Total Billed Charges,77% of total billed charges,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8384.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19855.61,74,,,Percent of Total Billed Charges,74% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,22538.8,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23880.4,89,,,Percent of total Billed Charges,89% of total Billed charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20660.57,77,,,Percent of total Billed charges,77% of total billed charges,22807.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7714.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13415.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6707.98,23880.4,
Valrubicin (Valstar) 800mg/20ml Intravesical Kit,24201010104,CDM,250,RC,,,Outpatient,,,26831.91,13415.96,,20660.57,77,,,Percent of Total Billed Charges,77% of total billed charges,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8384.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19855.61,74,,,Percent of Total Billed Charges,74% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,22538.8,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23880.4,89,,,Percent of total Billed Charges,89% of total Billed charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20660.57,77,,,Percent of total Billed charges,77% of total billed charges,22807.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7714.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13415.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6707.98,23880.4,
Valrubicin (Valstar) 800mg/20ml Intravesical Kit,24201010104,CDM,250,RC,,,Outpatient,,,26831.91,13415.96,,20660.57,77,,,Percent of Total Billed Charges,77% of total billed charges,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6842.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,8384.97,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,19855.61,74,,,Percent of Total Billed Charges,74% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,18514.02,69,,,Percent of Total Billed Charges,69% of total billed charges,22538.8,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,23880.4,89,,,Percent of total Billed Charges,89% of total Billed charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20660.57,77,,,Percent of total Billed charges,77% of total billed charges,22807.12,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7714.17,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,13415.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10947.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,23880.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6707.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6707.98,23880.4,
Valsartan 80mg Tablet,78035834,CDM,250,RC,,,Outpatient,,,70.28,35.14,,54.12,77,,,Percent of Total Billed Charges,77% of total billed charges,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.01,74,,,Percent of Total Billed Charges,74% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,59.04,84,,,Percent of Total Billed Charges,84% of total billed charges,57.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.55,89,,,Percent of total Billed Charges,89% of total Billed charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.12,77,,,Percent of total Billed charges,77% of total billed charges,59.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,62.55,
Valsartan 80mg Tablet,78035834,CDM,250,RC,,,Outpatient,,,70.28,35.14,,54.12,77,,,Percent of Total Billed Charges,77% of total billed charges,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.01,74,,,Percent of Total Billed Charges,74% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,59.04,84,,,Percent of Total Billed Charges,84% of total billed charges,57.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.55,89,,,Percent of total Billed Charges,89% of total Billed charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.12,77,,,Percent of total Billed charges,77% of total billed charges,59.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,62.55,
Valsartan 80mg Tablet,78035834,CDM,250,RC,,,Outpatient,,,70.28,35.14,,54.12,77,,,Percent of Total Billed Charges,77% of total billed charges,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.01,74,,,Percent of Total Billed Charges,74% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,59.04,84,,,Percent of Total Billed Charges,84% of total billed charges,57.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.55,89,,,Percent of total Billed Charges,89% of total Billed charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.12,77,,,Percent of total Billed charges,77% of total billed charges,59.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,62.55,
Valsartan 80mg Tablet,78035834,CDM,250,RC,,,Outpatient,,,70.28,35.14,,54.12,77,,,Percent of Total Billed Charges,77% of total billed charges,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.01,74,,,Percent of Total Billed Charges,74% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,59.04,84,,,Percent of Total Billed Charges,84% of total billed charges,57.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.55,89,,,Percent of total Billed Charges,89% of total Billed charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.12,77,,,Percent of total Billed charges,77% of total billed charges,59.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,62.55,
Valsartan 80mg Tablet,78035834,CDM,250,RC,,,Outpatient,,,70.28,35.14,,54.12,77,,,Percent of Total Billed Charges,77% of total billed charges,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.01,74,,,Percent of Total Billed Charges,74% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,59.04,84,,,Percent of Total Billed Charges,84% of total billed charges,57.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.55,89,,,Percent of total Billed Charges,89% of total Billed charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.12,77,,,Percent of total Billed charges,77% of total billed charges,59.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,62.55,
Valsartan 80mg Tablet,78035834,CDM,250,RC,,,Outpatient,,,70.28,35.14,,54.12,77,,,Percent of Total Billed Charges,77% of total billed charges,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.92,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,21.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,52.01,74,,,Percent of Total Billed Charges,74% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,48.49,69,,,Percent of Total Billed Charges,69% of total billed charges,59.04,84,,,Percent of Total Billed Charges,84% of total billed charges,57.63,82,,,Percent of Total Billed Charges,82% of total billed charges ,62.55,89,,,Percent of total Billed Charges,89% of total Billed charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,54.12,77,,,Percent of total Billed charges,77% of total billed charges,59.74,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,20.21,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,35.14,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,28.67,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,17.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,62.55,
Vancomycin Oral 125mg Capsule,68180016613,CDM,250,RC,,,Outpatient,,,226.19,113.1,,174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.38,74,,,Percent of Total Billed Charges,74% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,190,84,,,Percent of Total Billed Charges,84% of total billed charges,185.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.31,89,,,Percent of total Billed Charges,89% of total Billed charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.17,77,,,Percent of total Billed charges,77% of total billed charges,192.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.55,201.31,
Vancomycin Oral 125mg Capsule,68180016613,CDM,250,RC,,,Outpatient,,,226.19,113.1,,174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.38,74,,,Percent of Total Billed Charges,74% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,190,84,,,Percent of Total Billed Charges,84% of total billed charges,185.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.31,89,,,Percent of total Billed Charges,89% of total Billed charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.17,77,,,Percent of total Billed charges,77% of total billed charges,192.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.55,201.31,
Vancomycin Oral 125mg Capsule,68180016613,CDM,250,RC,,,Outpatient,,,226.19,113.1,,174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.38,74,,,Percent of Total Billed Charges,74% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,190,84,,,Percent of Total Billed Charges,84% of total billed charges,185.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.31,89,,,Percent of total Billed Charges,89% of total Billed charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.17,77,,,Percent of total Billed charges,77% of total billed charges,192.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.55,201.31,
Vancomycin Oral 125mg Capsule,68180016613,CDM,250,RC,,,Outpatient,,,226.19,113.1,,174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.38,74,,,Percent of Total Billed Charges,74% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,190,84,,,Percent of Total Billed Charges,84% of total billed charges,185.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.31,89,,,Percent of total Billed Charges,89% of total Billed charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.17,77,,,Percent of total Billed charges,77% of total billed charges,192.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.55,201.31,
Vancomycin Oral 125mg Capsule,68180016613,CDM,250,RC,,,Outpatient,,,226.19,113.1,,174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.38,74,,,Percent of Total Billed Charges,74% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,190,84,,,Percent of Total Billed Charges,84% of total billed charges,185.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.31,89,,,Percent of total Billed Charges,89% of total Billed charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.17,77,,,Percent of total Billed charges,77% of total billed charges,192.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.55,201.31,
Vancomycin Oral 125mg Capsule,68180016613,CDM,250,RC,,,Outpatient,,,226.19,113.1,,174.17,77,,,Percent of Total Billed Charges,77% of total billed charges,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,57.68,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,70.68,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,167.38,74,,,Percent of Total Billed Charges,74% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,156.07,69,,,Percent of Total Billed Charges,69% of total billed charges,190,84,,,Percent of Total Billed Charges,84% of total billed charges,185.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,201.31,89,,,Percent of total Billed Charges,89% of total Billed charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,174.17,77,,,Percent of total Billed charges,77% of total billed charges,192.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,65.03,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,113.1,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,92.29,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,201.31,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,56.55,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,56.55,201.31,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 1000mg SDV,70594004602,CDM,250,RC,,,Outpatient,,,89.35,44.68,,68.8,77,,,Percent of Total Billed Charges,77% of total billed charges,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,66.12,74,,,Percent of Total Billed Charges,74% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,61.65,69,,,Percent of Total Billed Charges,69% of total billed charges,75.05,84,,,Percent of Total Billed Charges,84% of total billed charges,73.27,82,,,Percent of Total Billed Charges,82% of total billed charges ,79.52,89,,,Percent of total Billed Charges,89% of total Billed charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,68.8,77,,,Percent of total Billed charges,77% of total billed charges,75.95,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.69,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,44.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,36.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,79.52,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.34,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.34,79.52,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin 500mg SDV,409433201,CDM,250,RC,,,Outpatient,,,107.11,53.56,,82.47,77,,,Percent of Total Billed Charges,77% of total billed charges,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,33.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,79.26,74,,,Percent of Total Billed Charges,74% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,73.91,69,,,Percent of Total Billed Charges,69% of total billed charges,89.97,84,,,Percent of Total Billed Charges,84% of total billed charges,87.83,82,,,Percent of Total Billed Charges,82% of total billed charges ,95.33,89,,,Percent of total Billed Charges,89% of total Billed charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,82.47,77,,,Percent of total Billed charges,77% of total billed charges,91.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,30.79,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,53.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,43.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,95.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,26.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,26.78,95.33,
Vancomycin Oral Susp 50 mg/ml 80ml,62559083080,CDM,250,RC,,,Outpatient,,,1334.16,667.08,,1027.3,77,,,Percent of Total Billed Charges,77% of total billed charges,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.28,74,,,Percent of Total Billed Charges,74% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1187.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.3,77,,,Percent of total Billed charges,77% of total billed charges,1134.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,667.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.54,1187.4,
Vancomycin Oral Susp 50 mg/ml 80ml,62559083080,CDM,250,RC,,,Outpatient,,,1334.16,667.08,,1027.3,77,,,Percent of Total Billed Charges,77% of total billed charges,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.28,74,,,Percent of Total Billed Charges,74% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1187.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.3,77,,,Percent of total Billed charges,77% of total billed charges,1134.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,667.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.54,1187.4,
Vancomycin Oral Susp 50 mg/ml 80ml,62559083080,CDM,250,RC,,,Outpatient,,,1334.16,667.08,,1027.3,77,,,Percent of Total Billed Charges,77% of total billed charges,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.28,74,,,Percent of Total Billed Charges,74% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1187.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.3,77,,,Percent of total Billed charges,77% of total billed charges,1134.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,667.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.54,1187.4,
Vancomycin Oral Susp 50 mg/ml 80ml,62559083080,CDM,250,RC,,,Outpatient,,,1334.16,667.08,,1027.3,77,,,Percent of Total Billed Charges,77% of total billed charges,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.28,74,,,Percent of Total Billed Charges,74% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1187.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.3,77,,,Percent of total Billed charges,77% of total billed charges,1134.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,667.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.54,1187.4,
Vancomycin Oral Susp 50 mg/ml 80ml,62559083080,CDM,250,RC,,,Outpatient,,,1334.16,667.08,,1027.3,77,,,Percent of Total Billed Charges,77% of total billed charges,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.28,74,,,Percent of Total Billed Charges,74% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1187.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.3,77,,,Percent of total Billed charges,77% of total billed charges,1134.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,667.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.54,1187.4,
Vancomycin Oral Susp 50 mg/ml 80ml,62559083080,CDM,250,RC,,,Outpatient,,,1334.16,667.08,,1027.3,77,,,Percent of Total Billed Charges,77% of total billed charges,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,340.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,416.93,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,987.28,74,,,Percent of Total Billed Charges,74% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,920.57,69,,,Percent of Total Billed Charges,69% of total billed charges,1120.69,84,,,Percent of Total Billed Charges,84% of total billed charges,1094.01,82,,,Percent of Total Billed Charges,82% of total billed charges ,1187.4,89,,,Percent of total Billed Charges,89% of total Billed charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1027.3,77,,,Percent of total Billed charges,77% of total billed charges,1134.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,383.57,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,667.08,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,544.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1187.4,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,333.54,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,333.54,1187.4,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Vancomycin 750mg SDV,409653102,CDM,250,RC,,,Outpatient,,,120.93,60.47,,93.12,77,,,Percent of Total Billed Charges,77% of total billed charges,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,30.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,37.79,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,89.49,74,,,Percent of Total Billed Charges,74% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,83.44,69,,,Percent of Total Billed Charges,69% of total billed charges,101.58,84,,,Percent of Total Billed Charges,84% of total billed charges,99.16,82,,,Percent of Total Billed Charges,82% of total billed charges ,107.63,89,,,Percent of total Billed Charges,89% of total Billed charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,93.12,77,,,Percent of total Billed charges,77% of total billed charges,102.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,34.77,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,60.47,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,49.34,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,107.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,30.23,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.23,107.63,
Varicella Virus Vaccine (POX) 0.5 ML/Dose Vial,6482700,CDM,250,RC,,,Outpatient,,,851.81,425.91,,655.89,77,,,Percent of Total Billed Charges,77% of total billed charges,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.34,74,,,Percent of Total Billed Charges,74% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,715.52,84,,,Percent of Total Billed Charges,84% of total billed charges,698.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,758.11,89,,,Percent of total Billed Charges,89% of total Billed charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.89,77,,,Percent of total Billed charges,77% of total billed charges,724.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.95,758.11,
Varicella Virus Vaccine (POX) 0.5 ML/Dose Vial,6482700,CDM,250,RC,,,Outpatient,,,851.81,425.91,,655.89,77,,,Percent of Total Billed Charges,77% of total billed charges,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.34,74,,,Percent of Total Billed Charges,74% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,715.52,84,,,Percent of Total Billed Charges,84% of total billed charges,698.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,758.11,89,,,Percent of total Billed Charges,89% of total Billed charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.89,77,,,Percent of total Billed charges,77% of total billed charges,724.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.95,758.11,
Varicella Virus Vaccine (POX) 0.5 ML/Dose Vial,6482700,CDM,250,RC,,,Outpatient,,,851.81,425.91,,655.89,77,,,Percent of Total Billed Charges,77% of total billed charges,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.34,74,,,Percent of Total Billed Charges,74% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,715.52,84,,,Percent of Total Billed Charges,84% of total billed charges,698.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,758.11,89,,,Percent of total Billed Charges,89% of total Billed charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.89,77,,,Percent of total Billed charges,77% of total billed charges,724.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.95,758.11,
Varicella Virus Vaccine (POX) 0.5 ML/Dose Vial,6482700,CDM,250,RC,,,Outpatient,,,851.81,425.91,,655.89,77,,,Percent of Total Billed Charges,77% of total billed charges,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.34,74,,,Percent of Total Billed Charges,74% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,715.52,84,,,Percent of Total Billed Charges,84% of total billed charges,698.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,758.11,89,,,Percent of total Billed Charges,89% of total Billed charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.89,77,,,Percent of total Billed charges,77% of total billed charges,724.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.95,758.11,
Varicella Virus Vaccine (POX) 0.5 ML/Dose Vial,6482700,CDM,250,RC,,,Outpatient,,,851.81,425.91,,655.89,77,,,Percent of Total Billed Charges,77% of total billed charges,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.34,74,,,Percent of Total Billed Charges,74% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,715.52,84,,,Percent of Total Billed Charges,84% of total billed charges,698.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,758.11,89,,,Percent of total Billed Charges,89% of total Billed charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.89,77,,,Percent of total Billed charges,77% of total billed charges,724.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.95,758.11,
Varicella Virus Vaccine (POX) 0.5 ML/Dose Vial,6482700,CDM,250,RC,,,Outpatient,,,851.81,425.91,,655.89,77,,,Percent of Total Billed Charges,77% of total billed charges,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,217.21,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,266.19,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,630.34,74,,,Percent of Total Billed Charges,74% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,587.75,69,,,Percent of Total Billed Charges,69% of total billed charges,715.52,84,,,Percent of Total Billed Charges,84% of total billed charges,698.48,82,,,Percent of Total Billed Charges,82% of total billed charges ,758.11,89,,,Percent of total Billed Charges,89% of total Billed charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,655.89,77,,,Percent of total Billed charges,77% of total billed charges,724.04,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,244.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,425.91,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,347.54,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,758.11,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,212.95,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,212.95,758.11,
Zoster Recombinant Vaccine 0.5 ml/Dose Vial/Kit,58160081912,CDM,250,RC,,,Outpatient,,,921.53,460.77,,709.58,77,,,Percent of Total Billed Charges,77% of total billed charges,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.93,74,,,Percent of Total Billed Charges,74% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,774.09,84,,,Percent of Total Billed Charges,84% of total billed charges,755.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.16,89,,,Percent of total Billed Charges,89% of total Billed charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.58,77,,,Percent of total Billed charges,77% of total billed charges,783.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.16,
Zoster Recombinant Vaccine 0.5 ml/Dose Vial/Kit,58160081912,CDM,250,RC,,,Outpatient,,,921.53,460.77,,709.58,77,,,Percent of Total Billed Charges,77% of total billed charges,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.93,74,,,Percent of Total Billed Charges,74% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,774.09,84,,,Percent of Total Billed Charges,84% of total billed charges,755.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.16,89,,,Percent of total Billed Charges,89% of total Billed charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.58,77,,,Percent of total Billed charges,77% of total billed charges,783.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.16,
Zoster Recombinant Vaccine 0.5 ml/Dose Vial/Kit,58160081912,CDM,250,RC,,,Outpatient,,,921.53,460.77,,709.58,77,,,Percent of Total Billed Charges,77% of total billed charges,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.93,74,,,Percent of Total Billed Charges,74% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,774.09,84,,,Percent of Total Billed Charges,84% of total billed charges,755.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.16,89,,,Percent of total Billed Charges,89% of total Billed charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.58,77,,,Percent of total Billed charges,77% of total billed charges,783.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.16,
Zoster Recombinant Vaccine 0.5 ml/Dose Vial/Kit,58160081912,CDM,250,RC,,,Outpatient,,,921.53,460.77,,709.58,77,,,Percent of Total Billed Charges,77% of total billed charges,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.93,74,,,Percent of Total Billed Charges,74% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,774.09,84,,,Percent of Total Billed Charges,84% of total billed charges,755.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.16,89,,,Percent of total Billed Charges,89% of total Billed charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.58,77,,,Percent of total Billed charges,77% of total billed charges,783.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.16,
Zoster Recombinant Vaccine 0.5 ml/Dose Vial/Kit,58160081912,CDM,250,RC,,,Outpatient,,,921.53,460.77,,709.58,77,,,Percent of Total Billed Charges,77% of total billed charges,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.93,74,,,Percent of Total Billed Charges,74% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,774.09,84,,,Percent of Total Billed Charges,84% of total billed charges,755.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.16,89,,,Percent of total Billed Charges,89% of total Billed charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.58,77,,,Percent of total Billed charges,77% of total billed charges,783.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.16,
Zoster Recombinant Vaccine 0.5 ml/Dose Vial/Kit,58160081912,CDM,250,RC,,,Outpatient,,,921.53,460.77,,709.58,77,,,Percent of Total Billed Charges,77% of total billed charges,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,234.99,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,287.98,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,681.93,74,,,Percent of Total Billed Charges,74% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,635.86,69,,,Percent of Total Billed Charges,69% of total billed charges,774.09,84,,,Percent of Total Billed Charges,84% of total billed charges,755.65,82,,,Percent of Total Billed Charges,82% of total billed charges ,820.16,89,,,Percent of total Billed Charges,89% of total Billed charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,709.58,77,,,Percent of total Billed charges,77% of total billed charges,783.3,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,264.94,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,460.77,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,375.98,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,230.38,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,230.38,820.16,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vasopressin 20units/ml SDV,42023016425,CDM,250,RC,,,Outpatient,,,518.26,259.13,,399.06,77,,,Percent of Total Billed Charges,77% of total billed charges,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,132.16,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,161.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,383.51,74,,,Percent of Total Billed Charges,74% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,357.6,69,,,Percent of Total Billed Charges,69% of total billed charges,435.34,84,,,Percent of Total Billed Charges,84% of total billed charges,424.97,82,,,Percent of Total Billed Charges,82% of total billed charges ,461.25,89,,,Percent of total Billed Charges,89% of total Billed charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,399.06,77,,,Percent of total Billed charges,77% of total billed charges,440.52,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,149,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,259.13,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,211.45,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,461.25,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,129.57,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,129.57,461.25,
Vecuronium 10mg SDV,,,250,RC,,,Outpatient,,,220.41,110.21,,169.72,77,,,Percent of Total Billed Charges,77% of total billed charges,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.1,74,,,Percent of Total Billed Charges,74% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,185.14,84,,,Percent of Total Billed Charges,84% of total billed charges,180.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.16,89,,,Percent of total Billed Charges,89% of total Billed charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.72,77,,,Percent of total Billed charges,77% of total billed charges,187.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.1,196.16,
Vecuronium 10mg SDV,,,250,RC,,,Outpatient,,,220.41,110.21,,169.72,77,,,Percent of Total Billed Charges,77% of total billed charges,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.1,74,,,Percent of Total Billed Charges,74% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,185.14,84,,,Percent of Total Billed Charges,84% of total billed charges,180.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.16,89,,,Percent of total Billed Charges,89% of total Billed charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.72,77,,,Percent of total Billed charges,77% of total billed charges,187.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.1,196.16,
Vecuronium 10mg SDV,,,250,RC,,,Outpatient,,,220.41,110.21,,169.72,77,,,Percent of Total Billed Charges,77% of total billed charges,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.1,74,,,Percent of Total Billed Charges,74% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,185.14,84,,,Percent of Total Billed Charges,84% of total billed charges,180.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.16,89,,,Percent of total Billed Charges,89% of total Billed charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.72,77,,,Percent of total Billed charges,77% of total billed charges,187.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.1,196.16,
Vecuronium 10mg SDV,,,250,RC,,,Outpatient,,,220.41,110.21,,169.72,77,,,Percent of Total Billed Charges,77% of total billed charges,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.1,74,,,Percent of Total Billed Charges,74% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,185.14,84,,,Percent of Total Billed Charges,84% of total billed charges,180.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.16,89,,,Percent of total Billed Charges,89% of total Billed charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.72,77,,,Percent of total Billed charges,77% of total billed charges,187.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.1,196.16,
Vecuronium 10mg SDV,,,250,RC,,,Outpatient,,,220.41,110.21,,169.72,77,,,Percent of Total Billed Charges,77% of total billed charges,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.1,74,,,Percent of Total Billed Charges,74% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,185.14,84,,,Percent of Total Billed Charges,84% of total billed charges,180.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.16,89,,,Percent of total Billed Charges,89% of total Billed charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.72,77,,,Percent of total Billed charges,77% of total billed charges,187.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.1,196.16,
Vecuronium 10mg SDV,,,250,RC,,,Outpatient,,,220.41,110.21,,169.72,77,,,Percent of Total Billed Charges,77% of total billed charges,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,56.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,68.88,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,163.1,74,,,Percent of Total Billed Charges,74% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,152.08,69,,,Percent of Total Billed Charges,69% of total billed charges,185.14,84,,,Percent of Total Billed Charges,84% of total billed charges,180.74,82,,,Percent of Total Billed Charges,82% of total billed charges ,196.16,89,,,Percent of total Billed Charges,89% of total Billed charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,169.72,77,,,Percent of total Billed charges,77% of total billed charges,187.35,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,63.37,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,110.21,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,89.93,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,196.16,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,55.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.1,196.16,
Vedolizumab (Entyvio) 300mg/5ml Powder SDV,64764030020,CDM,250,RC,,,Outpatient,,,40233.33,20116.67,,30979.66,77,,,Percent of Total Billed Charges,77% of total billed charges,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12572.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29772.66,74,,,Percent of Total Billed Charges,74% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,33796,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,35807.66,89,,,Percent of total Billed Charges,89% of total Billed charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30979.66,77,,,Percent of total Billed charges,77% of total billed charges,34198.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11567.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20116.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10058.33,35807.66,
Vedolizumab (Entyvio) 300mg/5ml Powder SDV,64764030020,CDM,250,RC,,,Outpatient,,,40233.33,20116.67,,30979.66,77,,,Percent of Total Billed Charges,77% of total billed charges,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12572.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29772.66,74,,,Percent of Total Billed Charges,74% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,33796,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,35807.66,89,,,Percent of total Billed Charges,89% of total Billed charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30979.66,77,,,Percent of total Billed charges,77% of total billed charges,34198.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11567.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20116.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10058.33,35807.66,
Vedolizumab (Entyvio) 300mg/5ml Powder SDV,64764030020,CDM,250,RC,,,Outpatient,,,40233.33,20116.67,,30979.66,77,,,Percent of Total Billed Charges,77% of total billed charges,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12572.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29772.66,74,,,Percent of Total Billed Charges,74% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,33796,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,35807.66,89,,,Percent of total Billed Charges,89% of total Billed charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30979.66,77,,,Percent of total Billed charges,77% of total billed charges,34198.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11567.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20116.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10058.33,35807.66,
Vedolizumab (Entyvio) 300mg/5ml Powder SDV,64764030020,CDM,250,RC,,,Outpatient,,,40233.33,20116.67,,30979.66,77,,,Percent of Total Billed Charges,77% of total billed charges,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12572.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29772.66,74,,,Percent of Total Billed Charges,74% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,33796,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,35807.66,89,,,Percent of total Billed Charges,89% of total Billed charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30979.66,77,,,Percent of total Billed charges,77% of total billed charges,34198.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11567.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20116.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10058.33,35807.66,
Vedolizumab (Entyvio) 300mg/5ml Powder SDV,64764030020,CDM,250,RC,,,Outpatient,,,40233.33,20116.67,,30979.66,77,,,Percent of Total Billed Charges,77% of total billed charges,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12572.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29772.66,74,,,Percent of Total Billed Charges,74% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,33796,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,35807.66,89,,,Percent of total Billed Charges,89% of total Billed charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30979.66,77,,,Percent of total Billed charges,77% of total billed charges,34198.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11567.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20116.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10058.33,35807.66,
Vedolizumab (Entyvio) 300mg/5ml Powder SDV,64764030020,CDM,250,RC,,,Outpatient,,,40233.33,20116.67,,30979.66,77,,,Percent of Total Billed Charges,77% of total billed charges,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10259.5,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12572.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29772.66,74,,,Percent of Total Billed Charges,74% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,27761,69,,,Percent of Total Billed Charges,69% of total billed charges,33796,84,,,Percent of Total Billed Charges,84% of total billed charges,15000,100,,,Percent of Total Billed Charges,100% of total billed charges,35807.66,89,,,Percent of total Billed Charges,89% of total Billed charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30979.66,77,,,Percent of total Billed charges,77% of total billed charges,34198.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11567.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20116.67,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16415.2,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35807.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10058.33,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10058.33,35807.66,
Venlafaxine 37.5mg XR Capsule,,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Venlafaxine 37.5mg XR Capsule,,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Venlafaxine 37.5mg XR Capsule,,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Venlafaxine 37.5mg XR Capsule,,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Venlafaxine 37.5mg XR Capsule,,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Venlafaxine 37.5mg XR Capsule,,,250,RC,,,Outpatient,,,40.1,20.05,,30.88,77,,,Percent of Total Billed Charges,77% of total billed charges,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,10.23,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.53,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,29.67,74,,,Percent of Total Billed Charges,74% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,27.67,69,,,Percent of Total Billed Charges,69% of total billed charges,33.68,84,,,Percent of Total Billed Charges,84% of total billed charges,32.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,35.69,89,,,Percent of total Billed Charges,89% of total Billed charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,30.88,77,,,Percent of total Billed charges,77% of total billed charges,34.09,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,11.53,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,20.05,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,16.36,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.03,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.03,35.69,
Venlafaxine 75mg XR Capsule,65862052890,CDM,250,RC,,,Outpatient,,,46.12,23.06,,35.51,77,,,Percent of Total Billed Charges,77% of total billed charges,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.13,74,,,Percent of Total Billed Charges,74% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.74,84,,,Percent of Total Billed Charges,84% of total billed charges,37.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.05,89,,,Percent of total Billed Charges,89% of total Billed charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.51,77,,,Percent of total Billed charges,77% of total billed charges,39.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.53,41.05,
Venlafaxine 75mg XR Capsule,65862052890,CDM,250,RC,,,Outpatient,,,46.12,23.06,,35.51,77,,,Percent of Total Billed Charges,77% of total billed charges,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.13,74,,,Percent of Total Billed Charges,74% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.74,84,,,Percent of Total Billed Charges,84% of total billed charges,37.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.05,89,,,Percent of total Billed Charges,89% of total Billed charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.51,77,,,Percent of total Billed charges,77% of total billed charges,39.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.53,41.05,
Venlafaxine 75mg XR Capsule,65862052890,CDM,250,RC,,,Outpatient,,,46.12,23.06,,35.51,77,,,Percent of Total Billed Charges,77% of total billed charges,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.13,74,,,Percent of Total Billed Charges,74% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.74,84,,,Percent of Total Billed Charges,84% of total billed charges,37.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.05,89,,,Percent of total Billed Charges,89% of total Billed charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.51,77,,,Percent of total Billed charges,77% of total billed charges,39.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.53,41.05,
Venlafaxine 75mg XR Capsule,65862052890,CDM,250,RC,,,Outpatient,,,46.12,23.06,,35.51,77,,,Percent of Total Billed Charges,77% of total billed charges,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.13,74,,,Percent of Total Billed Charges,74% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.74,84,,,Percent of Total Billed Charges,84% of total billed charges,37.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.05,89,,,Percent of total Billed Charges,89% of total Billed charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.51,77,,,Percent of total Billed charges,77% of total billed charges,39.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.53,41.05,
Venlafaxine 75mg XR Capsule,65862052890,CDM,250,RC,,,Outpatient,,,46.12,23.06,,35.51,77,,,Percent of Total Billed Charges,77% of total billed charges,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.13,74,,,Percent of Total Billed Charges,74% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.74,84,,,Percent of Total Billed Charges,84% of total billed charges,37.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.05,89,,,Percent of total Billed Charges,89% of total Billed charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.51,77,,,Percent of total Billed charges,77% of total billed charges,39.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.53,41.05,
Venlafaxine 75mg XR Capsule,65862052890,CDM,250,RC,,,Outpatient,,,46.12,23.06,,35.51,77,,,Percent of Total Billed Charges,77% of total billed charges,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,11.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.41,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,34.13,74,,,Percent of Total Billed Charges,74% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,31.82,69,,,Percent of Total Billed Charges,69% of total billed charges,38.74,84,,,Percent of Total Billed Charges,84% of total billed charges,37.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,41.05,89,,,Percent of total Billed Charges,89% of total Billed charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.51,77,,,Percent of total Billed charges,77% of total billed charges,39.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.26,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,23.06,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,18.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,41.05,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,11.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.53,41.05,
Venlafaxine 75mg Tablet (non-XR),68084085601,CDM,250,RC,,,Outpatient,,,25.46,12.73,,19.6,77,,,Percent of Total Billed Charges,77% of total billed charges,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,21.39,84,,,Percent of Total Billed Charges,84% of total billed charges,20.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.66,89,,,Percent of total Billed Charges,89% of total Billed charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.6,77,,,Percent of total Billed charges,77% of total billed charges,21.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.37,22.66,
Venlafaxine 75mg Tablet (non-XR),68084085601,CDM,250,RC,,,Outpatient,,,25.46,12.73,,19.6,77,,,Percent of Total Billed Charges,77% of total billed charges,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,21.39,84,,,Percent of Total Billed Charges,84% of total billed charges,20.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.66,89,,,Percent of total Billed Charges,89% of total Billed charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.6,77,,,Percent of total Billed charges,77% of total billed charges,21.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.37,22.66,
Venlafaxine 75mg Tablet (non-XR),68084085601,CDM,250,RC,,,Outpatient,,,25.46,12.73,,19.6,77,,,Percent of Total Billed Charges,77% of total billed charges,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,21.39,84,,,Percent of Total Billed Charges,84% of total billed charges,20.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.66,89,,,Percent of total Billed Charges,89% of total Billed charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.6,77,,,Percent of total Billed charges,77% of total billed charges,21.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.37,22.66,
Venlafaxine 75mg Tablet (non-XR),68084085601,CDM,250,RC,,,Outpatient,,,25.46,12.73,,19.6,77,,,Percent of Total Billed Charges,77% of total billed charges,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,21.39,84,,,Percent of Total Billed Charges,84% of total billed charges,20.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.66,89,,,Percent of total Billed Charges,89% of total Billed charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.6,77,,,Percent of total Billed charges,77% of total billed charges,21.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.37,22.66,
Venlafaxine 75mg Tablet (non-XR),68084085601,CDM,250,RC,,,Outpatient,,,25.46,12.73,,19.6,77,,,Percent of Total Billed Charges,77% of total billed charges,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,21.39,84,,,Percent of Total Billed Charges,84% of total billed charges,20.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.66,89,,,Percent of total Billed Charges,89% of total Billed charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.6,77,,,Percent of total Billed charges,77% of total billed charges,21.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.37,22.66,
Venlafaxine 75mg Tablet (non-XR),68084085601,CDM,250,RC,,,Outpatient,,,25.46,12.73,,19.6,77,,,Percent of Total Billed Charges,77% of total billed charges,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,7.96,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,18.84,74,,,Percent of Total Billed Charges,74% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,17.57,69,,,Percent of Total Billed Charges,69% of total billed charges,21.39,84,,,Percent of Total Billed Charges,84% of total billed charges,20.88,82,,,Percent of Total Billed Charges,82% of total billed charges ,22.66,89,,,Percent of total Billed Charges,89% of total Billed charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,19.6,77,,,Percent of total Billed charges,77% of total billed charges,21.64,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,7.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,12.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,10.39,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,22.66,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.37,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.37,22.66,
Verapamil 180mg ER Tablet,,,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
Verapamil 180mg ER Tablet,,,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
Verapamil 180mg ER Tablet,,,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
Verapamil 180mg ER Tablet,,,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
Verapamil 180mg ER Tablet,,,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
Verapamil 180mg ER Tablet,,,250,RC,,,Outpatient,,,18.51,9.26,,14.25,77,,,Percent of Total Billed Charges,77% of total billed charges,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.72,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.78,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,13.7,74,,,Percent of Total Billed Charges,74% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,12.77,69,,,Percent of Total Billed Charges,69% of total billed charges,15.55,84,,,Percent of Total Billed Charges,84% of total billed charges,15.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,16.47,89,,,Percent of total Billed Charges,89% of total Billed charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.25,77,,,Percent of total Billed charges,77% of total billed charges,15.73,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.32,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,9.26,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,7.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,16.47,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.63,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.63,16.47,
Verapamil 5mg/2ml SDV,70710164301,CDM,250,RC,,,Outpatient,,,51.68,25.84,,39.79,77,,,Percent of Total Billed Charges,77% of total billed charges,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.24,74,,,Percent of Total Billed Charges,74% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,84,,,Percent of Total Billed Charges,84% of total billed charges,42.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,46,89,,,Percent of total Billed Charges,89% of total Billed charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.79,77,,,Percent of total Billed charges,77% of total billed charges,43.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.92,46,
Verapamil 5mg/2ml SDV,70710164301,CDM,250,RC,,,Outpatient,,,51.68,25.84,,39.79,77,,,Percent of Total Billed Charges,77% of total billed charges,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.24,74,,,Percent of Total Billed Charges,74% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,84,,,Percent of Total Billed Charges,84% of total billed charges,42.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,46,89,,,Percent of total Billed Charges,89% of total Billed charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.79,77,,,Percent of total Billed charges,77% of total billed charges,43.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.92,46,
Verapamil 5mg/2ml SDV,70710164301,CDM,250,RC,,,Outpatient,,,51.68,25.84,,39.79,77,,,Percent of Total Billed Charges,77% of total billed charges,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.24,74,,,Percent of Total Billed Charges,74% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,84,,,Percent of Total Billed Charges,84% of total billed charges,42.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,46,89,,,Percent of total Billed Charges,89% of total Billed charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.79,77,,,Percent of total Billed charges,77% of total billed charges,43.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.92,46,
Verapamil 5mg/2ml SDV,70710164301,CDM,250,RC,,,Outpatient,,,51.68,25.84,,39.79,77,,,Percent of Total Billed Charges,77% of total billed charges,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.24,74,,,Percent of Total Billed Charges,74% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,84,,,Percent of Total Billed Charges,84% of total billed charges,42.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,46,89,,,Percent of total Billed Charges,89% of total Billed charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.79,77,,,Percent of total Billed charges,77% of total billed charges,43.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.92,46,
Verapamil 5mg/2ml SDV,70710164301,CDM,250,RC,,,Outpatient,,,51.68,25.84,,39.79,77,,,Percent of Total Billed Charges,77% of total billed charges,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.24,74,,,Percent of Total Billed Charges,74% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,84,,,Percent of Total Billed Charges,84% of total billed charges,42.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,46,89,,,Percent of total Billed Charges,89% of total Billed charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.79,77,,,Percent of total Billed charges,77% of total billed charges,43.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.92,46,
Verapamil 5mg/2ml SDV,70710164301,CDM,250,RC,,,Outpatient,,,51.68,25.84,,39.79,77,,,Percent of Total Billed Charges,77% of total billed charges,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,13.18,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,16.15,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,38.24,74,,,Percent of Total Billed Charges,74% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,35.66,69,,,Percent of Total Billed Charges,69% of total billed charges,43.41,84,,,Percent of Total Billed Charges,84% of total billed charges,42.38,82,,,Percent of Total Billed Charges,82% of total billed charges ,46,89,,,Percent of total Billed Charges,89% of total Billed charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,39.79,77,,,Percent of total Billed charges,77% of total billed charges,43.93,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,14.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,25.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,21.09,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.92,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.92,46,
Verapamil 240mg ER Tablet,68462026001,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Verapamil 240mg ER Tablet,68462026001,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Verapamil 240mg ER Tablet,68462026001,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Verapamil 240mg ER Tablet,68462026001,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Verapamil 240mg ER Tablet,68462026001,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Verapamil 240mg ER Tablet,68462026001,CDM,250,RC,,,Outpatient,,,20.39,10.2,,15.7,77,,,Percent of Total Billed Charges,77% of total billed charges,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,5.2,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,6.37,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,15.09,74,,,Percent of Total Billed Charges,74% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,14.07,69,,,Percent of Total Billed Charges,69% of total billed charges,17.13,84,,,Percent of Total Billed Charges,84% of total billed charges,16.72,82,,,Percent of Total Billed Charges,82% of total billed charges ,18.15,89,,,Percent of total Billed Charges,89% of total Billed charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,15.7,77,,,Percent of total Billed charges,77% of total billed charges,17.33,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,5.86,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,10.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,8.32,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,18.15,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.1,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.1,18.15,
Verapamil 80mg Tablet,23155002601,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Verapamil 80mg Tablet,23155002601,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Verapamil 80mg Tablet,23155002601,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Verapamil 80mg Tablet,23155002601,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Verapamil 80mg Tablet,23155002601,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Verapamil 80mg Tablet,23155002601,CDM,250,RC,,,Outpatient,,,7.91,3.96,,6.09,77,,,Percent of Total Billed Charges,77% of total billed charges,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.02,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.47,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,5.85,74,,,Percent of Total Billed Charges,74% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,5.46,69,,,Percent of Total Billed Charges,69% of total billed charges,6.64,84,,,Percent of Total Billed Charges,84% of total billed charges,6.49,82,,,Percent of Total Billed Charges,82% of total billed charges ,7.04,89,,,Percent of total Billed Charges,89% of total Billed charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,6.09,77,,,Percent of total Billed charges,77% of total billed charges,6.72,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,2.27,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.96,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,3.23,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.04,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.98,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.98,7.04,
Vilazodone 10mg Tablet,456111030,CDM,250,RC,,,Outpatient,,,86.81,43.41,,66.84,77,,,Percent of Total Billed Charges,77% of total billed charges,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.24,74,,,Percent of Total Billed Charges,74% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,72.92,84,,,Percent of Total Billed Charges,84% of total billed charges,71.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.26,89,,,Percent of total Billed Charges,89% of total Billed charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.84,77,,,Percent of total Billed charges,77% of total billed charges,73.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77.26,
Vilazodone 10mg Tablet,456111030,CDM,250,RC,,,Outpatient,,,86.81,43.41,,66.84,77,,,Percent of Total Billed Charges,77% of total billed charges,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.24,74,,,Percent of Total Billed Charges,74% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,72.92,84,,,Percent of Total Billed Charges,84% of total billed charges,71.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.26,89,,,Percent of total Billed Charges,89% of total Billed charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.84,77,,,Percent of total Billed charges,77% of total billed charges,73.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77.26,
Vilazodone 10mg Tablet,456111030,CDM,250,RC,,,Outpatient,,,86.81,43.41,,66.84,77,,,Percent of Total Billed Charges,77% of total billed charges,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.24,74,,,Percent of Total Billed Charges,74% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,72.92,84,,,Percent of Total Billed Charges,84% of total billed charges,71.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.26,89,,,Percent of total Billed Charges,89% of total Billed charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.84,77,,,Percent of total Billed charges,77% of total billed charges,73.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77.26,
Vilazodone 10mg Tablet,456111030,CDM,250,RC,,,Outpatient,,,86.81,43.41,,66.84,77,,,Percent of Total Billed Charges,77% of total billed charges,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.24,74,,,Percent of Total Billed Charges,74% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,72.92,84,,,Percent of Total Billed Charges,84% of total billed charges,71.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.26,89,,,Percent of total Billed Charges,89% of total Billed charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.84,77,,,Percent of total Billed charges,77% of total billed charges,73.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77.26,
Vilazodone 10mg Tablet,456111030,CDM,250,RC,,,Outpatient,,,86.81,43.41,,66.84,77,,,Percent of Total Billed Charges,77% of total billed charges,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.24,74,,,Percent of Total Billed Charges,74% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,72.92,84,,,Percent of Total Billed Charges,84% of total billed charges,71.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.26,89,,,Percent of total Billed Charges,89% of total Billed charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.84,77,,,Percent of total Billed charges,77% of total billed charges,73.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77.26,
Vilazodone 10mg Tablet,456111030,CDM,250,RC,,,Outpatient,,,86.81,43.41,,66.84,77,,,Percent of Total Billed Charges,77% of total billed charges,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.14,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.13,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.24,74,,,Percent of Total Billed Charges,74% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,59.9,69,,,Percent of Total Billed Charges,69% of total billed charges,72.92,84,,,Percent of Total Billed Charges,84% of total billed charges,71.18,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.26,89,,,Percent of total Billed Charges,89% of total Billed charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,66.84,77,,,Percent of total Billed charges,77% of total billed charges,73.79,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,24.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.42,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.26,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.7,77.26,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,5206.4,2603.2,,4008.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1627,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3852.74,74,,,Percent of Total Billed Charges,74% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4373.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4269.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,4633.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4008.93,77,,,Percent of total Billed charges,77% of total billed charges,4425.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1496.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2603.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.6,4633.7,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,3282.66,1641.33,,2527.65,77,,,Percent of Total Billed Charges,77% of total billed charges,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2429.17,74,,,Percent of Total Billed Charges,74% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2757.43,84,,,Percent of Total Billed Charges,84% of total billed charges,2691.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2921.57,89,,,Percent of total Billed Charges,89% of total Billed charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.65,77,,,Percent of total Billed charges,77% of total billed charges,2790.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,943.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1641.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.67,2921.57,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,5206.4,2603.2,,4008.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1627,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3852.74,74,,,Percent of Total Billed Charges,74% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4373.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4269.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,4633.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4008.93,77,,,Percent of total Billed charges,77% of total billed charges,4425.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1496.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2603.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.6,4633.7,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,3282.66,1641.33,,2527.65,77,,,Percent of Total Billed Charges,77% of total billed charges,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2429.17,74,,,Percent of Total Billed Charges,74% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2757.43,84,,,Percent of Total Billed Charges,84% of total billed charges,2691.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2921.57,89,,,Percent of total Billed Charges,89% of total Billed charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.65,77,,,Percent of total Billed charges,77% of total billed charges,2790.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,943.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1641.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.67,2921.57,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,5206.4,2603.2,,4008.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1627,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3852.74,74,,,Percent of Total Billed Charges,74% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4373.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4269.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,4633.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4008.93,77,,,Percent of total Billed charges,77% of total billed charges,4425.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1496.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2603.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.6,4633.7,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,3282.66,1641.33,,2527.65,77,,,Percent of Total Billed Charges,77% of total billed charges,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2429.17,74,,,Percent of Total Billed Charges,74% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2757.43,84,,,Percent of Total Billed Charges,84% of total billed charges,2691.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2921.57,89,,,Percent of total Billed Charges,89% of total Billed charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.65,77,,,Percent of total Billed charges,77% of total billed charges,2790.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,943.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1641.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.67,2921.57,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,5206.4,2603.2,,4008.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1627,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3852.74,74,,,Percent of Total Billed Charges,74% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4373.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4269.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,4633.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4008.93,77,,,Percent of total Billed charges,77% of total billed charges,4425.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1496.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2603.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.6,4633.7,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,3282.66,1641.33,,2527.65,77,,,Percent of Total Billed Charges,77% of total billed charges,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2429.17,74,,,Percent of Total Billed Charges,74% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2757.43,84,,,Percent of Total Billed Charges,84% of total billed charges,2691.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2921.57,89,,,Percent of total Billed Charges,89% of total Billed charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.65,77,,,Percent of total Billed charges,77% of total billed charges,2790.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,943.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1641.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.67,2921.57,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,5206.4,2603.2,,4008.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1627,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3852.74,74,,,Percent of Total Billed Charges,74% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4373.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4269.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,4633.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4008.93,77,,,Percent of total Billed charges,77% of total billed charges,4425.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1496.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2603.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.6,4633.7,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,3282.66,1641.33,,2527.65,77,,,Percent of Total Billed Charges,77% of total billed charges,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2429.17,74,,,Percent of Total Billed Charges,74% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2757.43,84,,,Percent of Total Billed Charges,84% of total billed charges,2691.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2921.57,89,,,Percent of total Billed Charges,89% of total Billed charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.65,77,,,Percent of total Billed charges,77% of total billed charges,2790.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,943.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1641.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.67,2921.57,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,5206.4,2603.2,,4008.93,77,,,Percent of Total Billed Charges,77% of total billed charges,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1327.63,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1627,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3852.74,74,,,Percent of Total Billed Charges,74% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,3592.42,69,,,Percent of Total Billed Charges,69% of total billed charges,4373.38,84,,,Percent of Total Billed Charges,84% of total billed charges,4269.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,4633.7,89,,,Percent of total Billed Charges,89% of total Billed charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4008.93,77,,,Percent of total Billed charges,77% of total billed charges,4425.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1496.84,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2603.2,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2124.21,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4633.7,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1301.6,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1301.6,4633.7,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,3282.66,1641.33,,2527.65,77,,,Percent of Total Billed Charges,77% of total billed charges,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,837.08,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1025.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2429.17,74,,,Percent of Total Billed Charges,74% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2265.04,69,,,Percent of Total Billed Charges,69% of total billed charges,2757.43,84,,,Percent of Total Billed Charges,84% of total billed charges,2691.78,82,,,Percent of Total Billed Charges,82% of total billed charges ,2921.57,89,,,Percent of total Billed Charges,89% of total Billed charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2527.65,77,,,Percent of total Billed charges,77% of total billed charges,2790.26,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,943.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1641.33,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1339.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2921.57,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,820.67,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,820.67,2921.57,
vinBLAStine 10mg/10ml Liquid MDV,63323027810,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,2025.04,1012.52,,1559.28,77,,,Percent of Total Billed Charges,77% of total billed charges,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1498.53,74,,,Percent of Total Billed Charges,74% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1701.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1660.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1802.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.28,77,,,Percent of total Billed charges,77% of total billed charges,1721.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1012.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.26,1802.29,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,1203.74,601.87,,926.88,77,,,Percent of Total Billed Charges,77% of total billed charges,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,890.77,74,,,Percent of Total Billed Charges,74% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.14,84,,,Percent of Total Billed Charges,84% of total billed charges,987.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.88,77,,,Percent of total Billed charges,77% of total billed charges,1023.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.94,1071.33,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,2025.04,1012.52,,1559.28,77,,,Percent of Total Billed Charges,77% of total billed charges,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1498.53,74,,,Percent of Total Billed Charges,74% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1701.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1660.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1802.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.28,77,,,Percent of total Billed charges,77% of total billed charges,1721.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1012.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.26,1802.29,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,1203.74,601.87,,926.88,77,,,Percent of Total Billed Charges,77% of total billed charges,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,890.77,74,,,Percent of Total Billed Charges,74% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.14,84,,,Percent of Total Billed Charges,84% of total billed charges,987.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.88,77,,,Percent of total Billed charges,77% of total billed charges,1023.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.94,1071.33,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,2025.04,1012.52,,1559.28,77,,,Percent of Total Billed Charges,77% of total billed charges,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1498.53,74,,,Percent of Total Billed Charges,74% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1701.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1660.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1802.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.28,77,,,Percent of total Billed charges,77% of total billed charges,1721.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1012.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.26,1802.29,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,1203.74,601.87,,926.88,77,,,Percent of Total Billed Charges,77% of total billed charges,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,890.77,74,,,Percent of Total Billed Charges,74% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.14,84,,,Percent of Total Billed Charges,84% of total billed charges,987.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.88,77,,,Percent of total Billed charges,77% of total billed charges,1023.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.94,1071.33,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,2025.04,1012.52,,1559.28,77,,,Percent of Total Billed Charges,77% of total billed charges,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1498.53,74,,,Percent of Total Billed Charges,74% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1701.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1660.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1802.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.28,77,,,Percent of total Billed charges,77% of total billed charges,1721.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1012.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.26,1802.29,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,1203.74,601.87,,926.88,77,,,Percent of Total Billed Charges,77% of total billed charges,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,890.77,74,,,Percent of Total Billed Charges,74% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.14,84,,,Percent of Total Billed Charges,84% of total billed charges,987.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.88,77,,,Percent of total Billed charges,77% of total billed charges,1023.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.94,1071.33,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,2025.04,1012.52,,1559.28,77,,,Percent of Total Billed Charges,77% of total billed charges,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1498.53,74,,,Percent of Total Billed Charges,74% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1701.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1660.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1802.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.28,77,,,Percent of total Billed charges,77% of total billed charges,1721.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1012.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.26,1802.29,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,1203.74,601.87,,926.88,77,,,Percent of Total Billed Charges,77% of total billed charges,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,890.77,74,,,Percent of Total Billed Charges,74% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.14,84,,,Percent of Total Billed Charges,84% of total billed charges,987.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.88,77,,,Percent of total Billed charges,77% of total billed charges,1023.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.94,1071.33,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,2025.04,1012.52,,1559.28,77,,,Percent of Total Billed Charges,77% of total billed charges,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,516.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,632.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1498.53,74,,,Percent of Total Billed Charges,74% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1397.28,69,,,Percent of Total Billed Charges,69% of total billed charges,1701.03,84,,,Percent of Total Billed Charges,84% of total billed charges,1660.53,82,,,Percent of Total Billed Charges,82% of total billed charges ,1802.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1559.28,77,,,Percent of total Billed charges,77% of total billed charges,1721.28,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,582.2,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1012.52,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,826.22,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1802.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,506.26,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,506.26,1802.29,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,1203.74,601.87,,926.88,77,,,Percent of Total Billed Charges,77% of total billed charges,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,306.95,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,376.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,890.77,74,,,Percent of Total Billed Charges,74% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,830.58,69,,,Percent of Total Billed Charges,69% of total billed charges,1011.14,84,,,Percent of Total Billed Charges,84% of total billed charges,987.07,82,,,Percent of Total Billed Charges,82% of total billed charges ,1071.33,89,,,Percent of total Billed Charges,89% of total Billed charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,926.88,77,,,Percent of total Billed charges,77% of total billed charges,1023.18,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,346.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,601.87,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,491.13,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1071.33,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,300.94,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,300.94,1071.33,
vinCRIStine 1mg/ml Liquid SDV,61703030906,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1776.73,888.37,,1368.08,77,,,Percent of Total Billed Charges,77% of total billed charges,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1314.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1456.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1581.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368.08,77,,,Percent of total Billed charges,77% of total billed charges,1510.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,510.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,888.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.18,1581.29,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1068.07,534.04,,822.41,77,,,Percent of Total Billed Charges,77% of total billed charges,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,790.37,74,,,Percent of Total Billed Charges,74% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,897.18,84,,,Percent of Total Billed Charges,84% of total billed charges,875.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.58,89,,,Percent of total Billed Charges,89% of total Billed charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,822.41,77,,,Percent of total Billed charges,77% of total billed charges,907.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,534.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.02,950.58,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1776.73,888.37,,1368.08,77,,,Percent of Total Billed Charges,77% of total billed charges,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1314.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1456.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1581.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368.08,77,,,Percent of total Billed charges,77% of total billed charges,1510.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,510.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,888.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.18,1581.29,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1068.07,534.04,,822.41,77,,,Percent of Total Billed Charges,77% of total billed charges,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,790.37,74,,,Percent of Total Billed Charges,74% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,897.18,84,,,Percent of Total Billed Charges,84% of total billed charges,875.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.58,89,,,Percent of total Billed Charges,89% of total Billed charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,822.41,77,,,Percent of total Billed charges,77% of total billed charges,907.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,534.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.02,950.58,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1776.73,888.37,,1368.08,77,,,Percent of Total Billed Charges,77% of total billed charges,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1314.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1456.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1581.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368.08,77,,,Percent of total Billed charges,77% of total billed charges,1510.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,510.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,888.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.18,1581.29,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1068.07,534.04,,822.41,77,,,Percent of Total Billed Charges,77% of total billed charges,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,790.37,74,,,Percent of Total Billed Charges,74% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,897.18,84,,,Percent of Total Billed Charges,84% of total billed charges,875.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.58,89,,,Percent of total Billed Charges,89% of total Billed charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,822.41,77,,,Percent of total Billed charges,77% of total billed charges,907.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,534.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.02,950.58,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1776.73,888.37,,1368.08,77,,,Percent of Total Billed Charges,77% of total billed charges,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1314.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1456.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1581.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368.08,77,,,Percent of total Billed charges,77% of total billed charges,1510.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,510.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,888.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.18,1581.29,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1068.07,534.04,,822.41,77,,,Percent of Total Billed Charges,77% of total billed charges,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,790.37,74,,,Percent of Total Billed Charges,74% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,897.18,84,,,Percent of Total Billed Charges,84% of total billed charges,875.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.58,89,,,Percent of total Billed Charges,89% of total Billed charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,822.41,77,,,Percent of total Billed charges,77% of total billed charges,907.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,534.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.02,950.58,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1776.73,888.37,,1368.08,77,,,Percent of Total Billed Charges,77% of total billed charges,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1314.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1456.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1581.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368.08,77,,,Percent of total Billed charges,77% of total billed charges,1510.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,510.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,888.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.18,1581.29,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1068.07,534.04,,822.41,77,,,Percent of Total Billed Charges,77% of total billed charges,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,790.37,74,,,Percent of Total Billed Charges,74% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,897.18,84,,,Percent of Total Billed Charges,84% of total billed charges,875.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.58,89,,,Percent of total Billed Charges,89% of total Billed charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,822.41,77,,,Percent of total Billed charges,77% of total billed charges,907.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,534.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.02,950.58,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1776.73,888.37,,1368.08,77,,,Percent of Total Billed Charges,77% of total billed charges,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,453.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,555.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1314.78,74,,,Percent of Total Billed Charges,74% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1225.94,69,,,Percent of Total Billed Charges,69% of total billed charges,1492.45,84,,,Percent of Total Billed Charges,84% of total billed charges,1456.92,82,,,Percent of Total Billed Charges,82% of total billed charges ,1581.29,89,,,Percent of total Billed Charges,89% of total Billed charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1368.08,77,,,Percent of total Billed charges,77% of total billed charges,1510.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,510.81,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,888.37,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,724.91,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1581.29,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,444.18,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,444.18,1581.29,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,1068.07,534.04,,822.41,77,,,Percent of Total Billed Charges,77% of total billed charges,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,272.36,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,333.77,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,790.37,74,,,Percent of Total Billed Charges,74% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,736.97,69,,,Percent of Total Billed Charges,69% of total billed charges,897.18,84,,,Percent of Total Billed Charges,84% of total billed charges,875.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,950.58,89,,,Percent of total Billed Charges,89% of total Billed charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,822.41,77,,,Percent of total Billed charges,77% of total billed charges,907.86,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,307.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,534.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,435.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,950.58,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,267.02,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,267.02,950.58,
vinCRIStine 2mg/2ml Liquid SDV,61703030916,CDM,250,RC,,,Outpatient,,,111.5,55.75,,85.86,77,,,Percent of Total Billed Charges,77% of total billed charges,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,28.43,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,34.84,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,82.51,74,,,Percent of Total Billed Charges,74% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,76.94,69,,,Percent of Total Billed Charges,69% of total billed charges,93.66,84,,,Percent of Total Billed Charges,84% of total billed charges,91.43,82,,,Percent of Total Billed Charges,82% of total billed charges ,99.24,89,,,Percent of total Billed Charges,89% of total Billed charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,85.86,77,,,Percent of total Billed charges,77% of total billed charges,94.78,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,32.06,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,55.75,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,45.49,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,99.24,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,27.88,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,27.88,99.24,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2791.11,1395.56,,2149.15,77,,,Percent of Total Billed Charges,77% of total billed charges,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2065.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2344.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2288.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,2484.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.15,77,,,Percent of total Billed charges,77% of total billed charges,2372.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1395.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,697.78,2484.09,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2722.79,1361.4,,2096.55,77,,,Percent of Total Billed Charges,77% of total billed charges,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2014.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2287.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2232.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2423.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2096.55,77,,,Percent of total Billed charges,77% of total billed charges,2314.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.7,2423.28,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2791.11,1395.56,,2149.15,77,,,Percent of Total Billed Charges,77% of total billed charges,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2065.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2344.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2288.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,2484.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.15,77,,,Percent of total Billed charges,77% of total billed charges,2372.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1395.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,697.78,2484.09,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2722.79,1361.4,,2096.55,77,,,Percent of Total Billed Charges,77% of total billed charges,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2014.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2287.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2232.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2423.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2096.55,77,,,Percent of total Billed charges,77% of total billed charges,2314.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.7,2423.28,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2791.11,1395.56,,2149.15,77,,,Percent of Total Billed Charges,77% of total billed charges,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2065.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2344.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2288.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,2484.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.15,77,,,Percent of total Billed charges,77% of total billed charges,2372.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1395.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,697.78,2484.09,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2722.79,1361.4,,2096.55,77,,,Percent of Total Billed Charges,77% of total billed charges,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2014.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2287.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2232.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2423.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2096.55,77,,,Percent of total Billed charges,77% of total billed charges,2314.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.7,2423.28,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2791.11,1395.56,,2149.15,77,,,Percent of Total Billed Charges,77% of total billed charges,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2065.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2344.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2288.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,2484.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.15,77,,,Percent of total Billed charges,77% of total billed charges,2372.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1395.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,697.78,2484.09,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2722.79,1361.4,,2096.55,77,,,Percent of Total Billed Charges,77% of total billed charges,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2014.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2287.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2232.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2423.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2096.55,77,,,Percent of total Billed charges,77% of total billed charges,2314.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.7,2423.28,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2791.11,1395.56,,2149.15,77,,,Percent of Total Billed Charges,77% of total billed charges,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2065.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2344.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2288.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,2484.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.15,77,,,Percent of total Billed charges,77% of total billed charges,2372.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1395.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,697.78,2484.09,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2722.79,1361.4,,2096.55,77,,,Percent of Total Billed Charges,77% of total billed charges,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2014.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2287.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2232.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2423.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2096.55,77,,,Percent of total Billed charges,77% of total billed charges,2314.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.7,2423.28,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2791.11,1395.56,,2149.15,77,,,Percent of Total Billed Charges,77% of total billed charges,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,711.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,872.22,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2065.42,74,,,Percent of Total Billed Charges,74% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,1925.87,69,,,Percent of Total Billed Charges,69% of total billed charges,2344.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2288.71,82,,,Percent of Total Billed Charges,82% of total billed charges ,2484.09,89,,,Percent of total Billed Charges,89% of total Billed charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2149.15,77,,,Percent of total Billed charges,77% of total billed charges,2372.44,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,802.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1395.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1138.77,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2484.09,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,697.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,697.78,2484.09,
Vinorelbine 10mg/ml Liquid SDV,25021020401,CDM,250,RC,,,Outpatient,,,2722.79,1361.4,,2096.55,77,,,Percent of Total Billed Charges,77% of total billed charges,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,694.31,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,850.87,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2014.86,74,,,Percent of Total Billed Charges,74% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,1878.73,69,,,Percent of Total Billed Charges,69% of total billed charges,2287.14,84,,,Percent of Total Billed Charges,84% of total billed charges,2232.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,2423.28,89,,,Percent of total Billed Charges,89% of total Billed charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2096.55,77,,,Percent of total Billed charges,77% of total billed charges,2314.37,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,782.8,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1361.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1110.9,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2423.28,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,680.7,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,680.7,2423.28,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3395.3,1697.65,,2614.38,77,,,Percent of Total Billed Charges,77% of total billed charges,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1061.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2512.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2852.05,84,,,Percent of Total Billed Charges,84% of total billed charges,2784.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3021.82,89,,,Percent of total Billed Charges,89% of total Billed charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2614.38,77,,,Percent of total Billed charges,77% of total billed charges,2886.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,976.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1697.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.83,3021.82,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3311.35,1655.68,,2549.74,77,,,Percent of Total Billed Charges,77% of total billed charges,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1034.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2450.4,74,,,Percent of Total Billed Charges,74% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2715.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2947.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2549.74,77,,,Percent of total Billed charges,77% of total billed charges,2814.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1655.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.84,2947.1,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3395.3,1697.65,,2614.38,77,,,Percent of Total Billed Charges,77% of total billed charges,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1061.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2512.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2852.05,84,,,Percent of Total Billed Charges,84% of total billed charges,2784.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3021.82,89,,,Percent of total Billed Charges,89% of total Billed charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2614.38,77,,,Percent of total Billed charges,77% of total billed charges,2886.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,976.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1697.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.83,3021.82,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3311.35,1655.68,,2549.74,77,,,Percent of Total Billed Charges,77% of total billed charges,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1034.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2450.4,74,,,Percent of Total Billed Charges,74% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2715.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2947.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2549.74,77,,,Percent of total Billed charges,77% of total billed charges,2814.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1655.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.84,2947.1,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3395.3,1697.65,,2614.38,77,,,Percent of Total Billed Charges,77% of total billed charges,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1061.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2512.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2852.05,84,,,Percent of Total Billed Charges,84% of total billed charges,2784.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3021.82,89,,,Percent of total Billed Charges,89% of total Billed charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2614.38,77,,,Percent of total Billed charges,77% of total billed charges,2886.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,976.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1697.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.83,3021.82,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3311.35,1655.68,,2549.74,77,,,Percent of Total Billed Charges,77% of total billed charges,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1034.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2450.4,74,,,Percent of Total Billed Charges,74% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2715.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2947.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2549.74,77,,,Percent of total Billed charges,77% of total billed charges,2814.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1655.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.84,2947.1,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3395.3,1697.65,,2614.38,77,,,Percent of Total Billed Charges,77% of total billed charges,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1061.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2512.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2852.05,84,,,Percent of Total Billed Charges,84% of total billed charges,2784.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3021.82,89,,,Percent of total Billed Charges,89% of total Billed charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2614.38,77,,,Percent of total Billed charges,77% of total billed charges,2886.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,976.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1697.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.83,3021.82,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3311.35,1655.68,,2549.74,77,,,Percent of Total Billed Charges,77% of total billed charges,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1034.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2450.4,74,,,Percent of Total Billed Charges,74% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2715.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2947.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2549.74,77,,,Percent of total Billed charges,77% of total billed charges,2814.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1655.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.84,2947.1,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3395.3,1697.65,,2614.38,77,,,Percent of Total Billed Charges,77% of total billed charges,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1061.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2512.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2852.05,84,,,Percent of Total Billed Charges,84% of total billed charges,2784.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3021.82,89,,,Percent of total Billed Charges,89% of total Billed charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2614.38,77,,,Percent of total Billed charges,77% of total billed charges,2886.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,976.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1697.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.83,3021.82,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3311.35,1655.68,,2549.74,77,,,Percent of Total Billed Charges,77% of total billed charges,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1034.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2450.4,74,,,Percent of Total Billed Charges,74% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2715.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2947.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2549.74,77,,,Percent of total Billed charges,77% of total billed charges,2814.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1655.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.84,2947.1,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3395.3,1697.65,,2614.38,77,,,Percent of Total Billed Charges,77% of total billed charges,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,865.8,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1061.03,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2512.52,74,,,Percent of Total Billed Charges,74% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2342.76,69,,,Percent of Total Billed Charges,69% of total billed charges,2852.05,84,,,Percent of Total Billed Charges,84% of total billed charges,2784.15,82,,,Percent of Total Billed Charges,82% of total billed charges ,3021.82,89,,,Percent of total Billed Charges,89% of total Billed charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2614.38,77,,,Percent of total Billed charges,77% of total billed charges,2886.01,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,976.15,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1697.65,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1385.28,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3021.82,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,848.83,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,848.83,3021.82,
Vinorelbine 50mg/5ml Liquid SDV,25021020405,CDM,250,RC,,,Outpatient,,,3311.35,1655.68,,2549.74,77,,,Percent of Total Billed Charges,77% of total billed charges,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,844.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1034.8,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2450.4,74,,,Percent of Total Billed Charges,74% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2284.83,69,,,Percent of Total Billed Charges,69% of total billed charges,2781.53,84,,,Percent of Total Billed Charges,84% of total billed charges,2715.31,82,,,Percent of Total Billed Charges,82% of total billed charges ,2947.1,89,,,Percent of total Billed Charges,89% of total Billed charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2549.74,77,,,Percent of total Billed charges,77% of total billed charges,2814.65,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,952.01,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1655.68,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1351.03,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2947.1,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,827.84,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,827.84,2947.1,
Voriconazole 200mg Tablet,27241006303,CDM,250,RC,,,Outpatient,,,290.03,145.02,,223.32,77,,,Percent of Total Billed Charges,77% of total billed charges,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.62,74,,,Percent of Total Billed Charges,74% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,243.63,84,,,Percent of Total Billed Charges,84% of total billed charges,237.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.13,89,,,Percent of total Billed Charges,89% of total Billed charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.32,77,,,Percent of total Billed charges,77% of total billed charges,246.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,145.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.51,258.13,
Voriconazole 200mg Tablet,27241006303,CDM,250,RC,,,Outpatient,,,290.03,145.02,,223.32,77,,,Percent of Total Billed Charges,77% of total billed charges,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.62,74,,,Percent of Total Billed Charges,74% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,243.63,84,,,Percent of Total Billed Charges,84% of total billed charges,237.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.13,89,,,Percent of total Billed Charges,89% of total Billed charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.32,77,,,Percent of total Billed charges,77% of total billed charges,246.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,145.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.51,258.13,
Voriconazole 200mg Tablet,27241006303,CDM,250,RC,,,Outpatient,,,290.03,145.02,,223.32,77,,,Percent of Total Billed Charges,77% of total billed charges,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.62,74,,,Percent of Total Billed Charges,74% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,243.63,84,,,Percent of Total Billed Charges,84% of total billed charges,237.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.13,89,,,Percent of total Billed Charges,89% of total Billed charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.32,77,,,Percent of total Billed charges,77% of total billed charges,246.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,145.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.51,258.13,
Voriconazole 200mg Tablet,27241006303,CDM,250,RC,,,Outpatient,,,290.03,145.02,,223.32,77,,,Percent of Total Billed Charges,77% of total billed charges,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.62,74,,,Percent of Total Billed Charges,74% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,243.63,84,,,Percent of Total Billed Charges,84% of total billed charges,237.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.13,89,,,Percent of total Billed Charges,89% of total Billed charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.32,77,,,Percent of total Billed charges,77% of total billed charges,246.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,145.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.51,258.13,
Voriconazole 200mg Tablet,27241006303,CDM,250,RC,,,Outpatient,,,290.03,145.02,,223.32,77,,,Percent of Total Billed Charges,77% of total billed charges,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.62,74,,,Percent of Total Billed Charges,74% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,243.63,84,,,Percent of Total Billed Charges,84% of total billed charges,237.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.13,89,,,Percent of total Billed Charges,89% of total Billed charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.32,77,,,Percent of total Billed charges,77% of total billed charges,246.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,145.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.51,258.13,
Voriconazole 200mg Tablet,27241006303,CDM,250,RC,,,Outpatient,,,290.03,145.02,,223.32,77,,,Percent of Total Billed Charges,77% of total billed charges,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,73.96,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,90.63,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,214.62,74,,,Percent of Total Billed Charges,74% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,200.12,69,,,Percent of Total Billed Charges,69% of total billed charges,243.63,84,,,Percent of Total Billed Charges,84% of total billed charges,237.82,82,,,Percent of Total Billed Charges,82% of total billed charges ,258.13,89,,,Percent of total Billed Charges,89% of total Billed charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,223.32,77,,,Percent of total Billed charges,77% of total billed charges,246.53,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,83.38,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,145.02,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,118.33,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,258.13,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,72.51,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,72.51,258.13,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,719.65,359.83,,554.13,77,,,Percent of Total Billed Charges,77% of total billed charges,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.54,74,,,Percent of Total Billed Charges,74% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,604.51,84,,,Percent of Total Billed Charges,84% of total billed charges,590.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.49,89,,,Percent of total Billed Charges,89% of total Billed charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.13,77,,,Percent of total Billed charges,77% of total billed charges,611.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.91,640.49,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,747.97,373.99,,575.94,77,,,Percent of Total Billed Charges,77% of total billed charges,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.5,74,,,Percent of Total Billed Charges,74% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,628.29,84,,,Percent of Total Billed Charges,84% of total billed charges,613.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.69,89,,,Percent of total Billed Charges,89% of total Billed charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.94,77,,,Percent of total Billed charges,77% of total billed charges,635.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,373.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.99,665.69,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,719.65,359.83,,554.13,77,,,Percent of Total Billed Charges,77% of total billed charges,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.54,74,,,Percent of Total Billed Charges,74% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,604.51,84,,,Percent of Total Billed Charges,84% of total billed charges,590.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.49,89,,,Percent of total Billed Charges,89% of total Billed charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.13,77,,,Percent of total Billed charges,77% of total billed charges,611.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.91,640.49,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,747.97,373.99,,575.94,77,,,Percent of Total Billed Charges,77% of total billed charges,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.5,74,,,Percent of Total Billed Charges,74% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,628.29,84,,,Percent of Total Billed Charges,84% of total billed charges,613.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.69,89,,,Percent of total Billed Charges,89% of total Billed charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.94,77,,,Percent of total Billed charges,77% of total billed charges,635.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,373.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.99,665.69,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,719.65,359.83,,554.13,77,,,Percent of Total Billed Charges,77% of total billed charges,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.54,74,,,Percent of Total Billed Charges,74% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,604.51,84,,,Percent of Total Billed Charges,84% of total billed charges,590.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.49,89,,,Percent of total Billed Charges,89% of total Billed charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.13,77,,,Percent of total Billed charges,77% of total billed charges,611.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.91,640.49,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,747.97,373.99,,575.94,77,,,Percent of Total Billed Charges,77% of total billed charges,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.5,74,,,Percent of Total Billed Charges,74% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,628.29,84,,,Percent of Total Billed Charges,84% of total billed charges,613.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.69,89,,,Percent of total Billed Charges,89% of total Billed charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.94,77,,,Percent of total Billed charges,77% of total billed charges,635.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,373.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.99,665.69,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,719.65,359.83,,554.13,77,,,Percent of Total Billed Charges,77% of total billed charges,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.54,74,,,Percent of Total Billed Charges,74% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,604.51,84,,,Percent of Total Billed Charges,84% of total billed charges,590.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.49,89,,,Percent of total Billed Charges,89% of total Billed charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.13,77,,,Percent of total Billed charges,77% of total billed charges,611.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.91,640.49,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,747.97,373.99,,575.94,77,,,Percent of Total Billed Charges,77% of total billed charges,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.5,74,,,Percent of Total Billed Charges,74% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,628.29,84,,,Percent of Total Billed Charges,84% of total billed charges,613.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.69,89,,,Percent of total Billed Charges,89% of total Billed charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.94,77,,,Percent of total Billed charges,77% of total billed charges,635.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,373.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.99,665.69,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,719.65,359.83,,554.13,77,,,Percent of Total Billed Charges,77% of total billed charges,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.54,74,,,Percent of Total Billed Charges,74% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,604.51,84,,,Percent of Total Billed Charges,84% of total billed charges,590.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.49,89,,,Percent of total Billed Charges,89% of total Billed charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.13,77,,,Percent of total Billed charges,77% of total billed charges,611.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.91,640.49,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,747.97,373.99,,575.94,77,,,Percent of Total Billed Charges,77% of total billed charges,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.5,74,,,Percent of Total Billed Charges,74% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,628.29,84,,,Percent of Total Billed Charges,84% of total billed charges,613.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.69,89,,,Percent of total Billed Charges,89% of total Billed charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.94,77,,,Percent of total Billed charges,77% of total billed charges,635.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,373.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.99,665.69,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,719.65,359.83,,554.13,77,,,Percent of Total Billed Charges,77% of total billed charges,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,183.51,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,224.89,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,532.54,74,,,Percent of Total Billed Charges,74% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,496.56,69,,,Percent of Total Billed Charges,69% of total billed charges,604.51,84,,,Percent of Total Billed Charges,84% of total billed charges,590.11,82,,,Percent of Total Billed Charges,82% of total billed charges ,640.49,89,,,Percent of total Billed Charges,89% of total Billed charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,554.13,77,,,Percent of total Billed charges,77% of total billed charges,611.7,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,206.9,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,359.83,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,293.62,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,640.49,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,179.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,179.91,640.49,
Voriconazole 200mg SDV,781341694,CDM,250,RC,,,Outpatient,,,747.97,373.99,,575.94,77,,,Percent of Total Billed Charges,77% of total billed charges,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,190.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,233.74,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,553.5,74,,,Percent of Total Billed Charges,74% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,516.1,69,,,Percent of Total Billed Charges,69% of total billed charges,628.29,84,,,Percent of Total Billed Charges,84% of total billed charges,613.34,82,,,Percent of Total Billed Charges,82% of total billed charges ,665.69,89,,,Percent of total Billed Charges,89% of total Billed charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,575.94,77,,,Percent of total Billed charges,77% of total billed charges,635.77,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,215.04,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,373.99,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,305.17,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,665.69,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,186.99,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,186.99,665.69,
Warfarin 1mg Tablet,832121101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Warfarin 1mg Tablet,832121101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Warfarin 1mg Tablet,832121101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Warfarin 1mg Tablet,832121101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Warfarin 1mg Tablet,832121101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Warfarin 1mg Tablet,832121101,CDM,250,RC,,,Outpatient,,,10.72,5.36,,8.25,77,,,Percent of Total Billed Charges,77% of total billed charges,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.73,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.35,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,7.93,74,,,Percent of Total Billed Charges,74% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,7.4,69,,,Percent of Total Billed Charges,69% of total billed charges,9,84,,,Percent of Total Billed Charges,84% of total billed charges,8.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.54,89,,,Percent of total Billed Charges,89% of total Billed charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.25,77,,,Percent of total Billed charges,77% of total billed charges,9.11,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.08,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.36,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.37,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.54,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.68,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.68,9.54,
Warfarin 2mg Tablet,62584098401,CDM,250,RC,,,Outpatient,,,10.82,5.41,,8.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.01,74,,,Percent of Total Billed Charges,74% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.09,84,,,Percent of Total Billed Charges,84% of total billed charges,8.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.63,89,,,Percent of total Billed Charges,89% of total Billed charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,77,,,Percent of total Billed charges,77% of total billed charges,9.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.71,9.63,
Warfarin 2mg Tablet,62584098401,CDM,250,RC,,,Outpatient,,,10.82,5.41,,8.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.01,74,,,Percent of Total Billed Charges,74% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.09,84,,,Percent of Total Billed Charges,84% of total billed charges,8.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.63,89,,,Percent of total Billed Charges,89% of total Billed charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,77,,,Percent of total Billed charges,77% of total billed charges,9.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.71,9.63,
Warfarin 2mg Tablet,62584098401,CDM,250,RC,,,Outpatient,,,10.82,5.41,,8.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.01,74,,,Percent of Total Billed Charges,74% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.09,84,,,Percent of Total Billed Charges,84% of total billed charges,8.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.63,89,,,Percent of total Billed Charges,89% of total Billed charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,77,,,Percent of total Billed charges,77% of total billed charges,9.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.71,9.63,
Warfarin 2mg Tablet,62584098401,CDM,250,RC,,,Outpatient,,,10.82,5.41,,8.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.01,74,,,Percent of Total Billed Charges,74% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.09,84,,,Percent of Total Billed Charges,84% of total billed charges,8.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.63,89,,,Percent of total Billed Charges,89% of total Billed charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,77,,,Percent of total Billed charges,77% of total billed charges,9.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.71,9.63,
Warfarin 2mg Tablet,62584098401,CDM,250,RC,,,Outpatient,,,10.82,5.41,,8.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.01,74,,,Percent of Total Billed Charges,74% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.09,84,,,Percent of Total Billed Charges,84% of total billed charges,8.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.63,89,,,Percent of total Billed Charges,89% of total Billed charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,77,,,Percent of total Billed charges,77% of total billed charges,9.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.71,9.63,
Warfarin 2mg Tablet,62584098401,CDM,250,RC,,,Outpatient,,,10.82,5.41,,8.33,77,,,Percent of Total Billed Charges,77% of total billed charges,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.76,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.01,74,,,Percent of Total Billed Charges,74% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,7.47,69,,,Percent of Total Billed Charges,69% of total billed charges,9.09,84,,,Percent of Total Billed Charges,84% of total billed charges,8.87,82,,,Percent of Total Billed Charges,82% of total billed charges ,9.63,89,,,Percent of total Billed Charges,89% of total Billed charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.33,77,,,Percent of total Billed charges,77% of total billed charges,9.2,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.11,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.41,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.41,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,9.63,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.71,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.71,9.63,
Warfarin 5mg Tablet,832121601,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
Warfarin 5mg Tablet,832121601,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
Warfarin 5mg Tablet,832121601,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
Warfarin 5mg Tablet,832121601,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
Warfarin 5mg Tablet,832121601,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
Warfarin 5mg Tablet,832121601,CDM,250,RC,,,Outpatient,,,11.48,5.74,,8.84,77,,,Percent of Total Billed Charges,77% of total billed charges,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,2.93,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.59,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,8.5,74,,,Percent of Total Billed Charges,74% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,7.92,69,,,Percent of Total Billed Charges,69% of total billed charges,9.64,84,,,Percent of Total Billed Charges,84% of total billed charges,9.41,82,,,Percent of Total Billed Charges,82% of total billed charges ,10.22,89,,,Percent of total Billed Charges,89% of total Billed charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,8.84,77,,,Percent of total Billed charges,77% of total billed charges,9.76,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,3.3,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,5.74,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,4.68,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.22,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.87,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2.87,10.22,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 100ml SDV,409488799,CDM,250,RC,,,Outpatient,,,80.79,40.4,,62.21,77,,,Percent of Total Billed Charges,77% of total billed charges,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,20.6,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.25,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,59.78,74,,,Percent of Total Billed Charges,74% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,55.75,69,,,Percent of Total Billed Charges,69% of total billed charges,67.86,84,,,Percent of Total Billed Charges,84% of total billed charges,66.25,82,,,Percent of Total Billed Charges,82% of total billed charges ,71.9,89,,,Percent of total Billed Charges,89% of total Billed charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,62.21,77,,,Percent of total Billed charges,77% of total billed charges,68.67,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,23.23,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,40.4,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,32.96,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,71.9,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,20.2,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,20.2,71.9,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 10ml SDV,409488710,CDM,250,RC,,,Outpatient,,,48.55,24.28,,37.38,77,,,Percent of Total Billed Charges,77% of total billed charges,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,12.38,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,15.17,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,35.93,74,,,Percent of Total Billed Charges,74% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,33.5,69,,,Percent of Total Billed Charges,69% of total billed charges,40.78,84,,,Percent of Total Billed Charges,84% of total billed charges,39.81,82,,,Percent of Total Billed Charges,82% of total billed charges ,43.21,89,,,Percent of total Billed Charges,89% of total Billed charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,37.38,77,,,Percent of total Billed charges,77% of total billed charges,41.27,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,13.96,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,24.28,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,19.81,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,43.21,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,12.14,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,12.14,43.21,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Sterile Water For Injection 20ml SDV,63323018520,CDM,250,RC,,,Outpatient,,,87.13,43.57,,67.09,77,,,Percent of Total Billed Charges,77% of total billed charges,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,22.22,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,27.23,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,64.48,74,,,Percent of Total Billed Charges,74% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,60.12,69,,,Percent of Total Billed Charges,69% of total billed charges,73.19,84,,,Percent of Total Billed Charges,84% of total billed charges,71.45,82,,,Percent of Total Billed Charges,82% of total billed charges ,77.55,89,,,Percent of total Billed Charges,89% of total Billed charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,67.09,77,,,Percent of total Billed charges,77% of total billed charges,74.06,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,25.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,43.57,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,35.55,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.55,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,21.78,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,21.78,77.55,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Bacteriostatic Water for Injection 30ml MDV,409397703,CDM,250,RC,,,Outpatient,,,55.63,27.82,,42.84,77,,,Percent of Total Billed Charges,77% of total billed charges,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,14.19,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,17.38,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,41.17,74,,,Percent of Total Billed Charges,74% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,38.38,69,,,Percent of Total Billed Charges,69% of total billed charges,46.73,84,,,Percent of Total Billed Charges,84% of total billed charges,45.62,82,,,Percent of Total Billed Charges,82% of total billed charges ,49.51,89,,,Percent of total Billed Charges,89% of total Billed charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,42.84,77,,,Percent of total Billed charges,77% of total billed charges,47.29,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,15.99,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,27.82,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,22.7,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,49.51,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.91,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.91,49.51,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Sterile Water For Injection 50ml SDV,63323018550,CDM,250,RC,,,Outpatient,,,101.11,50.56,,77.85,77,,,Percent of Total Billed Charges,77% of total billed charges,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,25.78,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,31.6,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,74.82,74,,,Percent of Total Billed Charges,74% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,69.77,69,,,Percent of Total Billed Charges,69% of total billed charges,84.93,84,,,Percent of Total Billed Charges,84% of total billed charges,82.91,82,,,Percent of Total Billed Charges,82% of total billed charges ,89.99,89,,,Percent of total Billed Charges,89% of total Billed charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,77.85,77,,,Percent of total Billed charges,77% of total billed charges,85.94,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,29.07,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,50.56,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,41.25,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,89.99,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,25.28,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,25.28,89.99,
Unna-Flex Elastic Unna Boot,68455010763,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Unna-Flex Elastic Unna Boot,68455010763,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Unna-Flex Elastic Unna Boot,68455010763,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Unna-Flex Elastic Unna Boot,68455010763,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Unna-Flex Elastic Unna Boot,68455010763,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Unna-Flex Elastic Unna Boot,68455010763,CDM,250,RC,,,Outpatient,,,15.45,7.73,,11.9,77,,,Percent of Total Billed Charges,77% of total billed charges,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,3.94,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,4.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,11.43,74,,,Percent of Total Billed Charges,74% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,10.66,69,,,Percent of Total Billed Charges,69% of total billed charges,12.98,84,,,Percent of Total Billed Charges,84% of total billed charges,12.67,82,,,Percent of Total Billed Charges,82% of total billed charges ,13.75,89,,,Percent of total Billed Charges,89% of total Billed charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,11.9,77,,,Percent of total Billed charges,77% of total billed charges,13.13,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,4.44,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,7.73,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,6.3,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,13.75,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3.86,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3.86,13.75,
Zinc Oxide Ointment 28gm,536131628,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Zinc Oxide Ointment 28gm,536131628,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Zinc Oxide Ointment 28gm,536131628,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Zinc Oxide Ointment 28gm,536131628,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Zinc Oxide Ointment 28gm,536131628,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Zinc Oxide Ointment 28gm,536131628,CDM,250,RC,,,Outpatient,,,2.06,1.03,,1.59,77,,,Percent of Total Billed Charges,77% of total billed charges,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.53,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,0.64,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,1.52,74,,,Percent of Total Billed Charges,74% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.42,69,,,Percent of Total Billed Charges,69% of total billed charges,1.73,84,,,Percent of Total Billed Charges,84% of total billed charges,1.69,82,,,Percent of Total Billed Charges,82% of total billed charges ,1.83,89,,,Percent of total Billed Charges,89% of total Billed charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.59,77,,,Percent of total Billed charges,77% of total billed charges,1.75,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,0.59,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1.03,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,0.84,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.83,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,0.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,0.52,1.83,
Zinc Sulfate 220mg  (50mg Zinc),731040106,CDM,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
Zinc Sulfate 220mg  (50mg Zinc),731040106,CDM,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
Zinc Sulfate 220mg  (50mg Zinc),731040106,CDM,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
Zinc Sulfate 220mg  (50mg Zinc),731040106,CDM,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
Zinc Sulfate 220mg  (50mg Zinc),731040106,CDM,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
Zinc Sulfate 220mg  (50mg Zinc),731040106,CDM,250,RC,,,Outpatient,,,6.13,3.07,,4.72,77,,,Percent of Total Billed Charges,77% of total billed charges,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.56,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.92,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.54,74,,,Percent of Total Billed Charges,74% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,4.23,69,,,Percent of Total Billed Charges,69% of total billed charges,5.15,84,,,Percent of Total Billed Charges,84% of total billed charges,5.03,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.46,89,,,Percent of total Billed Charges,89% of total Billed charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.72,77,,,Percent of total Billed charges,77% of total billed charges,5.21,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.76,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,3.07,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.5,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.46,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.53,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.53,5.46,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3774.08,1887.04,,2906.04,77,,,Percent of Total Billed Charges,77% of total billed charges,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2792.82,74,,,Percent of Total Billed Charges,74% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.23,84,,,Percent of Total Billed Charges,84% of total billed charges,3094.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,3358.93,89,,,Percent of total Billed Charges,89% of total Billed charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.04,77,,,Percent of total Billed charges,77% of total billed charges,3207.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1887.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.52,3358.93,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3929.67,1964.84,,3025.85,77,,,Percent of Total Billed Charges,77% of total billed charges,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1228.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2907.96,74,,,Percent of Total Billed Charges,74% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3300.92,84,,,Percent of Total Billed Charges,84% of total billed charges,3222.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3497.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.85,77,,,Percent of total Billed charges,77% of total billed charges,3340.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1129.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1964.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.42,3497.41,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3774.08,1887.04,,2906.04,77,,,Percent of Total Billed Charges,77% of total billed charges,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2792.82,74,,,Percent of Total Billed Charges,74% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.23,84,,,Percent of Total Billed Charges,84% of total billed charges,3094.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,3358.93,89,,,Percent of total Billed Charges,89% of total Billed charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.04,77,,,Percent of total Billed charges,77% of total billed charges,3207.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1887.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.52,3358.93,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3929.67,1964.84,,3025.85,77,,,Percent of Total Billed Charges,77% of total billed charges,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1228.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2907.96,74,,,Percent of Total Billed Charges,74% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3300.92,84,,,Percent of Total Billed Charges,84% of total billed charges,3222.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3497.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.85,77,,,Percent of total Billed charges,77% of total billed charges,3340.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1129.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1964.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.42,3497.41,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3774.08,1887.04,,2906.04,77,,,Percent of Total Billed Charges,77% of total billed charges,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2792.82,74,,,Percent of Total Billed Charges,74% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.23,84,,,Percent of Total Billed Charges,84% of total billed charges,3094.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,3358.93,89,,,Percent of total Billed Charges,89% of total Billed charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.04,77,,,Percent of total Billed charges,77% of total billed charges,3207.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1887.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.52,3358.93,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3929.67,1964.84,,3025.85,77,,,Percent of Total Billed Charges,77% of total billed charges,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1228.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2907.96,74,,,Percent of Total Billed Charges,74% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3300.92,84,,,Percent of Total Billed Charges,84% of total billed charges,3222.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3497.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.85,77,,,Percent of total Billed charges,77% of total billed charges,3340.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1129.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1964.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.42,3497.41,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3774.08,1887.04,,2906.04,77,,,Percent of Total Billed Charges,77% of total billed charges,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2792.82,74,,,Percent of Total Billed Charges,74% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.23,84,,,Percent of Total Billed Charges,84% of total billed charges,3094.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,3358.93,89,,,Percent of total Billed Charges,89% of total Billed charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.04,77,,,Percent of total Billed charges,77% of total billed charges,3207.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1887.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.52,3358.93,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3929.67,1964.84,,3025.85,77,,,Percent of Total Billed Charges,77% of total billed charges,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1228.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2907.96,74,,,Percent of Total Billed Charges,74% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3300.92,84,,,Percent of Total Billed Charges,84% of total billed charges,3222.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3497.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.85,77,,,Percent of total Billed charges,77% of total billed charges,3340.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1129.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1964.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.42,3497.41,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3774.08,1887.04,,2906.04,77,,,Percent of Total Billed Charges,77% of total billed charges,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2792.82,74,,,Percent of Total Billed Charges,74% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.23,84,,,Percent of Total Billed Charges,84% of total billed charges,3094.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,3358.93,89,,,Percent of total Billed Charges,89% of total Billed charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.04,77,,,Percent of total Billed charges,77% of total billed charges,3207.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1887.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.52,3358.93,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3929.67,1964.84,,3025.85,77,,,Percent of Total Billed Charges,77% of total billed charges,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1228.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2907.96,74,,,Percent of Total Billed Charges,74% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3300.92,84,,,Percent of Total Billed Charges,84% of total billed charges,3222.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3497.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.85,77,,,Percent of total Billed charges,77% of total billed charges,3340.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1129.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1964.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.42,3497.41,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3774.08,1887.04,,2906.04,77,,,Percent of Total Billed Charges,77% of total billed charges,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,962.39,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1179.4,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2792.82,74,,,Percent of Total Billed Charges,74% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,2604.12,69,,,Percent of Total Billed Charges,69% of total billed charges,3170.23,84,,,Percent of Total Billed Charges,84% of total billed charges,3094.75,82,,,Percent of Total Billed Charges,82% of total billed charges ,3358.93,89,,,Percent of total Billed Charges,89% of total Billed charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2906.04,77,,,Percent of total Billed charges,77% of total billed charges,3207.97,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1085.05,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1887.04,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1539.82,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3358.93,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,943.52,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,943.52,3358.93,
Zoledronic Acid 4mg/5ml Liquid SDV,55111068507,CDM,250,RC,,,Outpatient,,,3929.67,1964.84,,3025.85,77,,,Percent of Total Billed Charges,77% of total billed charges,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1002.07,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1228.02,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,2907.96,74,,,Percent of Total Billed Charges,74% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,2711.47,69,,,Percent of Total Billed Charges,69% of total billed charges,3300.92,84,,,Percent of Total Billed Charges,84% of total billed charges,3222.33,82,,,Percent of Total Billed Charges,82% of total billed charges ,3497.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3025.85,77,,,Percent of total Billed charges,77% of total billed charges,3340.22,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1129.78,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,1964.84,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1603.31,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3497.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,982.42,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,982.42,3497.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zoledronic Acid 5mg/100ml Premix,55111068852,CDM,250,RC,,,Outpatient,,,4415.07,2207.54,,3399.6,77,,,Percent of Total Billed Charges,77% of total billed charges,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1125.84,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1379.71,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,3267.15,74,,,Percent of Total Billed Charges,74% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3046.4,69,,,Percent of Total Billed Charges,69% of total billed charges,3708.66,84,,,Percent of Total Billed Charges,84% of total billed charges,3620.36,82,,,Percent of Total Billed Charges,82% of total billed charges ,3929.41,89,,,Percent of total Billed Charges,89% of total Billed charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3399.6,77,,,Percent of total Billed charges,77% of total billed charges,3752.81,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1269.33,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2207.54,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,1801.35,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,3929.41,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1103.77,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1103.77,3929.41,
Zolpidem 5mg Tablet,904608261,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Zolpidem 5mg Tablet,904608261,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Zolpidem 5mg Tablet,904608261,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Zolpidem 5mg Tablet,904608261,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Zolpidem 5mg Tablet,904608261,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,
Zolpidem 5mg Tablet,904608261,CDM,250,RC,,,Outpatient,,,5.84,2.92,,4.5,77,,,Percent of Total Billed Charges,77% of total billed charges,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.49,25.5,,,percent of total billed charges,25.5% of billed charges which is 102% of Medicare rate,1.83,31.25,,,fee schedule,31.25% of billed charges which is 125% of Medicare rate,4.32,74,,,Percent of Total Billed Charges,74% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.03,69,,,Percent of Total Billed Charges,69% of total billed charges,4.91,84,,,Percent of Total Billed Charges,84% of total billed charges,4.79,82,,,Percent of Total Billed Charges,82% of total billed charges ,5.2,89,,,Percent of total Billed Charges,89% of total Billed charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,4.5,77,,,Percent of total Billed charges,77% of total billed charges,4.96,85,,,Percent of Total Billed Charges,85% of Total Billed Charges,1.68,28.75,,,fee schedule,28.75% of billed charges which is 115% of Medicare rate,2.92,50,,,Percent of Total Billed Charges,50% of Total Billed Charges,2.38,40.8,,,Percent of Total Billed Charges,40.8% Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,5.2,89,,,Percent of Total Billed Charges,89% of Total Billed Charges,1.46,25,,,percent of total billed charges,25% of billed charges which is 100% of Medicare rate,1.46,5.2,